The Clinical Characteristics, Microbiology and Risk Factors for Adverse Outcomes in Neonates with Gram-Negative Bacillary Meningitis.

Background: We aimed to describe the clinical features of Gram-negative bacillary (GNB) meningitis in neonates and investigate the risk factors associated with final adverse outcomes of neonatal GNB meningitis. Methods: From 2003 to 2020, all neonates (aged ≤ 90 days old) with bacterial meningitis who were hospitalized in four tertiary-level neonatal intensive care units (NICUs) of two medical centers in Taiwan were enrolled. Neonates with GNB meningitis were compared with those with Streptococcus agalactiae (group B streptococcus, GBS) meningitis. Results: During the study period, a total of 153 neonates with bacterial meningitis were identified and enrolled. GNB and GBS accounted for 40.5% (n = 62) and 35.3% (n = 54) of all neonatal bacterial meningitis, respectively. In neonates with GNB meningitis, the final mortality rate was 6.5% (4 neonates died); 48 (77.4%) had neurological complications, and 26 (44.8%) of 58 survivors had neurological sequelae at discharge. Although the final outcomes were comparable between neonates with GNB meningitis and those with GBS meningitis, neonates with GNB meningitis were more likely to have more severe clinical manifestations initially and have ventriculomegaly at follow-up. After multivariate logistic regression analysis, neonates with seizure at onset, early onset sepsis, and requirement of surgical intervention for neurological complications were independently associated with final adverse outcomes. Conclusions: GNB meningitis was associated with a high risk of neurological complications and sequelae, although it did not significantly increase the final mortality rate. Close monitoring of the occurrence of neurological complications and advanced therapeutic strategies to optimize the outcomes are urgently needed in the future.

Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis.

Background: Empiric antibiotics are often prescribed in critically ill and preterm neonates at birth until sepsis can be ruled out. Although the current guideline suggests narrow-spectrum antibiotics, an upgrade in antibiotics is common in the neonatal intensive care unit. The impacts of initial broad-spectrum antibiotics on the outcomes of critically ill neonates with respiratory failure requiring mechanical intubation have not been well studied. Methods: A total of 1162 neonates from a tertiary level neonatal intensive care unit (NICU) in Taiwan who were on mechanical ventilation for respiratory distress/failure at birth were enrolled, and neonates receiving ampicillin plus cefotaxime were compared with those receiving ampicillin plus gentamicin. Propensity score-matched analysis was used to investigate the effects of ampicillin plus cefotaxime on the outcomes of critically ill neonates. Results: Ampicillin plus cefotaxime was more frequently prescribed for intubated neonates with lower birth weight, higher severity of illness, and those with a high risk of early-onset sepsis. Only 11.1% of these neonates had blood culture-confirmed early-onset sepsis and/or congenital pneumonia. The use of ampicillin plus cefotaxime did not significantly contribute to improved outcomes among neonates with early-onset sepsis. After propensity score-matched analyses, the critically ill neonates receiving ampicillin plus cefotaxime had significantly worse outcomes than those receiving ampicillin plus gentamicin, including a higher risk of late-onset sepsis caused by multidrug-resistant pathogens (11.2% versus 7.1%, p = 0.027), longer duration of hospitalization (median [IQR], 86.5 [47-118.8] days versus 78 [45.0-106.0] days, p = 0.002), and a significantly higher risk of in-hospital mortality (14.2% versus 9.6%, p = 0.023). Conclusions: Ampicillin plus cefotaxime should not be routinely prescribed as the empiric antibiotics for critically ill neonates at birth because they were associated with a higher risk of infections caused by multidrug-resistant pathogens and final worse outcomes.

Maternal risk factors associated with offspring biliary atresia: population-based study.

BACKGROUND: Biliary atresia (BA) is a progressive, idiopathic, fibro-obliterative disease of the intra and extrahepatic biliary tree. If untreated, it results in severe liver injury and death. The etiology and pathogenesis of BA remain unclear. Few studies have investigated the association between maternal illness/drug use and the occurrence of BA in offspring. METHODS: We used the data from the Birth Certificate Application of Taiwan and linked to National Health Insurance Research Database and Taiwan Maternal and Child Health Database for the years 2004 to 2017 (N = 1,647,231) on 2022/03, and identified BA cases according to diagnosis and procedure code. A total of 285 BA cases were identified. RESULTS: Mothers with type 2 diabetes mellitus and non-dependent drug abuse had higher rates having BA children than non-BA children, with an odds ratio of 2.17 (95% confidence interval [CI] = 1.04-4.53) and OR: 3.02 (95% CI = 1.34-6.78), respectively. CONCLUSION: These results support the notion that BA occurrence is related to maternal reasons. Further studies should be designed to identify additional maternal and pregnancy risk factors and to understand the underlying pathophysiology. IMPACT: 1. The occurrence of offspring biliary atresia may be related to maternal illness/drug use. 2. Maternal drug abuse and type 2 diabetes mellitus pose a high risk for offspring biliary atresia. 3. If maternal etiology is found, biliary atresia might be a preventable disease.

Effects of Probiotics on Gut Microbiomes of Extremely Preterm Infants in the Neonatal Intensive Care Unit: A Prospective Cohort Study.

Background: Probiotics have been previously reported to reduce the incidence of necrotizing enterocolitis (NEC) in extremely preterm infants, but the mechanisms by which the probiotics work remain unknown. We aimed to investigate the effects of probiotics on the gut microbiota of extremely preterm infants. Methods: A prospective cohort study was conducted on 120 extremely preterm neonates (gestational age ≤ 28 weeks) between August 2019 and December 2021. All neonates were divided into the study (receiving probiotics) and the control (no probiotics) groups. Multivariate logistic regression analysis was performed to investigate the significantly different compositions of gut microbiota between these two groups. The effects of probiotics on the occurrence of NEC and late-onset sepsis were also investigated. Results: An increased abundance of Lactobacillus was noted in neonates who received the probiotics (AOR 4.33; 95% CI, 1.89-9.96, p = 0.009) when compared with the control group. Subjects in the probiotic group had significantly fewer days of total parenteral nutrition (median [interquartile range, IQR]) 29.0 (26.8-35.0) versus 35.5 (27.8-45.0), p = 0.004) than those in the control group. The probiotic group had a significantly lower rate of late-onset sepsis than the control group (47.1% versus 70.0%, p = 0.015), but the rate of NEC, duration of hospitalization and the final in-hospital mortality rates were comparable between these two groups. Conclusions: Probiotic supplementation of extremely preterm infants soon after the initiation of feeding increased the abundance of Lactobacillus. Probiotics may reduce the risk of late-onset sepsis, but further randomized controlled trials are warranted in the future.

Separation of Gagua Rise from Great Benham Rise in the West Philippine Basin during the Middle Eocene.

The West Philippine Basin (WPB) has started opening at ~ 58 Ma and ceased spreading at ~ 33 Ma, developing a fast spreading (~ 44 mm/yr half-spreading rate) magmatic episode between 58 and 41 Ma and the second amagmatic episode between 41 and 33 Ma. The occurrence of the first stage of spreading is closely related to the Oki-Daito mantle plume and related Benham Rise (BR) and Urdaneta Plateau (UP) activity. To the east of the Luzon-Okinawa Fracture Zone (LOFZ), BR was the most active volcanism from 48 to 41 Ma. The geomagnetic ages on both sides of the LOFZ have been determined; however, their causal relationship and evolution in the WPB remain unclear. In this study, we performed integrated analyses of multichannel seismic data and swath bathymetry data for the area to the west of the LOFZ. To the west of the LOFZ, the Gagua Rise (GR), is identified by a high residual free-air gravity anomaly, volcanic seamount chains and an overlapping spreading center. The GR is located at magnetic isochrons C20/C22 (50 to 44 Ma) and shows a thick oceanic crust of at least 12.7 km. We first propose an oceanic plateau named Great Benham Rise (GBR) which includes GR, UP and BR. We infer that the GR was a portion of the GBR since ~ 49 Ma and was separated from the GBR at ~ 41 Ma by the right-lateral LOFZ motion. Later, the relict GBR magmatism only continued in the area to the east of the LOFZ. Overall, the GBR dominates the spreading history of the WPB.

Tribological Properties of Oil-in-Water Emulsion with Carbon Nanocapsule Additives.

An experimental investigation was performed on the coefficients of friction (COFs) and wear properties of pure water and oil-in-water (O/W) working fluids containing carbon nanocapsules (CNCs) with concentrations ranging from 0 to 1.0 wt.%. For the O/W working fluid, the ratio of oil to water was set as 6%. It was shown that for the water working fluid, the COF decreased by around 20% as the CNC content increased from 0 to 1.0 wt.%. In contrast, the wear volume increased by 50% as the CNC addition increased from 0 to 0.5 wt.%, but it fell to a value slightly lower than that achieved using only pure water (i.e., no CNCs) as the CNC content was further increased to 1.0 wt.%. For the O/W emulsion, the addition of 0.8 wt.% CNCs reduced the COF by around 30% compared to that of the emulsion with no CNCs. Overall, the results showed that while the addition of a small quantity (6%) of oil to the water working fluid had a relatively small effect on the wear performance, the addition of an appropriate quantity of CNCs (i.e., 0.8 wt.%) resulted in a significantly lower COF and an improved wear surface.

Optical characterization of porcine articular cartilage using a polarimetry technique with differential Mueller matrix formulism.

A method is proposed for characterizing the optical properties of articular cartilage sliced from a pig's thighbone using a Stokes-Mueller polarimetry technique. The principal axis angle, phase retardance, optical rotation angle, circular diattenuation, diattenuation axis angle, linear diattenuation, and depolarization index properties of the cartilage sample are all decoupled in the proposed analytical model. Consequently, the accuracy and robustness of the extracted results are improved. The glucose concentration, collagen distribution, and scattering properties of samples from various depths of the articular cartilage are systematically explored via an inspection of the related parameters. The results show that the glucose concentration and scattering effect are both enhanced in the superficial region of the cartilage. By contrast, the collagen density increases with an increasing sample depth.

Induced groundwater flux by increases in the aquifer's total stress.

Fluid-filled granular soils experience changes in total stress because of earth and oceanic tides, earthquakes, erosion, sedimentation, and changes in atmospheric pressure. The pore volume may deform in response to the changes in stress and this may lead to changes in pore fluid pressure. The transient fluid flow can therefore be induced by the gradient in excess pressure in a fluid-saturated porous medium. This work demonstrates the use of stochastic methodology in prediction of induced one-dimensional field-scale groundwater flow through a heterogeneous aquifer. A closed-form of mean groundwater flux is developed to quantify the induced field-scale mean behavior of groundwater flow and analyze the impacts of the spatial correlation length scale of log hydraulic conductivity and the pore compressibility. The findings provided here could be useful for the rational planning and management of groundwater resources in aquifers that contain lenses with large vertical aquifer matrix compressibility values.

Uncertainty estimation in one-dimensional heat transport model for heterogeneous porous medium.

In many practical applications, the rates for ground water recharge and discharge are determined based on the analytical solution developed by Bredehoeft and Papadopulos (1965) to the one-dimensional steady-state heat transport equation. Groundwater flow processes are affected by the heterogeneity of subsurface systems; yet, the details of which cannot be anticipated precisely. There exists a great deal of uncertainty (variability) associated with the application of Bredehoeft and Papadopulos' solution (1965) to the field-scale heat transport problems. However, the quantification of uncertainty involved in such application has so far not been addressed, which is the objective of this wok. In addition, the influence of the statistical properties of log hydraulic conductivity field on the variability in temperature field in a heterogeneous aquifer is also investigated. The results of the analysis demonstrate that the variability (or uncertainty) in the temperature field increases with the correlation scale of the log hydraulic conductivity covariance function and the variability of temperature field also depends positively on the position.