新生儿胃穿孔的临床特点及影响预后的因素

目的探讨新生儿胃穿孔的临床特点及影响预后的相关因素。方法本研究为回顾性研究。研究对象为山西省儿童医院新生儿外科2008年1月至2017年12月手术治疗的49例新生儿胃穿孔病例。分析这些患儿的临床表现、辅助检查、手术情况及预后等临床资料。根据预后将患儿分为存活组和死亡组,探讨影响患儿预后的相关因素。采用独立样本t检验或连续性校正χ^2检验(或Fisher精确概率法)分析数据。结果(1)49例患儿中,男29例(59.2%),女20例(40.8%);早产儿30例(61.2%),足月儿19例(38.8%);体重(2450±700)g,范围为1010~5000 g。29例(59.2%)为低出生体重儿。11例(22.4%)有围产期不良事件;17例(34.7%)术前合并感染性休克;6例(12.2%)合并其他消化道畸形。2例(4.1%)有生后窒息复苏史,2例(4.1%)合并呼吸窘迫综合征行机械通气,12例(24.5%)有留置胃管或洗胃史。(2)49例患儿的发病时间为(3.8±2.0)d,47例(95.9%)于生后1周内发病,其中36例于生后≤4 d发病;25例(51.0%)发病到手术时间≤12 h。(3)首发症状以单纯腹胀最常见[69.4%(34/49)],12例(24.5%)腹胀伴呕吐,39例(79.6%)患儿术前腹部立位X射线片可见膈下大量游离气体,肝脏受压下移,胃泡影减小或消失。(4)所有患儿入院后均急诊行开腹探查、胃壁一期修补术。术中见27例(55.1%)穿孔位于胃大弯,5例(10.2%)位于胃小弯,14例(28.6%)位于胃前壁,3例(6.1%)位于胃后壁。33例(67.3%)穿孔长径≥3 cm。术后3例(6.1%)发生切口感染,2例(4.1%)吻合口漏;1例术后48 h发现大量气液胸,再次手术证实为食道重复并食道穿孔。(5)49例中,35例(71.4%)的病因为先天性胃壁肌层缺损,4例(8.2%)为损伤,10例(20.4%)为自发性穿孔。(6)49例中,8例(16.3%)死亡,36例(73.5%)存活,5例(10.2%)术后放弃治疗。剔除5例放弃治疗的患儿后,存活组中发病到手术时间≤12 h及穿孔长径<3 cm患儿的比例高于死亡组[61.1%(22/36)与1/8,χ^2=4.404;41.7%(15/36)与0/8];死亡组合并感染性休克的比例高于存活组[6/8与22.2%(8/36),χ^2=6.147](P值均<0.05)。结论新生儿胃穿孔病死率较高,先天性胃壁肌层缺损是新生儿胃穿孔的病理基础和主要病因,突然出现的腹胀是其主要的临床表现。尽早手术有助于提高治愈率。     

Incidence and determinants of new AIDS-defining illnesses after HAART initiation in a Senegalese cohort

Background  

Although a dramatic decrease in AIDS progression has been observed after Highly Active Anti Retroviral Therapy (HAART) in both low- and high-resource settings, few data support that fact in low-resource settings.     

Developing equine mtDNA profiling for forensic application

Horse mtDNA profiling can be useful in forensic work investigating degraded samples, hair shafts or highly dilute samples. Degraded DNA often does not allow sequencing of fragments longer than 200 nucleotides. In this study we therefore search for the most discriminatory sections within the hypervariable horse mtDNA control region. Among a random sample of 39 horses, 32 different sequences were identified in a stretch of 921 nucleotides. The sequences were assigned to the published mtDNA types A–G, and to a newly labelled minor type H. The random match probability within the analysed samples is 3.61%, and the average pairwise sequence difference is 15 nucleotides. In a “sliding window” analysis of 200-nucleotide sections of the mtDNA control region, we find that the known repetitive central motif divides the mtDNA control region into a highly diverse segment and a markedly less discriminatory segment.     

Seasonal fluctuations of the nematode communities in a hop garden soil

A study on the seasonal fluctuation of nematode population was conducted during three vegetation periods (2005 – 2007), at 20 and 40 cm soil depth, from May to October, in a hop garden at Nemšová (Slovak Republic). The seasonal fluctuation of the nematode population was related to temperature and rainfall. At 20 cm soil depth of each year, the largest nematode population was recorded in July, and the smallest from July to October. At 40 cm soil depth, nematode abundance was not significantly different between the years 2006 and 2007. In general, at the same depth, a decrease of nematode abundance was observed from May to October. The soil nematode community was rich in bacteriovorous nematodes, especially in the top 20 cm soil. The genus Rhabditis was the eudominant taxon at both soil depths. This genus with the genera Cephalobus, Heterodera, Merlinius and Aglenchus represented the 50 % of the total nematode population at 20 cm soil depth and with the genera Cephalobus, Helicotylenchus, Heterodera and Merlinius represented the 52 % of total nematodes abundance at 40 cm depth.     

Using constrained optimal control to model a socially sustainable fishery

In the so‐called sole‐owner‐case of a renewable resource harvesting, it is known that the optimal policy includes a period with no harvesting, if the population is insufficiently small. Therefore, the fishermen have no income in this phase. To avoid this problem, the optimal control problem was enhanced in two different ways. First, the capital accumulation rate was bounded from below what generated a global mixed constraint. Second, lower bounds for the capital stock at a finite number of time points were introduced, which at first led to one and afterwards several isolated inequality constraints. For the resulting constrained optimal control problems, the necessary conditions were derived and an iterative algorithm was implemented to calculate the solutions in several numerical examples. Copyright © 2010 John Wiley & Sons, Ltd.     

Role of endocytic inhibitory drugs on internalization of amyloidogenic light chains by cardiac fibroblasts

Amyloidosis is a disease of protein misfolding that ultimately impairs organ function. Previously, we demonstrated that amyloidogenic light chains (kappa1, lambda6, and lambda3 subtypes), internalized by cardiac fibroblasts, enhanced sulfation of secreted glycosaminoglycans. In this study, we investigated the internalization and cellular trafficking of urinary immunoglobulin light chains into cardiac fibroblasts. We demonstrate that these light chains have the ability to form annular rings in solution. Internalization was assessed by incubating cells in the presence of light chain conjugated to Oregon Green 488 followed by monitoring with live cell confocal imaging. The rate of light chain internalization was reduced by treatment with methyl-beta-cyclodextrin but not filipin. Amyloid light chain did co-localize with dextran-Texas Red. Once internalized, the light chains were detected in lysosomes and then secreted into the extracellular medium. The light chain detected in the cell lysate and medium possessed a lower hydrophobic species. Nocodazole, a microtubule inhibitor, did not disperse aggregates. In addition, internalization and retention of the light chain proteins was altered in the presence of the proteasomal inhibitor MG132. These results indicate that the cell internalizes light chain by a fluid phase endocytosis, which is then modified and ultimately compromises the cell.     

Male expulsion in cooperative Mongolian gerbils (Meriones unguiculatus)

Mongolian gerbils are territorial rodents of steppes and semideserts of Mongolia and Northern China. At least under laboratory conditions, the family life is characterized by long-term harmonious and short-term aggressive periods in which some members are expelled. The purpose of this study was to clarify which features of male offspring promote their expulsion. Therefore body mass, absolute and relative weight of testes and epididymis, histology of testes and testosterone concentrations were analyzed in males derived from five families living in semi-natural enclosures with food and water ad libitum. Males expelled (EFM, n=40) had significantly higher relative testes and relative epididymis weight and higher testosterone concentrations in harmonious periods than it did non-attacked ones (IFM, n=13). A stepwise discriminant analysis has established the relative testes weight as decisive for the affiliation to EFM or IFM. Based on this parameter, 71.7% of the offspring could be classified correctly. Moreover, histological results showed that 50.0% of integrated and 29.4% of the expelled family members had incomplete spermiogenesis, indicating a reduced fertility. It is concluded, that males do compete for reproduction within the families which triggers the expulsion of the males with the highest reproductive capacity.