Comprehensive Assessment of Mid-Regional Proadrenomedullin, Procalcitonin, Neuron-Specific Enolase and Protein S100 for Predicting Pediatric Severe Trauma Outcomes.

The development of multiple organ failure and septic complications increases the cumulative risk of mortality in children with severe injury. Clinically available biochemical markers have shown promise in assessing the severity and predicting the development of complications and outcomes in such cases. This study aimed to determine informative criteria for assessing the severity and outcome prediction of severe injury in children based on levels of mid-regional proadrenomedullin (MR-proADM) procalcitonin (PCT), neuron-specific enolase (NSE), and protein S100. Biomarker levels were measured in 52 children with severe injury (ISS ≥ 16) on the 1st, 3rd, 7th, and 14th days after admission to the ICU. The children were divided into groups based on their favorable (n = 44) or unfavorable (n = 8) outcomes according to the Severe Injury Outcome Scale, as well as their favorable (n = 35) or unfavorable (n = 15) outcomes according to the Glasgow Coma Outcome Scale (GOS). The study also evaluated the significance of biomarker levels in predicting septic complications (with SC (n = 16) and without SC (n = 36)) and diagnosing and stratifying multiple organ failure (with MOF (n = 8) and without MOF (n = 44)). A comprehensive assessment of MR-proADM and PCT provided the highest diagnostic and prognostic efficacy for early diagnosis, risk stratification of multiple organ failure, and outcome prediction in severe injury cases involving children. Additionally, the inclusion of the S100 protein in the study allowed for further assessment of brain damage in cases of traumatic brain injury (TBI), contributing to the overall prognostic model.

Whole Genome Sequencing of the Novel Probiotic Strain Lactiplantibacillus plantarum FCa3L.

Lactiplantibacillus plantarum is best known for its significant adaptive potential and ability to colonize different ecological niches. Different strains of L. plantarum are widely used as probiotics. To characterize the probiotic potential of the novel L. plantarum FCa3L strain isolated from fermented cabbage, we sequenced its whole genome using the Illumina MiSeq platform. This bacterial isolate had a circular chromosome of 3,365,929 bp with 44.3% GC content and a cyclic phage phiX174 of 5386 bp with 44.7% GC content. The results of in vitro studies showed that FCa3L was comparable with the reference probiotic strain L. plantarum 8PA3 in terms of acid and bile tolerance, adhesiveness, H2O2 production, and acidification rate. The strain 8PA3 possessed higher antioxidant activity, while FCa3L demonstrated superior antibacterial properties. The antibiotic resistance of FCa3L was more relevant to the probiotic strain than that of 8PA3, although a number of silent antibiotic resistance genes were identified in its genome. Genomic evidence to support adhesive and antibacterial properties, biosynthesis of bioactive metabolites, and safety of FCa3L was also presented. Thus, this study confirmed the safety and probiotic properties of L. plantarum FCa3L via complete genome and phenotype analysis, suggesting its potential as a probiotic, although further in vivo investigations are still necessary.

Microbiota of the Colonic Diverticula in the Complicated Form of Diverticulitis: A Case Report.

Intestinal microbiota appears to be implicated in the pathogenesis of diverticular disease. We present the case of a patient with diverticular colon disease complicated by a pelvic abscess. During the successful surgical treatment, two specimens were taken from the resected colon segment for the microbiota analysis: an inflamed and perforated diverticulum and a diverticulum without signs of inflammation. Culturing and 16S rRNA gene sequencing revealed significant changes in the microbial community structure and composition associated with the acute inflammation and perforation of the colonic diverticulum. The characteristics that are usually associated with the inflammatory process in the gut, namely reduced microbial diversity and richness, decreased Firmicutes-to-Bacteroidetes (F/B) ratio, depletion of butyrate-producing bacteria, and Enterobacteriaceae blooming, were more pronounced in the non-inflamed diverticulum rather than in the adjacent inflamed and perforated one. This is the first study of the intraluminal microbiota of the diverticular pockets, which is more relevant to the etiology of diverticular disease than mucosa-associated microbiota via biopsies and luminal microbiota via fecal samples.

Brain Biomarkers in Children After Mild and Severe Traumatic Brain Injury.

Brain biomarkers (protein S100b and neuron-specific enolase (NSE)), antibodies (aAb) to the NR2 subunit of N-methyl-D-aspartate (NR2(NMDA)) and to the GluR1 subunit of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (GluR1(AMPA)) subtype of glutamate receptors (GluR), NR2 and AMPA peptides, nitrogen oxides (NOx; "nitrites and nitrates"), and 3-nitrotyrosine (NT) were measured in blood from 159 children after mild traumatic brain injury (mTBI), moderate traumatic brain injury (mdTBI), or severe traumatic brain injury (sTBI) within 1-2 days and at intervals during the first 15 days after brain trauma. S100b and NSE levels on the first day were not a strict criterion for injury outcomes. Children with mTBI had the most significant elevations in antibodies to NR2(NMDA) and AMPA peptides, a slight increase in NOx, and, in 25% of cases, appearance of NT in the blood right after TBI. The lowest level of antibodies to NR2(NMDA) GluR detected shortly after the initial TBI was found in children with sTBI, with a negative outcome. The opposite characters of antibodies to NR2(NMDA) on the first day in children with mild and moderate versus severe TBI may be associated with an important mechanism aimed at protecting neurons from Glu excitotoxicity. We hypothesized that a slight increase in NOx after the onset of TBI rapidly activates the innate immune system and contributes to an increase in antibodies to NR2(NMDA). An increase in the AMPA peptide level in mTBI may be early signs of diffuse axonal injury.

Estimation of the Accuracy of Prognostic Scores for the Treatment of Children with Severe Trauma in a Specialized Trauma Hospital.

The aim of the present work was to study the validity and prognostic accuracy of scores for assessing the severity of the condition in children with severe trauma, located in the Department of Anesthesiology and Resuscitation in the Clinical and Research Institute of Urgent Pediatric Surgery and Trauma. The prospective study was conducted using clinical and physiological data collected at the admission and during the first 24 hours of hospitalization from 474 patients. The validity and prognostic accuracy of prognostic scores were assessed by determining their discrimination and calibration ability. A comparison of the discriminatory ability of scores was carried out by comparing the areas under the ROC curves with the z-criterion. Four prognostic scores were included into the study: PRISM, APACHE II, ISS-RTS-TRISS, which were used for calculating the severity of injury and for prognosis of death. Score PTS was used for evaluating the severity index only. Our results indicate that only score ISS-RTS-TRISS may be useful in practice (has excellent discrimination ability and significant calibration ability). The other lack either discrimination ability (PRISM) or calibration ability (PTS, APACHE II). The result of the study has shown that only one of the four prognostic scores, ISS-RTS-TRISS, can be successfully used in everyday practice in the department of anesthesiology and resuscitation in the specialized hospital of children's traumatology to assess the severity of the condition, with the possibility of predicting the likelihood of a lethal outcome.

Prognosis of Severe Traumatic Brain Injury Outcomes in Children.

OBJECTIVES: We aimed to determine prognostic factors that can influence the outcome of severe traumatic brain injury (TBI) in children. MATERIALS AND METHODS: One hundred and sixty-nine patients with severe TBI were included. Consciousness was evaluated using the Glasgow Coma Scale (GCS). Severity of concomitant injuries was evaluated using the Injury Severity Score (ISS). Computer tomography (CT) scanning was used on admission and later. Intracranial injuries were classified using the Marshall CT scale. Intracranial pressure (ICP) monitoring took place in 80 cases. Serum samples of 65 patients were tested for S-100ß protein and of 43 patients for neuron specific enolase (NSE). Outcomes were evaluated 6 months after trauma using the Glasgow Outcome Scale (GOS). Statistical and mathematical analysis was conducted. The accuracy of our prognostic model was defined in another group of patients (n = 118). RESULTS: GCS, pupil size and photoreaction, ISS, hypotension and hypoxia are significant predictors of outcome of severe TBI in children. CT results complement the forecast significantly. The accuracy of surviving prognosis came to 76% (0.76) in case of S-100ß protein level ≤ 0.25 µg/l and NSE level < 19 µg/l. A mathematical model of outcome prognosis was based on discriminant function analysis. The model of prognosis was tested on the control group. The accuracy of prognosis was 86%. CONCLUSIONS: A personalised prognostic model makes it possible to predict the outcome of severe TBI in children on the first day after trauma.

Emergence of the Uncommon Clone ST944/ST78 Carrying blaOXA-40-like and blaCTX-M-like Genes Among Carbapenem-Nonsusceptible Acinetobacter baumannii in Moscow, Russia.

Carbapenem-nonsusceptible (Carba-NS) Acinetobacter baumannii has emerged as an important cause of nosocomial infections. In the present study, we characterized 91 Carba-NS A. baumannii isolates collected from patients of surgical departments and intensive care units at three hospitals in Moscow in 2012-2015. Multilocus sequence typing (MLST) using the Oxford (Oxf) scheme identified 16 sequence types (STs) of three clonal complexes (CCs), including CC92Oxf (67%), CC109Oxf (1%), CC944Oxf (29%), and the singleton ST1100Oxf (3%). CC944Oxf was composed of ST944Oxf (n = 16) and two of its newly described single locus variants ST1103Oxf (n = 3) and ST1104Oxf (n = 7); all the three STs were identical to the Pasteur (Pas) MLST scheme ST78. All CC944Oxf/ST78Pas isolates were blaOXA-40-like positive and all but one isolate harbored a blaCTX-M-like gene. ST944Oxf was the only ST found in each of the three study hospitals. Biofilm growth capacity was similar among Carba-NS and nonclonal carbapenem-susceptible isolates. Our data demonstrate the predominance of two clonal lineages among Carba-NS A. baumannii. One of these, the uncommon blaOXA-40-like/blaCTX-M-like-positive clone of CC944Oxf/ST78Pas, seems to be endemic in Russia.