ABSTRACT
Objective: To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies. Methods: This retrospective study collected the clinical data, including general state, clinical characteristics, treatment and follow-up(till 1 year and 6 months after discharge), of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children's Hospital due to acute chlorine poisoning in August 2019. Results: There were 6 children characterized by severe dyspnea in this accident, among whom 4 were boys and two girls, aged 4-12 years. When the accident occurred, they were within 5 m of the chlorine source. These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning. The child who was the closest to the chlorine source (1.5 m) and took the longest time (5 min) to evacuate was the most severe one. He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock, then had veno-arterial extracorporeal membrane oxygenation(ECMO) treatment started 10 h after the accident. All the 6 children in this study survived. Following-up found no growth and developmental abnormality. The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma, and the lung CT, electhoencephalogram, and brain magnetic resonance imaging were all normal. Conclusions: Severe chlorine poisoning is mainly characterized by respiratory failure. Mechanical ventilation is often required within a few hours after poisoning. When conventional mechanical ventilation is ineffective, ECMO could save live. Timely treatment could improve prognosis.
Subject(s)
Child , Female , Humans , Male , Chlorine , Critical Illness , Extracorporeal Membrane Oxygenation , Respiratory Insufficiency/therapy , Retrospective StudiesABSTRACT
Objective To analyze the difference of radiomics features between solitary brain metastasis and glioma using routine 3T TI, T2 and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging, to explore the significance of texture features constructed in different directions and angles in tumor regions in distinguishing the two kinds of tumors, and to explore a feasible method for high-precision classification of solitary brain metastases and gliomas. Methods Given the multimodal images of 43 patients with glioma and 45 age- and sex- matched patients with solitary brain metastasis, the gray level co-occurrence matrices of different angles of each slice were constructed from the transverse, coronal and sagittal directions of the tumor regions of these images, and the texture spatial relationship features (including contrast, correlation, energy and homogeneity) were calculated. Wilcoxon rank sum test was used to eliminate redundant features and select features with strong distinguishing ability. Finally, SVM linear kernel classifier was used to classify the selected features to achieve the identification of the two kinds of tumors. Results When classifying glioma and solitary brain metastasis, the precision, recall, Fl score and accuracy of multimodal and multidirectional combination features were 0.8857, 0.9114, 0.8944 and 0.8922, respectively. The area under the receiver operating characteristic curve obtained by linear kernel SVM classifier was 0. 9602. Totally 40 of the 45 patients with solitary brain metastases were correctly classified, and 39 of the 43 gliomas were correctly classified. Conclusion The multimodal and multi-directional combination features of tumor areas can be classified by linear kernel SVM classifier to distinguish gliomas from solitary brain metastases, which can be used as a second opinion to effectively assist doctors in making diagnosis.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) isolates from Chinese children in seven cities.</p><p><b>METHOD</b>A total of 134 MRSA isolates were collected from nine hospitals. Multilocus sequence typing and spa typing were analyzed by polymerase chain reaction (PCR), and staphylococcal chromosomal cassette mec (SCCmec) type was analyzed by multiplex PCR. The Panton-Valentine leukocidin (pvl) gene was also detected.</p><p><b>RESULT</b>Most MRSA strains were isolated from pneumonia and skin and soft tissue infection (SSTIs) patients, accounting for 82.1%. Overall, 16 sequence types (STs) were obtained, and CC59 (51.7%) was found to be the most prevalent, which included ST 59 and ST 338, followed by ST239 (16.4%). SCCmec types II, III, IV, and V were also identified in the current study. SCCmec type IV was the most predominant type at 50.0%, followed by SCCmec type V at 23.9% and III at 23.9%. SCCmec subtypes IVa, IVc, and IVg were found among SCCmec type IV strains, whereas IVa was the main subtype at 77.6%. Twenty-six spa types were also identified, among which the predominant type was t437 (47.8%). The prevalence of pvl genes and the SCCmec type of strain was relevant, and the pvl gene positive rate was higher in SCCmec type IV and V-type strains than in SCCmec type II and III strains (58.6% vs. 14.3%, P < 0.05); there was a significant difference between them. In the strains isolated from pneumonia and SSTIs, ST59-MRSA-IVa(t437) was the predominant clone. There were five clones detected from the strains isolated from septicemia, with ST59-MRSA-IVa(t437) and ST59-MRSA-V(t437) as the main clones (57.1%). Various predominant clones existed in different regions. ST59-MRSA-IVa(t437) was the prevalent clone in the Guangzhou, Beijing, Chongqing, and Shenzhen areas, whereas ST239-MRSA-III(t037) was the prevalent clone in the Shanghai area. Fifty percent of the isolates from the Wenzhou area belonged to ST910-MRSA-V(t318), whereas three clinical strains isolated from the Shenyang region belonged to three different types.</p><p><b>CONCLUSION</b>The results indicate that MRSA isolates from Chinese children are largely associated with the ST59-MRSA-IV(t437) and ST239-MRSA-III(t037) clones. These two may belong to community-acquired MRSA and hospital-acquired ones, respectively. Different prevalent clones were detected in different diseases and different regions. Therefore, there is a need to conduct further research on clinical isolates, which can guide the choice of antibiotic treatment and the examination of MRSA prevalence.</p>