Evaluation of a modified paediatric early warning score for children with congenital heart disease

BACKGROUND

Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation.

AIM

The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD.

DESIGN

Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital.

RESULTS

The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor "requirement of action" showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862-0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637-0.824, p = 0.001) compared to 0.862 (95% CI 0.809-0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%).

CONCLUSION

The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.

Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium

BACKGROUND/AIMS

Perioperative pain in children is often inadequately treated, and emergence agitation is common. The purpose of this analysis was to determine whether nalbuphine is suitable for perioperative eye pain and to analyse if it influences the occurrence of emergence delirium/agitation (EDA) in children undergoing ophthalmic surgery in general anaesthesia.

METHODS

Retrospective cohort analysis of 50 children in preschool age undergoing general anaesthesia for ophthalmic surgery receiving nalbuphine as a postoperative analgesic in a German university hospital from June 2020 to February 2021.Scores and values for pain and EDA were routinely recorded after awakening and during the stay in the recovery room. Data were evaluated retrospectively from the medical records.

RESULTS

A total of 50 children (17 girls and 33 boys) underwent general anaesthesia for ophthalmic surgery. The median age of the children included was 20.5 months (range, 1-68 months), the median body weight was 12.25 kg (range, 2.9-29 kg). All patients received ibuprofen (10 mg/kg1) during induction of anaesthesia and nalbuphine (0.1 mg/kg) at the end of surgery. All patients had an Paediatric-Anaesthesia-Emergence-Delirium-I-score (PAED-ED-I Score) of less than 6 and acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC less than 3) on waking and on leaving the recovery room.

CONCLUSION

Nalbuphine shows a sufficient analgesic effect for pain therapy following ophthalmic surgery in preschool children. Nalbuphine seems to reduce the incidence of EDA in children undergoing ophthalmic surgery.

Human metapneumovirus infection in the cardiac paediatric ICU before and during COVID-19 pandemic: a retrospective cohort analysis

INTRODUCTION

This study investigates the hygiene standards in the context of the COVID-19 pandemic and their impact on the perioperative incidence of human metapneumovirus as well as the typical symptom burden of human metapneumovirus-infected children with CHDs.

MATERIALS AND METHODS

Between March 2018 and July 2021, all patients of a cardiac paediatric ICU of a German university hospital were included in this retrospective cohort analysis.

RESULTS

A total of 589 patients with CHD were included in the analysis. Three hundred and fifty-two patients (148 females and 204 males) were admitted before the introduction of social distancing and face masks between March 2018 and 15 April 2020 (cohort A). Two hundred and thirty-seven patients (118 females and 119 males) were admitted after the introduction between April 16 and July 2021 (cohort B). In cohort A, human metapneumovirus was detected in 11 out of 352 patients (3.1%) during their stay at cardiac paediatric ICU. In cohort B, one patient out of 237 (0.4%) tested positive for human metapneumovirus. Patients who tested positive for human metapneumovirus stayed in cardiac paediatric ICU for a median of 17.5 days (range, 2-45 days). Patients without a detected human metapneumovirus infection stayed in the cardiac paediatric ICU for a median of 4 days (range, 0.5-114 days). Nine out of 12 (75%) human metapneumovirus-positive patients showed atelectasis.

CONCLUSION

Perioperative human metapneumovirus infections prolong cardiac paediatric ICU stay in children with CHD. In affected patients, pulmonary impairment with typical symptoms appears. Under certain circumstances, a complication-rich perioperative infection with human metapneumovirus could be prevented in paediatric cardiac high-risk patients by prophylactic hygiene intervention.

Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis

BACKGROUND

Many different sedation concepts for magnetic resonance imaging have been described for prematurely and term-born infants, ranging from "no sedation" to general anesthesia. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate older children, because the anesthesiologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards.

AIMS

The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for prematurely and term-born infants less than 60 weeks postconceptional age undergoing diagnostic procedures.

METHODS

We performed a retrospective monocentric analysis of n = 39 prematurely and term-born infants (<60 weeks postconceptional age or a body weight <5 kg) who were sedated with dexmedetomidine for an MRI at a German university hospital from August 2016 to November 2018.

RESULTS

Successful imaging was achieved in all cases. The median initial bolus of dexmedetomidine administered over 10 min was 1.39 μg kg^-1 body weight (range 0.34-3.64 μg kg^-1 ), followed with a continuous infusion at a median rate of 1.00 μg kg^-1  h^-1 (range 0.5-3.5 μg kg^-1  h^-1 ); however, 3 patients (7%) needed some additional sedation (ketamine or propofol). All patients, including 10 infants who had previously required respiratory support, underwent the procedure without any relevant desaturation or apnea. Bradycardia was observed in up to 15 out of 39 cases (38.5%), but only four (10.3% in total and 26.7% of bradycardia) required atropine.

CONCLUSIONS

These results indicate that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of prematurely and term-born infants less than 60 weeks postconceptional age. Apnea during procedural sedation and subsequent stay in the recovery room is avoided, but bradycardia remains a relevant risk that may require treatment.

Potential of Hymenopteran larval and egg parasitoids to control stored-product beetle and moth infestation in jute bags

The control of stored-product moths in bagged commodities is difficult because the developmental stages of the moths are protected by the bagging material from control measures such as the application of contact insecticides. Studies were carried out to assess the ability of Hymenopteran parasitoids to locate their hosts inside jute bags in the laboratory. The ability of different parasitoids to penetrate jute bags containing rice was investigated in a controlled climate chamber. Few Habrobracon hebetor (Say) (Hymenoptera: Braconidae) passed through the jute material while a high percentage of Lariophagus distinguendus (Förster), Anisopteromalus calandrae (Howard) (Hymenoptera: Pteromalidae), Theocolax elegans (Westwood) (Hymenoptera: Pteromalidae) and Trichogramma evanescens Westwood (Hymenoptera: Trichogrammatidae) were able to enter the Petri-dishes. Significantly more L. distinguendus and T. elegans entered compared to H. hebetor. There was significant difference in the mean percentage parasitoids invading depending on species. Head capsules and/or thorax widths were measured in order to determine whether the opening in the jute material would be large enough for entry of the parasitoids. These morphometric data differed depending on parasitoid species and sex. The parasitoid Venturia canescens (Gravenhorst) (Hymenoptera: Ichneumonidae) did not enter the bags, but located host larvae inside the jute bags and parasitized rice moths Corcyra cephalonica larvae by stinging through the jute material. Venturia canescens significantly reduced the number of C. cephalonica adults emerging from the bagged rice; therefore, it could be released in storage rooms containing bagged rice for biological control of C. cephalonica. The use of parasitoids to suppress stored-product insect pests in bagged commodities could become a valuable supplement to the use of synthetic pesticides.

Responses of Arabidopsis thaliana plant lines differing in hydroxylation of aliphatic glucosinolate side chains to feeding of a generalist and specialist caterpillar

Plants contain variable chemical compositions which play a role in direct defense against phytophagous insects. Glucosinolates (GSs) are the predominant secondary metabolites and defense compounds in brassicaceous species. As a consequence of co-evolution between adapted crucifer-feeding specialists and their associated host-plants, specific plant-insect interactions have developed in a divergent manner from non-adapted generalists. Therefore, generalist and specialist insects may provoke different insect-inducible plant responses. Here, we have investigated the specific biochemical and molecular plant responses of Arabidopsis thaliana (L.) induced by the generalist Spodoptera exigua (Hübner) and the specialist Pieris brassicae L. To get more detailed information about herbivore-mediated-specific plant responses in different chemotypes within one species, we used multiple plant lines with either the non-hydroxylated 3-methylsulfinylpropyl GS or the hydroxylated 3-hydroxypropyl GS in a comparable genetic background. Caterpillar feeding induced a stronger GS accumulation in the 3-hydroxypropyl GS chemotype than the 3-methylsulfinylpropyl GS chemotype, considering the overall insect-mediated changes in aliphatic and indole GS levels in all lines. Herbivory by the generalist S. exigua and the specialist P. brassicae had similar effects on biochemical and transcriptional response pattern. Contrary to the paradigm that specialists may minimize the induction of chemical defenses, we observed a higher elicitation of GSs by the specialist species. The accumulation of especially 1-methoxy-indol-3-ylmethyl GS and the induced gene transcripts by the two species point to an insect-mediated activation of the jasmonic acid signaling pathway in the plant lines.

Phaedon cochleariae (F.) performance on different crucifer varieties with different glucosinolate profiles

The mustard leaf beetle, Phaedon cochleariae (F.) (Coleoptera: Chrysomelidae), is a serious insect pest of cruciferous crops, known especially in Europe. Feeding performances of P. cochleariae on six varieties of crucifer crops (Sinapis alba, Flata and Litember; Raphanus sativus, Münchener Bier and Runder Schwarzer Winter; and Brassica chinensis, Joi Choi and Black Behi) was investigated. The larval performance, measured by weight increase within seven days, was significantly different among six cultivars. The highest larval weight increase observed was on the B. chinensis cultivars with the lowest GS contents, followed by R. sativus and S. alba cultivars. Furthermore, a better larval performance co-insisted with the presence of indolyl and aliphatic GS in cultivars like B. chinensis and R. sativus and was poor on mustard cultivars with aromatic GS. Similar to the weight increase observation, the oviposition performance of P. cochleariae adult beetle was also investigated on three varieties: S. alba: Litember, R. sativus: Muinchener Bier, and B. chinensis: Joi Choi. The female P. cochleoriae laid significantly different numbers of eggs within three days on the different cultivars of crucifers. The highest number of eggs was laid on the B. chinensis cultivar Joi Choi, followed by the radish and mustard cultivars Muinchener Bier and Litember, respectively. Differential oviposition behaviour of P. cochleariae on the different varieties might be explained by their different GS profiles and the dominating group of GS. Indolyl GS, which are abundant in B. chinensis, may have a more stimulatory effect on the oviposition of P. cochleariae than aromatic and aliphatic GS.

Monitoring Diabrotica v. virgifera (Col.: Chrysomelidae) in southeastern Slovenia: increasing population trend and host spectrum expansion

Ever since the western corn rootworm (WCR) (Diabrotica virgifera virgifera), an alien invasive species from North America, has been introduced into Europe on at least 3 separate occasions, it spread within 15 years over the entire area of south-eastern and central Europe (except Denmark). Until quite recently, Zea mays L. was the only known host plant whereas in North America WCR also attacks members of the plant family Cucurbitaceae. In August of 2006, we were able to validate these findings also in the Old World by observing WCR visiting blossoms of oil pumpkin (Cucurbita pepo L.). Beside this first report of WCR on this regionally and economically important crop, a population increase in Gaberje near Lendava, Eastern Slovenia, was observed. Some future consequences of multiple hosts for integrated pest management (IPM) of WCR are being discussed.

Basic fibroblast growth factor controls migration in human mesenchymal stem cells

Little is known about the migration of mesenchymal stem cells (MSCs). Some therapeutic approaches had demonstrated that MSCs were able to regenerate injured tissues when applied from different sites of application. This implies that MSCs are not only able to migrate but also that the direction of migration is controlled. Factors that are involved in the control of the migration of MSCs are widely unknown. The migratory ability of isolated MSCs was tested in different conditions. The migratory capability was examined using Boyden chamber assay in the presence or absence of basic fibroblast growth factor (bFGF), erythropoietin, interleukin-6, stromal cell-derived factor-beta, and vascular endothelial growth factor. bFGF in particular was able to increase the migratory activity of MSCs through activation of the Akt/protein kinase B (PKB) pathway. The results were supported by analyzing the orientation of the cytoskeleton. In the presence of a bFGF gradient, the actin filaments developed a parallelized pattern that was strongly related to the gradient. Surprisingly, the influence of bFGF was not only an attraction but also routing of MSCs. The bFGF gradient experiment showed that low concentrations of bFGF lead to an attraction of the cells, whereas higher concentrations resulted in repulsion. This ambivalent effect of bFGF provides the possibility to a purposeful routing of MSCs.

Improving green roofs and rail road greening systems using Bacillus subtilis and Lactobacillus ssp

Aim of the present study was the improvement of existing methods for green roof and rail road greening systems using soil borne bacteria. Bacillus subtilis and Lactobacillus ssp. alone and in combination with vinasse applied to different growing substrates were tested. The substrates were brick chips, textile mats, mineral wool mats, and a commercial available substrate for the Swedish company VegTech. All four substrates were tested along an artificial rail track on the experimental station at Humboldt University Berlin, and partly on an existing rail track in Munich, Germany. Plants selected for the experiments belong to the genus Sedum, which is relatively tolerant to dry conditions. Inoculation of plants with bacteria had no effect on plant growth parameters and on coverage of different mobile bedding systems with Sedum plants. There was no significant difference between the various treatments in Munich. In both experiments, the addition of vinasse alone improved plant growth. Plant growth was significantly different on all substrates, whereas brick chips and the commercial roof soil was the best substrate. Brick chips are a cheap substrate which can be used for rail track greening. The results indicate that the quality of the substrate is the most important factor for remediation and greening of rail tracks and roof tops. The rapid growth of plants can be influenced by the application of vinasse as additional nutrient solution (potash (K) source) or nutrient enriched substrate.

Variability of aliphatic glucosinolates in Arabidopsis and their influence on insect resistance

Due to the sessile nature of plants they have to cope up dynamically with diverse biotic and abiotic stressors. Plants developed diverse, complex defense mechanisms for dealing with their enemies, including the glucosinolate(GS)-myrosinase system of the Brassicaceae and other families of the order Brassicales. GS are classified by their precursor amino acid and aliphatic, aromatic, and indolyl GS are distinguished. Indolyl GS are widely distributed in Arabidopsis thaliana (L.) ecotypes and the Brassicaceae family, but the presence of aliphatic GS is variable and under strong genetic control. There are only few studies paying attention to the impact of certain GS on insect resistance. Due to this, we have investigated the plant resistance of A. thaliana ecotypes with different aliphatic profiles against two specialized insects. For the experiments we selected 20 ecotypes, divided into three groups after HPLC analysis: containing 1) methylsulfinyl, 2) 3-hydroxypropyl, and 3) allyl GS. As herbivore insects the generalist Spodoptera exigua Hübner and the specialist Pieris brassicae L. were selected. The selected A. thaliana ecotype groups were different suitable for consumption, but similar for both insect species. In general, the percentage weight gain of larvae on A. thaliana plants containing 3-hydroxypropyl GS and allyl GS was significantly higher for both insect species, the specialist and the generalist, compared to methylsulfinyl GS containing ecotypes. But the tendency was stronger for P. brassicae than for S. exigua. Additionally, we used simple correlation to examine the relationship between insect feeding and the GS contents in the ecotypes. It can be concluded that 3-hydroxypropyl GS containing ecotypes were less resistant than ecotypes with methyl-sulfinyl GS as main compounds. Weight gain by S. exigua was statistically significant negatively related to constitutive GS levels of methylsulfinyl GS containing ecotypes. There was also a negative relation to constitutive GS levels of methylsulfinyl GS containing ecotypes for P. brassicae but less strong and not statistically significant. A reason for a better host plant suitability of ecotypes containing 3-hydroxypropyl GS might be the short chemical structure and/or different reactivity of this compound compared to ecotypes containing methylsulfinyl GS.

Electrostatic application of inert silica dust based insecticides onto plant surfaces

One of the most effective naturally occurring insecticide powders is diatomaceous earth (DE), which contains above 96 % of silica (silicon dioxide SiO2). In recent days, the possibility to use new improved DE formulations for plant protection in horticulture has been the focus of research. For aphids and other under-leaf insects only insecticides deposited on leaf undersides are effective. We tested electrostatic application of different silica containing dusts onto the cruciferous crop pak-choi (Brassica chinensis). The materials tested were Fossil Shield 90.0s, Advasan, Biobeck PA910, and a formulation newly developed by the Urban Horticultural Section at Humboldt University called "Al-06". Silica materials were tested for their effect on plant photosynthesis and efficacy against the mustard beetle (Phaedon cochleariae F.). All materials have been effective in contact experiments against tested insects. However, significant differences were observed between materials after application onto plant leaves. Fossil Shield, Advasan, and Al-06 application resulted in a good coverage and in high protection against the mustard beetle. Biobeck PA910 was easily removed by wind from leaf surfaces and did not protect the plants well. However, photosynthesis has been reduced in treated plants and remained at a lower level even after dust removal. Experimental results are critically discussed in the view of future potential for crop protection programs.

Action of amorphous diatomaceous earth against different stages of the stored product pests Tribolium confusum, Tenebrio molitor, Sitophilus granarius and Plodia interpunctella

Environmental and human health problems associated with the use of synthetic pesticides have prompted the demand for non-polluting, biologically specific insecticides. The current study tested the use and action of diatomaceous earth against several stored product pests. Fossil Shield(R) applied to wooden plates was lethal to adult Tenebrio molitor and Tribolium confusum, but larvae of the mealworm were unaffected. Beetles died within 14 days exposure in the absence of food to a dose of 2 and 4 g/m(2), but mortality was reduced in those fed grain bran. Fossil Shield(R) was lethal to first instar larvae of Plodia interpunctella, but not lethal to older larval stages. Two-week old larvae of T. confusum were more sensitive to diatomaceous earth than P. interpunctella at the same age. Contact with diatomaceous earth caused adult Sitophilus granarius, T. molitor and T. confusum to lose weight and reduced their water content, suggesting disruption of "the water barrier". Death of stored product insects treated with diatomaceous earth decreased with increased r.h., due to reduced transpiration through the cuticle. High r.h. delays, or above 60% can prevent, the drying action of diatomaceous earth.

Etiologic classification of severe hypospadias: implications for prognosis and management

OBJECTIVE

Classification of severe hypospadias employing a broad array of diagnostic tools. Standardization of a diagnostic approach to children with hypospadias. Indentification of patients at risk of having malignancies and endocrine problems.

DESIGN

Retrospective analysis of patients in a single-center study.

SUBJECTS

Thirty-three patients with severe (scrotal or penoscrotal) hypospadias, aged 1 to 18 years.

METHODS

Clinical assessment, ultrasonography, karyotyping, endocrine evaluation including adrenal steroid concentrations, sex hormone-binding globulin test for androgen sensitivity, human chorionic gonadotropin stimulation with determination of testosterone and dihydrotestosterone concentrations to exclude 5 alpha-reductase deficiency, and molecular genetic analysis of the androgen receptor gene and the 5 alpha-reductase gene.

RESULTS

In 12 patients the cause was clarified. Diagnoses included Drash syndrome with Wilms tumor in infancy (3 patients), partial androgen insensitivity resulting from androgen receptor mutations (2), true hermaphroditism (2), chromosomal aberration (1), deficiency of antimüllerian hormone (1), gonadal dysgenesis (1), partial 5 alpha-reductase deficiency caused by a novel point mutation (1), and XX-male syndrome (1). Twelve patients had associated findings such as cardiac malformations (3 patients), rectal atresia (1), dilation of urinary tract (2), cystinuria (1), and others.

CONCLUSIONS

Patients with severe hypospadias should be submitted to a standardized set of diagnostic procedures in infancy. A stepwise diagnostic study avoids unnecessary, invasive, and expensive testing. A high proportion of classified causes can be expected. Patients at risk of having malignancies or hormonal disorders must remain under close surveillance.