The effectiveness and safety of nasojejunal tube placement by gastroscopic wire drawing in children / 中国小儿急救医学

Objective:To investigate the effectiveness and safety of nasojejunal tube placement in children by gastroscopic drafting method.Methods:We retrospectively analyzed the clinical data of children with nasojejunal tube placement from January 2016 to December 2021 in our hospital, and compared the operation time, successful rate and complications of nasojejunal tube placement in the gastroscopic wire drawing method retraction group(observation group)and the gastroscopic foreign body clamp placement method placement group(control group).Results:All of the 167 cases, 65 cases were in observation group and 102 cases in control group.There were no significant differences in sex and age between two groups( P>0.05). The operation time was(6.7±0.8)min in observation group and(8.2±1.3)min in control group, and the difference was statistically significant( t=8.312, P<0.001). The successful rate was 100% in observation group and 96% in control group.One child in control group complicated with the mucosal erosion and bleeding in the duodenal bulb, while the observation group with no erosion, bleeding, perforation, and other complications. Conclusion:The gastroscopic wire drawing method of nasojejunal tube placement has a shorter operation time, higher successful rates, and lower complication rates, which is significantly superior to the gastroscopic foreign body clamp placement method.

SARS-CoV-2 causes human BBB injury and neuroinflammation indirectly in a linked organ chip platform

COVID-19 is a multi-system disease affecting many organs outside of the lungs, and patients generally develop varying degrees of neurological symptoms. Whereas, the pathogenesis underlying these neurological manifestations remains elusive. Although in vitro models and animal models are widely used in studies of SARS-CoV-2 infection, human organ models that can reflect the pathological alterations in a multi-organ context are still lacking. In this study, we propose a new strategy to probe the effects of SARS-CoV-2 on human brains in a linked alveolus-BBB organ chip platform. The new multi-organ platform allows to recapitulate the essential features of human alveolar-capillary barrier and blood-brain barrier in a microfluidic condition by co-culturing the organ-specific cells. The results reveal direct SARS-CoV-2 exposure has no obvious effects on BBB chip alone. While, infusion of endothelial medium from infected alveolus chips can cause BBB dysfunction and neuroinflammation on the linked chip platform, including brain endothelium disruption, glial cell activation and inflammatory cytokines release. These new findings suggest that SARS-CoV-2 could induce neuropathological alterations, which might not result from direct viral infection through hematogenous route, but rather likely from systemic inflammation following lung infection. This work provides a new strategy to study the virus-host interaction and neuropathology at an organ-organ context, which is not easily obtained by other in vitro models. This will facilitate to understand the neurological pathogenesis in SARS-CoV-2 and accelerate the development of new therapeutics. SUMMARYO_LIA linked human alveolus-BBB chip platform is established to explore the influences of SARS-CoV-2 on human brains in an organ-organ context. C_LIO_LISARS-CoV-2 infection could induce BBB injury and neuroinflammation. C_LIO_LIThe neuropathological changes are caused by SARS-CoV-2 indirectly, which might be mediated by systemic inflammation following lung infection, but probably not by direct viral neuroinvasion. C_LI

Risk factors analysis of the complications caused by button battery ingestions in 58 children / 中国小儿急救医学

Objective:To analyze the clinical characteristics, endoscopic manifestations, complications and related risk factors of button battery ingestion in 58 children, thus providing the basis for clinical diagnosis and treatment.Methods:The medical data of 58 children with button battery ingestion were collected and researched at Children′s Hospital Affiliated to Zhengzhou University from September 2015 to September 2020.The demographic information, battery impaction location, duration, symptoms, mucosal injury level, battery size, treatment, complications and follow-up results were analyzed.Results:The average age of the patients with button battery ingestion was (25.7±15.4)months, including 40 boys(68.9%). The average retention time of the battery in digestive tract was 13.8(2, 96) h. Vomiting, salivation, dysphagia, cough and fever were the common chief complaints.There were 29(50.0%) cases of grade I mucosal injury, as well as 14(24.1%) cases, 10(17.2%) cases and 10(17.2%) cases for grade Ⅱ, grade Ⅲ and grade Ⅳ, respectively.Additionally, common complications included esophageal stenosis, esophageal perforation and esophageal-tracheal fistula.Logistic regression analysis showed that location(esophagus) and diameter(≥15 mm) of battery incarceration were important predictors of complications.Conclusion:The degree of mucosal damage is associated with the diameter and impaction location of battery.The button battery embedded in the esophagus is prone to complications, while the ones retained in the stomach were not vulnerable to serious complications.Endoscopy and other related examinations should be performed again in 1 to 3 weeks after the button removal to determine the outcome of complications and to intervene in time.

The clinical characteristics of different treatment in children with esophageal foreign bodies / 中国小儿急救医学

Objective:To summarize and analyze the clinical characteristics of different treatment in children with esophageal foreign bodies.Methods:This study collected 246 children with esophageal foreign bodies in our hospital from January 2016 to January 2020, which was divided into endoscopic group and operative group.The general and clinical data of children treated with different treatment were collected and statistical analyzed.Results:There were 222 children in endoscopic group and 24 children in operative group, respectively.The rate of surgery was 9.75%.There were no significant differences in gender and location of esophageal foreign bodies.However, the average age of operative group was(2.92±2.67) years, which significantly younger than that in endoscopic group(4.12±3.37)years( P=0.049). The residence time in operative group(median 29.10 h)was remarkable longer than that in operative group(median 11.80 h)( P<0.001). The proportion of sharpness(50.00%) and corrosive(45.83%) foreign bodies in operative group were more than those in endoscopic group[16.22% and 8.11%( P<0.001)]. Moreover, the occurrence rate of major complication in operative group was 83.33%, which was dramatically higher than that in endoscopic group(0.90%)( P<0.001). Conclusion:The younger and longer residence time of esophageal foreign bodies in children contribute to the rate of operative treatment.Additionally, the sharpness and corrosive foreign bodies increase the risk of surgery and serious complications.

Modeling SARS-CoV-2 infection in vitro with a human intestine-on-chip device

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has given rise to a global pandemic. The gastrointestinal symptoms of some COVID-19 patients are underestimated. There is an urgent need to develop physiologically relevant model that can accurately reflect human response to viral infection. Here, we report the creation of a biomimetic human intestine infection model on a chip system that allows to recapitulate the intestinal injury and immune response induced by SARS-CoV-2, for the first time. The microengineered intestine-on-chip device contains human intestinal epithelium (co-cultured human intestinal epithelial Caco-2 cells and mucin secreting HT-29 cells) lined in upper channel and vascular endothelium (human umbilical vein endothelial cells, HUVECs) in a parallel lower channel under fluidic flow condition, sandwiched by a porous PDMS membrane coated with extracellular matrix (ECM). At day 3 post-infection of SARS-CoV-2, the intestine epithelium showed high susceptibility to viral infection and obvious morphological changes with destruction of intestinal villus, dispersed distribution of mucus secreting cells and reduced expression of tight junction (E-cadherin), indicating the destruction of mucous layer and the integrity of intestinal barrier caused by virus. Moreover, the endothelium exhibited abnormal cell morphology with disrupted expression of adherent junction protein (VE-cadherin). Transcriptional analysis revealed the abnormal RNA and protein metabolism, as well as activated immune responses in both epithelial and endothelial cells after viral infection (e.g., up-regulated cytokine genes, TNF signaling and NF-kappa B signaling-related genes). This bioengineered in vitro model system can mirror the human relevant pathophysiology and response to viral infection at the organ level, which is not possible in existing in vitro culture systems. It may provide a promising tool to accelerate our understanding of COVID-19 and devising novel therapies.

A human disease model of SARS-CoV-2-induced lung injury and immune responses with a microengineered organ chip

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that seriously endangers human health. There is an urgent need to build physiological relevant human models for deep understanding the complex organ-level disease processes and facilitating effective therapeutics for COVID-19. Here, we first report the use of microengineered alveolus chip to create a human disease model of lung injury and immune responses induced by native SARS-CoV-2 at organ-level. This biomimetic system is able to reconstitute the key features of human alveolar-capillary barrier by co-culture of alveolar epithelial and microvascular endothelial cells under microfluidic flow. The epithelial cells on chip showed higher susceptibility to SARS-CoV-2 infection than endothelial cells identified by viral spike protein expression. Transcriptional analysis showed distinct responses of two cell types to SARS-CoV-2 infection, including activated type I interferon (IFN-I) signaling pathway in epithelium and activated JAK-STAT signaling pathway in endothelium. Notably, in the presence of circulating immune cells, a series of alveolar pathological changes were observed, including the detachment of endothelial cells, recruitment of immune cells, and increased production of inflammatory cytokines (IL-6, IL-8, IL-1{beta} and TNF-). These new findings revealed a crucial role of immune cells in mediating lung injury and exacerbated inflammation. Treatment with antiviral compound remdesivir could suppress viral copy and alleviate the disruption of alveolar barrier integrity induced by viral infection. This bioengineered human organ chip system can closely mirror human-relevant lung pathogenesis and immune responses to SARS-CoV-2 infection, not possible by other in vitro models, which provides a promising and alternative platform for COVID-19 research and preclinical trials.

Isolation and Characterization of 2019-nCoV-like Coronavirus from Malayan Pangolins

The outbreak of 2019-nCoV in the central Chinese city of Wuhan at the end of 2019 poses unprecedent public health challenges to both China and the rest world1. The new coronavirus shares high sequence identity to SARS-CoV and a newly identified bat coronavirus2. While bats may be the reservoir host for various coronaviruses, whether 2019-nCoV has other hosts is still ambiguous. In this study, one coronavirus isolated from Malayan pangolins showed 100%, 98.2%, 96.7% and 90.4% amino acid identity with 2019-nCoV in the E, M, N and S genes, respectively. In particular, the receptor-binding domain of the S protein of the Pangolin-CoV is virtually identical to that of 2019-nCoV, with one amino acid difference. Comparison of available genomes suggests 2019-nCoV might have originated from the recombination of a Pangolin-CoV-like virus with a Bat-CoV-RaTG13-like virus. Infected pangolins showed clinical signs and histopathological changes, and the circulating antibodies reacted with the S protein of 2019-nCoV. The isolation of a coronavirus that is highly related to 2019-nCoV in the pangolins suggests that these animals have the potential to act as the intermediate host of 2019-nCoV. The newly identified coronavirus in the most-trafficked mammal could represent a continuous threat to public health if wildlife trade is not effectively controlled.

Endoscopic therapy of children with high-risk gastrointestinal foreign bodies and complications / 中华实用儿科临床杂志

Gastrointestinal foreign body is a common emergency in children, especially the esophageal foreign bodies or the sharp, corrosive, magnetic bodies, which highly induce the complications and urgently need treatment with endoscope.Moreover, the complications, including gastrointestinal bleeding, perforation, fistula and luminal stenosis, can be treated by using endoscope.Therefore, the characteristics and the therapy of high-risk gastrointestinal foreign bodies are illustrated.

The effects of tumor necrosis factor-αand interleukin-6 on acute myocardial function lesion after the severe craniocerebral injury / 重庆医学

Objective To investigate the effects of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)on acute myocardial functional lesion after severe craniocerebral injury.Methods Sixty five examples with severe craniocerebral injury are collected in the 253th hospital of PLA from February in 2009 to May in 2012,of whom glasgow coma scale was low or equal to 8 points.They are examined creatine kinase-MB(CK-MB),cardiac troponin T(cTnT),TNF-αand IL-6 for correlative analysis while they are emer-gency treated at the same time.Results The myocardial function of the observe group examined results:CK-MB(198.63±37.72) U/L,cTnT(548.17±49.58)pg/mL;injury factors examined results:TNF-α(39.93± 18.88)ng/mL,IL-6(469.61 ±73.66)ng/mL.It both has evidently difference between the control group and the observe group and has obviously correlation between the my-ocardial function and injury factors of the observe group (P 0.911 4)and cTnT(r>0.942 1)had statistically significant difference.Conclusion TNF-αand IL-6 all participate in the process of the acute myocardial functional lesion after severe craniocerebral injury.The inchoate interference and treatment against TNF-αand IL-6 are possible to have inhibited the high expression of TNF-αand IL-6 in the blood and to improve the myocardial functional lesion after severe craniocerebral injury.

Correlation between tumor necrosis factor-α,interleukin-6 and platelet activating factor with the blood coagulation disorders in severe craniocerebral injury / 中国医师进修杂志

Objective To investigate the correlation between tumor necrosis factor (TNF)-α,interleukin (IL)-6,platelet activating factor (PAF) with the blood coagulation disorder in severe craniocerebral injury.Methods Collected 65 subjects (observation group) with severe craniocerebral injury from January in 2009 to June in 2012 with the trauma index ≥17 points,glasgow coma scale ≤ 10 points,combined with other parts of the injury and died in the emergency department were excluded.Examined platelet count (PLT),activated partial thromboplastin time (APTT),prothrombin time (PT),D-dimer (D-D),TNF-α,IL-6 and PAF meanwhile were emergency treated,selected the same period 43cases of health as control group,these indicators were compared.Results PLT in observation group was significantly lower than that in control group [(74.91 ± 30.70) × 109/L vs.(191.52 ± 23.31) × 109/L] (P ＜0.01),APTT,PT in observation group was significantly longer than that in control group [(69.44 ± 15.52) s vs.(22.47 ± 9.41) s,(30.37 ± 8.22) s vs.(9.57 ±4.53) s] (P ＜0.01),D-D,TNF-α,IL-6,PAF in observation group was significantly higher than that in control group[(1 934.92 ± 708.49) U/L vs.(105.78 ± 44.53) U/L,(39.93 ± 18.88) μg/L vs.(1.28 ±0.59) μg/L,(417.61 ±73.66) μg/L vs.(63.93 ±41.49) μ g/L,(16 359.91 ±4 321.92) ng/L vs.(3 823.45 ±529.72) ng/L](P＜0.01).PLT in observation group was negatively correlated with TNF-α,IL-6 and PAF (r =-0.929 2,-0.944 5,-0.932 4,P ＜ 0.01),APTT was positively correlated with TNF-α,IL-6 and PAF (r =0.910 2,0.932 7,0.978 6,P ＜0.01),PT was positively correlated with TNF-α,IL-6 and PAF (r =0.934 1,0.955 4,0.978 6,P ＜ 0.01),D-D was positively correlated with TNF-α,IL-6 and PAF (r =0.942 1,0.943 8,0.941 8,P ＜ 0.01).Conclusions TNF-α,IL-6 and PAF all participate in the process of the blood coagulation disorder in severe craniocerebral injury.The inchoate interference and treatment such as lessening stress responses and inflammation responses against TNF-α,IL-6,PAF is possible to improve the blood coagulation disorder in severe craniocerebral injury and to decrease the death rate of patients.