[Eighteen cases of 2009 influenza A H1N1 associated with respiratory failure in adults].

OBJECTIVE: To investigate the clinical feature, treatment and outcome of respiratory failure in patients with 2009 influenza A H1N1 infection in critically ill adults. METHODS: A prospective observational study of 18 patients with respiratory failure suffering from 2009 influenza A H1N1 infection admitted between November 22, 2009 and January 16, 2010. Their clinical data were analyzed. RESULTS: Respiratory failure occurred in 18 patients with confirmed (n=9) or probable (n=9) 2009 influenza A H1N1. Among the 18 patients 8 patients were male, 10 patients were female (7 were pregnant or postpartum). Eight patients had pre-existing medical conditions. Twelve patients were between 20 and 40 years of age, the mean age was 37.1 years. Three were obese with body mass index over 30 kg/m (2). The 28-day mortality was 33.3% (6/18) with 1 additional late death. The median duration from the onset of the illness to hospital admission was 4.1 days (1-5 days) and from the onset to first dose of oseltamivir was 5.5 days (2-12 days), from onset to mechanical ventilation initiation was 6.8 days (4-12 days). Seventeen patients had primary viral pneumonia and 1 patient had an asthma exacerbation and 3 patients experienced multiple organ dysfunction syndrome (MODS). Twelve patients received corticosteroids, 10 patients required vasopressors. All patients were mechanically ventilated, 1 patient underwent extracorporeal membrane oxygenation (ECMO). Patients who died had higher acute physiology and chronic health evaluation II score compared to survivors (29.2 + or - 7.3 vs. 18.6 + or - 6.4, P=0.02). All deceased patients received high-level ventilation settings [peak inspiratory pressure > or = 35 cm H(2)O (1 cm H(2)O=0.098 kPa) and positive end-expiratory pressure > or = 18 cm H(2)O] within the first 7 days of ventilation, and the hypoxemia [oxygenation index < or = 60 mm Hg (1 mm Hg=0.133 kPa)] lasted 24 hours. In contrast only 1 among survivors did (9.1% vs. 100.0%, P<0.01). Compared with survivors, acute kidney injury and barotrauma occurred more frequently in non-survivors (42.9% vs. 27.3%, 28.6% vs. 9.1%, both P<0.05). Whereas all deceased patients received vasopressors, only 4 survivors required vasopressor support (100.0% vs. 36.4%, P<0.05). CONCLUSION: Severe acute respiratory distress syndrome is the most common manifestation in critically ill patients with 2009 influenza A H1N1 infection in adult. Failure to obtain satisfactory oxygenation with high-level ventilation settings within the first 7-days, onset of acute kidney injury and barotrauma, and continuous need for vasopressors portend a poor prognosis.

Petrocodon wenshanensis, a new species of Gesneriaceae from southwestern China.

A new species of Petrocodon, P. wenshanensis from Yunnan province of southwestern China, is described and illustrated here. P. wenshanensis morphologically closely resembles P. jingxiensis and P. lithophilus, but differs in vegetative and generative characters. Differences between the new species and others Petrocodon species occurring in Yunnan Province are also shown in the identification key.

Oreocharis flavovirens, a new species of Gesneriaceae from Southern Gansu Province, China.

Oreocharis flavovirens is a new species of Gesneriaceae from Gansu, China and is described and illustrated here. It is morphologically similar to O. glandulosa, O. humilis and O. farreri, but those congeners of this new taxon can be distinguished by several salient characters. A description of O. flavovirens, together with illustrations and photos, are presented.

[Clinical effects of low-stretch ventilation on acute respiratory distress syndrome].

OBJECTIVE: To investigate the effectiveness of low-stretch as compared with low-tidal-volume strategy in the treatment of acute respiratory distress syndrome (ARDS). METHODS: Eighty-five cases of ARDS patients were randomly divided into low-stretch group (42 cases) and low-tidal-volume group (43 cases). The former group of patient received pressure assist control mode with not higher than 35 cm H(2)O (1 cm H(2)O=0.098 kPa) of peak pressure or pressure support mode ventilation with not higher than 30 cm H(2)O of Pplateau, while in low-tidal-volume group tidal volume of no more than 6 ml/kg of predicted body weight was given. The mortality rate within 28 days, the incidence of hypercapnia, the duration of using sedatives and neuromuscular blockade agents, the time of ventilation and the length of intensive care unit (ICU) stay were compared between two groups. According to the monitored expiratory tidal volume (V(T)e), the low-stretch group was divided into low-tidal-volume subgroup (V(T)e < or =6 ml/kg, 11 cases) and non-low-tidal-volume subgroup (V(T)e >6 ml/kg, 31 cases). The mortality within 28 days and the incidence of hypercapnia were compared between two subgroups. RESULTS: There was no significant difference in the 28-day mortality rate between two groups (34.0% vs. 37.0%, P>0.05), but patients of low-stretch group had lower incidence of hypercapnia than low-tidal-volume group (10.6% vs. 40.7%, P<0.05), and also the duration of using sedatives [(4.5+/-1.2) days vs. (8.7+/-2.3) days] and neuromuscular blockade agents [(8.4+/-2.1) days vs. (10.7+/-1.2) days], and the length of ventilation and ICU stay [(10.2+/-2.2) days vs. (13.7+/-3.1) days, all P<0.05] were less. Low tidal volume occurred in 26.2% of low-stretch group, and the low-tidal-volume subgroup had higher 28-day mortality rate (40.8%) and incidence of hypercapnia (65.7%) than non-low-tidal-volume subgroup (13.2% and 8.6%, both P<0.05). CONCLUSION: Compared with low-tidal-volume strategy, low-stretch strategy can reduce the incidence of hypercapnia, the length of ventilation and ICU stay for ARDS patients, but have similar mortality rate. When low-stretch strategy is exercised, an inappropriate low tidal volume may be associated with poor outcome of ARDS.

A new variety of Didymocarpus (Gesneriaceae) from Guangdong, China.

A new variety of Didymocarpus, D.heucherifoliusvar.gamosepalus from Guangdong, China, is described and illustrated with photographs. It closely resembles the more widespread D.heucherifolius within a number of morphological characters. However, it can be easily distinguished from the latter according to the new taxon: calyx base connate, 5-lobed from middle to above middle, larger flowers (up to 5 cm long) and glabrous corolla.

Two new species of Primulina (Gesneriaceae) from limestone karsts of China.

The limestone karst area of South China is a major biodiversity hotspot of global terrestrial biomes. During extensive field work on the Guangxi limestone formations, two unknown species of Gesneriaceae were collected. After conducting a comprehensive study of the literature and herbarium specimens, Primulina davidioides and P. hiemalis are recognized as two species new to science, and described and illustrated here. P. davidioides is morphologically close to P. lunglinensis based on the shape of the leaf and flower, but it can be easily distinguished by the shape of the bracts, corolla and stigma, indumentum of peduncles, pedicels and pistil and number of staminodes. P. hiemalis is closely relate to P. luzhaiensis in vegetative appearance, but differs in the shape of the calyx and stigma, number of bracts and staminodes, indumentum of the leaf blade and peduncle, and position of stamens in the corolla tube. Considering that not enough is known about their populations, it is proposed that their conservation statuses should currently be classed as data deficient (DD) according to the IUCN Red List Category and Criteria.

[Concentrations and safety evaluation of heavy metals in aquatic products of Yancheng, Jiangsu Province].

Current status and intake risk of heavy metal pollution in aquatic products were studied in Yancheng, Jiangsu Province. Twenty-two kinds of aquatic products were sampled in May 2012, and the concentrations of Cd, Cu, Zn, Pb and Cr in muscles were measured using atomic absorption spectroscopy. Single factor pollution index (Pg) and metal pollution index (MPI) were used to evaluate the degree of pollution, and provisional tolerable weekly intake (PTWI) and carcinogenic risks were used to assess the edible safety and health risk, respectively. We found all the aquatic products were contaminated, and the pollutions by Cd, Pb and Cr were more serious, with the exceeding rates of 31.8% , 31.8% and 40.9% , respectively. Pi indices indicated the contents of Cd, Pb and Cr exceeded the allowable criteria of " Light Pollution", while Cd and Pb in freshwater fish, Pb and Cr in shellfish, and Cr in cephalopoda reached the criteria of " Heavy Pollution". The MPI results showed that heavy metal pollution in shellfish was the most severe, followed by crustacean, freshwater fish, and cephalopoda, while it was slight in marine fish. At present, the edible safety of heavy metals in aquatic products was acceptable in Yancheng, but the Cr intake of shellfish and cephalopoda was approaching PTWI and that of a minority of marine fishes even exceeded the PTWI value. The model estimation for health risk indicated that the health risk value of heavy metal ingestion was still below the maximal acceptable level (5.0 x 10(-5) a-1), recommended by International Commission on Radiation Protection (ICRP) , but the values of Cr for shellfish and cephalopoda were approaching the criterion. In summary, heavy metal pollution in aquatic products in Yancheng is rather severe, especially for Cr pollution, and more attention should be paid to the pollution status, edible safety and health risk.

RIM-BP3 is a manchette-associated protein essential for spermiogenesis.

During spermiogenesis, round spermatids are converted into motile sperm in mammals. The mechanisms responsible for sperm morphogenesis are poorly understood. We have characterized a novel protein, RIM-BP3, with a specialized function in spermatid development in mice. The RIM-BP3 protein is associated with the manchette, a transient microtubular structure believed to be important for morphogenesis during spermiogenesis. Targeted deletion of the RIM-BP3 gene resulted in male infertility owing to abnormal sperm heads, which are characterized by a deformed nucleus and a detached acrosome. Consistent with its role in morphogenesis, the RIM-BP3 protein physically associates with Hook1, a known manchette-bound protein required for sperm head morphogenesis. Interestingly, RIM-BP3 does not interact with the truncated Hook1 protein characterized in azh (abnormal spermatozoon head) mutant mice. Moreover, RIM-BP3 and Hook1 mutant mice display several common abnormalities, in particular with regard to the ectopic positioning of the manchette within the spermatid, a presumed cause of sperm head deformities. These observations suggest an essential role for RIM-BP3 in manchette development and function through its interaction with Hook1. As the occurrence of deformed spermatids is one of the common abnormalities leading to malfunctional sperm, identification of RIM-BP3 might provide insight into the molecular cue underlying causes of male infertility in humans.

Quantitative study on selective stacking of zwitterions in large-volume sample matrix by moving reaction boundary in capillary electrophoresis.

The paper advanced the theoretical procedures for quantitative design on selective stacking of zwitterions in full capillary sample matrix by a cathodic-direction moving reaction boundary (MRB) in capillary electrophoresis (CE) under control of electroosmotic flow (EOF). With the procedures, we conducted the theoretical computations on the selective stacking of two test analytes of L-histidine (His) and L-tryptophan (Trp) by the MRB created with 30 mM pH 3.0 formic acid-NaOH buffer and 2-80 mM sodium formate. The results revealed the following three predictions. At first, the MRB cannot stack His and Trp plugs if less than 12.5 mM sodium formate is used to form the MRB and prepare the sample matrix. Second, the MRB can stack His and/or Trp sample plugs completely if higher than 50 mM sodium formate is chosen to form the MRB. Third, the MRB can only focus His plug completely, but stack Trp plug partially if 20-50 mM sodium formate is used; this implied the complete MRB-induced selective stacking to His rather than Trp. All the three predictions were quantitatively proved by the experiments. With great dilution of sample matrix and control of EOF, controllable, simultaneous and MRB-induced selective stacking and separation of zwitterions were achieved. The theoretical results hold evident significances to the quantitative design of selective stacking conditions and the increase of detection sensitivity of zwitterions in CE. In addition, the control of EOF by cetyltrimethylammonium bromide (CTAB) can evidently improve the stacking efficiency to both His and Trp.

Quantitative predictions to conditions of zwitterionic stacking by transient moving chemical reaction boundary created with weak electrolyte buffers in capillary electrophoresis.

This paper develops a novel procedure of quantitative predictions for the on-column stacking conditions of a zwitterionic analyte by a moving chemical reaction boundary (MCRB) in capillary electrophoresis (CE). The procedure concerns the choice of the weak acidic running and alkaline sample buffers and the velocity design of MCRB created with the two buffers. Based on the theory of MCRB, the theoretical computations are performed. From the computations, the following two predictions are refined for the stacking conditions of zwitterion. (1) The zwitterion velocity in the acidic buffer should be greater than that of MCRB moving toward the cathode, or the zwitterion cannot be well stacked by the MCRB. (2) The gap between pH values of the acidic and alkaline sample buffers ought to comprise the isoelectric point (pI) of zwitterion to be stacked; namely, there exists the relation of pH (acidic buffer) < pI < pH (sample). The predictions are quantitatively proved by the experiments of zwitterionic stacking with two kinds of MCRBs. In addition, the experiments also show the tightly stacked peak of zwitterion existing in the process of MCRB, but not after the MCRB. The theoretical and experimental results hold obvious significances to other zwitterion (such as peptide and protein) on-column stacking in CE.