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Therapeutic Effect of Antenatal Corticosteroids and Postnatal Pulmonary Surfactant on Neonatal Respiratory Distress Syndrome

Fa-lin, XU ; Kumar Him SHRESTHA ; Xiu-yong, CHENG

Journal of Applied Clinical Pediatrics.2008;23(16):1305-1309.

Objective To explore the prevention and treatment effects of either antenatal corticosteroids (ACS) or postnatal pulmonary surfactant (PS) alone or the combination of both ACS and PS on neonatal respiratory distress syndrome (RDS). Methods One hundred and forty - three cases of RDS admitted to our neonatal intensive care unit ( NICU ) from Jan. 2003 to Jan. 2007 were selected, and divided into 4 groups:group 1 received both ACS and PS (n =36) ;group 2 only received ACS(n =33) ;group 3 only received PS (n =39) ;group 4 didn't receive both ACS and PS (n =35). The clinical parameters like sex,gestational age,birth weight,mode of dellvery,associated maternal risk factors, the Apgar score,the need of resuscitation at the time of delivery and associated perinatal complications of the babies were analyzed.The relation between the 4 groups regarding the different modes of supplemental oxygen use ( nasal prong and head box), continuous positive airway pressure (CPAP) ,the need of mechanical ventilator (MV) ,the mean NICU days to cure from the RDS and finally the treatment outcomes were compared. Results There were no significant differences between the 4 groups with regards to their general features and clinical parameters( P > 0.05 ). There was a significant difference between the groups regarding the mean hour requirement of the supplemental oxygen ( nasal prong and head box), CPAP and MV. Nasal prong : The mean hour for each group was ( 75.81 ± 15.63 ), ( 130.09 ± 27.32 ),(150.67 ±28.59) ,( 174.32 ± 25.92) h,respectively (P=0.041). Head box: The mean hour for each group was (37.16 ±5.51) ,(55.29 ±11.71 ), (62.69 ±12.39 ), ( 100.75 ± 28.10 ) h, respectively ( P = 0.047 ). CPAP: The mean hour for each group was ( 24.33 ± 4.41 ),(27.44 ±4.47), (26.53±3.13 ), (56.50 ± 5.50 ) h, respectively ( P = 0. 005 ). MV: The mean hour for MV use for each group was ( 56.12 ±15.65 ), ( 110.19 ± 21.59 ), ( 127.79 ± 26.36 ), ( 156.61 ± 12.92 ) h, respectively ( P = 0. 009 ). The mean number of days in NICU to recover for each group was ( 15.89 ± 1.29 ), (21.61 ± 2.30 ), ( 28.31 ± 3.40 ), ( 32.73 ± 4.57 ) d, respectively ( P = 0 ). The complete cure rate for each group was 63.89%, 51.52% ,35.90% ,20. 0% ,respectively. It shown a significant difference (P =0. 005 ) among the 4 groups regarding treatment outcomes. Conclusions ACS and PS combined therapy is the most effective therapy for the prevention of RDS,followed by ACS therapy alone,then PS therapy alone,and no ACS/no PS therapy is the least effective.

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Therapy Effect of N-Acetylcysteine on Lipopolysaccharide-Sensitized Neonatal Rat with Hypoxic-Ischemic Brain Damage

Chun-xia, NIE ; Xiao-yang, WANG ; Chang-lian, ZHU

Journal of Applied Clinical Pediatrics.2006;21(6):378-381.

Objective To evaluate the effect of N- acetylcysteine(NAC) on lipopolysaccharide (LPS) - sensitized neonatal rats with hypoxic- ischemic brain damage(HIBD) and possible mechanism except the antioxidant. Methods With the total number of 98 Wistar pups at postnatal day 8 of either sex was used in this study. There were 86 pups which were divided into three groups to evaluate the brain injury:vehicle group ( n = 29) ,low dose (25 mg/kg) ( n = 31 ) and high dose NAC (200 mg/kg) ( n - 26) treatment group. The pups were injected with LPS(0.1 mg/kg)intraperitoneally 3 days before hypoxic- ischemic(HI) insult. Multiple dose of NAC (25 mg/kg or 200 mg/kg) or vehicle was injected intraperitoneally before and after HI. Brain injury was evaluated 7 days after HI. For the Caspase - 3 activity and immunoblotting analysis, the samples were collected at 24 h after HI treated either with vehicle or high dose NAC ( n = 6 per group). Results The brain injury volume was significantly reduced by high dose NAC (200 mg/kg) treatment compared with that of vehicle (77% reduction, P ＜ 0.001 ). The tissue loss was reduced 67 % ( P ＜ 0.001 ) in high dose NAC treated group compared with that of vehicle. However,there was no significant reduction of brain injury in the low dose NAC treatment group compared with vehicle group. Caspase - 3 like activity measurement showed that the activity decreased 53 % after high dose NAC treatment ( P ＜ 0. 001 ) compared with that of vehicle treatment. The immunoblots showed that the active form of Caspase - 3, 17 kDa band, was abolished by the high dose NAC treatment. Conclusions NAC treatment attenuate LPS - sensitized neonatal HI brain injury is dose dependent. The neuroprotective effect involves Caspase - 3 inhibition.

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Induction of Apoptosis and Upregulation of Fas Ligand and Fas - Associated Death Domain by Doxorubicin in Human Jurkat Leukemia T- Cells

Jia-hao, LIU ; Hong-li, TANG ; Wei-yong, RUAN ; Wei, WANG ; Li, HUANG

Journal of Applied Clinical Pediatrics.2006;21(1):53-56.

Objective To investigate the dose and time kinetics of induction of apoptosis induced by doxorubicin in J urkat leukemiacells, and to explore its pertinent molecular mechanisms. Methods Human Jurkat leukemia T - cells were treated with doxorubicin at theconcentration of 0.1 mg/L, 0.2 mg/L, 0.5 mg/L and 1.0 mg/L for 6,12,24 and 36 hours, respectively, of which one sample was pre-treated with zVAD- fmk (benzyloxycarbonyl - Val -Ala - Asp - fluoromethylketone) prior to addition of doxorubicin 0.2 mg/L. Apop-tosis was detected with both annexin V - FITC and propidium iodide ( PI ) staining and annexin V FITC and PI double positive cellswere analyzed by flow cytometry. Western blot was used to evaluate the level of Fas ligand (FasL) and FADD (Fas - associated death do-main) expression. Results The differences of apoptotic cells induced by all dose of doxorubicin were not significant (P＞0.05 ) at 6hour;at 12 hour, only the highest dose, 1 mg/L, significantly induced cell apoptosis;while the lowest dose,0.1 mg/L, did not significantlycaused cell apoptosis for all time points. After exposure to the doses of 0.2 and 0.5 mg/L for 24 or 36 hours,a significant increase in per-centage of apoptotic cells was observed (P ＜ 0.001 ). Apoptosis induced by doxorubicin was completely inhibited when the cells were incu-bated with doxorubicin in the presence of zVAD - fmk (P ＜ 0. 001 ). The level of FasL and FADD expression correspondingly increasedwith exposure time to doxorubicin. Conclusions Doxorubicin induces apoptosis in a dose - and time - dependent manner; upregulatedFasL may initiate the activation of the Fas signaling pathway and caspases are the ultimate executioner in the induction of leukemia cellapoptosis by doxorubicin.

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Epidemiological Investigation of Child Simple Obesity in Zhengzhou Area and Intervention Research on Massage Along Channel of Traditional Chinese Medicine

Hong-ling, LI ; Wei, JU ; Lin-lin, LI ; Xiao-ping, LUO ; Mu-ti, WANG

Journal of Applied Clinical Pediatrics.2005;20(12):1260-1262.

Objective To explore incidence of child obesity in Zhengzhou area and intervention measures.Methods In 2001, spot check was conducted on 5688 cases of high and primary school students ,including 2848 boys and 2840 girls at the age of 7-18.Child obesity was diagnosed by meeting reference BMI value published by Cole et al,conducted comprehensive treatment consisting of massage intervention along channel of traditional Chinese medicine, behavior modification, dietetic and sport adjustment for 22 cases of simple obesity children (7-15 years old, 18 boys, 4 girls) selected for one month, and follow-up survey 6 months after treatment.Results Five thousands,six hundreds and eighty-eight high and primary school students investigated had an overweight incidence of 15.4%, an obesity incidence of 3.2%,boys' overweight incidence and obesity incidence(19.2%,4.6%) were remarkably higher than those of girls (11.5%,1.7% P<0.001). Overweight incidence of various age groups evidently differed(χ2=42.88 P<0.001) with the group of 8-15 years old children as popular. Incidence of various age groups also differed(χ2=21.28 P<0.05) with 7-10 years old and 14-15 years old children as popular. After one-month treatment, weight of all the 22 cases of fat children decreased from (76.45±19.87) kg upon hospitalized to (69.06±17.98) kg with a decrease of (7.43±2.58)kg, BMI value decreased from (31.05±3.96) before treatment to (27.72±3.54).Weight and BMI value before and after treatment differed evidently (t=13.6,12.88 P<0.01), and weight and BMI value decrease were remarkably related with those upon hospitalized (r=0.77 P<0.01;r=0.49 P<0.05).Conclusions Incidence of child obesity has been increasing in recent years, comprehensive treatment consisting of massage intervention along channel of traditional Chinese medicine, behavior modification, dietetic and sport adjustment have good curative effect and are comfortable, well received by children and suitable to promote and apply.

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Bailing Capsule in Preventing Epithelial- Mesenchymal Transition in Rats with Tubulointerstitial Fibrosis

De-an, ZHAO ; Da-sheng, YANG ; Ling-yun, BI ; Hui-qin, XU ; Ying, ZHAO ; Xin-de, CHEN

Journal of Applied Clinical Pediatrics.2005;20(9):939-942.

Objective To explore the effect of Bailing capsule on epithelial-mesenchymal transition( EMT) in rats with adenine-in-duced tubulointerstitial fibrosis. Methods Tubulointerstitial fibrosis animal models were established and SD rats were divided into mo-del group ( n = 30), treatment group ( n = 30) and control group( n = 30), randomly. Experimental rats were harvested at 7 w, 12 w,17 w after onset of experiment and functional evaluations were performed. Histology, immunohistology were examined to investigateboth histolopathology changes and the expression of bone morphogenic protein-7 (BMP-7), transforming growth factor-β1 (TGF-β1 )and a-smooth muscle actin (α-SMA) in kidneys at three time points mentioned above, respectively. Results Compared with controlgroup, 24 h urinary protein in model group lost increasingly and significantly difference appeared at three time points relative to controlgroup ( P ＜ 0.01 ). Urinary NAG in model group was markedly higher than that in control group from 7 w after onset (P ＜ 0.01 ) andwas increasingly raised at 12 w and 17 w (P＜0.01). The value of blood BUN and Cr in model group increased at 7 w (P＞0.05) rel-ative to control group. There was significant difference at 12 w and 17.w (P ＜ 0.01 ). Histologically, kidneys in model group, at 7 w,exhibited tubular casts and gently tubular dilation, granuloma in cortex, mononuclear cells infiltration in tubulointerstitial areas, andmild interstitial fibrosis. At 12 w, the degree of tubular injury and tubulointerstitial fibrosis gradually aggravated. Up to 17 w, diffusetubular dilation or atrophy was observed and focal tubules disappear. Diffuse interstitial fibrosis was exhibited. In normal kidneys, im-munohistochemistry suggested that the light expression of BMP-7 was detected in proximal renal tubular epithelial cells and marked ex-pression was identified in distal tubule, collecting duct, and renal tubular epithelial in junction area between cortex and medulla. How-ever, the expression of BMP-7 in kidneys of model group significantly decreased with increasing tubulointerstitial fibrosis and was nega-tive correlation with the expression of TGF-β1(r = -0. 981 P＜0.01) and α-SMA (r= -0.975 P＜0.01). Bailing capsule ad-ministration protected the expression of BMP-7 and reduced TGF-β1 and α-SMA expression before 12 w(P＜ 0.01 ). Conclusions Ourstudy shows an anti-fibrotic reno-protective function of Bailing capsule in rats with tubulointerstitial fibrosis via prevention of epithelial-mesenchymal transition at early stage. However, the beneficial effect lost with increasing tubulointerstitial fibrosis.

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Epidemiology of Mycoplasma Pneumoniae Infection

quan, LU ; min, LU

Journal of Applied Clinical Pediatrics.1994;0(04):-.

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Differentiation of Dendritic Cells from Embryonic Stem Cells

Jing, HUANG ; Zhi-xu, HE ; Qian-qian, WU ; Zhi-hua, WANG

Journal of Applied Clinical Pediatrics.2007;22(3):233-235.

Objective To investigate the method of directed differentiation dendritic cells from embryonic stem cells(ESC) and to amplify high purity DCS in vitro for immunity therapy.Methods E14 ESC line were generated ESC-derived dendritic cells(ES-DC) in complete medium further supplemented with granulocyte-macrophage colony-stimulating factor(GM-CSF) and interleukin-3(IL-3).ES-DCs was used flow cytometry to determine CD11c,CD80,CD86,MHC-Ⅱ cell surface phenotype. Lipopolysaccharide (LPS) were added to induce the ES-DCs matured. The matured ES-DCs was harvested 24 hours later to be identified with morphology, transmission electron microscopy, analyzed by flow cytometry and compared with the immatured ES-DCs phenotype. The antigen presenting was evaluated by mixed lymphocyte responses.Results The ES-DC had obviously dendritic processes under scanning electron microscope . The immature DCs express low level of CD11c(4.33±0.23)%,CD80 (7.62±0.19) %, CD86 (4.77±1.22) % and MHC-Ⅱ (9.68±0.15) %, but the mature DCs express higher lerve of CD11c(47.36±2.68)%,CD80 (74.4±1.47) %, CD86 (29.77±2.00) % and MHC-Ⅱ (87.56±2.75) %. MLR showed that ES-DCs could effectively stimulate lymphocyte to proliferate.Conclusion These results provide evidence that DCs can be generated from E14 ESC with GM-CSF and IL-3, express high level of CD11c,CD80, CD86, MHC-Ⅱ and can effectively stimulate lymphocyte to proliferate. ES cells may become new origin for DCs which provided the immunotherapy.

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Preliminary Study on Personality Characteristics of Abused Children

Shi-chang, YANG ; Ya-lin, ZHANG ; Yu-ping, CAO ; Guo-ping, HUANG ; Guo-yi, GUO

Journal of Applied Clinical Pediatrics.2005;20(7):716-718.

Objective To explore the personality characteristics of abused children in order to reduce the incidence of child abuse.Methods Two hundred and ninty five middle school students were investigated with general questionnaire and Eysenck Personality Questionnaire of children. Eighty six students experiencing child abuse (CA) last year as study group and one hundred and ninety six non-abuse children as controls (NCA) were analyzed by means of Eysenck Personality Questionnaire of children.Results The score of neuroticism in CA group was significantly higher than that in the control group (55.62±10.60/52.65±10.98,t=-2.114 P=0.035). The score of lie in CA group was significantly lower than that in control group (42.21±9.87/46.04±9.20,t=3.184 P=0.002). On the impact of different sex, the psychoticism score of male was significantly higher than that in the control group(52.37±11.49/48.04±9.97,t=-2.227 P=0.028), and the lie score was significantly lower than that in control group(41.03±9.18/46.18±8.79,t=3.125 P=0.002).The scores of those in the female were not significant.Conclusions There is a close association between the unstable emotion and child abuse in children, so training emotional self-control and emotional expression of children might be a intervention strategy in the future. In addition, the frequency of lie in children is probably one of factors that determine whether children are abused or not.

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Surgical Treatment of Low and Intermediate Anorectal Anomalies by Transperineal Da- W Anorectoplasty

Gen-sheng, LIU ; Yue-jie, WU ; Cui-ping, SONG ; Wang, RAO

Journal of Applied Clinical Pediatrics.2006;21(11):713-714.

Objective To explore a technical modification by transperineal Da- W anorectoplasty (Da WARP) on treating low, intermediate anorectal anomalies(AA) and to evaluate the results of long - term follow up. Methods Forty six cases of AA underwent a Da-W ARP,which involved preservation of the rectal end of the fistula and invagination of the perineal skin flap through the neoanus.The clinical records were reviewed and analyzed retrospectively. Results The median follow - up period was 7 years and 2 months. All of them achieved a good fecal continence exception of 1 patient with intermediate AA and associated anomaly,had fair result. Conclusions The Da - WARP is relatively simple and practical methods for surgical treatment of low, intermediate AA, with good long - term results.

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Follow-Up Study of One Family with Generalized Epilepsy with Febrile Seizures Plus

Jia-qin, WANG ; Jian-hua, LI ; Jing-gang, YIN ; Xi-shun, HUANG ; Xue-peng, GUO

Journal of Applied Clinical Pediatrics.2006;21(13):872-874.

Objective To investigate the clinical significance of generalized epilepsy with febrile seizures plus(GEFS+ ). Methods The data of one family with GEFS+ were retrospectively analyzed by studying clinical manifestations, physical examinations, electroencephalogram(EEG), 24 hours dynamic EEG monitoring, et al. Some of the patients were examined by CT. Results Ⅳ 12, her chief complaints when admitted to hospital were frequent spasm for 3 days. She began to appear febrile seizures (FS) from 8 months after birth, and frequent generalized tonic - clonic FS appeared during that time. There were 36 people in 5 generations of the family including 14 patients (8 males and 6 females) ,aged from 4 years and 5 months to 82 years. FS presented in 8 cases (Ⅱ 2, Ⅲ1, Ⅲ4, Ⅲ6, Ⅳ1, Ⅳ11, Ⅳ17, Ⅴ2),febrile seizures plus(FS +) in 4 cases ( Ⅳ2, Ⅳ12, Ⅳ13, Ⅳ14), ES + and absence seizures in 1 case ( Ⅴ1 ), uncertain type in 1 case (Ⅰ2). The results of EEG indicated that 12 cases were normal and 4 cases with FS+ and 1 case with absence seizures had epileptic discharges. Apart form Ⅳ13, Ⅳ14 who were treated with magnesium valproate, the dosage for the other patients decreased, or medicine terminated or without medicine, and all the patients had no recurrence of seizures. The intelligence, movement development and neurological examinations of the family were all normal. Head CT scan of 3 cases were normal. Conclusions GEFS+ is autosomal dominant inheritance disease with conspicuous genetic heterogeneity and phenotypic heterogeneity. The apprehension of GEFS+ plays an important role in diagnosis and differential diagnosis of epilepsy in childhood.

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