[Prognostic factors of extracorporeal membrane oxygenation in the treatment of severe pediatric acute respiratory distress syndrome].

Objective: To explore the factors affecting the prognosis of severe pediatric acute respiratory distress syndrome (ARDS) after receiving extracorporeal membrane oxygenation (ECMO) support. Methods: It was a multicenter prospective observational study. A total of 95 children with severe ARDS who were treated with ECMO salvage therapy from January 2018 to December 2022 in 9 pediatric ECMO centers in China were enrolled in the study. The general data, disease severity, organ function, comprehensive treatment and prognosis were recorded, and they were divided into survival group and death group according to the outcome at discharge. T test, chi-square test, multivariate Logistic regression and mixed linear model were used to analyze the relationship among baseline before ECMO treatment, some important indicators (pediatric critical scores, platelet count, albumin, fibrinogen, etc) during ECMO treatment and prognosis. Results: Among the 95 children with severe ARDS who received ECMO, 55 (58%) were males and 40 (42%) were females, aged 36.9 (0.5, 72.0) months. Twelve children (13%) were immunodeficient. Sixty-eight (72%) children were treated with venous artery (VA) mode and 27 (28%) with venous vein (VV) mode. The discharge survival rates of overall, VA, and VV mode children were 51% (48/95), 47% (32/68), and 59% (16/27), respectively. The number of immunodeficient children in the death group was higher, and there were lower pediatric critical scores, platelet count, albumin, fibrinogen and arterial oxygen partial pressure/fraction of inspired oxygen (PaO2/FiO2), higher ventilator driving pressure (ΔP), oxygenaion index (OI), and longer ARDS duration before ECMO (all P<0.05). There were no statistically significant differences in other indicators, including age, gender, weight, and ECMO mode among different prognostic groups (all P>0.05). High ΔP, high OI, low P/F, and low albumin were high-risk factors affecting prognosis(all P<0.05). After further grouping, it was found that ΔP≥25 cmH2O (1 cmH2O=0.098 kPa), P/F≤67 mmHg (1 mmHg=0.133 kPa) and OI≥35 were the thresholds for predicting poor prognosis (P<0.05). From 24 h after ECMO, there were significant differences in ΔP, P/F and OI between the dead group and the survival group (all P<0.05), and the differences gradually increased with the ECMO process. The platelet level was significant from 7 days after ECMO (P<0.05) and gradually expanded. Blood lactate levels showed a significant difference between the 2 groups on before and after ECMO (P<0.05) and gradually increased from 24 h after ECMO. Conclusions: The risk factors affecting the prognosis of severe ARDS in ECMO include high ΔP, high OI, low P/F and low albumin purification therapy before ECMO. The gradual decrease of ΔP, OI and increase of P/F from 24 h of ECMO predicted a good prognosis, while the gradual increase of lactate after ECMO application showed a poor prognosis.

[Risk factors for mortality in pediatric acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support].

Objective: To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support. Methods: Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors. Results: In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) vs. 21.8% (12/55), χ²=8.318, P=0.004) and coagulation dysfunction (22.2% (12/54) vs. 7.3% (4/55), χ²=4.862, P=0.027), and higher rate of renal replacement therapy (48.1% (26/54) vs. 21.8% (12/55), χ²=9.694, P=0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support (HR=3.88,95%CI 1.04-14.52, HR=4.84,95%CI 1.21-19.46, both P<0.05). Conclusion: AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.

[Interfacility transport with extracorporeal membrane oxygenation in pediatric patients: a multicenter study in China].

Objective: To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China. Methods: The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children's Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People's Hospital and Children's Hospital of Zhejiang University School of Medicine. The data of patients' characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test. Results: All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO(2) or SaO(2) before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO(2) and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ(2)=0.615, P>0.05; 4/28 vs. 2/14, χ(2)=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ(2)=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ(2)=0.845, P>0.05; 6/42 vs. 7/50, χ(2)=0.001, P>0.05; 29/19 vs. 38/19, χ(2)=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ(2)=0.775, P>0.05; 32/48 vs. 35/57, χ(2)=0.313, P>0.05; 20/48 vs. 22/57, χ(2)=0.102, P>0.05). Conclusion: With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.

Microalgae biomass from swine wastewater and its conversion to bioenergy.

Ever-increasing swine wastewater (SW) has become a serious environmental concern. High levels of nutrients and toxic contaminants in SW significantly impact on the ecosystem and public health. On the other hand, swine wastewater is considered as valuable water and nutrient source for microalgae cultivation. The potential for converting the nutrients from SW into valuable biomass and then generating bioenergy from it has drawn increasing attention. For this reason, this review comprehensively discussed the biomass production, SW treatment efficiencies, and bioenergy generation potentials through cultivating microalgae in SW. Microalgae species grow well in SW with large amounts of biomass being produced, despite the impact of various parameters (e.g., nutrients and toxicants levels, cultivation conditions, and bacteria in SW). Pollutants in SW can effectively be removed by harvesting microalgae from SW, and the harvested microalgae biomass elicits high potential for conversion to valuable bioenergy.

Problematic effects of antibiotics on anaerobic treatment of swine wastewater.

Swine wastewaters with high levels of organic pollutants and antibiotics have become serious environmental concerns. Anaerobic technology is a feasible option for swine wastewater treatment due to its advantage in low costs and bioenergy production. However, antibiotics in swine wastewater have problematic effects on micro-organisms, and the stability and performance of anaerobic processes. Thus, this paper critically reviews impacts of antibiotics on pH, COD removal efficiencies, biogas and methane productions as well as the accumulation of volatile fatty acids (VFAs) in the anaerobic processes. Meanwhile, impacts on the structure of bacteria and methanogens in anaerobic processes are also discussed comprehensively. Furthermore, to better understand the effect of antibiotics on anaerobic processes, detailed information about antimicrobial mechanisms of antibiotics and microbial functions in anaerobic processes is also summarized. Future research on deeper knowledge of the effect of antibiotics on anaerobic processes are suggested to reduce their adverse environmental impacts.

Bioprocessing for elimination antibiotics and hormones from swine wastewater.

Antibiotics and hormones in swine wastewater have become a critical concern worldwide due to the severe threats to human health and the eco-environment. Removal of most detectable antibiotics and hormones, such as sulfonamides (SAs), SMs, tetracyclines (TCs), macrolides, and estrogenic hormones from swine wastewater utilizing various biological processes were summarized and compared. In biological processes, biosorption and biodegradation are the two major removal mechanisms for antibiotics and hormones. The residuals in treated effluents and sludge of conventional activated sludge and anaerobic digestion processes can still pose risks to the surrounding environment, and the anaerobic processes' removal efficiencies were inferior to those of aerobic processes. In contrast, membrane bioreactors (MBRs), constructed wetlands (CWs) and modified processes performed better because of their higher biodegradation of toxicants. Process modification on activated sludge, anaerobic digestion and conventional MBRs could also enhance the performance (e.g. removing up to 98% SMs, 88.9% TCs, and 99.6% hormones from wastewater). The hybrid process combining MBRs with biological or physical technology also led to better removal efficiency. As such, modified conventional biological processes, advanced biological technologies and MBR hybrid systems are considered as a promising technology for removing toxicants from swine wastewater.

Clinicopathological and multisection CT features of primary pulmonary mucoepidermoid carcinoma.

AIM: To delineate the multisection computed tomography (MSCT) features and the clinical characteristics of primary pulmonary mucoepidermoid carcinoma (PMEC). Prognostic factors were also analysed. MATERIALS AND METHODS: A retrospective study was undertaken to investigate the medical records and MSCT performance of histopathologically confirmed PMECs from 2007 to 2015. RESULTS: A total of 83.3% of patients with high-grade PMECs were aged >40 years, whereas there were 1.5-times more women than men with low-grade PMECs. Cough (n=29) and haemoptysis (n=12) were the most common symptoms. Upon MSCT, 30 cases showed a round or lobulate mass, and few demonstrated bronchial-wall thickening or cavities. Distal obstruction (n=14) and "air crescent sign" (n=5) could be detected. Tumours showed mild (n=19), moderate (n=5), and marked enhancement (n=5). Moreover, 18 cases showed foci of low density in lesions. Mean survival for patients with low-grade PMECs was 59.2 months, whereas that for high-grade PMECs was 20.4 months; 3-year survival rates were 55% and 14%, respectively. Tumour staging was a significant independent predictor of survival according to the Cox proportional hazards model. CONCLUSION: High-grade PMECs occurred more frequently in patients aged >40 years and were more predominant in men. Young females were predisposed to having low-grade PMECs. MSCT revealed an oval or lobulate mass with mild enhancement, as manifested by calcification and visible mucus lakes, which may be suggestive of PMECs. Furthermore, a central nodule or mass may suggest low-grade PMECs; high-grade PMECs tend to be peripheral and associated with lymph-node metastasis. Pathological grade, lymph node metastasis, and TNM stage correlate with the survival of patients with PMEC.

Glucose consumption and alpha-glucosidase inhibitory activities of aqueous root extract of Helicteres angustifolia.

OBJECTIVE: The root of Helicteres angustifolia L. (Sterculiaceae) has been used as tea to treat diabetics effectively by local people in Laos. However, no scientific evidence is available for this ethnomedicinal usage. This study was undertaken to explore the hypoglycemic effect of aqueous extract from Helicteres angustifolia root. PATIENTS AND METHODS: The effect of aqueous extract from Helicteres angustifolia root on glucose consumption in C2C12 myotubes was investigated at a dose of 25, 50 and 100 µg/mL, respectively. The alpha-glucosidase inhibitory activity of the extract was evaluated using rat intestinal maltase and sucrose. Moreover, oral sucrose tolerance test (OSTT) in normal and streptozotocin induced diabetic rats was performed. Finally, their cytotoxicity in C2C12 cells and acute oral toxicity in rats was analyzed. RESULTS: Aqueous root extract of Helicteres angustifolia significantly enhanced glucose consumption in C2C12 myotubes. The extract also significantly inhibited rat intestinal maltase (IC50 = 1.44 ± 0.24 mg/mL) and sucrase activity (IC50 = 0.54 ± 0.12 mg/mL), respectively. The OSTT results showed that the extract significantly suppressed the increase of blood glucose levels in normal and diabetic rats. The extract was also proven to have low acute toxicity (LD50 > 5 g/kg) and low cytotoxicity in C2C12 cells (IC50 > 0.4 mg/mL). CONCLUSIONS: The findings from this study indicate that aqueous root extract of Helicteres angustifolia possesses significant alpha-glucosidase inhibitory activity and moderate enhanced glucose consumption activity, while with low cytotoxic and acute toxicity.

Two new alkaloidal glycosides from the root bark of Ailanthus altissima.

Two new alkaloidal glycosides, canthin-6-one-5-o-beta-D-xylopyranosyl- (1 --> 6)-beta-D-glucopyranoside (1) and canthin-6-one-1-o-beta-D-xylopyranosyl- (1 --> 6)-beta-D-glucopyranoside (2) named ailantcanthinosides A and B, were isolated from the root bark of Ailanthus altissima. Their structures were elucidated by one-and two-dimensional (1)H NMR, (13)C NMR, FAB-MS, HRESI-MS spectra and chemical methods.

In vitro digestion of sinigrin and glucotropaeolin by single strains of Bifidobacterium and identification of the digestive products.

Three strains of Bifidobacterium sp., B. pseudocatenulatum, B. adolescentis, and B. longum were studied for their ability to digest glucosinolates, sinigrin (SNG) and glucotropaeolin (GTL), in vitro. All strains digested both glucosinolates during 24-48 h cultivation, accompanied by a decline in the medium pH from 7.1 to 5.2. The digestion of glucosinolates by a cell-free extract prepared from sonicated cells of B. adolescentis, but not cultivated broth, increased in the presence of 0.5 mM l-ascorbic acid. Also, a time-dependent formation of allyl isothiocyanate (AITC) was observed when the cell-free extract was incubated with 0.25 mM SNG for 120 min at pH 7.0. These reaction features suggest that the digestive activity may have been due to an enzyme similar to myrosinase, an enzyme of plant origin. GC-MS analysis of the Bifidobacterial cultured broth showed that the major products were 3-butenenitrile (BCN) and phenylacetonitrile (PhACN), from SNG and GTL, respectively and nitriles, probably due to a decrease in the pH of the media. AITC and benzyl isothiocyanate (BzITC) were barely detectable in the broth. It was concluded that the three species of Bifidobacteria could be involved in digestive degradation of glucosinolates in the human intestinal tract.

Self-organized nanoscale pattern formation on vicinal Si(111) surfaces via a two-stage faceting transition.

We demonstrate a self-organized pattern formation on vicinal Si(111) surfaces that are miscut toward the [2;11] direction. All the patterns, consisting of a periodic array of alternating (7 x 7) reconstructed terraces and step-bunched facets, have the same periodicity and facet structure, independent of the miscut angle, while the width of the facets increases linearly with miscut angle. We attribute such unique pattern formation to a surface faceting transition that involves two transition stages: the first stage forms a stress-domain structure defining the universal periodicity; the second stage forms the low-energy facets controlling the facet width.

Iridoids from Phlomis umbrosa.

Two epimeric pairs of iridoid aglycones, named shanzhigenin methyl ester and 1-epishanzhigenin methyl ester, and 8-acetylshanzhigenin methyl ester and 8-acetyl-1-epishanzhigenin methyl ester, were isolated from Phlomis umbrosa roots, along with five known iridoid glucosides. The four iridoid aglycones are reported for the first time from a natural source. Their structures were established by spectroscopic methods, mainly 1D- and 2D-NMR spectroscopic experiments, and chemical methods.

[Study on application of CODIS loci to excluding paternity].

OBJECTIVE: The study was carried out on application of CODIS loci (FGA, vWA, CSF1PO, TH01, TPOX, D3S1358, D5S818, D7S820, D8S1179, D13S317, D16S539, D18S51 and D21S11) in 100 cases of excluding paternity. METHODS: The PCR amplified products of Profiler Plus and Cofiler amplification kit were injected into a capillary on the ABI PRISM 310 Genetic Analyzer. GeneScan software analyzed the collected data, which can then be imported into Genotyper software for genotyping of alleles. RESULTS: In the group of Mother-Child-Alleged Father, more than 3 STR loci incompatibilities between alleged father and child were found in all observed cases, the mean incompatibility was 6.63; In the group of Alleged Father-Child, 94.0% of all cases observed was found more than 3 STR loci incompatibilities, the mean incompatibility was 5.01. CONCLUSION: The results showed that CODIS loci had good application to excluding paternity, and the choice of hyperpolymorphic markers in investigation, which were valued by DP, H and PE, had direct relation with the augmentation of incompatibilities in excluding paternity.

Iridoid glucosides from Caryopteris mongholica.

Two new iridoid glucosides, 8-acetyl-6'-O-(p-coumaroyl) harpagide and 6'-O-(p-coumaroyl) antirrinoside, were isolated from the Caryopteris mongholica, together with two known iridoid glucosides, 8-acetylharpagide and harpagide. Their structures were elucidated, mainly by interpretation of their spectroscopic data (UV, IR, MASS, 1H, 13C, 1H/1H-COSY, HMQC, HMBC and NOESY NMR) and chemical methods.

[The phenomenon of gene linkage and recombination in the paternity test].

The phenomenon of gene linkage and recombination may nearly be overlooked in paternity test of one single child, but it is likely encountered in paternity test of twin or more. In a case of paternity test, the results of 17 items including eight DNA loci were analyzed and the phenomenon of gene linkage and recombination was discussed in detail. This phenomenon should be brought into necessary attention in the paternity test.

Role of benzathine penicillin G in prophylaxis for recurrent streptococcal cellulitis of the lower legs.

Cellulitis of the lower leg is an infection caused by streptococci or, less commonly, Staphylococcus aureus and other gram-negative rods. Recurrence of cellulitis is a common problem. In the present study, we evaluated the use of monthly intramuscular injections of benzathine penicillin G to prevent recurrences of cellulitis. A total of 115 patients with definite or presumptive cases of streptococcal cellulitis were enrolled in this study. Eighty-four of these patients who declined follow-up or received incomplete prophylaxis were considered controls. Recurrence occurred in four (12.9%) of 31 cases who received prophylaxis and 16 (19%) of the 84 cases who did not receive prophylaxis. The difference was not statistically significant. Predisposing factors for cellulitis were found in 57 (49.6%) of the 115 enrolled cases and were mostly related to the impairment of local circulation. Administration of prophylaxis successfully reduced the recurrence rate to zero among patients without predisposing factors but failed to prevent recurrence in those with predisposing factors (20%). We conclude that monthly benzathine penicillin G prophylaxis benefits only patients without predisposing factors for cellulitis.

Skin and soft-tissue manifestations of Shewanella putrefaciens infection.

Shewanella putrefaciens, a saprophytic gram-negative rod, is infrequently recovered from clinical specimens. Although a number of clinical syndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putrefaciens infection that occurred at the Veterans General Hospital-Kaohsiung in Taiwan between 1990 and 1995. S. putrefaciens infection was associated with a wide clinical spectrum including bacteremia/septicemia, skin and soft-tissue infection, biliary tract infection, peritonitis, and empyema. Five of our patients had skin and soft-tissue manifestations, including fulminant periorbitofacial cellulitis, dacryocystitis, perineal abscess, finger abscess, and postcholecystectomy wound infection. These clinical features deviated from the chronic ulcers or infected burns of the lower extremities that have been described in previous reports. Seven (44%) of our 16 patients had bacteremia/septicemia, and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; Escherichia coli was the most common coisolate. Hepatobiliary diseases and malignancy were the major predisposing factors for S. putrefaciens infection of the biliary tract and S. putrefaciens bacteremia/septicemia.

Antibacterial activity of cefpodoxime in vitro.

Cefpodoxime proxetil is a new orally administered prodrug which is absorbed and de-esterified by the intestinal mucosa to release the third-generation cephalosporin, cefpodoxime, and which is undergoing in vitro and in vivo evaluations. Using the standard agar dilution method, we compared the in vitro activity of this drug with other oral cephalosporins and quinolones against 637 recent clinical isolates from Kaohsiung Veterans General Hospital in Taiwan. Against Escherichia coli and Klebsiella pneumoniae, cefpodoxime showed excellent activity, inhibiting over 90% of these isolates at 1 mg/l. Like other oral drugs of its class, it had little activity against Pseudomonas aeruginosa and Acinetobacter spp. Against Haemophilus influenzae, irrespective of beta-lactamase production, its activity was similar to comparative drugs. Against methicillin-susceptible Staphylococcus aureus, cefpodoxime showed moderate activity, inhibiting 90% of these isolates at 4 mg/l, whereas it was inactive against methicillin-resistant S. aureus. However, all cephalosporins have shown little in vivo activity against methicillin-resistant S. aureus regardless of in vitro results. Cefpodoxime was inactive against Enterococcus spp. Against other streptococci, its activity was similar to other oral cephalosporins and quinolones tested. The results of this in vitro study indicated that oral administration of cefpodoxime should be an ideal agent in the empirical outpatient treatment for community-acquired cutaneous, respiratory and urinary tract infections.

Comparison of the Roche AMPLICOR MYCOBACTERIUM assay and Digene SHARP Signal System with in-house PCR and culture for detection of Mycobacterium tuberculosis in respiratory specimens.

Two commercial primer kits and detection systems, the Roche AMPLICOR MYCOBACTERIUM test and the Digene primer-probe kit with the SHARP Signal System, were compared to in-house PCR as well as standard culture techniques. For the 27 culture-positive specimens, the Roche AMPLICOR MYCOBACTERIUM test detected 20 specimens, the Digene system detected 19, and in-house PCR detected 21. Of the 86 culture-negative specimens, 13 were positive by the Roche AMPLICOR MYCOBACTERIUM test, 16 were positive by the Digene system, and 21 were positive by in-house PCR. When clinical situations were evaluated, 11 of 13 culture-negative Roche AMPLICOR MYCOBACTERIUM test-positive specimens, 10 of 16 culture-negative Digene system-positive specimens, and 13 of 21 culture-negative-in-house PCR-positive specimens were diagnosed as true-positive specimens. The sensitivities of Roche AMPLICOR MYCOBACTERIUM test, the Digene system, and in-house PCR were 73.81, 69.05, and 80.95%, and the specificities were 97.18, 91.55 and 88.73%, respectively. The positive predictive values were 93.94, 82.86, and 80.95%, and the negative predictive values were 86.25, 83.33, and 88.73%, respectively. For the commercial kits, the Roche AMPLICOR MYCOBACTERIUM test seems to be more sensitive and specific than the Digene system. However, the Roche AMPLICOR MYCOBACTERIUM test cannot be used on nonrespiratory specimens.

Group a streptococcal meningitis.

Meningitis due to group A Streptococcus is uncommon. Only a few cases have been reported in the literature. In this paper, we report a case of a 19-year-old man who presented with fever, headache, nausea, vomiting and a decrease in level of consciousness. Five days prior to admission, he had an episode of acute pharyngitis. Group A Streptococcus was isolated from both the cerebrospinal fluid and blood. He recovered without sequelae after therapy with penicillin G for 2 weeks. Physicians should be aware that group A streptococcal infection may cause meningitis.