Massive neurocysticercosis in a ten-year-old girl: a case report.

BACKGROUND: Massive neurocysticercosis is a rare form of neurocysticercosis, and can lead to serious conditions and even death. CASE PRESENTATION: Here we present a case of ten-year-old Tibetan girl who developed headache and vomiting. Her brain magnetic resonance imaging (MRI) illustrated lots of intracranial cystic lesions, and no obvious extracranial lesions were found. Serum immunoglobulin G antibodies against cysticerci were positive by the use of an enzyme-linked immunosorbent assay (ELISA). These results in combination with her medical history were in line with massive neurocysticercosis. The patients recovered well after supportive management and antiparasitic treatment. CONCLUSIONS: This case provides insights on the diagnosis and treatment of massive neurocysticercosis. The treatment of patients with massive neurocysticercosis should be in an individualized fashion, and the use of antiparasitic drugs in these patients must be decided after carefully weighing the risks and benefits.

Association between low ambient temperature during pregnancy and adverse birth outcomes: A systematic review and meta-analysis.

BACKGROUND: Extreme temperature events, including extreme cold, are becoming more frequent worldwide, which might be harmful to pregnant women and cause adverse birth outcomes. We aimed to investigate the association between exposure to low ambient temperature in pregnant women and adverse birth outcomes, such as preterm birth, low birth weight, and stillbirth, and to summarize the evidence herein. METHODS: Relevant studies were searched in PubMed, Cochrane, and Embase electronic databases until November 2021. Studies involving low ambient temperature, preterm birth, birth weight, and stillbirth were included. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed to conduct this study risk of bias and methods for data synthesis. RESULTS: A total of 34 studies were included. First, pregnant women exposed to low ambient temperature had an increased risk of preterm birth (risk ratio [RR] 1.08; 95% confidence interval [CI] 1.04-1.13). Subgroup analyses revealed that exposure during late pregnancy was more likely to induce preterm birth. In addition, only pregnant women exposed to <1st percentile of the mean temperature suffered increased risk of preterm birth. Moreover, pregnant women living in medium or hot areas were more prone to have preterm births than those in cold areas when exposed to low ambient temperatures. Asians and Blacks were more susceptible to low ambient temperatures than Caucasians. Second, pregnant women exposed to low ambient temperature had an increased risk of low birth weight (RR 1.07; 95% CI 1.03-1.12). Third, pregnant women had an increased risk of stillbirth while exposed to low ambient temperature during the entire pregnancy (RR 4.63; 95% CI 3.99-5.38). CONCLUSIONS: Exposure to low ambient temperature during pregnancy increases the risk of adverse birth outcomes. Pregnant women should avoid exposure to extremely low ambient temperature (<1st percentile of the mean temperature), especially in their late pregnancy. This study could provide clues for preventing adverse outcomes from meteorological factors. REGISTRATION: No. CRD42021259776 at PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ).

A Retrospective Study from 2 Tertiary Hospitals in China to Evaluate the Risk Factors for Surgical Site Infections After Abdominal Hysterectomy in 188 Patients.

BACKGROUND Surgical site infections in patients after abdominal hysterectomy can increase medical expenses and increase the risk of death in patients. This retrospective study from 2 grade A tertiary hospitals in China aimed to evaluate the risk factors for postoperative surgical site infections (SSIs) in 188 patients undergoing abdominal hysterectomy between September 2013 and June 2021. MATERIAL AND METHODS Of the 188 patients, 94 patients with SSIs were classified into the infected group, and 94 patients without SSIs were classified into the control group. Wound drainage was sampled for bacterial isolation and culture. RESULTS The suspected risk factors for SSIs after abdominal hysterectomy were body mass index, whether the patient had comorbidities of diabetes mellitus, cancer, or hypoproteinemia, surgical wound classification, whether preoperative skin preparation was performed, whether the patient had chemotherapy, length of incision, amount of blood loss during surgery, duration of surgery, necessity of a second surgery, whether a wound drainage tube was inserted, and whether delayed suturing was used in wound. Of them, body mass index (OR=1.133; 95% CI: 1.012~1.266; P=0.029), more than 3 hours of surgery (OR=0.261; 95% CI: 0.108~0.631; P=0.003), and wound drainage tube insertion (OR=0.223; 95% CI: 0.094~0.531; P=0.001) were the independent risk factors. CONCLUSIONS The findings support previous studies and showed that risk factors for SSIs after abdominal hysterectomy included increased patient BMI, increased operation duration, and the number of surgical drainage tubes used.

Mesenchymal Stem Cells Protect Against Hypoxia-Ischemia Brain Damage by Enhancing Autophagy Through Brain Derived Neurotrophic Factor/Mammalin Target of Rapamycin Signaling Pathway.

Hypoxic-ischemic encephalopathy (HIE) is a serious disease for neonates. However, present therapeutic strategies are not effective enough for treating HIE. Previous study showed that mesenchymal stem cells (MSCs) can exert neuroprotective effects for brain damage, but its mechanism remains elusive. Using in vitro coculture of rat cortical primary neurons and MSCs in HI conditions, we demonstrated that MSCs help increase brain derived neurotrophic factor (BDNF) and autophagy markers (LC3II and Beclin1) in the cultures and decrease cells death (lactate dehydrogenase levels). We demonstrated a similar mechanism using an in vivo rat model of HI in combination with MSCs transplantation. Using a behavioral study, we further showed that MSCs transplantation into the rat brain after HI injury can attenuate behavioral deficits. Finally, we found that the increase in BDNF and autophagy related factors after HI injury combined with MSCs transplantation can be reversed by anti-BDNF treatment and strengthen the point that the protective effects of BDNF work through inhibition of the mammalin target of rapamycin (mTOR) pathway. Collectively, we proposed that coculture/transplantation of MSCs after HI injury leads to increased BDNF expression and a subsequent reduction in mTOR pathway activation that results in increased autophagy and neuroprotection. This finding gives a hint to explore new strategies for treating neonates with HIE. Stem Cells 2018;36:1109-1121.

[Epidemiological study on nasal carriage in hospitalized children infected with Staphylococcus aureus].

OBJECTIVE: To study the relationship between nasal carriage and Staphylococcus aureus (S. aureus) infection in hospitalized children. METHODS: Fifty-six hospitalized children infected with S. aureus were recruited in this study. Nasal swabs were collected and cultured, and the nasal carriage rate of S. aureus was examined. PVL virulence gene and mecA resistance gene were both detected in clinical strains and nasal carriage strains by PCR. RESULTS: Twenty-two (39%) of the 56 children had nasal carriage of S. aureus, and most of them (18 cases) were younger than one year. Among these 22 children, 11 (50%) had previous hospitalization over the past year. In the infected strains, the rate of methicillin-resistant S. aureus (MRSA) was 29% (16/56), while it was 32% (7/22) in carriage strains. The mecA positive results in clinical strains were consistent with the results in nasal carriage strains. Among 5 PVL-positive nasal carriage strains, 4 (90%) could be matched with their clinical strains, all of which were MRSA. CONCLUSIONS: Nasal carriage is a potential risk factor for S. aureus infection. Nosocomial transmission may lead to nasal carriage, which can cause S. aureus infection. The isolation rate of MRSA is high in hospitalized children infected with S. aureus, which implies that more attention is needed for this situation. The isolates from noses may be clonally identical to the isolates from clinical secretions, and the homology between them needs to be confirmed by multi-locus sequence typing.

Circadian rhythm disruption was observed in hand, foot, and mouth disease patients.

Hand, foot, and mouth disease (HFMD) with central nerve system complications may rapidly progress to fulminated cardiorespiratory failure, with higher mortality and worse prognosis. It has been reported that circadian rhythms of heart rate (HR) and respiratory rate are useful in predicting prognosis of severe cardiovascular and neurological diseases. The present study aims to investigate the characteristics of the circadian rhythms of HR, respiratory rate, and temperature in HFMD patients with neurological complications. Hospitalized HFMD patients including 33 common cases (common group), 61 severe cases (severe group), and 9 critical cases (critical group) were contrasted retrospectively. Their HR, respiratory rate, and temperatures were measured every 4 hours during the first 48-hour in the hospital. Data were analyzed with the least-squares fit of a 24-hour cosine function by the single cosinor and population-mean cosinor method. Results of population-mean cosinor analysis demonstrated that the circadian rhythm of HR, respiratory rate, and temperature was present in the common and severe group, but absent in the critical group. The midline-estimating statistic of rhythm (MESOR) (P = 0.016) and acrophase (P < 0.01) of temperature and respiratory rate were significantly different among 3 groups. But no statistical difference of amplitude in temperature and respiratory rate was observed among the 3 groups (P = 0.14). MESOR value of HR (P < 0.001) was significantly different in 3 groups. However, amplitude and acrophase revealed no statistical difference in circadian characteristics of HR among 3 groups. Compared with the common group, the MESOR of temperature and respiratory rate was significantly higher, and acrophase of temperature and respiratory rate was 2 hours ahead in the severe group, critical HFMD patients lost their population-circadian rhythm of temperature, HR, and respiratory rate. The high values of temperature and respiratory rate for the common group were concentrated between 3 and 9 PM, whereas those for the severe group were more dispersive. And the high values for the critical group were equally distributed in 24 hours of the day. Circadian rhythm of patients' temperature in the common group was the same as the normal rhythm of human body temperature. Circadian rhythm of patients' temperature, HR and respiratory rate in 3 groups were significantly different.

Efficacy and safety of acotiamide for the treatment of functional dyspepsia: systematic review and meta-analysis.

BACKGROUND: There are no treatments with established efficacy for this disorder so far. AIM: To systematically review the efficacy of acotiamide in the treatment of patients with FD. METHODS: We searched main electronic databases through November 2013. RCTs evaluating the efficacy of acotiamide versus placebo in FD patients were included. Pooled risk ratio (RR) with 95% confidential interval (CI) was calculated. RESULTS: Six publications including seven RCTs were eligible for inclusion. The summary RR of overall improvement of FD symptoms in patients receiving acotiamide versus placebo was 1.29 (95% CI, 1.19-1.40, P < 0.00001; I(2) = 15%). Acotiamide improved the symptoms of patients with postprandial distress syndrome (PDS) (RR, 1.29; 95% CI, 1.09-1.53, P = 0.003; I(2) = 0%), and the summary RR for patients with epigastric pain syndrome (EPS) was 0.92 (95% CI, 0.76-1.11, P = 0.39; I(2) = 0%). Acotiamide showed a significantly beneficial effect on the elimination of some individual FD symptoms compared with placebo. Adverse events were not significantly different between acotiamide and placebo groups. Subgroup analyses suggested that acotiamide 100 mg three times daily (tid) showed consistent efficacy not only for the overall improvement but also for the elimination of some individual symptoms in FD patients. CONCLUSIONS: Acotiamide has the potential to improve the symptoms of patients with FD, particularly of patients with PDS, without major adverse effects. The dosage of acotiamide 100 mg tid might be the appropriate dose in the treatment of FD.

[A comparative study of the gene chip technology and acid-fast staining or mycobacterial culture to diagnose].

OBJECTIVE: To investigate the clinical value of mycobacterial DNA microarray technology for diagnosis of childhood tuberculosis. METHODS: 120 clinical specimens were collected from hospitalized child patients. Acid-fast staining, mycobacterial culture and DNA microarray assays were performed using these clinical specimens. The results of DNA microarray assays were compared with the results of acid-fast staining and mycobacterial culture. RESULTS: The sensitivity of DNA microarray assays for specimens from children with tuberculosis was 24.3% (17/70), of acid-fast staining 17.1% (12/70), of mycobacterial culture 20.0% (14/70), and the specificity of the three methods was all 100.0% (50/50). The difference between results of DNA microarray assays and that of acid-fast staining or mycobacterial culture was not significant. CONCLUSION: DNA microarray assay has reference value for the diagnosis of childhood tuberculosis. It provides a new way for the diagnosis of childhood tuberculosis.

[Clinical distribution and drug resistance of Staphylococcus aureus isolated from hospitalized children].

OBJECTIVE: To learn about the clinical distribution and drug resistance of Staphylococcus aureus (S. aureus) isolated from inpatients and provide evidence for clinically reasonable use of antibiotics. METHODS: Data including clinical features and drug sensitivity of S. aureus isolated from hospitalized patients in the last two years were analyzed. RESULTS: 248 S. aureus strains were isolated from inpatients of our hospital in the last 2 years. The most common disease caused by S. aureus was pneumonia with a total of 163 patients. The second was skin and soft tissue infection with 21 patients in total. Sepsis occurred in 11 patients. The most commonly used antibiotics included oxacillin, nafcillin, cefathiamidine and vancomycin. The average course of antibiotic was 12.48 days. Treatment course of pneumonia and sepsis was 13.71 and 15.11 respectively. 96.31% (235/244) of S. aureus were resistant to penicillin. Vancomycin-resistant S. aureus has not been isolated. CONCLUSION: S. aureus pneumonia is the leading cause of hospitalization of children with S. aureus infection. S. aureus is highly resistant to commonly used antibiotics and related infections need longer therapy. Clinicians should pay more attention to S. aureus infection.

Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: systematic review and meta-analysis.

Evidence has shown that mild therapeutic hypothermia (MTH) could improve survival and neurological outcome in patients following cardiac arrest. But this therapy may cause some adverse effects. The authors sought to take a systematic approach to describe the safety aspects and outcome of MTH following cardiac arrest to help clinical practice. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, BIOSIS Previews and clinicaltrials.gov were searched up to June 2011. Bibliographies of relevant studies were also reviewed. Comparative studies reporting the mortality or any other studies reporting any kind of adverse events in patients undergoing MTH after cardiac arrest and published in English were included. Of 1742 abstracts, 63 studies were included. Most adverse events potentially associated with therapeutic hypothermia were not significantly different between the hypothermia therapy and the normothermia groups. No significant difference was found in the inhospital mortality, bleeding, pneumonia and bradycardia events between surface and endovascular-cooled groups in this study. Cooling device-related adverse events were generally mild. Serious adverse events potentially attributable to therapeutic hypothermia were seldom reported. MTH was associated with reduced inhospital mortality, mortality at 1 month and at 6 months. Evidence about the safety of MTH in children has been limited. These results suggest that while it may result in some adverse events, MTH is generally safe in patients following cardiac arrest and could improve the short-term and long-term survival of comatose patients after cardiac arrest. But awareness of these adverse events should be kept in mind in clinical practice.