Oxidative stress biomarkers in pediatric sepsis: a prospective observational pilot study

Objectives: Oxidative stress is known to participate in the progression of sepsis. Definite data regarding the behavior of oxidative stress biomarkers in pediatric sepsis is still lacking. This study hypothesized that oxidative stress occurs in pediatric sepsis and that the magnitude of the redox derangement is associated with worse clinical progression.

Methods: Forty-two previously healthy pediatric patients with sepsis and a group of control subjects were included. Oxidative stress and inflammatory activity biomarkers were determined in blood samples. Patients were prospectively followed until their discharge or death.

Results: Patients with non-severe and severe sepsis showed higher levels of plasmatic antioxidant capacity, lower erythrocyte thiol index, lower superoxide dismutase and catalase activities, higher glutathione peroxidase activity, and higher plasmatic F₂-isoprostanes concentration than controls. Patients with severe sepsis had higher NF-kappaB activation than those with non-severe sepsis. Although we observed changes in some biomarkers in patients with worse clinical evolution, the explored biomarkers did not correlate with clinical estimators of outcome.

Discussion: Oxidative stress occurs in pediatric sepsis, resulting in oxidative damage. The explored biomarkers are not useful as outcome predictors in the studied population. The behavior of these biomarkers still needs to be addressed in broader groups of pediatric patients with sepsis.     

Neuroimaging of mitochondrial disorders

Mitochondrial disease is frequently a multisystem disorder which often involves the central nervous system. Imaging finding although diverse are characterized by focal lesions with T2 hyperintensity, which may be most evident on FLAIR imaging and often progress to atrophy. Deep brain structures including brainstem and basal ganglia structures are particularly vulnerable though white matter and cortex may also be involved. In this paper we describe in detail the imaging features of the spectrum of mitochondrial diseases and suggest a scoring technique for recording severity and extent of brain involvement. Although there is overlap between the imaging features of disease phenotypes, magnetic resonance imaging may be useful in supporting the clinical diagnosis. There is little correlation between molecular defect and imaging findings with some noticeable exceptions such as the MELAS syndrome.     

推拿对失神经骨骼肌萎缩大鼠的治疗作用及其机制*

目的:探讨推拿对失神经骨骼肌萎缩大鼠的治疗作用及其机制。方法:48只雄性SD大鼠随机分为模型组(n=24)和推拿组(n=24),通过切断右侧胫神经制备腓肠肌萎缩大鼠模型。术后第2日开始给推拿组大鼠手术侧腓肠肌给予手法干预,模型组不予干预。两组分别在0 d、7 d、14 d、21 d四个时间点各处死6只大鼠,取大鼠双侧腓肠肌,称重后计算各组大鼠腓肠肌湿重比;HE染色测定肌纤维截面积和直径,实时荧光定量PCR检测腓肠肌中miR-23a、Akt、MuRF1、MAFbx基因相对表达量。结果:与0 d比较,模型组和推拿组大鼠腓肠肌湿重比、肌纤维截面积和直径呈现进行性下降的趋势,其中7 d、14 d、21 d推拿组腓肠肌湿重比、肌纤维截面积和直径均显著高于模型组(P＜0.05,P＜0.01);与0 d比较,模型组和推拿组MuRF1、MAFbx、Akt mRNA表达均呈现先升后降的趋势,其中7 d、21 d推拿组MuRF1 mRNA表达均显著低于模型组(P＜0.05,P＜0.01),7 d、14 d、21 d推拿组MAFbx mRNA表达均显著低于模型组(P＜0.01,P＜0.05,P＜0.01),7 d、14 d、21 d推拿组Akt mRNA表达均显著高于模型组(P＜0.05,P＜0.01);与0 d比较,模型组和推拿组21 d时miR-23a mRNA表达升高,推拿组miR-23a mRNA表达显著高于模型组(P＜0.05)。结论:推拿能延缓失神经骨骼肌的萎缩,其机制可能与上调miR-23a、Akt基因的表达,下调 MuRF1、MAFbx基因的表达,使蛋白降解速度受到抑制,从而减轻骨骼肌蛋白的降解程度有关。     

Genomic diversity and antimicrobial susceptibility profiling of nasal carriage Staphylococcus aureus isolated from pediatric ward in Western Iran

Nasal carriage of Staphylococcus aureus (S. aureus) probably causes the transmission of infection between individuals in hospital and community. This study aimed to evaluate the molecular epidemiology and antibiotic resistance pattern of nasal carriage S. aureus in pediatric ward patients and personnel. A total of 122 Nasal samples were taken from 28 personnel and 94 hospitalized patients in the pediatric ward. Minimum Inhibitory Concentration (MIC) to vancomycin and cefoxitin was determined by Agar dilution method strips. All S. aureus isolates were analyzed by pulsed-field gel electrophoresis (PFGE). A total of 41 S. aureus were isolated from the patients. 16 isolates (39.09%) were hospital-associated S. aureus (HA-SA) and 25 (60.97%) were community-associated S. aureus (CA-SA); also, 13 S. aureus isolates were obtained from the personnel. Based on MIC results, all of S. aureus isolates were susceptible to vancomycin, and in 41 patient isolates, 13 isolates (31.7%) were resistant to cefoxitin (MRSA). Of 13 S. aureus isolates of the personnel, 3 (23%) isolates were MRSA. Totally 11 common clones and 13 single clones were obtained. In conclusion the prevalence of CA-SA in the ward was higher than that of HA-SA. In the strains obtained from a hospital ward, there was a high epidemiology, genotypic diversity in the studied ward. However, horizontal transfer of S. aureus was observed between patients and between personnel and patients, which indicated the risk of transmission of resistant strains in the hospital wards.     

快通道麻醉在小儿先天性心脏病手术中的应用及对镇静、镇痛效果的影响

目的:探讨快通道麻醉在小儿先天性心脏病手术中的应用及对镇静、镇痛效果的影响。方法:选择2016年6月至2018年5月在桂林医学院附属医院进行手术治疗的小儿先天性心脏病患儿82例,按照随机数字表法分为对照组(41例)和观察组(41例),对照组进行常规麻醉,观察组则采用快通道麻醉。对比两组患儿麻醉药物用量、手术时间、阻断时间、体外循环时间、术后拔管时间、住院时间、住院费用及并发症发生情况,观察两组患儿术后12h镇静、镇痛效果。结果:观察组患儿芬太尼和罗库溴铵用量明显低于对照组(P0.05)。两组患儿的术中各指标比较无统计学差异(P0.05),而与对照组相比,观察组患儿术后住院时间、拔管时间均缩短,且住院费用减少(P0.05)。观察组患儿术后12h的镇静及镇痛效果均优于对照组(P0.05)。观察组患儿术后并发症发生率为17.07%(7/41),低于对照组的39.02%(16/41)(P0.05)。结论:快通道麻醉可减少小儿先天性心脏病手术的芬太尼和罗库溴铵用量,不仅缩短术后拔管时间和住院时间,降低住院费用,而且可改善镇静及镇痛效果,安全有效。     

综合康复治疗对分泌性中耳炎致小儿听力损伤的临床效果

目的:探讨综合康复治疗对分泌性中耳炎致小儿听力损伤的临床效果。方法:以88例2016年1月-2017年8月于我院诊治的分泌性中耳炎致听力损伤患儿为研究对象,将其随机分为综合组和对照组,每组44例。综合组采用综合康复治疗,对照组采用耳部按摩治疗,观察并比较两组临床疗效,治疗前后气导、骨导听阈值的变化。结果:治疗后,综合组有效率为79.55%,显著高于对照组(56.82%,P0.05)。与治疗前相比,两组治疗后0.25-0.8 Hz各频率下气导听阈值及2.0和4.0 kHz下骨导听阈值均显著降低(P0.05),且综合组患儿以上指标均显著低于对照组(P0.05)。结论:综合康复治疗即联合感音训练、耳部按摩、音乐感知及运动训练对分泌性中耳炎致小儿听力损伤有较好的疗效,能改善患儿气导、骨导听阈水平。     

High Serum Level of Soluble Programmed Death Ligand 1 is Associated With a Poor Prognosis in Hodgkin Lymphoma

Blockade of the programmed cell death 1-programmed cell death ligand 1 pathway is a new and promising therapeutic approach in Hodgkin lymphoma (HL). To our knowledge, the impact of soluble programmed cell death ligand 1 (sPD-L1) serum levels on HL patient prognosis has not yet been investigated. In this study, the prognostic value of sPD-L1 was assessed in patients with HL. We measured serum sPD-L1 levels and identified their prognostic value in 108 newly diagnosed HL patients using an enzyme-linked immunosorbent assay (ELISA). We found higher serum sPD-L1 concentrations in HL patients than in healthy controls. The best sPD-L1 cutoff value for predicting disease progression risk was 25.1674 ng/ml. The 4-year progression-free survival (PFS) rates for the high-sPD-L1 and low-sPD-L1 groups were 78.8% and 93.3%, respectively. Multivariate survival analysis showed that advanced stage and higher sPD-L1 levels (>25.1674 ng/ml) were independent prognostic factors for shorter PFS. In addition, higher sPD-L1 levels were positively correlated with advanced stage and negatively correlated with peripheral blood monocyte number. The serum sPD-L1 level is an independent prognostic factor for PFS in HL patients and may allow identification of a subgroup of patients who require more intensive therapy and who may benefit from anti-PD-1 agents.     

Electromyography responses of pediatric and young adult volunteers in low-speed frontal impacts

No electromyography (EMG) responses data exist of children exposed to dynamic impacts similar to automotive crashes, thereby, limiting active musculature representation in computational occupant biomechanics models. This study measured the surface EMG responses of three neck, one torso and one lower extremity muscles during low-speed frontal impact sled tests (average maximum acceleration: 3.8 g; rise time: 58.2 ms) performed on seated, restrained pediatric (n = 11, 8–14 years) and young adult (n = 9, 18–30 years) male subjects. The timing and magnitude of the EMG responses were compared between the two age groups. Two normalization techniques were separately implemented and evaluated: maximum voluntary EMG (MVE) and neck cross-sectional area (CSA). The MVE-normalized EMG data indicated a positive correlation with age in the rectus femoris for EMG latency; there was no correlation with age for peak EMG amplitudes for the evaluated muscles. The cervical paraspinous exhibited shorter latencies compared with the other muscles (2–143 ms). Overall, the erector spinae and rectus femoris peak amplitudes were relatively small. Neck CSA-normalized peak EMG amplitudes negatively correlated with age for the cervical paraspinous and sternocleidomastoid. These data can be useful to incorporate active musculature in computational models, though it may not need to be age-specific in low-speed loading environments.     

Superior performance of continuous over pulsatile flow ventricular assist devices in the single ventricle circulation: A computational study

This study compares the physiological responses of systemic-to-pulmonary shunted single ventricle patients to pulsatile and continuous flow ventricular assist devices (VADs). Performance differences between pulsatile and continuous flow VADs have been clinically observed, but the underlying mechanism remains poorly understood. Six systemic-to-pulmonary shunted single ventricle patients (mean BSA=0.30 m²) were computationally simulated using a lumped-parameter network tuned to match patient specific clinical data. A first set of simulations compared current clinical implementation of VADs in single ventricle patients. A second set modified pulsatile flow VAD settings with the goal to optimize cardiac output (CO). For all patients, the best-case continuous flow VAD CO was at least 0.99 L/min greater than the optimized pulsatile flow VAD CO (p=0.001). The 25 and 50 mL pulsatile flow VADs exhibited incomplete filling at higher heart rates that reduced CO as much as 9.7% and 37.3% below expectations respectively. Optimization of pulsatile flow VAD settings did not achieve statistically significant (p<0.05) improvement to CO. Results corroborate clinical experience that continuous flow VADs produce higher CO and superior ventricular unloading in single ventricle patients. Impaired filling leads to performance degradation of pulsatile flow VADs in the single ventricle circulation.     

CDFI在儿童过敏性紫癜致急性双下肢静脉瓣膜功能不全中的应用

目的:探讨CDFI在儿童过敏性紫癜至下肢静脉瓣膜功能不全中的应用,以提高临床认识。方法:对经临床诊断过敏性紫癜引发下肢静脉瓣膜功能不全5例患儿图像资料给以回顾、归纳总结。结果:5例患儿下肢深静脉表现血液流速稍减慢,CDFI呈节阶段性红蓝相间血流,频谱多普勒呈节段性基线上下血流频谱。结论:CDFI为儿童急性过敏性紫癜致急性双下肢静脉瓣膜功能不全,提供了早期、无创和具有高敏感性、特异性的检查方法,对临床的诊治有重要价值。