Whether critically ill neonates needing a surgical intervention should be transferred to an operating room (OR) or receive the intervention in a neonatal intensive care unit (NICU) is controversial. In this study, we report our experience in performing surgical procedures in a NICU including air cleanliness.This was a retrospective study performed at a metropolitan hospital. The charts of all neonates undergoing surgical procedures in the NICU and OR were retrospectively reviewed from January 2007 to June 2017. Data on baseline characteristics, procedure and duration of surgery, ventilator use, hypothermia, instrument dislocations, surgery-related infections and complications, and outcomes were analyzed.Ninety-two neonates were enrolled in this study, including 44 in the NICU group and 48 in the OR group. The air cleanliness was International Organization for Standardization (ISO) 14644-1 class 7 in the NICU and class 5-6 in the OR. The NICU group had a younger gestational age and lower birth body weight than the OR group. The OR group had a higher incidence of hypothermia than in the NICU group (56.3% vs 9.1%, P < .001). However, there were no significant differences in surgical site related infections or mortality between the 2 groups.This study suggests that performing surgical procedures in a NICU with air cleanliness class 7 is as safe as in an OR, as least in part, when performing patent ductus arteriosus ligation and exploratory laparotomy.

median age was 63 years old (range 31w91). Nearly one third (56, 30.6%) of the patients had received at least three lines of prior therapies. The majority of the patients (148, 80.9%) were diagnosed as stage IV lung cancer, among them, 40 (21.9%) underwent prior surgery and 136 (74.3%) received prior chemotherapy. Of all the patients, the majority had an ECOG PS of 1 and 79 (69.4%) were histologically classified as adenocarcinoma. Overall, 127 patients were eligible for effectiveness evaluation, and of them, no patient achieved CR, 26 achieved PR, 84 achieved SD, and 17 showed PD, resulting in an ORR of 20.5% and a DCR of 86.7%. The primary study endpoint (PFS) and secondary endpoint (OS) has not been reached. Subgroup analysis revealed that the ORR and DCR values were slightly higher in patients received less than three lines of prior therapies than those in patients received at least three lines of prior therapies (ORR: 21.6% vs 18.8%; DCR: 87.8% vs 84.9%) The incidence of treatment-related AEs was 53.0% and grade 3-4 AEs were not observed. The most common AE caused by camrelizumab was reactive cutaneous capillary endothelial proliferation (REECP) (24.4%). Conclusion: In the real-world setting, advanced NSCLC patients with an older age, stage IV disease, cancer type of adenocarcinoma or ECOG PS 1 were more likely to be treated with camrelizumab. Camrelizumab monotherapy or in combination with chemotherapy and/or antiangiogenic agent were proved to be effective and safe in advanced NSCLC patients. Further study with a larger sample size is needed to explore the most potential camrelizumab-based therapeutic regimen for NSCLC patients.

Rationale:Late-onset transient adrenal insufficiency with circulatory collapse is a rare condition that occurs in preterm infants. Although the incidence of late-onset transient adrenal insufficiency in preterm infants has been reported in Japan, reports from Western countries are lacking. In addition, no study has investigated the effect of twin-to-twin transfusion syndrome (TTTS) in monozygotic twins.Patient concerns:A pair of extremely low birth weight twins presented with TTTS.Diagnoses:Both twins developed late-onset adrenal insufficiency with oliguria, hypotension, hyponatremia, and pulmonary edema at a postnatal age of 24 days and 51 days, respectively.Intervention:Temporary administration of intravenous hydrocortisone was initiated.Outcomes:Their symptoms improved dramatically and they survived the event without any neurologic sequelae after 3 years of follow-up.Lessons:Late-onset circulatory collapse may occur, especially in extremely preterm infants, even at 2 months after birth. Hydrocortisone therapy is an effective treatment to rescue circulatory collapse caused by adrenal insufficiency in preterm infants and may not affect long-term neuromotor and cognitive outcomes.

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