远端缺血预处理在婴幼儿心脏外科手术中的心肺保护作用

目的 观察远端缺血预处理对婴幼儿心肺功能的保护作用.方法 将48例先天性心脏病患儿随机分为远端缺血预处理组(RIPC组)和对照组.分别在麻醉诱导后,超滤结束时,ICU1、3、6、12、24 h采集血标本,测定肌钙蛋白I(cTnI)浓度,记录动脉血氧分压、气道阻力、氧和指数、肺顺应性.结果 术后RIPC组血清cTnI升高水平低于对照组,但差异无统计学意义(P＞0.05),RIPC组ICU 3 h血清cTnI水平显著低于对照组(10.8±8.5比16.3±15.9,P＜0.01).ICU时间RIPC组高于对照组[(4±2)d比(3±1)d,P＜0.05).结论 远端缺血预处理对心肌的缺血再灌注损伤有保护作用,对肺功能未产生有利影响.

Abstract：

Objective To investigate the protective effect of remote ischemic preconditioning (RIPC) on infants subject to cardiac surgery. Methods Forty-eighty infants were randomized into two groups: RIPC group ( n = 24) and control group ( n = 24). Blood samples were taken after the induction of anesthesia, at the end of ultrafiltration, and at 1,3, 6, 12 and 24 h after ICU arrival for determination of plasma cardiac troponin I (cTnI) concentrations. The pulmonary functional data including artery blood oxygen pressure (PaO2), airway resistance, oxygenation index (OI) and pulmonary compliance were recorded. Results Levels of plasma cTnI were lower in RIPC group than in control group, but there was no significant difference ( P ＞ 0. 05). Levels of plasma cTnI at 3 h after ICU arrival in RIPC group were markedly lower than in control group ( 10. 8 ± 8.5 vs. 16. 3 ± 15.9,P ＜ 0. 01 ). The ICU time in RIPC group was significantly longer than in control group[(4 ± 2) days vs. (3 ± 1 ) days,P ＜ 0. 05 )]. Conclusion RIPC appears to protect the heart against ischemia-reperfusion injury, but can not improve the pulmonary function or the postoperative clinical course in the settings of cardiac surgery of infants.     

Genetics of Bone Mass in Childhood and Adolescence: Effects of Sex and Maturation Interactions

We aimed to determine if adult bone mineral density (BMD) susceptibility loci were associated with pediatric bone mass and density, and if sex and pubertal stage influenced any association. We analyzed prospective areal BMD (aBMD) and bone mineral content (BMC) data from the Bone Mineral Density in Childhood Study (n = 603, European ancestry, 54% female). Linear mixed models were used to assess if 77 single‐nucleotide polymorphisms (SNPs) near known adult BMD susceptibility loci interacted with sex and pubertal stage to influence the aBMD/BMC; adjusting for age, BMI, physical activity, and dietary calcium. The strongest main association was observed between an SNP near C7orf58 and distal radius aBMD. However, this association had a significant sex?SNP interaction, revealing a significant association only in females (b = –0.32, p = 1.8 × 10^–6). Furthermore, the C12orf23 locus had significant interactions with both sex and pubertal stage, revealing associations in females during Tanner stage I for total hip aBMD (b = 0.24, p = 0.001) and femoral neck aBMD (b = 0.27, p = 3.0 × 10^–5). In contrast, the sex?SNP interactions for loci near LRP5 and WNT16 uncovered associations that were only in males for total body less head BMC (b = 0.22, p = 4.4 × 10^–4) and distal radius aBMD (b = 0.27, p = 0.001), respectively. Furthermore, the LRP5 locus interacted with both sex and pubertal stage, demonstrating associations that were exclusively in males during Tanner V for total hip aBMD (b = 0.29, p = 0.003). In total, significant sex?SNP interactions were found at 15 loci; pubertal stage?SNP interactions at 23 loci and 19 loci interacted with both sex and pubertal stage. In conclusion, variants originally associated with adult BMD influence bone mass in children of European ancestry, highlighting the fact that many of these loci operate early in life. However, the direction and magnitude of associations for a large number of SNPs only became evident when accounting for sex and maturation. © 2015 American Society for Bone and Mineral Research.     

Binding characteristics of anti-Rh0(D) antibodies to Rh0(D)-positive and Du red cells

The relation of human erythrocyte Rh0(D) to Du sites is an important unresolved question in the field of immunohematology. To compare the immunological reactivity of Rh0(D)-positive and Du erythrocytes, the binding characteristics of two anti-Rh0(D) antisera to human Rh0(D)- positive and Du ("low-grade") erythrocytes were studied. 14C-Protein A and direct antibody-labeled techniques were used to generate binding curves and to derive double-reciprocal plots. The results show that the number of antigen sites differ by a factor of 10 to 15 between the Rh0(D)-positive and Du red cells, but that the dissociation constants between anti-Rh0(D) and the Rh0(D) and Du antigens are indistinguishable when studied by the two labeling methods and two different anti-Rh0(D) antibodies. The extent of binding to 112 different Du samples showed a normal distribution and was independent of apparent phenotype. These data suggest immunologic identity of Rh0(D) and Du ("low-grade") sites and that the difference between the antigens of Rh0(D) and Du cells is quantitative only. The data are incompatible with the "missing mosaic" and gene interaction theories of mechanism.     

体外循环术中去白细胞常温血心脏停搏液灌注对心肌的保护作用

目的 :研究体外循环术中去白细胞常温血心脏停搏液微流量连续灌注对心肌的保护作用。方法 :临床随机选择主动脉 (AO)阻断时间在 60min以上的心脏瓣膜置换患者 2 0例。随机分为试验组和对照组 ,每组 1 0例 ,检测术中不同时间点脂肪酸结合蛋白 (HH FABP)水平和右心房心肌内髓过氧化物酶 (MPO)含量。结果 :①试验组AO开放后 2 0min ,40min ,60min血清HH FABP均较AO阻断前及开放即刻升高 (P <0 .0 1或P <0 .0 5) ,且含量均明显低于对照组 (P <0 .0 1 )。②试验组AO开放即刻及开放后 2 0min心房心肌内MPO与阻断前相比无明显增加 ,而对照组与阻断前相比明显增加 (P <0 .0 1 ) ,2组之间比较 ,差异有统计学意义 (P <0 .0 1 )。HH FABP与AO阻断时间呈正相关 ,试验组r=0 .962 4 ,P <0 .0 1 ,对照组r=0 .70 31 ,P <0 .0 5。结论 :去白细胞常温血心脏停搏液微流量连续灌注可减轻心肌缺血 再灌损伤 ,有利于心肌保护     

彩色多普勒超声诊断良恶性甲状腺结节的参考价值

目的分析良、恶性甲状腺结节的彩色多普勒超声表现,以提高超声诊断和鉴别诊断良、恶性甲状腺结节的价值。方法回顾性分析经手术、病理明确诊断的157个良、恶性甲状腺结节的彩色多普勒超声表现,良、恶性结节的形态、回声、钙化特点、彩色多普勒血流图血流信号分布等。结果157个甲状腺结节经病理诊断,其中 90个为良性结节,67个为恶性结节;本组病例彩色多普勒超声检查的特异性为92.2%,敏感性为80.6%,诊断符合率为87.2%;彩色多普勒超声图像显示甲状腺良、恶性结节的形态、边界、包膜、回声、血流信号分布、内部钙化情况、血流阻力指数值比较,差异比较均具有统计学意义（P<0.05）。结论彩色多普勒超声可诊断甲状腺病变,依据重要的参考指标,可评价甲状腺结节的良、恶性。     

温氧合血连灌与冷晶体液间灌心肌线粒体量化计分及形态改变的对比研究

目的：对温血连续灌注与冷晶体液间断灌注下心肌线粒体结构及量化计分进行了对比研究。方法：病人分两组（每组７例）,主动脉阻断６０分钟后及再灌注２０分钟各取２ｍｍ直径心室壁肌肉置入４℃２．５％戊二醛液中固定２小时。在Ｈ６００型电镜下选择５个视野、每视野随机观察２０个线粒体。依受损程度分为０～４级（０级为正常结构,４级受损程度最重）,将１００个线粒体按级得分总和除以１００即为该组得分数。结果：阻断６０分钟线粒体量化计分冷晶组为２．５１４３±０．２８６３,温血组计分为１．５４８６±０．０９１５（Ｐ＜０．００１）。再灌注２０分钟后冷晶组记分为３．０１４３±０．１７９２,温血组记分为１．６８２９±０．１５８１（Ｐ＜０．０１）。阻断６０分钟再灌２０分钟电镜下冷晶组线粒体嵴断裂、溶解、基质颗粒丢失明显、内外膜完整性消失;温血组线粒体嵴无断裂、外膜完整、基质颗粒略少。结论：电镜下线粒体超微结构及量化计分证明温血组心肌保护作用明显优于冷晶组。     

Paediatricians' perspectives on global health priorities for newborn care in a developing country: a national survey

ABSTRACT: BACKGROUND: An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. METHODS: Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with MannWhitney U test. RESULTS: Valid responses were received from 152 (65.8%) of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. CONCLUSIONS: Current global priorities for neonatal survival in Nigeria largely accord with paediatricians' views except for neonatal jaundice which is commonly subsumed under miscellaneous neonatal conditions. While the importance of these priority conditions extends beyond mortality thus suggesting the need for a broader conceptualisation of newborn health, paediatricians should be actively engaged in advancing the attainment of global priorities for child survival and health in this population.     

Recommendations for a standardized avian coronavirus (AvCoV) nomenclature: outcome from discussions within the framework of the European Union COST Action FA1207: “towards control of avian coronaviruses: strategies for vaccination,diagnosis and surveillance”*

Viruses within the Coronaviridae family show variations within their genome sequences, especially within the major structural protein the Spike (S) glycoprotein gene. Therefore, many different antigenic forms, serotypes or variant strains of avian coronaviruses (AvCoV) exist worldwide. Only a few of them, the so called protectotypes, cross protect against different serotypes. New serotypes arise by recombination or spontaneous mutations. From time to time, antigenic virus variants appear, which differ significantly from known serotypes. The result of this variability is an inconsistent nomenclature and classification of virus strains. Furthermore, there are currently no standard classification methods defined. Within the framework of the COST Action FA1207 “Towards control of avian coronaviruses: strategies for diagnosis, surveillance and vaccination” (working groups “Molecular virology” and “Epidemiology”), we aimed at defining and developing a unified and internationally standardized nomenclature and classification of AvCoVs. We recommend the use of “CoV Genus/AvCov/host/country/specimen id/year” to refer to AvCoV strains.     

Ability of inactivated vaccines based on far-eastern tick-borne encephalitis virus strains to induce humoral immune response in originally seropositive and seronegative recipients

Tick-borne encephalitis (TBE) remains one of the major public health concerns in northern Eurasia, and its’ area is expanding. TBE virus (TBEV) includes three subtypes and several monophyletic groups, cocirculating in Russia. Five inactivated vaccines are used for TBE prophylaxis. The rising number of people subjected to vaccination brings up the issue of the impact of individual recipient characteristics on vaccination efficacy. The present work studies correlations among the vaccination scheme, sex, age, body mass index (BMI), chronic diseases, postvaccinal reaction, pre-existing anti-TBEV antibodies, and postvaccinal humoral immunity development. Sera were collected during clinical trials in the TBEV Siberian subtype endemic area. Adult recipients were vaccinated with Tick-E-Vac and EnceVir vaccines based on Far-Eastern TBEV strains. Vaccine ability to induce humoral immunity in different categories of recipients was estimated by seroconversion rates and the percentage of recipients with high neutralizing antibody titers (≥1:500). High immunogenicity of vaccines based on Far-Eastern TBEV strains in the TBEV Siberian subtype endemic area in all groups of recipients was demonstrated. Impact of pre-existing contact with the virus and high BMI on humoral immune response development 14 days after the first immunization was evidenced. Nevertheless, the difference was significantly less pronounced 30 days after the first vaccination and undetectable after the second one.