Toward early intervention based on age-specific vision checkups: A vision impairment survey in Yantai, China.

The prevalence of myopia among children and adolescents is currently rising to alarming levels (>80%) in China. This study used several routinely collected demographic factors to quantify myopia and glass-wearing rates for primary and secondary school students. We identified myopia risk factors and proposed new aspects for early intervention. This study was a cross-sectional survey of myopia and glass-wearing rates for students (6-18 years old) in Yantai, China. We collected both vision (vision acuity [VA] and spherical equivalence [SE]) and glass-wearing information to establish respective logistic models for quantifying myopia and glass-wearing rate. We further propose a joint decision region (VA, SE, age) to guide early intervention. Among 10,276 children, 63% had myopia (65% wore glasses). The prevalence of myopia increases with age and levels off during adulthood. Females had a higher overall prevalence rate than males (P < .001). The rural age mode (≈15.5) is about 2 years larger than the urban age (≈13.5) for myopia students. For the myopia rate, in the age ≤14.5, the linear age effect was significant (odds ratio [OR] = 1.73, P < .0001), males had a significant negative baseline effect at the start of schooling (vs. females) (OR = 0.68, P < .0001), and the urban group had a significant positive baseline effect (vs. rural) (OR = 1.39, P < .0001). The correlation between VA and SE increases with age and has a directional shift (from negative to positive) at ages 8 to 9. For the glass-wearing rate, age had a significant positive effect (OR = 1.25, P < .0001), VA had a significant negative effect (OR = 0.002, P < .0001), and body mass index had a slightly significant positive effect (OR = 1.02, P = .03). Urban female have a higher myopia rate than rural male at the start of schooling, and vocational high school has improved vision upon high school. Body mass index was not a significant factor for myopia. The myopia rate model is specific to age range (separated at 14.5 years old). Students of lower ages are less likely to wear glasses for correction, and this may require intervention. The temporal age-specific (VA, SE) correlations and joint distributions strengthen the speculation in the literature that age 8 to 9 is a critical intervention period and motivates us to propose a rigorous intervention decision region for (age, VA, and SE) which mainly applies for this tight age period.

Foodborne Disease Outbreaks Caused by Biotoxins in Yantai City: A 10-Year Spatiotemporal Monitoring Study.

Unsafe food causes 600 million cases of foodborne diseases and 420,000 deaths every year. Meanwhile, biological toxins such as poisonous mushrooms, saponins, and aflatoxin can cause significant damage to humans. Therefore, it is particularly important to study foodborne disease outbreaks caused by biotoxins (FDOB). We collected FDOB in Yantai City from 2013 to 2022 and further established a corresponding database. Statistical analysis was carried out according to time, place, pathogen, and contamination of pathogenic factors. There were 128 FDOB, resulting in 417 patients and 6 deaths. The third quarter was a high season for foodborne disease outbreaks, the number of events, patients and deaths accounted for 65.63% (84/128), 55.88% (233/417), and 100% (6/6) of the total number, respectively. The highest number of outbreaks per 10,000 persons was Qixia (0.41), followed by Zhifu (0.36) and Laiyang (0.33). The top three causes of outbreaks were poisonous mushroom toxin, saponins and hemagglutinin, and Lagenaria siceraria (Molina) Standl. Sixty-five (50.78%) outbreaks were attributed to poisonous mushroom toxin, 18 (14.06%) outbreaks to saponin and hemagglutinin, and 12 (9.38%) outbreaks to L. siceraria (Molina) Standl. The largest number of outbreaks, patients and deaths all occurred in families, accounting for 82.81% (106/128) outbreaks, 66.19% (276/417) patients, and 100% (6/6) deaths, respectively. Followed by catering service establishments, accounting for 14.84% (19/128), 30.22% (126/417), and 0% (0/6), respectively. The main poisoning link of outbreaks was ingestion and misuse, accounting for 72.66% (93/128), followed by improper processing, accounting for 20.31% (26/128). It is necessary to carry out targeted family publicity and education, strengthen the integration of medical and prevention, explore innovative monitoring and early warning mechanisms for foodborne diseases, and reduce the occurrence of underreporting of foodborne disease outbreaks.

Novel blood product transfusion regimen to prevent clotting and citrate accumulation during continuous renal replacement therapy with regional citrate anticoagulation in children.

Objective: Introduce a novel protocol to prevent clotting and citrate accumulation (CA) from blood product transfusion (BPT) during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in children. Methods: We prospectively compared fresh frozen plasma (FFP) and platelet transfusions between the two BPT protocols, direct transfusion protocol (DTP) and partial replacement of citrate transfusion protocol (PRCTP), in terms of the risks of clotting, citric accumulation (CA), and hypocalcemia. For DTP, blood products were directly transfused without any adjustment to the original RCA-CRRT regimen. For PRCTP, the blood products were infused into the CRRT circulation near the sodium citrate infusion point, and the dosage of 4% sodium citrate was reduced depending on the dosage of sodium citrate in the blood products. Basic information and clinical data were recorded for all children. Heart rate, blood pressure, ionized calcium (iCa) and various pressure parameters were recorded before, during and after BPT, as well as coagulation indicators, electrolytes, and blood cell counts before and after BPT. Results: Twenty-six children received 44 PRCTPs and 15 children received 20 DTPs. The two groups had similar in vitro ionized calcium (iCa) concentrations (PRCTP: 0.33 ± 0.06 mmol/L, DTP: 0.31 ± 0.04 mmol/L), total filter lifespan (PRCTP: 49.33 ± 18.58, DTP: 50.65 ± 13.57 h), and filter lifespan after BPT (PRCTP: 25.31 ± 13.87, DTP: 23.39 ± 11.34 h). There was no visible filter clotting during BPT in any of the two groups. The two groups had no significant differences in arterial pressure, venous pressure, and transmembrane pressure before, during, or after BPT. Neither treatment led to significant decreases in WBC, RBC, or hemoglobin. The platelet transfusion group and the FFP group each had no significant decrease in platelets, and no significant increases in PT, APTT, and D-dimer. The most clinically significant changes were in the DTP group, in which the ratio of total calcium to ionized calcium (T/iCa) increased from 2.06 ± 0.19 to 2.52 ± 0.35, the percentage of patients with T/iCa above 2.5 increased from 5.0% to 45%, and the level of in vivo iCa increased from 1.02 ± 0.11 to 1.06 ± 0.09 mmol/L (all p < 0.05). Changes in these three indicators were not significant in the PRCTP group. Conclusion: Neither protocol was associated with filter clotting during RCA-CRRT. However, PRCTP was superior to DTP because it did not increase the risk of CA and hypocalcemia.

Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver injury.

Background: Regional citrate anticoagulation (RCA) is increasingly used for continuous renal replacement therapy (CRRT) in children, but it is rarely used in children with liver injury, especially liver failure (LF). We analyze this issue through the following research. Methods: We retrospectively analyzed 75 children with liver injury who underwent RCA-CRRT in the Pediatric Intensive Care Unit (PICU) of Children's Hospital of Chongqing Medical University. The patients were divided into the LF group and liver dysfunction (LD) group. The two groups were compared to evaluate the clinical safety and efficacy of RCA-CRRT in children with liver injury and to explore RCA-CRRT management strategies, in terms of the following indicators: the incidence of bleeding, clotting, citrate accumulation (CA), acid-base imbalance, and electrolyte disturbance, as well as filter lifespans, changes in biochemical indicators, and CRRT parameters adjustment. Results: The total incidence of CA (TCA) and persistent CA (PCA) in the LF group were significantly higher than those in the LD group (38.6 vs. 16.2%, p < 0.001; 8.4 vs. 1.5%, p < 0.001); and the CA incidence was significantly reduced after adjustment both in the LF (38.6 vs. 8.4%, p < 0.001) and LD groups (16.2 vs. 1.5%, p < 0.001). The incidence of hypocalcemia was significantly higher in the LF group than in the LD group either before (34.9 vs. 8.8%, p < 0.001) or after treatment (12.0 vs. 0%, p < 0.001). The speed of the blood and citrate pumps after adjustment was lower than the initial setting values in both the LF and LD groups. The dialysis speed plus replacement speed were higher than the initial settings parameters. Conclusion: For children undergoing RCA-CRRT, the risks of CA and hypocalcemia are significantly higher in children with liver failure than those with liver dysfunction, but through the proper adjustment of the protocol, RCA-CRRT can still be safely and effectively approached for children with LD and even LF.

Effect of blood analysis and immune function on the prognosis of patients with COVID-19.

INTRODUCTION: This retrospective study investigated the implications of changes in blood parameters and cellular immune function in patients with Coronavirus Disease 2019 (COVID-19). METHODS: Records were reviewed of 85 patients admitted with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital death. RESULTS: Fourteen patients died. The baseline leukocyte count, neutrophil count and hemoglobin was significantly higher in non-survivors compared with survivors, while the reverse was true of lymphocyte count, platelet, PaO2/FiO2, CD3+ count and CD4+ count. The percentage of neutrophil count > 6.3×109/L in death group was significantly higher than that in survival group, and multivariate logistic regression showed neutrophil count > 6.3×109/L was independently associated with mortality. However, there were not significant difference in IgG, IgM, IgA, C3, C4 and the percentage of IgE > 100 IU/ml between the death group and survival group. Areas under the receiver operating characteristic curves of the following at baseline could significantly predict mortality: leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts. CONCLUSIONS: For hospitalized patients with COVID-19, lymphocyte, CD3+ and CD4+ counts that marked decrease suggest a poor outcome. Admission neutrophil count > 6.3 ×109/L is independently associated with mortality. At admission, leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts should receive added attention.

Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit.

Objective: To compare the ability of different indices of glycemic variability (GV) in the prognostic evaluation of critically ill children and investigate whether heterogeneity of glucose control exists within this population group. Methods: We conducted a retrospective study of the GV data collected from patients admitted to the pediatric intensive care unit, Children's Hospital of Chongqing Medical University between January 2016 and December 2016. We calculated the mean glucose level (MGL) and four indices of GV, namely, standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), and glycemic lability index (GLI). The 28-day mortality was considered as the primary endpoint. Results: Survivors and non-survivors showed significant differences in terms of the SD, CV, MAGE, and GLI (P < 0.05, for all). However, GLI was superior to the other indices and showed an independent association with ICU mortality (odds ratio [OR], 1.082; 95% confidence interval [CI], 1.031-1.135; P < 0.01). Sub-group analysis disaggregated by quartiles of MGL and GV revealed that younger subjects (age ≤ 36 months) had significantly higher mortality in the lowest quartile of the MGL and in the highest quartile of GV; the older children (age > 36 months) experienced significantly higher mortality in the highest quartiles of MGL and GV. Conclusion: GV is closely associated with mortality, and among all glucose parameters evaluated, GLI was found to be the strongest predictor of outcomes. This paper is the first report of age being a potentially important modifier of the association between GV, MGL, and mortality in critically ill children.

Five-year change in body mass index category of childhood and the establishment of an obesity prediction model.

The prevalence of childhood obesity in China has recently become increasingly severe, and intervention measures are needed to stop its growth. Currently, there is a lack of assessment and prediction methods for childhood obesity. We develop a predictive model that uses currently measured predictors [gender, age, urban/rural, height and body mass index (BMI)] to quantify children's probabilities of belonging to one of four BMI category 5 years later and identify the high-risk group for possible intervention. A total of 88,980 students underwent a routine standard physical examination and were reexamined 5 years later to complete the study. The full model shows that boys, urban residence and height have positive effects and that age has a negative effect on transition to the overweight or obese category along with significant BMI effects. Our model correctly predicts BMI categories 5 years later for 70% of the students. From 2018 to 2023, the prevalence of obesity in rural boys and girls is expected to increase by 4% and 2%, respectively, while that in urban boys and girls is expected to remain unchanged. Predictive models help us assess the severity of childhood obesity and take targeted interventions and treatments to prevent it.

Bioinformatic identification of hub genes and key pathways in neutrophils of patients with acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is characterized as a neutrophil-dominant disorder without effective pharmacological interventions. Knowledge of neutrophils in ARDS patients at the transcriptome level is still limited. We aimed to identify the hub genes and key pathways in neutrophils of patients with ARDS. The transcriptional profiles of neutrophils from ARDS patients and healthy volunteers were obtained from the GSE76293 dataset. The differentially expressed genes (DEGs) between ARDS and healthy samples were screened using the limma R package. Subsequently, functional and pathway enrichment analyses were performed based on the database for annotation, visualization, and integrated discovery (DAVID). The construction of a protein-protein interaction network was carried out using the search tool for the retrieval of interacting genes (STRING) database and the network was visualized by Cytoscape software. The Cytoscape plugins cytoHubba and MCODE were used to identify hub genes and significant modules. Finally, 136 upregulated genes and 95 downregulated genes were identified. Gene ontology analyses revealed MHC class II plays a major role in functional annotations. SLC11A1, ARG1, CHI3L1, HP, LCN2, and MMP8 were identified as hub genes, and they were all involved in the neutrophil degranulation pathway. The MAPK and neutrophil degranulation pathways in neutrophils were considered as key pathways in the pathogenesis of ARDS. This study improves our understanding of the biological characteristics of neutrophils and the mechanisms underlying ARDS, and key pathways and hub genes identified in this work can serve as targets for novel ARDS treatment strategies.

Predictive value of C-reactive protein and the Pediatric Risk of Mortality III Score for occurrence of postoperative ventilator-associated pneumonia in pediatric patients with congenital heart disease.

IMPORTANCE: Ventilator-associated pneumonia (VAP) is one of the most common complications after cardiac surgery in children with congenital heart disease (CHD). Early prediction of the incidence of VAP is important for clinical prevention and treatment. OBJECTIVE: To determine the value of serum C-reactive protein (CRP) levels and the Pediatric Risk of Mortality III (PRISM III) score in predicting the risk of postoperative VAP in pediatric patients with CHD. METHODS: We performed a retrospective review of clinical data of 481 pediatric patients with CHD who were admitted to our pediatric intensive care unit. These patients received mechanical ventilation for 48 hours or longer after corrective surgery. On the basis of their clinical manifestations and laboratory results, patients were separated into two groups of those with VAP and those without VAP. CRP levels were measured and PRISM III scores were collected within 12 hours of admission to the pediatric intensive care unit. The Pearson correlation coefficient was used to evaluate the association of CRP levels and the PRISM score with the occurrence of postoperative VAP. A linear regression model was constructed to obtain a joint function and receiver operating curves were used to assess the predictive value. RESULTS: CRP levels and the PRISM III score in the VAP group were significantly higher than those in the non-VAP group (P < 0.05). Receiver operating curves suggested that using CRP + the PRISM III score to predict the incidence of VAP after congenial heart surgery was more accurate than using either of them alone (CRP + the PRISM III score: sensitivity: 53.2%, specificity: 85.7%). When CRP + the PRISM III score was greater than 45.460, patients were more likely to have VAP. INTERPRETATION: Although using CRP levels plus the PRISM III score to predict the incidence of VAP after congenial heart surgery is more accurate than using either of them alone, its predictive value is still limited.

Lysozyme Associated Liposomal Gentamicin Inhibits Bacterial Biofilm.

Bacteria on living or inert surfaces usually form biofilms which make them highly resistant to antibiotics and immune clearance. Herein, we develop a simple approach to overcome the above conundrum through lysozyme-associated liposomal gentamicin (LLG). The association of lysozyme to the surface of liposomes can effectively reduce the fusion of liposomes and undesirable payload release in regular storage or physiological environments. The LLG was more effective at damaging established biofilms and inhibiting biofilm formation of pathogens including Gram-positive and Gram-negative bacteria than gentamicin alone. This strategy may provide a novel approach to treat infections due to bacterial biofilm.

Synthesis, characterization and anticancer activity of tanshinone I grafted low molecular chitosan.

In this study, we synthesized a novel water-soluble low molecular chitosan (LMC) derivative through Vilsmeier reaction and reductive amination reaction. The derivative was characterized by UV-visible spectroscopy, 1H NMR, FTIR and SEM techniques. The results showed that the derivative effectively reduced the cell viability rate, inhibited cell metastasis, induced cell apoptosis and dissipated mitochondrial membrane potential (ΔΨm). Moreover, the antitumor activity was strengthened with the increase of the degree of substitution of tanshinone I (TanI). These findings provided important support for developing new water-soluble antitumor agent and expand the scope of application of LMC.

Preparation and sulfation of an α-glucan from Actinidia chinensis roots and their potential activities.

In this study, one homopolysaccharide (ACPA1) with a molecular weight (Mw) of 5.5×103g/mol was prepared from the roots of Actinidia chinensis. It was characterized as an α-d-glucan consisting of predominant 4-linked α-d-Glcp residues branched at O-6. Three sulfated derivatives of ACPA1 (SA1, SA2 and SA3) with different degrees of sulfation (DS) were obtained by SO3-pyridine procedure. Moisture-preserving tests demonstrated that the sulfated derivatives with the highest DS values, SA1 and SA2, exhibited better moisture-preserving abilities than ACPA1 and SA3. All sulfated derivatives exerted stimulatory effects on phagocytosis activity and nitric oxide production by RAW 264.7 macrophages while ACPA1 did not. These findings suggested that the sulfated derivatives of ACPA1 might be used as moisture-preserving or immunopotentiating reagents.

Chitosan conjugation enables intracellular bacteria susceptible to aminoglycoside antibiotic.

Most chronic infections are difficult to eradicate because bacteria capable of surviving in host-infected cells may be protected from the killing actions of antibiotics, leading to therapy failures and disease relapses. Here we demonstrated that covalent-coupling chitosan to streptomycin significantly improved intracellular bactericidal capacity towards multiple organisms within phagocytic or nonphagocytic cells. Structure-activity relationship investigations indicated that antibiotic contents, molecular size and positive charges of the conjugate were the key to retain this intracellular bactericidal activity. Mechanistic insight demonstrated the conjugate was capable to target and eliminate endocytic or endosomal escaped bacteria through facilitating the direct contact between the antibiotic and intracellular organism. In vivo acute infection models indicated that compared to equal dose of the antibiotic, chitosan-streptomycin (C-S) conjugate and especially the human serum album binding chitosan-streptomycin conjugate (HCS) complex formed by human serum album and C-S conjugate greatly decreased the bacteria burden in the spleen and liver in both wild type and immuno-suppressive mice. Furthermore, the HCS complex remarkably reduced mortality of infected TLR2 deficient mice, mimicking immune-compromised persons who were more susceptible to bacterial infections. These findings might open up a new avenue to combat intracellular bacterial infection by aminoglycosides antibiotics at a lower effective dose.

[Pathogens and risk factors for ventilator-associated pneumonia in children with congenial heart disease after surgery].

OBJECTIVE: To investigate the distribution and drug sensitivity of pathogens and risk factors for ventilator-associated pneumonia (VAP) in children with congenial heart disease (CAD) after surgery. METHODS: According to the occurrence of VAP, 312 children with CAD who received mechanical ventilation after surgery for 48 hours or longer between January 2012 and December 2014 were classified into VAP (n=53) and non-VAP groups (n=259). Sputum samples were collected and cultured for pathogens in children with VAP. The drug sensitivity of pathogens was analyzed. The risk factors for postoperative VAP were identified by multiple logistic regression analysis. RESULTS: The sputum cultures were positive in 51 out of 53 children with VAP, and a total of 63 positive strains were cultured, including 49 strains of Gram-negative bacteria (78%), 9 strains of Gram-positive bacteria (14%) and 5 strains of funqi (8%). The drug sensitivity test showed that Gram-negative bacteria were resistant to amoxicillin, piperacillin, cefotaxime and ceftazidime, with a resistance rate of above 74%, and demonstrated a sensitivity to amikacin, polymyxin and meropenem (resistance rate of 19%-32%). Single factor analysis showed albumin levels, preoperative use of antibiotics, duration of mechanical ventilation, times of tracheal intubation, duration of anesthesia agent use, duration of acrdiopulmonary bypass, duration of aortic occlusion and use of histamin2-receptor blockade were significantly different between the VAP and non-VAP groups (P<0.05). The multiple logistic regression showed albumin levels (<35 g/L), duration of mechanical ventilation (≥ 7 d), times of tracheal intubation (≥ 3), duration of acrdiopulmonary bypass (≥ 100 minutes) and duation of aortic occlusion (≥ 60 minutes) were independent risk factors for VAP in children with CAD after surgery. CONCLUSIONS: Gram-nagative bacteria are main pathogens for VAP in children with CAD after surgery. The antibiotics should be used based on the distribution of pathogens and drug sensitivity test results of pathogens. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to reduce the morbidity of VAP in children with CAD after surgery.

Designer D-form self-assembling peptide nanofiber scaffolds for 3-dimensional cell cultures.

Traditional 2-D cell cultures have many limitations because they do not truly mimic the natural environment. In order to fully understand the in vivo 3-D environment, it is crucial to develop a biomimetic 3-D culture system. Recently progress toward 3-D tissue cell cultures has been gradually made by addressing many critical issues including the microenvironment, gradient diffusion and apoptosis. Here we report a D-form self-assembly peptide system that provides insight into the relationships between nanofiber scaffolds and cell behaviors in 3-D cell cultures. We observed the peptide secondary structures response to ions and confirmed that their participation increases mechanical force rapidly. We also showed the enzymes attachment to nanofibers, investigated scaffolds to form 3-D microenvironment and described a modified protocol for 3-D cell culture D-form self-assembly peptide. Using this protocol, we showed cell behavior in the D-form peptide with high cell viability and low-level cell apoptosis for weeks. Furthermore, we proposed a plausible model for chiral self-assembly peptides in 3-D culture. Our research may further stimulate others to design novel biological materials at single chiral amino acid level, and may broaden the applications of designer D-form self-assembling peptides in clinical and medical nanobiotechnology.