Association between left precuneus functional connectivity and early neurodevelopment in preterm infants.

Objective To evaluate the effect and value expression of amplitude integrated electroencephalography (aEEG) combined with neonatal behavioral neurological assessment (NBNA) in the diagnosis of brain injury of premature infants (BIPI). Methods From January 2017 to December 2018, 218 cases of premature infants (gestational age was 28 to 36 weeks) in our hospital were divided into brain injury group (102 cases) and non brain injury group (116 cases) according to the presence of brain damage factors. Within 6 hours after premature birth, aEEG was recorded in continuous 3 hours; head B ultrasonic examination was performed within 24 hours and on the third day after birth; head Magnetic Resonance Imaging (MRI) detection was performed before leaving the hospital. In addition, NBNA score was performed until 40 weeks of gestational age. According to the characteristics of aEEG and NBNA score, the value of combined two methods in the diagnosis of brain injury in premature infants was evaluated. Results Clinical application showed that the sensitivity of aEEG combined with NBNA in the diagnosis of brain injury of premature infants was 91.87%, which was higher than 86.31% of aEEG and 76.32% of NBNA; the specificity of aEEG combined with NBNA was 67.53%, which was lower than 75.42% of aEEG and 86.37% of NBNA; the area under the ROC curve of combined diagnosis was 0.856, which was higher than 0.813 of aEEG and 0.754 of NBNA. Conclusion The combined evaluation method has a larger area under the ROC curve and higher sensitivity than single evaluation method, is worthy of clinical promotion and application. Key words: Amplitude integrated electroencephalography; Neonatal Behavioral Neurological Assessment; Premature infant; Brain injury

Objective To investigate the effects of dexmedetomidine (Dex) on cesarean delivery women and newborn undergoing combined spinal-epidural anesthesia.Methods Ninety ASA Ⅰ-Ⅱ full-term pregnancy women who underwent elective cesarean section were randomly divided into 3 groups(n=30):control group (group A) and Dex group (group B and group C).Dex was respectively infused intravenously at 0.5 μg/kg in group B and 1 μg/kg in group C while in group A equal volume of normal saline was infused instead of Dex.The maternal mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation(SpO2),Ramsay scores of mothers were recorded at six time points:before iv(T1),5 min after iv(T2),10 min after iv(T3),15 min after iv (T4),20 min after iv (T5) and the neonate was delivered (T6).Sensory block onset time,duration,the highest level,the time required to achieve the highest level were also recorded,as well as motor block onset time,the highest scores,the time required to achieve the highest scores.Umbilical arterial blood was obtained immediately after breaking the umbilical cord for analysis of blood gas and lactic acid.Apgar scores 1 min and 5 min after labor were recorded,and neonatal behavioral neurological assessment (NBNA) scores 2 d and 14 d after labor were evaluated.Results Ramsay scores were significantly higher,MAP,HR,SpO2 were lower in group C than in group A and B(P＜0.05).Sensory block onset time,duration,the highest level median,the time required to achieve the highest level of group A,group B,group C were respectively as follows:(5.5±1.9) min vs (3.9±1.5) min vs (3.9±1.6) min,(80.1±13.4) min vs (92.0±14.5) min vs (91.3±15.5) min,5.5 (6,4) vs 4 (4,3) vs 4 (4,3),(13.2±3.2) min vs (10.4±1.9) min vs (10.2±2.5) min.The differences were statistically significant (P＜O.05) compared with group A.Motor block o nset time,the highest scores,the time required to achieve the highest scores of group A,group B,group C were respectively as follows:(4.2±1.7) min vs (3.3±1.4) min vs (3.1±1.2) min,(84.5±10.4) min vs (95.6±14.3) min vs (98.3±12.3) min,(16.5±5.8) min vs (13.3±2.7) min vs (12.4±2.7) min.The differences were statistically significant compare with group A(P＜0.05).There was no significant differences in umbilical arterial blood gas analysis,lactic acid,Apgar Scores and NBNA scores among the 3 groups (P＞0.05).Conclusions Dex can provide good sedation,shorten onset time of spinal anesthesia and extend the blocking duration with no adverse effects on Apgar scores and NBNA scores before employing combined spinal-epidural anesthesia.The effect on maternal hemodynamics was less at 0.5 μg/kg than 1 μg/kg of Dex. Key words: Dexmedetomidine; Combined spinal-epidural anesthesia; Cesarean delivery; Parturient ; Newborn

Exposure to fine particulate matter (PM2.5) during pregnancy has been inversely associated with neonatal neurological development. However, the associations of exposure to specific PM2.5 constituents with neonatal neurological development remain unclear. We investigated these associations and examined the mediating role of meconium metabolites in a Chinese birth cohort consisting of 294 mother-infant pairs. Our results revealed that exposure to PM2.5 and its specific constituents (i.e., organic matter, black carbon, sulfate, nitrate, and ammonium) in the second trimester, but not in the first or third trimester, was inversely associated with the total neonatal behavioral neurological assessment (NBNA) scores. The PM2.5 constituent mixture in the second trimester was also inversely associated with NBNA scores, and sulfate was identified as the largest contributor. Furthermore, meconium metabolome analysis identified four metabolites, namely, threonine, lysine, leucine, and saccharopine, that were associated with both PM2.5 constituents and NBNA scores. Threonine was identified as an important mediator, accounting for a considerable proportion (14.53-15.33%) of the observed inverse associations. Our findings suggest that maternal exposure to PM2.5 and specific constituents may adversely affect neonatal behavioral development, in which meconium metabolites may play a mediating role.

Objective To explore the safety and efficacy of intrathecal administration of adipose stem cells derived from bioactive secretome (ASCBS) in treatment of whiter matter injury (WMI) in the preterm infants. Methods Sixty-three cases of WMI were recruited according to the uniform standards from multiple medical centers and they were divided into 3 gestational age (GA) subgroups, which were 21 cases in group A (GA 24-28+ 6), 20 cases in group B (GA 29-32+ 6), and 22 cases in group C (GA 33-36+ 6). The patients were randomly divided into treatment groups and control groups by tossing coins.The treatment groups received lumbar puncture followed with ASCBS intra-thecal injection once daily for 3 consecutive days.Follow-up study included Neonatal Behavioral Neurological Assessment (NBNA) at term-equivalent age and neurodevelopment at corrected age of 6-month.Neurodevelopment was assessed by using the Bayley Scales of Infant Development and Peabody Developmental Motor Scale.The survival rates, NBNA scores, mental development index (MDI), psychomotor develop index (PDI), total motor development quotient, gross motor development quotient and fine motor development among each subgroup were compared. Results Sixty-three cases were recruited, including 31 in the treatment group and 32 in the control group.Only 1 case in the treatment groups lost in the follow-up.No clinical side effects were found in the treatment groups.There was no significant diffe-rence in the survival rate and complication in the preterms in all subgroups of the treatment group and control group (all P>0.05). The gross and total motor development quotient in the treatment group A was higher than that in the control group A(gross motor development quotient: 98.330±6.282 in treatment group A, 90.330±3.777 in control group A, P=0.040; total motor development quotient: 97.330±4.803 in treatment group A, 91.000±4.472 in control group A, P=0.023). The rest findings showed no significant difference between groups. Conclusion The treatment of WMI in preterm infants with ASCBS is safe and can promote the motor development of preterm infants with GA in 24 -28 weeks. Key words: Stem cells; Infant, premature; White matter injury; Lipid stem cells bioactive secretion

To evaluate the efficacy and safety of selective brain hypothermia (SBH) in the treatment of neonates with moderate or severe neonatal hypoxic-ischemic encephalopathy (HIE), and the effect of SBH treatment on serum levels of neuron-specific enolase (NSE) and central nervous specific protein S100. A prospective randomized controlled trial was conducted. From January 2015 to June 2017, 42 children with moderate to severe HIE in the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Bengbu Medical College were enrolled, and they were randomly divided into SBH treatment group and routine treatment group after obtaining the consent of the guardian of the children. The children in routine treatment group were given the traditional symptomatic supportive treatment, supplemented by drugs to promote nerve cell growth. On the basis of traditional treatment, the children in the SBH treatment group were given SBH treatment within 6 hours after birth. The nasopharyngeal temperature was maintained at 33.0-34.5 centigrade and the rectal temperature was maintained at 34.5-35.0 centigrade. The general clinical data of the two groups including gender, gestational age, birth weight, age, 5-minute neonatal asphyxia score (Apgar score), score for neonatal acute physiology perinatal extension version II (SNAPPE II) were collected. The primary outcomes were hospitalized death, severe disability at 15 months of age, neonatal behavioral neurological assessment (NBNA) score at 28 days of age, and Bayley scales of infant development (BSID) score [including mental development index (MDI) score and psychomotor development index (PDI) score] at 15 months of age at follow-up. The secondary outcomes were serum levels of NSE and S100 protein. The occurrences of adverse events in the two groups were recorded. Among 42 HIE children, 1 child of severe congenital malformation and 1 child of platelet count (PLT) < 50×109/L were excluded, and 40 children were enrolled in the study group. During the follow-up period, 2 children of SBH treatment group and 2 children of routine treatment group were lost or the outcome was unknown. Finally, 18 children of each group were enrolled in the analysis. There was no significant difference in the baseline data of gender, gestational age, birth weight, age, 5-minure Apgar score or SNAPPE II score between the two groups, indicating that the baseline data of the two groups were balanced and comparable. The incidence of severe disability in the SBH treatment group was significantly lower than that in the routine treatment group [5.6% (1/18) vs. 44.4% (8/18), P < 0.05]. There was 1 child death in the routine treatment group and no death in the SBH treatment group. Compared with the routine treatment group, the 28-day NBNA score of the SBH treatment group was increased by 2.9 [95% confidence interval (95%CI) = 1.0-4.8], BSID score at 15 months of age was improved significantly, MDI score was increased by 11.8 (95%CI = 4.3-19.3), and PDI score was increased by 12.4 (95%CI = 2.5-22.3), with significant differences between the two groups (all P < 0.05). After 3 days of treatment, the serum NSE and S100 protein levels in both groups were significantly decreased as compared with those before treatment [NSE (μg/L): 30.15±15.18 vs. 31.32±14.75, S100 (ng/L): 387.5 (273.3, 573.0) vs. 890.0 (590.5, 1 162.5) in routine treatment group; NSE (μg/L): 29.09±16.22 vs. 32.25±15.43, S100 (ng/L): 402.5 (302.2, 580.5) vs. 842.0 (462.3, 1 200.5) in SBH treatment group, all P < 0.05]. There was no significant difference in serum NSE or S100 protein level between the two groups (all P > 0.05). There was no serious adverse event such as arrhythmia, large vein thrombosis or irreducible hypotension in both groups, and there was no significant difference in the incidence of general adverse events such as sinus bradycardia, scleredema, blood glucose disorder, or systemic infection between the two groups [16.7% (3/18) vs. 11.1% (2/18), 5.6% (1/18) vs. 5.6% (1/18), 22.2% (4/18) vs. 11.1% (2/18), 5.6% (1/18) vs. 5.6% (1/18), all P > 0.05]. SBH treatment could significantly increase the NBNA score at 28 days of birth and BSID score at 15 months of age, reduce the incidence of severe disability in moderate and severe HIE children, but it was not be proved that SBH could reduce the mortality. Compared with routine treatment, SBH treatment had no significant superiority on improving the levels of serum NSE and S100 protein, suggesting that SBH could not protect the brain by inhibiting the apoptosis of nerve cells and promoting the repair of nerve cells.

Objective To explore the correlation between apparent diffusion coefficient(ADC)and neonatal behavioral neurological assessment(NBNA) of newborns with hypoxic ischemic encephalopathy (HIE), and to evaluate ADC in the early diagnosis of HIE from the imaging perspective. Method One hundred and nine neonates aged 0—7 days with HIE underwent conventional MRI and DWI. According to HIE grading standards, there were 43 neonates in the mild group, 38 in the moderate group, 28 in the severe group, and meanwhile 24 normal neonates with the same ages were selected as the control group. All cases were assessed with NBNA, and ADC values of bilateral frontal white matter, parietal white matter, periventricular white matter, posterior limb of the internal capsule (PLIC), ventral lateral nucleus of thalamus, lenticular nucleus, splenium of the corpus callosum, brainstem were measured. ADC values of different groups were compared by analysis of variance, and the correlations between ADC values of all ROIs and NBNA were analyzed by Pearson correlation. Results Except lenticular nucleus and the brainstem, ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum were decreased in the mild, moderate, severe group. In the mild, moderate, and severe group, the ADC values of frontal deep white matter were (1.82±0.33)×10-3, (1.77±0.34)×10-3 and (1.62±0.31)×10-3 mm2/s, while they were (1.81±0.34)×10-3, (1.79±0.27)× 10-3 and (1.72±0.31)×10-3 mm2/s for the parietal deep white matter, (1.27±0.15)×10-3, (1.23±0.12)×10-3 and (1.15±0.17)×10-3 mm2/s for the periventricular white matter, (1.08±0.09)×10-3, (0.97±0.07)×10-3 and (0.84±0.06)×10-3 mm2/s for the PLIC, (1.13±0.07)×10-3, (1.08±0.13)×10-3 and (1.00±0.13)×10-3 mm2/s for the ventral lateral nucleus of thalamus, (1.27±0.22)×10-3, (1.18±0.16)×10-3 and (1.00±0.23)×10-3 mm2/s for the splenium of the corpus callosum. There were statistically significant differences between the 3 groups (F=61.27, 16.27, 23.26, 72.70, 26.73, 66.09, all P<0.05). In the mild, modreate and severe group, NBNA were (36.8±1.4) in the mild group, (33.5±1.6) in the moderate, and (29.3±2.6) in the severe group. There was positive correlation between ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum and NBNA scores (r=0.60, 0.49, 0.54, 0.67, 0.56, 0.65, all P<0.05). Conclusions There are correlations between ADC values of the related ROIs of HIE and NBNA scores. Combining two aspects might diagnose the brain injury of HIE more accurately and objectively. Key words: Diffusion magnetic resonance imaging; Infant, newborn; Hypoxia-ischemia, brain

Objective To investigate the clinical effect of mild hypothermia complicated with heperbaric oxygen in the treatment of neonatal hypoxic-ischemic encephalopathy.Methods Seventy-five neonatal hypoxic-ischemic encephalopathy patients were randomly divided into mild hypothermia complicated with heperbaric oxygen group(40 cases) and the control group(35 cases).The newborns in control group were given routine and comprehensive treatment.The newborns in treatment group were given mild hypothermia complicated with heperbaric oxygen therapy on the basis of routine and comprehensive treatment.The newborns with HIE were estimated by neonatal behavioral neurological assessment (NBNA) after being born 4 days and 14 days and were examined by mental and psycho-motor development after being born 3 months,6months and 12 months.Results The NBNA score when the newborns were 4 days had no obvious difference between the two groups (t=0.126,P>0.05).The NBNA score when the newborns were 14 days had obvious difference between the two groups(t=2.48,P<0.05).The index of mental and psychomotor development when the newborns were 3 months,6months and 12 months in mild hypothermia complicated with heperbaric oxygen therapy group was obviously higher than that in control group.There were obvious difference between the two groups(P<0.05).Conclusions Mild hypothermia complicated with heperbaric oxygen therapy have obvious near ang long neurological protective action on neonatal hypoxic-ischemic encephalopathy and can improve the living quality.The treatment effect is positive. Key words: Neonatal hypoxic-ischemic encephalopathy; Mild hypothermia; Hyperbaric oxygen; Asphyxia; Organ injury; Prognosis

Background and PurposeTemporomandibular disorders (TMD), especially pain-related TMD, are closely related to social and psychological factors. We aimed to measure changes in spontaneous brain activity and its related functional connectivity (FC), as well as FC characteristics within the mood-regulating circuits (MRC) in TMD patients by resting-state functional magnetic resonance imaging (RS-fMRI), and to analyze the relationship between these parameters and emotional symptoms.Materials and MethodsTwenty-one adult TMD patients and thirty demographically matched healthy controls (HCs) underwent clinical scale evaluation and RS-fMRI scanning. After processing RS-fMRI data, the values of the amplitude of low-frequency fluctuation (ALFF) between the two groups were compared. Regions with abnormal ALFF values were selected as areas of interest (ROIs) to compare the differences of whole-brain seed-based FC between groups. The FCs between regions within MRC were also analyzed and compared. In addition, the relationships between RS-fMRI characteristics and pain and mood were explored by correlation and mediation analyses.ResultsCompared with HCs, TMD patients showed increased ALFF in the right parahippocampal gyrus (PHG), the right supplementary motor area, and the bilateral precentral gyrus, with decreased ALFF in the right cerebelum_crus2. Patients showed enhanced right PHG-related FC in the vermis and posterior cingulate cortex, orbitofrontal cortex (OFC)-related FC in the striatal-frontal regions, while decreased dorsolateral prefrontal cortex-related FC in the amygdala. In TMD patients, ALFF values in the right PHG and FC values between the right PHG and the vermis were positively correlated with depressive symptoms. Abnormal FCs in the left striatal-orbitofrontal pathway were correlated with pain and depressive symptoms. More importantly, mediation analysis revealed that chronic pain mediates the relationship between FC of right PHG with vermis and depressive symptoms, and abnormal FC in the left striatal-orbitofrontal pathway can mediate the association between pain and depressive symptoms.ConclusionTMD patients have dysregulated spontaneous activity and FC in the default mode network, sensorimotor network and pain-related regions, as well as dysfunction of the fronto-striatal-limbic circuits. The development of negative emotions in TMD may be related to the dysfunction of components within the reward system (especially hippocampus complex, OFC, striatum) due to chronic pain.

ObjectiveBenign paroxysmal positional vertigo (BPPV) is a common clinical vertigo disease, and the most effective treatment for this disease is canal repositioning procedures (CRP). Most patients return to normal after a single treatment. However, some patients still experience residual dizziness (RD) after treatment, and this disease’s pathogenesis is currently unclear. The purpose of this study is to explore whether there are abnormal brain functional activities in patients with RD by using resting-state functional magnetic resonance imaging (rs-fMRI) and to provide imaging evidence for the study of the pathogenesis of RD.Materials and methodsThe BPPV patients in the Second Affiliated Hospital of Xuzhou Medical University had been included from December 2021 to November 2022. All patients had been received the collection of demographic and clinical characteristics (age, gender, involved semicircular canal, affected side, CRP times, BPPV course, duration of RD symptoms, and whether they had hypertension, diabetes, coronary heart disease.), scale assessment, including Dizziness Handicap Inventory (DHI), Hamilton Anxiety Inventory (HAMA), Hamilton Depression Inventory (HAMD), rs-fMRI data collection, CRP treatment, and then a one-month follow-up. According to the follow-up results, 18 patients with RD were included. At the same time, we selected 19 healthy individuals from our hospital’s physical examination center who matched their age, gender as health controls (HC). First, the amplitude of low-frequency fluctuations (ALFF) analysis method was used to compare the local functional activities of the two groups of subjects. Then, the brain regions with different ALFF results were extracted as seed points. Functional connectivity (FC) analysis method based on seed points was used to explore the whole brain FC of patients with RD. Finally, a correlation analysis between clinical features and rs-fMRI data was performed.ResultsCompared to the HC, patients with RD showed lower ALFF value in the right precuneus and higher ALFF value in the right superior temporal gyrus (STG). When using the right STG as a seed point, it was found that the FC between the right STG, the right supramarginal gyrus (SMG), and the left precuneus was decreased in RD patients. However, no significant abnormalities in the FC were observed when using the right precuneus as a seed point.ConclusionIn patients with RD, the local functional activity of the right precuneus is weakened, and the local functional activity of the right STG is enhanced. Furthermore, the FC between the right STG, the right SMG, and the left precuneus is weakened. These changes may explain the symptoms of dizziness, floating sensation, walking instability, neck tightness, and other symptoms in patients with RD to a certain extent.

Objective To investigate the efficacy of hyperbaric oxygen (HBO) combined with recombinant human erythropoietin injection on neonatal hypoxic-ischemic encephalopathy (HIE), and the effects on the expression levels of cysteine aspartic protease-3 (caspase-3) and endogenous activin A (ACT A). Methods eventy-six child patients with HIE admitted to the Department of Pediatrics of the hospital from October 2015 to May 2017 were enrolled for the study, and were randomly divided into the observation group and the control group, each consisting of 38 patients. The patients in the control group received HBO therapy on the basis of conventional treatment, while the patients in the observation group had human erythropoietin injection in addition to the treatment received by the control group. After 10 days of treatment, treatment efficacy was evaluated for the 2 groups. After 5 and 10 days of treatment, the neonatal behavioral neurological assessment (NBNA) scores were evaluated, and nerve reflex recovery time and conscious recovery time for the patients of the 2 groups were recorded. The levels of serum caspase-3 and ACT A in the patients of the 2 groups were measured by enzyme-linked immunosorbent assay (ELISA), and adverse reactions of the two groups were recorded as well. Results Total efficacy rate for the observation group (89.47%)was significantly higher than that for the control group (71.05%)(P<0.05), After 5 and 10 days of treatment, the NBNA scores of the 2 groups were all significantly higher than those before treatment and the NBNA scores of the observation group were significantly higher than those before treatment, and the NBNA scores of the observation group were also obviously higher than those of the control group (P<0.05 or P<0.01). After treatment, the nerve reflex recovery time and conscious recovery time of the observation group were all shorter than those of the control group (P<0.05). After 5 days of treatment, the caspase-3 levels of the two groups were significantly higher than those before treatment, and that of the observation group was obviously lower than that of the control group(P<0.05). However, after 10 days of treatment, the caspase-3 levels in the 2 groups all decreased markedly, as compared with those after 5 days of treatment, and. that of the observation group was obviously lower than that of the control group(P<0.05). Conclusion HBO combined with recombinant human erythropoietin injection was superior to simple HBO therapy in the treatment of HIE, and could down-regulate the expression levels of Caspase-3 and ACT A, inhibit cell apoptosis, promote cell repair and ultimately lessen nerve damage. Key words: Hyperbaric oxygen; Recombinant human erythropoietin; Neonatal hypoxic-ischemic encephalopathy; Caspase-3; Endogenous activin A(ACTA)

BackgroundAlcohol use disorder (AUD) is associated with cognitive impairment and disruptions in brain function. This study aimed to investigate the neural mechanisms underlying these cognitive changes. This study employed multiple analytical approaches to analyze resting-state functional magnetic resonance imaging (RS-fMRI) data.MethodsIn total, 30 individuals with AUD and 29 healthy control (HC) individuals were enrolled in the study. All the participants completed the Montreal Cognitive Assessment (MoCA) and underwent RS-fMRI scans. Neural activity was assessed using the amplitude of low-frequency fluctuation (ALFF) method, and a seed-based functional connectivity (FC) analysis was then conducted to examine network interactions.ResultsCompared to the HC group, the AUD group had significantly lower total MoCA scores, particularly in terms of visuospatial/executive function, attention, and orientation (P<0.05). In the AUD group, there was a significant increase in ALFF in the right inferior frontal gyrus and bilateral parahippocampal gyrus, and a significant decrease in ALFF in the right middle frontal gyrus (P<0.05). A positive correlation was found between the ALFF values and total MoCA scores in the right inferior frontal gyrus of the AUD group (P<0.05). Additionally, there was enhanced self-interactive FC between the medial and lateral regions of the right inferior frontal gyrus (different subregions within the same brain area), and a positive correlation between the FC values and attention scores in the group (P<0.05).ConclusionsThe AUD patients demonstrated significant resting-state functional alterations across multiple brain regions, and dysregulation in the right inferior frontal gyrus emerged as a potential neural substrate for their cognitive deficits.

Relation of prenatal low-level mercury exposure with early child neurobehavioral development and exploration of the effects of sex and DHA on it

To explore the relationship between umbilical cord blood brain-derived neurotrophic factor (BDNF) and neonatal neurobehavioral development in lead exposure infants. All infants and their mother were randomly selected during 2011 to 2012, subjects were selected according to the umbilical cord blood lead concentrations, which contcentration of lead was higher than 0.48 μmol/L were taken into high lead exposure group, about 60 subjects included. Comparing to the high lead exposure group, according to gender, weight, pregnant week, length and head circumferenece, the level of cord blood lead concentration under 0.48 μmol/L were taken into control group, 60 cases included. Lead content was determined by graphite furnace atomic absorption spectrometry. Neonatal behavioral neurological assessment (NBNA) was used to determine the development of neonatal neuronal behavior. The content of BDNF was detected by ELISA. Comparing the BDNF and the NBNA score between two groups, and linear correlation was given on analysis the correlation between lead concentration in cord blood and BDNF, BDNF and the NBNA score. Lead content in high exposure group was (0.613±0.139) μmol/L, and higher than (0.336±0.142) μmol/L in low exposure group (t=3.21, P<0.001) . NBNA summary score (36.35±1.86), active muscle tension score (6.90±0.27) and general assessment score (5.93±0.32) in high exposure group were lower than those (38.13±0.96, 7.79±0.35, 6.00±0.00) in low exposure group (t values were 8.21, 10.23, 2.32, respectively, P values were <0.001, <0.001 and 0.037) . BDNF content in high exposure group which was (3.538±1.203) ng/ml was higher than low exposure group (2.464±0.918) ng/ml (t=7.60, P<0.001). The correlation analysis found that the cord blood BDNF content was negatively correlated with NBNA summary score, passive muscle tension and active muscle tone score (r was -0.27, -0.29, -0.30, respectively, P values were <0.001, respectively) . Prenatal lead exposure results poor neonatal neurobehavioral development and cord blood BDNF was negatively correlated with neonatal neurodevelopment, may serve as a useful biomarker.

There is increasing evidence of abnormal neurodevelopmental outcomes in preterm infants with low-grade intraventricular hemorrhage (IVH). The purpose of the study was to explore whether brain microstructure and volume are associated with neuro-behavioral outcomes at 40 weeks corrected gestational age in preterm infants with low-grade IVH. MR imaging at term-equivalent age (TEA) was performed in 25 preterm infants with mild IVH (Papile grading I/II) and 40 control subjects without IVH. These subjects all had neonatal behavioral neurological assessment (NBNA) at 40 weeks’ corrected age. Microstructure and volume evaluation of the brain were performed by using diffusion kurtosis imaging (DKI) and Synthetic MRI. Correlations among microstructure parameters, volume, and developmental outcomes were explored by using Spearman's correlation. In preterm infants with low-grade IVH, the volume of brain parenchymal fraction (BPF) was reduced. In addition, mean kurtosis (MK), fractional anisotropy (FA), radial kurtosis (RK), axial kurtosis (AK) in several major brain regions were reduced, while mean diffusivity (MD) was increased (P < 0.05). BPF, RK in the cerebellum, MK in the genu of the corpus callosum, and MK in the thalamus of preterm infants with low-grade IVH were associated with lower NBNA scores (r = 0.831, 0.836, 0.728, 0.772, P < 0.05). DKI and Synthetic MRI can quantitatively evaluate the microstructure alterations and brain volumes in preterm infants with low-grade IVH, which provides clinicians with a more comprehensive and accurate neurobehavioral assessment of preterm infants with low-grade IVH.

Objective To investigate the placental transfer and neonatal effects of remifentanil as an adjuvant for cesarean section.Methods Forty ASA Ⅰ parturients at full term aged 26-32 yr weighing 70-90 kg undergoing elective cesarean section under combined spinal epidural anesthesia (CSEA) were randomly divided into 2 groups (n = 20 each): control group (C) and remifentanil group (R). The CSEA was performed at L3-4interspace and the upper spread of sensory block reached T6-8. Group R received TCI of remifentanil (target plasma concentration was set at 1.5 ng/ml) starting from performance of CSEA until blood samples were obtained. In group C equal volume of normal saline was infused instead of remifentanil. MAP, HR, RR, minute ventilation (MV), and OAA/S scores were recorded after the parturients had settled down for 5 min in the operating room (T0), at skin incision (T1), when the baby was being delivered (T2), uterus repaired (T3) and peritoneum closed (T4). Fetal heart rate (FHR) at T0 and immediately before skin disinfection, the duration between uterus incision and delivery of the baby (delivery time), body weight of the newborn, Apgar score at 1 min and 5 min after delivery and neonatal behavioral neurological assessment (NBNA) at 1 h and 24 h after delivery were also recorded.Adverse effects including hypotension, sinus bradycardia, raspiratory depression, muscle rigidity , nausea and vomiting were recorded. The middle segment of umbilical cord (about 10-15 cm long) was clamped at both ends with two clamps at delivery. Umbilical arterial (UA) and venous (UV) blood samples and maternal arterial (MA) blood samples were obtained within 3 min after delivery for blood gas analysis and determination of plasma remifentanil concentration using C,C-MS-SIM method. Results OAA/S scores were significantly lower at T1,2 in group R than in group C. There were no significant differences in MAP, HR, MY, RR, delivery time, FHR, blood gases, bedy weight of the newborn, Apgar scores and NBNA scores between the 2 groups. The plasma concentrations (C) of remifentanil were (0.85±0.31),(0.57±0.12) and (0.22±0.09) ng/ml respectively in maternal arterial, umbilical venous and arterial blood samples, CUV/CMA was 0.67±0.41 and CUA/CUV was 0.39±0.08. Conclusion Remifentanil given by TCI at a target plasma concentration of 1.5 ng/ml has no adverse effects on the newborn because of raid metabolism and redistribution of remlfentanil in the neonate after rapid placental transfer. Key words: Piperidines; Cesarean section; Infant, newborn; Placenta