Recent advances in retrolental fibroplasia

Retrolental fibroplasia is the most common cause of preschool blindness. Changes identical to retrolental fibroplasia in humans have been produced in animals by exposing them to high oxygen concentration. Oxygen should be ordered for premature infants in a careful and precise manner. Concentrations of over 40 per cent should be avoided whenever possible. Withdrawal to air should be a gradual process.     

Retrolental fibroplasia; blindness in infants of low weight at birth

Retrolental fibroplasia is today the principal cause of blindness in children of preschool age, exceeding all other causes combined. The disease occurs in infants of low weight at birth, commonly those born prematurely. The incidence of the disease is rising at an alarming rate. Vitamin E deficiency, corticotropin (ACTH) deficiency, the use of cow's milk in place of mother's milk, and improper oxygenation have been suggested as etiologic factors but the cause remains a mystery. Often the incidence is high in institutions in which maximal care is given premature infants.Clinically, the disease advances through an "active" phase during which regression is possible, and a "subsiding" or "cicatricial" phase which terminates with the formation of a disorganized opaque mass behind the lens. The earliest manifestations are noted in the fundi. Hemorrhages, neovascularization, transudation commencing in the periphery, and retinal separation contribute to the formation of the characteristic retrolental membrane. The diagnosis may be made when the retrolental membrane is observed in the eye of an infant whose weight at birth was low. Differential diagnosis is required occasionally. Thus far, no form of therapy has prevented or reversed the pathologic changes successfully. Use of vitamin E, corticotropin and mother's milk has not influenced the incidence of the disease. Avoidance of premature delivery if possible is indicated.     

RETROLENTAL FIBROPLASIA—Blindness in Infants of Low Weight at Birth

Retrolental fibroplasia is today the principal cause of blindness in children of preschool age, exceeding all other causes combined. The disease occurs in infants of low weight at birth, commonly those born prematurely. The incidence of the disease is rising at an alarming rate. Vitamin E deficiency, corticotropin (ACTH) deficiency, the use of cow''s milk in place of mother''s milk, and improper oxygenation have been suggested as etiologic factors but the cause remains a mystery. Often the incidence is high in institutions in which maximal care is given premature infants.Clinically, the disease advances through an “active” phase during which regression is possible, and a “subsiding” or “cicatricial” phase which terminates with the formation of a disorganized opaque mass behind the lens. The earliest manifestations are noted in the fundi. Hemorrhages, neovascularization, transudation commencing in the periphery, and retinal separation contribute to the formation of the characteristic retrolental membrane. The diagnosis may be made when the retrolental membrane is observed in the eye of an infant whose weight at birth was low. Differential diagnosis is required occasionally.Thus far, no form of therapy has prevented or reversed the pathologic changes successfully. Use of vitamin E, corticotropin and mother''s milk has not influenced the incidence of the disease. Avoidance of premature delivery if possible is indicated.     

新生儿低血糖症的高危因素及临床防治探讨

目的：探讨新生儿低血糖症的高危因素及临床防治。方法：对2010年1月．2012年8月我院收治的有低血糖高危因素的267例新生儿的临床资料进行回顾性分析。结果：检出低血糖83例,无特异性临床症状;惠有新生儿窒息、新生儿缺氧缺血性脑病、早产儿及小于胎龄儿及糖尿病母亲娩出的新生儿发生低血糖症的发生率较高。早产儿、低出生体重儿、巨大儿低血糖症的发生率显著高于正常胎儿,P〈0．05。结论：对于有低血糖症的高危因素的患儿应严密监测血糖情况,尽早进行防治,避免因低血糖造成脑损伤。     

Clinical uses and abuses of vitamin E in children.

The major benefits arising from elevated dosages of vitamin E have been the relief of symptoms of vitamin E deficiency in humans with abetalipoproteinemia and chronic cholestasis. In addition, supplements of vitamin E prevent the isolated vitamin E deficiency that has recently been associated with spinocerebellar symptoms. In keeping with the view that newborn infants, and especially premature infants, suffer from vitamin E deficiency, elevated dosages of vitamin E have been administered to prevent the anemia of premature infants, retrolental fibroplasia, bronchopulmonary dysplasia, and intraventricular hemorrhage. However, the results have been conflicting. Furthermore, some infants treated with vitamin E die unexpectedly. The life-threatening hazard of such treatments has been attributed mainly to polysorbates that are used as detergents in preparations of vitamin E for intravenous use rather than to vitamin E itself. The possibility that vitamin E, in its action as an antioxidant, inhibits the generation of superoxide anion in leukocytes is examined in this paper.     

0～3岁婴幼儿超声骨密度现状调查及影响因素分析

目的:了解0~3岁婴幼儿的骨密度现状,并分析其相关影响因素,为婴幼儿骨密度不足的预防工作提供依据。方法:选取2016年1月-2018年10月期间于我院进行健康体检的0~3岁婴幼儿860例为研究对象。采用超声骨密度测量仪对入选婴幼儿左腿胫骨中段骨密度进行检测,并对婴幼儿的骨密度现状进行分析。采用问卷调查方式收集所有婴幼儿的性别、年龄、喂养方式、是否补充维生素D、户外活动时间等资料,并采用单因素和多因素Logistic回归分析0~3岁婴幼儿骨密度的影响因素。结果:860例婴幼儿中,骨密度正常婴幼儿336例,轻度骨密度不足婴幼儿196例,中度骨密度不足婴幼儿179例,重度骨密度不足婴幼儿149例,骨密度不足发生率为60.93%。单因素分析结果显示,不同年龄、性别、是否补充维生素D及不同户外活动时间婴幼儿之间的骨密度不足发生率比较差异有统计学意义(P0.05),而不同喂养方式婴幼儿之间的骨密度不足发生率比较差异无统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄(0~6个月,7~12个月)、性别(女)、补充维生素D(否)、户外活动时间(1 h)为0~3岁婴幼儿骨密度的危险因素(P0.05)。结论:0~3岁婴幼儿的骨密度不足发生率较高,年龄、女性、未补充维生素D、户外活动时间过少均是0~3岁婴幼儿骨密度的危险因素,可通过适量补充维生素D、增加户外活动时间以提高婴幼儿骨密度值。     

426例小儿消化道出血的临床分析

目的 探讨小儿消化道出血的临床特点,了解小儿消化道出血的病因.方法 对我院2002年1月～2009年6月收治的426例消化道出血患儿的临床资料进行回顾性分析.结果 426例患儿中,男孩多于女孩;婴幼儿期发生率最高,其中以新生儿期多见;农村儿童发生率高于城市儿童.上消化道出血的临床表现以呕血多见,下消化道出血以便血多见....     

A FIVE-YEAR STUDY OF PREMATURITY

To get a comprehensive picture of prematurity and neonatal death or survival, all factors on the maternal and fetal records that might be pertinent were recorded. This information, having to do with factors such as age, gravida of the mother, blood group incompatibility, period of gestation, weight at birth, type of delivery, medication and anesthesia administered to the mother, is presented in tabular form.In the study of perinatal mortality it was noted that failure to establish normal pulmonary ventilation is the most common cause of death in the neonatal period. Maternal history of relative infertility, that is, previous abortions, stillbirths and premature deliveries, was the most impressive finding in the stillborn series.In the follow-up study of premature infants who survived the neonatal period, 8.5 per cent were found to be severely handicapped. In four cases the handicap was due to congenital anomalies, in two others probably to infection, leaving 12 with complications possibly ascribable to prematurity. Six of these had retrolental fibroplasia as a major handicap. In seven, mental retardation was the presenting problem. Most of the handicapped children had multiple handicaps, which included spasticity, delayed motor development, strabismus, etc. The incidence of the necessity for corrective measures for feet and legs appeared relatively high.In general, survivors compared favorably with the rest of the childhood population. Complications and twinning were associated inordinately often.     

Biomechanics of tendon healing

The biomechanics of tendon healing was investigated with unsutured rat achilles tendons. After two, three, and four weeks of healing tensile parameters were assayed with a bone-muscle-tendon-bone preparation elongated to failure at a controlled physiological strain rate.

In the third week of healing, stiffness, strength, and energy absorbing capacity all increased approximately 50%. These changes correlated with early fibroplasia.

In the fourth week of healing, strength, energy absorbing capacity and elongation to failure all increased relatively more than stiffness. Histologically, larger fibers with better longitudinal alignment developed during this period.

At the end of four weeks the tendon's strength was approximately 25% of normal.

To summarize, the return of stiffness in a healing tendon preparation correlated with the presence of fibroplasia and the return of other tensile parameters was a function of the amount and organization of the fibroplasia.     

TGF-β1 stimulates cultured human fibroblasts to proliferate and produce tissue-like fibroplasia: A fibronectin matrix-dependent event

During wound repair, fibroblasts accumulate in the injured area until any defect is filled with stratified layers of cells and matrix. Such fibroplasia also occurs in many fibrotic disorders. Transforming growth factor-β (TGF-β), a promotor of granulation tissue in vivo and extracellular matrix production in vitro, is expressed during the active fibroplasia of wound healing and fibroproliferative diseases. Under usual tissue culture conditions, normal fibroblasts grow to confluence and then cease proliferation. In this study, culture conditions with TGF-β1 have been delineated that promote human fibroblasts to grow in stratified layers mimicking in vivo fibroplasia. When medium supplemented with serum, ascorbate, proline, and TGF-β was added thrice weekly to normal human dermal fibroblasts, the cells proliferated and stratified up to 16 cell layers thick within the culture dish, producing a tissue-like fibroplasia. TGF-β stimulated both DNA synthesis as measured by 1H-thymidine uptake and cell proliferation as measured by a Hoechst dye DNA assay in these postconfluent cultures. The stratification was dependent on fibronectin assembly, as demonstrated by anti-fibronectin antibodies which inhibited both basal and TGF-β-stimulated cell proliferation and stratification. Suppression of collagen matrix assembly in cell layers with β-amino-proprionitrile (BAPN) did not inhibit basal or TGF-β stimulated in vitro fibroplasia. BAPN did not interfere with fibronectin matrix assembly as judged by immunofluorescence microscopy. Thus, in concert with serum factors, TGF-β stimulates postconfluent, fibronectin matrix-dependent, fibroblast growth creating a fibroplasia-like tissue in vitro. J Cell Physiol 170:69–80, 1997 © 1997 Wiley-Liss, Inc.     

NICU内早产儿早期肠道内添加益生菌的临床观察

目的 探讨NICU病房早产儿在住院早期肠道内添加益生菌对临床治疗的影响.方法 本研究系前瞻性单中心初步研究.选择2011年1月至2011年12月期间在东南大学附属中大医院NICU住院,胎龄28 ～ 34周的早产儿,随机分为治疗组161例和对照组148例.治疗组予以肠道益生菌口服,对照组不使用益生菌.观察两组患儿第一次经口喂养时间、完全经口喂养时间、完全胃肠道营养时间、晚期败血症发生率、NEC发生率、住院时间和住院死亡率的差异.结果 在最终完成研究时,共有22例被排除,纳入研究的287例患儿中,治疗组149例,对照组138例.治疗组与对照组各观察指标相比较,完全经口喂养时间、完全胃肠道营养时间、晚期败血症发生率、NEC发生率、住院时间和住院死亡率分别为(7.3±4.7)vs(11.6 ±5.7)d、(9.8 ±4.7)vs( 16.9±6.8)d、6.7％ vs 15.2％、3.4％ vs 10.9％、(25.0±7.5)vs(30.8 ±7.0)d和4.0％ vs 6.5％.除死亡率外,其余各项比较差异均有统计学意义(均P＜0.05).结论 早期肠道内补充益生菌,有利于早产儿胃肠道功能建立,减少并发症,缩短住院时间,降低医疗成本.     

杭州地区腹泻儿童轮状病毒与腺病毒感染调查

目的分析不同季节及不同年龄段腹泻患儿感染轮状病毒(RV)与腺病毒(Eads)情况,为临床提供早期、快速、准确、可靠的依据,以便及时采取相应的治疗使患儿早日康复。方法采用杭州艾博医药有限公司提供的轮状病毒(A组)/腺病毒检测试剂盒(乳胶法),对2012年1月至2015年12月浙江省人民医院门诊和住院就诊的3 368例腹泻儿童粪便标本进行轮状病毒和腺病毒抗原检测。结果 3 368例腹泻儿童粪便中,RV阳性578例占17.16%,Eads阳性106例占3.15%。11月至次年1月为轮状病毒感染的高发月份,1~3岁为儿童感染的高发年龄;腺病毒感染阳性率低,呈散发性。结论杭州地区近年1~3岁婴幼儿的腹泻主要是由轮状病毒和腺病毒引起,其中轮状病毒感染率明显高于腺病毒,且有明显的季节性;而腺病毒感染呈散发流行,未表现出明显的季节性及年龄分布。     

215例出生缺陷围生儿临床分析

目的：探讨近几年出生缺陷发生率的变化,反思出生缺陷的发生与干预措施之间的关系。方法：收集1999年1月至2010年12月在我院分娩的围生儿7875例,回顾分析十二年我院检查及分娩的胎儿出生缺陷变化情况,分析其出生缺陷的种类及发生率的变化、结果：有出生缺陷的围产几215例,发生率为27．30‰。行产前诊断确诊后在孕妇知情同意下选择治疗性引产的88例,纠正足月活产婴儿的出生缺陷率为16．13‰,差异有显著意义（X2=22．16,P〈0．01）。结论：有效的产前诊断技术能及早作出出生缺陷的宫内诊断,对优生优育、提高人口素质及疾病控制有很大帮助。     

Congenital and hereditary anomalies in the rhesus monkeys (Macaca mulatta) of Cayo Santiago

During seven annual birth seasons, from January 1976 to July 1982, 963 infants were born in the Cayo Santiago, Puerto Rico, colony of free-ranging rhesus monkeys (Macaca mulatta). The reproductive rate for mature females, 4 years of age and older, ranged between 74.1% and 84.7%, with a cumulative mean of 80.8% over 7 years. Live births comprised 95.3% of the total and the secondary sex ratio was 109 male to 100 female births. No twinning was observed. Aborted and stillborn monkeys represented 4.7% of all births. The percentage of stillborn females was greater than that of males (4.0% vs. 3.1%). Neonatal death, defined as mortality within 48 hours postpartum, occurred in 0.8% of the live births. Two cases of congenital abnormalities were observed. The first was an anencephalic, acranial female and the second a congenitally blind male. Both infants were born to matrilineally unrelated 7-and 8-year-old multiparous females with no prior history of delivering malformed offspring. The incidence of each defect, based on 963 births, was 0.10%, with a cumulative incidence of 0.20% for all teratisms seen during the study. Multiple occurrences of a rare, nonpathological and nonlethal hereditary anomaly were also seen. Five "golden" macaques were born into two genetically distinct social groups within the last 2 years of observation. The incidence of this phenotype, based on five cases, was 0.52%, 52 times the expected rate (.01%).     

IFN-gamma-inducible protein-10 attenuates bleomycin-induced pulmonary fibrosis via inhibition of angiogenesis.

Few studies have addressed the importance of vascular remodeling in the lung during the development of bleomycin-induced pulmonary fibrosis (BPF). For fibroplasia and deposition of extracellular matrix to occur, there must be a geometric increase in neovascularization. We hypothesized that net angiogenesis during the pathogenesis of fibroplasia and deposition of extracellular matrix during BPF are dependent in part on a relative deficiency of the angiostatic CXC chemokine, IFN-gamma-inducible protein-10 (IP-10). To test this hypothesis, we measured IP-10 by specific ELISA in whole lung homogenates in either bleomycin-treated or control mice and correlated these levels with lung hydroxyproline. We found that lung tissue from mice treated with bleomycin, compared with that from saline-treated controls, demonstrated a decrease in the presence of IP-10 that was correlated to a greater angiogenic response and total lung hydroxyproline content. Systemic administration of IP-10 significantly reduced BPF without any alteration in lung lymphocyte or NK cell populations. This was also paralleled by a reduction in angiogenesis. Furthermore, IP-10 had no direct effect on isolated pulmonary fibroblasts. These results demonstrate that the angiostatic CXC chemokine, IP-10, inhibits fibroplasia and deposition of extracellular matrix by regulating angiogenesis.     

Maternal fever and neural tube defects

It has been proposed that hyperthermia in the pregnant woman is associated with neural tube defects in her offspring. We analyzed retrospective interview data for a maternal history of probable febrile illness during the first trimester of pregnancy among mothers of infants with anencephaly or spina bifida. There were two control groups--mothers of infants with Down syndrome and mothers of infants with cleft lip or palate. With the Down syndrome group serving as controls, the incidence of febrile illness among mothers of all infants with neural tube defects was significantly elevated. With the cleft group as controls, the fever incidence was not significantly increased in the neural tube defect groups. When the combined cleft and Down syndrome controls were used, only mothers of the spina bifida group had an elevated fever incidence. Epidemiology data suggest an association of maternal fever during pregnancy with neural tube defects in the offspring.     

Aplasie d'une artère ombilicale

A study was undertaken at St-François d''Assise Hospital, Quebec City, to determine the incidence of single umbilical artery. During a two-year period the umbilical cord was examined in 4138 consecutive deliveries. Thirty-three cases of aplasia of an umbilical artery were found, an incidence of 0.79%, which is almost identical to that reported in previous studies. Five of the 33 newborn infants with this vascular anomaly had other congenital malformations; this incidence of associated malformations is 10 times higher than that found in a control series. In studying the weight of the infants in relation to the period of gestation, it was found that many of the 33 infants with aplasia of the umbilical artery had a lower weight at birth than normal infants. The possibility that the absence of one umbilical artery might be responsible for intrauterine malnutrition is advanced by the authors.     

The incidence of the sudden infant death syndrome in relation to climate

Incidences of the sudden infant death syndrome (SIDS) for eight metropolitan communities in U.S.A. are shown to correlate strongly with the mean percentages of cold-wet weather experienced by these places in the seven months centred on January. For white infants aged 4–51 weeks at death, the incidence varies from about one per thousand live births in the more favourable climates to around two per thousand under the less favourable conditions of northwest U.S.A. Incidences are higher for the nonwhite infants but exhibit a similar variation with climate.To be able to extend the study to other countries for which cold-wet weather percentages are not available, a surrogate cold-wet weather index is developed, based on mean cold-season temperature, insolation and number of days with precipitation.Australian and British SIDS incidences related to the surrogate cold-wet weather index exhibit a variation parallel to that for U.S.A. but somewhat higher over the whole range.The incidences used in this study are from the more extensive investigations in which diagnosis was made as a result of thorough postmortem examination.     

酪酸梭菌预防早产儿坏死性小肠结肠炎的疗效观察

目的探讨宝乐安（酪酸梭菌CGMCC0313．1散剂）预防早产儿坏死性小肠结肠炎（NEC）的疗效。方法将胎龄在28—35周的早产几90例,随机分为预防组和对照组,预防组在原发病治疗的基础上出生后即喂服宝乐安,500mg／次,2次／d;对照组仅予原发病治疗。全部早产儿观察NEC的发病率及轻重程度、病程时间、NEC并发肺部感染及早产儿体重增长情况,予大便培养进行病原菌的检测。结果预防组的早产儿在NEC的发病率及轻重程度、病程时间、NEC并发肺部感染、体重增长、病原菌克雷伯菌及大肠埃希菌检出情况等方面与对照组的早产儿比较,差异均具有显著性（P〈0．05）。结论早期服用宝乐安可以降低早产儿坏死性小肠结肠炎的发病率,并能缩短NEC的病程,减轻NEC病情,降低NEC并发肺部感染的发病率,有助于早产儿体重的恢复增长。     

Epidemiology and initial management of ambiguous genitalia at birth in Germany

BACKGROUND: In this epidemiological study, we sought to capture the incidence of ambiguous genitalia in neonates and to describe initial management strategies. METHODS: We used the registry for rare diseases in pediatrics in Germany to ascertain cases and asked reporting institutions for information on phenotype, laboratory tests, imaging results, diagnosis, initial management and sex assignment. RESULTS: We identified 80 cases within a 2-year study period and calculated an incidence of 2 per 10,000 births with ambiguous genitalia per year in Germany. Prevalence was higher in infants from non-German family background. In more than 50% of all infants a definite diagnosis was lacking even at the age of 6 months. In those cases where the etiology was confirmed, the most common diagnosis was congenital adrenal hyperplasia, followed by androgen insensitivity syndrome and mixed gonadal dysgenesis. Associated malformations were very common, affecting 37.5% of all infants. Sex assignment was female in 46,XY infants with predominately female phenotype and all 46,XX infants. Early surgery was performed in many cases irrespective whether a definite diagnosis had been established or not. Integrated psychosocial care was the exception rather than the rule. CONCLUSIONS: Classification and management of ambiguous genitalia at birth remain a challenge for all professionals involved. National and international registries may help to provide a better understanding of the incidence and clinical course of such disorders.