先天性膈疝疝囊的产前识别及其对预后的影响CSCD

目的评估胎儿磁共振(magnetic resonance,MR)产前识别先天性膈疝(congenital diaphragmatic hernia,CDH)疝囊的准确性以及疝囊对CDH预后的影响。方法以2013年1月1日至2020年12月31日在广州市妇女儿童医疗中心行胎儿MR评估、且生后行手术干预的62例CDH患儿为研究对象,根据是否存在疝囊分为疝囊组(n=26)和非疝囊组(n=36),收集并对比两组患儿产前评估、产时情况、临床特征及预后等情况。结果62例CDH患儿中,共26例术中证实存在疝囊,其中18例通过胎儿MR发现疝囊且术中得到证实,MR产前识别CDH疝囊的灵敏度为69.2%(18/26)。两组患儿总肺容积实测值与预测值的比值(observed/expected total fetal lung volume,o/e TFLV)、性别构成、出生胎龄、出生体重、1分钟及5分钟Apgar评分、手术方式及术中使用补片情况、缺损大小、呼吸机辅助通气时间、住院时间、持续肺动脉高压(persistent pulmonary hypertension of newborn,PPHN)及体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)使用率等比较,差异均无统计学意义(P>0.05)。疝囊组患儿具有更高的预测肺容积比(percentage of predicted lung volume,PPLV),差异有统计学意义(P<0.05);疝囊组患儿缺损位于右侧及肝疝入的比例高于非疝囊组(P<0.05);疝囊组患儿存活率为100%,非疝囊组患儿存活率为86.1%,差异具有统计学意义(P<0.05)。结论MR能够在产前较好识别CDH是否存在疝囊;有疝囊CDH患儿产前肺发育程度评估指标整体优于无疝囊CDH患儿,且出生后存活率更高。     

胎儿膈疝不同程度分级的临床特征及预后

目的总结胎儿膈疝不同程度分级的产前评估及预后情况。方法以广州市妇女儿童医疗中心胎儿医学中心2017年1月1日至2020年3月31日收治的62例先天性膈疝(congenital diaphragmatic hernia, CDH)患者为研究对象。根据胎儿超声和MRI结果分为轻度CDH组(29例)和中重度CDH组(33例),对比两组间出生胎龄、出生体重、诊断孕周、肺头比实测值与预测值的比值(observed/expected lung-to-head ratio, o/e LHR)、总肺体积实测值与预测值的比值(observed/expected total fetal lung volume, o/e TFLV)、预测肺容积比(Percentage of the predicted lung volume, PPLV)、肝脏疝入、疝囊及预后情况等资料。结果两组在性别构成、出生胎龄、出生体重、膈疝侧别、MRI是否发现疝囊方面比较,差异均无统计学意义(P0.05);中重度CDH组的5分钟Apgar评分7分、肝脏疝入的人数比例高于轻度CDH组(P0.05);中重度CDH组的首诊孕周、o/e LHR、o/e TFLV、PPLV以及出生后存活率低于轻度CDH组(P0.05);中重度CDH组出生后符合ECMO指征率及PPHN发生率高于轻度CDH组(P0.05)。结论胎儿膈疝的严重程度与临床预后相关,产前评估有助于对胎儿膈疝进行严重程度分级,为产前咨询、规划患者出生后诊疗方案提供依据。     

新生儿膈疝胸腔镜治疗后存活率的影响因素分析

目的先天性膈疝(congenital diaphragmatic hernia,CDH)是指因先天性膈肌结构缺损致腹腔内容物疝入胸腔。本研究旨在总结首都儿科研究所附属儿童医院近5年入院诊断为CDH患儿的临床资料,分析CDH患儿生存率的影响因素,为患儿产前及生后病情评估提供循证依据,进而提高CDH患儿诊疗技术。方法本组患儿经产科儿科产前咨询,新生儿外科医生产房待产,生后经绿色通道转运至我中心SNICU,由新生儿外科与超声科、NICU、心脏外科等多学科对患儿进行围术期的联合诊疗,首选胸腔镜治疗。结果2014年4月至2019年12月经我中心普通(新生儿)外科诊治的58例CDH患儿中,42例行胸腔镜手术修补膈肌,35例存活,7例死亡,死亡率占总经治量的12%,其中6例为胸腔镜手术中转为开放手术,4例存活,2例死亡,死亡率占总经治量3%;13例行开放手术修补膈肌,5例存活,8例死亡。另有3例产前诊断发现CDH,术前死亡。存活患儿与死亡患儿在产前诊断孕周、住院时间、有创通气时间、手术时机及手术方式上比较差异存在统计学意义(P<0.05)。结论胸腔镜手术在新生儿CDH治疗中安全可行。产前诊断时间、手术时机、手术方式是预测患儿预后情况的重要指标。     

肺容量和肺功能检测在先天性膈疝中的应用和研究进展

先天性膈疝(CDH)是指由单侧或双侧膈肌发育缺损,腹腔脏器疝入胸腔为主要病理生理改变的一种先天性疾病.该病发病率约1/2 000～1/5 000.随着呼吸支持技术的发展以及膈疝患儿生后标准化治疗方案的初步形成,CDH患儿离院前的存活率明显提高.但目前CDH患儿的总体存活率差异仍然很大,尤其是不同类型及不同病情程度的膈疝患儿的存活率有显著性差异.患儿术后仍面临着肺发育不全导致的种种威胁.本文对膈疝患儿的肺功能检测进行综述.     

多学科联合诊疗模式对先天性重症膈疝诊治疗效10年评估

目的总结上海交通大学医学院附属新华医院小儿外科实施先天性膈疝(congenital diaphragmatic hernia,CDH)患儿产前-产时-产后-随访程序化多学科综合诊疗模式(multidisciplinary treatment,MDT)10年经验,评估MDT诊疗模式对先天性重症膈疝的诊疗效果。方法收集2001年1月至2018年12月在上海交通大学医学院附属新华医院小儿外科诊治的产前诊断CDH患儿临床资料,包括明确诊断时孕周、娩出孕周、Apgar评分、膈疝类型、出生体重、肝脏位置、血气分析指标、手术方式、呼吸机维持时间和住院周期等。将152例产前诊断为膈疝的患儿纳入分析,其中男80例,女72例,左侧膈疝120例,右侧膈疝32例。将2001年1月至2008年2月收治的产前诊断膈疝病例作为非MDT组;2008年3月至2018年12月收治的产前诊断膈疝病例作为MDT组,进行对比分析。其中非MDT组8例,MDT组144例。MDT组患儿均采取多学科综合诊疗模式,包括产前管理(产前诊断、评估与产前咨询)、产时管理(分娩及抢救)、产后管理及围手术期综合管理。结果非MDT组8例,MDT组144例。135例患儿行手术治疗,非MDT组8人均行经腹开放手术;MDT组患儿中,17例因出生后呼吸、循环衰竭死亡而未行手术治疗,127例行手术治疗,66例经腹开放手术,61例为胸腔镜手术。与非MDT组患儿相比,MDT组患儿手术时间延后(4.8±2.3比1.1±0.4)d,胸腔镜辅助手术比例较大(0比48.0%),且治愈率提高(75.0%比37.5%),组间比较,差异均具有统计学意义(P<0.05)。在性别、出生体重、膈疝类型、膈肌缺损大小分级等方面,两组间的差异无统计学意义。结论应用MDT诊疗模式管理CDH患儿,使CDH的诊断和治疗形成无缝连接,有助于提高治愈率。     

产前诊断先天性膈疝79例治疗与结局分析

目的总结先天性膈疝的围手术期管理经验,探讨产前诊断先天性膈疝的手术治疗时机、手术方法与临床疗效。方法 2014年1月至2016年11月通过产前诊断确诊为先天性膈疝患儿79例。根据LHR、O/E LHR以及肝脏位置将患儿分为轻、中、重度三组,对比分析各组手术时机、手术方法以及胸腔引流管放置情况。依据手术时机分为急诊手术组和亚急诊手术组;依据手术方法分为非微创组(经腹或经胸膈肌修补术)和微创组(胸腔镜下膈肌修补术)。结果 79例患儿中,产前评估轻度46例,中度24例,重度9例。产前诊断评估与出生后评估结果 Kappa值为0.695,具有较好一致性。治愈55例,死亡24例。比较轻度CDH患儿急诊手术和亚急诊手术,两组存活率差异无统计学意义(x~2=0.06,P=0.914);分别比较中度、重度CDH患儿急诊手术和亚急诊手术,两组存活率差异有统计学意义(P=0.001);79例CDH患儿中,轻、中度患儿复发率差异无统计学意义(P0.05)。32例未留置胸腔引流管的轻度CDH患儿中,8例在后期因胸腔积液行胸腔闭式引流;13例手术治疗的中度CDH患儿,8例未留置胸腔引流管;中度CDH患儿6例在后期因胸腔积液行胸腔闭式引流,1例术后死亡;5例手术治疗的重度CDH患儿,3例未留置胸腔引流管,术后死亡。结论手术时机对于轻度CDH预后无影响;对于中重度CDH,呼吸循环功能稳定后延期手术可以提高存活率;微创手术是一种安全、可行的手术方法;中重度CDH术后需留置胸腔引流管。     

胎儿磁共振在先天性膈疝患儿预后评估中的应用研究CSCD

目的回顾性分析先天性膈疝患儿产前胎儿磁共振图像,探讨磁共振测量和评价参数与患儿预后的关系,初步探讨胎儿磁共振参数在先天性膈疝患儿预后评估中的应用价值。方法收集西安交通大学第二附属医院2011—2020年胎儿磁共振图像结果,收集诊断为先天性膈疝的50例胎儿磁共振图像,包括左侧膈疝37例,右侧膈疝13例,检测并分析观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等与患儿预后的关系。结果50例患儿中,存活35例(为存活组),死亡15例(为死亡组)。胎儿磁共振图像观察-预期肺容积比:存活组比死亡组为(35.09±10.87)比(24.29±6.86);肺肝比:存活组比死亡组为(2.68±1.01)比(1.93±0.93);纵膈移位角:存活组比死亡组为(30.88±7.07)比(39.05±4.21);差异均有统计学意义(P<0.05)。图像分析结果显示,胎儿磁共振肺底基线不完整、肝脏及胃泡位置疝入胸腔患儿的预后较差,差异具有统计学意义(P<0.05)。受试者操作特征曲线分析结果显示,联合应用观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等判断患儿预后,较单一参数判断更为准确,差异具有统计学意义(P<0.05)。结论胎儿磁共振观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线完整性、肝脏及胃泡位置均可作为判断先天性膈疝患儿预后的评价指标,联合应用上述六项参数可以更加准确地判断患儿预后,以上述参数为基础构建先天性膈疝的评估体系,有助于先天性膈疝患儿的肺发育评估、体外膜肺氧合的应用判断以及手术方式的选择。     

危重新生儿评分对转运新生儿的病情评估

目的 比较新生儿转运生理稳定指数（TRIPS）、新生儿急性生理评分-Ⅱ（SNAP-Ⅱ）、围产期-新生儿急性生理评分-Ⅱ（SNAPPE-Ⅱ）早期评估转运新生儿病情的准确性。方法 收集2012-01-01—2012-12-31由重庆医科大学附属儿童医院急救中心转运入住本病房新生儿的临床资料进行回顾性分析,比较TRIPS、SNAP-Ⅱ和SNAPPE-Ⅱ等对7 d内死亡、重度脑室内出血（≥Ⅲ级）以及需要机械通气（MV）的预测准确性。结果 共475例新生儿纳入统计。Hosmer-Lemeshow 拟合度检验提示三种评分系统模型均有较好的拟合度（P＞0.05）,P值分别为0.73 （TRIPS）, 0.30（SNAP-Ⅱ）和0.27（SNAPPE-Ⅱ）,TRIPS拟合最好。TRIPS、SNAP-Ⅱ、SNAPPE-Ⅱ预测7 d内死亡的受试者工作特征曲线下面积（AUC）分别为0.80,0.82,0.84,预测重度脑室内出血的AUC分别为0.70,0.69,0.83,预测MV的AUC分别为0.72,0.72和0.74;各评分系统预测准确度差异均无统计学意义（P＞0.05）。ROC曲线截点分析提示,TRIPS≥20分时,7 d内死亡、需要MV预测的敏感度分别为89.1%,72.5%,特异度分别为57.7%,66.8%。结论 与SNAP-Ⅱ、SNAPPE-Ⅱ及NCIS相比,TRIPS评分操作更简便易行,适于临床使用,对新生儿转运后7 d内死亡、重度脑室内出血及MV发生率预测的准确性较高。     

产前诊断先天性膈疝的转运救治机制与临床实证分析

目的探讨产前诊断先天性膈疝(congenital diaphragmatic hernia,CDH)的转运救治机制与临床实践效果。方法首都儿科研究所附属儿童医院与北京市及周边地区8家产前诊断中心建立合作网,以2018年1月至2020年12月期间在合作网接受产前咨询的CDH孕妇为研究对象。产前转运救治机制包括:产前以新生儿外科与产科为主导,协同超声影像科、遗传科组成专家小组进行不定期多学科会诊,对产前发现畸形患儿的诊断与预后进行评估;同时对分娩时间、分娩方式、出生后处置及转运、治疗等问题进行商讨,初步确定病情危重程度,分析出生后可能出现的风险,制定最优个性化诊疗方案。结果共88例CDH孕妇接受产前咨询,最终经绿色通道转运收治63例。63例中,男41例,女22例;足月儿52例,早产儿11例(中位出生胎龄34周);出生体重(2978.73±607.69)g;产时气管插管22例(34.9%),产房内高频呼吸机辅助呼吸22例(34.9%)。9例二氧化碳分压大于70 mmHg,54例小于70 mmHg。产前评估为重度CDH 31例,中度CDH 32例。产前诊断孕周(27.69±5.33)周。左侧膈疝53例,右侧膈疝10例。肝脏疝入15例。58例行手术治疗,术后存活率为87.9%(51/58);5例产前评估为极重度膈疝,出生后虽经全面抢救仍无法改变呼吸循环衰竭状态而死亡。58例采用手术治疗的患儿中,开放手术8例(13.8%),腔镜手术50例(86.2%);无疝囊35例,有疝囊23例;术中发现B级缺损20例(34.5%),C级和D级缺损共38例(65.5%)。使用补片修补膈肌者占10.3%(6/58)。结论先天性膈疝治疗水平的提升有赖于产科、儿科密切合作。新生儿外科专业转运团队在产前参与诊断和评估、产时进驻产房共同完成生后抢救及转运工作、以及后续有效的手术治疗和围术期管理,对改善先天性膈疝患者预后有着积极的作用。     

超声心动图评估先天性左侧膈疝新生儿预后的价值

目的探讨超声心动图评估左侧先天性膈疝(CDH)新生儿预后的价值。方法以2015年1月—2018年1月出生的左侧CDH新生儿为研究对象,回顾其一般情况及超声心动图资料,并按其生后30天是否存活分为存活组、死亡组,进行比较分析。结果共纳入65例左侧CDH新生儿,存活组48例、死亡组17例。两组患儿胎龄及出生体质量、动脉导管持续右向左分流的比例、三尖瓣跨瓣压差、右肺动脉(RPA)及左室收缩末期(LVDd)内径差异均有统计学意义(P0.05)。多元logistic回归分析发现,三尖瓣跨瓣压差及LVDd为不良预后的独立预测因子(P0.05)。结论超声心动图在评估左侧CDH新生儿的临床预后中有重要价值。     

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??Abstract??Objective To evaluate the performance of the Transport Risk Index of Physiologic Stability??TRIPS????Score for Neonatal Acute Physiology??Version ??SNAP-?? and Score for Neonatal Acute Physiology-Perinatal Extension?? Version ??SNAPPE-?? for severity of transported neonates. Methods The study enrolled the neonates transported to Department of Neonatology?? Children’s Hospital of Chongqing Medical University from Jan.1 to Dec. 31 of 2012. The clinical data were collected and analyzed retrospectively to compare the prediction accuracy of 7-day mortality??severe ??≥Grade ?? intra-ventricular hemorrhage??IVH?? and mechanical ventilation??MV??. Results Totally 475 neonates were enrolled.Hosmer-Lemeshow goodness-of-fit test showed good calibration of the TRIPS??P = 0.73????SNAP-??P = 0.30?? and SNAPPE-??P = 0.27????and the TRIPS was the best. TRIPS??SNAP-??and SNAPPE-?? discriminated 7-day mortality with receiver operating characteristic area??AUC?? of 0.80??0.82 and 0.84??respectively??whereas the predictive performance for severe IVH was 0.70?? 0.69 and 0.83??and the performance for MV 0.72??0.72 and 0.74??respectively. There was no significant difference among these three scoring systems??P??0.05??. With the cut-off value of 20 points?? the sensibility of TRIPS predicting 7-day mortality and MV was 89.1% and 72.5%??respectively??whereas the specificity 57.7% and 66.8%. Conclusion Compared with SNAP-??SNAPPE-?? and NCIS??TRIPS is more suitable for quick severity evaluation due to its simplicity and feasibility??especially in accurately predicting 7-day mortality??severe IVH and MV of transported neonates.     

几种新生儿危重评分的比较

新生儿危重评分是一种评估疾病危重程度,预测死亡风险的评分系统,用以指导新生儿重症监护室的临床工作,对我国日益发展的新生儿医学有其必要性和重要性.该文着重介绍并比较了几种国际上常用的危重评分系统.与新生儿急性生理学评分、新生儿急性生理学评分围生期补充及国内新生儿危重评分相比,新生儿临床危险指数、新生儿急性生理学评分-Ⅱ、新生儿急性生理学评分围生期补充-Ⅱ及新生儿临床危险指数-Ⅱ的变量更精简,分度更科学,评分时间缩短,预测死亡风险的准确性较高,具有更高的实用及推广价值.     

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目的 比较新生儿危重病例评分(NCIS)与美国新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)在危重新生儿死亡风险预测方面的优越性,探索适合我国新生儿疾病危重度判断的评分系统。方法 对2008年1-12月入住东南大学附属中大医院新生儿重症监护室(NICU)的525例患儿同时采用NCIS和SNAPPE-Ⅱ两种评分系统进行评分,根据评分将入组病例分为极危重、危重、非危重3组,分别对各组病死率进行比较,并描绘受试者工作特征曲线(ROC),比较ROC曲线下面积(AUC),以观察两种评分系统在预测危重新生儿死亡风险的特异度及灵敏度。结果 非危重组、极危重组中,NCIS评分及SNAPPE-Ⅱ的病死率比较,差异无统计学意义(P>0.05);危重组中,两种评分病死率比较,差异有统计学意义(P<0.05);AUC分别为NCIS评分0.934,SNAPPE-Ⅱ评分0.926,两组差异无统计学意义(P>0.05)。结论 NCIS评分对危重新生儿的筛出能力较强,但对临床决策无早期指导作用。SNAPPE-Ⅱ评分能早期、较准确预测患儿死亡风险,临床应用较简便,宜推广使用。     

Neurodevelopmental outcome at 3.5 years of age in children treated with extracorporeal life support: relationship to primary diagnosis

OBJECTIVE: Recent studies suggest that for neonates treated with extracorporeal membrane oxygenation (ECMO), children with congenital diaphragmatic hernia (CDH) have poorer neurodevelopmental outcome than children with other diagnoses. We therefore analyzed the neurodevelopmental outcome at 3(1/2) years of age in 130 neonatal ECMO survivors with 6 different primary diagnoses. STUDY DESIGN: Children were assessed with the McCarthy Scales of Children's Abilities, Peabody Picture Vocabulary Test, Vineland Adaptive Behavior Scales, and a neurologic/physical examination; 12 factors related to infant characteristics and ECMO/hospital course including primary diagnosis were identified as independent variables. Dependent variables included test scores and 2 outcome categories: functional status (normal, risk, abnormal) and major neurologic sequelae (presence or absence). Statistical tools included chi-squared analysis, t test, analysis of variance, and discriminant and regression analysis. RESULTS: No significant differences were found between diagnostic groups in functional status or neurologic sequelae. Hospital days was the only variable consistently expressed in all analyses as having significant influence on the outcome measures. This was not a factor of the longer hospital days experienced by children with CDH. CONCLUSION: Neurodevelopmental outcome in neonatal ECMO is multifactorial. Although hospital days has the greatest association with outcome at age 3(1/2) years, these days likely reflect degree of illness and various complications that are independent of diagnostic group. Further study is required to determine which factors influencing the length of hospital stay may be the best predictor of long-term outcome.     

先天性膈疝危险因素评估

目的 先天性嗝疝是围产期死亡的重要病因之一，本文分析影响先天性膈疝的危险因素和其变化特征。方法 回顾性分析1996年1月～2001年10月治疗的18例先天性膈疝患儿的外科处理资料及预后情况。结果 18例患儿中12例存活(66％)。影响治疗后果的因素包括出生Apgar评分、产前诊断、合并畸形及外科修补的时间。结论 先天性膈疝的产前诊断、合并有明显的畸形、Apgar评分和外科治疗时间对生存率有重要影响。     

Congenital diaphragmatic hernia: experience without extracoporeal membrane oxygenation

While extracorporeal membrane oxygenation (ECMO) is used in the management of congenital diaphragmatic hernia (CDH), its value is questioned. The charts of all newborn infants who presented in respiratory distress due to CDH over the past 27 years were reviewed. Inborn versus outborn, year of repair, use of ultrasound (US), and the predictive value of various parameters was evaluated. Fisher's exact test and logistic regression tests were used to analyze data. There were 81 patients, 43 males and 38 females. Repair occurred after stabilization without ECMO; 65 patients survived (80%). Apgar scores at 1 min (P=0.03) and 5 min (P=0.005), best postductal PaO₂ (BPDPaO₂) (P=0.02), and type of repair (P=0.01) were predictive of outcome. There was no difference in survival between inborn and outborn patients or over the years of review (P=0.29). Forty-six patients had documented prenatal US scans, with no obvious impact on outcome. Thus, survival of CDH patients without ECMO is comparable to the best results reported with ECMO, suggesting that the costs and associated morbidity of ECMO may not justify its use for such patients. Apgar scores, BPDPaO₂, and type of repair are good predictors of outcome. Accepted: 9 March 2001     

Comparison of the prediction of extremely low birth weight neonatal mortality by regression analysis and by neural networks

AIMS: To compare the prediction of mortality in individual extremely low birth weight (ELBW) neonates by regression analysis and by artificial neural networks. STUDY DESIGN: A database of 23 variables on 810 ELBW neonates admitted to a tertiary care center was divided into training, validation, and test sets. Logistic regression and neural network models were developed on the training set, validated, and outcome (mortality) predicted on the test set. Stepwise regression identified significant variables in the full set. Regression models and neural networks were then tested using data sets with only the identified significant variables, and then with variables excluded one at a time. RESULTS: The area under the curve (AUC) of receiver operating characteristic (ROC) curves for neural networks and regression was similar (AUC 0.87+/-0.03; p=0.31). Birthweight or gestational age and the 5-min Apgar score contributed most to AUC. CONCLUSIONS: Both neural networks and regression analysis predicted mortality with reasonable accuracy. For both models, analyzing selected variables was superior to full data set analysis. We speculate neural networks may not be superior to regression when no clear non-linear relationships exist.     

Limited sampling strategy for cyclosporine (Neoral) area under the curve monitoring in pediatric kidney transplant recipients

Cyclosporine (CSA; Neoral) is one of the most common immunosuppressants used in pediatric renal transplantation. Research in adult renal transplant recipients has shown that 2-h post-dose concentration (C2) monitoring and limited sampling strategies (LSSs) are better at predicting drug exposure and outcome than trough concentrations (C0). While C0 monitoring is the usual practice in pediatric renal transplant patients, area under the curve (AUC) monitoring has been shown to be superior in terms of predictive ability and outcomes. However, AUC monitoring is impractical and inconvenient in a clinic setting because it involves many blood samples. An LSS provides a reliable alternative. The purpose of this study was to prospectively define an LSS (AUC(0-12)) for CSA monitoring and to test its predictive performance. As well, an LSS (AUC(0-4)) for CSA was developed and its predictive performance tested. Blood samples for CSA concentrations were collected in 29 stable pediatric renal transplant patients prior to (t = 0) and at 0.5, 1, 2, 4, 6, and 8 h following a steady-state morning CSA dose. AUC was calculated by the trapezoidal method; LSSs for AUC(0-12) and AUC(0-4) were determined using multiple regression analysis in 14 patients; and the LSSs' predictive performance was tested in 15 additional patients. Both LSSs require two blood samples. For the LSS (AUC(0-12)), blood samples are required immediately before the dose and 2 h post-dose: AUC(0-12) = 12.45 C0 + 2.17 C2 + 723.16 (r2 = 0.909). For the LSS (AUC(0-4)), blood samples are required at one and 2 h post-dose, AUC(0-4) = 1.17 C1 + 1.85 C2 - 41.00 (r2 = 0.971). The LSSs demonstrated low bias and high precision for both AUC(0-12) and AUC(0-4). Our two-concentration LSSs are accurate and precise predictors that are more clinically useful for our patient population than other LSSs that have been developed for pediatric renal transplant patients. Our study template provides a guide for other centers to develop accurate and precise LSSs specific to their own patient population.     

Serum monocyte chemotactic protein-1 levels in congenital diaphragmatic hernia

To measure serum monocyte chemotactic protein-1 (MCP-1) in patients with congenital diaphragmatic hernia (CDH) and investigate its relationship to the development of persistent pulmonary hypertension (PPH). Serum MCP-1 was measured in 13 neonates with high risk for CDH at the time of diagnosis and postoperatively, and in five age-matched controls using an ELISA system. The 13 CDH subjects were divided into four groups according to the presence of PPH and outcome. Group I (severe-pre group): subjects with severe PPH who died prior to surgery (n = 5); Group II (mild-pre group): subjects with mild PPH controlled by medications (n = 8); Group IIa (severe-post group): subjects who subsequently developed severe PPH postoperatively and died (n = 3); and Group IIb (mild-post group): subjects who continued to have mild PPH controlled by medications. We also examined nitrofen-induced hypoplastic lungs from five rat fetuses with CDH and five control lung specimens for MCP-1 using immunohistochemistry. Mean serum MCP-1 in Group I was (1038.0 ± 95.8 pg/ml), which was significantly higher than Group II (444.9 ± 39.7 pg/ml) (P < 0.0001) and controls (147.3 ± 11.3 pg/ml) (P < 0.0001). Postoperatively, Group IIa was significantly higher than Group IIb from 24 to 120 h postoperatively (P < 0.001). In Group IIb serum MCP-1 did not rise at all between 24 and 120 h postoperatively. Hypoplastic fetal rat CDH lungs had strong expression of MCP-1 compared with control lungs. Up-regulated expression and high circulating levels of MCP-1 in CDH patients with PPH suggest that MCP-1 may play a role in the development of PPH in CDH.