Hospital admission for neurologic disorders among 5-year survivors of noncentral nervous system tumors in childhood: A cohort study within the Adult Life after Childhood Cancer in Scandinavia study

Large, comprehensive studies of the risk for neurologic disorders among long-term survivors of noncentral nervous system (CNS) childhood cancers are lacking. Thus, the aim of our study was to assess the lifetime risk of Nordic non-CNS childhood cancer survivors for neurologic disorders. We identified 15,967 5-year survivors of non-CNS childhood cancer diagnosed in Denmark, Iceland, Finland and Sweden in 1943–2008, and 151,118 matched population comparison subjects. In-patient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs). A neurologic disorder was diagnosed in 755 of the survivors while 370 were expected, yielding a RR of 2.0 (95% confidence interval (CI) 1.9–2.2). The highest risks were found among survivors of neuroblastoma (4.1; 95% CI 3.2–5.3) and leukemia (2.8; 95% CI 2.4–3.2). The AER decreased from 331 (278–383) excess neurologic disorders per 100,000 person-years 5–9 years after diagnosis to 82 (46–118) ≥ 20 years after diagnosis. Epilepsy was the most common diagnosis (n = 229, 1.4% of all survivors), and significantly increased risks were seen among survivors of eight out of 12 types of childhood cancer. Survivors of neuroblastoma had remarkably high risks (RR ≥ 10) for hospitalization for paralytic syndromes and hydrocephalus, while survivors of leukemia had additional high risks for dementia and encephalopathy. In conclusion, survivors of non-CNS childhood cancer are at high risk for neurologic disorders, especially within the first decade after diagnosis. Therefore, intensive follow-up to identify those who require close management is needed.     

改进穿透性胎盘植入患者预后的综合管理措施

        胎盘植入性疾病（placenta accrete spectrum disorders，PAS）包括胎盘粘连（placenta accreta，PA）、胎盘植入（placenta increta，PI）和穿透性胎盘植入（placenta percreta，PP）［1］。PA是指胎盘绒毛突破蜕膜基底层，与子宫肌层粘连；PI是指胎盘绒毛侵入子宫肌层；PP是指胎盘绒毛侵及子宫全层，并达到浆膜层，严重者侵及宫旁、宫颈及膀胱等子宫毗邻器官。PP系最严重的PAS类型，随着孕周进展PP发生自发性破裂导致严重出血及子宫切除的风险最高。 浏览更多请关注本刊微信公众号及当期杂志。     

儿童睡眠障碍性疾病的研究进展

儿童睡眠是一个重要且动态的过程,影响着健康和发展的许多方面,目前由于电子设备的长时间使用、家庭关系的不和谐、看护人不良的睡眠习惯、哮喘病史、精神病史等多种因素导致儿童睡眠时间日益缩短,儿童面临发作性睡病、异态睡眠、周期性肢体运动障碍、不宁腿综合征等睡眠障碍问题。同时,睡眠质量与各个系统的疾病具有循环关系,故临床上应当重视儿童睡眠障碍的治疗与研究。     

Negative influence of maternal smoking during pregnancy on infant outcomes

BackgroundAccording to the INPES 2014 health barometer, the prevalence of smoking in pregnant women in France is the highest in Europe : 17.8% of expectant mothers who smoke continue to do so during pregnancy. Several epidemiological studies have confirmed multiple risks for tobacco-exposed infants (low birth weight; digestive, respiratory, neurological, and psychological disorders; obesity; type 1 diabetes).PurposeThis study compared a cohort of infants exposed to tobacco in utero (T + ) with those unexposed (T−). Birth weight, diet, presence of colic (ROME III criteria) and regurgitations (Vandenplas scale) were specifically analyzed.MethodsThis observational, cross-sectional, and multicenter survey was conducted in France by pediatricians and general practitioners from September 2016 to February 2017. Infants with a chronic pathology and those with parents under 18 years of age were excluded. The data were collected by the physician and by the mother through a self-administered questionnaire.ResultsA total of 452 physicians recruited 759 T+ and 741 T- infants in the study. The mean birth weight of T+ infants was significantly lower (3.1 ± 0.5 kg [WHO z-score -0.476 ± 1.081]) than that of T− infants (3.3 ± 0.5 kg [0.033 ± 0.965]; P < 0.001). At the time of leaving the maternity facility, 47.7% of T+ infants were breastfed by their mother compared with 70.1% of T− infants. The median reported duration of breastfeeding was 1 month vs. 2 months for T+ and T− infants, respectively. Colic was significantly more common in T+ than in T− infants: 25.6% vs. 12.3% according to the ROME III criteria, and 45.7% vs. 29.7% according to the doctor's opinion (P < 0.001 for both). In the T+ group, cases of regurgitation (63.6% vs. 56.5%; P = 0.005), respiratory disorder (6.3% vs. 2.4%, P < 0.001), and bronchiolitis (6.5% vs. 3.0%; P = 0.001) were also more frequent.ConclusionThis study confirms that maternal smoking during pregnancy is associated with health risks; exposed infants had significantly more digestive/respiratory symptoms and lower birth weight than unexposed infants. Preventive and educational actions need to be further strengthened in the face of this public health problem.     

Does perturbation in the mitochondrial protein folding pave the way for neurodegeneration diseases?

Mitochondria, which are cell compartments that are widely present in eukaryotic cells, have been shown to be involved in a variety of synthetic, metabolic, and signaling processes, thereby playing a vital role in cells. The mitochondrial unfolded protein response (mtUPR) is a response in which mitochondria reverse the signal to the nucleus and maintain mitochondrial protein homeostasis when unfolded and misfolded proteins continue to accumulate. Multiple neurodegeneration diseases, including Alzheimer's disease (AD), Parkinson’s disease (PD), and familial amyotrophic lateral sclerosis (fALS), are public health challenges. Every year, countless efforts are expended trying to clarify the pathogenesis and treatment of neurological disorders, which are associated with mitochondrial dysfunction to some extent. Numerous studies have shown that mtUPR is involved in and plays an important role in the pathogenesis of neurological disorders, but the exact mechanism of the disorders is still unclear. Further study of the process of mtUPR in neurological disorders can help us more accurately understand their pathogenesis in order to provide new therapeutic targets. In this paper, we briefly review mtUPR signaling in Caenorhabditis elegans (C. elegans) and mammals and summarize the role of mtUPR in neurodegeneration diseases, including AD, PD and fALS.