ABSTRACT
Objective:To explore the scope, mode, anticoagulation mode and complications of blood purification in children with acute and critical illness.Methods:A total of 377 times of treatment of 102 children treated with blood purification in PICU at the First Affiliated Hospital of Xinxiang Medical College from January 2018 to December 2020 were retrospectively analyzed.Results:Among 102 critically ill children treated with blood purification, acute and chronic renal failure ranked the first in terms of disease distribution, with 23 cases in total, followed by 16 cases of severe viral encephalitis (meningoencephalitis), 11 cases of septic shock, seven cases of acute poisoning, five cases of severe allergic purpura, five cases of necrotic encephalopathy.In terms of clinical prognosis, 51(50.0%) cases were cured, 29(28.4%) cases were improved, 10(9.8%) cases died, and 12 cases abandoned treatment.In 2019, the blood purification application frequency was the highest, with a total of 47 cases, which was higher than those in 2018 and 2020( P<0.05). Continuous veno-venous hemofiltration was used in the largest number of children, with a total of 56 cases.There was a statistically significant difference in the application ratio of this mode during 3 years ( P<0.05), while there was no statistically significant difference in the application ratio of other modes.In terms of the selection of anticoagulation methods, the proportions of systemic anticoagulation and extracorporeal anticoagulation had significantly difference among different years( P<0.05), and the application of extracorporeal anticoagulation had increased year by year.There was no statistically significant difference in the proportion of patients without anticoagulants.The incidence of complications of blood purification was the highest in 2019, with catheter related thrombus in the majority (30 person-times), followed by hypothermia, catheter filter coagulation, hematoma formation, catheter related infection, hypotension, heparin-induced thrombocytopenia, etc.There was statistically significant difference in the total complications among different years( P<0.05). Conclusion:Blood purification is widely used in children with acute and critical illness, with a variety of diseases.The most commonly used mode is continuous veno-venous hemofiltration and in vitro anticoagulation.Catheter-related thrombosis is the most common complication.
ABSTRACT
Objective To investigate the influences of exposure to different environmental microbes on early-life gut microbiota colonization in mice.Methods Male (n=8) and female (n=16) adult specific pathogen free (SPF) BALB/c mice were caged together at a ratio of 2:l.After conception,the mice were divided into four groups according to the environments where the offsprings were reared at three different periods (fetal period,breastfeeding period and childhood).Group A:Offsprings were kept in a SPF environment throughout the study;group B:SPF environment during fetal and breastfeeding periods,and then ordinary environment during childhood;group C:SPF environment during fetal period,and then ordinary environment during breastfeeding period and childhood;group D:ordinary environment all the time.Fecal samples were collected at the end of week 3 and 5.Total bacterial DNA was extracted from each sample and analyzed by high throughput analysis.Kruskal-Wallis and Dunn-Bonferroni test were applied for statistical anaysis.Results 1.At the end of three weeks:(1) Diversity:① Phylum level:There were significant differences in the abundance of Firmicutes,Verrucomicrobia,Proteobacteria and Actinobacteria among the four group (all P＜0.01).Compared with group C and D,group A and B showed significantly decreased abundance of Firmicutes [30.876(23.448-41.218)× 10-2,3.317(1.116-4.641) 10-2 vs 71.936(53.587-86.713)× 10-2,79.105(56.305-82.736)× 10-2],but increased abundance of Verrucomicrobia and Proteobacteria [Verrucomicrobia:17.249(9.748-35.106)× 10-2,58.883(0.017-6.047)× 10-2 vs 0.152(0.066-1.890)× 10-2,0.003(0.000-0.016)× 10-2;Proteobacteria:12.640(0.336-15.070)× 10-2,3.653(3.362-4.5955)× 10-2 vs 0.219(0.134-0.325)× 10-2,0.124(0.116-0.165) × 10-2,all P＜0.05 or 0.01].② Genus level:There were significant differences in the abundance of Lactobacillus,Akkermansia and Bacteroides among the four groups (all P＜0.01).Compared with group C and D,group A and B showed significantly decreased abundance of Lactobacillus [19.283(8.618-31.541)× 10-2,0.339(0.264-22.278) × 10-2 vs 58.414(34.874-71.942)× 10-2,66.007(55.141-76.940)× 10-2],but increased abundance of Akkermansia,Bacteroides and Klebsiella [Akkermansia:17.247(9.748-35.106)× 10-2,58.883(0.017-60.475)× 10-2 vs 0.152(0.066-1.890)× 10-2,0.003(0.000-0.017)× 10-2;Bacteroides:3.978(0.683-25.171)× 10-2,8.216(6.023-9.946)× 10-2 vs 0.141(0.061-0.281)× 10-2,0.568(0.149-1.455)× 10-2;Klebsiella:0.209(0.050-8.888)× 10-2,1.402(0.865-1.692)× 10-2 vs 0.003(0.000-0.039) 10-2,0.000(0.000 0.001)× 10-2,all P＜0.05 or 0.01].(2) Alpha diversity:Significant differences were found in operational taxonomic unit (OTU) and Chaol index (P＜0.05),but not in Shannon index among the four groups (P＞0.05).The OTUs of group A and B were significantly lower than that of group D [246(221-348),257(209-280) vs 387(324-478),P=0.045 and 0.008,respectively].2.At the end of five weeks:(1) Diversity:① Phylum level:There were significant differences in the abundance of Firmicutes,Verrucomicrobia and Proteobacteria among the four groups (P＜0.05 or 0.01).The abundance of Firmicutes in gut microbiota in group A was lower than that in group B,C and D [13.765(64.181-24.238)× 10-2 vs 48.912(37.280-59.466)× 10-2,86.065(50.149-89.856) × 10-2,53.847(31.946-72.936) × 10-2],while that of Verrucomicrobia was higher [58.089(22.459-61.285)× 10-2 vs 0.001(0.000-0.005)× 10-2,0.000(0.000-0.001)× 10-2,0.003(0.000-0.006)× 10-2],all P＜0.05 or 0.01.② Genus level:There were significant differences in the abundance of Lactobacillus and Akkermansia among the four groups (P＜0.01).The abundance of Lactobacillus in gut microbiota in group A was lower than that in group B,C and D[1.755(0.805-8.833)× 10-2 vs 26.391(17.550-37.265)× 10-2,70.688(45.713-77.953) × 10-2,28.675 (15.660-57.224) × 10-2],while that of Akkermansia was higher [58.089(22.460-61.285)× 10-2 vs 0.000(0.000-0.006)× 10-2,0.000(0.000-0.001)× 10-2,0.003(0.000-0.006)× 10-2,all P＜0.05 or 0.01].(2) Alpha diversity:There were significant differences in OTU,Chaol and Shannon index among the four groups (P＜0.05 or 0.01).The OTU of group A was lower than that of group B,C and D [268(241-410) vs 438(380-516),562(533-588),546(473-599)],and the OTU,Chaol and Shannon index of group B were all lower than those of group C and D [OTU:438(380-516) vs 562(533-588),546(473-599);Chaol index:1 033(883-1 181) vs 1 285(1 220-1 338),1 328(1 155-1 516);Shannon index:3.85(3.25-4.50) vs 4.28(3.30-5.11),4.17(3.62-4.38),all P＜0.05 or 0.01].Conclusions Early-life exposure to different environments has an obvious impact on the diversity and composition of intestinal microbiota in mice.The less clean the living environment is,the more diverse the gut microflora will be.Furthermore,the window of opportunity for gut microbiota colonization seems to be related to breastfeeding period.
ABSTRACT
Objective To analyze the influence of mode of delivery on post-neonatal gut microbiota using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) technology.Methods From April to August in 2013,thirty healthy urban full-term neonates in Nanjing City were enrolled in the study,including fifteen exclusive breastfed ones (seven born of caesarean section and eight born vaginally) and fifteen mixed feeding ones (eight born of cesarean section and seven born vaginally).Stool specimens were collected on the 28th day after birth and bacterial genomic DNA was extracted and examined by PCR on 16S rDNA V3 variable region.Bacterial community profiles were obtained by DGGE.Diversity and similarity differences of the gut microbial community structures were analyzed.Two independent sample t test or Chi-square tests were used for stastistical analysis.Results (1)Diversity analysis showed that among exclusive breastfeeding infants,the Strip number and Shannon-Weaver Diversity Index of gut microbiota in infants born abdominally were significantly lower than those born vaginally [9.71 ±4.27 vs 15.12±4.19,2.13±0.39 vs 2.61±0.32,both P＜0.05],but the Simpson index of gut microbiota was significantly higher [0.13 ± 0.04 vs 0.08± 0.03,P＜0.05],and no significant difference was shown in Pielou Index (P＞0.05).In the mixed feeding group,the Strip number and Shannon-Weaver Diversity Index of gut microbiota in infants born abdominally were significantly lower than those born vaginally [10.88±3.23 vs 16.29±5.38,2.26±0.37 vs 2.66±0.31,both P＜0.05],the Simpson index was higher,but together with the Pielou Index,neither showed significant difference (both P＞0.05).(2) Similarity analysis found that gut microbiota from neonates born of same mode of delivery mostly gathered together and had much more similar structures.Conclusions In the post-neonatal period,the species and numbers of gut microbiota in infants born abdominally are all behind of those born vaginally.The predominant microbiota in babies born of cesarean section are more prominent,and gut microbiota in vaginal delivered babies are more uniformly distributed.
ABSTRACT
ObjectiveTo explore the clinical characteristics, diagnosis and treatment of neonatalCandida arthritis. Methods The clinical data from one case of neonatalCandida arthritis with swelling and pain in multiple joints as the ifrst symp-toms were reviewed.Results Boy born at 31 weeks' gestational age had the birth weight of 2100 g. The patients was admitted to neonatal intensive care unit after birth and treated with antibiotics for a long time due to infection. At 24 days after birth, blood culture showed the growth ofCandida albicans. At 29 days after birth, the bilateral knee joints showed swelling. TheCandida arthritis was diagnosed through X ray and joint-cavity lfuid culture. The patient was treated with Fluconazole for 13 weeks. When discharged, the joints swelling had been disappeared, while the muscle tension of the double upper limbs was signiifcantly weak. The shoulders had visible slight activities independently. The ifngers, wrists and elbows had less independent activities. The muscle tension of the double lower limbs was slight and the independent activity was more than upper limbs, but the extend was smaller than normal. The palmar grasp relfex was weak. The 30 months follow-up showed that each joint had even length, no abnormality and normal activities. The language and intelligence were normal.Conclusions NeonatalCandida arthritis is mostly combined with or secondary to systemic disseminated candidiasis, and the priority therapy is antifungal drugs. Surgical operation can be considered if necessary, which can improve the prognosis.
ABSTRACT
Objective To evaluate the efficacy and safety of covered metallic stents in the management of proximal esophageal strictures.Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus.Main outcome measures included improvement of dysphagia,sealing of fistula and complications were evaluated.Results A total of 45 stents were placed in 43 patients,with a success rate of 95.6％ (43/45) at the first stent placement attempt.The dysphagia score improved significantly from 3.3 ± 0.6 to 1.8 ± 0.9 (P ＜ 0.001),with 18 having an excellent response and 25 having a good response.Improvement rate of dysphagia was 95.6％ (43/45).Fistula sealing was achieved in 7 of 9 patients (77.8％).Early complications included severe pain (n =5),mediastinal emphysema (n =1),moderate fever (n =9) and collapse of the proximal end of the stent (n =1),while late complications included migration (n =3) and tissue overgrowth (n =6).Conclusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures.