ObjectiveTo review the recent studies about sentinel lymph node biopsy in breast cancer.MethodsThe literatures in recent years on the history, concept, technique and clinical application of sentinel lymph node biopsy were reviewed and summarized.ResultsThere was no unified method for sentinel lymph node biopsy. There was a wide range of detection rate and falsenegative rate.ConclusionProspective multicenter random clinical trials will help to evaluate the clinical application of sentinel lymph node biopsy.
In November 2017, the American Heart Association updated the pediatric basic life support and cardiopulmonary resuscitation (CPR) quality. The new guidelines focused on the clinical value of chest compression-only CPR versus CPR using chest compressions with rescue breaths in children, rather than a comprehensive revision of the 2015 edition guidelines. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated part content of the guidelines according to the continuous evidence review process. Guidelines recommend CPR using chest compressions with rescue breaths should be provided for infants and children with cardiac arrest. Bystanders provide chest compressions if they are unwilling or unable to deliver rescue breaths. This article mainly interprets the updated content.
In November 2018, the American Heart Association (AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Rather than a comprehensive revision of the 2015 edition guidelines, the 2018 AHA guidelines update was updated again according to the rule " the update of the guideline is whenever new evidence is available”, providing the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated the guideline, reaffirming the 2015 pediatric advanced life support guideline recommendation that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.
In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.
ObjectiveTo evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.MethodsA retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.ResultsFrom 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ2trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ2=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ2=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ2=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ2=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).ConclusionAlthough the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.
Interfacility transport of critically ill children is an important part of pre-hospital emergency care. The development of 5th generation mobile networks has brought revolutionary changes to emergency medicine, which can realize real-time sharing of information between hospitals and transfer ambulance units. In order to give full play to the advantages of superior medical institutions in diagnosis and treatment technology, equipment resources, and realize the safe and fast transfer of critically ill children, the technical specifications for the construction of interfacility transport of critically ill children’s ambulances with 5th generation mobile networks are specially formulated to standardize the team building, equipment and materials, transport process and quality control requirements for critically ill children’s ambulance transport, so as to reduce the fatality rate of critically ill children and improve the prognosis.
ObjectiveTo understand the distribution of demographic sociological characteristics and co-morbidities among primiparous and multiparous pregnant women under the China's universal two-child policy, to provide baseline data for clinical high-risk management and medical resources allocation.MethodsWe included pregnant women from 24 hospitals in 16 provinces (municipality, autonomous region) of China and collected their demographic sociological characteristics and obstetrics information by questionnaires between September 19th, and November 20th, 2016. Then, we used descriptive analysis to present the distribution of demographic sociological characteristics and pregnancy co-morbidities among primiparous and multiparous women and compared differences between groups by t test or Chi-square test.ResultsAmong 12 403 investigated pregnant women, 8 268 (66.7%) were primiparous and 4 135 (33.3%) were multiparous, with highest proportion in East (931/2 008, 46.4%) and lowest in Northeast (385/2 179, 17.7%). Multiparous women, comparing to primiparous women, were more likely to be elderly than 35 years (accounting for 30.6% vs. 6.5%), lower educated with high school or below (29.7% vs. 16.9%), occupied in physical labor or unemployed (49.2% vs. 42.5%), non-local residents (12.7% vs. 10.5%), family annual income higher than 120 thousand yuan (41.3% vs. 33.3%), pre-pregnancy body mass index≥24 kg/m2 (13.6% vs. 9.9%), history of artificial abortions (44.9% vs. 24.0%), or pregnancies≥4 times (23.8% vs. 3.1%) and were less likely to receive assisted reproductive technology (2.3% vs. 4.7%). The most common co-morbidities were gynecology disease (5.5%), thyroid disease (5.4% in all women), blood system disease (5.0%), digestive system disease (4.2%) and hepatitis B infection (2.5%). Multiparous women, comparing to primiparous women, had higher proportions with blood system disease (5.7% vs. 4.7%), hepatitis B infection (3.1% vs. 2.2%) and chronic hypertension (0.6% vs. 0.2%), but lower proportions with thyroid diseases, polycystic ovary syndrome, and immune system diseases, whose distribution also showed regional differences.ConclusionThere existed distribution differences regarding demographic sociological characteristics and co-morbidities proportions between primiparous and multiparous women. Therefore, we should improve clinical risk management and medical resources allocation based on pregnant women’s baseline and gestational characteristics.