Effects of routine procedures on salivary cortisol in mechanically ventilated neonates.

Even though the stress secondary to invasive procedures has been investigated, less attention has been paid to the stimulation or pain caused by routine procedures on neonates. The changes in salivary cortisol concentration in mechanically ventilated NICU patients during routine procedures were monitored to provide reference and guidance for pain management. 80 mechanically ventilated neonates in the hospital from Sep 2021 to Mar 2022 were selected. The salivary cortisol levels of the neonates were monitored during nursing procedures and were categorized by their risk levels to the following groups: high-risk (endotracheal suctioning and arterial blood sampling), moderate-risk (gastric tube insertion, venipuncture), and low-risk (bedside bathing and diaper changes). The changes in heart rate were also recorded and compared. The concentration of cortisol in the saliva of the neonates was 1.5 ± 0.8 nmol/L during the sleeping state, 6.2 ± 1.3 nmol/L during endotracheal suctioning, 6.4 ± 1.4 nmol/L during arterial blood sampling, 6.1 ± 1.2 nmol/L during venipuncture, 4.4 ± 1.1 nmol/L during gastric tube insertion, 3.5 ± 0.8 nmol/L during bedside bathing, and 3.3 ± 0.9 nmol/L during a diaper change. The results revealed a statistically significant effect between routine procedures on salivary cortisol levels. Compared with the neonates in the control sleep state, there was a significant (P < 0.05) change in salivary cortisol concentration of infants undergoing high and moderate-risk nursing procedures. There was a small but significant (P < 0.05) change in salivary cortisol levels in infants who underwent low-risk procedures compared to infants in the control sleep state. Further, the fluctuation of salivary cortisol levels in routine procedures was more frequent compared with routine handling at night. The fluctuations of salivary cortisol concentration in high-risk procedures were larger than that of infants who underwent low-risk procedures, with the difference being statistically significant (P < 0.05). It was also determined that the top four influencing factors on the infants' heart rate were arterial blood sampling venipuncture, intubation, endotracheal suctioning, and gastric tube insertion (P < 0.05). Monitoring the saliva cortisol concentration index and heart rates can reflect the impact of different routine procedures on newborns and can be used to manage neonatal pain in the future.

Noncardiac anomalies in children with congenital heart disease.

Introduction: Noncardiac anomalies (NCAs) in patients with congenital heart defects (CHDs) are crucial for perioperative management and etiology studies. This study aimed to investigate NCAs in Chinese children with CHDs. Methods: Medical records for CHD-diagnosed children hospitalized from 1 January 2015 to 31 December 2019 were collected and subjected to retrospective analyses to excavate potential association rules between CHDs and noncardiac malformations. Results: A total of 3,788 CHD patients were included in this study. The main phenotypes of CHD were Ventricular Septal Defect (VSD, 33.69%), Atrial Septal Defect (ASD, 12.72%), and Tetralogy of Fallot (TOF, 5.54%). A total of 887 (23.42%) cases showed noncardiac anomalies, which were mainly associated with the central nervous system (34.61%), nose/ear/mandibular/face (19.39%), genitourinary system (15.78%), and musculoskeletal system (15.56%). Compared to other CHD subtypes, septal defects had a lower percentage of associated NCAs (P = 3.7 × 10-9) while AVSD had a higher percentage (P = 0.0018). Disscussion: NCAs are prevalent among CHD-diagnosed children in China, and the spectrums of NCAs in different CHD subcategories were different.

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.