OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.
Bronchopulmonary Dysplasia/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Respiratory Distress Syndrome, Newborn/epidemiology* ; Retrospective Studies ; Treatment Outcome

Pulmonary hypertension ( PH) is occult, with no distinctive clinical manifestations and poor prognosis.Pulmonary vascular remodelling is an important pathological feature in which pulmonary artery smooth muscle cell ( PASMCs) pheno- typic switching plays a crucial role.MicroRNA (miRNA) is a class of evolutionary highly conserved single-stranded small non-coding RNA.Recently, an increasing number of scholars have found that miRNA can play an important role in the occurrence and development of PH by regulating the phenotypic switching of PASMCs, which is expected to be a potential target for the prevention and treatment of PH.It has been found that miR NA such as miR-221 , miR-24, miR-15b, miR-96, miR-23a.miR-9, miR-214, miR-20a can promote the phenotypic switching of PASMCs, while miRNA such as miR-21, miR-132, miR-182, miR-449, miR-206 .miR-124, miR-30c, miR-140.miR-17-92 cluster can inhibit it.This article aims to review the research progress on miRNA that mediates PASMCs phenotypic switching in PH from both growth factor-related miRNA and hy- poxia-related miRNA.

Cognition ; Cognitive Dysfunction ; Humans ; Presbycusis

BACKGROUNDS: Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range. METHODS: We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied. RESULTS: There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level. CONCLUSIONS Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Objective: To investigate the correlation between age-related hearing loss and cognitive impairment. Methods: 201 elderly patients, who were admitted to the Department of Otorhinolaryngology of Peking University People′s Hospital from March 1, 2017 to March 31, 2017, were evaluated with hearing screening and the Montreal Cognitive Assessment Scale. Among them, 101 were female and 100 were male, aged 60-90 years old. Taking the cognitive level as the dependent variable, and taking the age, sex, education, occupation, marital status, residence, and average hearing loss (average hearing threshold of 500, 1 000, 2 000, and 4 000 Hz), as well as the length of conscious hearing loss as the independent variables, the single factor analysis and multivariate linear regression analysis were used to screen the main factors affecting the cognitive level of the elderly. Results: Of the 201 elderly patients, 39 had normal hearing, 65 had mild hearing loss, 80 had moderate hearing loss, 16 had severe hearing loss, and 1 had profound hearing loss. The average degree of hearing loss was the influencing factor of cognitive impairment, and it mainly affected the directional force and abstract ability in the cognitive domains (P<0.05); The age, self-reported hearing loss, years of education, marital status, past ear diseases, and hypertension were relatively independent factors that affected the cognitive level(P<0.05). Conclusions Age-related hearing loss is the risk factor for the cognitive impairment, especially for abstraction and orientation, in the elderly. The self-reported hearing loss is an independent risk factor for cognitive impairment.

Objective To explore the expression of macrophage migration inhibitory factor(MIF)in rat hearts with experimental autoimmune myocarditis(EAM)and the possible mechanism of resveratrol's therapeutic effect.Methods Experimental myocarditis model was established by using porcine myocardial immunoglobulin. Twenty-four male 6-week-old Lewis rats were randomly divided into control group(Con),EAM model group(MC) and resveratrol treatment group(MC+ Res).All the rats were detected and compared in the cardiac function according to echocardiographic analysis,and the expression of MIF was detected by Western blot.The degree of myocardial injury was detected by HE staining and the degree of macrophage infiltration in the myocardium was detected by immunohistochemistry.Results In control group,there was no significant inflammatory infiltration or myocardial injury in the myocardium.Heavy local infiltration of macrophages,and dissolved and fractured myocardial fibers were observed in model group.Resveratrol significantly decreased macrophage density and myocardial injury in the heart(P＜ 0.05).Compared with those in control group,LVEDs were significantly increased(P＜0.01)while LVEF and LVFS were markedly decreased in model group(P＜0.01).Compared with model group,LVEDs were significantly decreased(P＜0.05)while LVEF and LVFS were markedly increased in resveratrol group(P＜0.05).The protein expression of MIF was markedly increased in rats of model group(P＜0.01),but was decreased in resveratrol group compared with model groups(P＜ 0.05).Conclusion Increased expression of MIF may be involved in the pathogenesis of EAM.The therapeutic effect of resveratrol on EAM may be associated with down-regulated MIF expression and decreased macrophage infiltration.

Objective To investigate the relationship between histological chorioamnionitis (HCA),funisitis (FV) and lung injury in preterm infants.Method Data of preterm infants with gestational age of less than 34 weeks,who were born in our Hospital and admitted to the neonatal ward during the period of October 2015 to August 2016 were retrospectively collected.According to reports of placenta pathologies,participants were assigned into three groups,non-infection group,HCA group and HCA + FV group.Demographic and infectious characteristics,duration of respiratory support,partial pressure of oxygen (PaO2) and pulmonary function testing results at corrected gestational age 40 weeks were compared among groups.Result A total of 151 preterm infants were included,with 33 cases in noninfection group,61 cases in HCA group and 57 cases in HCA + FV group.Non-invasive ventilation duration and number of days in room air in HCA + FV groups were both longer than those in the non-infection group [0 (0,66) h vs.0 (0,0) h,65 (0,176) h vs.0 (0,8) h].The duration of invasive ventilation and total ventilation days in HCA + FV group were longer than those of the other two groups [0 (0,4) h vs.0 (0,0) and 0 (0,0) h,0 (0,99) h vs.0 (0,0) and 0 (0,52) h],the differences were statistically significant (P ＜ 0.05).However,there was no significant difference of PaO2 after 0.5 hour respiratory support among the three groups (P ＞ 0.05).Pulmonary functional parameters,such as respiratory frequency,VPEF/TE,VPEF/VE,VPEF and TPEF,gradually decreased with the degree of inflammatory progress,but there was no statistically significant difference (P ＞ 0.05).Conclusion HCA and FV are highly associated with premature lung injury.The worse the placental inflammation is,the longer respiratory support duration will be needed or required.However,HCA and FV may have no significant effect on lung function.

Objective To investigate the significance of interleukin-6 IL-6),interleukin-8 (IL-8) and metal matrix protease-9 (MMP-9) in lung injury caused by intrauterine infection in ueonatal rats.Method Eighteen 18-day-old SD pregnant rats were selected and randomly assigned into 0.6,0.7,0.8,0.9,1.0 mg/kg lipopolysaccharide (LPS) groups and control group.Rats of LPS group were injected intraperitoneally with LPS 0.6.0.7,0.8,0.9,1.0 mg/kg,those of control group was injected with equal volume of sterile saline.After 24 hours of injection,one pregnant rat from each group underwent cesarean seetion and placentae were collected for pathological evaluation.The other pregnant rats delivered spontaneously.When the neonatal rats came to 1,3,and 7 days of age,8 rats were randomly selected from each group.The respiratory frequency,body weight,lung weight,and blood samples for detecting inflammatory factors using enzyme-linked immunosorbent assay were measured among 3-day-old neonatal rats.Lung tissue for hematoxylin-eosin staining and lung pathology score were taken in the 1,3 and 7-day-old neonatal rats.Result (1) The mortality rate of neonatal rats increased gradually with the increasing dose of LPS injection.The mortality rate of neonatal rats in the LPS 1.0 mg/kg group was 20％.The placental pathology score and the frequency of 3-day-old neonatal rats in LPS 0.8,0.9,and 1.0 mg/kg groups were higher than control group and other LPS groups (P ＜ 0.05).(2) The histopathological scores of the neonatal rats in the control group and LPS 0.6,0.7,0.8,0.9,1.0 mg/kg groups on the first day after birth were (0.08±0.08),(0.17±0.11),(1.33±0.19),(1.75±0.33),(1.92±0.36),(2.67±0.14),respectively,and that of the third day after birth were (0.00 ± 0.00),(0.50 ± 0.15),(0.67 ±0.19),(1.33 ±0.36),(2.17 ±0.21),(2.92 ±0.08),respectively.LPS 1.0 mg/kg group on the 1st and 3rd day after birth were significantly different from the other groups (P ＜0.05),LPS 0.8 mg/kg group on the 1st and 3rd day after birth were significantly different from the control group and LPS 0.6 mg/kg group (P ＜ 0.05),and there was significant difference among the LPS 0.9 mg/kg group and the other groups on the 3rd day after birth (P ＜ 0.05).When the concentration of LPS was less than 0.8 mg/kg,there was no significant difference in the pathological scores of the lung tissues between each group (P ＞0.05).(3) The concentrations of IL-6,IL-8,and MMP-9 in the neonatal rats of LPS 0.7,0.8,0.9,and 1.0 mg/kg groups were significantly higher than those in the control group at 3 days of age,and the difference among LPS groups were statistically significant (P ＜ 0.05).Conclusion The intraperitoneal injection of LPS in rats 18 days after gestation can lead to lung injury,pulmonary edema,and increasing level of blood IL-6,IL-8,and MMP-9 in the neonatal rats,and this damage lasts until 7 days after birth which suggests the important meaning for lung diseases caused by intrauterine infection.

Objective To explore the clinical characteristics and outcome in myathenia gravisac companied with thymoma or thymic hy-perplasia.Methods From January,2007 to December,2016,118 myathenia gravis patients with thymoma,and 42 myathenia gravis patients with thymic hyperplasia were enrolled.Their age of onset,gender,initial symptom,osserman classification,muscles involved,myasthenia crisis,low-frequency repetitive nerve stimulation and complete stable remission rate data were retrospectively analyzed.Results Compared with myathenia gravis patients with thymic hyperplasia,myathenia gravis patients with thymoma showed older age in onset,higher propor-tion in type III and lower rate in complete stable remission rate(P<0.05),and more respiratory muscle involved(χ2=6.364,P=0.011)and myasthenia crisis(χ2=5.455,P=0.022).There were significant differences in respiratory muscle involved(χ2=8.532,P=0.036)and the inci-dence rate of myasthenia crisis(χ2=8.956,P=0.030)among thymoma with different pathological types,in which type B3 was the highest, and type A+AB was the lowest.The low-frequency repetitive nerve stimulation positive rate was higher in myathenia gravis patients with thymoma than with thymic hyperplasia,however,there was no significant difference(χ2<1.357,P>0.05).There was a rising trend with path-ological classification altered in the low-frequency repetitive nerve stimulation positive rate with no significant difference (χ2<6.623, P>0.05).Conclusion Myathenia gravis patients with thymoma were common in middle-aged to old people,who were serious in clinical symp-tom,particularly respiratory muscle involved and myasthenia crisis.Myathenia gravis patients with thymic hyperplasia were more benefit from thymectomy.The low-frequency repetitive nerve stimulation positive rate of myathenia gravis patients does not correlate with thymic lesion type.Respiratory muscle involved and myasthenia crisis are relevant with pathological types of thymoma.

Objective:To assess the midterm clinical and radiological outcomes of internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure.Methods:In the study,36 patients were treated with anterior cervical internal fixation and fusion.The clinical outcomes including muscle strength and atrophy were recorded.The radiological outcomes including range of motion of cervical spine and the cross-sectional area of spinal cord at each level on MRI scan were measured before and at 3 month,1 year and 2 years follow-up time points after surgery.Results:(1) Clinical outcomes:all the patients showed no further progression of symptoms except one patient with mild progression of muscular weakness and atrophy.As the time passed by,the ratio of the patients with muscle strength and atrophy improvement increased.There were 26.5 ％ of patients in 3 months,36.0％ in 1 year and 85.7％ in 2 years who experienced muscle strength improvement.8.8％ of patients in 3 months,24.0％ in 1 year and 35.8％ in 2 years felt muscle atrophy improvement.And 12 of the 14 patients showed improved muscle strength and atrophy at the end of 2 years period follow-up.(2) Radiological outcomes:the range of motion (ROM) of C2-C7 was significantly decreased after the operation.The ROM of preoperation was 62.25° ±2.10° and that of 2 years postoperation was 13.67° ± 7.51°(P ＜ 0.01).The spinal cord was of no compression on flexion MRI.The cross-section area of spinal cord on MRI was significantly increased only at C6 level (P ＜0.05) at the end of three months follow-up.The level of increased cross-section area rose to C4-C5-C6 levels (P ＜0.01) in 1 year and to C4-C5-C6-C7 levels at the end of 2 years follow-up P ＜ 0.05).The cross-section area increased 15.60％ at C4,19.08％ at C5,21.60％ at C6 and 23.91％ at C7 with significant difference (P ＜0.05) 2 years after the operation.Conclusion:Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable midterm clinical and radiological outcomes.This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.