Following the improvement of survival rate of very premature infants，the incidence of bronchopulmonary dysplasia（BPD）has been showing a rising trend in recent years.BPD is the most common and severe pulmonary complication in premature infants.Although prematurity and immature pulmonary growth are the most important risk factors in the development of BPD，the precise pathogenesis of BPD remains to be verified.Silent information regulator 2 homolog 1（SIRT1）belongs to sirtuin family，which plays an important role in the progress of inflammation，oxidative stress，apoptosis，autophagy and epithelial-mesenchymal transition，which is closely associated with BPD.Current studies of SIRT1 in the mechanism of BPD are reviewed in this article，which may provide reference for pathogenesis of BPD and potential therapeutic target.

Synapse is the key part of information transmission between neurons,which has certain plasticity.Glutamate receptor plays an important role in the synaptic plasticity of the central nervous system,and acupuncture can regulate the glutamate receptor to normal under pathological conditions,and its research is also deepening.This paper summarizes the recent research literature on the effects of two types of glutamate receptors,ionic glutamate receptor and metabotropic glutamate receptor,on synaptic plasticity,as well as acupuncture regulating the expression of ionic glutamate receptor and metabotropic glutamate receptor,in order to provide a theoretical basis for acupuncture regulating synaptic plasticity based on glutamate receptor expression,and provide reference for subsequent research.

Depressive disorder seriously affects people's physical and mental health.Acupuncture is a safe and effective treatment for depression,yet,its mechanism is unclear.Therefore,acupuncture's action mechanism in intervening depression was summarized from several perspectives,including morphology and ultrastructure of neurons in depression-related brain areas,function and structure of glial cells,brain functional and structural connectivity,and neuroelectrophysiology.It's discovered that acupuncture can repair the morphological and ultrastructural damage of neurons in the hippocampus and prefrontal lobe,mitigate the functional and structural injuries of glial cells in the hippocampus and prefrontal lobe,strengthen functional connectivity and heal structural connection,and promote neuroelectrophysiological activities,which possibly are the principal mechanisms of how acupuncture works in intervening depressive disorder.

Objective: To explore the abnormal changes in neuroelectric activity in the primary visual cortex of rats deprived of vision in one eye and to investigate the regulatory effect of acupuncture in the sensitive period on the abnormal coding and conduction of electrical signals of rats' optic neurons.Methods: Sixty 14-day-old Sprague-Dawley rats were randomly divided into a blank group, a model group, an early-stage acupuncture group, a middle-stage acupuncture group, and a late-stage acupuncture group, with 12 rats in each group. Rats in every group except the blank group received right eyelid suturing to create a monocular deprivation model in the sensitive period of visual development (from the day rats open their eyes to the 45th day after their birth). Rats in the three acupuncture groups started to undergo acupuncture respectively on the 3rd, 12th, and 21st days after the model replication was done, with each group receiving nine-day treatment. The activity level of the neuroelectrical signal of the primary visual cortex in each group, including the latency and amplitude of P100 wave, average discharge frequency and amplitude of neurons, the power spectral density (PSD), and interspike interval (ISI), were measured by neuroelectric evaluation technology after the acupuncture treatment was finished. Results: Compared with the blank group, the latency of P100 wave in the visual center of vision-deprived eyes was significantly prolonged, and the amplitude was significantly reduced (P<0.05); the average discharge frequency and amplitude of the neurons in the visual cortex also decreased significantly (P<0.05); PSD decreased and ISI was prolonged significantly (P<0.05). Compared with the model group, the abnormal electrical activity of optic neurons in the three acupuncture groups ameliorated, the latency of P100 shortened, and the amplitude of P100 increased (P<0.05), the discharge frequency and amplitude increased significantly (P<0.05), the PSD reduced, and the ISI shortened (P<0.05). In addition, among the three acupuncture groups, the early-stage acupuncture group had the best effect on various indicators. Conclusion: Abnormal electrophysiological activity is significant in the visual center of vision-deprived rats, and acupuncture treatment in the sensitive period of visual development can enhance the bioelectrical activity of visual nerve cells, improve the efficiency of optic nerve conduction, and regulate the inhibition and retardation of visual response caused by visual deprivation.

Objective:To investigate the clinical and molecular genetic characteristics of 6q24-related transient neonatal diabetes mellitus (6q24-TNDM).Methods:The clinical data of two neonates with 6q24-TNDM admitted to Shanghai Children's Hospital, Shanghai Jiao Tong University in 2017, were retrospectively collected. The methylation levels of 16 cytidine-phosphate-guanosine (CpG) sites from the methylated differentially modified region (DMR) in 6q24 were quantitatively analyzed by pyrosequencing.Results:Case 1, aged 5 d, was born at 37 +4 gestational weeks due to fetal growth restriction, and case 2 was 11-days old and born at 38 +2 gestational weeks. Both infants were male and small for age. They were born through a cesarean section. The birth weight of case 1 and case 2 were 2 340 g and 2 600 g, respectively. They were admitted due to hyperglycemia with blood glucose of 12.95 and 8.00 mmol/L on admission, respectively. Physical examination showed slightly poor skin elasticity and thin subcutaneous fat. Laboratory examination revealed lower serum insulin (<1.39 and 3.94 pmol/L) and peptide C (0.05 and 0.14 nmol/L) levels, positive results of urine glucose, negative tests for urine ketone, serum anti-glutamic acid decarboxylase antibody, anti-insulin antibody, and islet cell antibody in both cases. Normal size of the pancreas was observed by ultrasonography. The infants were improved and were discharged after subcutaneous insulin infusion for more than two weeks. The treatment was discontinued at 69 d and 42 d postnatally for case 1 and case 2. Prenatal diagnosis of the two infants showed normal karyotypes and uniparental disomy of chromosome 6 indicated by single nucleotide polymorphism chip. No pathogenic mutations were detected by next-generation sequencing after admission. The methylation levels of 16 CpG sites in DMR of 6q24 in the two cases, which were quantitatively analyzed by pyrosequencing, were lower than 10% (normal value in healthy matched controls: 40%), indicating an obvious hypomethylation. Conclusions:For children with TNDM who are small for gestational age at birth, presenting hyperglycemia with decreased serum insulin and C-peptide levels, pyrosequencing can be used to quantitatively analyze the methylation levels of CpG sites in 6q24 DMR, which can quickly and directly assist in the diagnosis of 6q24-TNDM, thereby contributing to the treatment and prognosis assessment.

Objective:To study the early predictive value of urine neutrophil gelatinase-associated lipoprotein (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in neonates with severe asphyxia.Method:From January 2019 to June 2020, neonates with severe asphyxia admitted to our hospital within 6 hours after birth were enrolled in the study. The dynamic changes of urine NGAL and KIM-1 at admission, 24 h, 48 h and 1 w after birth were examined. Neonates were assigned into AKI group and non-AKI group according to the clinical practice guidelines for AKI issued by KDIGO (Kidney Disease: Improving Global Outcome). The sensitivity and specificity of NGAL and KIM-1 predicting AKI at different time points were evaluated using ROC curve and area under curve (AUC).Result:According to the diagnostic criteria of neonatal AKI, 9 cases were in the AKI group and 42 cases in the non-AKI group, and the incidence of AKI was 17.6%. Urine NGAL was significantly increased in AKI group at admission and 24 h after birth compared with the non-AKI group [(115.6±75.5) ng/ml vs. (49.8±29.0) ng/ml, (90.7±35.6) ng/ml vs. (55.6±30.7) ng/ml] ( P<0.05). No significant differences existed at 48 h and 1 w after birth between the two groups. At 24 h after birth, urine KIM-1 in the AKI group was significantly higher than the non-AKI group [(808.3±555.3) pg/ml vs. (318.4±234.0) pg/ml, P<0.05] and no significant differences existed between the two groups at admission, 48 h and 1 w after birth. The AUC of NGAL predicting AKI at admission, 24 h, 48 h and 1w after birth were 0.804 (95% CI 0.573~1.000), 0.792 (95% CI 0.580~1.000), 0.732 (95% CI 0.517~0.947) and 0.551(95% CI 0.371~0.730), respectively. The AUC of KIM-1 predicted AKI at admission, 24 h, 48 h and 1 w after birth was 0.860 (95% CI 0.676~1.000), 0.824 (95% CI 0.655~0.993), 0.768 (95% CI 0.622~0.914), 0.622 (95% CI 0.392~0.852), respectively. Conclusion:At admission, 24 h and 48 h after birth, urine NGAL and KIM-1, as kidney injury markers, may predict the occurrence of AKI after severe neonatal asphyxia.

Objective:To study the correlations of neonatal hemodynamic parameters with gestational age (GA) and birth weight (BW) using non-invasive ultrasound cardiac output monitor (USCOM).Method:From March to September 2019, neonates with stable hemodynamics admitted to the Department of Neonatology of our hospital were enrolled in this prospective study. According to their GA, they were assigned into <29 w group, 29~33 w group, 34~36 w group and ≥37 w group. According to their BW, they were assigned into <1 000 g group, 1 000~1 499 g group, 1 500~2 499 g group and ≥2 500 g group. Cardiac output (CO), cardiac index (CI), stroke volume (SV), myocardial contractility (inotropy, INO), flow time corrected (FTC), systemic vascular resistance index (SVRI) and heart rate (HR) were measured using USCOM. The univariate linear regression method was used to analyze the correlation of hemodynamic parameters with different GA and BW.Result:A total of 120 neonates with stable hemodynamics were enrolled, including 69 males and 51 females. The average GA was (34.2±3.8)w and the average BW was (2 221±860) g. SV ( r=0.489, P<0.001), CO ( r=0.681, P<0.001), CI ( r=0.348, P<0.001), FTC ( r=0.266, P=0.003), INO ( r=0.446, P<0.001)and HR ( r=-0.322, P<0.001) showed significant linear correlations with GA. No linear correlation existed between SVRI ( r=-0.052, P=0.574) and GA. SV ( r=0.603, P<0.001), CO ( r=0.852, P<0.001), CI ( r=-0.390, P<0.001), INO ( r=0.576, P<0.001) and HR ( r=-0.440, P<0.001) showed significant linear correlations with BW. No significant linear correlations existed between SVRI ( r=-0.076, P=0.409) or FTC ( r=0.090, P=0.329) and BW. Conclusion:USCOM can monitor neonatal hemodynamic parameters in real-time.Hemodynamic parameters including SV, CO, CI and INO are significantly different among newborns with different GA and BW and these parameters are linearly correlated with GA and BW.

Objective To study the clinical efficacy and safety of extracorporeal membrane oxygenation (ECMO) in critically ill neonates.Method From November 2016 to September 2018,the clinical data of 5 cases who received ECMO treatment in NICU of our hospital were retrospectively analyzed.The indication of ECMO was reversible respiratory failure irresponsive to conventional therapy.The treatment mode was V-A ECMO.Oxygenation index (OI),vasoactive-inotropic score,blood lactate before and 24 h after ECMO were recorded.Complications of ECMO were also studied.Paired t-test was used to compare the pre and post treatment parameters.Result Among the 5 cases,4 cases were male and 1 case was female.3 cases were diagnosed with meconium aspiration syndrome,2 cases pulmonary hypertension.OI[(9.5 ± 1.8) vs.(60.6 ± 19.4)],vasoactive-inotropic score[(19.5 ± 12.0) points vs.(204.0 ± 143.8) points]and blood lactate [(2.8 ± 1.5) mmol/L vs.(9.6 ± 3.6) mmol/L]) were all significantly decreased at 24 h after ECMO treatment (P ＜ 0.05).During follow-up,3 cases survived,2 cases died.All the 5 cases showed thrombocytopenia,3 cases developed renal failure and received continuous renal replacement therapy,1 case got intracranial hemorrhage.2 of the 3 survived cases developed neurological impairment and need long term follow-up and rehabilitation therapy.Conclusion ECMO treatment has remarkable effects on critically ill neonates and may actually save lives,but the risk of complications are quite high.

Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI).Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiaotong University,from June 2012 to June 2017,and among them there were 15 cases with AKI,and the clinical data of these 15 patients were retrospectively analyzed,while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVH-DF) in 13 cases,plasma exchange (PE) in 2 cases.The changes of blood pressure(BP),renal function,electrolyte,acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment,12 h,24 h,48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates.Results Gestational age of 15 AKI newborns was 33 +4-40 +1 weeks,admission day age was 2-28 days,birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases,neonatal septicemia in 5 cases,congenital hereditary metabolic disease in 2 cases,traumatic asphyxia in 1 case,and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value [(50.8 ± 6.57) mmHg(1 mmHg =0.133 kPa)] could reach normal level after 12 h CRRT treatment,and blood pH value (7.31 ± 0.25) increased significantly after 12 h CRRT treatment,while blood K+[(5.51 ±1.86) mmoL/L],urea nitrogen (BUN) [(9.5 ±3.7) mmol/L],creatinine(Cr) [(93± 14)μmol/L] significantly decreased after 12 h CRRT treatment,and reached the normal range [K + (4.78 ± 2.95)mmol/L,BUN (7.5 ±2.1) mmol/L,Cr (54 ± 13) μmol/L] after 24 h treatment,but urine volume[(0.8 ±0.2)mL/(kg· h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg after 24 h treatment.CRRT treatment of 15 AKI neonates turned out to be effective.Conclusions CRRT can effectively improve the internal environment of AKI neonates and reduce the death rate of neonatal AKI,which can provide an effective adjuvant treatment measures for the treatment of AKI neonates.

Objective To evaluate the safety,feasibility,complications and outcome of continuous renal replacement therapy (CRRT) in neonates weighting less than 3 000 g.Method A total of 6 neonates weighting less than 3 000 g treated with CRRT in the Department of Neonatology,Shanghai Children's hospital,from January 2015 to December 2017 were studied.The birth weight,primary disease,indications of CRRT,treatment duration,age,complications and outcome of the neonates were collected and analyzed.Serum creatinine (Scr),blood urea nitrogen (BUN) and blood ammonia were analyzed before and after CRRT.T test was used for statistical analysis of the data.Result (1) Among the 6 neonates,2 were full-term infants and 4 were premature infants.The average gestational age of the neonates was (35.0± 2.1) weeks and the average birth weight was (2 542±586) g.(2) The catheterization was successful in all of the 6 neonates.The model for CRRT was continuous veno-venous hemofiltration dialysis,and the duration was 50(48,154)h,the neonates' age of CRRT was 3.0(2.0,4.5)days.The primary disease included 3 perinatal asphyxia,1 hemolytic uremic syndrome,1 ornithine transcarboxylase deficiency,1 jejunal atresia.There were 5 patients with acute kidney injury and fluid overload,and another one with hyperammonemia.(3) Compared with before CRRT,serum creatinine,urea nitrogen and serum ammonia all decreased significantly and reached the normal range after CRRT.(4)The complications of CRRT in the 6 neonates included 2 hypotension,1 hypokalemia,1 hypocalcemia and 1 hypophosphatemia.Catheter related infection,blockage and other complications had not occurred.(5) After treatment,3 patients survived,1 witdrew and 2 died.Conclusion The application of CRRT in neonates with weight less than 3 000 g is safe and feasible,the prognosis and survival rate of which can be improved with fewer and controllable complications.