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Ventilator-associated events: From surveillance to optimizing management

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Journal of intensive Medicine 2023年第3期3卷 204-211页

作者： Sergio Ramirez-Estrada Yolanda Peña-Lopez Tarsila Vieceli Jordi Rello intensive care Department Hospital Sanitas CIMABarcelona 08034Spain paediatric Critical care Department Hospital Universitari Vall d’HebronBarcelona 08035Spain Clinical Research/Epidemiology in Pneumonia and Sepsis(CRIPS) Vall d’Hebron Research InstituteBarcelona 08035Spain Infectious Diseases Department Hospital de Clínicas de Porto AlegrePorto Alegre RS 90035-007Brazil Universitat Internacional de Catalunya Barcelona 08195Spain

Mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)defined criteria for ventilator-associated events(VAE).Ten years later,a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published.Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher thanlower severity.To date,it is estimated that around 30%of ventilated patients in the intensive care unit(ICU)develop VAE.While surveillance enhances the detection of infectious and non-infectious MV-related complicationsthat are severe enough to impact the patient’s outcomes,there are still many gaps in its classification and management.In this review,we provide an update by discussing VAE etiologies,epidemiology,and classification.Preventive strategies on optimizing ventilation,sedative and neuromuscular blockade therapy,and restrictivefluid management are warranted.An ideal VAE bundle is likely to minimize the period of intubation.We believethat it is time to progress from just surveillance to clinical care.Therefore,with this review,we have aimed toprovide a roadmap for future research on the subject.

关键词： intensive care Mechanical ventilation Infection control Ventilator-associated pneumonia

Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 343-349页

作者： Kirill Marakhouski Elena Malyshka Katsiaryna Nikalayeva Larysa Valiok Aleh Pataleta Kiryl Sanfirau Aliaksandr Svirsky Vasily Averin Division of Diagnostic Republican Scientific and Practical Centre of Paediatric SurgeryMinsk 220113Belarus Department of Newborn Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Department of Pediatric Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Division of Diagnostic Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Academic Chair of Pediatric Surgery Belarusian State Medical UniversityMinsk 220116Belarus

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;Pintensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

关键词： Newborns Congenital duodenal obstruction Perforated duodenal membrane Endoscopy Balloon dilation

Neuroprotective measures in children with traumatic brain injury

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World Journal of Critical care Medicine 2016年第1期5卷 36-46页

作者： Shruti Agrawal Ricardo Garcia Branco Department of paediatric intensive care Cambridge University Hospitals NHS Foundation Trust

Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.

关键词： paediatrics Intracranial pressure Traumatic brain injury Neuroprotection paediatric critical care Advanced neuromonitoring

Stevens-Johnson Syndrome complicated by obstructive uropathy,pneumothorax,and pneumomediastinum:a case report and literature review

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Burns & Trauma 2019年第1期7卷 125-131页

作者： Damian Bruce-Hickman Xiao Jiang Joshua Jin-Ping Thia Amit Kansal Department of intensive care Medicine Ng Teng Fong HospitalSingaporeSingap

Background:Stevens-Johnson Syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentation:A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces,pneumomediastinum,and obstructive uropathy as early complications of her disease.She required intubation,chest tube insertion,and bilateral ureteric stenting as part of her intensive care management.These extracutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.Conclusion:Despite paucity of cases in adult literature,post-renal causes for acute kidney injury must be considered in SJS,especially in the setting of gross haematuria.Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy.Pneumothorax is a rare but documented complication of SJS in paediatric cases and,to a lesser extent,adult patients.Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.

关键词： Stevens-Johnson Syndrome Obstructive uropathy Ureteric stenting Pneumothorax Pneumomediastinum

Upregulation of miR-489-3p and miR-630 inhibits oxaliplatin uptake in renal cell carcinoma by targeting OCT2

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Acta Pharmaceutica Sinica B 2019年第5期9卷 1008-1020页

作者： Lu Chen Le Chen Zhiyuan Qin Jinxiu Lei Sheng Ye Kui Zeng Hua Wang Meidan Ying Jianqing Gao Su Zeng Lushan Yu Institute of Drug Metabolism and Pharmaceutical Analysis Zhejiang Province Key Laboratory of Anti-Cancer Drug ResearchCollege of Pharmaceutical SciencesZhejiang UniversityHangzhou310058China paediatric intensive care unit the Children's HospitalZhejiang University School of MedicineHangzhou310003China Department of Urology Cancer Hospital of Zhejiang ProvinceHangzhou310022China

Renal cell carcinoma(RCC) is one of the most common malignant tumors affecting the urogenital system, accounting for 90% of renal malignancies. Traditional chemotherapy options are often the front-line choice of regimen in the treatment of patients with RCC, but responses may be modest or limited due to resistance of the tumor to anticarcinogen. Downregulated expression of organic cation transporter OCT2 is a possible mechanism underlying oxaliplatin resistance in RCC treatment. In this study, we observed that mi R-489-3 p and mi R-630 suppress OCT2 expression by directly binding to the OCT2 30-UTR. Meanwhile, via 786-O-OCT2-mi RNAs stable expression cell models, we found that mi RNAs could repress the classic substrate 1-methyl-4-phenylpyridinium(MPP+), fluorogenic substrate N,N-dimethyl-4-(2-pyridin-4-ylethenyl) aniline(ASP+), and oxaliplatin uptake by OCT2 both in vitro and in xenografts. In 33 clinical samples, mi R-489-3 p and mi R-630 were significantly upregulated in RCC, negatively correlating with the OCT2 expression level compared to that in adjacent normal tissues, using tissue microarray analysis and q PCR validation. The increased binding of c-Myc to the promoter of pri-mi R-630, responsible for the upregulation of mi R-630 in RCC, was further evidenced by chromatin immunoprecipitation and dual-luciferase reporter assay. Overall, this study indicated that mi R-489-3 p and mi R-630 function as oncotherapy-obstructing micro RNAs by directly targeting OCT2 in RCC.

关键词： OCT2 mi RNA Renal cell carcinoma Epigenetic regulation Oxaliplatin

Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning

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World Journal of Pediatrics 2023年第11期19卷 1094-1103页

作者： Wen‑Yuan Zhang Zhong‑Hua Chen Xiao‑Xia An Hui Li Hua‑Lin Zhang Shui‑Jing Wu Yu‑Qian Guo Kai Zhang Cong‑Li Zeng Xiang‑Ming Fang Department of Anesthesiology and intensive care School of MedicineThe First Affiliated HospitalZhejiang UniversityQingChun Road 79Hangzhou 310003China Department of Anesthesiology Shaoxing People’s Hospital(Shaoxing HospitalZhejiang University School of Medicine)Shaoxing 312000China Department of Anesthesiology Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA

Background Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children.It is associated with high rates of morbidity and mortality,and rapid detection and administration of antimicrobials have been emphasized.The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness.Methods Three gene expression datasets were available from the Gene Expression Omnibus collection.First,the differentially expressed genes(DEGs)were found with the use of the R program,and then gene set enrichment analysis was carried out.Subsequently,the DEGs were combined with the major module genes chosen using the weighted gene co-expression network.The hub genes were identified by the use of three machine-learning algorithms:random forest,support vector machine-recursive feature elimination,and least absolute shrinkage and selection operator.The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes.In addition,the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT).The relationship between the diagnostic markers and infiltrating immune cells was further studied.Results Overall,after overlapping key module genes and DEGs,we detected 402 overlapping genes.As pediatric sepsis diagnostic indicators,CYSTM1(AUC=0.988),MMP8(AUC=0.973),and CD177(AUC=0.986)were investigated and demonstrated statistically significant differences(P<0.05)and diagnostic efficacy in the validation set.As indicated by the immune cell infiltration analysis,multiple immune cells may be involved in the development of pediatric sepsis.Additionally,all diagnostic characteristics may correlate with immune cells to varying degrees.Conclusions The candidate hub genes(CD177,CYSTM1,and MMP8)were identifi

关键词： paediatric sepsis Bioinformatics Machine-Learning Biomarkers Immune cell infiltration

Gastroesophageal reflux and congenital gastrointestinal malformations

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World Journal of Gastroenterology 2015年第28期21卷 8508-8515页

作者： Lucia Marseglia Sara Manti Gabriella D'Angelo Eloisa Gitto Carmelo Salpietro Antonio Centorrino Gianfranco Scalfari Giuseppe Santoro Pietro Impellizzeri Carmelo Romeo Neonatal intensive care unit Department of Pediatrics University of Messina unit of paediatric Genetics and Immunology Department of Paediatrics University of Messina unit of Pediatric Surgery Department of Pediatrics University of Messina Department of Biomedical Sciences and Morpho-Functional Images University of Messina

Although the outcome of newborns with surgical congenital diseases(e.g.,diaphragmatic hernia;esophageal atresia;omphalocele;gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery,infant survivors often require intensive treatment after birth,have prolonged hospitalizations,and,after discharge,may have longterm sequelae including gastro-intestinal comorbidities,above all,gastroesophageal reflux(GER).This condition involves the involuntary retrograde passage of gastric contents into the esophagus,with or without regurgitation or vomiting.It is a well-recognized condition,typical of infants,with an incidence of 85%,which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus,in the first few months after birth.Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood,it has been hypothesized that common(increased intra-abdominal pressure after closure of the abdominal defect) and/or specific(e.g.,motility disturbance of the upper gastrointestinal tract,damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects.Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases.The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations.

关键词： Gastroesophageal reflux Congenital diaphragmatichernia Esophageal atresia Omphalocele Gastroschisis

Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children’s hospital before second pandemic wave in Germany

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World Journal of Pediatrics 2021年第5期17卷 484-494页

作者： Marietta Neumann Annette Aigner Eileen Rossow David Schwarz Maria Marschallek Jorg Steinmann Ralf Stucker Ingo Koenigs Philippe Stock Department of paediatrics Altona Children's HospitalUniversitat HamburgAltonaer KinderkrankenhausBleickenallee 3822763 HamburgGermany Corporate Member of Freie Universitat Berlin and Humboldt-Universitat Zu Berlin Institute of Biometry and Clinical Epidermiology BerlinCharite-Universitatsmedizin BerlinBerlinGermany Department of Neonatology and paediatric intensive care Medicine Altona Children's HospitalHamburgGermany Department of paediatric Surgery Altona Children's HospitalHamburgGermany Labor Dr.Fenner and Colleagues Hamburg.Germany Department of paediatric Orthopaedics Altona Children's HospitalHamburgGermany Department of paediatric Surgery University Medical Centre Hamburg Eppendorf(UKE)HamburgGermany Department of paediatrics Altona Children's HospitalHamburgGermany

Background Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019(COVID-19)pandemic.Healthcare workers in paediatries are a unique subgroup:they come into frequent contact with children,who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2(SARS CoV-2)and,therefore,may transmit the disease to unprotected staff.In Germany,no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.Methods We tested the staff at a large children's hospital in Germany for immunoglobulin(Ig)G antibodies against the nucle-ocapsid protein of SARS CoV-2 in a period between the first and second epidemic wave in Germany.We used a questionnaire to assess each individual's exposure risk and his/her own perception of having already been infected with SARS-CoV-2.Results We recruited 619 participants from all sectors,clinical and non-clinical,constituting 70%of the entire staff.The seroprevalence of SARS CoV-2 antibodies was 0.325%(95%confidence interval 0.039-I.168).Self-perceived risk of a previ-ous SARS-CoV-2 infection decreased with age(odds ratio,0.81;95%confidence interval,0.70-0.93).Having experienced symptoms more than doubled the odds of a high self-perceived risk(odds ratio,2.18;95%confidence interval,1.59--3.00).There was no significant difference in self perceived risk between men and women.Conclusions Seroprevalence was low among healtheare workers at a large children's hospital in Germany before the second epidemic wave,and it was far from a level that confers herd immunity.Self-perceived risk of infection is often overestimated.

关键词： Health personnel SARS CoV-2 Seroepidemiologic studies Pediatrics

Childhood obesity in New Zealand

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World Journal of Pediatrics 2019年第4期15卷 322-331页

作者： Valentina Chiavaroli John D.Gibbins Wayne S.Cutfield JoséG.B.Derraik Neonatal intensive care unit Pescara Public HospitalPescaraItaly Liggins Institute University of AucklandAucklandNew Zealand A Better Start-National Science Challenge University of AucklandAucklandNew Zealand Endocrinology Department Children's Hospital of Zhejiang University School of MedicineHangzhouChina Department of Women's and Children's Health Uppsala UniversityUppsalaSweden

Background paediatric obesity has reached epidemic proportions globally,resulting in significant adverse effects on health and wellbeing.Early life events,including those that happen before,during,and after pregnancy can predispose children to later obesity.The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents,and to determine their underlying risk factors and associated comorbidities.Data sources PubMed,Web of Science,and Google Scholar searches were performed using the key terms 'obesity','overweight','children','adolescents',and 'New Zealand'.Results Obesity is a major public health concern in New Zealand,with more than 33% of children and adolescents aged 2-14 years being overweight or obese.Obesity disproportionately affects Māori (New Zealand's indigenous population) and Pacific children and adolescents,as well as those of lower socioeconomic status.New Zealand's obesity epidemic is associated with numerous health issues,including cardiometabolic,gastrointestinal,and psychological problems,which also disproportionately affect Māori and Pacific children and adolescents.Notably,a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions.Conclusions The prevalence of overweight and obese children and adolescents in New Zealand is markedly high,with a greater impact on particular ethnicities and those of lower socioeconomic status.Alleviating the current burden of pediatric obesity should be a key priority for New Zealand,for the benefit of both current and subsequent generations.Future strategies should focus on obesity prevention,particularly starting at a young age and targeting those at greatest risk.

关键词： Obesity Children Adolescents New Zealand Pacific Islands