Epidemiology and Clinical Characteristics of Pediatric Sepsis in PICUs in Southwest China: A Prospective Multicenter Study.

OBJECTIVES: To describe the epidemiological characteristics of pediatric sepsis in Southwest China PICUs. DESIGN: A prospective, multicenter, and observational study. SETTING: Twelve PICUs in Southwest China. PATIENTS: The patients admitted to the PICU from April 1, 2022, to March 31, 2023. The age ranged from 28 days to 18 years. All patients met the criteria of severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 31 PICUs invited to participate, 12 PICUs (capacity of 292 beds) enrolled patients in the study. During the study period, 11,238 children were admitted to the participating PICUs, 367 (3.3%) of whom met the diagnosis of severe sepsis or septic shock. The most prevalent sites of infection were the respiratory system (55%) and the digestive system (15%). The primary treatments administered to these patients included antibiotics (100%), albumin (61.3%), invasive mechanical ventilation (58.7%), glucocorticoids (55.6%), blood products (51%), gammaglobulin (51%), and vasoactive medications (46.6%). Sepsis-related mortality in the PICU was 11.2% (41/367). Nearly half of the sepsis deaths occurred within the first 3 days of PICU admission (22/41, 53.7%). The mortality rate of septic shock (32/167, 19.2%) was significantly higher than that of severe sepsis (9/200, 4.5%; p < 0.001). The outcomes of a multivariate logistic regression analysis suggested that a higher pediatric Sequential Organ Failure Assessment score, and the use of invasive mechanical ventilation and vasoactive medications were independently associated with PICU mortality in children with sepsis. CONCLUSIONS: This report updates the epidemiological data of pediatric sepsis in PICUs in Southwest China. Sepsis is still a life-threatening disease in children.

The prognostic implications of perioperative endogenous hydrogen sulfide and nitric oxide levels in children with congenital heart disease complicated by pulmonary arterial hypertension.

The goal of this study was to measure perioperative changes in endogenous hydrogen sulfide (H2S) and nitric oxide (NO) levels in children with congenital heart disease (CHD) complicated by pulmonary arterial hypertension (PAH), with the goal of better monitoring these children and evaluating their prognosis. For this study, we enrolled 48 normal control cases, 48 preoperative CHD cases including 16 without PAH, 16 with mild PAH, and 16 with moderate-to-severe PAH. We additionally enrolled a cohort of 32 other children with PAH-CHD that had undergone CHD correction prior to transfer to an intensive care unit (ICU). These children were further subdivided based on whether or not PAH was still present after operation (n = 16 per group). Spectrophotometry was used to assess endogenous H2S and NO levels at 24 and 48 h postoperatively in each group. Correlations between postoperative endogenous H2S and NO levels at these two time points, as well as duration of mechanical ventilation, ICU length of stay, duration of hospitalization, and vasoactive drug score values at 24 and 48 h postoperation were assessed. Endogenous H2S and NO values differed significantly between the control and preoperative CHD groups (P < 0.05). These values also differed significantly among the three different preoperative CHD subgroups and were negatively correlated with pulmonary arterial pressure (P < 0.05). Spearman rank correlation analyses indicated that endogenous H2S levels at 24 and 48 h postoperation were negatively correlated with the duration of mechanical ventilation, ICU length of stay, and maximum vasoactive drug score values at both 24 and 48 h postoperation. We similarly identified a negative correlation between NO concentrations at 24 and 48 h postoperation and maximum vasoactive drug score at these same time points (P < 0.05).Conclusions: Endogenous H2S and NO levels are closely associated with CHD-PAH incidence, and there is a correlation between endogenous H2S levels and the postoperative prognosis of CHD in children. Higher H2S concentrations seem to correspond to better patient prognosis, and as such these values can be used as a prognostic index at an early time point. These values can additionally guide treatment efforts and improve outcomes among children with CHD-PAH. What is Known: • Hydrogen sulfide and nitric oxide are both vasodilating factors. • Hydrogen sulfide and nitric oxide can regulate pulmonary vascular remodeling, which is closely related to the occurrence and prognosis of pulmonary arterial hypertension. What is New: • This study was designed to explore the relationship between short-term prognostic indexes and hydrogen sulfide and nitric oxide levels, in an effort to provide a frame of reference for the postoperative monitoring and treatment of children with congenital heart disease complicated by pulmonary arterial hypertension.

Identification, characterization and hypolipidemic effect of novel peptides in protein hydrolysate from Protaetia brevitarsis larvae.

The proteins were mainly derived from Protaetia brevitarsis larval extracts obtained using two empty intestine methods (traditional static method: TSM or salt immersion stress method: SISM) and extraction solvents (water: W or 50 % water-ethanol: W:E), and the proteins were used as objects to investigate the effect of emptying intestine methods on hypolipidemic peptides. The results revealed that the F-2 fractions of protein hydrolysate had stronger in vitro hypolipidemic activity, with the peptides obtained by SISM possessing a stronger cholesterol micelle solubility inhibition rate, especially in SISM-W:E-P. Moreover, a total of 106 peptides were tentatively identified, among which SISM identified more peptides with an amino acid number < 8. Meanwhile, five novel peptides (YPPFH, YPGFGK, KYPF, SPLPGPR and VPPP) exhibited good hypolipidemic activity in vitro and in vivo, among which YPPFH, VPPP and KYPF had strong inhibitory activities on pancreatic lipase (PL) and cholesteryl esterase (CE), and KYPF, SPLPGPR and VPPP could significantly reduce the TG content in Caenorhabditis elegans. Thus, P. brevitarsis can be developed as a naturally derived hypolipidemic component for the development and application in functional foods.

Support vector machine optimization via an improved elephant herding algorithm for motor energy efficiency rating.

Accurate evaluation of motor energy efficiency under off-condition operation can provide an important basis for an energy-saving upgrade of the motor and the elimination of backward motors. By considering the power quality, motor characteristics and load characteristics, a motor energy efficiency evaluation system with seven indexes and 10 grades was constructed. An improved elephant herding optimization method combined with a support vector machine rating model is proposed, it achieved an accuracy higher than 98%. Considering the slow convergence speed and low convergence precision of the standard elephant herding optimization (EHO) method, it is easy to fall into the local optimum problem. To improve population initialization, chaotic mapping and adversarial learning were used to achieve EHO with population diversity and global search capability. Group learning and elite retention have been added to improve the local development ability of the algorithm. The improved EHO has been compared with other intelligent optimization algorithms by using 12 benchmark functions, and the results show that the improved algorithm has better optimization performance.

Enzymatic induction of supramolecular order and bioactivity.

We showed in this study that enzymatic triggering is a totally different pathway for the preparation of self-assembling nanomaterials to the heating-cooling process. Because the molecules were under lower energy levels and the molecular conformation was more ordered during the enzymatic triggeration under mild conditions, nanomaterials with higher supramolecular order could be obtained through biocatalytic control. In this study, nanoparticles were obtained by an enzymatic reaction and nanofibers were observed through the heating-cooling process. We observed a distinct trough at 318 nm from the CD spectrum of a particle sample but not a fiber sample, suggesting the long range arrangement of molecules and helicity in the nanoparticles. The nanoparticles with higher supramolecular order possessed much better potency as a protein vaccine adjuvant because it accelerated the DC maturation and elicited stronger T-cells cytokine production than the nanofibers. Our study demonstrated that biocatalytic triggering is a useful method for preparing supramolecular nanomaterials with higher supramolecular order and probably better bioactivity.