[Clinical characteristics and prognosis in 12 children with SARS-CoV-2 Omicron variant infection-associated acute necrotizing encephalopathy]. / 12ä¾‹æ–°åž‹å† çŠ¶ç— æ¯’Omicronå˜å¼‚æ ªæ„ŸæŸ“ç›¸å ³æ€¥æ€§åæ­»æ€§è„‘ç— å„¿ç«¥çš„ä¸´åºŠç‰¹ç‚¹åŠé¢„åŽåˆ†æž.

OBJECTIVES: To study the clinical characteristics and prognosis of SARS-CoV-2 Omicron variant infection-associated acute necrotizing encephalopathy (ANE) in children. METHODS: A retrospective analysis was conducted on the medical data of 12 children with SARS-CoV-2 Omicron variant infection-associated ANE who were admitted to the Pediatric Intensive Care Unit, Qingdao Women and Children's Hospital from December 18 to 29, 2022. The children were divided into two groups based on outcomes: death group (7 cases) and survival group (5 cases). The clinical manifestations and auxiliary examination results were compared between the two groups. RESULTS: The median age of the 12 patients was 30 months, with a male-to-female ratio of 1:1. All patients presented with persistent high fever, with a median highest body temperature of 41℃. The median time from fever onset to seizure or consciousness disturbance was 18 hours. The death group had a higher proportion of neurogenic shock, coagulation dysfunction, as well as elevated lactate, D-dimer, interleukin-6, interleukin--8, and interleukin-10 levels compared to the survival group (P<0.05). CONCLUSIONS: Children with SARS-CoV-2 Omicron variant infection-associated with ANE commonly present with persistent high fever, rapidly progressing disease, and have a high likelihood of developing consciousness disorders and multiorgan dysfunction within a short period. The occurrence of neurogenic shock, coagulation dysfunction, and significantly elevated cytokine levels suggests an increased risk of mortality.

Exome Sequencing Identifies a Novel DES Mutation (R227C) in a Chinese Dilated Cardiomyopathy Family.

OBJECTIVES: Dilated cardiomyopathy (DCM) is a common disease in the clinic, and it is the leading cause of heart failure and sudden cardiac death. Previous studies have proven that genetic factors play a crucial role in the occurrence of DCM; more than 50 disease genes including desmin (DES) have been identified to be associated with DCM. At present, most DES mutations are reported in desmin-related myofibrilla myopathy patients, but variants leading to isolated DCM are rarely reported. METHODS: We applied whole-exome sequencing and cardiomyopathy-related gene filtering strategies to discover the genetic factors in a Chinese DCM family. RESULTS: A novel mutation (c.679 C>T /p.R227C) in exon 3 of DES was identified and cosegregated with the affected members of a Chinese family with isolated DCM phenotypes (left ventricle and left atrial diameters). CONCLUSION: This mutation leads to a substitution of arginine by cysteine and it is predicted to be deleterious by bioinformatics programs. Our study not only contributes to the genetic diagnosis and counseling of families with DCM, but it also further proves that DES mutations may lead to isolated DCM and provides a new case for the study of the relationship between DES mutations and DCM.

[Effects of different doses of fentanyl on the stress response in patients undergoing valve replacement].

OBJECTIVE: To investigate the effects of different doses of fentanyl on the stress response in valve replacement surgery during cardiopulmonary bypass (CPB). METHODS: Thirty ASA II-III adult patients scheduled for cardial valve replacement were randomly divided into 3 groups: Group A (fentanyl 30 microg/kg), Group B (fentanyl 60 microg/kg), and Group C (fentanyl 100 microg/kg). Anesthesia was induced with medazalam 0.1 mg/kg, fentanyl 10 microg/kg and vecuronium 0.1 mg/kg; And were maintained with fentanyl and propofol infusion. Remained dose of fentanyl was used before the CPB. MAP, CVP, HR, P(ET)CO2, SpO2, nasal and rectal temperature were monitored continuously. Blood samples were taken before the operation (T1), before the CPB (T2), 30 min after the aortic declamping (T3), 2 h after the aortic declamping (T4), 24 h (T5) after the operation to determine the plasma levels of glucose, adrenocorticotropic hormone (ACTH), angiotensin II (AT II) and cortisol. RESULTS: Levels of glucose, ACTH, AT II and cortisol after the CPB (T3, T4 and T5) in 3 groups were significantly increased compared with that of T1 (P < 0.05 or P < 0.01). After CPB, at the same time point, among the 3 groups, the levels of the above index of Group A were the most highest, that of Group C were the most lowest. Glucose, ACTH, AT II and cortisol levels at T3 and T4 were significantly lower in Group B and C than those in Group A ( P < 0.05); But there was no significant difference between Group B and C. The duration of stay in the ICU and time of endotracheal extubation were significantly longer in patients of Group C than Group A and B (P < 0.05). CONCLUSION: Fentanyl (30-100 microg/kg) can completely suppress the stress response induced by intubation and intense surgical stimulus before CPB. Different doses of fentanyl seemed to be effective in reducing CPB-induced stress response. But the effect was not dependent on dose. So 60 microg/kg fentanyl seemed to be an ideal dose.

[Effects of fentanyl on cytokines and MDA during cardiopulmonary bypass in patients undergoing valve replacement].

OBJECTIVE: To investigate the effect of fentanyl on cytokines and MDA in valve replacement surgery during cardiopulmonary bypass ( CPB). METHODS: Thirty ASA II approximately III adult patients scheduled for cardial valve replacement were randomly divided into 3 groups: Group A (fentanyl 30 microg/ kg), Group B (fentanyl 60 microg/kg), and Group C (fentanyl 100 microg/kg). Anesthesia was induced with medazalam 0.1 mg/kg, fentanyl 10 microg/kg and vecuronium 0.1 mg/kg Administered intravenously. After tracheal intubation the patients were mechanically ventilated with pure oxygen. P(ET)CO2 was maintained between 35 approximately 45 mmHg. Anesthesia were maintained with fentanyl infusion combined with intermittent intravenous bolus of midazolam and vecuronium. MAP, CVP, HR, P(ET)CO2, SPO2, nasal and rectal temperature were monitored continuously. Remained dose of fentanyl was infused before the CPB. Blood Samples were taken before the operation (T1 ), before the CPB ( T2 ), 30 min after aortic declamping (T3 ) , 2 h after aortic declamping (T4 ), and 24 h (T5 ) after the operation for determination of plasma levels of tumor necrosis factor (TNF-alpha), interteukin IL-6 and IL-10, MDA. RESULTS: There was no significant change in the age, body weight, aortic cross-clomp time, CPB time, and operation time. Levels of TNF-alpha, IL-6, IL-10 and MDA after the CPB in the 3 groups were significantly higher compared with T, (P <0.01 ), TNF-alpha, IL-6 and MDA levels at T3, T4 were significantly lower in Group B and C than those in Group A. IL-10 levels at T4, T5 were significantly higher in Group B and C than those in Group A, but levels of TNF-alpha, IL-6, IL-10 and MDA in Group B were not significantly different compared with those in Group C. The duration of stay in the ICU and time of endotracheal extubation were significantly longer in patients of Group C than those of Group A and B. CONCLUSION: CPB leads to a proinflammatory and antiinflammatory response, as well as oxygen free radicals release. Larger dose fentanyl seemed to be effective in reducing CPB-induced inflammatory response and ischemic reperfusion injury, but the effect was not dependent on dose while fentanyl dose reaching some value, at the same time the duration of stay in ICU and time of endotracheal extubation is longer.

[Effects of ulinastatin on erythrocyte lipid peroxidation in patients undergoing open heart surgery].

OBJECTIVE: To investigate the effects of ulinastatin on erythrocyte lipid peroxidation in patients undergoing open heart surgery. METHODS: Twenty adult patients with rheumatic heart disease undergoing elective value replacement were divided randomly into 2 groups of 10 patients each: a control group (group C) and an ulinastatin group (group W). The patients were premedicated with intramuscular morphine 0.08 mg/kg and scopolamine 0.06 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 microg/kg and vecuronium 0.1 mg/kg. After the tracheal intubation, the patients were mechanically ventilated. Anesthesia was maintained with midazolam, fentanyl and isoflurane. Blood samples were taken from radial artery before the operation (T1), 30 min after the initiation of CPB (T2), at the end of the CPB (T3), 30 min after the aorta declamping (T4) and 24 h after the operation (T5) for the determination of plasma and erythrocyte MDA (P-MDA and E-MDA) and erythrocyte SOD (E-SOD). RESULTS: The levels of P-MDA and E-MDA increased significantly after the initiation of CPB and the level of E-SOD was higher than the baseline level at T2, and then decreased from T3 to T5 in group C (P <0.001). The levels of P-MDA and E-MDA didn't increased until T4 (P <0.001) and returned to the baseline level at T5 in group W. The levels of P-MDA and E-MDA were significantly higher in group C than those in group W and the level of E-SOD was markedly lower than that in group W (P <0.05). CONCLUSION: Ulinastatin can alleviate erythrocyte lipid peroxidation in patients undergoing open heart surgery.