Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: A systematic review and meta-analysis

BackgroundOptimum timing of umbilical cord clamping has not been established in preterm infants.ObjectivesWe compared the short- and long-term effects of umbilical cord milking (UCM) versus delayed cord clamping (DCC) on infants born at less than 37 weeks of gestation.Search methodsA systematic review and meta-analysis was conducted according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” statement. We searched CINAHL, CENTRAL, EMBASE, MEDLINE, PubMed and ClinicalTrials.gov for relevant randomized controlled trials (RCTs).Selection criteriaWe included individual and clustered RCTs comparing UCM to DCC for infants born before 37 weeks of gestation.Data collection and analysisFour reviewers independently assessed trial quality and eligibility for inclusion.Main resultsTwo trials (255 preterm infants, 23 0/7 to 32 6/7 weeks of gestation) were included in the analysis. UCM was associated with fewer intraventricular hemorrhages (IVHs) (two trials, 255 infants; relative risk [RR] 0.45, 95% confidence interval [CI] 0.20 to 0.98, low quality of evidence) and UCM was an increased proportion of infants with a Bayley score at 2 years of age (two trials, 174 infants; Cognitive: RR 1.14, 95% CI 1.03 to 1.26, Language: RR 1.24, 95% CI 1.03 to 1.49, low quality of evidence) compared to DCC.ConclusionsUCM wasn’t reduced in-hospital mortality and need for transfusion compared to DCC. But our study suggests that UCM may lower the risk of IVH and improve certain neurodevelopmental outcomes compared to DCC in preterm infants

Free Flap Blood Flow Evaluated Using Two-Dimensional Laser Speckle Flowgraphy

Objective. We investigated the efficiency of laser speckle flowgraphy for evaluating blood flow in free flaps used for plastic surgery. Methods. We measured blood flow using a visual laser meter capable of providing two-dimensional color graphic representations of flow distribution for a given area using a dynamic laser speckle effect. Using laser speckle flowgraphy, we examined the blood flow of 20 free flaps applied following the excision of head and neck tumors. Results. After anastomosis of the feeding and draining blood vessels and sewing the flap, musculocutaneous (MC) flaps showed significantly lower blood flow than jejunal or omental flaps (P < .05). The ratio of blood flow decrease from the edge to the center was significantly greater in MC flaps than in jejunal or omental flaps (P < .001). Conclusion. Laser speckle flowgraphy is useful for the perioperative measurement of blood flow in free flaps used in plastic surgery. This method is a highly useful, practical, and reliable tool for assessing cutaneous blood flow and is expected to be applicable to several clinical fields

Effect Of Isometric Exercises Using an Active Therapeutic Movement Device for Patients with Acute Low Back Pain

Background: This study aimed to investigate the effects of isometric exercise using ATM®2 for acute low back pain (LBP) patients as a flexion or extension type. Methods: The subjects were twenty individuals (age 39.7±8.0ys, 12 males / 8 females) with acute LBP of less than four weeks duration who volunteered to participate in the study. The participants were allocated into four groups. First, the participants were classified by the direction of the movement causing pain in flexion and extension types. Secondly, both types were allocated randomly into two groups which were given exercises using the ATM®2 group and the usual care group. Finally, both groups were treated three times weekly for two weeks, totaling six sessions. Results: In terms of the extension type of LBP, the effect of the extension pain in the ATM®2-group significantly decreased pain (p=0.04) immediately. And in both groups significantly decreased (p=0.01, 0.001) for two weeks of intervention. Furthermore, in the flexion type of LBP, the effect of the flexion pain in the ATM®2-group and usual care group significantly decreased (p=0.001, p=0.03) during the two weeks intervention. However, neither group had an immediate effect. Conclusion: Isometric exercise using ATM®2 may have an immediate and short-term effect on acute LBP, which is greater in patients with an extension-type pattern. The ATM®2 exercise may reduce the pain of the acute LBP. Furthermore, it will be a problem in the future to analyze if the influence of pain is reduced in the immediate natural period that gives to chronic LBP

Spondylolysis with pedicle fracture

We describe successful surgical treatment in a case of L5 unilateral spondylolysis with contralateral pedicle stress fracture that was not resolved by conservative treatment in a high-performing college baseball player. The 20-year-old man presented with left low back pain that stopped his sports activities. Over the previous year, he had experienced a couple of episodes of pain that subsided with cessation of sports but reappeared after a return to sports. Computed tomography and magnetic resonance imaging revealed a right terminal stage pars fracture and a left pedicle stress fracture at L5. The pain originated from the left pedicle fracture, with no pain from the right unilateral spondylolysis. Given that conservative treatment for 1 year had not been effective, we decided on surgical treatment. Bilateral pedicle screws and the smiley face rod method were applied, and both fractures subsequently healed. In the 2 years since the surgery, the patient has returned to sports and has the potential to become a professional player