MiRNA can regulate cell proliferation and differentiation,and promote the development of organisms.Phosphoinositide 3-kinase/protein kinase B(PI3K/AKT) signaling pathway plays an important role in cell proliferation and differentiation,and also in organ and organization development.Studies concerning miRNA and PI3K/AKT signaling pathways in cardiac development and their relationship might help explain the pathogenesis of cardiac malformations and related diseases.

The Human Milk Banking Association of North America(HMBANA) is a professional association for supporters of non-profit donor human milk banking.HMBANA develops guidelines for donor human milk banking practices.The construction of China's human milk bank has just begun in few areas in 2013.To further promote the development and implementation of donor human milk banking in our country,this review introduce the guideline for establishment and operation of a donor human milk bank which drafted by HMBANA in 2013.The guideline can provide the basis for the development of human milk bank in our country.

Objective To evaluate the safety and effects of feeding very low birth weight infants and extremely low birth weight infants with human donors' milk in China.Methods One hundred and ninety-nine very low birth weight infants and extremely low birth weight infants (VLBWI/ELBWI) admitted to NICU in Nanjing Maternity and Child Health Care Hospital were analyzed retrospectively (from August 1,2013 to July 31,2014) one year before and one year after the establishment of human donors' milk bank.Only 1 infant's parents(1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.One hundred and forty-eight infants admitted to NICU from August 1,2012 to July 31,2013 were chosen as the control group,who were fed with formula milk since their own mothers' milk was unavailable.The mortality,incidence of necrotizing enterocolitis (NEC) and sepsis,time to full enteral feeding and hospital stay between 2 groups were analyzed.Results One year before the establishment of breast milk bank,there were 148 cases of very low or extremely low birth weight infants receiving mixed feeding,and 16 cases of them had neonatal necrotizing enterocolitis,the incidence rate was 10.81％.Since the establishment of human milk bank,187 women donated breast milk in the first year and 260 555 mL of human milk were collected and delivered.Only 1 infant (1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.Nine babies with VLBWI/ELBWI were diagnosed as NEC in donor milk feeding group,and 16 cases were diagnosed as NEC in formula-feeding group.The incidence rate of NEC was lower in the donor-milk-feeding group (4.52％ vs 10.81％,x2 =5.02,P ＜ 0.05).Donor-milk-feeding group reached full enteral feeding[(16.4 ± 5.3) d vs (18.2 ± 6.2) d,t =2.84,P ＜ 0.05] and had shorter period of hospital stay[(35.1 ± 9.5) d vs (37.3 ± 10.4) d,t =2.05,P ＜ 0.05] compared with formula feeding group.The mortality and incidence of sepsis had no difference between 2 groups (all P ＞ 0.05).Conclusions Donors' breast milk is associated with a lower risk of NEC,sooner full enteral feeding and shorter hospital stay.Further research is needed to confirm these findings and measure the growth and long term neurodevelopment effects of donors' breast milk.

Objective To explore the influence of middle cerebral artery blood flow on mechanical ventilation in very low birth weight premature after using Budesonide(BUD) mixed with pulmonary surfactant(PS),and to explore the protection mechanism of cerebral injury.Methods Forty premature infants (gestational age ＜ 34 weeks,birth weight ＜ 1 500 g) with respiratory distress syndrome(RDS) were randomly assigned into study group and control group in Nanjing Maternal and Child Health Hospital from Aug.2010 to Mar.2012.PS and BUD mixture was used in study group (Per 70 mg PS adding BUD 0.25 mg),PS dose of 70 mg/kg,BUD dose of 0.25 mg/kg.Control group was only administered with PS,dose 70 mg/kg.It was administered intratracheally after 30 to 60 minutes of birth in both groups.The index of blood flow rate and blood vessel elasticity of arteria cerebri media [including systolic velocity (Vs),diastolic velocity (Vd),mean velocity (Vm),resistant index (RI) and elasticity index (PI)] were monitored by using transcranial Doppler.Results The Vs increased steadily in study group,but instability in control group,and there were of statistical differences on the 4 d,5 d,6 d and 7 d (t =3.21,2.95,3.12,3.43,all P ＜ 0.05).The Vd increased steadily in study group,but unsteadily in control group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =4.21,3.10,3.98,4.56,all P ＜0.05).The Vm of study group was higher than that in the PS group,and there were statistical differences on the 4 d,5 d,6 d and 7 d (t =2.68,2.98,3.98,3.57,all P ＜ 0.05).The RI of study group was higher than that in the control group,and there were statistical differences in the 5 d,6 d and 7 d(t =3.10,3.98,4.06,all P ＜ 0.05).PI steadily in study group,but instability in control group,and there were statistical differences in the 5 d,6 d and 7 d (t =4.18,3.23,3.02,all P ＜ 0.05).The overall incidence of periventricular/intraventricular hemorrhage showed no significant difference,but severe periventricular/intraventricular hemorrhage (grade Ⅲ,Ⅳ) of study group was less than that in the control group (x2 =4.80,P ＜ 0.05).The incidence of periventricular leukomalacia was reduced in the study group compared with that in the control group (x2 =3.31,P ＜ 0.05).Conclusion The very low birth weight infants treated with mechanical ventilation show steady cerebral blood flow and lower incidence of brain injury after using BUD mixed with pulmonary surfactant.

Objective To observe the expression changes in microRNA (miR)-379 in the developmental process of the mouse heart and during the differentiation of P19 cells into cardiac myocytes,and to explore the possible relationship between miR-379 and the differentiation of cardiacmyocytes.Methods Heart tissues were collected from fetal mice in pregnant ones at their gestational age (8.5,11.5,14.5 and 18.5 days) respectively.Heart tissue sections of the fatal mice were obtained to observe the heart development process.Then total RNA was isolated from heart tissues by using the TRIzol method.Complementary DNA was synthesized from 1 μg total RNA by using a Reverse Transcriptase Kit.Finally,real-time PCR (RT-PCR) was employed to detect the expression of miR-379.At the same time,P19 cells were cultured with 10 mL/L Dimethyl sulfoxide in suspension for 4 days to form cell aggregation,and these aggregations were transferred into 6-wells plate for culturing by adherence.Beating cells were detected with microscopy on the 10th day after induction.Afterwards,total RNA was extracted from cultured P19 cells at different time points.Reverse transcription was executed to get DNA.At last,RT-PCR was used to explore the expression of miR-379 on 0,4,6,10 days after aggregation.Results The expression level of miR-379 was down-regulated gradually in the developing heart (at gestational age of 8.5,11.5,14.5,16.5 days,respectively),and there were significant differences on the different days (F =21.13,P ＜ 0.05).On the other hand,myocardial markers of troponin T represented an increasing trend during the process of P19 cells induction,which demonstrated that P19 cells were successfully induced into cardiomyocyte-like cells.Meanwhile,miR-379 showed a low expression on day 0 of P19 cells aggregation.On day 4,miR-379 demonstrated a higher level.Afterwards,miR-379 proved to be down-regulated gradually.Conclusions miR-379 plays a role in the process of the heart development,but the specific mechanisms need further research.

Objective To determine the effects of feeding donor human milk versus formula milk on very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI).Methods The Cochrane library,PubMed,EMBASE,Wanfang,CNKI and VIP database were searched for the randomized controlled trials (RCT) that compare donor human milk with formula milk in VLBWI and ELBWI from the establishment of database up to February 2014.The quality of the included studies was assessed.Meta analysis was performed using RevMan 5.2.9 software.The results were expressed by mean difference (MD) and 95％CI for continuous variables,RR and 95％CI for categorical variables.Results Only five trials were included:in quality evaluation,two trials were graded B,and the other three were graded C.Meta-analysis showed that,compared with the formula milk,feeding of donor human milk could reduce the risk ofnecrotizing enterocolitis (RR=0.36,95％CI:0.18-0.73,P＜0.01),but not the risks of sepsis (RR=0.92,95％CI:0.50 1.72,P=0.80),retinopathy of prematurity (RR=1.21,95％CI:0.84-1.74,P=0.31) and in-hospital mortality (RR=0.66,95％CI:0.18-2.37,P=0.52).The significantly lower rates in weight gains in neonatal period (MD=-6.58,95％CI:-11.19 to-1.98,P＜0.01) and body length (MD=-0.30,95％CI:-0.41 to-0.20,P＜0.01)were found in donor human milk compared with formula milk.No significant difference in head circumference (MD=-0.16,95％CI:-0.33 to 0.01,P=0.13) was seen in comparison of donor human milk with formula milk.Conclusions Feeding with donor human milk can reduce the risk ofnecrotizing enterocolitis in VLBWI and ELBWI,but its effects on neonatal growth need to be further studied in large scale RCT.

Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.

Objective To explore the expression of 11-β hydroxysteroid dehydrogenase 2 (11-β HSD2) gene in placenta of pregnancy induced hypertension (PIH) complicated by intrauterine growth retardation (IUGR) and the relationship between different expression of 11-β HSD2 in placenta and newborn's birth weight or placental weight. Methods Thirteen cases of term pregnancy mothers with PIH complicated by IUGR were served as PIH complicated by IUGR group, 22 cases of term pregnancy mothers complicated by PHI with appropriate for gestational age (AGA) infant as PIH with AGA group and 36 cases of normal controls as control group. The mRNA expression level of 11-β HSD2 gene in placenta was evaluated by RT-PCR. The level of cord serum cortisol was detected by the method of chemiluminescence. Results The 11-β HSD2 gene mRNA was expressed in placenta. The mRNA expression level of 11-β HSD2 gene in PIH complicated by IUGR group's placenta was significantly lower (0.26±0.09) than that in PIH with AGA group (0.64±0.19) and control group (0.66±0.20). The level of cord serum cortisol in PIH complicated by IUGR group was significantly higher [(71.60±20.20)μg/L] than that in PIH with AGA group [(51.00±13.80)μg/L] and control group [(49.10±14.40)μg/L]. The newborn's birth weight and placental weight in PIH complicated by IUGR group was significantly lower than those in PIH with AGA group and control group. The mRNA expression level of 11-β HSD2 gene in placenta was positively correlated with the birth weight of their newborns and placental weight. Conclusion The lower mRNA expression level of 11-β HSD2 gene in placenta may contribute to the higher cortisol level in fetal of PIH complicated by IUGR and has a negative role on the fetal development.

Objective To evaluate the predictive accuracy of several risk-assessment strategies to predict the risk of significant neonatal hyperbilirubinemia, and to establish the best prediction model.Methods The transcutancous bilirubin (TcB) levels of 4907 term and near-team infants were measured.Trace blood bilirubin levels of the infants whose TcB levels ≥250 μmol/L were detected. Clinical data of newborns and their mothers were collected and were analyzed with Logistic regression model to investigate its correlation with signifrcant hyperbilirubinemia. Clinical high risk factors of significant neonatal hyperbilirubinemia were determined. Accuracy of three prediction methods for significant hyperbilirubinemia was compared by receiver operating characteristic (ROC) curve. The three methods included: whether predischarge bilirubin level (within 72 hours after birth) expressed in risk zone on an hour-specific bilirubin nomogram; clinical risk factors other than predischarge bilirubin level; and combination of the predischarge bilirubin risk zone and other clinical risk factors. Results Two hundred and eighty-six newborns (5.8%) were found with significant hyperbilirubinemia. The risk factors of significant neonatal hyperbilirubinemia were divided into three groups according to OR: (1) Major risk factors:predischarge (within 72 hours after birth) bilirubin level in the high risk-zone (OR=96. 39, 95% CI:53.32-174.27, P = 0. 000), large cephalohematoma (OR = 36.45, 95% CI: 10. 02-132.56,P=0. 0076), gestational age 35-36+6 weeks (OR= 30. 72, 95% CI 14.47-65.23, P=0. 0001) and exclusive breast feeding and weight loss was ＞9% of birth-weight (OR=22.44, 95% CI: 4.42-114. 03, P=0. 0016). (2) Minor risk factors: gestational age 37-37+6 weeks (OR=3.26, 95% CI:1.92-5. 55, P=0. 0232), predischarge bilirubin level in P76-P95(OR=13. 64, 95% CI: 8. 10-22.97,P=0. 0001) and bruising (OR = 2.32, 95% CI: 1.14-4.71, P = 0. 0497). (3)Protective factors (those factors associated with decreased risk of hyperbilirubinemia): predischarge bilirubin level in low-risk zone (≤P40) (OR=0. 00), gestational age ≥40 weeks (OR=0.21, 95% CI: 0.09-0.44,P=0. 0402) and mixed breeding (OR=0. 75, 95% CI: 0. 58-0.95, P=0.0059). The area under the ROC curve of predischarge bilirubin level was 0. 8687 and 0. 7375 for clinical risk factors other than predischarge bilirubin level. The area under the ROC curve of a combination of the predischarge bilirubin risk zone and additional clinical risk factors was 0. 9367. Conclusions The risk of significant neonatal hyperbilirubinemia could be simply and accurately predicted by infant's predischarge bilirubin level and the combination of predischarge bilirubin level, and clinical risk factors might improve the accuracy of prediction significantly.

Objective To explore the changes and significance of serum visfatin (VF) levels in patients with preeclampsia (PE). Methods Eighty-one cases of PE were served as observed group, 39 cases of mild PE (mild PE group) and 42 cases of severe PE(severe PE group), 45 cases of normal pregnant women as control group. Fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC) and triglyceride (TG) were measured and the homeostasis model assessment insulin resistance (HOMA-IR) were evaluated in these cases. The levels of serum VF were determined by enzyme-linked immunosorbent assay. Results There were no significant difference in the levels of FPG, FINS, HOMA-IR among three groups (P > 0.05). The levels of TG, TC were significantly increased in severe PE group compared with mild PE group or control group (P < 0.05). The level of serum VF in severe PE group [(22.45 ± 4.18) μ g/L]was significantly higher than that in control group [(14.52 ± 3.25) μg/L]and mild PE group [(18.75 ± 3.96) μ g/L](P < 0.05). The level of serum VF had no relationship with the levels of FPG, FINS (r = 0.21,0.24, P > 0.05), the positively correlation was found between the level of serum VF and HOMA-IR, TC, TG (r = 0.42,0.36,0.41, P < 0.05) in patients with PE. Conclusion VF elevates in the patients with preeclampsia and closely relates with the severity of PE, insulin resistance and lipid metabolism.