[Prognosis and related risk factors of acute respiratory distress syndrome in elder patients].

Objective: To study the risk factors associated with the hospital survival rate of elder patients with acute respiratory distress syndrome (ARDS) in Medical/Respiratory Intensive Care Units (MICUs/RICUs) by evaluating the prognosis, and therefore to provide insight into patient treatment strategy. Methods: Twenty MICUs/RICUs of 19 general hospitals in mainland China participated in the multicenter prospective cohort study carried out from Mar 1st, 2016 to Feb 28th, 2018. Patients who met the criteria of Berlin ARDS and older than 65 years were recruited. Baseline data, risk factors of ARDS, ventilator setup and prognosis data were collected from all patients. Univariant and multivariant regression analysis were conducted to analyze the factors associated with the prognosis. Results: 170 elder ARDS patients (age≥65 years) met the Berlin ARDS criteria, among whom 8.8% (15/170), 42.9% (73/170) and 48.2% (82/170) patients had mild, moderate and severe ARDS, respectively. The most common predisposing factor for elder ARDS was pneumonia, which was present in 134 patients (78.8%). 37.6% (64/170) patients were treated with noninvasive mechanical ventilation (NIV), but 43.8% (28/64) cases experienced treatment failure. 76.5% (130/170) patients were treated with invasive mechanical ventilation. All patients 80 years or older were given invasive mechanical ventilation. 51.8% (88/170) cases had complications of non-pulmonary organ failure. 61.8% (105/170) patients deceased during hospital stay. Multivariant logistic analysis showed that the independent risk factors for hospital survival rate in elder patients with ARDS were SOFA score (P=0.030, RR=0.725, 95% CI 0.543-0.969), oxygen index after 24 hours of ARDS diagnosis (P=0.030, RR=0.196, 95% CI 0.045-0.853), accumulated fluid balance within 7 days after diagnosis of ARDS (P=0.026, RR=1.000, 95% CI 1.000-1.000) and shock (P=0.034, RR=0.140, 95% CI 0.023-0.863). Conclusion: Among 20 ICUs, the high mortality rate of elder patients with ARDS was correlated with higher 24 hour SOFA score, lower 24 hour oxygen index after ARDS diagnosis, more positive fluid balance within 7 days and concomitant shock. The conservative fluid strategy within 7 days of ARDS diagnosis may benefit the elder ARDS patients.

Ascites, anemia and (intestinal) atresia.

We report a neonate who presented antenatally with fetal ascites and fetal anemia. The cause of this remained uncertain until 2 weeks later when bowel dilatation was noted on antenatal ultrasound. Clinical signs of intestinal obstruction became evident after delivery, and ileal atresia was found at laparotomy, which was resected with primary anastomosis. Recent reports in the literature have suggested a possible connection between fetal ascites, anemia and dilated bowel with neonatal intestinal obstruction. In these cases and ours, the likely sequence of events was that of in utero midgut volvulus with bleeding into ischemic bowel, hemorrhagic ascites resulting in fetal anemia and progressive bowel dilatation occurring as a consequence of intestinal atresia. Early treatment in our patient with intrauterine blood transfusion may have altered the natural history of her condition, allowing pregnancy to progress to term with a subsequent improved outcome.

ProMAT calibrator: A tool for reducing experimental bias in antibody microarrays.

Our research group has been developing enzyme-linked immunosorbent assays (ELISA) microarray technology for the rapid and quantitative evaluation of biomarker panels. Studies using antibody microarrays are susceptible to systematic bias from the various steps in the experimental process, and these biases can mask biologically significant differences. For this reason, we have developed a calibration system that can identify and reduce systematic bias due to processing factors. Specifically, we developed a sandwich ELISA for green fluorescent protein (GFP) that is included on each chip. The GFP antigen is spiked into each biological sample or standard mixture and the resulting signal is used for calibration between chips. We developed ProMAT Calibrator, an open-source bioinformatics tool, for the rapid visualization and interpretation of the calibrator data and, if desired, data normalization. We demonstrate that data normalization using this system markedly reduces bias from processing factors. Equally useful, this calibrator system can help reveal the source of the bias, thereby facilitating the elimination of the underlying problem. ProMAT Calibrator can be downloaded at http://www.pnl.gov/statistics/ProMAT .

Altered monocyte CD44 expression in peripheral arterial disease is corrected by fish oil supplementation.

BACKGROUND AND AIMS: CD44 and its splice variants can be expressed on all leukocytes, conferring adhesive properties and enhancing cellular recruitment to the endothelium during inflammation. CD44 expression is increased in inflammatory conditions such as rheumatoid arthritis and CD44 variant 3 (CD44v3) expression may be associated with inflammation. We have examined CD44 and CD44v3 expression on peripheral blood monocytes from patients with peripheral arterial disease (PAD) and healthy controls. We have also examined the effect of fish oil supplementation on these markers. METHODS AND RESULTS: CD44 and CD44v3 were assessed at baseline and following dietary supplementation with fish oil for 12 weeks in both PAD and control groups. Monocytes from PAD patients had higher CD44 expression than those from controls (median intensity fluorescence (MIF): 480+/-278 vs 336+/-251 (mean+/-SD); p<0.001). Following 12 weeks' dietary supplementation with fish oil, CD44 expression was reduced in PAD patients (MIF: 480+/-278 vs 427+/-262; p=0.05) but not in controls (336+/-251 vs 355+/-280; ns). Monocyte CD44v3 expression was lower in cultured monocytes from PAD patients compared to those from controls (0.15+/-0.15 vs 0.22+/-0.14 OD units; p<0.02). This was increased in the PAD group following fish oil supplementation (0.15+/-0.14 to 0.27+/-0.23 OD units; p<0.001). CONCLUSION: Monocyte CD44 and CD44v3 expression are altered in arterial disease but are returned towards levels seen in control subjects by dietary fish oil supplementation.

'Moya' than meets the eye: neurofibromatosis type 1 associated with Moyamoya syndrome.

Moyamoya syndrome (MMS) is an uncommon association of neurofibromatosis type 1 (NF1). We describe a seven-year-old chinese girl with NF1 and unilateral MMS with multiple hyperintensities on T2-weighted magnetic resonance (MR) images. The ischaemic lesions in the ipsilateral white matter were hypointense on fluid attenuated inversion recovery (FLAIR) MR images, in contrast to the hyperintense "unidentified bright objects" (UBOs) of NF1. Neuroradiologists should be aware of associated MMS in NF1 patients, and distinguish the effects of ischaemia from UBOs, especially on FLAIR MR imaging.

The epidemiology and prevention of drowning in Singapore.

INTRODUCTION: The aim of this study was to derive a profile of drowning victims in Singapore in the 10-year period 1992-2001 and determine if there are any patterns, trends or factors which may affect the risk profile of victims. Another objective was to recommend measures for reducing deaths from drowning through a review of some of the current literature and studies on drowning prevention. METHODS: Data for epidemiological analysis were studied and analysed. Data was primarily obtained from the annual drowning statistics reported in the annual reports of the Singapore Life Saving Society, which were in turn obtained from the Registry of Births and Deaths, and the Coroner's Court. The review of current literature and studies on drowning was concentrated on the publications of leading drowning experts and agencies and on the papers presented at two important international conferences, the International Drowning Symposium in May 1996 and the first World Congress on Drowning in June 2002. The review was done with a view to identify successful drowning prevention measures that may be adopted or enhanced in Singapore. RESULTS: The study revealed a few important findings. Firstly, Singapore had a drowning rate per 100,000 population that varied from a low of 0.88 in one year to a high of 1.72 in another in the period 1992-2001. Secondly, the male drowning mortality rate in Singapore was much higher than the female drowning mortality rate. Thirdly, persons in the age group of 20-29 years were at the highest risk. Fourthly, the sea, rivers and swimming pools were the locations with the highest number of drowning victims. The study also showed that the main measures of drowning prevention may be broadly divided into supervision, environmental design changes, legislation, swimming lessons and aquatic safety education. CONCLUSION: The situation in Singapore is generally comparable to that in high income or developed countries although there are some differences. Further studies and research need to be done to provide a better understanding of the epidemiology and prevention of drowning in Singapore. In the meantime, the main measures of drowning prevention should, as far as possible, be followed or enhanced.

Schistosomiasis in Kano State, Nigeria. I. Human infections near dam sites and the distribution and habitat preferences of potential snail intermediate hosts.

Stool and urine samples from 813 schoolchildren and adults from the Tomas and Rimin Gado dam areas of Kano State, Nigeria, showed Schistosoma haematobium to be present at both localities with prevalences of 26.6 and 36.8%, respectively. No cases of S. mansoni were found. The prevalence and intensity of S. haematobium was low and similar in both study areas. Statistical analysis revealed a correlation between prevalence and location, but no evident association with professed patterns of water contact. Investigation of 165 freshwater habitats throughout the state revealed the presence of a number of potential snail intermediate host species, namely Bulinus senegalensis, B. forskali, B. globosus, B. rohlfsi and Biomphalaria pfeifferi. The most widespread species was Bulinus senegalensis, which inhabited shallow pools and excavations on a variety of substrata. Its habitats were typically devoid of aquatic vegetation and included those with highly turbid waters and conductivities as low as 11 microseconds. Bulinus forskali was by contrast relatively rare, occurring in more permanent water courses, although it was often found in mixed populations with B. senegalensis. Bulinus globosus also occurred in seasonally rainfilled pools, but was confined to areas south of the 12 degrees N parallel, and its habitats tended to have a well-developed aquatic flora and clear water. The dominant species in man-made lakes was B. rohlfsi, which occurred in both the Tomas and Rimin Gado reservoirs. Biomphalaria pfeifferi was also primarily lake dwelling, although all species save B. senegalensis were found in irrigation canals.

Schistosomiasis in Kano State, Nigeria. II. Field studies on aestivation in Bulinus rohlfsi (Clessin) and B. globosus (Morelet) and their susceptibility to local strains of Schistosoma haematobium (Bilharz).

Aestivation patterns in Bulinus rohlfsi and B. globosus were studied by digging transects across the floor of their dried habitats and by monitoring changes in snail population structure during the period when the habitats were flooded. Bulinus rohlfsi, which inhabited a small man-made lake, was found to aestivate towards the bottom of its habitat, aestivation occurring during the last six weeks before the lake dried. The data on B. globosus from a temporary pool are less complete, but they show that this species also aestivates at the bottom of its habitat and can be found buried at depths up to 3 cm. A wide size range of both species of snail were found to aestivate, but there was differential mortality of young B. rohlfsi soon after the lake re-filled, and the optimally surviving size group of B. globosus was 9 mm. The beginning of aestivation in B. rohlfsi did not correlate with any of the physical parameters measured, but it coincided with the dying off of a bloom of unicellular algae. The importance of stimuli other than desiccation in the aestivation process of bulinids is stressed. Laboratory infections with isolates of Schistosoma haematobium showed that both Bulinus species were capable of transmitting local strains of the parasite and indicated the presence of snail host-specific strains.