Comparison between Bubble CPAP and Ventilator-derived CPAP in Rabbits

BackgroundContinuous positive airway pressure (CPAP) is used in infants with respiratory distress and apnea. Bubble CPAP (B-CPAP) and ventilator-derived CPAP (V-CPAP) are two of the most popular CPAP modes, and use different pressure sources. However, few studies have been performed to compare their differences and effectiveness. This study was to determine whether B-CPAP and V-CPAP would have different effects on vital signs and arterial blood gas analysis.MethodsWe performed a randomized crossover study to measure vital signs, including mean blood pressure (MBP), heart rate (HR), and respiratory rate (RR), in 12 ketamine-anesthetized healthy rabbits receiving endotracheal intubation by tracheostomy with B-CPAP or V-CPAP. Arterial blood was also sampled and analyzed for PaO2, PaCO2, HCO3− and pH.ResultsWe observed statistically significant decreases in RR, pH and PaO2 with corresponding incrases in PaCO2 and HCO3− during the V-CPAP; however, no significant changes from baseline were observed for B-CPAP. Neither modality resulted in statistically significant changes in MBP or HR. Both forms of CPAP altered vital signs and arterial blood gases in a similar manner. There was a trend towards a lower percentage of change from baseline in all variables in B-CPAP compared with V-CPAP.ConclusionsOur results suggest that B-CPAP seems to be superior to V-CPAP in terms of its effect on arterial blood gases and vital signs. We speculate that B-CPAP could have certain protective effects that better preserve both arterial blood gases and vital signs when compared to V-CPAP. However, the results of this study still need to be tested by clinical study

Ingested Button Battery Retrieved by a Modified Magnet Endoscope

Ingestion of button battery (BB) by toddlers has been seen with increasing frequency over the past decade. Significant morbidity may develop if the ingested BB cannot be removed in time. Herein, we describe 2 infants whose ingested BBs were smoothly and successfully retrieved, from a stenotic esophagus and stomach, by the use of a self-made modified magnet endoscope

Influence of Changing the Diameter of the Bubble Generator Bottle and Expiratory Limb on Bubble CPAP: An in vitro Study

The noisy component of bubble continuous positive airway pressure (CPAP) is thought to contribute to breathing efficiency and lung volume recruitment, mainly because of stochastic resonance. The magnitude and frequency of the superimposed noise are vital to this process. We wanted to evaluate the in vitro effect of changing various parameters of the bubble CPAP circuit regarding the magnitude and frequency of pressure oscillations transmitted to the lung model. Methods: In a bubble CPAP lung model, we immersed different sizes (3.0∼12.5 mm) of the expiratory limb of the CPAP circuit into different depths under water (2.0∼10.0 cm) and used various diameters (2.9∼9.0 cm) of bubble generator bottles. We also varied the compliance of the model lung. We measured the changes in mean, magnitude, and frequency of pressure oscillations transmitted to the lung model at three different flow rates (namely 4, 8, and 12 L/minute). Results: Increasing the size and submergence depth of the expiratory limb of a CPAP circuit and decreasing the diameter of the bubble generator bottle intensified the magnitude but diminished the frequency of noise transmitted to the lung model. Decreasing compliance of the lung model intensified both the magnitude and frequency content of pressure oscillations in the model lung. Conclusion: The size and submergence depth of an expiratory limb of a CPAP circuit, the diameter of the bubble generator bottle, and the compliance of the model lung all influence the magnitude and frequency of the transmitted pressure waveform. Therefore, these factors may affect lung volume recruitment and breathing efficiency in bubble CPAP

Applying Convolutional Neural Network in Automatic Assessment of Bone Age Using Multi-Stage and Cross-Category Strategy

Bone age is a common indicator of children’s growth. However, traditional bone age assessment methods usually take a long time and are jeopardized by human error. To address the aforementioned problem, we propose an automatic bone age assessment system based on the convolutional neural network (CNN) framework. Generally, bone age assessment is utilized amongst 0–18-year-old children. In order to reduce its variation in terms of regression model building, our system consists of two steps. First, we build a maturity stage classifier to identify the maturity stage, and then build regression models for each maturity stage. In this way, assessing bone age through the use of several independent regression models will reduce the variation and make the assessment of bone age more accurate. Some bone sections are particularly useful for distinguishing certain maturity stages, but may not be effective for other stages, and thus we first perform a rough classification to generally distinguish the maturity stage, and then undertake fine classification. Because the skeleton is constantly growing during bone development, it is not easy to obtain a clear decision boundary between the various stages of maturation. Therefore, we propose a cross-stage class strategy for this problem. In addition, because fewer children undergo X-rays in the early and late stages, this causes an imbalance in the data. Under the cross-stage class strategy, this problem can also be alleviated. In our proposed framework, we utilize an MSCS-CNN (Multi-Step and Cross-Stage CNN). We experiment on our dataset, and the accuracy of the MSCS-CNN in identifying both female and male maturity stages is above 0.96. After determining maturity stage during bone age assessment, we obtain a 0.532 and 0.56 MAE (mean absolute error) for females and males, respectively

Subclinical Histologic Chorioamnionitis and Related Clinical and Laboratory Parameters in Preterm Deliveries

Histologic chorioamnionitis (HCA) is associated with preterm delivery and with neonatal morbidity and mortality. Because HCA is usually subclinical, histologic examination of the placenta is essential for confirmatory diagnosis. In the present study, the correlations between subclinical HCA and relevant clinical and laboratory parameters were analyzed. Methods: This was a retrospective study. We reviewed the placental histopathologic findings and the charts of patients who were admitted to our neonatal intensive care unit after delivery and their mothers between January 2007 and March 2008. A total of 77 preterm infants [gastational age (GA): 32.2 ± 3.4 weeks, birth weight (BW): 1,718 ± 554 g] were categorized as group A with histologic evidence of placental inflammation (n = 27) or group B without histologic evidence of placental inflammation (n = 50). Placental histology was studied to identify the presence of inflammatory states such as chorioamnionitis, funisitis and deciduitis. Laboratory parameters including complete blood count, differential count, and C-reactive protein (CRP) level of mothers and initial arterial blood gas, glucose level and mean blood pressure of the infants were documented. Gestational age, Apgar score, history of prolonged premature rupture of membrane (prolonged PROM), gestational diabetes mellitus, meconium-stained amniotic fluid, pregnancy-induced hypertension and signs of pre-eclampsia were also collected as clinical parameters. All data were analyzed using independent t tests and Fisher's exact test, as appropriate. Results: Group A newborns had a significantly lower gestational age (30.8 ± 4.1 weeks vs. 33.0 ± 2.6 weeks, p < 0.05) and higher CRP level (0.56 ± 0.92 mg/dL vs. 0.12 ± 0.14 mg/dL, p < 0.05), together with higher maternal WBC count (13,002 ± 4,344/μL vs. 10,850 ± 3,722/μL, p < 0.05) and higher rate of prolonged PROM [14/27 (51.85%) vs. 8/37 (21.62%), p < 0.05] compared with group B newborns. Conclusion: We found that HCA was significantly correlated with lower gestational age, higher CRP level of preterm infants, higher maternal WBC count, and a higher rate of prolonged PROM. Our results demonstrate a significant association between HCA with an elevated CRP level in preterm infants. These findings further confirmed the association between maternal inflammation and preterm deliveries

Endogenous Nitric Oxide in the Nasal Airways of Healthy Term Newborn Infants in Taiwan

Nitric oxide (NO) in the respiratory tract is an important regulator of pulmonary homeostasis during the perinatal transition. In humans, much of the nitric oxide is derived from the upper airways, and autoinhalation of nasal NO has been suggested to influence pulmonary function. No standard methods for measuring nasal NO in neonates currently exist, and previous studies have reported varying levels of nasal nitric oxide in infants, due to the different measuring methods used. The use of nasal olives with a central lumen placed securely in the nares was recommended as a standardized procedure for the measurement of nasal NO in adults and children in 1999. We attempted to establish a safe, convenient and practical method for measuring nasal NO in healthy newborn infants, and investigated possible correlations between nasal NO and gender, postnatal age, gestational age, birth weight, and the differences between the right and left nostrils. Methods: Nasal NO was studied in healthy newborn infants within the first 3 postnatal days. Gas was sampled from the nostril, and NO concentrations were determined using a fast response chemiluminescence analyzer. Each newborn infant underwent NO measurements on the first, second and the third postnatal days. Ninety-one newborn infants completed the study. Results: Peak nasal NO in 91 newborn infants was 42.52 ± 16.82 (mean ± SD) parts per billion (ppb) (right nostril) and 40.86 ± 16.08 ppb (left nostril) on the first postnatal day, 48.75 ± 17.64 ppb (right nostril) and 49.47 ± 17.26 ppb (left nostril) on the second postnatal day, and 59.65 ± 19.72 ppb (right nostril) and 59.29 ± 20.09 ppb (left nostril) on the third postnatal day. Nasal NO increased significantly with postnatal age (p< 0.001). There were no significant differences in nasal nitric oxide between sexes, or in relation to gestational age or birth weight, or between left or right nostrils. Conclusion: We conclude that nasal NO increased significantly in the first 3 days of life

Transcranial pulsed ultrasound facilitates brain uptake of laronidase in enzyme replacement therapy for Mucopolysaccharidosis type I disease

Abstract Background Mucopolysaccharidosis type I (MPS I) is a debilitating hereditary disease characterized by alpha-L-iduronidase (IDUA) deficiency and consequent inability to degrade glycosaminoglycans. The pathological accumulation of glycosaminoglycans systemically results in severe mental retardation and multiple organ dysfunction. Enzyme replacement therapy with recombinant human alpha-L-iduronidase (rhIDU) improves the function of some organs but not neurological deficits owing to its exclusion from the brain by the blood-brain barrier (BBB). Methods We divided MPS I mice into control group, enzyme replacement group with rhIDU 2.9 mg/kg injection, enzyme replacement with one-spot ultrasound treatment group, and enzyme replacement with two-spot ultrasound treatment group, and compare treatment effectiveness between groups. All ultrasound treatments were applied on left side brain. Evans blue was used to simulate the distribution of rhIDU in the brain. Results Transcranial pulsed weakly focused ultrasound combined with microbubbles facilitates brain rhIDU delivery in MPS I mice receiving systemic enzyme replacement therapy. With intravenously injected rhIDU 2.9 mg/kg, the IDUA enzyme activity on the ultrasound treated side of the cerebral hemisphere raised to 7.81-fold that on the untreated side and to 75.84% of its normal value. Evans blue simulation showed the distribution of the delivered drug was extensive, involving a large volume of the treated cerebral hemisphere. Two-spot ultrasound treatment scheme is more efficient for brain rhIDU delivery than one-spot ultrasound treatment scheme. Conclusions Transcranial pulsed weakly focused ultrasound can open BBB extensively and facilitates brain rhIDU delivery. This novel technology may provide a new MPS I treatment strategy

PRKAG3 polymorphisms associated with sporadic Wolff–Parkinson–White syndrome among a Taiwanese population

Background: The aim of this study was to investigate whether mutation in AMP-activated protein kinase (AMPK) subunit genes (PRKAG3-230) is associated with sporadic, isolated Wolff–Parkinson–White (WPW) syndrome. Methods: This study consisted of 87 patients with symptomatic WPW syndrome and 93 healthy controls. PRKAG3-230 genotypes were determined using real-time polymerase chain reaction assay. Genotype and allele frequencies of PRKAG3-230 between patients with WPW syndrome and healthy controls were ascertained using chi-square test or Fisher exact test when appropriate. Results: PRKAG3-230 were genotyped in 87 patients (53 men and 34 women; age=24.4±18.0 years) with WPW syndrome and 93 healthy controls (57 men and 36 women; age=16.8±4.2 years). There were no significant differences between the two groups in terms of age and sex. The patients with CG and CG+CC genotypes had a significantly increased risk of WPW syndrome compared with those with GG genotype [odds ratio (OR)=1.99, 95% confidence interval (CI)=1.01–3.89, p=0.045; OR=1.99, 95% CI=1.04–3.78, p=0.037, respectively]. The allelic types were not associated with the risk of WPW syndrome. The patients with manifest type with CG and CG+CC genotypes had a significantly increased risk of WPW syndrome compared with those with GG genotype (OR=2.86, 95% CI=1.16–7.05, p=0.022; OR=2.84, 95% CI=1.19–6.80, p=0.019, respectively). The patients with right-side accessory pathways with CG and CG+CC genotypes had a significantly increased risk of WPW syndrome compared with those with GG genotype (OR=3.07, 95% CI=1.25–7.51, p=0.014; OR=2.84, 95% CI=1.19–6.80, p=0.019, respectively). The allelic types were not associated with the risk of WPW types and locations. Conclusion: This study shows that PRKAG3-230 may be associated with sporadic WPW syndrome among a Taiwanese population. Further studies are warranted to elucidate the role of mutations in AMPK subunit genes other than PRKAG3-230 in sporadic WPW syndrome

Reevaluating Reference Ranges of Oxygen Saturation for Healthy Full-term Neonates Using Pulse Oximetry

We compared our clinical experience with currently available reference oxygen saturation level (SpO2) values from the American Academy of Pediatrics/American Heart Association (AAP/AHA) neonatal resuscitation program guidelines. Methods: We enrolled 145 healthy full-term neonates; infants showing respiratory distress and those with serious congenital anomalies were excluded. SpO2 values at every 1 minute until 10 minutes after birth were measured and recorded. Infants were classified into the cesarean section (CS) and normal spontaneous delivery (NSD) groups for evaluating differences. The 10th percentiles of SpO2 at each minute were used as the lower limits of normal oxygen saturation, and these were compared with the lowest target values recommended in the AAP/AHA guidelines. Results: Overall, 130 vigorous full-term neonates (median gestational age: 38 5/7 weeks; body weight at birth: 2405–3960 g) were analyzed. The median SpO2 were 67% and 89% at the 1st and 4th minute, respectively. On average, SpO2 values reached >90% at the 5th minute. No statistical differences were noted in the SpO2 values between the CS and NSD groups after 5 minutes; however, a trend of higher SpO2 was observed in the NSD group. We noted a gradually increasing trend for SpO2 values over time, similar to that noted in the AAP/AHA guidelines. However, SpO2 values at the 10th percentiles of each minute within the first 5 minutes in our study were equal to or significantly lower than those in the AAP/AHA guidelines; moreover, at the 10th minute, SpO2 values at the 10th percentiles were significantly higher than those in the guidelines. Conclusion: The delivery modes did not affect the SpO2 values of full-term healthy neonates. Discrepancies in SpO2 changes in full-term neonates not requiring resuscitation between this study and the AAP/AHA guidelines were significant. SpO2 ranges for each time point within the first 10 minutes after birth should therefore be reevaluated locally