Effect of IGF-rich colostrum on bowel adaptation in neonatal piglets with short bowel syndrome.

BACKGROUND: Insulin-like growth factor 1 (IGF-1), a polypeptide growth factor with mitogenic effects on intestinal epithelial crypt cells occurs naturally in high concentrations in colostrum. The hypothesis for this study was that colostrum rich in IGF-1 could promote small bowel adaptation in neonatal piglets with short bowel syndrome. METHODS: Twenty-four piglets, aged 7 days, underwent 75% small bowel resection and were fed 525 kJ x kg(-1) x d(-1) (125 kcal) of colostrum-based formula (Rs(+)) or placebo formula (Rs(-)). Immunoglobulin G (IgG) accounted for 35% of the protein and was compensated with casein and whey protein in the control feed. The piglets were weighed daily and killed 28 days after surgery. Bowel samples were taken at surgery and at death. RESULTS: Relative body-weight increase did not differ between the Rs(+) and Rs(-) group (84% +/- 9% vs. 90% +/- 12%, P = 0.83). There was a significant relative increase in crypt depth in the Rs - compared with the Rs + group (201% +/- 15% vs. 147% +/- 17%, P = 0.02) and total protein (mg/cm bowel) (482 +/- 51 vs. 278 +/- 46, P = 0.008). Increase in villus length, DNA/RNA content, and mitotic index did not differ between groups. CONCLUSION: Colostrum supplement rich in IGF-1 has no benefits over protein-enriched feed with respect to growth and bowel adaptation in neonatal piglets with short bowel syndrome.     

高胆红素血症新生儿血清S-100蛋白及总胆红素与白蛋白比值的变化及意义

目的 研究高胆红素血症(高胆)新生儿血清S-100蛋白水平和总胆红素(TBC)与白蛋白(B/A)比值的变化,为早期预测胆红素脑损伤提供新的方法.方法 根据胎龄、体质量和是否符合黄疸干预标准将出生7 d内的84例新生儿分为足月高胆组、足月对照组、早产高胆组、早产对照组.检测4组血清S-100蛋白、TBC、白蛋白水平,计算B/A比值.结果 足月高胆组S-100蛋白含量[(0.36±0.14)μg/L]高于足月对照组[(0.25±0.07)μg/L],差异有显著性(P＜0.05),足月高胆组S-100蛋白含量与B/A比值呈正相关性(r=0.509,P＜0.05).早产高胆组S-100蛋白含量[(0.40±0.09)μg/L)高于早产对照组[(0.28±40.05)μg/L],差异有显著性(P＜0.05),S-100蛋白含量与B/A比值无相关性(r=0.356,P＞0.05).结论 血清S-100蛋白和B/A比值可作为早期预测胆红素神经毒性的敏感指标.     

Lipopolysaccharide endotoxemia reduces cell proliferation and decreases enterocyte apopotosis during intestinal adaptation in a rat model of short-bowel syndrome

Sepsis is frequently associated with or complicates short-bowel syndrome (SBS). To investigate the effects of lipopolysaccharide (LPS) endotoxemia on enterocyte proliferation and death via apoptosis in a rat model of SBS, adult male Sprague-Dawley rats were divided into three experimental groups: sham rats underwent bowel transection and reanastomosis; SBS rats underwent 75% small-bowel resection; and SBS-LPS rats underwent 75% bowel resection and were given intraperitoneal injections of LPS 10 mg/kg. Parameters of intestinal adaptation (bowel and mucosal weights, mucosal DNA and protein, villus height, and crypt depth), enterocyte proliferation, and death via apoptosis were determined on day 15 after the operation. Statistical analysis was determined by Student's and ANOVA tests with a P less than 0.05 considered significant. SBS-LPS animals demonstrated a significant decrease (vs SBS rats) in duodenal (20%), jejunal (30%), and ileal (15%) overall weight, duodenal (20%), jejunal (27%), and ileal (18%) mucosal weight, jejunal (20%) and ileal (30%) mucosal DNA, jejunal (29%) and ileal (31%) villus height, and jejunal (14%) and ileal (29%) crypt depth. LPS endotoxemia led to reduced cell proliferation and enterocyte apoptosis compared to untreated SBS animals. Thus, in a rat model of SBS, LPS endotoxemia inhibits intestinal adaptation. A possible mechanism may be decreased cell proliferation. Decreased enterocyte loss via apoptosis may reflect a reduced number of enterocytes. Other mechanisms (necrosis) may be mainly responsible for cell death following LPS injection.     

Rapid effects of hypoxia on the cerebrospinal fluid levels of adenosine and related metabolites in newborn and one-month-old piglets

The effect of hypoxia on the levels of adenosine, inosine and hypoxanthine in the cerebrospinal fluid (CSF) was determined by HPLC in newborn (1- to 3-day-old, n = 6) and 1-month-old (n = 5) piglets. Serial CSF samples (q 60 s) were obtained from the cisterna magna during normoxia and a 5-min hypoxia test (PaO2 = 26.5 +/- 2.9 Torr). In normoxia, newborns had a lower mean (+/- SEM) CSF concentration of adenosine (0.72 +/- 0.17 vs 2.60 +/- 0.44 microM) and a higher concentration of hypoxanthine (4.88 +/- 0.41 vs. 1.39 +/- 0.60 microM) than the mature piglets (p less than 0.05). In all animals, hypoxia induced an increase in CSF levels of adenosine and its metabolites between 2 and 4 min. However, peak adenosine concentrations were higher in mature (4.17 +/- 1.41 microM) than in newborn (1.55 +/- 0.29 microM) piglets (p less than 0.05). These data might explain deficient vasodilator adaptation required for neonatal CBF regulation.     

Colostrum protein concentrate enhances intestinal adaptation after massive small bowel resection in juvenile pigs

OBJECTIVES: Short bowel syndrome (SBS) usually results from the surgical removal of a large segment of small intestine. Patient outcome depends on the extent of intestinal resection and adaptation of the remaining intestine. We evaluated the impact of colostrum protein concentrate (CPC) on intestinal adaptation after massive small bowel resection in a porcine model of infant SBS. METHODS: Four-week-old piglets underwent an approximate 75% small bowel resection (R, n = 23) or a control transection operation (C, n = 14). Postoperatively, animals from both groups received either pig chow (R = 6, C = 5), polymeric infant formula (R = 6, C = 3) or polymeric infant formula supplemented with CPC (R = 11, C = 6) for 8 weeks until sacrifice. Clinical outcome measures included weight gain and stool consistency. Morphologic measures were intestinal villus height and crypt depth. Functional outcome measure was mucosal disaccharidase activity. RESULTS: Resected animals fed polymeric infant formula alone had reduced weight gain compared with controls fed the same diet (P < 0.005). Despite massive small bowel resection, animals fed pig chow or polymeric infant formula supplemented with CPC grew at an equivalent rate to controls fed polymeric infant formula alone. Resected animals supplemented with CPC had increased villus length and crypt depth in the jejunum (P < 0.001) and ileum (P < 0.001) compared with resected animals fed either pig chow or polymeric infant formula alone. CONCLUSION: In an animal model of SBS, CPC supplementation of polymeric infant formula resulted in normal weight gain and features of enhanced morphologic adaptation.     

吸毒孕妇所生新生儿临床结局分析

目的 分析吸毒孕妇围生儿的临床结局.方法 回顾性分析105例吸毒孕妇所生新生儿的临床资料,包括早产儿、低体重儿、新生儿窒息、新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)、颅内出血、先天畸形及死亡,并与50例健康孕妇所生的新生儿(对照组)进行比较,同时观察新生儿戒断综合征的发生情况.结果 105例吸毒孕妇中,自然分娩80例,剖宫产25例.早产56例(53.3％),平均出生体重(2 534±1 234)g,新生儿窒息25例(23.8％),NRDS 18例(17.1％),颅内出血16例(15.2％),先天畸形3例(2.9％).吸毒孕妇所生新生儿胎龄及出生体重低于对照组,吸毒孕妇围生儿发生早产、低体重儿、新生儿窒息、NRDS及颅内出血的比例高于对照组,差异有统计学意义(P＜0.05).与吸毒时间≤2年者比较,吸毒时间＞2年者所生新生儿早产、低体重儿、新生儿窒息、NRDS的比例更高,差异有统计学意义(P＜0.05).静脉注射吸毒孕妇发生早产、低体重儿、新生儿窒息、NRDS的比例高于口服吸毒者,差异有统计学意义(P＜0.05).吸毒组新生儿红细胞、白细胞、天门冬氨酸氨基转移酶、丙氨酸转氨酶高于对照组,血小板及白蛋白低于对照组,差异有统计学意义(P＜0.05).共30例新生儿出现新生儿戒断综合征表现.105例新生儿中治愈99例,死亡6例,死亡原因包括3例NRDS合并肺部感染,1例严重颅内出血,1例窒息,1例多器官功能衰竭.结论 吸毒会导致新生儿早产增加,窒息及NRDS的比例升高.妊娠晚期吸毒会导致新生儿戒断综合征.     

超早产儿出生窒息的危险因素分析

目的 探讨超早产儿发生出生窒息的危险因素.方法 选取2017年1月至2020年6月,解放军总医院第七医学中心儿科医学部超早产重症监护病房收治的超早产儿为研究对象,纳入窒息组184例,对照组153例.回顾性收集超早产儿及其母亲的临床资料,分析超早产儿发生出生窒息的危险因素.统计学方法采用t检验、χ2检验、单自变量和多自变...     

Effectiveness of topical acetate tocopherol for the prevention and treatment of skin lesions in newborns: a 5 years experience in a 3rd level Italian Neonatal Intensive Care Unit

AIM: Neonates in NICU (especially when premature) are particularly prone to skin damage by action of external aggressive conditions such as chemical, physical, infectious, radiant, mechanical and iatrogenic factors. Strategies for avoiding disruption of the skin barrier are thus highly needed in such patients. METHODS: We evaluated the effectiveness of a acetate tocopherol (AT) ointment for topical use in 21 neonates admitted to our NICU and affected by neonatal abstinence syndrome with severe diaper exulcerative and erosive erythema with ulcer and granulation tissue at the bottom of the lesion (group A), and compared them to 19 matched neonates affected by the same condition and treated with a commonly used skin ointment (emollient type, water-in-oil category) (group B). For all newborns we calculated: the dermatological severity score (using a clinical score from 0 to 9 points according to the increasing severity of the lesions) at time 0, 4 and 7 days; the mean days for achieving complete recovery; the rate of therapeutical failures. RESULTS: Mean score at day 0 was 7.8 in group A vs 7.9 in group B (P=0.35 NS). At day 4 it was 4.6 in group A vs 6.5 in group B (P=0.03), at day in 7 it was 3.1 in group A vs 5.2 in group B (P=0.04). A complete recovery with restitutio ad integrum occurred after 9.1 mean days in group A vs 12.2 mean days in group B (P=0.04). The rate of therapeutical failures was significantly lower in group A (4.2% vs 30.6%; OR 0.235; P<0.01) than in group B. No adverse effects related to AT use were reported. CONCLUSIONS: AT in our experience proved to be safe and more effective than the commonly used skin ointments in the topical treatment of exulcerative skin lesions in NICU neonates.     

Responsiveness of intestinal epithelial cell turnover to TGF-α after bowel resection in a rat is correlated with EGF receptor expression along the villus–crypt axis

Recent evidence suggests that transforming growth factor alpha (TGF-alpha) enhances enterocyte proliferation and stimulates intestinal adaptation after massive bowel resection. In the present study, we evaluated the effects of TGF-alpha on enterocyte turnover and correlated it with epidermal-growth factor (EGF) receptor expression along the villus-crypt axis in a rat model of short bowel syndrome (SBS). Male rats were divided into three groups, sham rats underwent bowel transection (group A); SBS rats underwent a 75% bowel resection (group B); and SBS/TGF-alpha rats underwent bowel resection and were treated with TGF-alpha (75 microg/kg) (group C) from the seventh postoperative day. Parameters of intestinal adaptation, enterocyte proliferation and apoptosis were determined on day 15. Villus tips, lateral villi and crypts were separated using laser capture microdissection. EGF receptor expression for each compartment was assessed by quantitative real-time PCR (Taqman). Statistical analysis was performed using one-way ANOVA test, with P < 0.05 considered statistically significant. Treatment with TGF-alpha resulted in a significant increase in all parameters of intestinal adaptation. EGF receptor expression in crypts significantly increased in SBS rats (vs sham rats) (0.035 +/- 0.013 vs 0.010 +/- 0.002 Log ng Total RNA/18 s) and was accompanied by a significant increase in enterocyte proliferation (169 +/- 8 vs 138 +/- 5 BrdU positive cells/per 10 crypts, P < 0.05) and decreased apoptosis following TGF-alpha administration (group C). A significant decrease in EGF receptor expression at the tip of the villus (0.005 +/- 0.002 vs 0.029 +/- 0.014 Log ng Total RNA/18 s) and in the lateral villus (0.003 +/- 0.001 vs 0.028 +/- 0.006 Log ng Total RNA/18 s) in SBS (group B) rats (vs sham, group A) was accompanied by increased cell apoptosis in these compartments following treatment with TGF-alpha (group C). In a rat model of SBS, TGF-alpha increased enterocyte proliferation and stimulated intestinal adaptation. The effect of TGF-alpha on enterocyte turnover is correlated with EGF receptor expression along the villus-crypt axis.     

早产儿黄疸早期干预的临床观察

目的探讨早期干预早产儿黄疸的疗效和对肠外营养及体质量增长的影响。方法174例早产儿，出生体质量1500～2000g者（A组）87例，出生体质量〈1500g者（B组）87例，分别按常规干预和早期干预分组。常规组血清总胆红素（TSB）达干预推荐方案的标准时光疗，早期组于出现黄疸，但TSB未达干预标准即光疗。结果A、B组的早期组胆红素峰值（PSB）均低于常规组[A组：（209．48±38．99）umol／L和（266．59±37．11）umol／L，B组：（180．23±31．63）umol／L和（243．68±37．45）umol／L，P均〈0．05]；早期组与常规组相比黄疸消退日龄早[A组：（14．5±4．4）d和（18．0±3．8）d，B组：（10．8±3．0）d和（18．8±5．5）d，P均〈0．05l，脂肪乳起始日龄早fA组：（5．8±2．7）d和（8．1±3．7）d，P〉0．05；B组：（3．8±1．8）d和（9．2±4．4）d，P〈0．05]，恢复出生体质量日龄早[A组：（13．1±6．0）d和（14．4±4．0）d，P〉0．05；B组：（9．3±4．8）d和（15．4±5．6）d，P〈0．05]。结论早期干预可以使早产儿尤其是极低出生体重儿PSB降低，黄疸持续时间缩短，利于早期添加脂肪乳和早产儿体质量增长。     

试管早产儿早期并发症及治疗转归

目的：探讨试管早产儿早期并发症的发生率及治疗转归。方法：回顾性分析并比较122例试管早产儿与183例自然妊娠早产儿（对照组）母亲围产期情况、出生一般情况及早期并发症的发生情况。结果：两组孕母围产期疾病的发生率差异无统计学意义（P>0.05）。试管早产儿新生儿呼吸窘迫综合征（RDS）发生率（25.4%）高于对照组（12.0%）,差异有统计学意义（P<0.05）;试管组先天性畸形发生率（3.3%）高于对照组（0%）,差异有统计学意义（P<0.05）;试管组病死率（9.0%）高于对照组（2.2%）,差异有统计学意义（P<0.05）。结论：试管早产儿与自然妊娠早产儿相比,更易患RDS,且畸形率及病死率均较自然受孕儿高,故仍应慎重选择辅助生殖技术的方式,并加强孕产期监护。     

Intraluminal casein model of necrotizing enterocolitis for assessment of mucosal destruction,bacterial translocation,and the effects of allopurinol and N-acetylcysteine

An intraluminal casein model (ICM) of necrotizing enterocolitis (NEC) is able to produce small-bowel changes reminiscent of human NEC in neonatal animals. We studied bacterial translocation (BT) in NEC induced by using the ICM in neonatal piglets. We also studied whether allopurinol (AL) and N-acetylcysteine (NAC) have an effect on BT and mucosal changes in the ICM of NEC. Twenty-eight neonatal piglets were randomized into four groups. NEC was induced in 21 by injecting casein-d-gluconate into a loop of terminal ileum: group Cas (n = 7) had no premedication, in group Cas/AL (n = 7) intravenous (i.v.) Al (100 mg/kg), and in group Cas/NAC (n = 7) i.v. NAC (200 mg/kg) was given. Group Sham (n = 7) had the ileum injected with 0.9% saline with no premedication. Immediately after the injection a mesenteric lymph node (MLN) adjacent to the loop was harvested for quantitative aerobic bacterial culture; 4 h after the injection another MLN and samples of spleen, liver, kidney, and lung were harvested and cultured. Comparison of the incidence of samples with positive bacterial cultures and the number of colony-forming units (CFU) in samples was made between groups. The severity of NEC in the ileum was graded from 0 to 3 according to macroscopic and histologic findings. NEC changes in the bowel were most severe in Cas piglets, less severe in Cas/NAC piglets ( P < 0.5), and sham piglets had the least severe changes ( P < 0.05). piglets with NEC changes in the ileum had a higher incidence of BT into the MLN than piglets without NEC changes ( P < 0.05), but the difference in CFU was not significant ( P > 0.05). In Cas and Cas/NAC piglets a high incidence of BT into the MLN was noted as early at -5 min after casein injection. The incidence of BT into the MLN was significantly higher in Cas and Cas/NAC piglets than in Sham piglets ( P < 0.05), the difference in CFU being not significant ( P > 0.05). BT in Cas/Al piglets was not significantly different from that of Cas piglets ( P > 0.05), but less than in Cas/NAC piglets ( P < 0.05). Four hours after casein injection into the ileum there was significant BT into the MLN. Premedication with NAC was associated with less severe NEC changes, but neither NAC nor AL significantly affected BT.     

新生儿肺炎死亡病例中B族链球菌的检测

目的对北京儿童医院新生儿肺炎死亡病例进行B族链球菌（GBS）回顾性检测,旨在初步揭示GBS感染在新生儿重症肺炎中的地位。方法收集200例1953年到2004年间新生儿肺炎死亡病例（研究组）和34例非感染性疾病新生儿死亡病例（对照组）的尸检病理标本,提取石蜡组织DNA,通过PCR和Southem blot技术检测GBS特异性基因片断咖基因。同时对所选病例的临床资料进行复习。结果（1）研究组200例中,PCR对GBS检出率为26％,Southern blot检出率为65％,检出率均明显高于对照组（PCR3％,x^2=8．82,P〈0．01;Southern blot,18％,x^2=26．77,P〈0．01）。（2）研究组中,年龄小于7d的病例（早发型）103例,年龄大于7d的病例（晚发型）97例,小于7d的患儿GBS检出率明显高于大于7d的患儿,其中PCR检出率在前者为37％,后者为13％（x^2=15．537,P〈0．01）,Southern blot检出率在前者为72％,后者为52％（x^2=4．37,P〈0．05）。早发型阳性病例中,39％为早产儿（29／74）。（3）研究组中,75例有完整临床资料,其中35例可查到一项或多项与GBS感染有关的危险因素,如早产,低体重,胎膜早破,羊水异常等,GBS检测结果均为阳性。阳性病例中,早发型最常见的表现有青紫、窒息,呼吸困难,晚发型最常见的表现有咳喘,呼吸困难。对照组中,1例PCR检测阳性者患恶性畸胎瘤,其他5例仅Southern blot检测阳性者分别为核黄疸、肝癌、先天性无肛合并膀胱尿道瘘、新生儿自然出血、先天性低位无肛合并直肠会阴瘘患者。结论GBS是新生儿肺炎死亡病例中的重要病原,尤其在早发型肺炎病例中GBS感染占很大比重。Southern blot是在石蜡标本中检测GBS的较为敏感方法。     

Effect of dietary fat on early morphological intestinal adaptation in a rat with short bowel syndrome

Among factors promoting mucosal hyperplasia after bowel resection, long-chain fatty acids may have a special role. The purpose of the present study was to evaluate the effects of high-fat diet (HFD) on early intestinal adaptation in rats with short bowel syndrome (SBS). Male Sprague-Dawley rats underwent either a bowel transection with re-anastomosis (Sham rats) or 75% small bowel resection (SBS rats). Animals were randomly assigned to one of three groups: Sham rats fed normal chow (Sham-NC); SBS rats fed NC (SBS-NC); and SBS rats fed HFD (SBS-HFD). Rats were killed on days 3 or 14. Body weight and parameters of intestinal adaptation (overall bowel and mucosal weight, mucosal DNA and protein, villus height, and crypt depth) were determined at time of killing. By day 3, SBS-HFD rats demonstrated higher duodenal and jejunal bowel and mucosal weights and ileal villus height and jejunal crypt depth vs SBS-NC rats. By day 14 SBS-HFD rats continued to demonstrate increased duodenal and jejunal bowel weight and duodenal mucosal weight vs SBS-NC animals. We conclude that early exposure to HFD both augmented and accelerated structural bowel adaptation in a rat model of SBS.     

Intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study.

BACKGROUND: Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short-bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status of intestinal mucosa of these patients. METHODS: Six children with short-bowel syndrome--median age, 12 months, and median small bowel length at birth, 30 cm--had a sugar test with 3-o-methyl-D-glucose, D-xylose, D-rhamnose, and melibiose approximately 2 months after operation. The melibiose/L-rhamnose ratio was used as an index of permeability, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were used as indices of absorption. Parenteral nutrition requirement, bowel length, liver disease, recent sepsis, and bacterial overgrowth were recorded. RESULTS: Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver disease. All subjects had malabsorption of 3-o-methyl-D-glucose, and five of six had malabsorption of D-xylose and L-rhamnose. The absorption of 3-o-methyl-D-glucose correlated with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time. CONCLUSIONS: Increased permeability was observed in three of six patients with short-bowel syndrome associated with a recent episode of sepsis and severe liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple points during the disease course whether the test can be helpful in the management of these patients.     

Retinopathy of prematurity: 10-year retrospective study at the University Hospital of Strasbourg]

OBJECTIVES: This work was splitted in two parts: the first one was the study of retinopathy incidence in premature infants less than 33 weeks gestation, born between 1988 and 1997; the second one is the identification of severe retinopathy different risk factors. PATIENTS AND METHODS: Our study was retrospective over ten years. All premature infants less than 33 weeks gestation born between January 1, 1988 and December 31 1997, admitted to the Strasbourg neonatal intensive care unit with retinopathy, were included (164 children). First we studied the incidence evolution of retinopathy over these ten years; then by a statistical study (univaried and multivaried) we looked for a significant difference for several factors between the infants with mild retinopathy and the group with severe ocular disease. RESULTS: Retinopathy incidence decreased in ten years from 13.7 to 6.7% for the moderate forms (P < 0.001) and from 3.7 to 1.7% for severe stage (non significant). A significant difference was found for various factors after comparison between both groups. The birth weight (P = 5 x 10(-4)), the gestational age (P = 4 x 10(-6)), were weaker in the group with severe retinopathy. A maternofetal or nosocomial infection (P = 0.009; P = 0.002), hemodynamic shock (P = 10(-6)), patent ductus arteriosus (P = 10(-6)), bronchopulmonary dysplasia (P = 3 x 10(-6)), postnatal steroid treatment (P = 0.007), respiratory distress syndrome (P = 0.01), were all more frequent in the severe retinopathy sample. The number of days with oxygenotherapy (P = 10(-6)) and mechanical ventilation (P = 10(-6)) the number of blood transfusion (P = 10(-5)) were higher in this group than in the other. The logistic regression analysis showed that the hemodynamic parameters influence mostly on the risk of severe ocular disease, like an hemodynamic shock syndrome (OR = 16.94; CI = 2.12-135.77) or a patent ductus arteriosus (OR = 5.36; CI = 1.53-18.74). CONCLUSION: A decrease of the retinopathy incidence in premature infants was observed in ten years, probably due to better care in the neonatal period. An unstable hemodynamic state would be one prominent risk factor in the genesis of severe retinopathy of prematurity.     

Neonatal short bowel syndrome: 'rectal feeding' in order to stimulate intestinal growth

Short bowel syndrome (SBS) is characterized by a state of malabsorption following extensive resection of the small bowel, resulting in insufficient nutritive supply requiring artificial nutrition with long-term parenteral nutrition. Here we present an illustrative case report of a premature infant born with gastroschisis and SBS, who was treated with enteral refeeding via rectum. The infant developed during the period of rectal feeding with jejunostomy loses bowel lengthening and could be fed orally within a few months after birth. Rectal feeding with ostomy loses could stimulate bowel growth and adaptation in neonatal SBS.
Conclusion: The purpose of this report is to describe an illustrative case of short bowel syndrome due to gastroschisis and to share a novel technique of rectal feeding to stimulate bowel growth and adaptation.     

先天性肠闭锁、肠狭窄120例临床分析

目的 总结先天性肠闭锁、肠狭窄的临床特点及手术治疗效果,探讨短肠综合征与预后的关系,提高临床治愈率.方法 回顾性分析120例先天性肠闭锁、肠狭窄患儿的临床表现、影像学检查、病理分型、手术方式及治愈情况,将随访的40例患儿按照术后保留肠管长度分为短肠组及非短肠组,以同年龄段正常儿童平均体重作为对照,将短肠组体重分别与非短...     

Endogenous production of nitric oxide in endotoxemic piglets

We sought to assess the relation between endotoxin-induced pulmonary hypertension and the production of nitric oxide (NO) in neonatal animals. Adult animals respond to endotoxin by increasing exhaled NO and plasma NO metabolites. The response of neonatal animals has not previously been reported. We administered 20 microg/kg of Escherichia coli lipopolysaccharide (LPS) to 12- to 18-day-old and to 5- to 7-week-old piglets. Pulmonary vascular resistance increased significantly in both age groups. Exhaled NO in the 12- to 18-day-old animals and in the 5- to 7-week-old piglets did not increase significantly. A similarly treated group of adult rats did show a significant increase in exhaled NO (2.6 +/- 1.0 to 109.5 +/- 54.3 ppb; p = 0.028). Plasma NO metabolite measurements followed the same pattern of no increase in both porcine groups, and a large increase in the rat group. However, immunostaining of lungs from 12- to 18-day-old piglets did reveal an increase in inducible NO synthase. These results suggest that piglets demonstrate a limited ability to modulate LPS-induced pulmonary hypertension by elevations in exhaled NO. They also demonstrate the differential response to LPS between species.     

吸入一氧化氮对早产猪未成熟肺的作用

目的：研究早产猪在机械通气下吸入一氧化氮(NO)对未成熟肺的呼吸功能、核转录因子(NFκB)表达的影响,以研究出生早期吸入NO是否对不成熟肺产生不良反应,并判断应用肺表面活性物质(PS)及NO的肺保护作用效果及其调节炎症反应的作用和机制。方法：选择101～103d孕龄(89%足月孕期)母猪,行剖宫产获得32头早产猪(平均出生体重870g),气管插管后行间歇正压机械通气,随机分成4组(每组n=8)治疗:单纯机械通气(C组);吸入NO(NO组);加用肺表面活性物质(PS组);NO和PS联合应用(SNO组)。另选同窝自主呼吸组(N组)用于比较NFκB水平、肺湿干重比及肺组织病理学。机械通气各组分别测肺功能,血气分析,计算氧合指数(OI)和通气指数(VI)。机械通气6h后处死动物。结果：治疗6h肺顺应性(Cdyn)和气道阻力(Raw)在各组间无统计学差异,OI在SNO组显著低于C组2.3±1.9vs9.5±7.5(P<0.05),VI在NO和SNO组低于C组和PS组(P<0.05或P<0.01)。NO组及N组NFκB活性最低,与C组相比差异有显著性,P<0.05。NO吸入过程中监测NO2水平均<1ppm。所有动物高铁血红蛋白(MetHb)浓度均<4%。NO和SNO组肺组织湿干重比显著低于C组6.88±0.53vs7.77±0.76(P<0.05)和6.61±0.56vs7.77±0.76(P<0.01)。病理检查见各组不同程度肺水肿、白细胞浸润,肺泡扩张度(Vv)和变异度(CV[Vv])显示肺泡中度成熟,但差异均无显著性。结论：出生早期应用iNO或联合应用PS治疗可改善早产猪氧合和机械通气效率;小剂量短时间NO吸入有利于肺液清除,没有显著改变PS成分和/或直接致肺损伤;NO通过下调NFκB可能具有抑制/调节早产肺炎症反应启动机制的作用。