Neonatal methicillin-resistant Staphylococcus aureus pneumonia-related recurrent fatal pyopneumothorax: A case report and review of literature.

BACKGROUND: Although neonatal Staphylococcus aureus pneumonia is common and usually curable, it can also be refractory and life-threatening. Herein, we report a case of severe neonatal community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) necrotizing pneumonia with bilateral recurrent pyopneumothorax, respiratory failure, heart failure, and cardiac arrest. We hope our report will add to the understanding of this disease. CASE SUMMARY: An 18-d-old boy presented with cough for five days, fever for three days, and dyspnea for two days. Preadmission chest radiograph revealed high-density shadows in both lungs. On admission, his oxygen saturation fluctuated around 90% under synchronized intermittent mandatory ventilation. He was unconscious, with dyspnea, weak heart sounds and hepatomegaly. Moist crackles were present throughout his left lung, while the breath sounds in the right lung were decreased. After high-frequency oscillatory ventilation, empiric antimicrobials (meropenem and vancomycin), improved circulation, and right pleural cavity drainage for right pneumothorax (approximately 90% compression), his oxygen saturation level stayed above 95%, and recruitment of the right lung was observed. His condition did not deteriorate until the 5th day of hospitalization (DOH 5). On the morning of DOH 5, his oxygen saturation decreased. Subsequent chest radiograph showed bilateral pneumothorax with nearly 100% compression of the left lung. Desaturation was not relieved after urgent left pleural cavity drainage, and cardiac arrest occurred soon thereafter. Although his spontaneous heartbeat returned through emergency resuscitation and salvage antibacterial therapy (linezolid and levofloxacin) was administered given the detection and antimicrobial susceptibility of MRSA, he showed no improvement, with recurrent pyopneumothorax and continued drainage of purulent fluid and necrotic lung tissue fragments from the pleural cavity. Eventually, his parents refused extracorporeal membrane oxygenation (ECMO) and gave up all the treatments, and the newborn passed away soon after withdrawal on DOH 13. CONCLUSION: Neonatal MRSA pneumonia can be refractory and lethal, especially in cases where necrotizing pneumonia leads to extensive lung necrosis and recurrent pneumothorax. Despite treatment with linezolid and other medical measures, it may still be ineffective. Currently, ECMO has been a remedial therapy, but if the lung tissue is too severely eroded to be repaired, it may be useless unless the infection can be controlled and lung transplantation can be performed. Regardless of whether ECMO is initiated, the key to successful treatment is to achieve control over the pneumonia caused by MRSA as soon as possible and to reverse lung injury as much as possible.

Bioinspired Hydrogel-Polymer Hybrids with a Tough and Antifatigue Interface via One-Step Polymerization.

Hydrogel hybrids are one of the key factors in life activities and biomimetic science; however, their development and utilization are critically impeded by their inadequate adhesive strength and intricate process. In nature, barnacles can stick to a variety of solid surfaces firmly (adhesive strength above 300 kPa) using a hydrophobic interface, which inspires us to firmly combine hydrogels and polymers through introducing an adhesive layer. By spreading a hydrophobic liquid membrane directly, tough combination of a hydrogel and a polymer substrate could be achieved after one-step polymerization. The fracture energy of the hydrogel attached to the surface of polyvinyl chloride was up to 1200 J m-2 and the tensile strength reached 1.21 MPa. Furthermore, the adhesion samples with this method exhibit an antifatigue performance, having withstood large bends and twists. It should be pointed out that this approach can also be applied to a variety of complicated surfaces. This work may expand the application range of hydrogels and provides an inspiration for hydrogel adhesion.

[Effect of maxillary protraction with or without rapid palatal expansion in treating early skeletal Class III malocclusion].

OBJECTIVE: To evaluate the effectiveness of treatment with maxillary protraction with or without rapid palatal expansion (RPE) for skeletal Class III malocclusion in mixed dentition. METHODS: A total of 31 children with Class III malocclusion in mixed dentition were selected, and 15 (group A) received maxillary protraction treatment with RPE, the other 16 (group B) received maxillary protraction without RPE. Cephalometric films were taken before and after treatment, and traditional and Pancherz analysis were used. RESULTS: The average duration of treatment was 10.14 months in group A and 9.77 months in group B respectively (P>0.05). According to Pancherz analysis, maxillary basal bone moved forwards by 2.99 mm in group A and 3.33 mm in group B respectively (P>0.05), mandibular basal bone moved backwards by 0.07 mm in group A, while forwards by 0.80 mm in group B (P>0.05), the overjet increased by 4.51 mm in group A and 6.37 mm in group B respectively (P<0.05), and the molar relationship improved by 4.97 mm in group A and 4.73 mm in group B respectively (P>0.05). The effects were clinically satisfactory in the both groups. Lower molar moved forwards by 1.18 mm in basal bone in group A, while backwards by 1.20 mm in group B (P<0.05). Traditional cephalometric analysis showed no statistic differences between the two groups except that upper incisior showed greater procline in group B than in group A (P<0.05). CONCLUSION: The study shows that maxillary protraction treatment, with or without RPE, is clinically satisfactory to correct early skeletal Class III malocclusion.