Two cases of Kawasaki disease: Clinical characteristics and onset of fever and gastrointestinal symptoms.

BACKGROUND: Kawasaki disease (KD) is a prevalent form of systemic vasculitis that can damage various organs and systems in children. Typical KD is not difficult to diagnose in clinical practice. In recent years, it has been shown that an increasing number of children do not satisfy the diagnostic criteria for typical KD. This condition is known as incomplete KD (IKD). It is challenging to promptly diagnose and treat such children in clinical practice. CASE DESCRIPTION: A 10-year-old girl was admitted to the hospital due to fever and abdominal pain. She presented with shock symptoms. An enhanced abdominal computed tomography scan revealed intestinal pneumatosis, effusion, and gallbladder enlargement, indicating intestinal obstruction. Due to the poor outcome following an emergency laparoscopic cholecystectomy, IKD was suspected. A 3-month-old male pediatric patient was admitted to the hospital due to a fever. Patchy, congestive rashes formed on the patient's body as KD progressed. IKD was suspected based on the clinical signs of fever, rash, and hyperemia of the lips. The two patients were then treated with human immunoglobulin and aspirin treatment. The prognosis for the two children was favorable following prompt treatment. CONCLUSION: Due to the fact that IKD is frequently misdiagnosed, it is vital to (1) improve the patient prognosis for the early identification of children with KD with prolonged fever and anti-infection failure as the initial manifestation and (2) perform timely diagnosis and comprehensive treatment.

Genetic Characterization of Enterobacter hormaechei Co-Harboring bla NDM-1 and mcr-9 Causing Upper Respiratory Tract Infection.

Purpose: With the spread of multiple drug-resistant bacteria, bla NDM-1 and mcr-9 have been detected in various bacteria worldwide. However, the simultaneous detection of bla NDM-1 and mcr-9 in Enterobacter hormaechei has been rarely reported. This study identified an E. hormaechei strain carrying both bla NDM-1 and mcr-9. We investigated the genetic characteristics of these two resistance genes in detail, elucidating various potential mechanisms by which they may be transmitted. Methods: Bacterial genomic features and possible origins were assessed by whole-genome sequencing (WGS) with Illumina and PacBio platforms and phylogenetic analysis. Subsequent investigations were performed, including antimicrobial susceptibility testing and multilocus sequence typing (MLST). Results: We isolated an E. hormaechei strain DY1901 carrying both bla NDM-1 and mcr-9 from the sputum sample. Susceptibility testing showed that the isolate was multidrug-resistant. Multiple antibiotic resistance genes and virulence genes are widely distributed in DY1901. S1-PFGE, Southern blotting, and plasmid replicon typing showed that DY1901 carried four plasmids. The plasmid carrying mcr-9 was 259Kb in size and belonged to IncHI2, while the plasmid carrying bla NDM-1 was 45Kb in length and belonged to IncX3. Conclusion: The E. hormaechei strain isolated in this study has a broad antibiotic resistance spectrum, posing a challenge to clinical treatment. Plasmids carrying mcr-9 are fusion plasmids, and those taking NDM are widely disseminated in China, suggesting that we should conduct routine genomic surveillance on such plasmids to curb the spread of drug-resistant bacteria in the region.

The role of miR-199b-3p in regulating Nrf2 pathway by dihydromyricetin to alleviate septic acute kidney injury.

The pathophysiology of septic acute kidney injury (AKI) is very complex and the fatality is high. Nrf2 is crucial for septic AKI, and dihydromyricetin (DMY) has a protective effect on LPS-induced AKI. We aimed to explore whether DMY could affect Nrf2 pathway by regulating miR-199b-3p and played a protective role in septic AKI. The mouse model was induced by cecal ligation and puncture (CLP) and the cell model was stimulated by LPS. Enzyme-linked immunosorbent assay was conducted to examine MDA, SOD, LDH, GSH, TNF-α, kidney injury molecule 1 (KIM-1), and IL-6 levels. The pathological changes were observed by hematoxylin-eosin staining. The targeted relationship between miR-199b-3p and Nrf2 was verified by a dual-luciferase reporter assay. Levels of SOD, GSH, NQO-1, Nrf2, and HO-1 were decreased, MDA, LDH, TNF-α, IL-6, and KIM-1, and miR-199b-3p were increased in the CLP group and LPS-induced HK-2 cells, while the effect was reversed after DMY treatment. There existed renal tubule cell edema and necrosis, inflammatory cell infiltration in the CLP group, the situation was partially improved by DMY. MiR-199b-3p bound to Nrf2. Nrf2 levels were increased, TNF-α, IL-6, and KIM-1 were decreased after transfected with miR-199b-3p inhibitor, these effects were reversed when co-transfected with si-Nrf2. TNF-α, IL-6, KIM-1, and miR-199b-3p levels were increased; Nrf2, NQO-1, and HO-1 levels were decreased in the LPS + DMY + mimics-miR group. MiR-199b-3p was increased in septic AKI models, DMY might alleviate septic AKI by regulating miR-199b-3p to affect the Nrf2 pathway.

The recent progress of synergistic supramolecular polymers: preparation, properties and applications.

Supramolecular polymers have the combined properties of both traditional polymers and supramolecules. They are generally formed via the self-assembled polymerization driven noncovalent interactions such as hydrogen bonding, π-π stacking, metal coordination, and host-guest interaction between building blocks. The driving force for the formation of supramolecular polymers has changed from single noncovalent interactions to multiple noncovalent interactions. The advantages of multiple noncovalent interactions driving the formation of supramolecular polymers are reviewed from four aspects: polymer construction, the enhancement of bonding strength, properties and topological structure. The applications are illustrated with detailed examples including self-healing, drug delivery, bioimaging, biomedicine, environmental sensing and electronics.

One minute of circulatory arrest for acute type A aortic dissection --------- a simple operation for acute type A aortic dissection (AAAD).

BACKGROUND: Sun's procedure is currently recognized as the standard procedure for acute type A aortic dissection (AAAD). But the operation istoo difficult for beginners. We hope to reduce the difficulty and complications of this operation. METHODS: The aortic arch was immediately cross-clamped after the stented graft was inserted into the distal aorta. Thereafter, the lower-body perfusion was restored. Then, anastomosis was performed between the proximal stent graft and the distal 4-branched Dacron graft. The other arteries were anastomosed to the arched branch of the 4-branched graft. RESULTS: The cardiopulmonary bypass (CPB) time was (207 ± 52) min, and the aortic cross-clamp time was (114 ± 39) min. The circulatory arrest time was (38 ± 16) sec. One patient (4%) died. The incidence of complications was stroke (4%), renal dysfunction requiring dialysis (4%), prolonged intubation(12%). CONCLUSIONS: The time of circulatory arrest in this operation is less than 1 min, which can avoid the complications caused by DHCA and decrease risk of bleeding and complexity by shifting anastomosis more proximally. The effect of our operation is similar to and even better than that of Sun's procedure. It does not even require relatively advanced skill, much experience and excellent psychological quality, especially suitable for beginners.

Synthesis of dynamic imine macrocyclic supramolecular polymers via synchronized self-assembly based on dynamic covalent bonds and noncovalent interactions.

The preparation of dynamic imine macrocycles and supramolecular polymers is combined into a single step to form supramolecular polymers (SPs). 1,4-Diazabicyclo[2.2.2]octane (DABCO) derived quaternary ammonium salts induce aldehyde and amine building blocks to covalently form imine macrocycles. Multiple noncovalent interactions between hosts (i.e., imine macrocycle) and guests (i.e., DABCO) act as driving forces. Thus, for the first time, dynamic imine macrocyclic supramolecular polymers (DIMPs) have been achieved through the synchronized self-assembly of dynamic covalent bond formed imine macrocycles and noncovalent interactions of hosts-guests.

Short-term outcomes of modified Y-graft technique in acute type a aortic dissection using the femoral artery bypass and one minute systemic circulatory arrest technique.

OBJECTIVE: Aortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation. Herein, we described our modified Y-graft technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) technique, and assessed the short-term outcomes of the patients. METHODS: Between February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients underwent FAB while 28 patients underwent both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies. RESULTS: In the FAB group, two patients died due to pulmonary infection (30-day survival rate, 91.3%), and two patients were paralyzed from the waist down. Hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received respiratory support for more than 2-days and eight patients (34.8%) for more than 5-days. These follow-up results were comparable or better than the patients with traditional Y-graft technique. Furthermore, compared to the FAB group, the morbidity due to neurological dysfunction and acute renal failure was significantly reduced in the FAB+OSCA group. Moreover, the respiratory support, length of postoperative stay and ICU stay were shortened. CONCLUSIONS: This study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients showed less surgical complications and favorable short-term outcomes after this surgery.

Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients.

BACKGROUND: Antibiotic-associated diarrhea (AAD) is a risk factor for exacerbating the outcome of critically ill patients. Dysbiosis induced by the exposure to antibiotics reveals the potential therapeutic role of fecal microbiota transplantation (FMT) in these patients. Herein, we aimed to evaluate the safety and potential benefit of rescue FMT for AAD in critically ill patients. METHODS: A series of critically ill patients with AAD received rescue FMT from Chinese fmtBank, from September 2015 to February 2019. Adverse events (AEs) and rescue FMT success which focused on the improvement of abdominal symptoms and post-ICU survival rate during a minimum of 12 weeks follow-up were assessed. RESULTS: Twenty critically ill patients with AAD underwent rescue FMT, and 18 of them were included for analysis. The mean of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at intensive care unit (ICU) admission was 21.7 ± 8.3 (range 11-37). Thirteen patients received FMT through nasojejunal tube, four through gastroscopy, and one through enema. Patients were treated with four (4.2 ± 2.1, range 2-9) types of antibiotics before and during the onset of AAD. 38.9% (7/18) of patients had FMT-related AEs during follow-up, including increased diarrhea frequency, abdominal pain, increased serum amylase, and fever. Eight deaths unrelated to FMT occurred during follow-up. One hundred percent (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia were improved after FMT. 44.4% (8/18) of patients recovered from abdominal symptoms without recurrence and survived for a minimum of 12 weeks after being discharged from ICU. CONCLUSION: In this case series studying the use of FMT in critically ill patients with AAD, good clinical outcomes without infectious complications were observed. These findings could potentially encourage researchers to set up new clinical trials that will provide more insight into the potential benefit and safety of the procedure in the ICU. TRIAL REGISTRATION: ClinicalTrials.gov, Number NCT03895593 . Registered 29 March 2019 (retrospectively registered).

Two new compounds from the roots of Scrophularia ningpoensis and their anti-inflammatory activities.

Aiming to investigate the bioactive constituents with anti-inflammatory activity from the roots of Scrophularia ningpoensis, two new compounds (1 and 3) were isolated from the extract of the roots of the plant. Their structures were elucidated on the basis of spectral analyses (UV, IR, NMR, and MS spectroscopy), as well as experimental and calculated electronic circular dichroism (ECD) analyses. All of the isolates were tested for their anti-inflammatory properties in terms of suppressing the production of NO in lipopolysaccharide-induced BV2 cells. Compound 2 exhibited stronger anti-inflammatory effects (77.65%) than the positive control curcumin (69.75%) at 10 µM.

The involvement of myocyte enhancer factor 2D in regulating tumor biology of cardiac myxoma.

The pro-survival transcription factor myocyte enhancer factor 2D (MEF2D) is identified to exhibit pro-tumor effects based on clinical and experimental studies. However, the detailed mechanisms underlying IGF-1-MEF2D pathway-induced tumor biology in cardiac myxoma (CM) was not clear. Here, we investigated the role of MEF2D in CM tissues and cells using RT-PCR, western blot, gene silencing, et al. Our findings revealed MEF2D was significantly increased in CM tissues compared with adjacent normal tissues and closely related to tumor size. In vitro assay demonstrated that IGF-1 enhanced CM cell proliferation in a time-dependent fashion. However, knockdown of MEF2D reversed the IGF-1-induced proliferative effects on CM cells in a time-dependent fashion and further resulted in cell cycle arrest. Based on the molecular level, IGF-1 enhanced the expression of epidermal growth factor receptor (EGFR) and matrix metalloprotein 9 (MMP9) in CM cells, whereas knockdown of MEF2D was able to reduce the expression of EGFR and MMP9 compared with vector control. Furthermore, we found knockdown of MEF2D directly affected G1/S transition in cultured CM cells. In conclusion, MEF2D regulates IGF-1-induced proliferation and apoptosis in CM development, indicating IGF-1-MEF2D pathway may be a useful target for treatment.

[INT-ETS activity change of activated sludge during nitrification, denirification and organism removal in SBR process].

Through nitrogen shock loading and organic shock loading experiments, we studied the changing rule and activity status of biological activity of activated sludge in organic matter biodegradation, nitrification and denitrification course in SBR process by the determination of INT-ETS activity. The experimental results show that INT-ETS activity could provide a good indication of the ongoing biological reactions of SBR process. Biological activity of organic matter biodegradation, nitrification and denitrification course in SBR process reduced orderly. INT-ETS activity reduced from 232.59 mg/(gxh) to 190.65 mg/(gxh) and resultly to 113.88 mg/(gxh) when the effluent concentration of COD and NH4(+)-N were 300 mg/L and 40 mg/L. Nitrogen shock loading (14.5 mg/L and 42.0 mg/L) and organic shock loading (COD are 293 mg/L and 685 mg/L) experiments cure verify that the operational conditions could not influence the changing rule of INT-ETS activity, but the time of the appearance of break points marking different reaction course in profile was influenced.