Infant cardiopulmonary bypass: CD73 kinetics, association with clinical outcomes, and influence on serum adenosine production capacity.

BackgroundExtracellular adenine nucleotides contribute to ischemia-reperfusion injury following infant cardiopulmonary bypass (CPB), whereas conversion to adenosine may be protective. Alkaline phosphatase (AP), a key enzyme responsible for this conversion, decreases after infant CPB. Indirect evidence suggests that soluble CD73 may simultaneously increase and partially offset this loss of AP. We sought to measure CD73 levels in infants undergoing CPB and determine its association with adenosine production capacity and postoperative support requirements.MethodsA prospective cohort study of infants ≤120 days of age undergoing CPB. CD73 was measured before CPB and during rewarming. Multivariable modeling evaluated the contributions of CD73/AP to adenosine production capacity and postoperative support requirements.ResultsSerum samples from 85 subjects were analyzed. The median CD73 concentration increased following CPB (95.2 vs. 179.8 ng/ml; P<0.0001). Rewarming CD73 was independently inversely associated with vasoactive inotropic support (P<0.005) and length of intensive care unit stay (P<0.005). Combined AP activity and CD73 concentration predicted adenosine production capacity (P<0.0001).ConclusionsSerum CD73 increases following infant CPB. Low rewarming CD73 is independently associated with increased postoperative support requirements. CD73 and AP together predict serum adenosine production capacity and may represent potential therapeutic targets to clear extracellular adenine nucleotides and improve outcomes following infant CPB.

Identification of new developmentally regulated genes involved in Streptomyces coelicolor sporulation.

BACKGROUND: The sporulation of aerial hyphae of Streptomyces coelicolor is a complex developmental process. Only a limited number of the genes involved in this intriguing morphological differentiation programme are known, including some key regulatory genes. The aim of this study was to expand our knowledge of the gene repertoire involved in S. coelicolor sporulation. RESULTS: We report a DNA microarray-based investigation of developmentally controlled gene expression in S. coelicolor. By comparing global transcription patterns of the wild-type parent and two mutants lacking key regulators of aerial hyphal sporulation, we found a total of 114 genes that had significantly different expression in at least one of the two mutants compared to the wild-type during sporulation. A whiA mutant showed the largest effects on gene expression, while only a few genes were specifically affected by whiH mutation. Seven new sporulation loci were investigated in more detail with respect to expression patterns and mutant phenotypes. These included SCO7449-7451 that affect spore pigment biogenesis; SCO1773-1774 that encode an L-alanine dehydrogenase and a regulator-like protein and are required for maturation of spores; SCO3857 that encodes a protein highly similar to a nosiheptide resistance regulator and affects spore maturation; and four additional loci (SCO4421, SCO4157, SCO0934, SCO1195) that show developmental regulation but no overt mutant phenotype. Furthermore, we describe a new promoter-probe vector that takes advantage of the red fluorescent protein mCherry as a reporter of cell type-specific promoter activity. CONCLUSION: Aerial hyphal sporulation in S. coelicolor is a technically challenging process for global transcriptomic investigations since it occurs only as a small fraction of the colony biomass and is not highly synchronized. Here we show that by comparing a wild-type to mutants lacking regulators that are specifically affecting processes in aerial hypha, it is possible to identify previously unknown genes with important roles in sporulation. The transcriptomic data reported here should also serve as a basis for identification of further developmentally important genes in future functional studies.

Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit.

Purpose of Review: This review summarizes the diverse uses of point-of-care ultrasound (POCUS) in critically ill children with congenital and acquired heart disease. Diagnostic utility and practicality of POCUS is reviewed. Importantly, the role of POCUS in the medical management of children in the cardiac intensive care unit is highlighted. Recent Findings: The use of POCUS in critically ill pediatric patients has emerged as an essential diagnostic tool that enhances the physical examination and influences delivery of care. Assessment of a wide range of body systems and pathologies has been impacted by the use of POCUS. Recent studies have demonstrated the use of POCUS for evaluation of cardiac tamponade, pneumonia, vocal cord function, and loss of muscle mass in critically ill children (Hamilton et al. Pediatr Crit Care Med 22(10):e532-e539, 2021; Hoffmann et al. Pediatr Crit Care Med 22(10):889-897, 2021; Najgrodzka et al. Ultrasound Q 35(2):157 163, 2019; Alerhand et al. Pediatr Ann 50(10):e424-e431, 2021). Summary: POCUS is a non-invasive, low-risk, imaging modality that can be used to diagnose and help guide management of critically ill children in the cardiac intensive care unit. POCUS can be performed by an intensivist at the patient's bedside with real-time interpretation, leading to rapid clinical decision-making and the hope of improving patient outcomes. Supplementary Information: The online version contains supplementary material available at 10.1007/s40746-022-00250-1.

Aspects of Expansive Learning in the Context of Healthy Ageing-A Formative Intervention between Dental Care and Municipal Healthcare.

There are great risks of diseases in the ageing population, and oral diseases are no exception. Poor oral health has profound negative impacts on the quality of life. It is therefore crucial to include the oral health perspective in the care for older adults. To meet the challenges associated with oral health in the ageing population, a formative intervention was launched. The intervention, called the TAIK project (="Dental hygienist in a municipality organization", in Swedish: Tandhygienist i kommunal verksamhet), meant that six dental hygienists served non-clinically as oral health consultants in five Swedish municipal organizations. The intervention formed an infrastructure and platform for work that benefits the ageing population and created a new basis for decisions regarding oral health in homecare. The aim of this paper is to explore how aspects of collaboration in an interprofessional and interorganizational intervention may lead to expansive learning. Expansive learning forms the theoretical framework of this study. The dental hygienists and the local head nurses were interviewed individually in-depth. Reflection documents from the dental hygienists were also part of the analyzed data. The conclusion is that the formative intervention was reliant of change which created a foundation for reciprocal understanding that led to expansive learning between dental care and municipal healthcare, with resilience and empowerment as crucial factors.

Oral Care Cards as a Support in Daily Oral Care of Frail Older Adults: Experiences and Perceptions of Professionals in Nursing and Dental Care-A Qualitative Study.

Frail older adults often have poor oral health. In Sweden, oral care cards are designed to be used as an interprofessional tool for documenting the oral health status of older adults with extensive care needs and to describe oral care recommendations. The aim of this study was to explore nursing and dental professionals' experiences and perceptions of oral care cards. Nursing and dental care staff were interviewed in groups or individually. The recorded data were transcribed verbatim and analyzed using qualitative content analysis. A theme emerged: Navigating an oral care responsibility that is not anchored in the nursing and dental care context. The theme was elucidated in three categories: "Accessibility and usefulness", "Coordination between nursing and dental care", and "Ethical approach". The participants perceived a lack of surrounding frameworks and collaboration concerning oral care and the use of oral care cards. An oral care card could ideally facilitate interprofessional and person-centered oral care. However, oral health does not seem to have found its place in the nursing care context. Further research is needed to investigate how oral care cards ought to be developed and designed to support oral health care work.

ST-Elevation Myocardial Infarction due to Acute Thrombosis in an Adolescent With COVID-19.

STEMI can be the presenting diagnosis in adults with COVID-19; presented is a case of a 15-year-old girl with coronary thrombosis-induced STEMI associated with COVID-19. ST-elevation myocardial infarction (MI) is an identified presentation of coronavirus disease 2019 in adults but has not been reported in children. We present a case of a 15-year-old girl with a coronary thrombosis-induced ST-elevation MI in the setting of acute severe acute respiratory syndrome coronavirus 2 infection, not associated with multisystem inflammatory syndrome in children. The patient presented with chest pain, ST elevation, and myocardial dysfunction. Coronary angiography identified thrombosis treated with anticoagulation and antiplatelet therapy. MI must be considered in children who present with coronavirus disease 2019-associated myocardial dysfunction.

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease.

Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability. Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC). Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82). Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

Rare appendicitis-like syndrome: the case of the obstructing broccoli.

The diagnosis of acute appendicitis can be somewhat obscure in a patient that presents with right lower quadrant abdominal pain. The advancement and ease of imaging have made CT scanning readily available in the emergency department. Management can be challenging when the patient has a high likelihood of appendicitis based on clinical suspicion and negative CT scan. The purpose of this case report is to demonstrate how an obstructing bezoar caused an appendicitis-like syndrome in a patient with negative CT scan and clinical diagnosis of acute appendicitis. This case report will discuss the appendicitis-like syndrome of an obstructing bezoar and an approach at management.

Molecular and cytological analysis of the expression of Streptomyces sporulation regulatory gene whiH.

The whiH gene is required for the orderly sporulation septation that divides aerial hyphae into spores in Streptomyces coelicolor. Here, we use a whiHp-mCherry transcriptional reporter construct to show that whiHp is active specifically in aerial hyphae, fluorescence being dependent on sporulation sigma factor WhiG. The results show that the promoter is active before the septation event that separates the subapical compartment from the tip compartment destined to become a spore chain. We conclude that WhiG-directed RNA polymerase activity, which is required for whiH transcription, must precede this septation event and is not restricted to apical sporogenic compartment of the aerial hyphae. Further, it is demonstrated that WhiH, a predicted member of the GntR family of transcription factors, is able to bind specifically to a sequence in its own promoter, strongly suggesting that it acts as an autoregulatory transcription factor. Finally, we show by site-directed mutagenesis and a genetic complementation test that whiH is translated from a start codon overlapping with the previously identified transcription start point, implying leaderless transcription.