Twelve-year outcomes of bedside laser photocoagulation for severe retinopathy of prematurity.

Purpose: The purpose of this study is to evaluate the 12-year outcomes of bedside laser photocoagulation (LP) for severe retinopathy of prematurity (ROP) under sedation combined with ocular surface anesthesia in neonatal intensive care units (NICU). Design: The study is a retrospective case series. Methods: Infants treated with bedside LP for severe ROP from April 2009 to September 2021 were included. All LP treatments were performed under sedation and surface anesthesia at the bedside in NICU. Data were recorded for clinical and demographic characteristics, total laser spots, duration of treatment, proportion of total regression of ROP, proportion of recurrence, and adverse events. Results: A total of 364 infants (715 eyes) were included, with a mean gestational age of 28.6 ± 2.4 weeks (range: 22.6-36.6 weeks) and a mean birth weight of 1,156.0 ± 339.0 g (range: 480-2,200 g). The mean number of laser spots was 832 ± 469, and the mean duration of treatment was 23.5 ± 5.3 min per eye. Of all the eyes, 98.3% responded to LP with complete regression of ROP. ROP recurred in 15 (2.1%) eyes after the initial LP. Additional LP was performed in seven (1.0%) eyes. No patient exhibited mistaken LP of other ocular tissues, and there were no serious ocular adverse effects. None of them needed endotracheal intubation. Conclusions: Bedside LP treatment is effective and safe for premature infants with severe ROP under sedation and surface anesthesia in NICU, especially for infants whose general condition is unstable and not suitable for transport.

Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy.

BACKGROUND: Thoracoscopic radical pneumonectomy is associated with a high incidence of postoperative chronic pain. Studies on the benefits of lidocaine intravenous infusion during the perioperative period were still controversial in thoracoscopic surgery. METHODS: Sixty-four lung cancer patients scheduled for thoracoscopic radical pneumonectomy were randomly divided into two groups: normal saline group (control group) or lidocaine group. In the lidocaine group, 1.5 mg/kg lidocaine was administered during the anesthesia induction, and 2 mg·kg-1·h-1 lidocaine was continuously intravenous infused until the end of the surgery. After the surgery, a mixture of 2 µg/kg sufentanil and 10 mg/kg lidocaine was continuously intravenous infused by postoperative patient-controlled intravenous analgesia pump (100 ml). In the control group, the same volume of normal saline was administered according to the calculation of lidocaine during anesthesia induction, maintenance and postoperative patient-controlled intravenous analgesia. The primary outcome was the incidence of chronic postoperative pain at 3 months after the surgery. The secondary outcomes include the incidence of chronic postoperative pain at 6 months after the surgery; the effect of lidocaine on postoperative pain within the first 24 and 48 h; total amount of sufentanil administered during entire procedure and the number of PCA triggers within 48 h after surgery. RESULTS: Compared with the control group, the incidence of chronic pain at 3 months after the surgery was significantly lower (13 cases, 46.4% vs. 6 cases, 20.7%, p < 0.05), but no significant difference at 6 months between two group. The cumulative dosage of sufentanil in perioperative period was significantly lower (149.64 ± 18.20 µg vs. 139.47 ± 16.75 µg) (p < 0.05), and the number of PCA triggers (8.21 ± 4.37 vs. 5.83 ± 4.12, p < 0.05) was significantly greater in the control group. The NRS pain scores at 24 h (1.68 ± 0.72 vs. 1.90 ± 0.86) and 48 h (1.21 ± 0.42 vs. 1.20 ± 0.41) after the operation were no significant difference. CONCLUSION: Perioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy. TRIAL REGISTRATION: http://www.chictr.org.cn : ChiCTR1900024759, frist registration date 26/07/2019.

Comparative Analysis Reveals Novel Changes in Plasma Metabolites and Metabolomic Networks of Infants With Retinopathy of Prematurity.

Purpose: Advances in mass spectrometry have provided new insights into the role of metabolomics in the etiology of several diseases. Studies on retinopathy of prematurity (ROP), for example, overlooked the role of metabolic alterations in disease development. We employed comprehensive metabolic profiling and gold-standard metabolic analysis to explore major metabolites and metabolic pathways, which were significantly affected in early stages of pathogenesis toward ROP. Methods: This was a multicenter, retrospective, matched-pair, case-control study. We collected plasma from 57 ROP cases and 57 strictly matched non-ROP controls. Non-targeted ultra-high-performance liquid chromatography-tandem mass spectroscopy (UPLC-MS/MS) was used to detect the metabolites. Machine learning was employed to reveal the most affected metabolites and pathways in ROP development. Results: Compared with non-ROP controls, we found a significant metabolic perturbation in the plasma of ROP cases, which featured an increase in the levels of lipids, nucleotides, and carbohydrate metabolites and lower levels of peptides. Machine leaning enabled us to distinguish a cluster of metabolic pathways (glycometabolism, redox homeostasis, lipid metabolism, and arginine pathway) were strongly correlated with the development of ROP. Moreover, the severity of ROP was associated with the levels of creatinine and ribitol; also, overactivity of aerobic glycolysis and lipid metabolism was noted in the metabolic profile of ROP. Conclusions: The results suggest a strong correlation between metabolic profiling and retinal neovascularization in ROP pathogenesis. These findings provide an insight into the identification of novel metabolic biomarkers for the diagnosis and prevention of ROP, but the clinical significance requires further validation.

A Single-Center Observational Clinical Study on Factors Associated with Regional Cerebral Oxygen Saturation in Full-Term Newborn Infants During Birth Transition.

BACKGROUND Hypoxic hypoperfusion injury in the brain is a cause of potential injury and even death in the growth period of newborns. Therefore, monitoring regional cerebral oxygen saturation (CrSO2) during this period is particularly important. This observational clinical study from a single center aimed to investigate the factors associated with CrSO2 in full-term newborn infants during birth transition. MATERIAL AND METHODS We enrolled 84 full-term newborn infants delivered by cesarean section. We started the stopwatch with the obstetrician clamping the newborns' umbilical cords and recorded the values of newborns' CrSO2, pulse oxygen saturation (SpO2), pulse rate (PR), end-tidal carbon dioxide (EtCO2), and respiratory rate (RR) at 2 min, 5 min, and 10 min. We weighed the newborns before they left the operating room and used statistical methods to compare the correlation between each observation factor. RESULTS Pearson correlation coefficients between CrSO2 and SpO2 measured at 2 min, 5 min, and 10 min were 0.491, 0.599, and 0.587, respectively (P<0.01). Pearson correlation coefficients between CrSO2 and EtCO2 measured at 2 min, 5 min, and 10 min were -0.304, -0.443, and -0.243, respectively (P<0.05). Regardless of a newborn's weight, PR, or RR, the correlation between any of those factors and the value of CrSO2 measured at the corresponding time point had no significance (P>0.05). CONCLUSIONS This study showed a correlation between CrSO2 and SpO2 and CrSO2 and EtCO2 during birth transition of full-term infants delivered by elective cesarean section, but CrSO2 had no significant correlation with neonatal weight, PR, or RR.

Changes in the Incidence of Retinopathy of Prematurity in Extremely Low Birth Weight Infants in South China From 2004 to 2018.

PURPOSE: To report the changes in incidence and risk factors of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants over a 15-year period in South China. METHODS: The medical records of ELBW infants were retrospectively reviewed through established database of Shenzhen Screening for ROP Cooperative Group. The incidence and severity of ROP were compared among three successive 5-year periods (P1: 2004-2008, P2: 2009-2013, P3: 2014-2018). Gestational age, birth weight, plurality, mode of delivery and gender were analyzed as risk factors for ROP in ELBW infants. RESULTS: Among the 1099 included ELBW infants, 557 (50.7%) had ROP, and 328 (29.9%) had severe ROP. The highest incidence of ROP (87.5%) and severe ROP (82.5%) were seen in P1. From P2 to P3, the incidence of ROP and severe ROP increased from 45.9% to 50.3% for ROP (P < .05) and from 26.4% to 28.3% for severe ROP (P < .05), respectively. Multivariate logistic regression analysis found only gestational age has a significant effect on the incidence of ROP and severe ROP. CONCLUSIONS: From 2004 to 2018, the incidence of ROP and severe ROP in ELBW infants in South China was 50.7% and 29.9%, respectively. Controlling for the other risk factors, only gestational age was statistically associated with ROP in ELBW infants.

Effect of intravenous administration of lidocaine on the ED50 of propofol induction dose during gastroscopy in adult patients: A randomized, controlled study.

WHAT IS KNOWN AND OBJECTIVE: Propofol provides a prominent sedation effect in gastroscopy. However, sedation with propofol alone during gastroscopy might result in circulatory and respiratory depression. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the ED50 of propofol induction dose during gastroscopy in adult patients while the respiratory and haemodynamic stability were not compromised. METHODS: Patients undergoing gastroscopy were randomly enrolled into lidocaine + propofol (L + P) group or normal saline + propofol (NS + P) group. Subjects were initially administered intravenous bolus of 1.5 mg/kg lidocaine in L + P group or equivalent volume of 0.9% saline in NS + P group. Anaesthesia was then induced with a single bolus of 1.0 µg sufentanil followed by injection of propofol in all patients. The induction dose of propofol for each individual patient was determined by the protocol of Dixon "up-and-down" method for both groups. The primary end point was the ED50 of propofol induction dose. RESULTS: Totally, 48 patients were enrolled and completed this study. Compared with the NS + P group, the ED50 of propofol induction dose was significantly reduced in the L + P group (2.01 mg/kg vs. 1.69 mg/kg) (U = 61.5, p < 0.001). WHAT IS NEW AND CONCLUSION: The addition of intravenous lidocaine significantly reduced the ED50 of propofol induction dose during gastroscopy in adult patients. TRIAL REGISTRATION: The present clinical trial was registered at http://www.chictr.org.cn/ (registration No. ChiCTR1900024025, 23 June 2019).

Comparison of basic regional cerebral oxygen saturation values in patients of different ages: a pilot study.

OBJECTIVE: To explore the basic values of regional cerebral oxygen saturation (rSO2) among different age groups. METHODS: One hundred twenty patients who were scheduled for elective surgery aged 0 to 80 years (American Society of Anesthesiologists [ASA] physical status I or II) or neonates just after birth via cesarean section were enrolled and divided into the following six groups: infant (0 month and ≤12 months), toddler (>1 and ≤3 years old), preschool (>3 and ≤6 years old), school age (>6 and ≤18 years old), adult (>18 and ≤65 years old), and elderly (>65 and ≤80 years old) groups. There were 20 patients in each group. RESULTS: The basic values of rSO2 in infant, toddler, preschool, school age, adults, and elderly groups were 70.41% ± 4.66%, 72.43% ± 3.81%, 70.77% ± 3.27%, 70.62% ± 2.20%, 69.76% ± 6.02%, and 62.69% ± 3.14%, respectively. The basic value in the elderly group was lower compared with other five groups. There was no significant difference among infant, toddler, preschool age, school age, and adult groups. CONCLUSIONS: The basic value of rSO2 in elderly patients is lower. Age is an important factor that affects the underlying value of rSO2.

Targeted Blood Metabolomic Study on Retinopathy of Prematurity.

Purpose: This study aims at exploring alterations of major metabolites and metabolic pathways in retinopathy of prematurity (ROP) infants and identifying biomarkers that may merit early diagnosis of ROP. Methods: We analyzed targeted metabolites from 81 premature infants (<34 weeks of gestational age), including 40 ROP cases (15 males and 25 females, birth weight 1.263 ± 0. 345 kg, gestational age 31.20 ± 4.62 weeks) and 41 cases (30 males, 11 females, birth weight 1.220 ± 0.293 kg, gestational age 30.96 ± 4.17 weeks) of well-matched non-ROP controls. Metabolites were measured by ultra-performance liquid chromatography-tandem mass spectrometry. Standard multivariate and univariate analysis was performed to interpret metabolomic results. Results: Glycine, glutamate, leucine, serine, piperidine, valine, tryptophan, citrulline, malonyl carnitine (C3DC), and homocysteine were identified as the top discriminant metabolites. In particular, discriminant concentrations of C3DC and glycine were also confirmed by univariate analysis as statistically significant different between ROP and non-ROP infants. Conclusions: This study gained an insight into the metabolomic aspects of ROP development. We suggest that higher blood levels of C3DC and glycine can be promising biomarkers to predict the occurrence, but not the severity of ROP.

Warming efficacy of Ranger™ and FT2800 fluid warmer under different room temperatures and flow rates.

The comparison of the heating capabilities with different warming system between 3M™ Ranger™ warmer (3M) and FT2800 fluid warmer (FT) under different room temperatures and infusion rates, has been rarely reported previously. The study was then aimed to compare the warming efficacies of dry heat technology (3M) and coaxial warming system (FT) under different room temperatures and infusion rates, the advantages and disadvantages of both infusion systems would be compared to provide reference for clinical infusion practice. In the study, both target warming temperatures of 3M and FT warmer were set at 41 °C, fluid was administrated under 20, 22 and 24 °C room temperatures and drip rates of 60, 80, 100, 120, 140, 160, 200, 350 drops min-1. The fluid temperature at the outlet of the infusion tube (Toutlet) was measured and compared. The Toutlet of FT was higher than that of 3 M (P < 0.001) under different room temperatures. The Toutlet of FT increased with the room temperature raised (P < 0.05). As for 3M, Toutlet was lowest at 20 °C (P < 0.001) and no statistical difference of Toutlet was found between 22 and 24 °C (P = 0.667). Linear regression showed that the Toutlet of 3M increased with the speed up of drip rate, while the Toutlet of FT was decreased. The relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers was calculated by a formula. 3M Ranger™ and FT2800 show different heating capabilities under different room temperatures and drip rates. 3M is more efficient at high flow rate while FT is more efficient at low flow rate. There is a formula relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers.

[Differences in intrauterine growth levels between full-term neonates born to primiparous or multiparous women].

OBJECTIVE: To establish the intrauterine growth percentile curves of full-term neonates with different gestational ages (GAs) born to primiparous or multiparous women, and to investigate the influence of parity on intrauterine growth potential. METHODS: Cross-sectional cluster sampling was performed from April 2013 to September 2015 to measure physical growth in full-term singleton infants with a GA of 37-41 weeks in two hospitals in Shenzhen, China. The Lambda-Mu-Sigma method was used for curve fitting. RESULTS: The mean values of birth weight, body length, head circumference, chest circumference, and crown-rump length were obtained in 14 529 full-term infants. The 10th, 25th, 50th, 75th, and 90th percentile curves of the five indices were established. The full-term infants born to multiparous women had similar patterns and growth trends of the five percentile curves of the above five indices to those born to primiparous women, while the full-term infants with a GA of 37-41 weeks born to multiparous women had higher mean values and percentile curve values of the above five indices than those born to primiparous women. In the group with a GA of 41 weeks, there was no significant difference in the crown-rump length between the infants born to primiparous women and those born to multiparous women, but there were significant differences in the means of the above five indices in all the other GA groups between the two group infants (P<0.05). CONCLUSIONS: Full-term infants with a GA of 37-41 weeks born to multiparous women have higher intrauterine growth levels of birth weight, body length, head circumference, chest circumference, and crown-rump length than those born to primiparous women, suggesting that parity is an important influencing factor for intrauterine growth potential.

[Intrauterine growth curves for body weight, body length, head circumference, chest circumference, and crown-rump length in 16 887 neonates with a gestational age of 27-42 weeks in Shenzhen, China].

OBJECTIVE: To establish the intrauterine growth curves of neonates in Shenzhen, China and to investigate the intrauterine growth of neonates in Shenzhen. METHODS: Cross-sectional cluster sampling was performed for an on-the-spot investigation of 16 887 neonates (9 418 males and 7 469 females) with a gestational age of 27-42 weeks who were born in two hospitals in Shenzhen from April 2013 to September 2015. The Lambda Mu Sigma (LMS) method was used for the curve fitting of body weight, body length, head circumference, chest circumference, and crown-rump length. RESULTS: The 3rd-97th percentile intrauterine growth curves for body weight, body length, head circumference, chest circumference, and crown-rump length were plotted for the neonates with a gestational age of 27-42 weeks who were divided into three groups (male, female, and mixed). The male neonates had significantly higher curves for the five indices than the female counterparts. The pattern and changing trend of body weight curves of these neonates were basically consistent with those in China Neonatal Network. CONCLUSIONS: The percentile intrauterine growth curves for body weight, body length, head circumference, chest circumference, and crown-rump length in neonates with a gestational age of 27-42 weeks in Shenzhen which has been established can provide a reference for clinical practice in the department of neonatology.

Association of VEGF gene polymorphisms with advanced retinopathy of prematurity: a meta-analysis.

Published data on the association of vascular endothelial growth factor (VEGF) gene polymorphisms with retinopathy of prematurity (ROP) are inconclusive. The aim of the study was to assess the association by using meta-analysis. Data were collected from the following electronic databases: PubMed, Elsevier Science Direct, Excerpta Medica Database, Cochrane Library and China National Knowledge Infrastructure, with the last report up to 30 April, 2012. The odds ratio (OR) and its 95 % confidence interval (95 %CI) were used to assess the strength of the association. Meta-analysis was performed in a fixed/random effect model by using the software Review Manager 4.2. A total of 7 studies based on the search criteria were involved in this meta-analysis. Meta-analysis was performed for four VEGF gene polymorphisms (-634G/C, -460T/C, -2578C/A and 936C/T). Significant association was found for -460T/C polymorphism (C vs T: OR = 0.74, 95 %CI = 0.57-0.95, P = 0.02; TC+CC vs TT: OR = 0.75, 95 %CI = 0.47-1.21, P = 0.24; CC vs TT+TC: OR = 0.45, 95 %CI = 0.26-0.76, P = 0.003; CC vs TT: OR = 0.45, 95 %CI = 0.24-0.84, P = 0.01; TC vs TT: OR = 0.96, 95 %CI = 0.59-1.57, P = 0.87) in the VEGF gene, but not for other polymorphisms (-634G/C, -2578C/A and 936C/T). This meta-analysis demonstrates that advanced ROP is associated with VEGF gene -460T/C polymorphism, but not -634G/C, -2578C/A and 936C/T.

[Treatment and a follow-up study on wound infection by Mycobacterium chelonae: report of 168 cases].

OBJECTIVE: To summarize the experience of treatment on wound infection by non-tuberculous Mycobacterium (NTM) after operations. METHODS: A hundred and sixty-eight patients with NTM incision infection were retrospectively reviewed in terms of diagnosis, treatment and follow-up in a period of 4.5 years. On the basis of the results of in vitro drug sensitivity test, the main antibiotics used were clarithromycin and amikacin. The course of therapy was 4 - 8 months. An extirpative excision was performed in 104 cases following one month treatment by antibiotics and then followed by antibiotic therapy for 3 - 5 months after excision. RESULTS: Primary closure was achieved in 98 of the 104 cases. Fifty patients were cured by the use of antibiotics with dressing change. Eight patients were cured by dressing change without antibiotics. Five children with wound infection by NTM after circumcision were cured by antibiotics with local laser therapy. One patient with infection after hernia operation was cured by amikacin blocking of the area surrounding the lesion. There was no relapse after follow-up for four and half years. CONCLUSION: The study demonstrates that sensitive antibiotics combined with surgery extirpative excision is effective for wound infection by NTM.