Objective To analyze the causes of non-elective removal of pereutaneously inserted central venous catheters (PICC) in premature infants. Methods We retrospectively collected the clinical data of 104 premature infants and analyzed the causes of non-elective removal of PICC. Results PICC was removed when the treatment was finished (n = 93, elective removal group) or due to complications ( n = 7, non-elective removal group). In non-elective removal group, the percentage of catheter tip located in the subclavian jugular was signifi-cantly higher in non-elective removal group than in the elective removal group (X2 = 24.931, P = 0. 000 ). The length of inserted catheter was ( 8.4 + 2.2 ) cm in the non-elective removal group and ( ( 10.2:1:1.6) cm in the elective removal group ( t = 3. 391, P = 0. 001 ). Conclusion The main cause of non-elective removal of cathe-ters in premature infants may be that catheter tip fails to reach the vena cava.

Objective To investigate the effects of total intravenous anesthesia (TIVA) and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery.Methods Forty-four spinal neurosurgery patients were divided into propofol combined with remifentanil group (PR group) and sevoflurane combined with remifentanil group (SR group ), 22 cases in each group,they were induced with propofol, sufentanil and rocuronium. Anesthesia was maintained with sevoflurane in SR group while propofol in PR group. Depth of anesthesia adaption according to bispectral index (BIS)(45 -55). Blood glucose, cortisol, haemodynamics were observed at different time points. Results The mean arterial pressure(MAP) was higher after induction in PR group than that in SR group(P ＜ 0.05 ). Sixty minutes after induction, MAP was lower than that before induction in PR group (P ＜ 0.05 ). Heart rate ( HR )in both SR group and PR group were lower at 60 and 120 minutes after induction than those before induction (P ＜ 0.05). HR was lower at 5 minutes after induction in PR group than that in SR group (P ＜ 0.05). No significant difference was showed in blood glucose and cortisol between the two groups (P ＞ 0.05 ). Cortisol level was significantly lower at 120 minutes after induction than that before induction [(40.6 ± 18.3) μg/L vs. ( 129.7 ± 36.7 ) μg/L, P ＜ 0.05 ] and at 24 hours postoperative [ (93.6 ± 19.8 ) μg/L ] recovered to the level before induction in PR group. Cortisol level was significantly higher before induction than 120 minutes after induction [ ( 130.5 ± 32.1 ) μg/L vs. (51.6 ± 16.8 ) μg/L, P ＜ 0.05 ] and 24 hours postoperative was (75.9 ± 18.2) μg/L in SR group. Conclusions Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. However, longer cortisol inhibition is probably happened when using sevoflurane.

As a new learning tool, mind mapping helps students master the learning content in a visual and radical way. This paper intro-duced the concept and method of making the mind map and analyzed the advantages of mind mapping in improving learning efficiency and its application in rehabilitation. It is pointed out that the use of mind mapping would help students to integrate new and old knowledge, to improve the ability to solve clinical problems, and to train innovative talents by stimulating students' divergent thinking. It is believed that the mind map has a broad application prospect in rehabilitation education in China.

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.

OBJECTIVE To analyze 28 cases in an outbreak of neonatal enterovirus nosocomial infection during summer of 2006.METHODS Demographic characteristics,clinical manifestations,laboratory data and outcome were analyzed to reveal the clinical severity.RESULTS The outbreak lasted more than one month and the nosocomial infection rate increased to 6.4%.There were 22 cases(78.6%) first presented with fever.Half of the patients were detected enterovirus from blood or cerebrospinal fluid by PCR.All of the 28 cases were diagnosed enterovirus infection based on the contact history,clinical signs and laboratory results.Among them,ten cases had viral meningitis.All patients discharged home after hospitalization with no sequelae.CONCLUSIONS Although this group of neonatal enterovirus infection developed viral meningitis,they had relatively mild illness with benign clinical course.Extreme vigilance is required in interrupting the spread of nosocomial enterovirus infections in neonatal units.This includes respect of strict hygiene measures and meticulous hand-washing.

ObjectiveTo investigate the effect of intensive insulin therapy in critically ill elderly patients.MethodsElderly patients ( ≥ 65 years) admitted to the ICU of Beijing Tongren Hospital from June 2005 to December 2007 were divided into Group A ( glucose control target was 4.4-6.1mmol/L) and Group B ( glucose control target was 7.3-8.3mmol/L).Blood glucose level was controlled with a computer-assisted glucose control protocoL ResultsA total of 639 patients were enrolled,of which 280 were in Group A and 359 in Group B.The mean blood glucose level of the 2 groups was (6.07 ± 0.56) mmol/L and (7.52 ± 0.87 ) mmol/L respectively,both within the target ranges.The hyperglycemic index was (0.69±0.44) mmol/L in Group A and ( 1.60 ±0.73) mmol/L in Group B (P =0.000).No hypoglycemia adverse events occurred in either group.No significant differences were observed in the length of stay in ICU,duration of mechanical ventilation,hospitalization expenses,ICU mortality,and hospital mortality of the 2 groups.ConclusionMaintaining the blood glucose level of critically ill elderly patients at ≤8.3 mmol/L is safe and practical.

Objective:To investigate the understanding and application of the knowledge of premature infants in pediatricians participating in the Second Chinese Preterm Infant Academic Conference through questionnaires, and to carry out targeted continuing education for pediatricians in order to better guide the clinical diagnosis and treatment of grassroots pediatricians.Methods:The research was conducted in the form of a questionnaire survey.The survey objects were pediatricians participating in the " Second Chinese Preterm Infant Academic Conference" , and the results of the questionnaire were summarized and analyzed.The questionnaires were designed based on personal education background, employment time, current status of neonatal specialty in the hospital where they were, and knowledge of premature infant nutrition.Results:A total of 554 valid questionnaires were received.Among the pediatricians surveyed, 37.2% had a master's degree or higher; 344(62.1%) pediatricians came from Grade Ⅲ class A hospitals.According to the geographical distribution, age, education, working years, hospital level, hospital nature, annual delivery of obstetrics in hospitals, the number of beds in neonatal specialty wards, and the number of beds in NICU, the respondents were grouped, and the current status of premature births in China and the situation of using the growth curve(Fenton2013) of premature infants in work were compared.It was found that the proportion of those who used the Fenton curve of the 2013 version in Grade Ⅲ class A hospitals was higher than that in Grade Ⅲ class B hospitals and Grade Ⅱ hospitals(χ 2=47.663, P<0.05). The ratio was higher among women and children's health centers and general hospitals(χ 2=8.072, P<0.05). Conclusion:The academic annual conference for the purpose of continuing education, set up a pre-conference questionnaire for the participants during the preparation period, and set the content of the annual conference according to the needs of the target population, which can better solve the clinical problems of primary doctors and promote the improvement of primary doctors' diagnosis and treatment.

Consensus and guidelines regarding point-of-care ultrasound (POCUS) carried out by neonatologists in neonatal intensive care unit (NICU) have been published in many countries. This review summarizes the development, advantages, limitations, and current issues of POCUS in NICU, aiming to promote the establishment of systematic training courses, accelerate the development of POCUS in NICU in China, and ensure the effectiveness and safety of POCUS implementation.

Correct neonatal resuscitation is the primary way to reduce perinatal mortality and neurological sequelae, and adequate preparation is essential. This article introduces the details for preparing neonatal resuscitation (including antenatal consultation) and ways to optimize the practice, aiming to improve the success rate of neonatal resuscitation.