Revealing the methanogenic pathways for anaerobic digestion of key components in food waste: Performance, microbial community, and implications.

Anaerobic digestion (AD) process is widely considered the most sustainable technology for food waste (FW) disposal due to its advantage of biomethane recovery and beneficial environmental consequences. However, the effects of key components in FW (i.e. starchy food, vegetables, fruits, and meats) on AD process and their methanogenic pathways remain unclear. In this study, the biochemical methane potential (BMP) of cooked rice, cabbage, banana peel, pork and local FW was 288, 283, 254, 630, and 476 NmL CH4/g VSadded, with t80 (time required for 80% methane produced) of 3, 9, 3, 11 and 11 days, respectively. Kinetic analysis suggested diverse hydrolysis rates (0.104-0.679 d-1) and specific methane yields (39-119 NmL CH4/g VSadded/d). The relative abundances of key methanogens in the reactors were diverse, leading to the variation in acetoclastic and hydrogenotrophic methanogenic pathways. This study provides fundamental information for the operation of AD systems with different FW compositions.

An Auxiliary Subxiphoid Incision in Nuss Procedure for the Treatment of Complex Pectus Excavatum.

An auxiliary subxiphoid incision was utilised to facilitate pectus bar placement and minimise operative risks in complex pectus excavatum. A series of 33 patients with recurrent or severe pectus excavatum underwent Nuss procedure with this incision from March 2013 to March 2016. The median age of the cohort was 6.9 years (9 females vs. 24 males). The mean Haller index was 5.22. There were 12 redo cases and 18 cases with a Haller index >6. Four cases underwent double bar correction. There was no perioperative death or major complication. Twenty-one cases had already the bars removed when this study was initiated. During follow-up (6-30 months), three cases presented with mild depression of lateral chest wall; while in the rest, the shapes of the chest wall remained satisfactory. The application of the auxiliary subxiphoid incision in Nuss procedure can make it safer in recurrent and severe pectus excavatum with favourable postoperative cosmetic effects.

Simultaneous operative repair of pectus excavatum and concurrent congenital heart defects.

OBJECTIVES: The aim of this study is to describe an effective surgical strategy for the treatment of children with pectus excavatum (PE) and concurrent congenital heart defect (CHD). METHODS: We retrospectively reviewed the medical records of all children (n = 16) who underwent simultaneous repair of PE with concurrent CHD at the Hunan Children's Hospital from July 2007 to December 2017. Among them, 7 patients had a simple atrial septal defect (ASD); 4 patients had a simple ventricular septal defect (VSD); 3 patients had both VSD and ASD; 1 patient had VSD, ASD and patent ductus arteriosus; and 1 patient had VSD complicated by pulmonary hypertension. To repair PE, we performed one of the 3 procedures: an open sternal elevation involving freeing the tissue from the posterior sternum and lifting the sternum by wires, a Nuss repair or a repair with a custom-made sternal lifting device. The CHDs were repaired using one of the 3 methods as well: open heart surgery using cardiopulmonary bypass, transcatheter closure under echocardiography or X-ray-guided percutaneous intervention. RESULTS: In all 16 patients, the operations led to satisfactory repair of both conditions without serious complications. All parents and children were satisfied with the postoperative appearance of the chests. CONCLUSIONS: By choosing the correct operative approach based on patient characteristics, simultaneous elective repair of PE and concurrent CHD is safe and effective, avoids the risk of multiple staged operations and achieves satisfactory outcomes.

Remote ischemic preconditioning upregulates microRNA-21 to protect the kidney in children with congenital heart disease undergoing cardiopulmonary bypass.

BACKGROUND: Acute kidney injury (AKI) is one of the most common emergencies and severe diseases in the clinic. We sought to verify whether remote ischemic preconditioning (RIPC) has a protective effect on the kidney of child with congenital heart disease undergoing cardiopulmonary bypass (CPB) surgery. We hypothesized it may be related to the up-regulation of microRNA-21 (miR-21). METHODS: We performed a prospective randomized clinical study among children with congenital heart disease undergoing CPB surgery between January and December 2016. Children were randomized to an RIPC or control group. Patients in each group were divided into an AKI and a non-AKI group according to the occurrence of AKI at 48 h after surgery. Remote ischemic preconditioning (RIPC) conducted by blood-pressure cuff was performed 12 h before surgery. Serum creatinine (SCr), tumor necrosis factor-α (TNF-α), and miR-21 expression in blood and urine were measured at different time points. RESULTS: A total of 449 cases (200 RIPC; 249 controls) were enrolled. The male/female ratio was 1.18, with a mean age of 37.50 ± 25.31 months. The incidence of AKI in the RIPC group was significantly lower than that in the control group (19.0% vs. 46.2%, P<0.01). In further analysis, at 6 h, 24 h, and 48 h after CPB operation, blood TNF-α levels were significantly lower in the RIPC group than in the control group (P<0.01); at 24 h, 48 h, and 72 h, urine TNF-α levels were significantly lower in the RIPC group than in the control group (P<0.05). Urine and blood miR-21 expression in the RIPC group increased significantly, while there was no obvious change in the control group. CONCLUSIONS: Remote ischemic preconditioning has a protective effect on the kidney in children with congenital heart disease, which may be related with the up-regulation of miR-21 and down-regulating the inflammatory mediator, such as TNF-α.

A straight pin foreign body in a child: ingested or aspirated?

BACKGROUND: Though foreign body (FB) aspiration or ingestion is not uncommon in children, a straight pin as the culprit FB is rarely seen. The nature of such a FB makes it sometimes difficult to diagnose and deal with, especially in children. CASE REPORT: Here we present such a case who was initially misdiagnosed with FB ingestion but turned out to be an aspiration case. Moreover, its remote location from the hilum made a more invasive surgical retrieval inevitable. A thoracotomy was finally performed to retrieve the pin. And the postoperative course was uneventful. CONCLUSION: For pediatric FB cases, especially in such a case, it is very important to diagnose timely and accurately. A multidisciplinary team approach would facilitate prompt and accurate diagnosis and potentially simplify treatment.

[Safety of surgical therapy for neonate aortic coarctation combined with ventricular septal defect].

OBJECTIVE: To evaluate the safety of surgical repair for neonatal aortic coarctation combined with ventricular septal defect.
 METHODS: Twenty-three aortic coarctation neonates received surgical treatment and their clinical data between April, 2013 and May, 2015 were analyzed retrospectively. All patients underwent coarctation repair + ventricular septal defect repair and mild hyperthermia cardiopulmonary bypass under the condition of general anesthesia. All patients were subjected to delayed sternal closure.
 RESULTS: One patient died at early post-operation, and no one died during 2-27 months' follow-up. Operation time, cardiopulmonary bypass time, aortic cross-clamp time, ICU stay time, mechanical ventilation time, delayed sternal closure time, and post-operative hospital stay time were (192.7±43.4) min, (132.4±26.4) min, (65.3±18.4) min, (185.3±56.4) h, (42.4±24.5) h, (36.3±18.6) h, and (15.3±4.6) d, respectively. Post-operative complications presented in 12 patients, including post-operative hemorrhage in 6 patients, acute renal insufficiency in 4 patients, wound infection in 1 patient, and post-operative coarctation of the aorta in 1 patient. 
 CONCLUSION: One-stage complete repair for severe aortic coarctation combined with ventricular septal defect in neonates is safe, and the outcomes are satisfied. Fully free of the aortic arch and individual aorta reconstruction are the keies to successful operation.

Cor triatriatum sinister: a rare underlying cause of pulmonary hemosiderosis.

Pulmonary hemosiderosis is a disorder with unknown cause and characterized by hemosiderin appreciation in alveolar interstitium from decomposed hemoglobin following alveolar capillary bleeding, which finally leads to pulmonary fibrosis. It can be divided into primary and secondary types in terms of its etiology. While primary types are related to autoimmunity, secondary types can be associated with cardiovascular and pulmonary causes such as mitral stenosis leading to pulmonary congestion. We report a case of cor triatriatum sinister in a child who presented with hemoptysis as a main clinical manifestation and had been previously diagnosed with idiopathic pulmonary hemosiderosis. Based on clinical signs and imaging examinations, we considered the hemoptysis was most likely due to cor triatriatum. The child underwent corrective surgery with uneventful recovery. The hemoptysis has not recurred any more after operation. Cardiovascular disease including cor triatriatum should be considered with regards to the etiology of pulmonary hemosiderosis.

[Effects of ulinastatin on coagulation in children after cardiopulmonary bypass].

OBJECTIVE: To study the effects of ulinastatin on coagulation in children who underwent open-heart surgery with cardiopulmonary bypass (CPB). METHODS: Fifty children who underwent open-heart surgery for ventricular septal defect were randomly divided into two groups: ulinastatin treatment and control. Before CPB, ulinastatin (1.0×10(4) U/kg) was added to CPB priming fluid only in the ulinastatin treatment group. Activated partial thromboplasin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen and international normalized ratio (INR) were measured both before and at 1 hr, 6 hrs and 24 hrs after CPB. RESULTS: The PT in the ulinastatin group was more prolonged than in the control group at 1 hr after CPB (18.7 ± 0.7 s vs 15.5 ± 0.5 s) and 6 hrs after CPB (17.5 ± 0.6 s vs 15.0 ± 0.6 s). The APTT in the ulinatatin group was also significantly more prolonged than in the control group at 6 hrs after CPB (38.7 ± 3.1 s vs 35.3 ± 3.1 s) and 24 hrs after CPB (34.2 ± 3.0 s vs 31.1 ± 2.6 s). CONCLUSIONS: Ulinastatin may prolong PT and APTT after CPB, and thus affects coagulation in children.

Limb ischemic preconditioning reduces heart and lung injury after an open heart operation in infants.

Open heart surgery supported by cardiopulmonary bypass is associated with heart and lung ischemia-reperfusion injury (IRI). Limb remote ischemic preconditioning (RIPC) reduces injury caused by ischemia-reperfusion in multiple distant organs. We conducted a prospective clinical trial (randomized and controlled) to test the feasibility and safety of limb RIPC, as well as its protective effects against myocardial and pulmonary IRI for infants undergoing repair of simple congenital heart defects. Infants undergoing repair of ventricular septal defects were enrolled in our study and randomly assigned to one of two treatment groups: limb RIPC or control. RIPC was induced twice (24 h and 1 h preoperatively) via three 5-min cycles of ischemia and reperfusion on the left upper arm using a blood pressure cuff. Lung compliance, respiratory index (RI), and cardiac inotropic score (IS) were calculated for each patient. Serum concentrations of the following factors were measured perioperatively: interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-alpha; lactate dehydrogenase (LDH), creatine kinase (CK), and its isoenzyme (CK-MB), and troponin I (TnI); malondialdehyde (MDA) and superoxide dismutase (SOD). The expression of heat shock protein 70 (HSP 70) in cardiomyocytes was analyzed by Western blot. Surgical outcomes, including limb movement and sensory function, were recorded in detail. Sixty infants weighting less than 7 kg were studied, with 30 patients in the RIPC group and 30 in the control group. Within 6 months of discharge from the hospital, no limb disability, sensory disturbance, or other surgical complications were found in any patient. Compared with the control group, patients in the RIPC group had higher Cs and Cd, along with lower RI and IS at various postoperative phases. At the beginning of the operation, serum concentrations of IL-6, IL-8, IL-10, TNF-alpha, LDH, CK, and TnI were higher in the RIPC group than the control group. Postoperatively, release of cytokines and leakage of heart enzymes were attenuated in the RIPC group; serum concentrations of cytokines and heart enzymes were lower in the RIPC group at some, but not all, postoperative time points. Furthermore, the RIPC group had lower coronary sinus venous concentrations of MDA and higher concentrations of SOD. Similarly, the expression of HSP 70 was upregulated in cardiomyocytes from the RIPC group. Limb RIPC can be applied safely and easily in infants, can attenuate systemic inflammatory response syndrome, and can increase systemic tolerance to IRI, imparting a protective effect against myocardial and pulmonary IRI. The expression of HSP 70 has an important role in the mechanism of action for RIPC.

[Effects of mechanical ventilation on plasma IL-6, IL-10 and TNF-alpha in children after cardiopulmonary bypass].

OBJECTIVE: To study the effects of different models of mechanical ventilation on inflammatory cytokines, IL-6, IL-10 and TNF-alpha, in children after cardiopulmonary bypass (CPB). METHODS: Sixty patients who underwent CPB were randomly divided into group A and group B. After CPB, group A was ventilated with high tidal volume (VT, 10-12 mL/kg) /low positive end-expiratory pressure (PEEP, 3-5 cm H2O), while group B was ventilated with low VT (6-8 mL/kg) /high PEEP (6-9 cm H2O). Plasma levels of IL-6, IL-10 and TNF-alpha were measured before operation, at the end of the operation, and 1 and 6 hrs after operation. RESULTS: Serum levels of IL-6, IL-10 and TNF-alpha in both groups increased significantly at the end of the operation and reached a peak by 1 hr after operation. Group B showed lower serum levels of IL-6, IL-10 and TNF-alpha than group A 1 and 6 hrs after operation. CONCLUSIONS: Mechanical ventilation with low VT /high PEEP may more effectively inhibit the release of inflammatory cytokines than that with high VT /low PEEP in children after CPB.