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Zhongguo Dang Dai Er Ke Za Zhi =... Oct 2023To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.
OBJECTIVES
To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.
METHODS
A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants.
RESULTS
The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%: 0.802-0.944, <0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%.
CONCLUSIONS
Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.
Topics: Child; Infant, Newborn; Humans; Infant, Extremely Premature; Birth Weight; Retrospective Studies; Ductus Arteriosus, Patent; Cerebral Hemorrhage; Prognosis; Hypotension; Risk Factors
PubMed: 37905755
DOI: 10.7499/j.issn.1008-8830.2304027 -
Molecular Horticulture Oct 2023We previously reported that ABA inhibits stomatal closure through AtNAP-SAG113 PP2C regulatory module during leaf senescence. The mechanism by which this module exerts...
We previously reported that ABA inhibits stomatal closure through AtNAP-SAG113 PP2C regulatory module during leaf senescence. The mechanism by which this module exerts its function is unknown. Here we report the identification and functional analysis of SAG114, a direct target of the regulatory module. SAG114 encodes SnRK3.25. Both bimolecular fluorescence complementation (BiFC) and yeast two-hybrid assays show that SAG113 PP2C physically interacts with SAG114 SnRK3.25. Biochemically the SAG113 PP2C dephosphorylates SAG114 in vitro and in planta. RT-PCR and GUS reporter analyses show that SAG114 is specifically expressed in senescing leaves in Arabidopsis. Functionally, the SAG114 knockout mutant plants have a significantly bigger stomatal aperture and a much faster water loss rate in senescing leaves than those of wild type, and display a precocious senescence phenotype. The premature senescence phenotype of sag114 is epistatic to sag113 (that exhibits a remarkable delay in leaf senescence) because the sag113 sag114 double mutant plants show an early leaf senescence phenotype, similar to that of sag114. These results not only demonstrate that the ABA-AtNAP-SAG113 PP2C regulatory module controls leaf longevity by dephosphorylating SAG114 kinase, but also reveal the involvement of the SnRK3 family gene in stomatal movement and water loss during leaf senescence.
PubMed: 37899482
DOI: 10.1186/s43897-023-00072-1 -
Orthopaedic Journal of Sports Medicine Oct 2023Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patients with patellofemoral disorders.
BACKGROUND
Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patients with patellofemoral disorders.
PURPOSE
To determine the rate of early (≤90 day) postoperative complications after TTO and variables related to postoperative complications.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients who underwent TTO at a single academic institution within a 15-year period (2008-2022) were identified. All patients with a minimum 90-day follow-up were considered for study inclusion. Exclusion criteria were age younger than 14 years and revision surgery. Patient characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications.
RESULTS
A total of 344 knees in 313 patients met eligibility criteria and were included in the final analysis. One intraoperative complication (0.3%), a premature closure of the incision before repair of the vastus medialis, was identified. There were 141 postoperative complications (138 surgical, 3 medical) in 118 patients for a complication rate of 34.3%. The most common complications were stiffness requiring a nonstandard-of-care intervention (16.3%), superficial wound infection/wound dehiscence (8.1%), and hemarthrosis/effusion requiring aspiration (5.8%). Patients experiencing postoperative complications were older (mean difference, 3.49 years; 95% CI, 1.26-5.73 years; = .002), had a higher mean Charlson Comorbidity Index (mean difference, 0.26; 95% CI, 0.08-0.45; = .006), and were more likely to be current smokers ( = .015) compared with patients with no complications. Inpatient surgery (defined as surgery in a hospital setting with at least 1 overnight stay) was associated with postoperative complications (odds ratio [OR], 2.29; 95% CI, 1.39-3.77; = .001); this association remained significant generation of a multivariate model (OR, 2.07; 95% CI, 1.19-3.58; = .010). Previous surgery on the ipsilateral knee ( < .001) and concomitant autologous chondrocyte implantation ( = .046) were also associated with postoperative complications.
CONCLUSION
The study findings indicated a low intraoperative complication rate (0.3%) and a relatively high early postoperative (≤90 day) complication rate (34.3%) after TTO. Variables associated with postoperative complications included greater age, higher Charlson Comorbidity Index, surgery in an inpatient setting, previous surgery on the ipsilateral knee, and concomitant autologous chondrocyte implantation.
PubMed: 37868217
DOI: 10.1177/23259671231194367 -
Pediatric Health, Medicine and... 2023The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new... (Review)
Review
The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new unknown enemy and were challenged with the overloaded patient flow, scarcity of healthcare staff, and evolving treatment modalities with a better understanding of the virus each day. Ophthalmology as a "branch of medicine" suffered challenges initially because of a lack of guidelines for patient management, close working distance during routine examinations, and halt of major surgeries, including cataracts. Pediatric ophthalmology had major implications, as reduced outpatient visits would mean deeper amblyopia, and changed lifestyles, including online classes and home refinement, predisposing children to myopia, digital eye strain, and worsening of strabismus. COVID-19 also unveiled underlying accommodation and convergence anomalies that predisposed pediatric and adolescent patients to an increased prevalence of headache and acute onset esotropia. Teleophthalmology and other innovative solutions, including the use of prism glasses, safe slit-lamp shields, alternative ways of school screening with the use of photoscreeners, performing retinoscopy only when needed, and using autorefractors were among the few guidelines or modifications adopted which helped in the efficient and safe management of pediatric patients. Many pediatric ophthalmologists also suffered in terms of financial constraints due to loss of salary or even closure of private practices. School screening and retinopathy of prematurity screening suffered a great setback and costed a lot of vision years, data of which remains under-reported. Important implications and learnings from the pandemic to mitigate future similar situations include using teleophthalmology and virtual platforms for the triage of patients, managing non-emergency conditions without physical consultations, and utilizing home-based vision assessment techniques customized for different age groups. Though this pandemic had a lot of negative implications, the innovations, modifications, and other important learnings helped pediatric ophthalmologists in navigating safely.
PubMed: 37849985
DOI: 10.2147/PHMT.S395349 -
Cureus Sep 2023In preterm newborns with extremely low birth weights, patent ductus arteriosus (PDA), which is defined as a remnant connection between the aorta and pulmonary artery... (Review)
Review
In preterm newborns with extremely low birth weights, patent ductus arteriosus (PDA), which is defined as a remnant connection between the aorta and pulmonary artery after 72 hours of birth, is frequently linked to substantial morbidity and mortality. If left untreated, a hemodynamically significant PDA (hsPDA) increases the risk for bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage among other morbidities, and can even lead to death. While instances of patent ductus arteriosus (PDA) resolving on their own are frequent, the primary approach for managing PDA closure in premature infants involves pharmacological interventions, commonly utilizing indomethacin, ibuprofen, or paracetamol. However, with these pharmacological treatment options, there is an increased risk of renal toxicity, gastrointestinal bleeding, and reopening of PDA among other complications. If pharmacological interventions are not successful or contraindicated, PDA can be closed via transcatheter closure or surgical ligation. As with any medically invasive procedure, it is not without risks and can lead to long-term complications. This review explores the different management options and the benefits and outcomes of conservative management vs. active management in order to get one step closer to standardizing the treatment for PDA. With so much controversy surrounding the best management option, there is a lack of evidence to support one treatment method superior to the other in reducing overall mortality, and this needs to be explored further.
PubMed: 37829984
DOI: 10.7759/cureus.45009 -
Medeniyet Medical Journal Sep 2023Although the role of thyroid hormones in functional and anatomical closure of patent ductus arteriosus (PDA) is well known, their effects on the medical or surgical...
OBJECTIVE
Although the role of thyroid hormones in functional and anatomical closure of patent ductus arteriosus (PDA) is well known, their effects on the medical or surgical closure of PDA in newborns remain unclear. This study aimed to assess the correlation between thyroid function tests and PDA closure through medical or surgical interventions in newborns.
METHODS
This retrospective study was conducted on 65 newborns diagnosed with hemodynamically significant PDA (hs-PDA), with a premature rate of 81.5% (n=53). The subjects were divided into two groups according to the nature of the ductal closure as medically responsive "MR-PDA" or surgically treated "ST-PDA". The groups were compared in terms of thyroid hormone levels and other clinical parameters.
RESULTS
Thirty-three (51%) of all 65 patients had PDA and responded to medical treatment. Gestational week, birth weight, and mode of delivery were similar between the medical and surgical treatment groups (p>0.05). Free thyroxine levels were significantly lower in the MR-PDA group than in the ST-PDA group (p=0.01).
CONCLUSIONS
Because hs-PDA is associated with increased morbidity and mortality in the neonatal period, especially in premature infants, we hypothesize that thyroid hormone levels may play a role in the closure of hs-PDA.
PubMed: 37766600
DOI: 10.4274/MMJ.galenos.2023.25853 -
Journal of Cardiovascular Development... Sep 2023Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when... (Review)
Review
Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications.
PubMed: 37754806
DOI: 10.3390/jcdd10090377 -
Interdisciplinary Cardiovascular and... Oct 2023The dislodgement of device during transcatheter procedure is a rare complication and the device can be retrieved by transcatheter techniques in most cases. In case of...
The dislodgement of device during transcatheter procedure is a rare complication and the device can be retrieved by transcatheter techniques in most cases. In case of failed attempts, the surgery may be required and in haemodynamically unstable patients cardiopulmonary bypass (CPB) may be unavoidable. A case of surgical retrieving of patent ductus arteriosus (PDA) occlusion device (OD) from the right pulmonary artery (PA) in a 1050 g baby on CPB was presented. In literature, CPB use in babies weighing under 1 kg has been rarely reported. CPB support was performed securely in our case who is one of the tiniest patients operated on. CPB can be safe enough in the surgical approach of a complication of very low birth weight patient.
PubMed: 37740326
DOI: 10.1093/icvts/ivad162 -
Journal of the American Academy of... Sep 2023The treatment of chondroblastoma in the epiphysis of the femoral head in skeletally immature individuals is challenging and often requires surgical hip dislocation. We...
The treatment of chondroblastoma in the epiphysis of the femoral head in skeletally immature individuals is challenging and often requires surgical hip dislocation. We present a unique method of percutaneous use of an expandable reamer (X-REAM, Wright Medical) to treat a chondroblastoma of the femoral head in a 9-year-old boy without requiring surgical hip dislocation. The described technique provides access to the tumor in the proximal femoral epiphysis and local tumor control. However, the approach involves placing a cannula through the epiphyseal plate, resulting in partial premature epiphyseal closure. At 5 years after surgery, the patient has an asymptomatic leg-length discrepancy and radiographic evidence of premature physeal closure, but no restrictions on activity or evidence of local recurrence. A percutaneous expandable reamer can be used to treat chondroblastoma of the femoral head while avoiding surgical hip dislocation.
Topics: Male; Humans; Child; Growth Plate; Femur Head; Chondroblastoma; Hip Dislocation; Bone Neoplasms
PubMed: 37703503
DOI: 10.5435/JAAOSGlobal-D-23-00012