丙种球蛋白联合美罗培南治疗新生儿败血症的疗效及对血清IL-6、GM-CSF、PCT水平的影响

目的:探讨丙种球蛋白联合美罗培南治疗新生儿败血症的疗效及对血清白介素-6 (IL-6)、粒细胞巨噬细胞集落刺激因子(GM-CSF)、降钙素原(PCT)水平的影响。方法:选择2017年1月至2018年12月我院接诊的80例新生败血症患儿作为本研究对象,通过随机数表法将其分为观察组和对照组,每组40例。对照组在常规处理基础上给予美罗培南治疗,观察组在对照组的基础上联合丙种球蛋白治疗。比较两组的临床疗效、症状改善时间、住院时间、治疗前后血清免疫球蛋白G(IgG)、IL-6、GM-CSF、PCT水平的变化及不良反应的发生情况。结果:治疗后7d,观察组临床疗效总有效率显著高于对照组(95%vs. 80%,P0.05);观察组拒奶改善时间、皮肤颜色及体温正常时间、住院时间均短于对照组(P0.05);观察组血清Ig G高于对照组,血清IL-6、GM-CSF、PCT均低于对照组(P0.05)。两组治疗治疗期间均无死亡病例和严重不良反应发生。结论:丙种球蛋白联合美罗培南治疗新生儿败血症的疗效显著优于单用美罗培南治疗,其可有效降低血清IL-6、GM-CSF、PCT的表达,促进患儿恢复。     

Neonatal exposure to estradiol decreases hypothalamic allopregnanolone concentrations and alters agonistic and sexual but not affective behavior in adult female rats

Exposure of developing female rats to estradiol during the perinatal period induced long-lasting dysregulation of gonadal axis and decreased cerebrocortical and plasma concentrations of allopregnanolone. We have now examined the effects of neonatal estradiol administration in female rats on hypothalamic allopregnanolone concentrations and on exploratory, affective, agonistic and sexual behaviors as well as social learning. A single administration of β-estradiol 3-benzoate (EB, 10 μg) on the day of birth resulted in a delay of vaginal opening, acyclicity and ovarian failure. These alterations were associated with a significant decrease in the concentrations of allopregnanolone in the hypothalamus at 21 and 60 days, but not at 7 days, after birth. Neonatal administration of EB also increased agonistic behaviors in adult rats, such as dominant behaviors and following of an ovariectomized intruder, while living attacks unaffected. EB-treated rats showed also an increase in anogenital investigation, associated with a drastic reduction in spontaneous and induced female sexual behaviors (receptivity and proceptivity). In contrast, neonatal administration of EB did not affect locomotor activity, anxiety- and mood-related behaviors, the social transmission of flavor preferences, and seizures sensitivity. These effects of estradiol suggest that it plays a major role in regulation of both the abundance of allopregnanolone and the expression of agonistic and sexual behaviors, while failing to influence affective behaviors and social learning. Thus, the pronounced and persistent decrease in hypothalamic allopregnanolone concentration may be related to the manifestation of agonistic and sexual behaviors.     

Gestational diabetes mellitus modulates neonatal high-density lipoprotein composition and its functional heterogeneity

Gestational diabetes mellitus (GDM) is related to neonatal macrosomia and an increased risk of vascular events. We hypothesized that GDM exerts qualitative effects on neonatal high-density lipoprotein (HDL). HDL was isolated from control (n = 11) and GDM maternal/neonatal donors (n = 9) and subjected to shotgun proteomics. Differences in HDL mobility were assessed by FPLC and native gel-electrophoresis. Paraoxonase (PON1) activity, cholesterol ester-transfer protein (CETP) mass and activity, phospholipid, triglyceride and cholesterol concentrations were quantified with commercial kits. Total anti-oxidative capacity and cholesterol efflux capability of HDLs were measured. Four proteins involved in lipid metabolism, inflammation and innate immunity were differentially expressed between controls and GDM neonates. ApoM (decreased, p < 0.05) and SAA1 (increased, p < 0.05) showed the same differences on both, maternal and neonatal GDM HDL. Lower PON1 protein expression was corroborated by lower activity (p < 0.05) which in turn was associated with attenuated anti-oxidant capacity of GDM HDL. Protein changes were accompanied by increased levels of triglycerides and decreased levels of cholesterol esters, respectively. The observed differences in GDM HDL lipid moiety may be related to CETP mass and activity alterations. The rate of cholesterol efflux from term trophoblasts to maternal and from placental endothelial cells to neonatal GDM HDL was impaired (p < 0.05). In conclusion, GDM causes changes in HDL composition and is intimately associated with impaired cholesterol efflux capability as well as diminished anti-oxidative particle properties. Remodeling of neonatal GDM HDL in utero supports the hypothesis that maternal conditions in pregnancy impact neonatal lipoprotein metabolism.     

围产期B族链球菌感染及预防的研究进展

B群链球菌可以引发产褥期败血症、新生儿肺炎和脑膜炎等感染,围产期B群链球菌感染和预防研究有着重要的价值。本研究就围产期女性B群链球菌感染、检测方法及预防相关研究进展作一综述,目的在于提高围产学界对该类微生物的认识。     

Selective accumulation of Th2-skewing immature erythroid cells in developing neonatal mouse spleen

Environmental factors likely regulate neonatal immunity and self-tolerance. However, evidence that the neonatal immune system is suppressed or deviated is varied depending on the antigen and the timing of antigen exposure relative to birth. These disparate findings may be related to the availability of the appropriate antigen presenting cells but also point to the possibility of homeostatic changes in non-lymphoid cells in the relevant lymphoid tissues. Here we show that, while leukocytes are the most abundant cell population present in spleen during the first 4-5 days after birth, a massive accumulation of nucleated immature erythroid population in the spleen takes places on day 6 after birth. Although the relative frequency of these immature erythorid cells slowly decreases during the development of neonates, they remain one of the most predominant populations up to three weeks of age. Importantly, we show that the immature erythroid cells from neonate spleen have the capacity to modulate the differentiation of CD4 T cells into effector cells and provide a bias towards a Th2 type instead of Th1 type. These nucleated erythroid cells can produce cytokines that participate in the Th2/Th1 balance, an important one being IL-6. Thus, the selective accumulation of immature erythroid cells in the spleen during a specific period of neonatal development may explain the apparent differences observed in the type(s) of immune responses generated in infants and neonates. These findings are potentially relevant to the better management of immune deficiency in and to the design of vaccination strategies for the young.     

Canine perinatal mortality: a cohort study of 224 breeds

Canine perinatal mortality is known to be relatively high. However, the literature on perinatal mortality in dogs is still sparse and often refers to a single or only a few breeds. The aim of this large-scale observational study was to describe the perinatal mortality in purebred dogs of various breeds at both puppy and litter level. In addition, the influence of breed, breed size, litter size, age of the bitch, litter number and season for whelping on the risk of perinatal mortality at litter level was studied and the mean litter size at eight days and eight wks after birth was calculated. A retrospective cohort study was performed by studying 10,810 litters of 224 breeds registered in the Norwegian Kennel Club in 2006 and 2007. Perinatal mortality was defined as the sum of stillborn puppies and puppies that died during the first wk after birth (early neonatal mortality) and was present in 24.6% of the litters. Eight percent of the puppies died before eight days after birth, with 4.3% as stillbirth and 3.7% as early neonatal mortality. For most breeds the perinatal mortality was low, but for some breeds a higher perinatal mortality was found. The mean litter size at eight days and eight wks after birth was 4.97 (±0.02) and 4.92 (±0.02) puppies, respectively. Of all puppies born, only 1% died during the period from eight days to eight wks after birth. Random effects logistic regression analysis indicated that increasing litter size and age of the bitch were associated with an increased risk of stillbirth, early neonatal mortality and total perinatal mortality at the litter level (P < 0.001). The random breed effect was significant for all outcomes. Litter number also had a significant effect on stillbirth, early neonatal mortality and total perinatal mortality at the litter level, with the highest risk of perinatal mortality found in the first litter (P < 0.001). Further, the risk of early neonatal mortality was doubled in litters with stillborn puppies. No significant effect of whelping season on perinatal mortality at litter level was found. An interaction existed between the age of the bitch and litter number and the risk of stillbirth was three times as high (odds ratio = 3.00) in litters from bitches having their first litter after the age of six y. Breed was a more important determinant of perinatal mortality in litters than breed size. However, more than 90% of the variation in perinatal mortality was found at the individual litter level and efforts to minimize puppy mortality should be targeted at the management of the individual litter rather than at the breed level.     

Vetrabutine clorhydrate use in dystocic farrowings minimizes hemodynamic sequels in piglets

The objective was to measure the effects of VC (a uterotonic drug with vasodilator effects) in eutocic and dystocic sows, on the acid-base balance and some vitality traits of piglets at birth. Farrowing was induced with prostaglandin F2α. Four groups of sows (20 sows/group) were monitored; Groups 1 and 2 were eutocic sows, whereas Groups 3 and 4 were dam-fetal dystocic sows. Groups 1 and 3 (control) were given saline, whereas Groups 2 and 4 were given VC im (1.66 mg/kg of body weight) after the first piglet was born. Piglets' physio-metabolic performance was monitored peripartum. Treatment with VC reduced (P < 0.0001) the percentage of intrapartum stillbirths in sows either with eutocic (5.2 vs. 10.0%) and dystocic (7.6 vs. 16.7%) farrowings and increased (P < 0.0001) the number of pigs born alive without any evidence of AFS (89.9 vs. 79.9%, eutocic and 81.6 vs. 65.2%, dystocic). In addition, for the group of pigs with no acute fetal suffering (AFS), VC treatment enhanced survival responses with a half point grater vitality score in Group 4; it also reduced the latency to first teat contact by 6 min (P < 0.05) in both treated groups compared to controls; and it improved the condition of the pigs' umbilical cord, with more adhered (98 vs. 86% in eutocic and 88 vs. 80% in dystocic; P < 0.05) and less ruptured cords. Moreover, VC reduced the severity of adverse physio-metabolic indicators and the acid-base balance of piglets with AFS at birth by lowering blood lactate (89.8 vs. 93.5 mmol/L in eutocic groups and 94.6 vs. 100.2 mmol/L in dystocic groups; P < 0.05), P_aco₂ and Ca²⁺, and by increasing blood pH, HCO₃ and P_ao₂ levels (P < 0.05).     

建立新生大鼠吸入麻醉模型及异氟醚对其海马凋亡的影响

目的:建立新生大鼠吸入麻醉模型并探讨吸入麻醉药异氟醚对其海马凋亡的影响。方法:Penlon Prima SP麻醉机、异氟醚挥发罐及自制带进出气口的麻醉小室。共55只7日龄的SD大鼠用于实验。将其中35只大鼠随机分为7组(n=5)。实验组(Ⅰ-Ⅵ组)异氟醚挥发罐刻度分别为0.125%,0.25%,0.5%,1%,1.5%,2%;新生大鼠置于自制密封麻醉小室内,分别通入含上述异氟醚浓度的混合气体。对照组(第Ⅶ组)给予未混合异氟醚的30%的氧气。将小室安放于37℃恒温箱内。调节气体流量2L/min。实验组于通入气体5,10,15,30,90,180,360 min(T1-7)时于小室出口处抽取10mL气体,采用气相色谱法测定麻醉小室内异氟醚浓度。于通入气体360 min(T7)自新生大鼠左心室采血行血气分析;另取SD大鼠20只,随机分为对照组(C组,n=10),1.5%异氟醚组(I组,n=10),按上述方法建立异氟醚吸入麻醉模型,麻醉结束后2h处死大鼠,采用免疫组织化学法观察C组和I组大鼠大脑海马区Active caspase-3的表达。结果:①麻醉小室出口异氟醚浓度(Y)与麻醉机挥发罐异氟醚浓度(X)的直线回归方程为Y=1.5472X-0.0575(r=0.9993)。②血气分析结果显示:Ⅰ-Ⅵ组与Ⅶ组血气分析组间差异无统计学意义(P0.05)。③免疫组化结果显示:与C组相比,I组大鼠海马Active caspase-3明显增加,差异有统计学意义(P0.05)。结论:通过麻醉机、异氟醚挥发罐及自制密封带进出气口的麻醉小室成功建立了新生大鼠异氟醚麻醉模型;为进一步研究异氟醚及相关吸入麻醉药对突触发生期的神经毒性提供了实验基础。     

先天性食管闭锁和气管食管瘘麻醉及围手术期管理

目的:探讨先天性食管闭锁和气管食管瘘(EA/TEF)的麻醉及围手术期管理方法.方法:回顾性分析40例手术治疗的新生儿EA/TEF的临床资料.总结麻醉及围手术期管理及转归情况.结果:40例麻醉过程较平稳顺利完成手术,3例术后拔管,37例继续呼吸支持.术后死亡7例,其中4例术后死亡,3例术后监护人放弃治疗出院后死亡.活33例中重症肺炎7例,低体温8例,吻合口瘘5例,切口感染2例,均经治疗后痊愈出院.结论:良好的麻醉及围术期管理是EA/TEF手术治疗的重要组成部分,是手术顺利进行及术后成功的关键.     

Sex differences and effects of neonatal aromatase inhibition on masculine and feminine copulatory potentials in prairie voles

Copulatory behaviors in most rodents are highly sexually dimorphic, even when circulating hormones are equated between the sexes. Prairie voles (Microtus ochrogaster) are monomorphic in their display of some social behaviors, including partner preferences and parenting, but differences between the sexes in their masculine and feminine copulatory behavior potentials have not been studied in detail. Furthermore, the role of neonatal aromatization of testosterone to estradiol on the development of prairie vole sexual behavior potentials or their brain is unknown. To address these issues, prairie vole pups were injected daily for the first week after birth with 0.5 mg of the aromatase inhibitor 1,4,6-androstatriene-3,17-dione (ATD) or oil. Masculine and feminine copulatory behaviors in response to testosterone or estradiol were later examined in both sexes. Males and females showed high mounting and thrusting in response to testosterone, but only males reliably showed ejaculatory behavior. Conversely, males never showed feminine copulatory behaviors in response to estradiol. Sex differences in these behaviors were not affected by neonatal ATD, but ATD-treated females received fewer mounts and thrusts than controls, possibly indicating reduced attractiveness to males. In other groups of subjects, neonatal ATD demasculinized males' tyrosine hydroxylase expression in the anteroventral periventricular preoptic area, and estrogen receptor alpha expression in the medial preoptic area. Thus, although sexual behavior in both sexes of prairie voles is highly masculinized, aromatase during neonatal life is necessary only for females' femininity. Furthermore, copulatory behavior potentials and at least some aspects of brain development in male prairie voles are dissociable by their requirement for neonatal aromatase.