[A comparative study of two ventilation modes in the weaning phase of preterm infants with respiratory distress syndrome]

OBJECTIVE

To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS).

METHODS

Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV+VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration (from onset of weaning to extubation), duration of nasal continuous positive airway pressure (NCPAP) after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and the mortality rate were compared between the two groups.

RESULTS

The PSV+VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group (P<0.05). There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups (P>0.05).

CONCLUSIONS

For preterm infants with RDS, the PSV+VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.

[Effects of Shenfu injection on calreticulin expression and neuronal apoptosis in the cerebral cortex of neonatal rats with hypoxic-ischemic brain damage]

OBJECTIVE

To examine the expression of calreticulin (CRT) and the changes of intracellular free calcium and neuronal apoptosis in the cerebral cortex of neonatal rats with hypoxic-ischemic brain damage (HIBD), and to investigate the intervention effects of Shenfu injection.

METHODS

Seven-day-old rats were randomly assigned to three groups: control, hypoxic-ischemia (HI) and Shenfu-treated. Each group (n=50) was subdivided into 5 groups sacrificed at 3, 6, 12, 24 and 72 hours. Rat models of HIBD were prepared according to the Rice's method. Rats in the control group only underwent the separation of right common carotidartery. Shenfu injection was administered by intraperitoneal injections right after HI insults and then once daily at a dosage of 10 mL/kg for 3 days in the Shenfu-treated group. The expression of CRT in the cerebral cortex was detected by RT-PCR and Western blot. The free calcium concentrations were determined under a fluorescent microscope. The apoptosis rate was measured by the flow cytometry.

RESULTS

Compared with the control group, the expression levels of CRT in the HI and the Shenfu-treated groups were obviously up-regulated (P<0.05), and the expression levels of CRT in the Shenfu-treated group were notably higher than those in the HI group (P<0.05) at all time points. The concentrations of intracellular free calcium and the apoptosis rate of neurons in the cerebral cortex in the Shenfu-treated group were significantly reduced compared with those in the HI group (P<0.05), but increased significantly compared with those in the control group at all time points (P<0.05).

CONCLUSIONS

Shenfu injection may have neuroprotective effects against HIBD by up-regulation of CRT expression and relief of calcium overload.

Strategies for the improvement of salidroside production in cell suspension cultures of Rhodiola sachalinensis

Strategies of elicitation and precursor feeding were applied to improve salidroside production in cell suspension cultures of Rhodiola sachalinensis. Of the seven elicitors examined, that extracted from Aspergillus niger was the most effective, increasing the salidroside content by five-fold when added on the day of inoculation 40 mg carbohydrate is medium. Three possible precursors for salidroside synthesis, L-phenylalanine, L-tyrosol and L-tyrosine were added to the cultures. A high content of salidroside (1.440%) was attained with an initial L-tyrosol concentration of 0.5 mM in the medium. Combined application of the two strategies resulted in a significantly high salidroside content of 1.734%, corresponding to a salidroside yield of 200 mg/l.

Anthropometrical antecedents of non-insulin dependent diabetes mellitus: an age and sex matched comparison study of anthropometric indices in schoolchildren from a high prevalence Port Moresby community

Anthropometrical indices of 66 school children aged between 7 and 9 years from a community with a very high prevalence of non-insulin dependent diabetes mellitus (NIDDM) were compared with those of age and sex matched school children from two low prevalence communities. Two way analysis of variance indicated that case children of both sexes were significantly lighter (P < 0.001), shorter (P < 0.001) and had lower body mass indices (BMI) (P < 0.001) than their comparisons but had greater triceps skinfold thickness (TSFT) (P = 0.01). These differences may be a reflection of subtle changes in metabolism in children destined, without intervention, to develop NIDDM. Anthropometrical indices may therefore have a role to play in the prediction of future disease. Although not the prime objective of the study, an analysis of available birth weights indicated a lower mean birth weight for the cases than the controls (difference of means, 0.35 kg; 95% confidence intervals (CI95%). 0.13-0.57). This finding is consistent with the theory that impaired intrauterine growth may predispose to NIDDM.

Profile of blood donors in Port Moresby

A record analysis study was conducted on blood donors in the greater Port Moresby area to determine the trend in the number of blood donations and the profile of donors between 1985 and 1994. There was no significant change in the donation trend between 1985-1989 and 1990-1994. While there were no changes in the age distribution between these two periods, there were significant increases in female donors (from 17% to 25%) and new donors (47% to 54%) during 1990-1994. The study data show that there has been a problem in the retention of donors in the greater Port Moresby area during the 1990-1994 period.

Persistent diarrhoea in children admitted to Port Moresby General Hospital

A retrospective study of the records of children admitted to Port Moresby General Hospital with diarrhoea during 1992 and 1993 was carried out to determine the morbidity, mortality and risk factors associated with persistent diarrhoea. 858 admissions of children under five years of age who had diarrhoea were identified from the ward admission registers, and case records for 724 were studied. Persistent diarrhoea occurred in 20%, and nearly half of these were in the 12-23 months age group. Children with persistent diarrhoea had a case fatality rate of 4.9%. Seasonality was similar for both persistent and non-persistent diarrhoea. In the crude analysis children of 12 months and older had a greater risk of developing persistent diarrhoea than those less than 12 months (odds ratio for children 12-23 months was 2.0 and for children 24-59 months 1.7; confidence intervals were 1.2-3.1 and 1.0-2.9 respectively); however, this difference was not found after logistic regression analysis. Poor nutritional status was a significant risk factor for persistent diarrhoea and remained so after controlling for confounding variables (odds ratio 2.7; confidence interval 1.8-4.0).

Energy intake and basal metabolic rate during maintenance chemotherapy

Energy intakes and basal metabolic rates were determined in 26 children receiving chemotherapy in remission from acute lymphoblastic leukaemia or solid tumours and 26 healthy controls matched for age and sex. Body weight and height on the two groups were comparable, although one patient was stunted (height for age) and three others wasted (weight for height). Energy intake in the patients at 7705 kJ/day (1842 kcal) and controls at 7773 kJ/day (1866 kcal)) and basal metabolic rate (BMR) in the patients at 4873 kJ/day (1172 kcal) and controls 4987 kJ/day (1196 kcal) for the two groups were not significantly different. Although the energy intake:BMR ratio for both groups was 1.59, the range of values for the patient group was large (0.96-2.73) and appeared to be greater than that observed in the control group (1.23-2.46). These results demonstrated that during this period of chemotherapy there was no evidence of raised energy expenditure at rest or reduced energy intake in the patient group. No indication of undernutrition in the patients as a group was evident, although some individuals might require further clinical nutritional assessment.

Bacteriologic studies of food and water consumed by children in Myanmar: 1. The nature of contamination

To isolate major bacterial pathogens from children's food and drinking water, a 3-month study was conducted in a suburban community in Yangon, Myanmar. From the morning meals and stored drinking water of 208 randomly selected children, 775 food and 113 water samples were collected and were cultured using standard methods. Escherichia coli, Vibrio cholerae non-01, and Salmonella were isolated from 505, 28 and 6 food samples respectively, and E. coli and V. cholerae non-01 were isolated from 29 and 5 water samples respectively. Among the E. coli isolates, 8 produced heat-stable toxin (ST) and 3 were enteroinvasive. Nine V. cholerae non-01 produced cholera-like toxin. Of the 29 E. coli isolates from the samples of drinking water, 3 produced ST. All water samples were negative for Salmonella. The study underscores the importance of bacterial contamination of children's food and drinking water and stresses the need to improve environmental sanitation.

Bacteriologic studies of food and water consumed by children in Myanmar: 2 Lack of association between diarrhoea and contamination of food and water

The association between contamination of morning samples of food and water of 208 children aged 6-29 months and the incidence of diarrhoea was investigated for 3 months in Yangon, Myanmar. Contamination of the samples was determined by isolation of faecal coliforms (FC) by standard methods. The children were divided into three groups, high, medium and low, according to the proportion of food and water samples found to be contaminated. The incidence of diarrhoea was recorded by weekly recall. Of the 779 food samples, 504 (65%), and of the 860 drinking water samples, 187 (22%) were positive for FC. The association between food and water contamination and the incidence of diarrhoea was assessed by comparing the cumulative incidences in the high and medium groups with that in the low group which served as reference. Diarrhoea risk ratios (RR) for children in the medium and high contamination groups (food, RR = 1.04 in medium and 0.78 in high vs 1 in low; water, RR = 0.73 and 0.73 vs 1) were not significantly different from those who were in the low-contamination group even after controlling for the confounding variables.

Measles-associated diarrhoea in the Infectious Diseases Hospital, Rangoon

A study was conducted in the Infectious Diseases Hospital in Rangoon (Burma) to determine the magnitude of measles-associated diarrhoea morbidity and mortality in children under 6 years of age contributing to the overall diarrhoeal morbidity and mortality, and to determine the bacterial pathogens of measles-associated diarrhoea cases. Measles-associated diarrhoea cases occur most frequently in younger age groups (12-23 and 0-11 months). Although not directly comparable, their contribution to the total diarrhoeal cases (8%) was high but the proportion of measles-associated diarrhoeal deaths contributing to total diarrhoeal deaths was lower than the theoretical estimates. A low fatality rate (2%) among the measles-associated diarrhoea cases was found and this suggests a much lower rate in the community. This implies that measles-associated diarrhoeal mortality is probably not a major public health problem in Burma. Chest infection was the most common complication (32%) and was found in the majority of deaths resulting from complicated measles. A definite seasonal distribution of measles and measles-associated diarrhoea cases was found. Only 10% of the stool samples examined were positive for bacterial pathogens and all were shigellae. We found that a significant number of measles-associated diarrhoeal cases were malnourished.

Contamination of drinking water during collection and storage

Drinking water contamination during abstraction, storage and use was determined in a suburban community in Rangoon, Burma, by detecting faecal coliforms (FC) with membrane filtration method. Increasing contamination during water collection, from the source to home storage, was found in all the studied households using 4 different types of drinking water. The implications of the findings are discussed.

Knowledge, attitudes and behaviour in relation to diarrhoea in a rural community in Burma

A study was conducted in a rural community in Burma, to determine how people perceive the importance of food, water and defecation in the causation of diarrhoea and to determine whether people wash hands or use soap after defecation or before preparing and eating food. 90% of mothers with under-five children in the community were interviewed. 53 to 86% of people were aware of the importance of food, water and defecation in the causation of diarrhoea. Although 34 to 88% practised hand washing before eating/food handling or after defecation, only 5 to 12% regularly used soap. Furthermore, drinking water for under-five children was obtained by dipping the drinking mug or cup into the drinking water pot (83%) which could result in contamination of drinking water.