Management and Prognosis of Snake Envenomation Among Pediatric Patients: A National Database Study.

Background: Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database. Methods: This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods. Results: A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation ( p = 0.035), receive IV antibiotic treatment ( p = 0.0078), and require surgical intervention ( p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage ( p = 0.2880), IV antibiotic usage ( p = 0.3190), hospitalization ( p = 0.3988), and surgical intervention ( p = 0.1874). Conclusions: In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization.

Engineered Bifunctional Luminescent Pillared-Layer Frameworks for Adsorption of CO2 and Sensitive Detection of Nitrobenzene in Aqueous Media.

Through a dual-ligand synthetic approach, five isoreticular primitive cubic (pcu)-type pillared-layer metal-organic frameworks (MOFs), [Zn2 (dicarboxylate)2 (NI-bpy-44)]⋅x DMF⋅y H2 O, in which dicarboxylate=1,4-bdc (1), Br-1,4-bdc (2), NH2 -1,4-bdc (3), 2,6-ndc (4), and bpdc (5), have been engineered. MOFs 1-5 feature twofold degrees of interpenetration and have open pores of 27.0, 33.6, 36.8, 52.5, and 62.1 %, respectively. Nitrogen adsorption isotherms of activated MOFs 1'-5' at 77 K all displayed type I adsorption behavior, suggesting their microporous nature. Although 1' and 3'-5' exhibited type I adsorption isotherms of CO2 at 195 K, MOF 2' showed a two-step gate-opening sorption isotherm of CO2 . Furthermore, MOF 3' also had a significant influence of amine functions on CO2 uptake at high temperature due to the CO2 -framework interactions. MOFs 1-5 revealed solvent-dependent fluorescence properties; their strong blue-light emissions in aqueous suspensions were efficiently quenched by trace amounts of nitrobenzene (NB), with limits of detection of 4.54, 5.73, 1.88, 2.30, and 2.26 µm, respectively, and Stern-Volmer quenching constants (Ksv ) of 2.93×103 , 1.79×103 , 3.78×103 , 4.04×103 , and 3.21×103 m-1 , respectively. Of particular note, the NB-included framework, NB@3, provided direct evidence of the binding sites, which showed strong host-guest π-π and hydrogen-bonding interactions beneficial for donor-acceptor electron transfer and resulting in fluorescence quenching.

MSC-derived exosomal miR-34a/c-5p and miR-29b-3p improve intestinal barrier function by targeting the Snail/Claudins signaling pathway.

AIMS: Mesenchymal stem cell (MSC)-derived exosomes (MSCs-exos) regulate biological functions in different diseases, such as liver fibrosis, diabetes, and ischaemic heart injury. However, the function of MSC-derived exosomes on the intestinal barrier and the underlying mechanisms are poorly characterized. MAIN METHODS: The expression of miR-34a/c-5p, miR-29b-3p and Claudin-3 in human normal intestinal tissues and damaged intestinal tissues was evaluated by RT-qPCR. The effect of MSC-secreted exosomes on Claudins in Caco-2 cells was measured by using confocal microscopy, RT-qPCR and Western blot. Dual luciferase reporter assays and RNA immunoprecipitation (RIP) assays were performed to study the interaction between miR-34a/c-5p, miR-29b-3p and Snail. I/R-induced intestinal damage in rats was used to determine the in vivo effect of MSC-exos on intestinal barrier function. KEY FINDINGS: In this study, we found that miR-34a/c-5p, miR-29b-3p and Claudin-3 were downregulated in damaged human intestinal tissues. MSC-exos increased the expression of Claudin-3, Claudin-2 and ZO-1 in Caco-2 cells. Further studies demonstrated that MSC-exos promoted Claudin-3, Claudin-2 and ZO-1 expression in Caco-2 cells by Snail, which was targeted by miR-34a/c-5p and miR-29b-3p. In vivo experiments showed that MSC-derived exosomes could improve I/R-induced intestinal damage through the Snail/Claudins signaling pathway. SIGNIFICANCE: The findings here suggest a novel molecular basis for the therapy of intestinal barrier dysfunction.

Development of a SYBR green-based real-time quantitative PCR assay to detect PCV3 in pigs.

Porcine circovirus 3 (PCV3) has been reported in cases of porcine dermatitis and nephropathy syndrome, reproductive failure, cardiac and multi-systemic inflammation. A SYBR green-based real-time quantitative PCR (qPCR) assay was established in this study to detect PCV3 in 203 clinical samples from suckling piglets affected by congenital tremors in China. The limit of detection (LOD) of PCV3 was 1.73×104 copies/µL for gel electrophoresis and 1.73×102 copies/µL for SYBR green-based real-time qPCR. The melt curve analysis showed a single melt peak at 82.5°C.The intra-assay coefficient of variation was up to 1.83% and the inter-assay coefficient of variation was up to 2.27%. The PCV3 positive detection rate of 203 clinical samples for the SYBR green-based real-time qPCR and the conventional PCR was 86.70% (176/203) and 26.60% (54/203), respectively. Each tissue detected in the SYBR green-based real-time qPCR showed a higher positive rate than that detected in the conventional PCR. These results indicated that the SYBR green-based real-time qPCR assay is a powerful method with high sensitivity, specificity and reproducibility for epidemiological investigations of PCV3.

Radix puerariae extracts ameliorate paraquat-induced pulmonary fibrosis by attenuating follistatin-like 1 and nuclear factor erythroid 2p45-related factor-2 signalling pathways through downregulation of miRNA-21 expression.

BACKGROUND: Puerarin, extracted from Radix puerariae, was reported to ameliorate airway inflammation, lung injury and lung fibrosis induced by paraquat (PQ) in mice. However, effects of Radix puerariae extracts (RPEs) on lung fibrosis or signalling pathways in PQ-induced lung injury have not been well studied. Therefore, the goals of our study were to investigate whether Radix puerariae extracts are antifibrotic in a paraquat (PQ) induced lung fibrosis model in mice and to propose possible mechanisms of action of the RPE effects. METHODS: We used a long-term exposure model of PQ-induced lung fibrosis in mice to evaluate effects of antioxidant-containing RPE. We examined effects of miR-21 on follistatin-like 1 (Fstl 1) pathways and oxidative stress in the lung. Gene expression levels of miR-21, Fstl 1, transforming growth factor-ß1 (TGF-ß1), connective tissue growth factor (CTGF), collagen-1 and collagen III were measured by real-time PCR. Protein expression levels of Fstl 1(FSTL1), heme oxygenase-1 (HO-1), nuclear factor erythroid 2p45-related factor-2 (Nrf2), Smad2/3, p38MAPK, nuclear factor-κB 65 (NF-κB65), and matrix metalloproteinase-9 were detected by western blotting. FSTL1 andalpha-smooth muscle actin (α-SMA) in lung tissue were detected by immunohistochemistry. Malondialdehyde, superoxide dismutase (SOD), reduced (GSH) and oxidised (GSSH) glutathione and reactive oxygen species levels, hydroxyproline and total lung collagen were also determined. RESULTS: Long-term challenge with PQ enhanced miRNA-21 (miR-21), Fstl 1 pathways, oxidative stress and development of fibrotic features in the lungs. RPE reduced features of lung fibrosis by blocking Fstl 1 pathways and oxidative stress through decreased miR-21 expression. This was accompanied by suppression of CTGF, TGF-ß1, vascular endothelial growth factor, collagen I, and collagen III. In addition, PQ-induced activation of NF-κB, Nrf2 and α-SMA were enhanced by puerarin. We also found that puerarin increased HO-1, SOD and GSH levels. CONCLUSIONS: These findings demonstrated that RPEs blocked PQ-induced Fstl 1 pathways and oxidative stress by inhibiting miR-21 expression, leading to attenuation of PQ-induced lung fibrosis.

Extradural transcavernous approach to cavernous sinus cavernous hemangiomas.

OBJECTIVE: Cavernous sinus cavernous hemangioma (CSCH) is a rare extra-axial vascular lesion and is difficult to be removed due to their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures. The purpose of this study is to report our experience of the removal of CSCHs through a completely extradural transcavernous approach. METHODS: Twelve patients with CSCH, who were operated through a purely extradural approach, were retrospectively studied. Clinical symptoms and signs, radiographic characteristics, operative techniques and outcomes of these patients were analyzed. RESULTS: Headache and visual impairment were the most common clinical symptoms, followed by facial hypesthesia and ptosis. Radiographically, CSCHs have a characteristic pattern. On computed tomography (CT) scans, CSCHs are isodense or minimally hyperdense, with an intense homogenous contrast administration. Magnetic resonance image (MRI) scans revealed well-demarcated and hypo- to isointense lesions on T1-weighted images and characteristically, markedly hyperintense lesions on T2-weighted images. The T2-weighted images showed a marked homogeneous and an intense enhancement after contrast administration. All CSCHs were treated by a completely extradural transcavernous approach. Gross total excision was achieved in all 12 patients. Post-operative complication included transient cranial nerve dysfunction for 2-3 months in eight patients, and three patients developed a permanent VI nerve palsy. The follow-up period ranged from 4 to 117 months (mean 62 months), and no patient had experienced tumor recurrence. CONCLUSION: CSCHs are rare and challenging skull base tumors. The microsurgical resection, using an extradural transcavernous approach which allows complete tumor resection with an acceptable intraoperative and postoperative complications, should be considered as a favorable choice among all treatments.

[Surgical management of petroclival meningiomas invading into cavernous sinus].

OBJECTIVE: To analyze the clinical features, surgical strategy and management outcomes of petroclival meningioma invading into cavernous sinus. METHODS: Fifteen cases with petroclival meningioma invading into cavernous sinus were retrospectively analyzed. The presigmoidal approach was selected to remove tumors. The surgical strategy for tumor in cavernous sinus was partial resection combined with radiosurgery. Postoperative cranial nerve function and patient survival status were analyzed. RESULTS: The main symptoms of subtype of petroclival meningiomas were headache, abducens nerve palsy and trigeminal neuropathy. Gross total tumor removal was achieved in 13 cases and more than 90% resection in 2 cases. There was no operative death. Nine cases suffered from new postoperative cranial nerve deficits. After a follow-up of 6 - 59 months, complete improvement was achieved in oculomotor nerve deficits, much improvement in VII nerve deficit, but V and VI nerve function deficits improved slightly. The tumor progression-free survival rate was 86.7%. CONCLUSION: Rational surgical strategy to petroclival meningiomas invading into cavernous sinus should be suggested to reduce the operative morbidity and improve the survival quality of these patients.