Objective:To analyze the cases referred to a higher-level hospital from the Department of Neonatology in a primary hospital, and evaluate the efficiency of clinical works related to the referrals.Methods:Data of neonates admitted to the Department of Neonatology at Maternal and Child Health Hospital of Dabu County from January 2018 to December 2020 and referred to the superior hospital were retrospectively analyzed.Results:A total of 1 670 neonates were included and 128 neonates were referred.The median age of the neonates referred was 0.5 hours(0 hours, 25 days), the median gestational age was 38 + 3(29 + 1, 42 + 4) weeks, the median weight was 3 000(1 250, 4 800) g, and the transport distance was 78 km.Twenty-four cases were assessed as critical cases before the referral, 125 cases were improved and discharged after treatment in the superior hospital, and three cases died.The referral rate in 2018, 2019 and 2020 showed a downward trend year by year (10.3%, 7.6% and 4.0%, respectively), and the difference was statistically significant( χ2=14.362, P=0.001). The proportion of critical cases in referral cases increased year by year (9.4%, 23.9% and 38.9%, respectively), and the difference was statistically significant( χ2=9.289, P=0.010). The incidence of critical case was higher in those whose mothers didn′t have regular prenatal examination during pregnancy( χ2=5.129, P=0.032). Conclusion:The ability of neonatal treatment in primary hospitals has been improved.The neonates need to be referred and critical cases are not rare in primary hospitals.More attention should be paid to the safety and effectiveness of the regional transport network.Also, enhancing the health awareness of residents and improving the primary medical technics are important to maximize the life safety and optimal transition of newborns.

Objective:To investigate the clinical and genetic characteristics of Simpson-Golabi-Behmel syndrome (SGBS) type Ⅰ caused by glypican-3 ( GPC3) gene mutations. Methods:Data of one neonate with SGBS type Ⅰ from Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University was reviewed retrospectively. Literature was retrieved to summarize the clinical and genetic characteristics of SGBS type Ⅰ caused by GPC3 mutations, using terms of "Simpson-Golabi-Behmel type Ⅰ", "GPC3" and "glypican-3" from China National Knowledge Infrastructure, VIP database, Wanfang database, and PubMed from January 2010 till April 2021. Results:The male infant was admitted to the hospital at 4 h after birth due to "abdominal distension for 1 h", presenting with dysmorphic facial features, including macrocephaly, coarse face, broad nasal bridge, macrostomia, tongue with a groove in the middle, as well as macrosomatia, supernumerary nipples, and hypospadias. Whole exome sequencing revealed a novel frameshift mutation (c.720delC) in GPC3 gene of the patient and his mother for hemizygous and heterozygous variation, respectively, based on which SGBS type Ⅰwas confirmed. During the follow-up, overgrowth, neuroblastoma, and motor development retardation were found in the boy. In addition to the index patient, 92 cases of SGBS type Ⅰ reported in 31 articles were analyzed, including 89(95.7%) males and 4(4.3%) females. The main clinical features were craniofacial dysmorphism, pre/postnatal overgrowth with multiple congenital anomalies. Most patients were combined with language disorders, motor retardation, and various degrees of dysnoesia, and were more likely to develop embryonic tumors. Among the 93 cases, 11(11.8%) suffered from tumors. Apart from 21 cases of termination, 63 cases were born alive and nine cases died after birth. Pathogenic variants in GPC3 gene were reported in 80 cases, which were nonsense mutation in 25 cases (31.2%), DNA fragment deletion in 21 cases (26.2%), frameshift mutation in 16 cases (20.0%), large duplications in eight cases (10.0%), missense mutation in five cases(6.2%), and splice site mutation in five cases(6.2%). Conclusions:SGBS type Ⅰ is an X-linked recessive genetic disease with various phenotypes. Patients with postnatal craniofacial dysmorphism, overgrowth, and multiple congenital anomalies should be highly suspected of SGBS type Ⅰ. Genetic testing is conducive to its early diagnosis. Treatment requires multidisciplinary cooperation and long-term follow-up, especially for those with tumors.

Objective:To investigate the clinical significance and correlation of arginase 1 (Arg-1) and inducible nitric oxide synthase (iNOS) expression in hepatocellular carcinoma (HCC).Methods:The expression of Arg-1and iNOS in 146 cases of hepatocellular carcinoma tissues and corresponding adjacent tissues was detected by immunohistochemistry. The clinicopathological characteristics and the correlation between the expressions and prognosis were determined by chi square test, Spearman’s rank correlation, Kaplan-Meier survival analysis and Cox regression analysis.Results:The positive rates of Arg-1 and iNOS were 18.7% (23/123) and 37.0% (54/146), respectively, which was significantly lower than the adjacent tissues [100%(146/146) and 93.8% (137/146)] and the difference was statistically significant ( χ2 = 212.521, P < 0.01, χ2 = 104.276, P < 0.01). There was a positive correlation between the both expression ( r = 0.331, P < 0.01). Arg-1 low expression was correlated with preoperative serum alpha-fetoprotein (AFP) level, tumor size, differentiation degree, histological types and Edmondson’s grade. iNOS low expression was correlated with the differentiation degree and Edmondson’s grade ( P < 0.05). Kaplan Meier survival analysis showed that in patients with recurrence-free survival (RFs), Arg-1 (+) group > Arg-1 (-) group and Arg-1 (+) iNOS (+) group > Arg-1 (+) iNOS (-) group > Arg-1 (-) iNOS (-) group ( P < 0.05). Cox multivariate analysis showed that age, tumor size, Edmondson’s grade, vascular tumor emboli were significantly correlated with RFs ( P < 0.05). Conclusion:There is a positive correlation between Arg-1 and iNOS expressions in HCC, and both may reflect the HCC malignant degree. The reduced/absent expression of both may participate in the occurrence and development of HCC. The combined detection of Arg-1 and iNOS on HCC may have certain significance for the judgment of differentiation degree and prognosis.

Objective: To investigate the efficacy and adverse effects of sustained lung inflation (SLI) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: This prospective randomized controlled trial included 124 premature infants (gestational age <34 weeks and birth weight <2 000 g) diagnosed with NRDS and in need of PS treatment in Shenzhen Maternity & Child Healthcare Hospital affiliated to Southern Medical University from July 1, 2016 to October 31, 2018. They were randomly divided into experimental or control group, with 62 cases in each. Infants in the experimental group were treated with SLI using T-piece and intratracheal PS, while those in the control group were given PS only. Blood gas analysis and measurement of fraction of inspiration O₂ (FiO₂) and ratio of partial pressure of oxygen (PO₂) over FiO₂ were performed before and 1 h after PS injection. Results of the treatments and incidence of complications were compared. Paired samples t-test, two independent samples t-test, rank-sum test and Chi-square test were used for statistical analysis. Results: There were 56 participants in the experimental group and 54 in the control group who were eventually analyzed. In the experimental group, the pH value, partial pressure of carbon dioxide (PCO₂), FiO₂ and PO₂/FiO₂ at 1 h after PS injection were all improved compared with those before treatment [pH value: 7.26±0.09 vs 7.19±0.09, t=3.814; PCO₂: (51.5±12.6) vs (59.8±16.3) mmHg (1 mmHg=0.133 kPa), t=2.610; FiO₂: 26.0 (21.0-31.5)% vs 40.5 (38.5-51.5)%, U=392.000; PO₂/FiO₂: (284.6±117.9) vs (173.4±59.7) mmHg, t=6.427; all P<0.05]. The overall decrement of FiO₂ after PS injection in the experimental group was more significant than that in the control group [-10.0 (-15.0 to -5.0)% vs -5.0 (-8.0 to 0.0)%, U=706.500, P<0.001]. The experimental group had a higher rate of extubation within 24 h than the control group [80% (45/56) vs 71% (32/54), χ²=5.830, P=0.016]. However, no significant differences were shown in total mechanical ventilation time, non-invasive/high-flow nasal cannula ventilation time, the ratio of re-intubation within 72 h, or the incidence of air leak, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, necrotizing enterocolitis or patent ductus arteriosus between the two groups (all P>0.05). Conclusions SLI combined with PS for NRDS babies can increase the rate of extubation within 24 h and promote the down-regulation of FiO₂ without causing significant complications.

Objective To investigate the preventive and adverse effects of postnatal inhalation of Budesonide in early stage on bronchopulmonary dysplasia (BPD) in very low birth weight infants.Methods A total of 105 cases of high risk premature infants with BPD,who were born in the Neonatal Intensive Care Unit (NICU) from Shenzhen Maternity and Child Healthcare Hospital from July 15,2015 to December 25,2016,and their gestational age ≥ 27 weeks and ＜ 32 weeks or birth weight ≥ 1 000 g and ＜ 1 500 g were collected for a prospective randomized controlled trial,and were randomly divided into 3 groups:early inhalation group(34 cases),late inhalation group(34 cases) and non-inhalation group(37 cases).The oxygen time,and the incidence of BPD,periventricular-intraventricular hemorrhage (IVH),retinopathy of prematurity (ROP),necrotizing enterocolitis of the newborns (NEC),patent ductus arteriosus in preterm infants (PDA),sepsis and hyperglycemia of infants in 3 groups were compared.Results The average oxygen time in early inhalation group was 9 days,while in late inhalation group and the non-inhalation group was 15 days and 18 days,respectively.The average oxygen time in early inhalation group was significantly lower than that in the late inhalation group and the non-inhalation group,with the difference being statistically significant (H =6.09,P ＜ 0.05).The noninvasive ventilation time in early inhalation group was 3 days,while both the late inhalation group and non-inhalation group were 6 days.The noninvasive ventilation time in early inhalation group was significantly lower than that in the late inhalation group and non-inhalation group,with the difference being statistically significant (H =6.17,P ＜0.05).The incidence of BPD in the early inhalation group,late inhalation group and non-inhalation group were 14.7％ (5/34 cases),20.6％ (7/34 cases) and 37.8％ (14/37 cases),respectively.The incidence of BPD in non-inhalation group was significantly higher than that in the early inhalation group and late inhalation group,with the difference being statistically significant (x2 =12.017,P ＜ 0.05).There were no significant differences in IVH,ROP,NEC,PDA,sepsis and hyperglycemia among the 3 groups (all P ＞ 0.05).Conclusions Postnatal inhalation of Budesonide in early stage in high risk very low birth weight infants can reduce the incidence of BPD and the oxygen time,and the adverse reactions are not obvious.

Objective: To explore the significance of Th17 in hepatocellular carcinoma, expecially with HBV infection.Methods:Cytometric bead array(CBA) was employed to detect 5 cytokines(IL-2,IL-4,IL-6,IFN-γ,IL-17A)from 39 tumor and non-tumor tissues of HCC and combined clinical data for comparative statistic analysis.Results:The expression of IL-2,IL-4,IFN-γin liver cancer tissue[(4.61±0.28),(3.37±0.58),(3.08±1.08)pg/ml,respectively] was significant lower than non-cancer tissue [(5.57±0.59),(3.77±0.70),(3.69±1.20)pg/ml,respectively].Otherwise,the expression of IL-6,IL-17A in cancer tissue [(280.09±254.68), (2.66±1.66) pg/ml, respectively] was higher than non-cancer [(6.58 ±1.92), (1.49 ±0.98) pg/ml, respectively].And,whatever cancer or non-cancer tissue,the expression of IL-17A in tissue[(3.45±1.86)pg/ml] with high HBV load (>1 000 U/ml) was significant higher than tissue with low HBV load[(1.97±1.16)pg/ml].Conclusion: IL-17A was highly expressed in HCC,and IL-2,IL-4,IFN-γmay inhibit its expression,and IL-6 may promote it.Hepatitis B virus infection may promote Th17 expression,thereby reducing patient′s prognosis.

ObjectiveTo study the feasibility,efficacy and safety of u tilizing the laryngeal mask airway (LMA) ventilation compared with the endotracheal intubation ( ET ) in neonatal resuscitation for moderate and severe asphyxiated neonates.MethodsNeonates requiring positive pressure ventilation with heartrate ＜60 beats/min were collected and grouped quasi-randomizedly into LMA(36 cases) or ET(32 cases)ventilation.Differences of resuscitation effect,inserting time,successful once insertion rate and adverse reactions between the two groups were observed and compared.Results( 1 ) No significant difference was observed in Apgar scores at 1 min and 5 min between the two groups ( P＞0.05 ).(2) Success rate of once insertion was 94.4％ with average inserting time ( 7.58±1.16 ) s for LMP group,while it was 90.6％ and ( 7.89 ± 1.52) s for ET group.( 3 ) Successful resuscitation rate of LMA group ( 86.11％ ) was slightly lower than ET group (96.88％ ),but there was no statistical difference (P＞0.05).(4) Mean response time of LMA group [ (34.06 ± 10.56) s] was slightly lower than that of ET group [ (41.38 ±27.19) s],also ventilation time of LMA group [( 137.19 ±80.14) s] was slightly lower than that of ET group [ ( 171.09±84.28 ) s ],but neither showed statistical difference ( P＞0.05 ).(5) Adverse reactions were found in LMA group including nausea( 2 cases )and abdominal distention (1 cases),while there were laryngeal edema( 1 cases),pneumothorax(2 cases),respiratory tract bleeding( 1 cases) in ET group.ConclusionThe LMA ventilation is much easier to operate,with its effect no less than that of ET ventilation on resuscitation for moderate and severe asphyxiated cases,even it seems more safe.LMA ventilation can be a good substitute for ET ventilation,especially for those medical staffs who are unfamiliar with ET operation and primary hospital doctors in case of emergency.

Objective To investigate the expression of arginase Ⅰ(ARG1)in hepatocellular carcinoma(HCC)and to analyze its correlation with clinicopathological features.Methods The expression of ARG1 at protein level in 167 samples of HCC and corresponding adjacent liver tissue was detected with high-throughput tissue microarray technique and immunohistochemistry.The correlation between ARG1 expression and clinicopathological features was analyzed with x2 test and Spearman rank correlation analysis.The expression of ARG1 at mRNA level in 68 samples of HCC and corresponding adjacent liver tissue was determined by real-time polymerase chain reaction(real-time PCR).Results The expression of ARG1 at protein level in HCC(3.540±3.702)was significantly lower than that of the corresponding adjacent liver tissues(10.290 ± 2.303)(t=-22.421,P=0.000).The ARG1 expression was correlated with differentiation degree of HCC,histological grade,vascular invasion,preoperative level of α-fetoprotein(AFP)and recurrence after operation(all P＜0.05).The ARG1 expression at mRNA level in 68 HCC tissue[0.0997(0.213)]was lower than that of the corresponding adjacent liver tissues[0.563(0.459)],and the difference was statistical significant(u=-6.544,P=0.000).Conclusion Low expression of ARG1 in HCC may take part inHCC genesis and development.Detecting the expression of ARG1 may be helpful in HCC diagnosis,differentiation degree and prognosis assessment.

Human Prostate Specific Membrane Antigen(PSMA) cDNA was amplified using total RNA extracted from prostate carcinoma tissue by RT-PCR. The cDNA fragment of extracellular domain of PSMA(edPSMA) gene was amplified by PCR and cloned into expression vector pMAL-c2x. Sequence analysis of both PSMA and edPSMA revealed identity to the GenBank reported. The edPSMA was expressed in E. coli as part of a fusion protein with MBP as the induction of IPTG. Western blot analysis showed the recombinant protein could react with PSMA monocloned antibodies 4G5. MBP-edPSMA fusion protein were purified by amylose resin affinity chromatography and showed to be homogeneity in SDS-PAGE(120 kD). BALB/C mice were immunized with the purified protein for the preparation of polyclonal antibody. The polyclonal antibody, which had a title of 1:12,800, were indicated the specificity to prostate tissue.
Animals ; Antibodies ; immunology ; Antibody Formation ; Antigens, Surface ; Carboxypeptidases ; biosynthesis ; genetics ; immunology ; isolation & purification ; Chromatography, Affinity ; methods ; Cloning, Molecular ; DNA, Complementary ; genetics ; Escherichia coli ; genetics ; Gene Expression ; Genetic Vectors ; Glutamate Carboxypeptidase II ; Humans ; Mice ; Mice, Inbred BALB C ; Protein Structure, Tertiary ; genetics ; physiology ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; immunology ; isolation & purification ; Reverse Transcriptase Polymerase Chain Reaction ; instrumentation

Objective To evaluate the expression of G250 mRNA in patients with renal cell carcinoma (RCC) and its clinical significance. Methods A semi-quantitative reverse transcription (RT)-PCR was developed to assay the levels of G250 mRNA obtained from 7 normal renal tissues and 33 cases of RCC.Of the 33 RCC cases,28 had clear cell carcinoma and 5 had non-clear cell carcinoma.By UICC staging, 8 cases were diagnosed with T_1 stage carcinoma,13 with T_2 and 12 with T_3.Pathological grading showed 11 cases of G_1,15 of G_2,and 7 of G_3. Results Among the 33 cases of RCC,G250 mRNA expression was present in 28 cases (84.8%).However, it was absent in all the 7 normal renal tissues.There was a significant difference between the 2 groups (P0.05);while they were 0.48?0.32,0.23?0.16 and 0.11?0.11,respectively,in RCC cases of G_1,G_2 and G_3,which showed that the expression of G250 mRNA was inversely correlated with tumor grades(P