Semi-Quantitative Analysis of Brain MR Imaging in 76 Cases of Neonatal Indirect Hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is indeed common. However, severe nerve injuries and bilirubin encephalopathy are rare and only occur in the unusual cases of extreme hyperbilirubinemia. Objectives: To investigate brain magnetic resonance imaging (MRI) changes and their correlations with perinatal predisposing factors in neonates with indirect hyperbilirubinemia, via regions of interest (ROIs) analysis. Methods: Seventy-six neonates with a gestational age of ≥35 weeks diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy all underwent brain MRI during hospitalization. Depending on peak total serum bilirubin (TSB), they were assigned to group A (<221 μmol/L), B (≥221 μmol/L μmol/L), C (≥42 μmol/L μmol/L), or D (≥428 μmol/L). The globus pallidus and the white matter around the anterior horn of the lateral ventricle and posterior horn of the lateral ventricle were selected as the ROIs. Average optical densities (AODs) of the ROIs and the cerebrospinal fluid region were measured. The ratio between the AODs was designated as the relative optical density (ROD), and used to determine relative signal intensity. Results: RODs of the globus pallidus were significantly lower in group D than in all other groups. TSB and the ratio of TSB to serum albumin concentration (B/A) was significantly negatively correlated with ROD in theglobus pallidus. Corrected age was significantly negatively correlated with the ROD of the ROIs. Conclusions: Semi-quantitative image analysis is a feasible method to assess conventional brain MRI for neonatal indirect hyperbilirubinemia. The signal intensity of the globus pallidus in T1-weighted images was significantly correlated with TSB level and B/A.

Bronchopulmonary Dysplasia in Premature Infants with Very Low Birth Weight: A Single Centre Retrospective Study in China

To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.

Effect of dexamethasone on intelligence and hearing in preterm infants: a meta-analysis

OBJECTIVE： A meta-analysis of published randomized controlled trials investigating the long- term effect of dexamethasone on the nervous system of preterm infants. DATA SOURCES： Online literature retrieval was conducted using The Cochrane Library （from January 1993 to June 2013）, EMBASE （from January 1980 to June 2013）, MEDLINE （from Janu- ary 1963 to June 2013）, OVID （from January 1993 to June 2013）, Springer （from January 1994 to June 2013） and Chinese Academic Journal Full-text Database （from January 1994 to June 2013）. Key words were preterm infants and dexamethasone in English and Chinese. STUDY SELECTION： Selected studies were randomized controlled trials assessing the effect of intravenous dexamethasone in preterm infants. The quality of the included papers was evaluated and those without the development of the nervous system and animal experiments were exclud- ed. Quality assessment was performed through bias risk evaluation in accordance with Cochrane Handbook 5.1.0 software in the Cochrane Collaboration. The homogeneous studies were analyzed and compared using Revman 5.2.6 software, and then effect model was selected and analyzed. Those papers failed to be included in the meta-analysis were subjected to descriptive analysis. MAIN OUTCOME MEASURES： Nervous system injury in preterm infants. RESULTS： Ten randomized controlled trials were screened, involving 1,038 subjects. Among them 512 cases received dexamethasone treatment while 526 cases served as placebo control group and blank control group. Meta-analysis results showed that the incidence of cerebral palsy, visual im- pairment and hearing loss in preterm infants after dexamethasone treatment within 7 days after birth was similar to that in the control group （RR = 1.47, 95%CI： 0.97-2.21; RR = 1.46, 95%CI： 0.97-2.20; RR = 0.80, 95%CI： 0.54-1.18; P 〉 0.05）, but intelligence quotient was significantly de- creased compared with the control group （MD = -3.55, 95%CI： -6.59 to -0.51; P = 0.02）. Prete rm infants treated with dexamethasone 7 days after birth demonstrated an incidence of cerebral palsy and visual impairment, and changes in intelligence quotient similar to those in the control group （RR = 1.26, 95%CI： 0.89-1.79; RR = 1.37, 95%CI： 0.73-2.59; RR = 0.53, 95%CI： 0.32-0.89; RR = 1.66, 95%CI： -4.7 to 8.01; P 〉 0.05）. However, the incidence of hearing loss was significantly increased compared with that in the control group （RR = 0.53, 95%CI： 0.32-0.89; P = 0.02）. CONCLUSION： Dexamethasone may affect the intelligence of preterm infants in the early stages after birth, but may lead to hearing impairment at later stages after birth. More reliable conclusions should be made through large-size, multi-center, well-designed randomized controlled trials.

The impact of water quality on the formation of halogenated benzoquinones and the adsorption efficiency by activated carbon

Halogenated benzoquinones(HBQs)could cause bladder cancer,but there were few related studies on the generation and control.In this study,the impact of different precursors,pH,bromide concentration,and algae-derived organic matters on the formation of HBQs and the removal efficiency by activated carbon were investigated.It was found that the chlorination of bisphenol A produced the most 2,6-dichloro-1,4-benzoquinone(2,6-DCBQ),reaching 14.86μg/L at 1 hr,followed by tyrosine,2-chlorophenol,P-hydroxybenzoic acid,trichlorophenol,and N-methylaniline.The production of 2,6-DCBQ increased first and then decreased from 0 to 36 hr(chlorination doses 0-20 mg/L),indicating that HBQs were unstable in water.Trihalomethanes(THMs)were detected during chlorination,and the concentration increased with prolongation of reaction time.2,6-DCBQ production decreased and 2,6-dibromo-1,4-benzoquinone(2,6-DBBQ)production increased with increment bromide concentration and the bromide promoted the formation of tribromomethane.The production of 2,6-DCBQ decreased with increase of pH,and the maximum production was 141.38μg/L at pH of 5.Microcystis aeruginosa,Chlorella algae cells,and intracellular organic matters(IOM)could be chlorinated as potential precursors for HBQs.The most amount of 2,6-DCBQ was generated from algae cells of Microcystis aeruginosa,followed by Chlorella algae cells,Microcystis aeruginosa IOM,and Chlorella IOM.This study compared the removal efficiency of HBQs by granular activated carbon(GAC)and columnar activated carbon(CAC)under different carbon doses and initial concentrations of HBQs.It was found that the removal efficiency by GAC(80.1%)was higher than that by CAC(51.8%),indicating that GAC has better control for HBQs.

Efficient Contact between H_(2)O and N-Coordinate Ru Nanoparticles in Three-Dimensionally Ordered Macro/Mesoporous Carbon Boosting Alkaline HER

In this study,a novel approach is proposed to achieve the uniformly dispersed Ru nanoparticles with N coordination loaded on three-dimensionally ordered macro/mesoporous carbon(3DOMMC)through simultaneous pyrolysis of Ru^(3+)and cyanamide on 33DOMMC.In an alkaline medium,the synthesized catalysts exhibit exceptional hydrogen evolution reaction(HER)performance.Specificall,Ru-N/3DOMMC demonstrates a significantly low overpotential of 13.8 mV to achieve acrent density of 10 mA.cmzandit exhibits a mass activity 17.5 times higher than that of commercial Pt/C.The outstanding performance could be attributed to the ultrahigh Ru dispersion and more efficient contact between active sites and reactant,which derived from the large specific surface area and interconnective three-dimensionally macro/mesopores of 3DOMMC.