Using phlebotomy to remove a difficult peripherally inserted central catheter insertion and removal in very low birth weight infants: case report of a rare complication.

Background: A peripherally inserted central catheter (PICC) is an important way to supply long-term intravenous infusion or parenteral nutrition for premature infants, especially very low birth weight (VLBW) infants. PICC removal difficulties occur mostly during use. It is rare to have difficulty removing a PICC due to reverse folding during catheterization. We presented a case to explore the nursing experience of caring for a VLBW infant with difficult PICC removal. Case Description: A 30-week, 1,240-g infant, suffered a difficult PICC removal during the catheterization adjustment process. The X-ray images showed that the tip of the catheter was bent at the elbow joint and formed three abnormal bends in the blood vessel. The result was that the catheter was removed by a multidisciplinary team, and the reasons for the difficulty were analyzed. We used multidisciplinary team collaboration to solve a clinical problem. First, we analyzed the possible causes of a difficult removal by consulting PICC nurses, vascular interventional surgeons, and venous specialist nurses. Second, we used nonsurgical treatment methods to try to solve the problem. Finally, the catheter was completely removed using phlebotomy. Healing of wound and the growth of blood vessel are both well. Conclusions: In neonates, PICC may have obstacles in insertion and removal, methods such as posture changes, wet and hot compresses, and local massage can help. Multidisciplinary cooperation can improve the success rate of removal with minimal trauma. Individualized analysis of causes and measures are key steps to solve the difficulty of PICC insertion and removal.

[Correlation analysis of Cobb angle and linear spinous process angle in adolescent idiopathic scoliosis].

OBJECTIVE: To analyze the correlation between Cobb angle and spinous process angle (SPA) on X-ray film and body surface in patients with mild to moderate adolescent idiopathic scoliosis(AIS). To explore the possibility of linear SPA to assess scoliosis. METHODS: Retrospective study for correlation of Cobb angle and linear SPA on X-ray film. AIS patients treated and taken full spine anteroposterior X-ray from January 2019 to December 2021 were analyzed correlation of Cobb angle and linear SPA on X-ray film. Prospective study for correlation of Cobb angle and body linear SPA. AIS patients treated and taken full spine anteroposterior X-ray from December 1 to December 9 this year were analyzed correlation of Cobb angle and body linear SPA. RESULTS: A total of 113 AIS patients with age an average of (14.02±2.16) years old(ranged from 10 to 18 years old) were recruited in retrospective study, involving 26 males and 87 females;there were 71 patients with mild AIS and 42 patients with moderate AIS. Cobb angle in AIS patients was significantly inversely associated with SPA(r=-0.564, P<0.001), the linear regression equation was:Cobb angle=169.444-0.878×SPA. Cobb angles in patients with mild scoliosis were significantly and inversely associated with SPA(r=-0.269, P=0.012), the linear regression equation was:Cobb angle=46.832-0.185×SPA. Cobb angles in patients with moderate scoliosis were also clearly correlated with SPA(r=-0.417, P=0.003), the linear regression equation was:Cobb angle=113.889-0.516×SPA. Thirty-eight patients were recruited in prospective study. The mean Cobb angle and body linear SPA were(18.70±6.98)°, ranged from 11.3° to 36.0° and (170.34±4.57)°, ranged from 162.1° to 177.7° respectively. There was significantly negative correlation(r=-0.651, P<0.001), the linear regression equation is:Cobb angle=187.91-0.99×SPA. CONCLUSION: Linear SPA on X-ray film or on the body was significantly negatively correlated with Cobb angles, but the regression equation fits poorly, so it's not suitable for diagnosis of scoliosis;however, linear SPA is appropriate for self-controlled assessment of scoliotic therapy or for dynamic assessment of spinal flexibility.

Obstacles to home-based dietary management for caregivers of children with citrin deficiency: a qualitative study.

BACKGROUND: Dietary management is the most important and effective treatment for citrin deficiency, as well as a decisive factor in the clinical outcome of patients. However, the dietary management ability of caregivers of children with citrin deficiency is generally poor, especially in East Asia where carbohydrate-based diets are predominant. The aim of this study was to identify the difficulties that caregivers encounter in the process of home-based dietary management, and the reasons responsible for these challenges. RESULTS: A total of 26 caregivers of children with citrin deficiency were recruited, including 24 mothers, one father, and one grandmother. Grounded theory was employed to identify three themes (covering 12 sub-themes) related to the dilemma of dietary management: dietary management that is difficult to implement; conflicts with traditional concepts; and the notion that children are only a part of family life. The first theme describes the objective difficulties that caregivers encounter in the process of dietary management; the second theme describes the underlying reasons responsible for the non-adherent behavior of caregivers; the third theme further reveals the self-compromise by caregivers in the face of multiple difficulties. CONCLUSIONS: This study reflects the adverse effects of multi-dimensional contradictions on the adherence of caregivers to dietary management. These findings reveal that the dietary management of citrin deficiency is not only a rational process, rather it is deeply embedded in family, social, and dietary traditions.

The correlation between weight gain and PICC tip shift in the very low birth weight infants.

BACKGROUND: Peripherally inserted central catheter (PICC) is one of the important ways to maintain nutrition in premature infants, especially for very low birth weight infants. There are studies have shown that as premature babies grow up after birth, the tip of the PICC will shift away from the heart. When the catheter remove from the central vein, the risk of complications is suddenly increased. Therefore, it is important to predict the position of catheter tip. METHODS: Select the very low birth weight infant (VLBW) infants who used PICC in our hospital from April 2017 to August 2018. And we recorded the birth weight, the weight and the position of the catheter tip of the each filming day, and calculated the rate and speed of weight gain during this period. The correlation was analyzed by the Spearman method. RESULTS: A total of 49 patients and 151 X-rays were enrolled in the study. Of the 49 remaining infants, 40 were in appropriate for gestational age group and 9 were in small for gestational age group. The correlation between weight gain and PICC tip shift in appropriate for gestational ages (AGAs) is statistically significant (P<0.05). But for SGAs group, the correlation between the rate of weight gain and PICC tip shift was -0.588 (P<0.05), but there was no correlation between the speed of weight gain and PICC tip shift. CONCLUSIONS: There is a close correction between catheter tip shift and weight gain for those babies. The PICC should be repositioned by X-ray when the rate of weight gain of AGA infants increased to 25%, 50%, 70% [10%, 35%, 55% for small for gestational age (SGA) infants]. For AGAs, when the baby's weight gain speed reaches 1% and 3.5%, the catheter tip had 2 and 3vertebral changes, so if the speed of weight gain is excessive faster, we need to increase the frequency of the positioning.

Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants.

AIMS: The objective of the present analysis was to evaluate and quantify the risk for gestational diabetes mellitus (GDM) according to maternal age. METHODS: Three electronic databases were searched for publications from inception to July 2018. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. A dose-response analsis was performed using generalised least squares regression. Subgroup and meta-regression analyses were conducted to explore the source of identified heterogeneity among studies. RESULTS: Twenty-four studies were included in the present meta-analysis. The ORs and 95% CIs for women aged <20 years vs 25-29 years, 30-34 years, 35-39 years and ≥40 years were 0.60 (95% CI = 0.50-0.72), 1.69 (95% CI = 1.49-1.93), 2.73 (95% CI = 2.28-3.27), 3.54 (95% CI = 2.88-4.34) and 4.86 (95% CI = 3.78-6.24), respectively. Dose-response analysis showed that GDM risk exhibited a linear relationship with maternal age (Ptrend < 0.001). For each one-year increase in maternal age from 18 years, GDM risk for the overall population, Asian, and Europid increased by 7.90%, 12.74%, and 6.52%, respectively. Subgroup analyses indicated that from the age of 25, Asian women had a significantly higher risk of developing GDM than Europid women (all Pinteractions < 0.001). CONCLUSIONS: This meta-analysis demonstrates that the risk of GDM increases linearly with successive age-groups.

An RNA-binding protein MUG13.4 interacts with AtAGO2 to modulate salinity tolerance in Arabidopsis.

Salt stress is a major constraint to plant growth and development, and plants have developed sophisticated mechanisms to cope with it. AtAGO2, an argonaute protein, is known to play an important role in plant adaptation to salt stress; however, the molecular mechanism of this phenomenon remains essentially unexplored. Here, we performed the yeast two-hybrid assay and found an R3H-domain containing protein, designated as MUG13.4, interacting with AtAGO2. Further bimolecular fluorescence complement (BiFC), glutathione-S-transferase (GST) pull-down, and co-immunoprecipitation (Co-IP) assays confirmed that MUG13.4 interacted with AtAGO2, and MUG13.4 could affect the slicing activity of AtAGO2 associated with miR173. MUG13.4 and AtAGO2 were both predominantly expressed in seeds and roots. Phenotypic analyses of the single and double mutants under salt stress confirmed involvement of MUG13.4-AtAGO2 complex as a component of the salt tolerance mechanism. The mug13.4×ago2-1 double mutant displayed retarded growth and hypersensitivity to salt stress that was more pronounced than in mug13.4 or atago2-1 single mutants. TAS1c-tasiRNA generating system in Nicotiana benthamiana revealed that MUG13.4 could influence the slicing activity of AtAGO2. We also found that MUG13.4 increasingly changed the phenotype of slicer-defected mutants of AtAGO2 in response to salt stress. These findings suggested that the function of AtAGO2 upon salt stress was dependent on MUG13.4. Further investigation suggested that AtAGO2 improved Arabidopsis tolerance to salt stress by affecting operation of the SOS signaling cascade at the transcript level. Taken together, these findings reveal a novel function of MUG13.4 in adjusting Arabidopsis adaptation to salt stress.