Team training significantly affects the performance of clinicians in neonatal resuscitation, which plays an important role in improving outcomes of asphyxiated newborns. Since 2016, team training was formally described in the Textbook of Neonatal Resuscitation, including 10 key points, which were summarized into three core elements in this review: teamwork, communication, and leadership. We review the application of these three elements in current team training and the main training approaches, aiming to offer a framework for standardized team training and to improve the success rate of neonatal resuscitation.

ObjectiveTo investigate the selection of dilivery of pregnant women and related factors.MethodsThe selection of delivery modes for pregnant women was investigated by analyzing the associated factors of the infants registered into a computerized health care managing system from January 1,2008 to December 31,2010 at a local community of Shanghai.The information associated with delivery modes of their mothers was collected and the choice of delivery modes investigated through a standardized questionnaire by interviewing the mothers at two months after birth.ResultsThe cesarean section (C/S)rate of pregnant women residing in this local area was 58.3 ％ (224/384).In the C/S group,the percentages of delivery age ≥24 yr,white-collar workers,education level at high school and above and monthly income ≥ 3000 yuan were 73.2％ ( 164/224 ),38.4％ ( 86/224 ),79.5％ ( 178/224 ) and 80.8％ ( 181/224 )respectively.And they were all higher than those of vaginal delivery (63.1％,n =101; 32.5％,n =52;69.4％,n =111; 70.6％,n =113 ).The choices of C/S depended on the existences of maternal,fetal,social-psychological and others factors during pregnancy.Most pregnant women and families who chose C/S without medical indications were afraid of pain ( 33.9％ ) or a failure of vaginal delivery ( 30.5％ ).ConclusionsThe social-psychological factors of pregnant women are important in the choices of delivery modes.Unnecessary C/S could be reduced by improving their knowledge of delivery with meticulous prenatal health care consultations.

Objective To explore the effects of static wrist on radial nerve palsies. Methods 60 patients with radial nerve palsies were devided into wrist group (n=20), acupuncture group (n=20) and intermediate-frequency (IF) group (n=20), who accepted static wrist wearing, electroacupuncture, and intermediate-frequency electro-stimulation respectively. Results The efficacy was not significantly different among these groups, but the time out of working and the cost for the management were the least in the wrist group. Conclusion Wearing static wrist is not only effective on radial nerve palsies, but also reduce the loss of working time and cost of treatment

Objective To investigate the effect of persistent hypoglycemia on the cerebral oxidative stress and matrix metalloproteinase-2 (MMP-2) activity of newborn rats and to explore the potential mechanism of hypoglycemia-induced brain injury of newborn.MethodsSeven-day-old rats were injected insulin subcutaneously to induce persistent hypoglycemia.Cerebral cortex,hippocampus and thalamus were collected after 36 hours' observation and stored in -80 ℃.Glutathione (GSH)and glutathione disulfide (GSSG) were detected by commercial kit and GSSG/GSH was calculated.MMP-2 activity was detected by gelatin zymography. The data were analyzed by t test,one or two-wayanalysis of variance and Pearson correlation analysis.Six rats were set as the normal glucose group. ResultsThirty-six hours after induction of hypoglycemia, the cerebral GSSG and GSSG/GSH of hypoglycemic pups elevated about 1.5 times higher than those of control group [GSSG:(15.89 ± 5.46) vs (6.15 ± 3.42) mg/g protein,t =3.704,P =0.004; GSSG/GSH:(5.58± 1.79) ％ vs (2.79±1.76) ％,t =2.712,P=0.022].The GSSG and GSSG/GSH in thalamus of hypoglycemia were significantly higher than those of control [GSSG:(15.93 ± 5.75) mg/g protein vs (5.03±5.14)mg/g protein,P＜0.05; GSSG/GSH:(6.50±3.25) ％ vs (2.41±3.12) ％,P＜0.05],whereas there were no significant differences in the cortex ard hippocampus.The total MMP-2 activity of hypoglycemic animals (2.22±0.59) was significantly higher than that of control (1.21± 0.17)(t=4.064,P=0.002),and significant differences were found between the two groups in cortex (2.14 ± 0.5 vs 1.17± 0.27),hippocampus (2.31± 0.72 vs 1.22 ± 0.37) and thalamus (2.22±0.68 vs 1.24±0.18) with all P＜0.01].The activity of MMP-2 was positively related to GSSG (r=0.575,P=0.0002) and GSSG/GSH (r=0.484,P=0.0003).ConclusionsOxidative stress might play an important role in the persistent hypoglycemia induced brain injury of 7-day-old rat pups and thalamus might be most vulnerable to hypoglycemia.Hypoglycemia might also elevate MMP-2 activity which is positively related to GSSG level and GSSG/GSH of the brain.

Objective To investigate the activation of apoptotic genes of the brain with hypoxia- ischemia (HI) in newborn SD rats, and MRI changes and memory and learning ability in adulthood. Methods HI was induced by right carotid artery ligation followed by 2.5 h of hypoxia (6% O2) on 3-day-old SD rats (n=36). Control pups were sham-operated (n = 27). Right brain hemisphere was collected at 12 h and 7 d after HI and subjected to an apoptosis Oligo GEArrayR. MRI and Morris water maze test were performed on both groups at 42 and 44 days old, respectively. Results Comparing to 12 h after HI, up-regulated apoptotic genes included TNF, Caspase and pro-apoptotit genes of Bcl2 families, whereas the anti-apoptotic genes of Bcl2 family were down-regulated at 7 d after HI. The MRI assessment of the rats in HI group demonstrated that the area of the right cerebra l cortex was significantly smaller than the left side and control [periventricular layer: (23.5±3.6) mm2 vs (33.0±4.3) mm2, (34.5±3.9) mm2; hippocampus layer: (18.9±4.4) mm2 vs (29.1±5.0) mm2,(30.8±4.5) mm2, both P<0.01]. During the navigation trial, the HI rats demonstrated longer escape latency (4th day: (52.7±35.9) vs (17.8±8. 9) s, P<0.01). HI rats passed the platform less times than the control ones (T= 292.5, P<0.05) in space probe trial. Conclusions The activation of apoptotic genes induced by HI brain injury remains until 7 days later, involving intrinsic and extrinsic apoptotic pathway. The apoptosis of neural cells may lead to poor development of the cortex and impair the memory and learning ability in the adult rats after neonatal hypoxia- ischemia injury.

To assess the effects of resuscitation with oxygen or room air on the cardiac circulation and the activity of superoxide dismutase (SOD) in a hypoxic newborn piglet model. Methods Newborn piglets(1.6-2.5 kg) were randomly assigned into three groups:control group (n=8) with no hypoxic insult;room air group (n=12) resuscitated with room air for 240 min after 120 min hypoxia;and oxygen group (n=12) resuscitated with 100% oxygen for 30 min followed by 210 min with room air after 120 min hypoxia. Blood gas analysis, blood pressure and hemodynamic parameters were recorded at 0, 10, 30, 60, 120, 180 and 240 min of resuscitation. The activity of superoxide dismutase (SOD) in the left ventricle was measured at 240 min of resuscitation using enzyme method . One-way analysis of variance, two-way analysis of variance measured repeatedly and Student-Newman-Keuls test were applied as statistical methods. Results Severe metabolic acidosis, hypotension and hypoxemia were caused by hypoxia.(1)Arterial oxygen partial pressure(PaO2):At 10 min of resuscitation, PaO2 of control group, room air group and oxygen group was (67±4), (78±12) and (409±42)mmHg(1 mmHg=0.133 kPa) (F=580.19, P<0.01). At 30 min of resuscitation, PaO2 of the three group was (68±3), (79±15) and (342±62)mmHg(F=173.67;P<0.01). PaO2 of oxygen group was higher than room air group and control group (10 min:q=42.51 and 39.28, 30 min: q=23.17 and 21.67, all P<0.05). There was no statistical significance between the room air group and control group. (2)Cardiac output(CO):At 240 min of resuscitation,CO of control group, room air group and oxygen group was(181.6±33.8), (150.9±70.1) and (103.6±53.6) dl/(min·kg) (F=4.82, P<0.05). CO of oxygen group was lower than control group (q=4.25,P<0.05). There was no statistical significance between oxygen group and room air group, neither was between room air group and control group (all P>0.05). (3)Arterial oxygen content (CaO2):At 10 min of resuscitation, CaO2 of control group, room air group and oxygen group was(87.0±16.1), (76.9±13.2) and (102.2±15.9) ml O2/dl (F=8.64, P<0.01). At 30 min of resuscitation, CaO2 of the three group was(87.5±14.9), (79.9±11.3) and (100.1±16.7) ml O2/dl (F=5.98, P<0.01). At 10 min of resuscitation, CaO2 of oxygen group was higher than control group and room air group (q=3.14 and 5.85, all P<0.05). At 30 min of resuscitation, CaO2 of oxygen group was higher than room air group (q=4.85, P<0.01), but there was no statistical significance between oxygen group and control group (q=2.71, P>0.05). (4)Oxygen delivery (DO2): At 10, 30, 60, 120, 180 and 240 min of resuscitation, there were no statistical significance among DO2 of control group, room air group and oxygen group [10 min:(16.5±3.3), (15.7±9.9) and (16.9±4.2)L O2/(kg·min), F=0.10;30 min:(16.2±4.1), (15.1±5.5) and (14.5±3.3) L O2/(kg·min), F=0.38;60 min:(16.1±4.2), (14.9±4.0)and(13.3±3.8)L O2/(kg·min), F=1.28;120 min:(15.5±3.7),(15.6±6.1)and(13.4± 4.6) L O2/(kg·min), F=0.66;180 min:(15.4±3.1), (15.3±9.3) and (11.9±5.0) L O2/(kg·min), F=0.97;240 min:(14.7±3.4), (13.4±6.7) and (9.3±5.2) L O2/(kg·min), F=2.84;all P>0.05]. (5) SOD activity in the left ventricle:At 240 min of resuscitation, SOD activity of control group (n=6), room air group (n=8) and oxygen group (n=8) was (289±107), (210±75) and (142±61)U/mg protein, F=5.75, P<0.05]. SOD activity of oxygen group was lower than control group (q=4.79, P<0.01). There was no statistical significance between oxygen group and room air group, neither was between room air group and control group(q=2.58 and 2.39, all P>0.05). Conclusions Despite higher oxygen content in the blood, resuscitation with oxygen is not beneficial to recovery from metabolic acidosis in newborn hypoxic piglets. Oxygen supplementation does not increase oxygen delivery but reduces SV compared to resuscitation with room air. Resuscitation with oxygen may impair the oxidative stress defense.

Objective To investigate the hemodynamic changes and their association with the expression of β 1 and β 2 adrenoceptors after hypoxia-reoxygenation injury in a neonatal swine model of asphyxia.Methods One to four day-old piglets were randomly assigned to control group (n=6),acute hypoxia group (n=8) and subacute hypoxia group (n=8).The piglets in the control group were observed for 50 h under normoxic mechanical ventilation; while the acute and subacute hypoxia groups were subject to two hours of hypoxic injury induced by ventilation with 0.10-0.15 oxygen followed by 4 or 48 h of observation under normoxic mechanical ventilation,respectively.Blood gases were analyzed and the mean arterial blood pressure,heart rate,and cardiac output were recorded at different time points during the experiment.Tissues from the left ventricle were also harvested to assay lactate,glutathione and β adrenoceptors at the end of the experiment.Analysis of variance,the Tukey test and Pearson correlation analysis were used for statistical analysis of the data.Results Two hours after hypoxia,pH,HCO3-and partial pressure of oxygens (PO2) in the acute hypoxia group and subacute hypoxia group were lower than in the control group,however,pH and HCO3-in animals in the subacute hypoxia group recovered to 7.38 ± 0.05 and (23.04± 2.40)mmol/L,respectively,after reoxygenation,which was similar to those in the control group,and higher than in the acute hypoxia group [7.25±0.07 and (16.88±2.40) mmol/L,respectively,q=6.76 and 7.81,both P＜0.01].Mean arterial pressure,cardiac output and stroke volume in the acute group and subacute group were lower than those in the control animals following two hours of hypoxic injury (all P＜0.01).After reoxygenation,the mean arterial pressure in the acute hypoxia group and subacute group recovered to (42.17±6.14) and (43.19± 5.55) mmHg (1 mmHg=0.133 kPa),cardiac output recovered to (150.04± 56.17) and (169.75 ± 37.85) dl/min,respectively,and there were no differences compared with the control group (all P＞0.05).Expressions of β 1 and β 2 adrenoceptors in the left ventricle in the subacute hypoxia group (1.51 ±0.51 and 2.14±0.66,respectively),were higher than those in the control group (0.56±0.24 and 0.38±0.21,q=7.02 and 10.97,both P＜0.01) and the acute hypoxia group (0.65±0.20 and 0.45±0.11,q=6.86 and 11.38,both P＜0.01).The lactate level in the acute hypoxia group and subacute hypoxia group was higher than that in the control group [(6.95±0.32) and (6.92±0.40) vs (5.03±0.19) μ mol/mg protein,respectively,q=15.43 and 15.19,both P＜0.01].The level of glutathione in the subacute hypoxia group was lower than the control group and acute hypoxia group [(352.00± 16.51) vs (438.35±33.66) and (464.66±52.65) nmol/mg protein,respectively,q=6.00 and 8.46,both P＜0.01).In the subacute hypoxia group,the expressions of β 1 and β 2 adrenoceptors were negatively correlated with the changes in cardiac output (r=-0.60 and-0.59,respectively,both P＜0.05).Conclusions Severe metabolic acidosis and cardiac dysfunction resulting from perinatal asphyxia may recover after reoxygenation,which may be associated with the enhanced expression of β adrenoceptors in the left ventricle during the subacute phase.

Objective Compare the analgesia effects of using different intervention method among neonatal infants, and then find out the most effective method. Methods Divided 120 neonatal infants into the control group, the NNS group and the position group, there were 40 cases in every group. Using the N-PASS scale evaluated the pain degree at the points of 1 and 5 minutes respectively after stimulation among the 3 groups. Results There was significant difference between the 3 groups on the pain degree,P

Objective To establish a reference range of cancellous bone ultrasonic backscatter coefficient (BSC) in term neonates,and to determine the significance of BSC in bone nutritional status in term newborns and infants.Methods Six hundred and sixty-five term newborns,who were born in Shanghai First Maternity and Infant Hospital from July 2014 to August 2014,were enrolled.On the third day and the 42nd day after birth,all infants underwent ultrasonic measurement of the calcaneum bone using a broadband-non-focus ultrasonic transducer at three frequencies (2.25,3.5 and 5 MHz).MATLAB software was used to analyze the backscatter signals.Clinical data of the infants,including gestational age,birth weight and birth age,were recorded at the same time.Statistical analyses of the data included variance analysis,Tukey's test,rank sum test,Dunn test and Pearson or Spearman correlation analysis.Results (1) Of the 665 infants,335 were male.The mean gestational age at birth was (38.0± 1.9) weeks,and the mean birth weight was (3 1524±226) g.(2) On the third day,there were significant differences in BSC values acquired at 2.25 and 3.5 MHz among the groups with different gestational ages or birth weights (2.25 MHz:H=9.842 and 17.271;3.5 MHz:H=6.275 and 21.450,respectively,all P＜0.05).At 3.5 and 2.25 MHz,BSC values were positively correlated with gestational age (r=0.047 and 0.035,respectively,both P＜0.05) and birth weight (r=0.125 and 0.186,both P＜0.05).(3) On the 42nd day,significant differences in BSC were observed at each frequency among the groups with different gestational ages or birth weights (gestational age:H=76.832,16.498 and 32.756;birth weight:H=70.014,18.095 and 34.126;all P＜0.01).Gestational age and birth weight were positively correlated with BSC value acquired at each frequency (r=0.397,0.286 and 0.272 for gestational age,0.451,0.223 and 0.196 for birth weight;all P＜0.01).Conclusions A preliminary BSC reference percentile in term-born infants is established.There are positive correlations between BSC value and newborn gestational age and birth weight at certain frequencies,which can reflect the status of the newborn's cancellous bone.Determination of BSC value should be performed during the follow-up period to assess the nutritional status of neonatal bone.

Objective To investigate the effect of syndecan-4 on the proliferation and extracellular matrix (ECM) secretion of human mesangial cells(HMC) stimulated by basic fibroblast growth factor (bFGF) and to evaluate the role of syndecan-4-PKCα pathway. Methods The expression of syndecan-4 in HMC was observed by immunofluorescence. After the down-regulation of syndecan-4 in HMC by RNA interference, the cell proliferation was detected by MTT. The secretion of fibronectin (FIN), type IV collagen, type Ⅰ collagen was assessed by ELISA. The copy number of syndecan-4 and PKCα was measured by fluorescent quantitation PCR at different time points. Results Syndecan-4 was expressed in HMC. bFGF could promote the cell proliferation and ECM secretion together with the PKCα copy number per million house-keeping genes of HMC, which could be reversed by the syndecan-4 siRNA transfection (MtT: 48-60 h, P<0.01; FiN: 24 h, P<0.01, 48-96 h, P<0.05; type Ⅳ collagen: 72-96 h, P<0.05; PKCa: 0 h, P<0.05, 12-48 h, P< 0.01). Conclusion Syndecan-4 may regulate the proliferation and ECM secretion of HMC stimulated by bFGF through syndecan-4-PKCα pathway.