Cerebral microhemorrhages in children with congenital heart disease: Prevalence, risk factors, and impact on neurodevelopmental outcomes.

Background: Infants with complex congenital heart disease (CHD) require life-saving corrective/palliative heart surgery in the first weeks of life. These infants are at risk for brain injury and poor neurodevelopmental outcomes. Cerebral microhemorrhages (CMH) are frequently seen after neonatal bypass heart surgery, but it remains unknown if CMH are a benign finding or constitute injury. Herein, we investigate the risk factors for developing CMH and their clinical significance. Methods: 192 infants with CHD undergoing corrective cardiac surgery with cardiopulmonary bypass (CPB) at a single institution were prospectively evaluated with pre-(n = 183) and/or postoperative (n = 162) brain magnetic resonance imaging (MRI). CMH severity was scored based on total number of microhemorrhages. Antenatal, perioperative, and postoperative candidate risk factors for CMH and neurodevelopmental (ND) outcomes were analyzed. Eighteen-month neurodevelopmental outcomes were assessed using the Bayley-III Scales of Infants and Toddler Development in a subset of patients (n = 82). Linear regression was used to analyze associations between risk factors or ND outcomes and presence/number of CMH. Results: The most common CHD subtypes were hypoplastic left heart syndrome (HLHS) (37%) and transposition of the great arteries (TGA) (33%). Forty-two infants (23%) had CMH present on MRI before surgery and 137 infants (85%) post-surgery. No parameters evaluated were significant risk factors for preoperative CMH. In multivariate analysis, cardiopulmonary bypass (CPB) duration (p < 0.0001), use of extracorporeal membrane oxygenation (ECMO) support (p < 0.0005), postoperative seizure(s) (p < 0.03), and lower birth weight (p < 0.03) were associated with new or worsened CMH postoperatively. Higher CMH number was associated with lower scores on motor (p < 0.03) testing at 18 months. Conclusion: CMH is a common imaging finding in infants with CHD with increased prevalence and severity after CPB and adverse impact on neurodevelopmental outcomes starting at a young age. Longer duration of CPB and need for postoperative ECMO were the most significant risk factors for developing CMH. However, presence of CMH on preoperative scans indicates non-surgical risk factors that are yet to be identified. Neuroprotective strategies to mitigate risk factors for CMH may improve neurodevelopmental outcomes in this vulnerable population.

Analysis of the Influencing Factors of Delirium after PCI for Acute Myocardial Infarction and its Impact on the Quality of Life of Patients.

Objective: Delirium is a common and serious issue in patients recovering from percutaneous coronary intervention (PCI). It can lead to longer hospital stays, increased mortality, and decreased quality of life. This study aims to investigate different nursing interventions to improve care for post-PCI patients by reducing the incidence and duration of delirium. Methods: Between December 2021 and April 2023, we enrolled patients who underwent PCI surgery for acute myocardial infarction at our hospital as study participants. Utilizing a clinical randomized controlled trial design, we allocated these patients randomly into either the intervention group or the control group. The control group received conventional nursing care, while the intervention group received routine nursing care augmented by family visit nursing care, encompassing emotional support, education, and enhanced communication with family members. Upon the completion of all intervention measures, we assessed the incidence of delirium in post-PCI patients using the Richmond Agitation Sedation Scale (RASS) and the ICU Ambiguity Assessment Method for the Intensive Care Unit (CAM-ICU). Furthermore, we evaluated the patients' quality of life using the US Medical Bureau's Quality of Life Health Survey (SF-36). Result: Significant differences were observed in Richmond Agitation Sedation Scale (RASS) scores at 24 and 48 hours post-PCI, favoring the intervention group (P < .05). The intervention group also exhibited a lower incidence of delirium at 24 hours (P < .05) and a significantly shorter delirium duration (P < .05). While baseline quality of life scores did not differ significantly between the groups, post-intervention, the intervention group demonstrated significantly higher quality of life scores. These results underscore the positive impact of combined nursing interventions on sedation levels, delirium incidence and duration, and overall quality of life for post-PCI patients. Conclusion: The combined approach of routine nursing care and home visit interventions significantly reduced delirium incidence and duration in post-PCI patients. This personalized care strategy emphasizes patient well-being and is indicative of a broader shift towards individualized healthcare. It highlights the potential for enhanced patient outcomes and improved quality of life in the context of post-PCI patient management.

De novo design and directed folding of disulfide-bridged peptide heterodimers.

Peptide heterodimers are prevalent in nature, which are not only functional macromolecules but molecular tools for chemical and synthetic biology. Computational methods have also been developed to design heterodimers of advanced functions. However, these peptide heterodimers are usually formed through noncovalent interactions, which are prone to dissociate and subject to concentration-dependent nonspecific aggregation. Heterodimers crosslinked with interchain disulfide bonds are more stable, but it represents a formidable challenge for both the computational design of heterodimers and the manipulation of disulfide pairing for heterodimer synthesis and applications. Here, we report the design, synthesis and application of interchain disulfide-bridged peptide heterodimers with mutual orthogonality by combining computational de novo designs with a directed disulfide pairing strategy. These heterodimers can be used as not only scaffolds for generating functional molecules but chemical tools or building blocks for protein labeling and construction of crosslinking hybrids. This study thus opens the door for using this unexplored dimeric structure space for many biological applications.

Simultaneous removal of NH3-N and COD from shale gas distillate via an integration of adsorption and photo-catalysis: A hybrid approach.

In view of the circulation cooling water (CCW) quality for refining and petrochemical enterprises, distillates obtained from shale gas produced water after alkali precipitation, filtration and multi-effect evaporation required further purification to remove NH3-N and COD. Illumination, adsorption, photocatalysis after adsorption equilibrium (AP) and integration of adsorption and photocatalysis (IOAP) were carried out to optimize the distillates treatment. AP and IOAP treatments were feasible for the simultaneous removal of NH3-N and COD from the target distillate, while IOAP treatment had much better adaptability and practicability due to its economic cost and easy operation. In IOAP, the removal rate of COD and NH3-N was high up to 59.0% and 88.9%, respectively, under Xenon lamp illumination (25 A) for 60 min with 10 g/L zeolite. The residual concentration of COD and NH3-N were 73.9 mg/L and 23.0 mg/L, respectively, which could well meet the CCW quality. Furthermore, the results of zeolites characterization (SEM-EDX, BET and FTIR) and kinetics analysis showed that the removal of COD in IOAP process mainly depended on the effect of photocatalysis excited by zeolite, while the removal of NH3-N was in virtue of the synergistic effect of photocatalysis and adsorption.