The fluid management and hemodynamic characteristics of PiCCO employed on young children with severe hand, foot, and mouth disease-a retrospective study.

BACKGROUND: Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which is particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema before progressing to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important to the treatment process. METHODS: We did a review of young patients who had been successfully treated in our department for severe HFMD, which had been caused by EV71. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve patients' clinical outcomes. RESULTS: After analysis, the findings informed that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or lower the number of cases which required mechanical ventilation, PiCCO did reduce the incidence of fluid overload (p = 0.085) and shorten the days of mechanical ventilation (p = 0.028). After effective treatment, PiCCO monitoring indicated that the cardiac index (CI) increased gradually(p < 0.0001), in contrast to their pulse (P, p < 0.0001), the extra vascular lung water index (EVLWI, p < 0.0001), the global end diastolic volume index (GEDVI, p = 0.0043), and the systemic vascular resistance index (SVRI, p < 0.0001), all of which decreased gradually. CONCLUSION: Our study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has some potential benefits, such as reducing fluid overload and the duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

[Clinical feature of severe hand, foot and mouth disease with acute pulmonary edema in pediatric patients].

OBJECTIVE: To explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema. METHODS: A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment. RESULTS: Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa×s×L(-1)×m(-2)): 148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8, P<0.05 or P<0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL×s(-1)×m(-2)): 75.0±8.0 vs. 55.5±8.5, both P<0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae. CONCLUSIONS: Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.

Application of nanoring amino-functionalized magnetic polymer dispersive micro-solid-phase extraction and ultra fast liquid chromatography-tandem mass spectrometry in dicyandiamide residue analysis of powdered milk.

In this study, a rapid and accurate ultra-fast liquid chromatography-tandem quadrupole mass spectrometry (UFLC-MS/MS) method combined with dispersive micro-solid-phase extraction (d-µ-SPE) using a core-shell nanoring amino-functionalized magnetic polymer (CS-NR-MP) was established and validated to determine trace dicyandiamide (DCD) in powdered milk. The developed d-µ-SPE cleanup procedure can dramatically reduce the matrix in samples, and lead to a significant reduction in absolute matrix effects. Chromatographic separation was performed on an Acquity UPLC BEH Amide column by using water-acetonitrile (9:91, v/v) as the mobile phase within 2 min. DCD was quantitatively analyzed by using DCD-(15)N2(13)C2 as an internal standard. The results showed that the recoveries were between 99.8 and 105.6% with RSDs in the range of 0.5-4.9%. The target compound had good linearity in the range of 0.1-20.0 µg L(-1) with a correlation coefficient (r) of 0.9996. The limit of quantification (LOQ) was 0.06 µg kg(-1). This method can be used for the rapid and sensitive determination of ultratrace DCD residue in powdered milk samples.

Amine-functional magnetic polymer modified graphene oxide as magnetic solid-phase extraction materials combined with liquid chromatography-tandem mass spectrometry for chlorophenols analysis in environmental water.

A novel planar-structure amine-functional magnetic polymer modified graphene oxide nanocomposite (NH2-MP@GO) was synthesized. The properties were characterized by transmission electron microscopy (TEM) and Fourier-transform infrared spectrometry (FTIR). The obtained adsorption results showed that the NH2-MP@GO had great adsorptive ability toward five chlorophenols (CPs), including 2-chlorophenol (2-CP), 2,4-dichlorophenol (2,4-DCP), 2,4,6-trichlorophenol (2,4,6-TCP), 2,3,4,6-tetrachlorophenol (2,3,4,6-TeCP) and pentachlorophenol (PCP). Based on these, an effective magnetic solid-phase extraction (MSPE) procedure coupled with high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the preconcentration and determination of the five CPs in environmental water samples was developed. Various experimental parameters that could affect the extraction efficiencies had been investigated in detail. Under the optimum conditions, the enrichment factors of the method for the target CPs were found to be 1000. The proposed method was successfully applied for the analysis of environmental water samples with recoveries ranging from 86.4 to 99.8% with correlation coefficients (R) higher than 0.9994. Good linearities were obtained ranging from 10 to 500ng/L for 2-CP, 5 to 500ng/L for 2,4-DCP, 2 to 500ng/L for 2,4,6-TeCP and 2,3,4,6-TeCP, and 1 to 500ng/L for PCP, respectively. The limits of quantitation for the five CPs were 0.6-9.2ng/L. It was confirmed that the planar-structure NH2-MP@GO was a kind of highly effective MSPE materials used for the trace CPs analyses.

Fast determination of 22 sulfonamides from chicken breast muscle using core-shell nanoring amino-functionalized superparamagnetic molecularly imprinted polymer followed by liquid chromatography-tandem mass spectrometry.

A novel, simple and sensitive method was developed for the simultaneous determination of 22 sulfonamides (SAs) in chicken breast muscle by using the dispersive micro-solid-phase extraction (d-µ-SPE) procedure combined with ultra-fast liquid chromatography-tandem quadrupole mass spectrometry (UFLC-MS/MS). The excellent core-shell nanoring amino-functionalized superparamagnetic molecularly imprinted polymer (CS-NR-Mag-MIP) was used as sorbent, and the main factors affecting the extraction efficiency were investigated in detail. All target compounds showed good linearities in the tested range with correlation coefficients (r) higher than 0.9980. The mean recoveries were in the range of 85.0-112.2% at low, medium and high concentration levels (0.1, 1.0 and 5.0 ng/g). The intra-day and inter-day relative standard deviations (RSDs) were lower than 6.0% and 8.9%, respectively. The limits of quantification for the 22 SAs were between 0.013 and 0.099 ng/g. The developed d-µ-SPE-UFLC-MS/MS method had been successfully applied to the chicken breast muscle samples for food-safety risk monitoring in Zhejiang Province, China. The results showed sulfamethazine, sulfamethoxazole and sulfaquinoxaline in five out of three hundred collected samples were detected with concentrations of 0.418-2.28, 16.4 and 2.93 ng/g, respectively. It was confirmed that the CS-NR-Mag-MIP was a kind of highly effective d-µ-SPE materials used for the SAs analyses.