OBJECTIVE: To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. METHODS: Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups. RESULTS: There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all CONCLUSIONS The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.
Bilirubin ; Erythroblastosis, Fetal/diagnosis* ; Female ; Humans ; Hyperbilirubinemia, Neonatal/diagnosis* ; Infant, Newborn ; Jaundice, Neonatal/diagnosis* ; Monitoring, Physiologic/methods* ; Phototherapy

Objectives To analyze the risk factors for transfusion in very low birth weight infants and to explore the strategies for prevention of anemia. Methods Neonates with gestational age <37 weeks and birth weight <1500 g admitted from January 2015 to June 2016 were included. The neonates were divided into blood transfusion group and non-blood transfusion group. The general conditions and complications were compared, and the risk factors of blood transfusion and the related factors were analyzed. Results One hundred fifty cases of very low birth weight infants were included, among whom 108 cases were from blood transfusion group and 42 cases were from non-blood transfusion group. Compared with the non-blood transfusion group, the gestational age and body weight of the blood transfusion group were smaller, the basic hemoglobin was lower, the parenteral nutrition time was longer, and the total volume of blood collection in hospital was higher, and these differences were all statistically significant (P all<0.05). The incidence of bronchopulmonary dysplasia (BPD), acute respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) in the blood transfusion group were higher than those in the non-blood transfusion group, and they were all statistically different (P all <0.05). Multiple linear regression analysis showed that the volume of blood transfusion was higher when the gestational age and body weight were smaller, the longer parenteral nutrition was needed, and the total volume of blood taken from the hospital was higher (P all <0.05). Conclusions The gestational age, body weight, parenteral nutrition time and the total volume of blood collection in very low birth weight infants have different effects on blood transfusion risk and transfusion volume. The incidences of BPD, RDS, and PDA in infants with blood transfusion are higher.

Objective To explore the effect of persistent stress on the ultrastructure of cancellous bone in the process of fracture healing.Method A transverse osteotomy on both sides of the femoral tuberositas was performed in 20 adult dogs. One side was fixed with a self-designed tuberositas memofy-pressure connector (TMC) which was made of NiTi shape memory alloy, and the other with compressive steel-wire (SW) cerclage.Five animals in each group were sacrificed at 2, 4, 8, 12 weeks after operation and observed under transmission electron microscope.Results The fracture healing was accelerated in the TMC group.The osteoblasts, chondroblasts and collagen fibers at the fracture sites showed significantly different morphology between the 2 groups at every observation time.Most cells and collagen fibers in the TMC group grew along the same direction as the stress, but those in the SW group grew in disorder.Both the number and functional activity of the osteoblasts and chondroblasts were higher in the TMC group than in the SW group.Conclusion Persistent stress can enhance healing and bone reconstruction following a cancellous bone fracture.

Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum.

OBJECTIVE: To compare the clinical effect between Gamma nail and proximal femoral nail (PFN) on the treatment for femoral intertrochanteric fractures in the elderly.METHODS: A total of 131 cases (39 males and 92 females; aged 70?81 years, mean age of 76 years) with femoral intertrochanteric fractures were collected from the Department of Orthopaedics, the Affiliated Changhai Hospital of the Second Military Medical University of Chinese PLA from January 2005 to January 2008. Femoral intertrochanteric fractures were classified based on AO system, including type A1 (n=56) and type A2 (n=75). All cases were randomly divided into Gamma nail group (n=65) and PFN group (n=66). Pre- and post-operative blood loss, blood transfusion volume, operating time, and length of stay were recorded, while the complications were detected following nail implantation. Functional changes of injured limbs were detected after 9 months.RESULTS: At 9 months after following up, there was no significant difference in blood loss, blood transfusion volume, operating time, and length of stay between the two groups before and after implantation (P> 0.05). Furthermore, complications did not occur during or after implantation. Six cases in the PFN group had infection in which of them had diabetes mellitus. There were no complications such as cutting out of femoral head, femoral shaft fractures, breakage of internal device or pushing out phenomenon. All cases got bone union at the final follow-up of nine months and did not get nonunion, delayed union of fractures or shortening of injured extremity.CONCLUSION: Gamma nail and PFN have equal effect on the treatment of femoral intertrochanteric fractures in the elderly.

BACKGROUND:Swan-like memory connector (SMC) can form a three-dimensional fixation on long bone shaft,ensure the stability of fracture ends,and produce a continuous dynamic compressive stress on the fracture ends.Insulin-like growth factorⅠ (IGF-Ⅰ) regulates bone development and metabolism,cell differentiation,as well as mitosis.During the union process of fracture,IGF-I is effective to promote cellular proliferation,stimulate bone formation and result in chondrogenesis.OBJECTIVE:To quantitatively determine the effect of SMC and conventional dynamic compression plate (DCP) on the concentration of local IGF-Ⅰ in the union duration of rabbit humerus fracture.DESIGN,TIME AND SETTING:A controlled observational animal study was performed in the laboratory,Department of Orthopaedics,Changhai Hospital,the Second Military Medical University of Chinese PLA from January to May in 2007.MATERIALS:SMC was Ni-Ti alloy panel,comprising 50%-53% Ni,was customized by Lanzhou Seemine Shape Memory Alloy Co.,Ltd.The temperature of shape recovery was (33±2) ℃.METHODS:Thirty adult New Zealand rabbits were used in this study and were processed into osteotomy.The experiment sides of rabbit humerus were cut and fixed with SMC at random,serving as SMC group,and the other sides were cut at the same position and fixed with DCP,serving as DCP group.Each five animals were put to death at the time points of 2,3,4,6,8,and 12 weeks after internal fixation.Specimens were obtained from the areas that were 0.5 cm besides the fracture line.MAIN OUTCOME MEASURES:Following internal fixation,the contents of local IGF-Ⅰ in the specimens of different time points (2,3,4,6,8,and 12 weeks) were determined in both SMC group and DCP group.RESULTS:In the SMC-treated group,the contents of IGF-I increased 2 weeks after internal fixation,reached the maximum at 6 weeks,and then decreased at 8-12 weeks.In the DCP-treated group,the contents of IGF-Ⅰincreased 2 weeks after internal fixation,reached the maximum at 8 weeks,and then decreased at 12 weeks.No significant differences were found between the SMC group and the DCP group at 2,8,12 weeks after internal fixation (P ＞ 0.05).Compared with the DCP group,the SMC group had a remarkably higher content of IGF-Ⅰ at the time points of 3,4 and 6 weeks (P ＜ 0.05).The difference was the most statistically significant at 4 weeks.CONCLUSION:Compared with conventional DCP,the SMC could better promote the secretion of IGF-Ⅰin fracture and facilitate the fracture union due to the continuous dynamic compressive stress and three-dimensional fixation.

Objective To discuss the therapy for acetabular comminuted fractur e combined with compressive defects. Methods From July 1997 to February 2005, 43 cases of comminuted acetabular fracture combined with compressive defect were t reated. 25 cases were obsolete, 16 fresh, and 2 malformed (90 days after injury) . 34 cases were complicated fractures with defects, and 9 simple fractures with defects. The defect volumes ranged from 3 to 9 cm3, averaging 4.5 cm3. They were treated with ATMFS (acetabular tridimensional memory fixation system) to fixate the comminuted bone fragments tridimensionally. The modified acetabular approac h, reduction of acetabular comminuted articular face, anatomical reconstruction of posterior wall of acetabulum with autogenous ilium, autogenous and artificial bone implantation and bone wax isolation were used. The follow-ups lasted from 5 to 86 months, averaging 15.7 months. Results 31 cases achieved anatomical red uction by filling up the compressive defects. 12 cases were treated by anatomica l reconstruction of posterior wall. On average, 5.3 months after operation, the injured hip joint was as good as the healthy one in 40 cases. Ischemia necrosis of femoral head occurred in 1 case, and 2 cases experienced heterotopic ossifica tion with ischemia necrosis of femoral head which led to osseous fusion of hip j oint. Conclusion The new methods for treatment of acetabular fractures with comp ressive defects elevate the reduction rate of acetabulum and femoral head, and a re effective for the functional recovery of hip joint.

Objective To develop a new method of treating fractures and nonunion of radial and ulnar diaphyses. Methods We designed a kind of radius-ulna shape memory connector (RSMC) on the basis of the shape memory property of nitinol alloy and the anatomic characteristics of radial and ulnar diaphyses. It is capable of providing 3-D fixation and exerting continually longitudinal compression upon fracture sites. It was used in 31 cases (57 bones) of fresh fractures and 39 cases (53 bones) of nonunion, totaling 70 cases (110 bones). Results The mean follow-up time was 1.5 years(from 7 months to 2 years). In the fresh fracture group, no delayed union or nonunion was observed, and the solid bone healing time averaged 2.3 months. In the nonunion group, all the cases were cured at one time and the solid bone healing time averaged 3.5 months, but two cases were complicated with slight skin infection which had little influence on the internal fixation and bone healing. Conclusion RSMC can provide a new and efficacious method for the treatment of fracture and nonunion of radial and ulnar diaphyses.

Objective To research on the new technique and method of bone grafting for nonunion of four limbs. Methods A new method of bone grafting was developed to take advantage of Nitinol Shape Memory Connector. It included splinting mode, padding mode and seeding mode. 148 cases of bone nonunion in 134 patients were treated with the modified method. Results The patients were followed up for 5.5 months to 6 years, with an average period of 2.25 years. On the average, the nonunion healed with lamellar bone 3.5 months after the operation. The healing rate was 99.3% . Conclusion The author s modified bone grafting provides a new and efficacious method for treatment of the limb nonunion.

Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.