The effect of developmental care on the length of hospital stay and family centered care practice for very low birth weight infants in neonatal intensive care units: A cluster randomized controlled trial.

BACKGROUND: Despite previous studies suggesting that developmental care can provide benign stimulation to promote neural development of newborns, more evidence is needed regarding the other clinical benefits of developmental care. OBJECTIVE: To evaluate the effect of implementing developmental care on the length of hospital stay, the improvement of care practice in neonatal intensive care units, as well as the short-term outcome of very low birth weight infants. DESIGN: Cluster-randomized controlled trial. SETTING(S) AND PARTICIPANTS: From March 1, 2021 to March 1, 2022, 1400 very low birth weight infants were recruited from 14 tertiary neonatal intensive care units in China. METHODS: We assigned 14 neonatal intensive care units to either developmental care or standard care. The length of hospital stay of the infants was the primary outcome analyzed at the individual level. Secondary outcomes were family centered care practice including parental involvement, the skin to skin care, exclusive breast milk, oral immune therapy and breastfeeding. The environmental management (noise and light) and the short-term outcomes were also evaluated. RESULTS: The length of hospital stay for the developmental care group was 65 % as long as that for the control group (HR: 0.65, 95 % CI, 0.451-0936, p = 0.021). After controlling the covariables, the adjusted HR = 0.755 (95 % CI, 0.515 to 1.107, p = 0.150). When compared to the control group, the developmental care group had greater access to SSC, with 22 infants (3.8 %) in the developmental care group compared to 13 infants (1.7 %) in the standard care group (p = 0.013). A greater proportion of infants in the developmental care group were fed at the breast, than those in the standard care group (136 [23.6 %] vs 9 [1.1 %]; p = 0.029). Compared to the control group, exclusively breast milk was significantly more favorable in the developmental care group (435 [75.6 %] vs 114 [15.0 %]; p = 0.001). The difference remained significant even after adjusting for covariates. However, the rate of oral immune therapy and parental involvement was similar in the two groups. The average noise and light levels in the developmental care group were significantly lower than those in the standard care group. After adjusting for confounders, the difference remained significant. There were no significant differences among groups in the mortality and major morbidity. CONCLUSIONS: Developmental care might have developed an accumulated effect over time on the length of hospital stay among very low birth weight infants. The implementation of developmental care can greatly improve family centered care practices and the neonatal intensive care unit environment. REGISTRATION: ClinicalTrials.govNCT05166720. Registration date: 1 March, 2021.

Three-dimensional morphometric differences of resected distal femurs and proximal tibias in osteoarthritic and normal knees.

BACKGROUND: There is a paucity of data concerning the morphological differences of resected distal femurs and proximal tibias in osteoarthritic (OA) and normal knees. The objective of this study was to determine whether morphometric differences in the surfaces of resected distal femurs and proximal tibias exist between OA and normal knees in a Chinese population. METHODS: Ninety-four OA knees and ninety-five normal knees were evaluated in Chinese individuals. Computed tomography was used to measure the femoral mediolateral (fML), medial anteroposterior (fMAP), lateral anteroposterior (fLAP), medial condylar width (fMCW), lateral condylar width (fLCW), medial posterior condylar curvature radii (fMCR), lateral posterior condyle curvature radii (fLCR), fML/fMAP aspect ratio, tibial mediolateral (tML), middle anteroposterior (tAP), medial anteroposterior (tMAP), and lateral anteroposterior (tLAP) tML/tMAP aspect ratio to determine the morphologic differences between OA and normal knees. RESULTS: The average fMCW and tMAP dimensions of OA knees were larger than those of normal knees in both male and female (p <0.05). The fMAP/fML aspect ratio and tMAP/tML aspect ratio were also significantly different in both sexs (p <0.05). OA knees have an oval-shaped distal femur with a wider ML length and more spherical-shaped proximal tibiae with relatively narrow ML dimensions. CONCLUSIONS: The study revealed the morphological differences in fMCW, tMAP, fMAP/fML and tMAP/tML between OA and normal knees in both males and females. These findings may provide guidelines that can be used to design better knee implants that are more size-matched for OA knees.

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China.

Aim. To evaluate the clinical risk factors influencing overall survival of patients with duodenal adenocarcinoma after potentially curative resection. Methods. A series of 201 patients with primary duodenal adenocarcinoma who underwent surgery from 1999 to 2014 at Chinese Medical Academic Cancer Hospital were studied by retrospective chart review and subsequent telephone follow-up. Results. Resectional surgery was performed in 138 of the 201 patients to attempt curative treatment, while 63 patients were treated with palliative surgery. Median survival of patients who underwent resectional operation was 57 months, whereas that of patients who had palliative surgery was shorter, 7 months (p < 0.001). For patients who underwent radical resection, the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1%, respectively. Multivariate Cox regression analysis revealed that lymph node metastasis (HR 31.76, 2.14 to 470.8; p = 0.012) and vascular invasion (HR 3.75, 1.24 to 11.38; p = 0.020) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups treated by the pancreaticoduodenectomy (n = 20) and limited resection (n = 10) for early-stage duodenal adenocarcinoma (p = 0.704). Conclusions. Duodenal adenocarcinoma is a rare disease. Curative resection is the best treatment for appropriate patients. Lymph node metastases and vascular invasion are negative prognostic factors.

Self-setting properties and in vitro bioactivity of Ca2SiO4/CaSO4.1/2H2O composite bone cement.

In this study, a biphasic injectable bone substitute based on beta-dicalcium silicate (Ca(2)SiO(4)) and plaster of Paris (CaSO(4).1/2H(2)O) is presented, and its behavior as cement was studied and compared to that of pure Ca(2)SiO(4) paste. The results demonstrated that the setting time of the workable Ca(2)SiO(4)/CaSO(4).1/2H(2)O pastes was only 15 min, which was significantly reduced as compared to that of the Ca(2)SiO(4) paste (100 min), and the composite showed higher short- and long-term mechanical strength (3.25 and 37.2 MPa, respectively) than those of the Ca(2)SiO(4) paste (0.2 and 24.6 MPa). Similar to the pure Ca(2)SiO(4) paste, the composite paste could induce apatite formation in simulated body fluid within a short period and degrade in Ringer's solution. Moreover, the degradation rate could be adjusted by modifying the content of the plaster within the composite cement. These results suggested that the addition of the plaster significantly improved the self-setting properties of the Ca(2)SiO(4) paste, and the bioactive composite cement could be a prospective candidate for further investigation as self-setting tissue-repairing substitute.

Clinical effects of acupuncture after surgical operation in patients with prolapse of the lumbar intervertebral disc.

OBJECTIVE: To investigate the clinical effects of acupuncture after surgical operation in patients with prolapse of the lumbar intervertebral disc (PLID). METHODS: Sixty-nine patients in this series, who had undergone the removal of nucleus pulposus and the intervertebral fusion as well, were randomly divided into a treatment group of 35 cases and a control group of 34 cases. The former was treated by acupuncture and conventional rehabilitation therapy, and the latter only by the rehabilitation therapy. The therapeutic effects were evaluated according to the scoring system stipulated by Japanese Orthopedics Association (JOA). RESULTS: In the treatment group, the average functional recovery rates in 3-month, 6-month and one-year periods were respectively 49.93%, 90.31% and 95.08%; while the rates were repesctively 26.24%, 63.42% and 71.36% in the control group, showing statistically significant difference between the two groups (P<0.05). CONCLUSIONS: Acupuncture can confirmatively promote the functional recovery for'patients with prolapse of the lumbar intervertebral disc after surgical removal of nucleus pulposus and with intervertebral fusion.