3例婴儿脑膜炎败血伊丽莎白菌脑膜炎临床分析

总结脑膜炎败血伊丽莎白菌感染患儿的临床特点,以期提高临床诊治水平。收集中山市博爱医院2010年1月至2020年12月收治的3例脑膜炎败血伊丽莎白菌引起的脑膜炎患儿临床资料,结合相关文献进行总结分析。结果显示,3例患儿脑脊液中培养出脑膜炎败血伊丽莎白菌,其中2例血培养为同种细菌。3例患儿均为足月顺产,2例为新生儿期发病,1例为出生后35天发病,起病前均未发现致病高危因素。患儿以发热为主要起病表现,无抽搐及脑膜刺激征表现。3例患儿外周血常规白细胞总数、C反应蛋白、降钙素原均升高;脑脊液潘氏试验均为阳性,伴脑脊液白细胞数增高,脑脊液蛋白明显增高,脑脊液葡萄糖降低。头颅磁共振成像(magnetic resonance imaging,MRI)或电子计算机断层扫描术(computer tomography,CT)可见脑膜强化、软脑膜增厚、脑外间隙增宽,均无脑实质受累。3例检出菌株的药敏结果表现出高度一致性,均提示对环丙沙星、哌拉西林/他唑巴坦、左氧氟沙星、复方新诺明敏感。2例患儿以环丙沙星治疗,1例患儿以美罗培南联合万古霉素治疗。其中1例治愈,2例临床症状好转后出院。经电话随访,3例患儿一般情况尚可,无生长发育异常。本病例报道提示,脑膜炎败血伊丽莎白菌脑膜炎主要见于新生儿期,以发热起病为主要表现,该菌对儿科常用抗菌药物多显示体外耐药,对喹诺酮类药物敏感。     

早产儿肠道微生态变化及其与胎龄、出生体质量的关系

目的探讨早产儿肠道微生态变化及其与胎龄、出生体质量的关系。方法选取2018年5月至2020年5月我院收治的80例早产儿作为早产组,同期收治的80例足月新生儿作为对照组。收集入组新生儿出生后3 d、3周的粪便,比较2组研究对象粪便标本中细菌丰富度和Shannon Wiener指数;根据早产组胎龄和出生体质量不同分组,分析胎龄、出生体质量与肠道微生态变化的关系。结果(1)出生3 d,早产组新生儿粪便标本的DGGE图谱条带数、Shannon Wiener指数均显著低于对照组(t=3.179、3.521,均P<0.05);(2)出生3 d,胎龄34⁺¹~36⁺⁶周组新生儿粪便标本的DGGE图谱条带数、Shannon Wiener指数显著高于28~30周组、30⁺¹~32周组和32⁺¹~34周组(q=9.653、6.476、4.848和8.796、8.008、6.277,均P<0.05);(3)出生3 d,体质量>2 000 g组新生儿粪便标本的的DGGE图谱条带数、Shannon Wiener指数显著高于≤1 500 g组(q=5.601和4.593,均P<0.05);(4)不同出生体质量、胎龄的早产儿,出生3周粪便标本的DGGE图谱条带数、Shannon Wiener指数相比差异无统计学意义(F=1.577和2.326,均P>0.05)。结论与足月新生儿相比,早产儿出生后细菌定植出现延迟且多样性差,胎龄越小、出生体质量越低的早产儿的肠道菌群的多样性更低、定植延迟的可能性更大,出生3周后其肠道微生态逐渐恢复正常。     

Changes of nitric oxide,carbon monoxide and oxidative stress in term infants at birth

The higher risk of respiratory problem in infants delivered by elective caesarean section in comparison with vaginally born infants may be favoured by lower level of nitric oxide (NO) and carbon monoxide (CO) and higher oxidative stress in infants born by caesarean section. We studied healthy term infants born by vaginal delivery or by elective caesarean section. Nitric oxide, CO, guanosine 3–5 cyclic monophosphate, total hydroperoxide and advanced oxidation protein products (AOPP) were measured at birth and 48–72 h of life. Nitric oxide, CO and cGMP were lower at birth and at 48–72 h of life in infants born by elective caesarean delivery. Total hydroperoxide and AOPP levels were similar in the two groups and increased from birth to 48–72 h of life. In conclusion, nitric oxide and CO concentrations were higher in term infants vaginally born than in infants born by elective caesarean section and decreased from birth to 48–72 h of life. The mode of delivery did not affect the oxidative stress which increases from birth to 48–72 h of life.     

Cigarette smoke metabolically promotes cancer,via autophagy and premature aging in the host stromal microenvironment

Cigarette smoke has been directly implicated in the disease pathogenesis of a plethora of different human cancer subtypes, including breast cancers. The prevailing view is that cigarette smoke acts as a mutagen and DNA damaging agent in normal epithelial cells, driving tumor initiation. However, its potential negative metabolic effects on the normal stromal microenvironment have been largely ignored. Here, we propose a new mechanism by which carcinogen-rich cigarette smoke may promote cancer growth, by metabolically “fertilizing” the host microenvironment. More specifically, we show that cigarette smoke exposure is indeed sufficient to drive the onset of the cancer-associated fibroblast phenotype via the induction of DNA damage, autophagy and mitophagy in the tumor stroma. In turn, cigarette smoke exposure induces premature aging and mitochondrial dysfunction in stromal fibroblasts, leading to the secretion of high-energy mitochondrial fuels, such as L-lactate and ketone bodies. Hence, cigarette smoke induces catabolism in the local microenvironment, directly fueling oxidative mitochondrial metabolism (OXPHOS) in neighboring epithelial cancer cells, actively promoting anabolic tumor growth. Remarkably, these autophagic-senescent fibroblasts increased breast cancer tumor growth in vivo by up to 4-fold. Importantly, we show that cigarette smoke-induced metabolic reprogramming of the fibroblastic stroma occurs independently of tumor neo-angiogenesis. We discuss the possible implications of our current findings for the prevention of aging-associated human diseases and, especially, common epithelial cancers, as we show that cigarette smoke can systemically accelerate aging in the host microenvironment. Finally, our current findings are consistent with the idea that cigarette smoke induces the “reverse Warburg effect,” thereby fueling “two-compartment tumor metabolism” and oxidative mitochondrial metabolism in epithelial cancer cells.     

Aberrant DNA methylation profiles in the premature aging disorders Hutchinson-Gilford Progeria and Werner syndrome

DNA methylation gradiently changes with age and is likely to be involved in aging-related processes with subsequent phenotype changes and increased susceptibility to certain diseases. The Hutchinson-Gilford Progeria (HGP) and Werner Syndrome (WS) are two premature aging diseases showing features of common natural aging early in life. Mutations in the LMNA and WRN genes were associated to disease onset; however, for a subset of patients the underlying causative mechanisms remain elusive. We aimed to evaluate the role of epigenetic alteration on premature aging diseases by performing comprehensive DNA methylation profiling of HGP and WS patients. We observed profound changes in the DNA methylation landscapes of WRN and LMNA mutant patients, which were narrowed down to a set of aging related genes and processes. Although of low overall variance, non-mutant patients revealed differential DNA methylation at distinct loci. Hence, we propose DNA methylation to have an impact on premature aging diseases.     

晚期早产儿颅内出血的相关因素分析

目的：探讨晚期早产儿颅内出血的相关因素,指导晚期早产儿颅内出血的防治。方法：2011年9月至2012年8月我院收治晚期早产儿253例,其中有210例行头颅MRI检查,以经头颅MRI检查确诊颅内出血30例为ICH组,同时随机抽取同期住院的经头颅MRI证实无颅内出血晚期早产儿60例作为对照组。应用SPSS 17.0进行统计学分析。结果：1.ICH组产前激素应用率显著低于对照组（P〈0.05）。2.ICH组经阴分娩、胎膜早破、代谢性酸中毒发生率显著高于对照组（P〈0.05）。3.Logistic回归分析显示产前激素是颅内出血的保护因素（P〈0.05）,而经阴分娩、胎膜早破（P〈0.01）、代谢性酸中毒（P〈0.05）是颅内出血的危险因素。结论：产前应用激素是晚期早产儿颅内出血的保护因素,经阴分娩、胎膜早破、代谢性酸中毒是晚期早产儿颅内出血高危因素。     

分娩方式对北京地区持续母乳喂养的34周龄婴儿肠道菌群影响

[目的] 比较持续母乳喂养条件下不同分娩方式的34周龄婴儿肠道菌群差异,探讨分娩方式对较大婴儿肠道菌群发育的影响。[方法] 在北京地区招募健康足月分娩母乳喂养婴儿,在34周仍然参与随访的持续母乳喂养婴儿共21例,其中剖宫产婴儿16例、阴道分娩婴儿5例,进行肠道菌群的16S rRNA检测。[结果] 两组共21个粪便样本中,共注释到6个门,分别为：疣微菌门、变形菌门、梭杆菌门、厚壁菌门、放线菌门和拟杆菌门;两组共21个样本中共有57个OTU注释到属水平,其中,26个属水平OTU被注释到厚壁菌门,18个属水平OTU被注释到变形菌门,6个属水平OTU被注释到放线菌门,5个属水平OTU被注释到拟杆菌门,梭杆菌门、疣微菌门各有1个属水平OTU被注释。其中变形菌门在阴道分娩组（44.17%）肠道菌群中的含量高于剖宫产组（16.10%）;而放线菌门在阴道分娩婴儿（0.00%）肠道菌群中的含量低于剖宫产婴儿（0.09%）。阴道分娩组与剖宫产组相比,共有7个菌属的丰度发生了显著降低（P<0.05）,分别为副杆菌属、葡萄球菌属、嗜血杆菌属、乳杆菌属、肠球菌属、双歧杆菌属及一注释到科水平的毛螺旋菌科OTU。[结论] 分娩方式对持续母乳喂养的婴儿肠道菌群结构存在影响,且这种影响在出生后34周仍然存在。     

The impact of paternity on male–infant association in a primate with low paternity certainty

In multimale groups where females mate promiscuously, male–infant associations have rarely been studied. However, recent studies have shown that males selectively support their offspring during agonistic conflicts with other juveniles and that father's presence accelerates offspring maturation. Furthermore, it was shown that males invest in unrelated infants to enhance future mating success with the infant's mother. Hence, infant care might provide fitness gain for males. Here, we investigate male–infant associations in rhesus macaques (Macaca mulatta), a primate with low paternity certainty as females mate with multiple partners and males ensure paternity less efficiently through mate‐guarding. We combined behavioural data with genetic paternity analyses of one cohort of the semi‐free‐ranging population of Cayo Santiago (Puerto Rico) and recorded affiliative and aggressive interactions between focal subjects and adult males from birth to sexual maturation (0–4 years) of focal subjects. Our results revealed that 9.6% of all interactions of focal subjects involved an adult male and 94% of all male–infant interactions were affiliative, indicating the rareness of male–infant aggression. Second and most interestingly, sires were more likely to affiliate with their offspring than nonsires with unrelated infants. This preference was independent of mother's proximity and emphasized during early infancy. Male–infant affiliation rose with infant age and was pronounced between adult males and male rather than female focal subjects. Overall, our results suggest that male–infant affiliation is also an important component in structuring primate societies and affiliation directed towards own offspring presumably represent low‐cost paternal care.