Further evidence is needed to explore the impact of high-altitude environments on the neurologic function of neonates.Non-invasive techniques such as cerebral near-infrared spectroscopy and amplitude-integrated electroencephalography can provide data on cerebral oxygenation and brain electrical activity.This study will conduct multiple cerebral near-infrared spectroscopy and amplitude-integrated electroencephalography monitoring sessions at various time points within the first 3 days postpartum for healthy full-term neonates at different altitudes.The obtained data on cerebral oxygenation and brain electrical activity will be compared between different altitudes,and corresponding reference ranges will be established.The study involves 6 participating centers in the Chinese High Altitude Neonatal Medicine Alliance,with altitude gradients divided into 4 categories:800 m,1 900 m,2 400 m,and 3 500 m,with an anticipated sample size of 170 neonates per altitude gradient.This multicenter prospective cohort study aims to provide evidence supporting the impact of high-altitude environments on early brain function and metabolism in neonates.[Chinese Journal of Contemporary Pediatrics,2024,26(4):403-409]

Decompression, Surgical ; Diskectomy, Percutaneous ; Humans ; Intervertebral Disc Displacement/surgery* ; Laser Therapy ; Lumbar Vertebrae/surgery* ; Robotic Surgical Procedures ; Treatment Outcome

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

BACKGROUND: Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions. METHODS: Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses. RESULTS: At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was -11.3% (95% confidence interval: -16.3% to -6.3%, Psuperiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (-0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group. CONCLUSIONS: In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov.

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.
Aged ; Aged, 80 and over ; Equipment Design ; Follow-Up Studies ; Humans ; Male ; Pacemaker, Artificial ; Prospective Studies ; Treatment Outcome

OBJECTIVE: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. METHODS: Forty SD rats were random-ly divided into four groups:normoxic control group (N), hypoxia hypercapnia group (HH), ERS inhibitor 4-phenylbutyric acid group (4-PBA), endoplasmic reticulum stress (ERS) pathway agonist tunicamycin group (TM), ten rats in each group.The mean pulmona-ry artery pressure (mPAP), mean carotid artery pressure (mCAP) and right ventricular hypertrophy index of rats in each group were measured.Pulmonary artery smooth muscle cells were identified by immunofluorescence α-smooth muscle actin (α-SMA).Morphologi-cal changes of lung tissue and pulmonary artery were observed by electron microscope.The apoptotic index of pulmonary artery smooth muscle cells in each group was detected by TUNEL.Reverse transcription polymerase chain reaction (RT-PCR) and Western blot were used to detect the expression of glucose-regulated protein (GRP78), C/EBP homologous protein (CHOP), c-Jun N-terminal kinase (JNK) and cysteinyl aspartate specific proteinase-12 (caspase-12) mRNA and protein in each group. RESULTS: ①Compared with the N group, the mPAP, the ratio of right ventricle weight to left ventricle plus ventricular septum weight[RV/(LV+S)]and the ratio of pulmonary artery wall area to total tube area (WA/TA) were increased (<0.01), and the ratio of pulmonary artery luminal area to total tube area (LA/TA) were decreased (<0.01), pulmonary artery smooth muscle cell apoptosis index were decreased (<0.05 or <0.01) in HH group, 4-PBA group and TM group.ERS related protein and mRNA expressions were increased, the differences were statistically significant.②Compared with the HH group, the mPAP, [RV/(LV+S)]and WA/TA of 4-PBA group were decreased ( <0.01), LA/TA and pulmonary artery smooth muscle cell apoptosis index were increased (<0.01, <0.05).The expressions of ERS related protein and mRNA were all decreased (<0.05 or <0.01).③Compared with the HH group, the mPAP, [RV/(LV+S)]and WA/TA of TM group were increased (<0.05 or <0.01), pulmonary artery middle layer thickened, LA/TA and pulmonary artery smooth muscle cell apoptotic index were decreased (<0.01).ERS related protein and mRNA expressions were increased with statistical significance except GRP78 protein. CONCLUSIONS Pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia may be related to the excessive proliferation of pulmonary artery smooth muscle cells and too little apopto-sis;ERS related factors (JNK, caspase-12 and CHOP) are involved in the regulation of pulmonary hypertension induced by hypoxia hypercapnia.
Animals ; Endoplasmic Reticulum Stress ; Hypercapnia ; Hypertension, Pulmonary ; Hypoxia ; Pulmonary Artery ; Rats ; Rats, Sprague-Dawley

Objective:To observe serum levels of high sensitive C reactive protein(hsCRP),interleukin(IL)-6, tumor necrosis factor(TNF)-α and hepatocyte growth factor(HGF)in patients with ischemic cerebrovascular dis-ease(ICVD),and analyze their correlation with blood lipids and anticardiolipin antibody(ACA)levels.Methods:A total of 45 ICVD patients treated in our hospital from Mar 2015 to Aug 2016 were regarded as ICVD group.An-other 45 non-ICVD patients treated in our hospital during the same period were regarded as non-ICVD control group.Serum levels of hsCRP,IL-6,TNF-α,HGF,blood lipids and ACA were observed and compared between two groups,and correlation among serum levels of hsCRP,IL-6,TNF-α and HGF,blood lipids and ACA levels were analyzed in ICVD patients.Results:Compared with non-ICVD control group,there were significant rise in se-rum levels of hsCRP[(4.69 ± 1.31)mg/L vs.(8.87 ± 1.56)mg/L],IL-6[(12.17 ± 4.33)mg/L vs.(34.26 ± 5.15)mg/L],TNF-α[(28.45 ± 2.18)pg/ml vs.(48.35 ± 3.15)pg/ml],HGF[(502.34 ± 15.36)pg/ml vs. (876.25 ± 18.15)pg/ml],ACA[(4.11 ± 0.65)IU/L vs.(7.89 ± 1.02)IU/L],total cholesterol[(4.68 ± 1.12) mmol/L vs.(5.57 ± 1.21)mmol/L],low density lipoprotein cholesterol[(2.62 ± 0.49)mmol/L vs.(3.24 ± 0.87) mmol/L]and triglyceride[(1.42 ± 0.31)mmol/L vs.(1.84 ± 0.37)mmol/L],and significant reduction in serum level of high density lipoprotein cholesterol[(1.28 ± 0.25)mmol/L vs.(1.02 ± 0.22)mmol/L]in ICVD group,P=0.001 all.Pearson correlation analysis indicated that serum levels of hsCRP,IL-6,TNF-α and HGF were signifi-cant positively correlated with serum levels of ACA,TC,LDL-C and TG(r=0.468~0.632,P<0.05 or <0.01), and significant inversely correlated with HDL-C level(r= -0.571~ -0.511,P<0.05 or < 0.01)in ICVD pa-tients.Conclusion:Serum levels of hsCRP,IL-6,TNF-α and HGF significantly rise in ICVD patients,and they are closely correlated with levels of blood lipids and ACA,which can serve as important indexes monitoring ICVD.

Blood Loss, Surgical ; prevention & control ; Epilepsy ; chemically induced ; Humans ; Orthopedic Procedures ; Spine ; surgery ; Tranexamic Acid ; adverse effects

The present study was to investigate the role of TRPC6 in pulmonary artery smooth muscle cells (PASMCs) proliferation and apoptosis under hypoxia and hypercapnia. PASMCs were isolated from chloral hydrate-anesthetized male Sprague-Dawley (SD) rats. Cellular purity was assessed by immunofluorescence staining for smooth muscle α-actin under fluorescence microscopy. Passage 4-6 PASMCs were starved for 24 h in serum-free DMEM and divided into 5 groups randomly: normoxia, hypoxia and hypercapnia, DMSO, TRPC6 inhibitor SKF-96365 and TRPC6 activator OAG groups. The normoxic group was incubated under normoxia (5% CO, 21% O, 37 °C) for 24 h, and the others were incubated with corresponding drugs under hypoxic and hypercapnic (6% CO, 5% O, 37 °C) atmosphere for 24 h. TRPC6 mRNA was detected by reverse transcription-PCR. TRPC6 protein was detected by Western blotting. The proliferation of PASMCs was performed by CCK-8 kit. Apoptosis of the PASMCs was detected using TUNEL assay. The [Ca]in the PASMCs was measured using Fura 2-AM fluorescence. The results showed that the expressions of TRPC6 mRNA and protein, and [Ca]were upregulated under hypoxic and hypercapnic conditions. Hypoxia and hypercapnia promoted cellular proliferation and inhibited apoptosis in the PASMCs. OAG enhanced the above-mentioned effects of hypoxia and hypercapnia, whereas SKF-96365 reversed these effects. These results suggest that TRPC6 may play a role in PASMCs proliferation and apoptosis under hypoxia and hypercapnia by regulating [Ca].
Actins ; Animals ; Apoptosis ; Calcium ; metabolism ; Cell Hypoxia ; Cell Proliferation ; Cells, Cultured ; Hypercapnia ; physiopathology ; Imidazoles ; Male ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; metabolism ; Pulmonary Artery ; cytology ; Rats ; Rats, Sprague-Dawley ; TRPC Cation Channels ; metabolism