Sivelestat Inhibits Vascular Endothelial Injury Induced by Inflammatory Response and Improves the Prognosis of Hemorrhagic Fever with Renal Syndrome in Children: An Ambispective Cohort Study.

Background: In Asia, Hanta virus (HTNV) results in severe hemorrhagic fever with renal syndrome (HFRS). The efficacy of sivelestat in treating children with HTNV-induced HFRS remains unclear. Methods: An ambispective cohort study was performed on children diagnosed with HFRS and hospitalized at the Children's Hospital Affiliated to Xi'an Jiaotong University from August 2018 to 2023. Patients who received neutrophil elastin-inhibitor infusion between August 2019 and August 2023 were assigned to the sivelestat group, while patients who did not were assigned to the control group. The independent sample t test was used for inter-group analysis. The Chi-square test and Fisher's exact probability test were used for categorical variables. Spearman correlation test was used to evaluate the correlation between two sets of continuous variables. Kaplan-Meier survival curve and Log -Rank test was used to evaluate the difference in cumulative probability of survival between the two groups. Results: No significant differences were observed between the two groups in gender, age, contact history, body mass index, HFRS severity, clinical indexes at admission. Compared to the control group, the sivelestat group exhibited a significant decrease in the interleukin-8 level at 48 h (28.5±3 vs 34.5±3.5) and 72 h (21.3±4.5 vs 31.5±5.6) (P<0.05), as well as the ICAM-1 level at 48 h (553±122 vs 784±187) and 72 h (452±130 vs 623±85) (P<0.05). The concentration of VCAM-1 in the sivelestat group exhibited a consistent downward trend. Moreover, the level of VCAM-1 was significantly lower than that in the control group at 24 h (1760±289 vs 2180±445), 48 h (1450±441 vs 1890±267), and 72 h (1149±338 vs 1500±396) (P<0.05). Kaplan-Meier curve analysis revealed a statistically significant difference in the cumulative probability of survival between two groups (P = 0.041). In the secondary outcomes, the sivelestat group demonstrated a decrease in the utilization rate of mechanical ventilation and continuous renal replacement therapy (CRRT). Conclusion: Sivelestat may suppress neutrophil-mediated inflammatory response to reduce endothelial and organ damage, and improve clinical outcomes in children with severe hemorrhagic fever and renal syndrome.

Blasting profile evaluation of sand-mud interbedded surrounding rock during the large-span tunnel construction.

The sand-mud interbedded surrounding rock contains discontinuities, such as horizontal bedding, joints, weak planes and weak interlayers. Drilling and blasting construction in this kind of surrounding rock is very likely to cause very serious over-/under-excavation phenomenon and excessive damage to surrounding rock, and the contour flatness after smooth blasting of the tunnel is also difficult to be guaranteed, which increases subsequent construction procedures and reduces production efficiency. In order to effectively evaluate the smooth blasting effect of the sand-mud interbedded surrounding rock tunnel, taking a tunnel project in southwest China as the research background, the blasting numerical simulation of the sand-mud interbedded surrounding rock tunnel was carried out using the dynamic analysis program, and the corresponding blasting optimization scheme was obtained. Subsequently, based on fuzzy mathematical theory, the evaluation system of blasting effect of sand-mud interbedded tunnel was established by combining the evaluation criteria of tunnel smooth blasting quality. Immediately afterwards, the weights of each influencing factor index were determined, and the blasting shaping effect of the original blasting scheme and the optimized blasting scheme was evaluated. Finally, the results have shown that the optimized tunnel blasting profile effect was better than the original blasting scheme. The corresponding research results have certain guiding significance for similar tunnel blasting effect evaluation and blasting parameter design.

Exploring mechanisms affecting environmental risk coping behaviors: evidence from China.

Environmental risk issues pose a threat to human life and well-being. In order to reduce environmental risks, environmental risk response strategies have become increasingly vital. As the group most affected by environmental risks, the public environmental risk coping behaviors affect the effectiveness of environmental risk management. However, the public adoption of such behaviors mainly depends on their willingness. Therefore, the key to effective governance lies in guiding the public to voluntarily adopt appropriate environmental risk coping behaviors. The theory of environmental psychology provides relevant references for this. The internal psychological motivations of the public (including attitudes and subjective norms etc.) affect their choices of environmental risk behavior. The main purpose of this research is to explore the determinants underlying environmental risk coping behaviors using extending the theory of planned behavior by additional constructs (trust, risk perception, interaction satisfaction). The research applies a questionnaire survey method to collect data from the public living in the vicinity of two locations in China-an industrial area and a waste incineration plant in a Chinese city. The result of SEM shows that the public's trust in governments has a positive influence on the intention to collaborate, while the public's trust in the government and enterprises is negatively correlated with their intention to engage in confrontational behavior. Also, there is a positive correlation between confrontational intention and confrontational behavior, while the intention to cooperate may not necessarily result in collaborative behavior. Risk perception is not related to trust and the intention to collaborate, but it positively affects the intention to confront. The reason for the public to willingly take collaborative actions is not because they have perceived a high level of risk, and the public's high trust in the government can enhance their intention to take collaborative actions. It is thus clear that government credibility plays an important guiding role in public risk responsive behavior. The research findings provide policy recommendations for guiding public environmental risk coping behavior.

Pathogens in PICU before and during the SARS-CoV-2 pandemic in China: a multicenter retrospective study.

BACKGROUND: Nonpharmacological interventions for COVID-19 could reduce the incidence of children hospitalized in pediatric intensive care units (PICU) and the incidence of children with bacterial infections. This study aimed to evaluate changes in the bacterial profile of children in PICU before and during the COVID-19 pandemics. METHODS: This is a retrospective study, involving clinical data of children with positive bacterial cultures admitted to the PICU respectively in 2019 and 2021. RESULTS: In total 652 children were included in this study. The total number of hospitalized patients and the incidence of bacteria-positive children in 2021 were lower than those in 2019. There were no significant differences in the ratio of Gram-positive bacterial infection, Gram-negative bacteria infection or fungi infection between the two years. The rate of Streptococcus pneumoniae in 2021 was higher than that in 2019(p = 0.127). The incidence of Haemophilus influenzae in hospitalized patients decreased with a downward trend(p = 0.002). The distribution of previous underlying diseases in children admitted to PICU with different outcomes of bacterial infection between the two years were homogeneous (p > 0.05). CONCLUSION: After the implementation of COVID-19 isolation, prevention and control measures, the number of hospitalizations and bacterial infections in PICU decreased, which may be due to changes in population's behavior patterns. Meanwhile, the incidence of Haemophilus influenzae in hospitalized patients decreased with a downward trend.

Correlation analysis of CD8+ cell overexpression and prognosis of hemorrhagic fever with renal syndrome-a case-control study.

Background: Hemorrhagic fever with Renal Syndrome (HFRS) is an infectious disease caused by Hantavirus with fever, hemorrhage and acute kidney injury (AKI) as clinical characteristics. The research on the etiology and pathogenesis of diseases has become a focus of attention. However, there are few related medical studies in children with HFRS. The prognosis of the children with HFRS remains to be explored. Objectives: We explored risk factors in children with HFRS and summarize sensitive indicators that are conducive to the prognosis of the disease. Methods: We designed a case-control study and recruited 182 HFRS pediatric patients (2014.01-2022.08). They were divided into two groups according to the severity of disease, including the control group(158 cases with mild and moderate subgroup)and the observation group (24 cases with severe and critical subgroup). Risk factors influencing prognosis were analyzed by binary logistic regression. The cutoff value, sensitivity and specificity of the risk factors prediction were calculated by receiver operating characteristic (ROC) and Yoden index. Results: Lymphocyte subsets characteristics analysis showed that in observation group the indexes were decreased in lymphocyte, T lymphocytes (CD3)+, helper/inducible T lymphocytes (CD4+)/inhibition/cytotoxic T cells (CD8+), B lymphocytes (CD19+); and the elevated index was CD8+, the difference were all significant between two groups. (P < 0.05). With death as the primary outcome, it was found that the serum CD8+ (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.65, 4.00; P < 0.01) was risk factor and significantly associated with mortality. The cutoff value of the serum CD8+ was 845 × 106/L, the sensitivity and specificity were 78.5%, 85.4%. With complications as the secondary outcomes, the serum CD8+ (OR 2.69, 95% CI 1.15, 4.88; P < 0.01) was found to be risk factors. The cutoff of the serum CD8+ was 690 × 106/L, the sensitivity and specificity were 69.3%, 75.1% respectively. Conclusion: CD8+ may be significantly correlated with the severity and prognosis of HFRS in children.

[Predictive value of Pv-aCO2/Ca-vO2 combined blood lactate concentration for primary peritonitis-related septic shock in children].

OBJECTIVE: To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO2/Ca-vO2) in children with primary peritonitis-related septic shock. METHODS: A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups. RESULTS: A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO2/Ca-vO2, pediatric sequential organ failure assessment, pediatric risk of mortality III in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO2/Ca-vO2 were independent risk factors affecting the prognosis of children [odds ratio (OR) and 95% confidence interval (95%CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO2/Ca-vO2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO2/Ca-vO2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO2/Ca-vO2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO2/Ca-vO2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). CONCLUSIONS: Pv-aCO2/Ca-vO2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.

Sivelestat improves clinical outcomes and decreases ventilator-associated lung injury in children with acute respiratory distress syndrome: a retrospective cohort study.

Background: Sivelestat, a neutrophil elastase inhibitor, is a selective and targeted therapy for acute respiratory distress syndrome (ARDS) in adults; and it is also reported to apply to children with ARDS. However, there is little evidence of its efficacy in children. Methods: This study recruited 212 patients ranging in age from 28 days to 18 years old, and who met the diagnostic criteria for pediatric ARDS (PARDS) while hospitalized in the Intensive Care Department of the Affiliated Children's Hospital of Xi'an Jiaotong University. A total of 125 patients (case group) received sivelestat treatment, and 87 were assigned to the control group. There were no significant differences in gender (P=0.445) or age (P=0.521). Control group data were collected from the Electronic Case Information System for pediatric patients diagnosed with ARDS between March 2017 to January 2020. Data for the case group were collected from the Electronic Case Information System between February 2020 to February 2022. Demographic data, clinically relevant indicators, respiratory parameters were recorded. The 28-day mortality was the primary endpoint; the Kaplan-Meier and log-rank tests were used to evaluate cumulative survival rate. Results: For general demographic and clinical characteristics, no significant differences were observed between the two groups. Compared to the control group, the case group displayed significant improvements in PaO2/FiO2 at 48 h (141±45 vs. 115±21, P<0.001) and 72 h (169±61 vs. 139±40, P<0.001) post-admission, and plateau pressure was lower than that in the control group at 24 h (24±3 vs. 28±7, P<0.001), 48 h (21±4 vs. 26±7, P<0.001), and 72 h (20±2 vs. 25±6, P<0.001) post-admission. Interleukin-8 levels were lower in the case group at 48 and 72 h post-admission. Overall, 28-day mortality was 25.47% (54/212). Twenty-five children died in the sivelestat group, 29 children died in the control group. Survival analysis revealed that cumulative survival in the case group was higher than that in the control group (P=0.028). Conclusions: ARDS is expected to have high morbidity and mortality in critical care medicine, and precise targeted drugs are lacking. Our study showed that sivelestat improved prognosis and reduces mortality in children with ARDS.

Case Report: Report of Infective Endocarditis Caused by Abiotrophia defectiva and Literature Review.

Objective: To report the clinical features of the first child with infective endocarditis (IE) caused by Abiotrophia defectiva in mainland China and to raise awareness of the disease. Methods: The clinical data of a child with IE caused by A. defectiva admitted to Xi'an Children's Hospital in July 2021 were collected, and the relevant literature was reviewed. Results: The child was a female, 8 years old, admitted with fever for 4 days and right-sided limb weakness for 3 days. The illness started with suppurative tonsillitis, followed by headache, fatigue, right-sided mouth, slurred speech, right limb weakness, and unstable holding. Transthoracic echocardiography showed that the mitral valve vegetation was formed and vegetation could also be seen at the entrance of the pulmonary vein at the posterior wall of the left atrium. Cranial contrast-enhanced MRI + magnetic resonance angiography showed multiple intracranial pseudoaneurysm formation and pontine infarction. After A. defectiva was detected by metagenomic next-generation sequencing (mNGS) in cerebrospinal fluid and blood detected, the infection was controlled by anti-infective treatment with meropenem and vancomycin. On the 36th day after admission, due to severe headache and slurred speech, the head CT showed hemorrhage of right parietal pseudoaneurysm and cerebral sickle hernia, and right temporo-occipital hematoma evacuation, cerebrovascular malformation resection, and cranial decompression were performed immediately. After the surgery, her speech ability gradually recovered, the muscle strength of her left upper limb was about grade III, while the muscle strength of the rest of the limbs was normal. After a total of 60 days of hospitalization, her family requested to be discharged. Conclusion: This pediatric patient is the first case of childhood IE caused by A. defectiva in mainland China, and the first time in the world that A. defectiva was detected by mNGS in patients with IE.

The Sharing of Costs and Benefits of Rural Environmental Pollution Governance in China: A Qualitative Analysis through Guanxi Networks Perspective.

Concern has been expressed in many parts of the world that community relations in rural areas are breaking down, making issues such as rural environmental degradation harder to resolve without external regulation. Guanxi is a specific Chinese idiom for characterizing social networks, as a broad term to represent existing relations among people, which can be loosely translated as ''relationship''. Based on a case study of an underdeveloped mountainous area of Southern China, this paper examined the problem from the perspective of guanxi, and explored the impacts of internal group differentiation catalyzed by pig farming pollution and the subsequent influences on the distribution of costs and benefits of different shareholders. It was found that the guanxi in the village were changed from blood relationship centered to economic interest centered. This disparity exerts a significant influence on the distribution of costs and benefits of pollution control and exacerbates environmental inequalities. This means that pig farmers dominated the narrative of pig farming pollution, while the ordinary villagers chose to suffer without protesting, which hinders the advancement of pollution control, and pig farmers took the benefits of weak pollution control and managed to transfer the external cost to others, while others became direct victims. The paper concludes that the rich become richer and the poor become poorer in both economic and environmental perspectives. It is strongly suggested that guanxi should be integrated into the consideration and decision-making process of rural environmental governance in order to guarantee the efficiency and efficacy of its implementation.

Thermochemical liquefaction of agricultural and forestry wastes into biofuels and chemicals from circular economy perspectives.

Waste produced in various fields and activities in society has been increasing, thereby causing immediate environmental harm and a serious-global problem. Recently, the attitude towards waste has changed along with innovations making waste as a new resource. Agricultural and forestry wastes (AFWs) are globally produced in huge amounts and thought to be an important resource to be used for decreasing the dependence on fossil fuels. The central issue is to take use of AFW for different types of products making it a source of energy and at the same time refining it for the production of valuable chemicals. In this review, we present an overview of the composition and pretreatment of AFWs, thermochemical liquefaction including direct liquefaction and indirect liquefaction (liquid products from syngas by gasification) for producing biofuels and/or chemicals. The following two key points were discussed in-depth: the solvent or medium of thermochemical conversion and circular economy of liquid products. The concept of bio-economy entails economic use of waste streams, leading to the widened assessment of biomass use for energy where sustainability is a key issue coined in the circular economy. The smart use of AFWs requires a combination of available waste streams and local technical solutions to meet sustainability criteria.