Systemic infections in newborns cause significant morbidity and mortality in spite of appropriate antimicrobial therapy. Consequently, Immune and adjuvant therapy has emerged as a potential adjuvant therapeutic modality to reduce the morbidity and mortality associated with neonatal sepsis. There were many recent trails including a few of animal trails described the use of intravenous immunoglobulin and colony stimulating factors in neonatal sepsis. In addition, the most recent findings describing the use of probiotics, glutamine supplementation, recombinant human protein C, lactoferrin and pentoxifylline in the treatment of neonatal sepsis have been reviewed.

Objective To compare the acute and late adverse events and quality of life (QOL) in patients with nasopharyngeal carcinomas receiving conventional external beam radiation therapy (RT) versus intensity modulated radiation therapy (IMRT).Methods Ninety-one patients with newly diagnosed nasopharyngeal carcinoma treated in our institution between August 2008 and September 2010 were systemically reviewed,including 35 cases administered with conventional RT ( RT group) and 56 cases with IMRT (IMRT group).Conjoint facio-cervical fields plus tangential lower neck-supraclavicular field initially,and then shrinking preauricular portals plus electron beams to the neck were adopted in RT groups,with a total dose of 70 Gy/35 fractions.Nine coplanar fields were conducted in IMRT group with a total dose of 69.96 Gy/33 fractions.Acute and late adverse reactions were observed and compared between RT and IMRT groups,including acute reactions as xerostomia,odynophagia,dermatitis/mucositis and late events as dysphagia,trismus,hypothyroidism,optic/acoustic impairments,skin injury,hypodermal fibrosis,spinal myelitis and brain injury.Results Compared with RT group,IMRT group showed less acute reactions in xerostomia,odynophagia,dysphagia and dermatitis and mucositis(x2 =85.73,56.03,26.58,69.28,55.99,P ＜ 0.05 ),and less late reactions in xerostomia,dysphagia,trismus,taste loss and skin injury (x2 =37.95,7.48,9.49,9.49,11.87,P ＜ 0.05 ),whereas the degree of acoustic/optic impairments and brain injury showed no difference in both groups.Conclusions As compared to conventional RT,IMRT could decrease acute and some late side events,and improve the quality of life in patients with nasopharyngeal carcinoma.

OBJECTIVETo study clinical characteristics and evaluate cardiac hemodynamic changes in premature infants with patent ductus ateriosus (PDA).

METHODOne hundred and five infants born at ≤ 34 weeks' gestational age (GA) and ≤2 000 g birth weight (BW) were prospectively enrolled, including 63 males and 42 females, and the mean GA was (31. 1 ± 1.9) weeks and BW (1 401 ± 314) g. Echocardiography was done to detect hemodynamically significant PDA (hsPDA) and to evaluate left ventricular function at 2, 3, 5 and 7 d respectively after birth. On the basis of clinical symptoms and echocardiographic outcome, all the cases were divided into 3 groups: hsPDA group (n = 34), non-hsPDA (nhsPDA) group (n = 44) and non-PDA (nPDA) group (n = 27) to survey and compare general conditions, DA diameter, shunt direction, left ventricular function and complications.

RESULTThe hsPDA group had smaller GA ((30. 5 ± 2. 1) vs. (31. 6 ± 1. 6) weeks, P = 0. 01) and greater proportion of pulmonary surfactant use and mechanical ventilation (2, 3, 5 d of birth) than the nhsPDA and the nPDA group (χ2 = 11. 62, 14. 95, 12. 73, 1:1. 59, P = 0. 00; 0. 00, 0. 01, 0. 01). Univariate and multivariate Logistic regression analysis indicated that the average length of stay (ALOS) was correlated with hsPDA (F =3. 52 and P =0. 03, OR 1. 03 and P =0. 02). The ALOS was longer in the hsPDA group than in the nhsPDA and the nPDA group ((39 ±23)vs. (30 ± 16)and(29 ±13) d, P =0.02, 0.03). There was no significant.difference in rates of mortality/giving-up of treatment among the three groups (5. 9% (2/34)vs. 0 (0/44) and 3. 7% (1/27), χ2 = 5. 26, P = 0. 06). Diastolic blood pressure and mean blood pressure were significantly lower in the hsPDA group than in the other two groups (P all <0. 05) at 2, 3 and 5 days after birth and the pulse pressure was found significantly higher in the hsPDA group than in the nPDA group at 2 d after birth. Univariate and multivariate Logistic regression analysis demonstrated that hsPDA was correlated significantly with neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) (χ2 =7. 34 and 7. 39, P = 0. 02 and 0. 02; OR = 3. 46 and 4. 01, P = 0. 04 and 0. 02). Premature infants with hsPDA had normal left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF), although the cardiac output (CO) of left ventricle increased significantly(F = 6. 93, P <0. 01) within seven days of birth. There was no significant difference in cardiac hemodynamic parameters among closed group of hsPDA group, nhsPDA group and nPDA group simutaneously reexamined at 7th day after birth. The CO was extremely significantly different among premature infants who had different GAs and BWs. The lower the GAs and the BWs, the lower the value of CO(F =5. 16 and 14. 87, P all <0. 01). The DA diameter was reduced much more dramatically after ibuprofen treatment than before in hsPDA group(t = 5. 58, P <0. 01).

CONCLUSIONThe GA, PS use and mechanical ventilation were probably associated with hsPDA. The mean blood pressure and diastolic blood pressure were decreased and pulse pressure was increased in preterm infants with hsPDA that correlated significantly with ALOS, NRDS and BPD. In addition, increased CO values were found in hsPDA group. Oral ibuprofen administered to preterm infants for hsPDA at > 24 h of life promoted ductal closure.

Birth Weight ; Bronchopulmonary Dysplasia ; Cardiac Output ; Cyclooxygenase Inhibitors ; therapeutic use ; Ductus Arteriosus, Patent ; physiopathology ; Echocardiography ; Female ; Gestational Age ; Hemodynamics ; Humans ; Ibuprofen ; therapeutic use ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; Male ; Pulmonary Surfactants ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Ventricular Function, Left

Objective To evaluate treatment outcomes and quality of life (QOL) in glioma patients treated with postoperative intensity-modulated radiotherapy (IMRT), and to explore the possible clinical factors of affecting QOL. Methods From 2007 to 2009, 37 patients with low or high grade glioma were analyzed retrospectively. All patients were operated by tumor resection below microscopy. IMRT began at 2-4 week postoperstion with 2.0 Gy/fractior, 5 fractions/week and to shrink portal and to add dose to 50-60 Gy/25-30 fractions after 40-50 Gy. The gross tumor volume (GTV) was defined as preoperation T2WI MRI high sign area and postoperation tumor cavity for low grade glioma, and with preoperation T1WI MRI enhanced abnormity area and postoperation tumor cavity for high grade glioma. The clinical target volume ( CTV ) was defined as GTV with a margin of 1.5 cm for low grade glioma and a margin of 2.5 cm for high grade ghoma, the planning target volume (PTV) with CTV plus 0.4 cm margin for setup errors according to the European Organization for Research and Treatment of Cancer ( EORTC ).The treatment outcomes and QOL were assessed. Results The half-year and one-year survival rates for all the patients were 100% and 79.2%, respectively. The median progression-free survival time was 10 months. The main side-responses after postoperative IMRT were fatigue and mild memory decline or cognitive disabilities, which were radiation dose-dependent. Conclusions Postoperative IMRT is an effective and safe modality of therapy for glioma patients.

Objective To assess the outcomes of involved field irradiation (IFI) and elective nodal irradiation (ENI) in patients older than 70 years with esophageal squamous-cell carcinoma(SCC) receiving radical IMRT,and to determine whether IFI is feasible in these patients.Methods Totally 79 patients older than 70 years diagnosed with SCC of esophagus without distant metastases were collected.48 patients were received IFI,and the other 31 patients were treated with ENI.With a median follow-up time of 24 months,disease-free survival,overall survival,patterns of failure,irradiated lung dose and radiation pneumonitis were observed and compared between IFI and ENI groups.Results In IFI and ENI arm,the disease-free survival rates of 1,2,3 years were 60.4％,34.9％,29.7％ and 64.5％,54.0％,35.0％,respectively(P ＞0.05).The 1-,2-,and 3-year survival rates were 72.9％,43.4％,31.5％ for the IFI arm,and 73.0％,53.0％,38.3％ for the ENI arm(P ＞ 0.05).The ENI arm had a tendency to expand survival,but the two arms had no significant difference (P ＞ 0.05).The patterns of failure also had no difference between the two arms.Distant failure,local failure,uninvolved nodal failure in IFI arm were 22.9％,27.0％,4.2％,while in ENI arm were 25.8％,0,19.4％,all of them had no significant difference (P ＞ 0.05).However,the lung V5,V20,mean lung dose in ENI arm were higher than that in IFI and all of them had a significantly difference (t =4.66,29.90,15.63,P ＜ 0.05).The radiation pneumonitis rates were higher in ENI than in IFI arm.The rates of degree 1-2 and degree 3 were 22％,19％,and 13％ and 4％ in the two arms,respectively,with a significantly difference(x2 =4.55,4.77,P ＜ 0.05).Conclusions It is feasible that IFI for definitive IMRT in the elderly patients older than 70 years with SCC,because it got similar disease-free survival and overall survival but with less lung doses along with decreased radio-pulmonary lesion when compared with ENI.

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC),and predicting the response of these nodes to concurrent chemoradiation (CRT).Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment,weekly during treatment,and one month after treatment.DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2.ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle.Totally fifty-two morphologically abnormal lymph nodes were analyzed.The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20),and the dynamic changes in ADC values of the lymph nodes before,during,and after therapy were observed and recorded.Results The average ADC of the 32 lymph nodes with the short axis ≥ 10 mm was (0.71±0.12) x 10-3mm/s,not significantly different from that of the 20 lymph nodes with the short axis < 10 mm [(0.73±0.16) x 10-3mm/s,t = 1.11 ,P =0.27].The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t = 19.35,P < 0.0001).During CRT,the ADC values of the lymph nodes increased gradually,with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter.The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t = 12.72,P < 0.0001),however,not statistically significant different from that of the normal tongue muscle (t = 0.34,P = 0.73).Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT,thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy.

Objective To investigate the cerebral haemodynamics change and morbidity of periventricular-intraventricular hemorrhages(PIVH) in premature infants with or without patent ductus ateriosus (PDA).Methods Bedside Echocardiography and transcranial sonography (TCS) were performed on 85 cases of preterm infants in 48 h,48 to 96 h,96 to 120 h,120 to 168 h after birth (gestational age≤34 weeks and birth weight≤2 000 g).PDA,peak systolic velocity (Vs),end-diastolic velocity (Vd),pulsatility index (PI) and resistant index (RI) of anterior and middle cerebral artery(ACA and MCA) and PIVH were monitored simutaneously.Results According to the Echocardiography and clinical symptoms,all the cases were divided into 3 groups:haemodynamic significant PDA group (hsPDA group,n =23),non-hsPDA group(nhsPDA group,n =38) and non-PDA group(nPDA group,n =24).The mean birth weight and gestational age did not differ significantly among the 3 groups.Single and multiple Logistic analysis indicated that invasive mechanical ventilation less than 48 h after birth was related to hsPDA (x2 =11.182,P =0.019; OR =10.06,P =0.039).Repetitive measurement deviation analysis found that:Vd of ACA and MCA were lower in the hsPDA group than those in the nhsPDA group (P =0.000,P =0.001) and the nPDA group (P =0.003,P =0.013),while PI and RI were higher than in the other 2 groups.Compared with non-closed group,at 7 days after birth in hsPDA group,RI and PI of closed group were significantly lower,while Vd was significantly higher.Nevertheless,there was no significant difference in hemodynamic parameters when comparison with nPDA group at 7 days after birth.There was no statistical difference in the grading and severity of PIVH with or without PDA.However,the rate of severe PIVH was found higher in hsPDA group than the other 2 groups(17.39％ vs 8.33％ vs 5.26％,x2 =2.405,P =0.280).Conclusions The invasive mechanical ventilation less than 48 h after birth was probably associated with preterm hsPDA.HsPDA could result in major cerebral haemodynamic changes and increase the morbidity of severe PIVH.

OBJECTIVETo explore use of interleukin-10 receptor (IL-10R) gene mutation in diagnosis and pathogenesis of neonatal inflammatory bowel disease (IBD) in 2 suspected cases.

METHODTwo cases of sibling brothers who had suspected IBD from Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University during the year 2010-2014 were enrolled in the study. The proband, male, 26 days old, weight 3.73 kg, presented with recurrent fever, increased stool frequency since 9 days of age, and was hospitalized at the age of 6 months in 2014. The proband's brother, male, 6 months old, weight 8 kg, had repeated bloody and mucous diarrhea for more than five months, recurrent fever five days, and was hospitalized in 2010. The blood samples were collected from the children and their families for IL-10 receptor genes including IL-10 receptor α subunit (IL-10RA) and β subunit (IL-10RB) PCR amplification. Reverse transcription polymerase chain reaction (RT-PCR) was used to amplify the proband IL-10RA transcripts. Sequencing was performed on the PCR products forward and reversely. Western blot analysis was used for protein expression of the proband and normal control's IL-10RA and P-STAT3 (Tyr705) expression after IL-10 stimulation, TNF-α level was detected using Human TNF-α ELISA Kit after PBMC was cultured and stimulated.

RESULTThe proband and his brother were IBD patients. Genome sequencing showed mutation in c.537G>A, namely the exon 4 and intron 4 connections changed CA/GT for CG/GT. Sequencing of the RT-PCR products and T-A clone showed that the mutation was (c.519-537del GGTGCCGGGAAACTTCAC, p.LYS173ASNfs*7), as the splice mutation. Two gene mutations were novel mutation. The parents were the mutations carrier. Both of the children were compound heterozygous mutations in IL-10RA. The Western blot analysis showed that the patient and normal children can express IL-10RA protein, however, the function of IL-10RA had obvious defects in the patient, IL-10RA downstream signaling pathways P-STAT3 had no expression. The average level of TNF-α secreted by PBMC after LPS + IL-10 co-stimulation in patient was significantly increased as compared with control group ((2 100±356) vs. (200±50) ng/L, t=9.154, P=0.001), suggesting that interleukin-10-dependent negative feedback regulation is disrupted in the patient.

CONCLUSIONIL-10 receptor mutations can cause neonatal-IBD, for which common treatment effect is poor. Early diagnosis and allogeneic stem-cell transplantation performed may save the children's life.