Probiotics in neonatology

Probiotics are micro-organisms that confer health benefits on the host. Postulated mechanisms include: increasing resistance of the mucosal barrier to migration of bacteria and their toxins by strengthening intestinal cell junctions, modification of host response to microbial products, augmentation of immunoglobulin A mucosal responses, enhancement of enteral nutrition to inhibit the growth of pathogens; production of antimicrobial proteins; and competitive exclusion of potential pathogens. Published meta-analyses and systematic reviews report the effects of probiotics on important clinical outcomes in neonates. This paper will review the evidence for probiotic supplementation in neonatology, with a focus on preterm infants.     

新生儿坏死性小肠结肠炎手术介入治疗的临床分析

目的：评价新生儿坏死性小肠结肠炎（NEC）手术介入治疗的高危因素、预后因素及手术时机。方法：选取2001年10月至2011年10月10年间入住新生儿重症监护室的62例NEC早产儿患者。根据患儿是否需要手术治疗分为手术组（n=20）和非手术组（n=42）。比较两组患儿的一般资料、合并症、临床症状、实验室检查、治疗方法、预后等各因素。结果：呼吸窘迫综合征发生率、肠鸣音消失比例、CRP及血小板水平、血培养阳性比例、X线表现为气腹和固定肠绊及机械通气比例在两组间差异有统计学意义（P<0.05）。手术组患儿预后因素分析显示治愈患儿多处穿孔率及循环衰竭率显著低于死亡患儿,差异有统计学意义（P<0.05）。手术组20例患儿中,19例（95％）在NEC诊断后1周进行手术,15例顺利完成手术。结论：NEC手术介入治疗的高危因素是多因素的;手术的预后与肠道病变及是否循环衰竭有关。NEC手术时间一般在NEC诊断后1周内。     

Does primary surgical closure of the patent ductus arteriosus in infants <1500 g or ≤32 weeks’ gestation reduce the incidence of necrotizing enterocolitis?

BACKGROUND:

The hemodynamic perturbation related to patent ductus arteriosus (PDA) is associated with a higher risk of necrotizing enterocolitis (NEC).

OBJECTIVE:

To determine whether primary surgical closure, as compared with treatment with indomethacin or exposure to prophylactic indomethacin, reduces the incidence of NEC in preterm infants <1500 g and/or ≤32 weeks’ gestation with clinically and echocardiogram-identified PDA.

METHODS:

The literature was reviewed using the methodology for systematic reviews for the Consensus of Science adapted from the American Heart Association’s International Liaison Committee on Resuscitation.

RESULTS:

Ten studies were reviewed. The incidence of NEC was not lower in infants who underwent primary surgery for closure of the PDA compared with infants treated with indomethacin or infants exposed to prophylactic indomethacin (level of evidence 2).

CONCLUSION:

Primary surgical closure of the PDA cannot be recommended as an intervention to decrease the incidence of NEC in infants <1500 g and/or ≤32 weeks’ gestation.     

极低出生体重儿坏死性小肠结肠炎发生率和高危因素分析

目的探讨极低出生体重儿坏死性小肠结肠炎(NEC)的发生率和高危因素。方法回顾性分析我院2006年8月至2011年4月在重症监护室住院时间>24h的极低出生体重儿,按照是否合并NEC分为病例组和对照组,对两组进行21个相关单因素及多因素分析。结果 323例极低出生体重儿发生Ⅱ期以上NEC20例,发生率6.2%。单因素分析显示,病例组医院感染败血症(χ2=29.449)、前置胎盘(χ2=6.648)、和先天性心脏病(χ2=11.353)的比例较对照组明显增加,早期微量喂养(χ2=8.355)的比例低于对照组,开奶时间较对照组延迟[8.5(3.3～15)天比3.0(2～7)天,Z=2.921],P均<0.05。多因素Logistic回归分析显示,医院感染败血症(OR9.050,95%CI3.272～25.030)、前置胎盘(OR6.841,95%CI1.491～31.392)和开奶延迟(OR1.065,95%CI1.007～1.127)是NEC发病的高危因素(P均<0.05)。结论医院感染败血症、前置胎盘、延迟开奶是NEC发病的危险因素。尽早开展微量喂养,积极预防极低出生体重儿医院感染,有助于降低NEC发生率。     

Protective effects of ischemic postconditioning on intestinal mucosa barrier function in rabbits with crush injury of hind limb: an experimental study

Objective: To explore the protective effects of two types of ischemic postconditioning (IP) on intestinal mucosa barrier in rabbits with crush injury of the hind limb.Methods: This study was conducted between August and December 2008 in the Department of Trauma Surgery,Daping Hospital, Third Military Medical University,Chongqing, China. The model of crush injury to the hind limb of rabbits was firstly developed by a 25 kg object with the right hind limbs fixed by wooden splints, and then two types of IP were established, including occluding/opening the common iliac artery and vein alternatively (traditional IP, IP A) and binding/loosening the proximum of the injured hind limb alternatively (modified IP, IP B). Thirty-six male New Zealand white rabbits were randomly divided into three groups: IP A group, IP B group and control group, with 12rabbits in each group. The serum levels of diamine oxidase (DAO) and intestinal fatty acid-binding protein (Ⅰ-FABP)were detected at 2, 6, 12 and 24 hours after injury. Pathological changes of ileum were examined at 24 hours alter injury.Results: The serum levels of I-FABP at 2, 6, 12 and 24hours after injury in both IP A and IP B groups had a significant decrease, compared with control group. DAO levels also showed the same change trend at 2 and 6 hours after injury, but showed no significant difference between two IP groups. No difference in pathological changes of ileum was found among the three groups.Conclusions: IP can protect intestinal mucosa barrier function on the model of hind limb crush injury in rabbits.Meanwhile the modified IP B shows the same protection as the traditional IP A, and is worth applying in clinic.     

瑞芬太尼心肌保护作用的研究进展

背景瑞芬太尼是一超短效阿片受体激动剂,可有效抑制心血管应激反应,维持血液动力学稳定;研究发现瑞芬太尼预处理及后处理可减轻心肌缺血/再灌注损伤（ischemia/reperfusion injury,I/RI）。目的就瑞芬太尼心肌保护作用的研究进展作一综述,使人们系统地了解瑞芬太尼的心肌保护作用及其可能机制。内容主要从瑞...     

Isolated abducens palsies due to pontine lesions

Thirty-seven patients with isolated abducens palsies and additional electro-oculographic (EOG) and/or blink reflex (BR) abnormalities indicating pontine lesions were observed over a 12-year period. The lesions were attributed to vertebrobasilar disease (17 patients), multiple sclerosis (12 patients), undiagnosed inflammatory disease (2 patients), pontine tumor (1 patient), and pontine hematoma (1 patient). In the remaining four patients, no specific cause was found. Main EOG abnormalities were slowed abduction or adduction saccades on the opposite eye (14 and 5 patients, respectively), saccadic pursuit eye movements (12 patients), and ipsilateral canal paresis (6 patients). BR-R 1 abnormalities were seen in four patients, ipsilateral in three, and contralateral in one. Recovery of the abducens palsy was almost always (in 35 patients) associated with recovery of at least one electrophysiologic abnormality, which strongly indicated that both were caused by the same actual lesion. MRI was conducted in 32 patients and disclosed lesions involving the region of the intrapontine abducens nerve in seven (inflammation: 4 patients; infarction, tumor and hematoma: 1 patient each). Abducens palsies are rarely the only clinical sign of pontine disease, but their frequency is underestimated, if based on MRI proven lesions only.     

踝臂指数与缺血性脑血管病的研究进展

踝臂指数(ABI)是评估下肢血液循环不良的指标。动脉粥样硬化可累及全身多处动脉,踝臂指数能反映全身其他动脉的粥样硬化程度。近年研究发现脑卒中发病的危险因素有很多,踝臂指数与颅内动脉粥样硬化程度关系密切,但踝臂指数可作为预测脑卒中患病率和病死率的重要因子之一。在此综述踝臂指数与缺血性脑血管病的关系。     

载脂蛋白H与缺血性脑血管病相关性研究进展

载脂蛋白H作为一种载脂蛋白参与脂蛋白酶的体外激活。近年来大量研究显示,载脂蛋白H及其抗体与动脉粥样硬化和体内血栓形成有较大的相关性,不论在原发性缺血性脑血管病患者中或者是一些血栓性疾病合并缺血性脑血管病的患者中,抗载脂蛋白H抗体浓度都有明显的增加。现对载脂蛋白H与各种缺血性脑血管病的相关性进行分析总结。     

曲美他嗪在缺血性心肌病心力衰竭治疗中的疗效评价

目的研究曲美他嗪治疗缺血性心肌病心力衰竭的临床疗效。方法选择72例缺血性心肌病患者,随机分为治疗组和对照组各36例,治疗组在常规治疗心力衰竭的基础上加曲美他嗪30mg,每日3次口服。对照组常规应用抗心力衰竭治疗,疗程为3个月,观察两组治疗前后左心室收缩末期内径(ESD)、舒张末期内径(EDD)、收缩末期容积(ESV)、舒张末期容积(EDV)、短轴缩短分数(FS)、每搏量(SV)、左心室射血分数(LVEF)、6 min步行距离。结果治疗组与对照组均能有效地治疗缺血性心肌病心力衰竭,两组治疗前后的自身比较显示ESV、FS、SV和LVEF均有统计学意义(P<0.05);治疗前两组比较差异无统计学意义;经过3个月的治疗后,组间比较显示治疗组的ESD、ESV、FS、SV和LVEF较对照组有进一步的改善(P<0.05),两组均未发现与药物相关的不良反应。结论曲美他嗪能有效改善缺血性心肌病患者的心功能,值得临床推广应用。