Continuous tracheal gas insufflation during protective mechanical ventilation in juvenile piglets with acute lung injury induced by endotoxin

Low tidal volume mechanical ventilation is difficult to correct hypoxemia, and prolonged inhalation of pure oxygen can lead to oxygen poisoning. We suggest that continuous tracheal gas insufflation （TGI） during protective mechanical ventilation could improve cardiopulmonary function in acute lung injury. Totally 12 healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH2O with a peak inspiratory pressure of 10 cmH2O. The piglets were challenged with lipopolysaccharide and randomly assigned into two groups （n=6 each group）： mechanical ventilation （MV） alone and TGI with continuous airway flow 2 I/min. FIO2 was set at 0.4 to avoid oxygen toxicity and continuously monitored with an oxygen analyzer. Tidal volume, ventilation efficacy index and mean airway resistant pressure were significantly improved in the TGI group （P〈0.01 or P〈0.05）. At 4 hours post ALl, pH decreased to below 7.20 in the MV group, and improved in the TGI group （P〈0.01）. Similarly, PaCO2 was stable and was significantly lower in the TGI group than in the MV group （P〈0.01）. PaO2 and PaO2/FIO2 increased also in the TGI group （P〈0.05）. There was no significant difference in heart rate, respiratory rate, mean artery pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between the two groups. Lung histological examination showed reduced inflammation, reduced intra- alveolar and interstitial patchy hemorrhage, and homogenously expanded lungs in the TGI group. Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy and may provide a better treatment for acute lung injury.

2023 China Guidelines for Lipid Management

Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death among urban and rural residents in China,and elevated low-density lipoprotein cholesterol(LDL-C)is a risk factor for ASCVD.Considering the increasing burden of ASCVD,lipid management is of the utmost importance.In recent years,research on blood lipids has made breakthroughs around the world,hence a revision of China guidelines for lipid management is imperative,especially since the target lipid levels in the general population vary in respect to the risk of ASCVD.The level of LDL-C,which can be regarded as appropriate in a population without frisk factors,can be considered abnormal in people at high risk of developing ASCVD.As a result,the“Guidelines for the prevention and treatment of dyslipidemia”were adapted into the“China Guidelines for Lipid Management”(henceforth referred to as the new guidelines)by an Experts’committee after careful deliberation.The new guidelines still recommend LDL-C as the primary target for lipid control,with CVD risk stratification to determine its target value.These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle,be used as an initial line of treatment,followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors,as necessary.The new guidelines provide guidance for lipid management across various age groups,from children to the elderly.The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest

Objective:Cardiopulmonary resuscitation(CPR)after cardiac arrest(CA)is one of the main causes of capillary leakage syndrome(CLS).This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation(CA-CPR)model in Sprague-Dawley(SD)rats.Methods:We conducted a prospective,randomized,animal model study.All adult male SD rats were randomly divided into a normal group(group N),a sham operation group(group S),and a cardiopulmonary resuscitation group(group T).The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins.In group S and group T,the endotracheal tube was intubated.In group T,CA induced by asphyxia(AACA)was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min,and the rats were resuscitated with manual chest compression and mechanical ventilation.Preresuscitation and postresuscitation measurements,including basic vital signs(BVS),blood gas analysis(BG),routine complete blood count(CBC),wet-to-dry ratio of tissues(W/D),and the HE staining results after 6 h were evaluated.Results:In group T,the success rate of the CA-CPR model was 60%(18/30),and CLS occurred in 26.6%(8/30)of the rats.There were no significant differences in the baseline characteristics,including BVS,BG,and CBC,among the three groups(P>0.05).Compared with pre-asphyxia,there were significant differences in BVS,CBC,and BG,including temperature,oxygen saturation(SpO_(2)),mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin,hematocrit,pH,pCO_(2),pO_(2),SO_(2),lactate(Lac),base excess(BE),and Na+(P<0.05)after the return of spontaneous circulation(ROSC)in group T.At 6 h after ROSC in group T and at 6 h after surgery in groups N and S,there were significant differences in temperature,heart rate(HR),respiratory rate(RR),SpO_(2),MAP,CVP,WBC,pH,pCO_(2),Na+,and K+among the three groups(P<0.05).Compared with the other two groups,the rats in group T showed a significantly increased W/D weight ratio(P<0.05).The HE-stained sections showed consistent severe lesions in the lung,small intestine,and brain tissues of the rats at 6 h after ROSC following AACA.Conclusion:The CA-CPR model in SD rats induced by asphyxia could reproduce CLS with good stability and reproducibility.

2016 Chinese guidelines for the management of dyslipidemia in adults

Abbreviations ACS： acute coronary syndrome ALT： alanine aminotransferase Apo： apolipoprotein ASCVD： atherosclerotic cardiovascular disease AST： aspartate aminotransferase

Vancomycin-related convulsion in a pediatric patient with neuroblastoma:A case report and review of the literature

BACKGROUND Vancomycin is often used as an anti-infective drug in patients receiving antitumor chemotherapy.There are concerns about its adverse drug reactions during treatment,such as nephrotoxicity,ototoxicity,hypersensitivity reactions,etc.However,potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.CASE SUMMARY A 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion.No other potential disease conditions could explain the occurrence of the convulsion.The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion.The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L,respectively,which were much higher than the safe range.Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg·h/L.Therefore,vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.CONCLUSION Unexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin.Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.

Brain development in newborns and infants after ECMO

Background Extracorporeal membrane oxygenation(ECMO)not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues.To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment,with a focus on motor deficits,cognitive impairments,sensory impairments,and developmental delays.This review aims to understand the incidence,prevalence,and risk factors for these problems and to explore current nursing care and management strategies.Data sources A comprehensive literature search was performed across PubMed,EMBASE,and Web of Science using a wide array of keywords and phrases pertaining to ECMO,neonates,infants,and various facets of neurodevelopment.The initial screening involved reviewing titles and abstracts to exclude irrelevant articles,followed by a full-text assessment of potentially relevant literature.The quality of each study was evaluated based on its research methodology and statistical analysis.Moreover,citation searches were conducted to identify potentially overlooked studies.Although the focus was primarily on neonatal ECMO,studies involving children and adults were also included due to the limited availability of neonate-specific literature.Results About 50%of neonates post-ECMO treatment exhibit varying degrees of brain injury,particularly in the frontal and temporoparietal white matter regions,often accompanied by neurological complications.Seizures occur in 18%–23%of neonates within the first 24 hours,and bleeding events occur in 27%–60%of ECMO procedures,with up to 33%potentially experiencing ischemic strokes.Although some studies suggest that ECMO may negatively impact hearing and visual development,other studies have found no significant differences;hence,the influence of ECMO remains unclear.In terms of cognitive,language,and intellectual development,ECMO treatment may be associated with potential developmental delays,including lower composite scores in cognitive and motor functions,as well as potential language and learning difficulties.These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors,possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations.Overall,further multicenter,large-sample,long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects.Conclusions The impact of ECMO on an infant’s nervous system still requires further investigation with larger sample sizes for validation.Fine-tuned management,comprehensive nursing care,appropriate patient selection,proactive monitoring,nutritional support,and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.

Deuterated N-difluoromethylthiophthalimide:A stable,scalable reagent for radical and electrophilic deuteriodifluoromethylthiolations

A new,stable and scalable reagent for deuteriodifluoromethylthiolation(deuterated N-difluoromethylthiophthalimide,PhthSCF_(2)D)has been developed.This reagent can be applied for the photocatalytic radical deuteriodifluoromethylthiolation of various olefins and aldehydes(30 examples).Meanwhile,it can achieve the electrophilic deuteriodifluoromethylthiolation of a series of electrophilic substrates including electron-rich arenes,aryl/vinylboronicacids,alkynes,amines,thiols andβ-ketoesters(22 examples).Some complex molecules can also be applied in both radical and electrophilic deuteriodifluoromethylthiolation using PhthSCF_(2)D as the reagent.

Clinical experiences in the management of critically ill patients with COVID‑19 in a designated children’s hospital in China

Omicron variant has been the dominant epidemic variant of novel coronavirus in the world since 2021.Studies have shown that the incidence of severe or critical cases with coronavirus disease 2019(COVID-19)is much lower than that of the previous novel coronavirus variants[1,2];however,it is still a major challenge to treat critical pediatric patients with COVID-19,especially for those with underlying diseases.

Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Background Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treat-ments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed. Methods National Health Commission of China assembled an expert committee for a revision of the guidelines. The com-mittee included 33 members who are specialized in diagnosis and treatment of HFMD. Results Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia;(2) involvement of nervous system;(3) worsening respiratory rate and rhythm;(4) circulatory dysfunction;(5) elevated peripheral WBC count;(6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases. Conclusion The guidelines can provide systematic guidance on the diagnosis and management of HFMD.

The synergistic catalysis on Co nanoparticles and CoNx sites of aniline-modified ZIF derived Co@NCs for oxidative esterification of HMF

An efficient sustainable and scalable strategy for the synthesis of porous cobalt/nitrogen co-doped carbons(Co@NCs) via pyrolysis of aniline-modified ZIFs,has been demonstrated.Aniline can coordinate and absorb on the surface of ZIF(ZIF-CoZn3-PhA),accelerate the precipitation of ZIFs,thus resulting in smaller ZIF particle size.Meanwhile,the aniline on the surface of ZIF-CoZn3-PhA promotes the formation of the protective carbon shell and smaller Co nanoparticles,and increases nitrogen content of the catalyst.Because of these prope rties of Co@NC-PhA-3,the oxidative esterification of 5-hydroxymethylfurfural can be carried out under ambient conditions.According to our experimental and computational results,a synergistic catalytic effect between CoNx sites and Co nanoparticles has been established,in which both Co nanoparticles and CoNx can activate O2 while Co nanoparticles bind and oxidize HMF.Moreover,the formation and release of active oxygen species in CoNx sites are reinfo rced by the electronic interaction between Co nanoparticles and CoNx.

Carbohydrate-derived porous carbon materials:An ideal platform for green organic synthesis

Porous carbon materials have attracted much attention in the field of organic synthesis in recent years,due to their tunable properties,excellent catalytic activity and stability.Biomass-based carbohydrates emerge as an ideal precursor for the generation of these materials owing to their renewability,low cost,non-toxicity and high content of functional groups.Thus,carbon materials prepared from carbohydrates is of considerable importance for the sustainable development of organic chemistry.The present review not only summarizes recent examples of carbohydrate-derived porous carbon material-catalyzed organic reactions including the oxidation,hydrogenation,cross-coupling,esterification and condensation reactions,but also introduces the preparation and functionalization strategies of these materials.Furthermore,the challenges and opportunities of organic synthesis over these sustainable materials have also been addressed.This review will stimulate further research on exploring novel carbohydrate-derived porous carbon materials and new sustainable organic synthetic processes over these materials.

Lignin-derived Zn single atom/N-codoped porous carbon forα-alkylation of aromatic ketones with alcohols via borrowing hydrogen strategy

A green and scalable strategy has been developed for the synthesis of lignin-derived Zn single atom/N-codoped porous carbon(LCN@Zn-SAC)containing similar ZnNx sites with carbonic anhydrases.This catalyst exhibits superior activity on theα-alkylation of ketones with alcohols via borrowing hydrogen strategy(TON up to 15 h^(−1))than most of previously reported works.The dehydrogenation of benzyl alcohol is the rate-determining step based on kinetic experiment results.According to experimental and theoretical calculation results,Zn electron density is inversely proportional to reaction energy barriers,because Zn sites with less positive charge(ZnN_(4) and ZnN_(3)C)in Zn-SACs display better borrowing hydrogen ability than other Zn sites.Furthermore,this catalyst can be recycled by simple centrifugation,which can be reused at least 8 runs with no obvious lose in activity.To the best of our knowledge,this is the first example of non-noble metal-SAC-catalyzedα-alkylation via borrowing hydrogen strategy.