Objective To investigate the value of adenosine deaminase (ADA) for the diagnosis of tuberculous serous cavity fluidify. Methods The literatures on the application of ADA for the diagnosis of tuberculous serous cavity fluidify in the database including PUBMED and CNKI were reviewed. Results Studies including randomized controlled trial or meta-analysis have performed to determine the level of ADA in the effusion of tuberculous serous cavity fluidify. These studies have sufficiently proved that ADA is a specific and sensitive method for the diagnosis of extrapulmonary tuberculosis. Most of the studies have determined the optimal cut-off value of ADA in the effusion of tuberculous serous cavity fluidify. Conclusion Measurement of ADA in the effusion of tuberculous serous cavity fluidify is widely used as a fast, convenient, safe and effective adjunctive diagnostic method of tubeculosis in clinic.
Objective To investigate the protective effect of the exosome on the organ damage induced by ische-mia-reperfusion (I/R) so as to provide a new way for the treatment of I/R damage. Methods The literature related to the treatment of I/R damage was reviewed and analyzed. Results The exosome volume is small and it is present in blood, cerebrospinal fluid, and urine, which has the function to cross the blood-brain barrier, and protect the heart, brain and other organs after I/R damage. Conclusion Exosome is a new material for the treatment of I/R organ injury, and it is important to understand the protective effect and possible mechanism.
ObjectiveTo systematically review the effectiveness and safety of interventions which target to improve the rate of successful extubation in preterm infants.MethodsPubMed, Web of Science, Cochrane Library, Chongqing VIP database, China National Knowledge Infrastructure, and Wanfang Database were searched for articles published from the dates of establishment of databases to August 2020, which compared different noninvasive respiratory support models or different doses of caffeine to improve the rate of successful extubation in preterm infants in randomized controlled trials. The references of included articles were also retrieved. And then a meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 randomized controlled trials involving 4 536 preterm infants were included. Compared with nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC) reduced the nose injury rate [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.15, 0.57), P=0.000 3] and the pneumothorax rate [OR=0.18, 95%CI (0.06, 0.55), P=0.003]; nasal intermittent positive pressure ventilation (NIPPV) reduced the extubation failure rate [OR=0.33, 95%CI (0.23, 0.48), P<0.000 01], the reintubation rate [OR=0.36, 95%CI (0.20, 0.65), P=0.000 7], the respiratory failure rate [OR=0.33, 95%CI (0.17, 0.64), P=0.000 9], and the pneumothorax rate [OR=0.29, 95%CI (0.12, 0.70), P=0.006]; and biphasic positive airway pressure (BiPAP) reduced the reintubation rate [OR=0.21, 95%CI (0.09, 0.46), P=0.000 1]. Compared with low-dose caffeine, high-dose caffeine reduced the extubation failure rate [OR=0.44, 95%CI (0.32, 0.60), P<0.000 01] and the bronchopulmonary dysplasia rate [OR=0.69, 95%CI (0.48, 0.99), P=0.04], but increased the rate of tachycardia [OR=1.99, 95%CI (1.22, 3.25), P=0.006].ConclusionAccording to the current evidence, compared with NCPAP, NIPPV and BiPAP could be used to improve the rate of successful extubation in preterm infants, HFNC could be used to decrease the risk of nose injury and pneumothorax; the optimal dose of caffeine should be chosen after evaluating the risk of adverse reactions such as tachycardia.
Objective To explore the change tendency of hypoxia-inducible factor-1α (HIF-1α) and extracellular signal-regulated kinase 1/2 (ERK1/2) in fetal rat cerebral cortex neurons cultured in vitro after hypoxia-ischemia reperfusion andto investigate their mutual relationship. Methods Cortical neurons obtained from cerebral cortex of 15 pregnant SD rats at16-18 days of gestation underwent primary culture. The primary neurons 5 days after culture were adopted to establ ish model of oxygen and glucose deprivation (OGD). The experiment was divided into 4 groups: the experimental group 1, culture medium was changed to neuron complete medium containing glucose after the preparation of OGD model to form reperfusion, and the neurons were observed 0, 2, 4, 8, 12 and 24 hours after reperfusion; the control group 1, the neurons were treated with normal medium; the experimental group 2, the neurons were pretreated with U0126 followed by the preparation of OGD model, and the neurons were observed 4 and 8 hours after reperfusion; the control group 2, the neurons were pretreated with DMSO, and other treatments were the same as the experimental group 2. Expressions of HIF-1α, VEGF protein, ERK1/2 and p-ERK1/2 were detected by Western blot. Expression and distribution of p-ERK1/2 and HIF-1α protein were detected by SABC immunocytochemistry method. Results Compl icated synaptic connections between cortical neurons processes were observed 5 days after culture. The expression of HIF-1α and VEGF were increased gradually, peaked at 8 hours, and decreased gradually after 12 hours in the experimental group 1, and there were significant differences between the experimental group 1 and the control group 1 (P lt; 0.05). There was no significant difference between the experimental group 1 and the control group 1 in terms of ERK1/2 protein expression (P gt; 0.05). The p-ERK1/2 protein expression in the experimental group 1 started to increase at 2 hours peaked at 4 hours, and started to decrease at 8 hours, showing significant differences compared with the control group 1 (P lt; 0.01). In the experimental group 2, the p-ERK1/2 protein decreased, and HIF-1αand VEGF protein expression subsequentlydecreased, showing significant differences compared with the control group 2 (P lt; 0.05). There was no significant difference between the experimental group 2 and the control group 2 in terms of ERK1/2 protein expression at each time point (P gt; 0.05). Immunocytochemistry staining showed that p-ERK1/2 and HIF-1α expression decreased, and the yellow-brown staining of the neurons was reduced. Conclusion Expressions of HIF-1α and its target-gene VEGF protein in the cortex neurons after OGD reperfusion are time-dependent. Their expressions decrease when ERK1/2 signal ing pathway is inhibited, indicating the pathway plays an important role in the regulation of HIF-1α and VEGF induced by OGD of cortical neurons
To set up an economic and effective method for islet isolation from rat, and thereby prove a laboratory protocol of animal model for cl inical islet transplantation. Methods Twenty-five adult male SD rats weighing 230-380 g were used as organ donor. In each of 5 repeated experiments, pancreatic islets of 5 animals were isolated by intraductal infusion of compound sodium chloride injection (CSCI), and subsequently, digested with low concentration (0.5 mg/mL)of collagenase V solution. Islet purification was performed by using a discontinuous density gradient centrifugation thatwas prepared with 27.0%, 23.0%, 20.5% and 11.0% of Ficoll 400. Islet yield and purity were determined by dithizon (DTZ)stain, and propidium iodide (PI)/fluorescein diacetate (FDA) double stain was used to check viabil ity of islets. The endocrine secretory function was assessed by insul in secretion in either low (2.8 mmol/L) or high (25.0 mmol/L) glucose incubation after 3 days of culture in RPMI1640 media. Results Average islet digestion time of 5 experiments was (13.8 ± 1.6) min. Before purification, average isolated number was (5 626 ± 422) islets, and the number was significantly reduced to (2 914 ± 485) islets after purification (P lt; 0.01). The average recovery rate was 51.6% ± 6.0%, and the average yield was (583 ± 97) islets/pancreas. The average purity and viabil ity of islets were 90.2% ± 3.4% and 81.6% ± 7.0%, respectively. After 3 days of culture, insul in secretion of the islets was (116.1 ± 17.4) EU/L in high glucose incubation, which was significantly higher than that of low glucose environment [(39.7 ± 7.5) EU/L, P lt; 0.01)]. The average insul in stimulation index was 3.0 ± 0.4. Conclusion The islet isolation with the CSCI solution and digestion with low concentration of collagenase V decrease experimental cost and also have a beneficial effect on islet recovery and their function.
ObjectivesTo systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection.MethodsThe clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis.ResultsA total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection.ConclusionsThe clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.
ObjectivesTo systematically review the clinical characteristics of pregnant females and juveniles (<18 years) with Middle East Respiratory Syndrome (MERS), so as to provide evidence for epidemic prevention and treatment of COVID-19.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on clinical characteristics of pregnant females and juveniles with MERS from inception to February 15th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 12 studies involving 12 pregnant females, and 21 juveniles with MERS were included. The results of studies showed that the male to female ratio of juveniles patients was 1 to 1.63 and the age ranged from 9 months to 16 years. The primary transmission route of juveniles cases was family contact infection, accounting for 57.1% (12/21). Asymptomatic juveniles accounted for 57.1% (12/21), and the most common symptoms were fever, cough and shortness of breath. Some patients exhibited gastrointestinal symptoms such as vomiting and diarrhea. The positive rate of MERS-CoV RCT test was 100.0% (21/21). As for chest radiograph, 73.7% (14/19) cases showed no obvious lesions, and juveniles with lesions were mainly bilateral. 3 patients with underlying diseases developed severe cases, the mortality was 9.5% (2/21). The age range of pregnant women was 27 to 39, with the gestational age from 6 to 38 weeks. The primary transmission route for pregnant women was nosocomial infection, accounting for 57.1% (4/7). Fever, cough, shortness of breath were common manifestations, while abdominal pain occurred in two female patients. The positive rate of MERS-CoV RCT test was 100.0% (11/11). The chest radiograph findings were mainly bilateral lesions, accounting for 55.6% (5/9). 80.0% of whole pregnant females were severe cases (8/10), 4 of them died, with the 50.0% (4/8) mortality in severe pregnant cases. Among the infective pregnant women, 2 were stillborn and 10 were delivered, of which 1 died due to premature delivery. The remaining 9 surviving newborns were not infected with MERS-CoV and there was no evidence of mother-to-child transmission.ConclusionsThe clinical symptoms of MERS in juveniles are similar to those in adults, however, considerably milder. Severe case rate is higher in patients with underlying diseases. However, maternal infections could be much severe with higher mortality. It is particularly important to strengthen the management of pregnant females, especially prevent hospital infection. There is still no evidence of MERS-CoV mother-to-child transmission.
ObjectiveTo analyze the clinical data of pregnant females and children infected with H1N1 during the global pandemic in 2009, and summarize the epidemiological characteristics.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect studies on H1N1 infection in pregnant females and children during the 2009 pandemic from January 1st, 2009 to February 17th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, epidemiological characteristics were descriptively analyzed.ResultsA total of 33 studies involving 939 children, 5 newborns and 2 416 maternal infections were included. The results showed that the age span of children was 0 to 18, the male-to-female ratio was 1.2:1, and the history of close contact accounts was 18.8% (80/425). The primary symptoms were fever, cough, headache, vomiting and other symptoms in some children. More than half of the children received oseltamivir antiviral treatment (545/807, 67.5%), and 6 died (6/861, 0.7%). The primary symptoms of pregnant females were fever, cough, sore throat, muscle pain, fatigue, headache, diarrhea, and so on. The majority of patients received antiviral therapy (1 571 to 1 783, 88.1%). A total of 178 mortalities (178/2 335, 7.6%), 48 stillbirths (48/966, 5.0%), and 9 live birth mortalities (9/494, 1.8%) were reported. All 5 newborns were positive for RT-PCR detection, including 4 premature infants. The mode of transmission was close contact in 3 cases (including 1 case in contact with sick medical staff), 1 case of vertical transmission from mother to child, and 1 case of unknown. The primary clinical manifestation of newborns was dyspnea. After treatment with oseltamivir, 4 cases were cured and 1 case deceased.ConclusionsPregnant females and children are at high risk of serious complications of H1N1 influenza. H1N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes. The symptoms of H1N1 infection in children and pregnant females are similar to those in adults, primarily respiratory and systemic symptoms. Oseltamivir and zanamivir are effective antiviral drugs.
High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to set up, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the grading of recommendations assessment, development and evaluation (GRADE). The guideline was formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. This guideline aims to be a source of evidence and references of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.