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1.
Childs Nerv Syst ; 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34762158

RESUMO

Febrile infection-related epilepsy syndrome (FIRES) is a devastating epileptic encephalopathy with limited treatment options and unclear etiology. Vagus nerve stimulation (VNS) is an FDA-approved therapy for refractory epilepsy that has been shown to decrease the frequency and severity of seizures. There is a growing interest in alternate non-pharmaceutical therapies for managing super-refractory status epilepticus (SRSE). We present a 29-month-old case, diagnosed with FIRES, whose seizures were successfully controlled by utilization of VNS after ineffective response to intensive pharmacotherapy and ketogenic diet treatment. The VNS was planted after 14 days of refractory seizure activity with a following rapid parameter titration for 42 days without evident side effect, which finally controlled the seizure in the acute phase. VNS may be a potential candidate for the treatment of SRSE in FIRES.

2.
J Hazard Mater ; : 127763, 2021 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-34801307

RESUMO

To solve the inherent defects of laccase, the first iron single-atom anchored N-doped carbon material (Fe1@CN-20) as a laccase mimic was disclosed. The FeN4 structure of this material can well mimic the catalytic activity of laccase. Although Fe1@CN-20 has a lower metal content (2.9 wt%) than any previously reported laccase mimics, it exhibits kinetic constants comparable to those of laccase, as its Km (Michaelis constant) and Vmax (maximum rate) are 0.070 mM and 2.25 µM/min respectively, which are similar to those of laccase (0.078 mM, 2.49 µM/min). This catalyst displays excellent stability even under extreme pH (2-9), high temperature (100 °C), strong ionic strength (500 mM of NaCl), high ethanol concentration (volume ratio 40%) and long storage time (2 months). Additionally, it can be reused for at least 7 times with only a slight loss in activity. Therefore, this material has a much lower price and better stability and recyclability than laccase, which has been applied in the detection and degradation of a series of phenolic compounds. In the detection of adrenaline, Fe1@CN-20 achieved a detection limit of 1.3 µM, indicating it is more sensitive than laccase (3.9 µM).

3.
Infect Drug Resist ; 14: 4611-4617, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34785912

RESUMO

Introduction: The recently developed DOT-MGA (direct-on-target microdroplet growth assay) has shown the desirability of direct application of this approach in positive blood cultures and its good performance in detection. This study selected 44 Enterobacteriaceae strains and implemented a DOT-MGA assay on blood cultures to detect their resistance to seven antibiotics. The results of DOT-MGA were compared with the other two antimicrobial susceptibility testing (AST) methods to analyze the detection performance of DOT-MGA. Methods: We adopted the differential centrifugation to process positive blood-culture (BC). Processed BC broth was directly used for rapid AST using DOT-MGA. Droplets of 6 µL with and without antibiotics at the EUCAST breakpoint concentration were spotted in triplicates onto the surface of a MALDI target. The plates were incubated in a wet box for 4 h before the broth was removed with filter paper. Bruker Biotyper software was used to analyze the test results compared with standard database, and the scores were used to quantify and determine the results. Results: DOT-MGA results were compared with the direct-from-BC disk-diffusion method and results were reported by broth microdilution method, respectively. The comparison demonstrated a 100% growth efficiency in DOT-MGA, a 100% classification consistency for ampicillin, ceftriaxone, and gentamicin, and >93% classification consistency for tobramycin, aztreonam, trimethoprim-sulfamethoxazole (TMP-SMX), and ceftazidime. Discussion: These study results have shown that DOT-MGA is suitable for directly identifying bacterial resistance to positive blood cultures in clinical microbiology laboratories. Furthermore, it is conducive for early diagnosis and treatment of patients with bloodstream infection due to its convenience, time efficiency, and good performance in identifying multiple antibiotic-insensitive bacteria.

4.
Ecotoxicol Environ Saf ; 228: 113005, 2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34839141

RESUMO

Column experiments were conducted to investigate the effects of ion type, ion strength, humic acid (HA), and nanometer alumina (NA) particles on the transport of hexavalent chromium (HC) in saturated porous media. A one-dimensional model is developed to simulate the migration of HC affected by NA particles. The results show that nano-alumina particles would enhance the mobility of HC in saturated porous media. However, the influence of NA on the migration of HC in porous media is complex. When the concentration of NA reaches 30 mg/L, HC has minimum retention parameter and best mobility. The transport of HC also is affected by ion strength and ion type. Higher ionic strength would decrease the retention of HC and enhance its mobility. Compared with sodium ion, calcium ion has larger effects on the transport of HC. Moreover, HA can improve the mobility of HC in saturated porous media, but the corresponding promoting effect decreases with the increase of HA concentration. As nanometer contaminants and HC come into the subsurface environment, findings from this study elucidate the key factors and processes controlling the transport of HC in porous media, which can promote the prediction and assessment of HC in the groundwater system.

5.
BMC Genomics ; 22(1): 732, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627155

RESUMO

BACKGROUND: Enzyme-based host depletion significantly improves the sensitivity of clinical metagenomics. Recent studies found that real-time adaptive sequencing of DNA molecules was achieved using a nanopore sequencing machine, which enabled effective enrichment of microbial sequences. However, few studies have compared the enzyme-based host depletion and nanopore adaptive sequencing for microbial enrichment efficiency. RESULTS: To compare the host depletion and microbial enrichment efficiency of enzyme-based and adaptive sequencing methods, the present study collected clinical samples from eight children with respiratory tract infections. The same respiratory samples were subjected to standard methods, adaptive sequencing methods, enzyme-based host depletion methods, and the combination of adaptive sequencing and enzyme-based host depletion methods. We compared the host depletion efficiency, microbial enrichment efficiency, and pathogenic microorganisms detected between the four methods. We found that adaptive sequencing, enzyme-based host depletion and the combined methods significantly enriched the microbial sequences and significantly increased the diversity of microorganisms (p value < 0.001 for each method compared to standard). The highest microbial enrichment efficiency was achieved using the combined method. Compared to the standard method, the combined method increased the microbial reads by a median of 113.41-fold (interquartile range 23.32-327.72, maximum 1812), and the number of genera by a median of 70-fold (interquartile range 56.75-86.75, maximum 164). The combined method detected 6 pathogens in 4 samples with a median read of 547, compared to 5 pathogens in 4 samples with a median read of 4 using the standard method. CONCLUSION: The combined method is an effective, easy-to-run method for enriching microbial sequences in clinical metagenomics from sputum and bronchoalveolar lavage fluid samples and may improve the sensitivity of clinical metagenomics for other host-derived clinical samples.


Assuntos
Sequenciamento por Nanoporos , Nanoporos , Criança , DNA , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenômica
6.
Front Cell Infect Microbiol ; 11: 665226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34504805

RESUMO

Bloodstream infection is a life-threatening complication in critically ill patients. Multi-drug resistant bacteria or fungi may increase the risk of invasive infections in hospitalized children and are difficult to treat in intensive care units. The purpose of this study was to use metagenomic next-generation sequencing (mNGS) to understand the bloodstream microbiomes of children with suspected sepsis in a pediatric intensive care unit (PICU). mNGS were performed on microbial cell-free nucleic acid from 34 children admitted to PICU, and potentially pathogenic microbes were identified. The associations of serological inflammation indicators, lymphocyte subpopulations, and other clinical phenotypes were also examined. mNGS of blood samples from children in PICU revealed potential eukaryotic microbial pathogens. The abundance of Pneumocystis jirovecii was positively correlated with a decrease in total white blood cell count and immunodeficiency. Hospital-acquired pneumonia patients showed a significant increase in blood bacterial species richness compared with community-acquired pneumonia children. The abundance of bloodstream bacteria was positively correlated with serum procalcitonin level. Microbial genome sequences from potential pathogens were detected in the bloodstream of children with suspected sepsis in PICU, suggesting the presence of bloodstream infections in these children.


Assuntos
Ácidos Nucleicos Livres , Sepse , Criança , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Unidades de Terapia Intensiva Pediátrica , Metagenômica , Sepse/diagnóstico
7.
Front Pharmacol ; 12: 699191, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34504424

RESUMO

Objectives: To develop a population pharmacokinetic model of meropenem in children with sepsis receiving extracorporeal life support (ECLS) and optimize the dosage regimen based on investigating the probability of target attainment (PTA). Methods: The children with sepsis were prospectively enrolled in a pediatric intensive care unit from January 2018 to December 2019. The concentration-time data were fitted using nonlinear mixed effect model approach by NONMEM program. The stochastic simulation considering various scenarios based on proposed population pharmacokinetics model were conducted, and the PTAs were calculated to optimize the dosage regimens. Results: A total of 25 children with sepsis were enrolled, of whom13 received ECMO, 9 received CRRT, and 4 received ECMO combined with CRRT. 12 children received a two-step 3-h infusion and 13 children received 1-h infusion. Bodyweight and creatinine clearance had significant impacts on the PK parameters. ECMO intervention was not related to the PK properties. If 100%T > MIC was chosen as target, children receiving 40 mg/kg q8h over a 3 h-infusion only reached the PTA up to 77.4%. If bacteria with MIC 2 mg/L were to be treated with meropenem and the PTA target was 50%T > MIC, a dose of 40 mg/kg q8h for 1 h infusion would be necessary. Conclusions: The PK properties of meropenem in septic children receiving extracorporeal life support were best described. We recommended the opitimized dosing regimens for septic children receiving ECLS depending on the PTA of PK target 50%T > MIC and 100%T > MIC, for children with sepsis during ECLS with different body weight, estimated creatinine clearance (eCRCL) and MIC of bacteria.

8.
Front Public Health ; 9: 669125, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422741

RESUMO

Background: Child unintentional injuries have become a hot topic worldwide, and substantial regional disparities existed in causes and characteristics. To date, limited data are available to investigate the causes and characteristics of child unintentional injuries from hospitals for children in China. Methods: A cross-sectional study was conducted between January 2017 and December 2018 in Shanghai, China. Patients aged <18 years with an unintentional injury presented to the emergency department were enrolled. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were retrieved from electronic health records (EHRs). Frequencies and proportions of categorical variables and means and SDs of continuous variables are presented. Chi-square test and Student's t-test were used for the comparison between groups, as appropriate. Logistic regression analysis was used to estimate potential risk factors for admission to the hospital. Results: A total of 29,597 cases with unintentional injuries were identified between January 2017 and December 2018, with boys vs. girls ratio of 1.75. Preschool children account for approximately two-thirds of unintentional injuries in the emergency department. A distinctive pattern of mechanisms of unintentional injuries between gender was documented, and sports injury was significantly higher in boys than in girls (10.2 vs. 7.8%). Compared with Canadian Emergency Department Triage and Acuity Scale (CTAS) Grade 3 patients, Grade 2 [odds ratio (OR) = 2.99, 95% CI = 1.93-4.63, P < 0.001] and Grade 1 (OR = 74.85, 95% CI = 12.93-433.14, P < 0.001) patients had higher risk of inhospital admission. For causes of injuries, compared with falling, foreign body and poison had a lower risk of inhospital admission, while transport injury (OR = 1.31, 95% CI = 1.07-1.59, P = 0.008) and high fall injury (OR = 2.58. 95% CI =1.48-4.49, P < 0.001) had a significantly higher risk of admission. Conclusions: There was a significant relationship between age-groups and unintentional injuries between gender, with decreased injuries among girls growing up older. Preventive measures should be taken to reduce transport injury and high fall injury, which had a significantly higher risk of admission.


Assuntos
Lesões Acidentais , Canadá , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino
9.
Langmuir ; 37(36): 10683-10691, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34448589

RESUMO

Herein, we describe pH-responsive Pickering emulsions stabilized by a sodium carboxylate-derived selenium surfactant (C10-Se-C10·(COONa)2) in combination with positively charged alumina nanoparticles. Unlike other bola-type carboxylate surfactants (e.g., disodium eicosanoate), C10-Se-C10·(COONa)2 is soluble in water with a low Krafft temperature (36.1 °C). The emulsions are sensitive to pH variations, and efficient demulsification can be achieved by a pH trigger. The carboxylic sodium group in the C10-Se-C10·(COONa)2 structure can be reversibly cycled between its anionic and nonionic states (carboxylic acid), resulting in a pH-controlled electrostatic attraction between the surfactant and alumina. The Pickering emulsion can be reversibly switched between "on" (stable) and "off" (unstable) states by pH at least four times. Compared with the emulsions stabilized by specially synthesized stimuli-responsive particles or surfactants, the method reported here is much easier to implement and requires very low concentrations of the surfactant and nanoparticles, with potential applications in the fields of biomedicine, drug delivery, and cosmetics.

10.
Epilepsy Behav ; 123: 108248, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34455296

RESUMO

OBJECTIVES: To describe the inpatient medical cost during hospitalization in children with status epilepticus (SE) and identify factors associated with the cost by a nationwide, multicenter study in China. MATERIALS & METHODS: We retrospectively identified pediatric inpatients with SE form Hospital Information System (HIS) of 44 hospitals in 27 provinces in China between 2013 and 2015. Inpatient medical cost and factors associated with the cost were analyzed. RESULTS: A total of 4041 children diagnosed with SE with inpatient medical cost were enrolled in the present study. The median age at admission was 2.9 (range 0.1-18) years, and 2271 patients were male (56.2%). The median inpatient medical cost of children with SE was $1175.5 (665.1-2320.6). The median inpatient medical cost was $3865.6 (1837.4-8210.4) in children with SRSE and $1048.6 (619.8-1865.4) in those with N-SRSE (p < 0.0001). Children with length of hospital stay (LOS) > 7 showed a much higher inpatient medical cost than those with LOS ≤ 7 day ($2300.7 vs. $767.2, p < 0.0001). Regarding different etiologies, children with acute symptomatic etiology showed the highest median inpatient medical cost of $1681.1 (901.0-3699.6), in which children with central nervous system (CNS) infection reported $2606.0 (1380.0-5016.1) and prolonged febrile seizures (PFS) reported $909.8 (649.3-1322.0). Additionally, children with idiopathic/cryptogenic etiology reported a medical cost of $923.2 (548.9-1534.5). Multiple linear regression analysis of cost-driving factors revealed LOS > 7, examinations, treatment equipment and procedures, and treatment medicines were independently associated with a higher inpatient medical cost (R2 = 60.91). In addition, PFS and idiopathic/cryptogenic epilepsy etiology were independently associated with a lower cost. CONCLUSIONS: SE in children was a cost intensive disease in China with a median inpatient medical cost of $1175.5. LOS, etiology and examinations, treatment equipment and procedures, and treatment medicines were significantly associated with inpatient medical cost.


Assuntos
Pacientes Internados , Estado Epiléptico , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Humanos , Lactente , Tempo de Internação , Masculino , Estudos Retrospectivos , Estado Epiléptico/epidemiologia , Estado Epiléptico/terapia
11.
Angew Chem Int Ed Engl ; 60(48): 25188-25202, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34138507

RESUMO

N-Heterocycles, such as pyrroles, pyrimidines, quinazolines, and quinoxalines, are important building blocks for organic chemistry and the fine-chemical industry. For their synthesis, catalytic borrowing hydrogen and acceptorless dehydrogenative coupling reactions of alcohols as sustainable reagents have received significant attention in recent years. To overcome the problems of product separation and catalyst reusability, several metal-based heterogeneous catalysts have been reported to achieve these transformations with good yields and selectivity. In this Minireview, we summarize recent developments using both noble and non-noble metal-based heterogeneous catalysts to synthesize N-heterocycles from alcohols and N-nucleophiles via acceptorless dehydrogenation or borrowing hydrogen methodologies. Furthermore, this Minireview introduces strategies for the preparation and functionalization of the corresponding heterogeneous catalysts, discusses the reaction mechanisms and the roles of metal electronic states, and the influence of support Lewis acid-base properties on these reactions.

12.
Pediatr Neonatol ; 62(4): 428-436, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34103261

RESUMO

BACKGROUND: The incidence and mortality of influenza in children had risen, but data are limited on children with severe influenza virus infection in China. METHODS: We conducted a retrospective case-control study and collected the patients' clinical data. Clinical data including demography, clinical presentation, laboratory findings, radiologic findings, treatment and outcomes were collected. Children were clinically confirmed to have virus infection in Shanghai in three hospitals from June 2014 to June 2019. RESULTS: During the study, 36,047 children were enrolled. Among them, 118 met the criteria for severe flu. Clinical symptoms such as fever, cough, gastrointestinal symptoms, coma and epilepsy were higher in the severe group. Complications such as pneumorrhagia, heart failure, septic shock, acute renal failure and influenza-associated encephalitis were higher in the severe influenza group than the death group. The laboratory findings including decreased hemoglobin, high alanine aminotransferase, high urea nitrogen and high lactate levels were risk factors for death in children with influenza. CONCLUSION: Influenza-associated encephalopathy (IAE), acute respiratory distress syndrome (ARDS) were the common clinical manifestations and complications for the severe influenza, and delayed use of oseltamivir was found to be associated with fatality.


Assuntos
Influenza Humana , Estudos de Casos e Controles , Criança , China/epidemiologia , Hospitais , Humanos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Estudos Retrospectivos , Fatores de Risco
13.
Crit Care Med ; 49(10): 1674-1683, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33935161

RESUMO

OBJECTIVES: To determine the diagnostic and clinical utility of trio-rapid genome sequencing in critically ill infants. DESIGN: In this prospective study, samples from critically ill infants were analyzed using both proband-only clinical exome sequencing and trio-rapid genome sequencing (proband and biological parents). The study occurred between April 2019 and December 2019. SETTING: Thirteen member hospitals of the China Neonatal Genomes Project spanning 10 provinces were involved. PARTICIPANTS: Critically ill infants (n = 202), from birth up until 13 months of life were enrolled based on eligibility criteria (e.g., CNS anomaly, complex congenital heart disease, evidence of metabolic disease, recurrent severe infection, suspected immune deficiency, and multiple malformations). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 202 participants, neuromuscular (45%), respiratory (22%), and immunologic/infectious (18%) were the most commonly observed phenotypes. The diagnostic yield of trio-rapid genome sequencing was higher than that of proband-only clinical exome sequencing (36.6% [95% CI, 30.1-43.7%] vs 20.3% [95% CI, 15.1-26.6%], respectively; p = 0.0004), and the average turnaround time for trio-rapid genome sequencing (median: 7 d) was faster than that of proband-only clinical exome sequencing (median: 20 d) (p < 2.2 × 10-16). The metagenomic analysis identified pathogenic or likely pathogenic microbes in six infants with symptoms of sepsis, and these results guided the antibiotic treatment strategy. Sixteen infants (21.6%) experienced a change in clinical management following trio-rapid genome sequencing diagnosis, and 24 infants (32.4%) were referred to a new subspecialist. CONCLUSIONS: Trio-rapid genome sequencing provided higher diagnostic yield in a shorter period of time in this cohort of critically ill infants compared with proband-only clinical exome sequencing. Precise and fast molecular diagnosis can alter medical management and positively impact patient outcomes.


Assuntos
Técnicas e Procedimentos Diagnósticos/tendências , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Sequenciamento Completo do Genoma/métodos , China , Estado Terminal/terapia , Humanos , Lactente , Recém-Nascido , Avaliação de Resultados em Cuidados de Saúde/métodos , Estudos Prospectivos , Fatores de Tempo , Sequenciamento Completo do Genoma/estatística & dados numéricos
14.
World J Clin Cases ; 9(13): 3070-3078, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33969093

RESUMO

BACKGROUND: Vancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. There are concerns about its adverse drug reactions during treatment, such as nephrotoxicity, ototoxicity, hypersensitivity reactions, etc. However, potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported. CASE SUMMARY: A 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion. No other potential disease conditions could explain the occurrence of the convulsion. The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion. The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L, respectively, which were much higher than the safe range. Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg· h/L. Therefore, vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy. CONCLUSION: Unexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin. Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.

15.
Front Pharmacol ; 12: 648668, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33935752

RESUMO

The aim of this study was to establish the population pharmacokinetics (PK) model of Vancomycin for Chinese pediatric patients which can extrapolate to whole age periods by bridging the published adult population PK model and the established pediatric population PK model. The final consolidated population PK model was used to explore the correlation of pharmacokinetics/pharmacodynamics (PK/PD) indices and efficacy of vancomycin and to provide evidence for the optimized regimen of vancomycin in Chinese pediatric patients with Gram-positive bacterial infection. 108 pediatric patients with Gram-positive infections from 2 pediatric hospitals in China in the first period of the prospective multi-center vancomycin clinical observational study were enrolled to establish the population PK model. A one-compartment population PK model was established and validated. The correlation between vancomycin PK/PD indices [trough concentration (Cmin), peak concentration (Cmax), 0-24 h area under the curve (AUC0-24) and the area under the curve to minimum inhibitory concentration ratio (AUC0-24/MIC)] and the overall clinical outcomes (clinical efficacy and microbiological efficacy) in Chinese pediatric patients were evaluated. There is no significant correlation between PK/PD indices and clinical efficacy or microbiological efficacy. Considering the high clinical effective rate (>90%) and median AUC0-24/MIC values of 200-300, Chinese pediatric patients with Gram-positive bacterial infection may be suitable for lower AUC0-24/MIC target value compared to the target value of 400-600 recommended by IDSA guideline. Different optimal dose regimen of vancomycin for Chinese pediatric patients should be considered. Further evaluation in more prospective studies will be needed.

16.
Transl Pediatr ; 10(3): 587-597, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33850817

RESUMO

Background: Understanding current hemodynamic monitoring (HM) practice patterns is essential to determine education and training strategies in China. The survey was to describe the practice of HM and management in children with septic shock in China. Methods: We conducted an Email-based survey of members of sub-association of pediatric intensive care physicians. The questionnaire consisted of 22 questions and gathered the following information: (I) general information on the hospitals, respective ICUs and participants, (II) the availability of technical equipment and parameters of HM and (III) management simulation of septic shock in three clinical case vignettes. Results: Surveys were received from 68 institutions (87.2%) and 368 questionnaires (response-rate 45.1%) were included. Basic HM (93-100%) were reported as the most utilized parameters, followed by advanced HM which included central venous pressure (CVP) (56.0%), cardiac output (53.5%), and central venous oxygen saturation (36.7%), 61.1% (225/368) of respondents stated the utilization of non-invasive HM equipment. The factors such as ICU specialist training center (P=0.003) and more than 30 cases of septic shock per year (P=0.002) were related to the utilization of non-invasive monitoring equipment. In the simulated case vignette, 49.7% (183/368) of respondents reported performing fluid responsiveness and volume status (FR-VS) assessment. Despite differences in training centers (P=0.005) and educational backgrounds (P=0.030), FR-VS assessment was not related to the volume expansion decision. Conclusions: There is a large variability in use advanced HM parameters, an increasing awareness and acceptance of non-invasive HM devices and a potential need for hemodynamic education and training in pediatric intensive care medicine in China.

17.
ISA Trans ; 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33814264

RESUMO

This paper deals with the parameter estimation of Hammerstein-Wiener (H-W) nonlinear systems which have unknown time delay. The linear variable weight particle swarm method is formulated for such time delay systems. This algorithm transforms the nonlinear system identification issue into a function optimization issue in the parameter space, then utilizes the parallel searching ability of the particle swarm optimization and the iterative identification technique to realize the simultaneous estimation of all parameters and the unknown time delay. Finally, parameters in the linear submodule, nonlinear submodule and the time delay are separated from the optimum parameter. Moreover, two illustrative examples are exhibited to evaluate the effectiveness of the proposed method. The simulation results demonstrate that the derived method has fast convergence speed and high estimation accuracy for estimating H-W systems with unknown time delay, and it is applied to the identification of the bed temperature systems.

18.
Front Pediatr ; 9: 645060, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33898360

RESUMO

Background: The gut is thought to play an important role in the pathogenesis of sepsis. Changes in the gut microbiota are closely related to the occurrence and development of human diseases, but few studies have focused on taxonomic composition of gut microbiota in septic patients. Knowledge of changes in the gut microbiota is a key issue in intensive care. Clinicians must understand how an altered gut microbiota affects the susceptibility and prognosis of septic patients. Measurements and Main Results: In the single-center case control study, 20 septic patients and 20 healthy children were recruited. The taxonomic composition of gut microbiota was determined via 16S rRNA gene sequencing. Gut microbiota diversity in children with sepsis was significantly reduced compared with that in healthy children. The taxonomic composition of gut microbiota can effectively distinguish children with sepsis from healthy children. Thirteen taxa of gut microbiota were significantly increased in the guts of children with sepsis compared with those of healthy children. The increased abundances of Enterococcaceae, Enterococcus, and Enterococcus durans in gut of septic patients were significantly positively correlated with blood inflammation indicators CRP and WBC. The abundances of seven bacteria were significantly decreased in the guts of septic children compared with those of healthy children. The decreased abundance of Bifidobacteriales in gut of septic patients is significantly negatively correlated with blood inflammation index WBC. A machine-learning classifier was built for distinguishing sepsis and achieved the AUC value of 81.25%. It shows that the composition of gut microbiota has certain potential for diagnosis of sepsis. Conclusions: Gut microbiota alterations in septic patients exhibit proliferation of opportunistic pathogenic bacteria, the massive reduction of the commensal flora, and the significant decrease in the diversity of the gut microbiota. Dysbiosis may also account for some changes in the inflammation indexes.

19.
IEEE Trans Cybern ; PP2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33909575

RESUMO

In this article, we study the finite-time stabilization and the asymptotic stabilization with probability one of Markovian jump Boolean control networks (MJBCNs) by sampled-data state feedback controls (SDSFCs). Based on the semi-tensor product (STP), we introduce an augmented variable multiplied by the vector form of the switching signal and the state of MJBCN. We find that under SDSFC, the sequence of the states of the augmented variable at sampling instants satisfies the Markov property. Based on the convergences of the switching signal and the augmented variable, we obtain the sufficient and necessary criteria for the finite-time stabilization and the asymptotic stabilization of MJBCNs by SDSFCs, respectively. Moreover, for the two kinds of stabilization, the feedback matrices of SDSFCs are constructed, respectively. Finally, the obtained results are applied to an apoptosis network and a model of the lactose operon in the Escherichia Coli.

20.
Transl Pediatr ; 10(2): 236-243, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33708509

RESUMO

Background: Code Blue is a popular hospital emergency code that is used to alert the emergency response team to any medical emergency requiring critical care. By retrospectively studying Code Blue cases in a children's hospital, we looked for high-risk factors associated with survival and how to improve the effectiveness of Code Blue systems through training. Methods: Data were collected on age, gender, department, diagnosis, time of Code Blue call activation, time between call and arrival of the Code Blue team, treatment details and outcome before and after the training process from January 2016 to December 2019. Chi-square test and logistic regression analysis were used to analyze the data. Results: A total of 139 Code Blue cases from the period of January 2016 to December 2019 were retrospectively studied. The wards where Code Blues occurred most frequently were the infectious diseases ward (n=31, 22.3%), the hematology and oncology ward (n=30, 21.6%), and the cardiology ward (n=15, 10.8%). Age, inpatient status, time of arrival, the time of cardiopulmonary resuscitation (CPR), and the cause of shock were all risk factors for death. After the training, the arrival time and recovery time were significantly reduced (P<0.01). The proportion of patients who were transferred to the ICU had increased (P<0.05), and the proportion of deaths had decreased (P<0.01). The survival curve improved (P<0.05). Conclusions: It is very important to summarize the risk factors related to Code Blue. It is clear that the efficacy of the Code Blue events improved after training of the hospital staff in the Children's Hospital.

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