Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines / 中国当代儿科杂志

In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.

Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors

Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors. Study Design: Cross-sectional cohort study with 307 pediatric patients. Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years) Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of <0.05 were considered significant. Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P < 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P < 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P < 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings. Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.

Analysis of the risk factors for extracorporeal membrane oxygenation use after surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary artery combined with severe left ventricular dysfunction / 中国胸心血管外科临床杂志

@#Objective    To analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) patients with severe left ventricular dysfunction after surgical repair, and to explore the predictors for extracorporeal membrane oxygenation (ECMO) support for these patients. Methods    The clinical data of ALCAPA patients with severe left ventricular dysfunction (left ventricular ejection fraction<40%) who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed. The patients were divided into an ECMO group and a non-ECMO group. Clinical data of the two groups were compared and analyzed. Results    A total of 64 ALCAPA patients were included. There were 7 patients in the ECMO group, including 4 males and 3 females aged 6.58±1.84 months. There were 57 pateints in the non-ECMO group, including 30 males and 27 females aged 4.34±2.56 months. The mortality of the patients was 6.25% (4/64), including 2 patients in the ECMO group, and 2 in the non-ECMO group. The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group (P=0.041). There were statistical differences in the cardiopulmonary bypass time [254 (153, 417) min vs. 106 (51, 192) min, P=0.013], aortic cross-clamping (ACC) time (89.57±13.66 min vs. 61.58± 19.57 min, P=0.039), and preoperative left ventricular end-diastolic diameter/body surface area (132.32±14.71 mm/m2 vs. 108.00±29.64 mm/m2, P=0.040) between the two groups. Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support (P=0.005). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.757, the sensitivity was 85.70%, specificity was 66.70%, with the cut-off value of 66 min. Conclusion    ACC time is an independent risk factor for postoperative ECMO support. Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.

The effects of quality improvement program on the incidence of bronchopulmonary dysplasia in very preterm infants / 中国新生儿科杂志

Objective:To evaluate the effects of quality improvement (QI) program on the incidence of bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs) [gestational age (GA)<32 weeks].Methods:From July to December 2017,VPIs admitted to the Department of Neonatology of Yancheng Maternity and Child Health Care Hospital were retrospectively enrolled and were assigned into pre-quality improvement program group (Pre-QI group).From July to December 2018, VPIs were assigned into post-quality improvement program group (Post-QI group). QI program included delayed umbilical cord clamping (DCC), early postnatal nasal continuous positive airway pressure ventilation (nCPAP) and minimally invasive pulmonary surfactant therapy (MIST). The clinical data and prognostic indicators of the two groups of VPIs and their mothers were compared. Independent sample t-test or continuity-adjusted Chi-square test (or Fisher's exact test) and Logistic regression were used for statistical analysis. Results:A total of 204 VPIs were enrolled, including 96 cases in Pre-QI group and 108 cases in Post-QI group. 1 min Apgar score and hematocrit on admission to the neonatal intensive care unit (NICU) in the Post-QI group were significantly higher than the Pre-QI group( P<0.05). The incidence of delivery room resuscitation, endotracheal intubation at birth and endotracheal intubation in NICU in the Post-QI group were significantly lower than the Pre-QI group( P<0.05). The application of pulmonary surfactant and mechanical ventilation, the incidence of neonatal respiratory distress syndrome and BPD in the Post-QI group were lower than the Pre-QI group ( P<0.05). After adjusting for confounding factors, Logistic regression analysis showed that DCC ( aOR=0.261,95% CI 0.091~0.718, P=0.023), nCPAP ( aOR=0.284,95% CI 0.123~0.667, P=0.015), MIST ( aOR=0.276,95% CI 0.114~0.627, P=0.011) were protective factors of BPD, and MV ( aOR=2.023,95% CI 1.048~3.918, P=0.036) was risk factor of BPD. Conclusions:The QI program consisting of DCC, early nCPAP and MIST for VPIs can reduce the incidence of BPD.

The influence of umbilical cord milking on important clinical outcomes of preterm infants / 中华实用儿科临床杂志

Placental blood transfusion can be achieved by delayed cord clamping and umbilical cord milking.The World Health Organization has proposed delayed cord clamping as the standard care for newborns that do not require resuscitation.In recent years, umbilical cord milking has become an alternative to delayed cord clamping due to the short duration, quick recovery of the fetus after delivery, and similar effect on placental blood transfusion to that of the delayed cord clamping.This study aims to summarize the research results of the two intervention methods, and their potential benefits and risks, aiming to provide references for the optimal umbilical cord cutting.

Influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks.@*METHODS@#PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis.@*RESULTS@#A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.

Arch-clamping technique for surgical repair of acute Type A aortic dissection / 中华胸心血管外科杂志

Objective:To evaluate the efficacy of arch-clamping technique in Sun’s procedure to repair acute type A aortic dissection.Methods:20 consecutive patients[17 males with mean age of (49.7±10.9)years old] with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk implantation (TAR+ FET) from May 2019 to April 2020 were divided into group with using arch-clamping technique during operation (arch-clamping group) or group without (traditional group). Circulatory arrest time, cardiopulmonary bypass time, recovery time, ventilation time, platelet count during the first 3 days postoperatively, blood loss during the first 12 h postoperatively, death, cerebral infarction and acute renal failure were compared. Patients with advanced age(age>70 years old ), or malperfusion syndrome preoperatively or who did not receiving TAR+ FET surgery were excluded from this study.Results:Circulatory arrest time[(4.1±0.6 )min vs. (17.2±2.6)min, P=0.001] and cardiopulmonary bypass time[(158.4±6.8 )min vs. (198.2±12.6)min, P=0.01] were significantly lower in arch-clamping group, compared with traditional group. Postoperative recovery time[(8.9±2.6 )h vs. (16.0±7.3)h, P=0.94] and ventilation time[(13.6±2.2)h vs. (34.1±14.3)h, P=0.18] were non significantly lower in arch-clamping group. Although postoperative platelet counts were higher in arch-clamping group during the first three days, those difference did not reach statistical significance ( P>0.05). All patients were discharged alive. There was no significant difference among the two group with respect to drainage during the first 12 h postoperatively, death, cerebral infarction and acute renal failure. Conclusion:Arch-clamping technique decrease circulatory arrest time dramatically and provide good protection of brain, coagulation and renal function by shortening ischemia time, thereby reducing postoperative complications. It is a safe and feasible innovative approach to effectively improve surgical outcome of Sun’s procedure for repair of acute type A aortic dissection.

Ligadura del cordón umbilical en recién nacidos prematuros / Umbilical cord clamping in preterm infants

La prematiridad fue aumentando la supervivencia desde hace varios años, y eso produce, sobre todo, una preocupación en los prematuros nacidos antes de las 28 semanas de gestación. El tiempo del clampeo del cordón umbilical puede generar diversos trastornos, principalmente, cuando se realiza temprano (10-15 segundos). Ya desde hace 20 años, a través de varias investigaciones, se pudieron demostrar los notorios beneficios del clampeo demorado del cordón (de 2 a 3 minutos). Esta práctica fue instalada en la asistencia obstétrica y neonatal por las recomendaciones de sociedades científicas y de las revisiones sistemáticas, que señalaron las sólidas evidencias que apoyaban esta conducta para prematuros. En esta revisión, se describen los artículos más relevantes en los últimos años, que sustentan notoriamente la aplicación del clampeo demorado del cordón versus el clampeo temprano. Asimismo, esta práctica genera una disminución de los trastornos graves en prematuros.

For several years now, the survival of preterm infants has been increasing, which has shifted our concern to preterm infants born before 28 weeks of gestation in particular. The timing of umbilical cord clamping may lead to several disorders, especially when done early (10-15 seconds). In the last two decades, several investigations have shown the considerable benefits of delayed cord clamping (2-3 minutes). Delayed cord clamping has been practiced in obstetrics and neonatal care based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in preterm infants. This review describes the most relevant articles from the last years, which strongly support the use of delayed cord clamping versus early cord clamping. In addition, this practice reduces the rate of severe disorders in preterm infants.

Axial Mechanical Properties of the Posterior Spinal Pedicle Fixation System / 医用生物力学

Objective To analyze factors that affect axial mechanical performance of the posterior pedicle fixation system. Methods The mechanical model for axial mechanical properties of the posterior pedicle fixation system was established to perform mechanical analysis. By referring to the Standard YY/T 0961-2014, tests on axial ejection force and axial clamping torque of JHL-I multi-axis components, JHL-I single-axis components, JHL-V multi-axis components and JHL-V single-axis components were performed by using Instron E3000 and Instron E10000 mechanical testing machines. Results The ejection rigidity of the single-axis component of vertebral nail system was significantly higher than that of the multi-axis component of vertebral nail system; the torsion rigidity of JHL-V was higher than that of JHL-I. The type and size of the locking bolt as well as its locking torque were the main factors affecting axial ejection force of the posterior spinal pedicle fixation system; the size of the locking bolt and the diameter of the connection rod were the main factors affecting axial clamping torque of the system; axial mechanical properties of the system could be improved by increasing the diameter of the connecting rod, the coefficient of friction between each connecting element, and the pitch diameter of the locking bolt. Conclusions The research findings provide references for optimizing and improving axial mechanical properties of the posterior pedicle fixation system.

To Study the Effect of Timing of Umbilical Cord Clamping on Neonatal Outcomes with Special Emphasis on Neonatal Hyperbilirubinemia and Hematocrit Levels in the Early Neonatal Period

Introduction: The umbilical cord of every newborn is clampedand cut at birth, yet the optimal timing for this interventionremains controversial. For at least over 200yrs, multiplecontroversies have arisen around the timing of umbilical cordclamping. Delayed cord clamping or placental transfusioncould be a cost effective intervention to improve the ironstatus of infants by enhancing their red cell mass. Search inliterature reveals that several controlled trials evaluating theshort term and long term hematological outcomes of delayedcord clamping have been performed in the past but veryfew studies have investigated the risk of hyperbilirubinemiaespecially from this part of the world. Hence this crosssectional study was conceptualized.Material and Methods: It was a cross-sectional studyconducted among 212 term infants born at RohilkhandMedical College and Hospital, Bareilly, over a period of 1year, who fulfilled the inclusion criteria were included in ourstudy.Results: In the present study, hemoglobin, bilirubin, andhematocrit levels at birth and at 24 hours of birth in Immediatecord clamping and Delayed cord clamping was taken. Meanlevels of hemoglobin, bilirubin and hematocrit was foundhigher in Delayed Cord Clamping group as compared toImmediate Cord Clamping group.Conclusion: The study was conclusive of the fact that interm infants delayed cord clamping increases hemoglobin,hematocrit and bilirubin levels at birth and at 24 hrs of birth ascompared to immediate cord clamping. Moreover, there wasno significant associated adverse effects.

Effects of Three Handing-Three Points on Thickness of Myelin Sheath and Expression of Neuregulin 1 and Human Epidermal Growth Factor Receptor 2 after Sciatic Nerve Injury in Rats / 中国康复理论与实践

Objective:To explore the effect of Tuina of Three Handing-Three Points on the recovery of motor function, the expression of neuregulin (NRG) 1 and human epidermal growth factor receptor (ErbB) 2 in the injured point of sciatic nerve and L4-6 spinal cord, and the morphological change of myelin sheath at the injured point of sciatic nerve of rats. Methods:A total of 76 male Sprague-Dawley rats were randomly divided into normal group, sham operation group, model group and Tuina group with 19 rats in each group. The right side sciatic nerve was clamped to make model in the model group and Tuina group. The sham operation group exposed sciatic nerve only. Tuina group received Tuina on Yinmen (BL37), Chengshan (BL57) and Yanglingquan (GB34) with dialing, plucking and kneading using Tuina technique simulator. All of them were tested with Oblique Plate Test before modeling, seven days and 28 days after modeling. Western blotting was used to detect the protein expression of NRG1 and ErbB2 in the injured point of sciatic nerve and L4-6 spinal cord. The change of myelin sheath at the sciatic nerve injury point was observed and analyzed by transmission electron microscope. Results:Seven days and 28 days after modeling, the scores of Oblique Plate Test were lower in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); 28 days after modeling, the scores was higher in Tuina group than in the model group (P < 0.05). At the sciatic nerve injury point, three days after modeling, the expression of NRG1 and ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); seven days and 28 days after modeling, there was no significant difference in NRG1 among groups (P > 0.05); 28 days after modeling, the expression of ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05). In L4-6 spinal cord, three days after modeling, the expression of NRG1 and ErbB2 was higher in the model group and Tuina group than in the normal group and sham operation group (P < 0.05); seven days after modeling, the expression of NRG1 was higher in the model group and Tuina group than in the sham operation group (P < 0.05), and the expression of ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); 28 days after modeling, the expression of NRG1 was higher in Tuina group than in the model group (P < 0.05), and there was no significant difference in ErbB2 among groups (P > 0.05). The electron microscope showed that, 28 days after modeling, the myelin sheath collapsed seriously in the model group; while the ultrastructure of the nerve injury point improved, and the myelin sheath of the nerve fiber was relatively intact in Tuina group; the g-ratio value was lower in the model group than in the sham operation group (P < 0.05), the g-ratio value was higher in Tuina group than in the model group (P < 0.05), and no difference was found in g-ratio value between Tuina group and sham operation group (P > 0.05). Conclusion:Three Handing-Three Points could improve the motor function of hind limbs in rats with sciatic nerve injury, which may be related to the adjustment of NRG1 and ErbB2 in the sciatic nerve and spinal cord, to maintain normal myelin sheath structure.

Cumplimiento de las prácticas integrales del parto en los hospitales de segundo nivel del Ecuador: un aporte a la política pública / Compliance with comprehensive delivery practices in second-level hospitals in Ecuador: a contribution to public policy

Introducción: El Ministerio de Salud Pública del Ecuador (MSP) recomienda la aplicación de prácticas integrales del parto en todo parto normal; sin embargo, no se conoce el nivel del cumplimiento de estas por parte de los alumnos de obstetricia y medicina que están al final de su carrera.Objetivo: Determinar si los internos rotativos de las carreras de Obstetricia y Medicina de la Universidad Central del Ecuador (UCE) cumplen con las prácticas integrales del parto.Métodos: Estudio de Pruebas Diagnósticas realizado en pacientes que acudieron a la consulta externa del servicio de gastroeEstudio transversal en 365 nacimientos atendidos por internos rotativos de Obstetricia y de Medicina de la UCE en cinco hospitales generales del Ecuador. Se evaluó el cumplimiento de las prácticas integrales del parto me-diante observación y llenado de un formulario preestablecido sobre el cumplimiento de cada uno de los parámetros de las normas (secado del recién nacido, apego precoz, identificación del RN, lactancia materna, alojamiento con-junto y tiempo de pinzamiento de cordón). Se calculó el porcentaje de cumplimiento de cada uno de los parámetros y del cumplimiento total.Resultados: Los partos fueron atendidos por 361 personas (49.8% Obstetricia, 42.4% Medicina y 5.7% profesio-nales). Se observó cumplimiento general de las prácticas integrales del parto >86%, sin diferencias significativas con respecto al grupo que atendió el parto. Todos los parámetros cualitativos se cumplieron en más del 95%; pero el corte del cordón umbilical a los tres-cuatro minutos se cumplió en 49.6%.Conclusiones: Los internos rotativos de Obstetricia y Medicina cumplen en un alto porcentaje las normas, pero necesitan reforzar la práctica de corte de cordón umbilical al tiempo correcto.

Background: Ministry of Public Health of Ecuador recommends the application of comprehensive childbirth practi-ces in all normal deliveries; however, the level of compliance with these by obstetric and medical students at the end of their career is not known.Objective: To determine if the internship students of medicine and obstetrics careers at Central University of Ecuador (UCE) comply with the integral practices of childbirth.Methods: Cross-sectional study in 365 births attended by internship students of medicine and obstetrics careers at UCE in five general hospitals in Ecuador. Compliance with comprehensive delivery practices was evaluated by ob-serving and filling out a pre-established form on compliance with each of the parameters of the standards (newborn drying, early attachment, newborn identification, breastfeeding, joint accommodation and time cord clamping). The percentage of overall compliance and with each of the parameters and of the total compliance were calculated.Results: 361 people (49.8% Obstetrics, 42.4% Medicine and 5.7% professionals) attended the deliveries. General compliance with the comprehensive delivery practices was observed in > 86%, without significant differences with respect to the group that attended the delivery. All qualitative parameters were fulfilled in more than 95%; but the cut of the umbilical cord at three to four minutes was completed in 49.6%.Conclusions: Practitioner students from Obstetrics and Medicine met the standards in a high percentage, but need to reinforce the practice of optimal time for clamping the umbilical cord after birth.

Immediate effects of clamping of the umbilical cord on the newborns

Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn't receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.

Safety and effectiveness of infra-hepatic inferior vena cava clamping combined with Pringle’s maneuver during hepatectomy: a meta-analysis / 中华肝胆外科杂志

Objective@#To study the safety and effectiveness of infra-hepatic inferior vena cava clamping combined with Pringle’s maneuver during hepatectomy.@*Methods@#The databases of PubMed, Cochrane Center, CNKI, VIP, Wan Fang were searched to extract the relevant data for the meta-analysis using the Revmanage 5.3 software.@*Results@#A total of 14 studies with 1595 patients were included in this meta-analysis. The results showed that total bleeding during the combined clamping was significantly lower than that of the Pringle’s maneuver alone (MD=-314.59, 95%CI: -362.37~-266.81, P<0.05). Bleeding during hepatectomy was significantly lower (MD=-217.79, 95% CI: -284.57~-151.00, P<0.05); so was the intraoperative blood transfusion rate (OR=0.48, 95% CI: 0.36~0.62, P<0.05). The incidence of complications was significantly lower (OR=0.74, 95% CI: 0.57~0.95, P<0.05). However, there were no significant differences in operation time, length of hospital stay, intraoperative monitoring index and postoperative liver and kidney function recovery (P>0.05).@*Conclusions@#Infra-hepatic inferior vena cava clamping combined with Pringle’s maneuver in hepatectomy was safe and reliable. Compared with the Pringle’s maneuver alone, the combined technique reduce bleeding and the incidence of complications. This technique is worth promoting in clinical practice.

Safety and effectiveness of infra-hepatic inferior vena cava clamping combined with Pringle' s maneuver during hepatectomy:a meta-analysis / 中华肝胆外科杂志

Objective To study the safety and effectiveness of infra-hepatic inferior vena cava clamping combined with Pringle' s maneuver during hepatectomy. Methods The databases of PubMed, Cochrane Center, CNKI, VIP, Wan Fang were searched to extract the relevant data for the meta-analysis using the Revmanage 5. 3 software. Results A total of 14 studies with 1595 patients were included in this meta-analysis. The results showed that total bleeding during the combined clamping was significantly lower than that of the Pringle's maneuver alone (MD= -314. 59, 95％CI:-362. 37～ -266. 81, P<0. 05). Bleeding during hepatectomy was significantly lower ( MD= -217. 79, 95％ CI: -284. 57 ～ -151. 00, P<0. 05); so was the intraoperative blood transfusion rate ( OR = 0. 48, 95％ CI: 0. 36 ～ 0. 62, P<0. 05). The incidence of complications was significantly lower (OR =0. 74, 95％ CI: 0. 57 ～0. 95, P<0. 05). However, there were no significant differences in operation time, length of hospital stay, intrao-perative monitoring index and postoperative liver and kidney function recovery ( P >0. 05 ) . Conclusions Infra-hepatic inferior vena cava clamping combined with Pringle' s maneuver in hepatectomy was safe and reliable. Compared with the Pringle' s maneuver alone, the combined technique reduce bleeding and the incidence of complications. This technique is worth promoting in clinical practice.

Research on the application of bladder volume evaluation under ultrasound radiography for early removal of indwelling catheter in critical patients / 中国实用护理杂志

Objective@#To evaluate the influence of bedside ultrasound on indwelling catheter removal and bladder function recovery for critically ill patients with long-term indwelling catheter.@*Methods@#Use random sampling to choose 92 patients during October 2018 to December 2018 as research objects, objects were allocated into observation group and control group by random digits table method with 46 cases each. All patients had their indwelling catheter clamped 72 hours after insertion as per routine practice, control group had clamp opened and indwelling catheter drained third hourly during the day and fourth hourly through the night; for patients in observation group, bladder volume were evaluated with USS scanner hourly, indwelling catheter was opened and drained when bladder urine volume was about 300 ml, use the shortest bladder-filling time as the interval for indwelling catheter opening time, increasing the interval by one hour through the night. the leakage rate, first urination time, first urination volume, bladder residual volume, indwelling catheter reinsertion rate, voluntary urination rate for patients from two groups were compared.@*Results@#The incidence of urinary leakage in the observation group was 7.14%(3/42),which lower than that in the control group (25.58%, 11/43), the difference was statistically significant (χ2=5.251, P<0.05). The residual urine volume in the bladder was 16 (8.50, 37.00) ml in the observation group, which lower than that in the control group 41 (13.75, 130.25) ml, the difference was statistically significant (t=2.103, P<0.05). The rate of self-urination was 57.15%(24/42) in the observation group, which higher than that in the control group (34.88%,15/43), the difference was statistically significant (χ2=4.24, P<0.05). Induced urination rate and urethral replacement rate were 7.14%(3/42), 11.9%(5/42), 30.95%(13/42) in the observation group and 9.3%(4/43), 16.28%(7/43), 48.84%(21/43) in the control group respectively. There was no significant difference between the two groups (χ2= 0.131, 0.335, 2.832, P > 0.05). The first urination time was (144.66± 66.13) in the observation group and (179.55± 87.50) in the control group, respectively. There was no significant difference between the two groups(t= 1.623, P > 0.05).@*Conclusions@#The use of bedside USS scan to evaluate the bladder volume of critical patients with indwelling catheter can help facilitate early indwelling catheter removal and encourage patients to regain bladder function.

Effect of delayed cord clamping on cerebral tissue oxygen saturation in newborns / 中华实用儿科临床杂志

Objective@#To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.@*Methods@#From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.@*Results@#After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups.@*Conclusions@#Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes.

Effects of delayed cord clamping and early targeted nursing intervention on the control effect of umbilical infection in premature infants / 中国实用护理杂志

Objective@#To investigate the effects of delayed cord clamping and early targeted care intervention on the infection control of premature infants.@*Methods@#A retrospective study of 362 premature babies admitted to our hospital from June 2016 to June 2017 was conducted. There are two groups based on the time of the broken navel. The control group (n=202) was the group with premature umbilical rupture. The observation group (n=160) was the late umbilicus breaking group. The umbilical cord complications, the residual blood volume of the placenta and the time of umbilical cord shedding were observed.@*Results@#The umbilical cord complications of premature infants were compared between the two groups. The incidence of umbilical hemorrhage, periumbilical redness, infection of umbilicus in the observed group was 1.88%(3/160), 2.50%(4/160), 3.75%(6/160), and the control group was 9.90%(20/202), 7.92% (16/202), and 13.27% (27/202), respectively. There were significant differences between the two groups (χ2=9.666, 5.026, 9.965, P<0.05). Umbilical cord abscission time and residual blood volume of placenta in the observation group were (7.36±2.18) d, (67.43±17.37) ml, and the control group were (9.98±3.18)d, (146.03±31.45)ml, with significant differences between the two groups (t=4.151, 13.577, P<0.05).@*Conclusions@#Delayed cord clamping can reduce the incidence of anemia and umbilical infection in premature infants, reducing the incidence of umbilical infection.but in clinical practice, it is recommended to select appropriate methods according to the condition of premature infants.

Effects of placental transfusion on neonatal circulation stability / 国际儿科学杂志

Delayed umbilical cord clamping and umbilical cord milking could promote blood flowing from the placenta to the newborn, which would increase neonatal blood volume, avoid suddenly cardiac preload changes caused by the interruption of placental transfusion at birth, and make the neonatal cardiovascular system transition more stable and physiological.Although there have been cases of neonatal jaundice and polycythemia caused by placental transfusion in clinical, studies have shown that placental transfusion does not increase the incidence.At present, umbilical cord clamping immediately after birth is the commonly clinical practice in most countries, including China.The method of umbilical cord clamping, the factors effecting placental transfusion and the pros and cons of placental transfusion still need further research.

Shape memory alloy actuation of non-bonded piezo sensor configuration for bone diagnosis and impedance based analysis

In the recent years, there has been a growing interest in research community towards the application of smart materials for bio-medical structural health monitoring. Amongst the smart materials, directly bonded piezo sensors (DBPS), based on the electro-mechanical impedance (EMI) technique, have been successfully employed for the above purpose. The principle behind the EMI technique is that high frequency excitations (typically > 30 kHz) generated by a surface bonded PZT patch are used to detect changes in structural drive point impedance caused by cracks or any other type of damage. Bone healing and damage have been shown to be successfully monitored using the DBPS. However, in most of the diagnostic cases of live human and animal subjects, directly bonding a PZT patch is always an irritant or hazard for a live subject. To circumvent direct bonding, the authors have developed and experimentally demonstrated a non-bonded piezo sensor (NBPS) configuration as a good alternative to DBPS while maintaining the effectiveness of measurement well within discernible limits. This paper presents further improvement in the NBPS configuration aiming at autonomous operation of the gripping mechanism using shape memory alloy (SMA) wires. The experiments are performed on replicas of femur bone in healthy and osteoporosis state. This paper shows the effective use of SMA clamping for bone identification and its damage assessment in comparison to earlier mechanical gripping using jubilee clamps. This paper also covers impedance based identification applied to SMA and clamp based NBPS configurations. In place of raw admittance signatures, effective drive point impedance is utilized for the purpose of bone diagnostics which provides a more realistic assessment of the condition of bone.