Nested case-control study of multiple serological indexes and Brighton pediatric early warming score in predicting death of children with sepsis

BACKGROUND

Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the post-treatment status of children with sepsis.

AIM

To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.

METHODS

A total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested case-control study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.

RESULTS

A total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h (P = 0.017), shock (P = 0.044), multiple organ dysfunction syndrome (MODS) (P = 0.027), serum procalcitonin (PCT) (P = 0.047), serum albumin (ALB) (P = 0.024), and PEWS (P = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest (0.908).

CONCLUSION

Antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.

Copper Oxide Nanoparticle Foliar Uptake, Phytotoxicity, and Consequences for Sustainable Urban Agriculture

Throughout the world, urban agriculture supplies fresh local vegetables to city populations. However, the increasing anthropogenic uses of metal-containing nanoparticles (NPs) such as CuO-NPs in urban areas may contaminate vegetables through foliar uptake. This study focused on the CuO-NP transfer processes in leafy edible vegetables (i.e., lettuce and cabbage) to assess their potential phytotoxicity. Vegetables were exposed via leaves for 5, 10, or 15 days to various concentrations of CuO-NPs (0, 10, or 250 mg per plant). Biomass and gas exchange values were determined in relation to the Cu uptake rate, localization, and Cu speciation within the plant tissues. High foliar Cu uptake occurred after exposure for 15 days for lettuce [3773 mg (kg of dry weight)-1] and cabbage [4448 mg (kg of dry weight)-1], along with (i) decreased plant weight, net photosynthesis level, and water content and (ii) necrotic Cu-rich areas near deformed stomata containing CuO-NPs observed by scanning electron microscopy and energy dispersive X-ray microanalysis. Analysis of the CuO-NP transfer rate (7.8-242 μg day-1), translocation of Cu from leaves to roots and Cu speciation biotransformation in leaf tissues using electron paramagnetic resonance, suggests the involvement of plant Cu regulation processes. Finally, a potential health risk associated with consumption of vegetables contaminated with CuO-NPs was highlighted.

Measurement of metal bioaccessibility in vegetables to improve human exposure assessments: field study of soil-plant-atmosphere transfers in urban areas, South China

The quality of cultivated consumed vegetables in relation to environmental pollution is a crucial issue for urban and peri-urban areas, which host the majority of people at the global scale. In order to evaluate the fate of metals in urban soil-plant-atmosphere systems and their consequences on human exposure, a field study was conducted at two different sites near a waste incinerator (site A) and a highway (site B). Metal concentrations were measured in the soil, settled atmospheric particulate matter (PM) and vegetables. A risk assessment was performed using both total and bioaccessible metal concentrations in vegetables. Total metal concentrations in PM were (mg kg^-1): (site A) 417 Cr, 354 Cu, 931 Zn, 6.3 Cd and 168 Pb; (site B) 145 Cr, 444 Cu, 3289 Zn, 2.9 Cd and 396 Pb. Several total soil Cd and Pb concentrations exceeded China's Environmental Quality Standards. At both sites, there was significant metal enrichment from the atmosphere to the leafy vegetables (correlation between Pb concentrations in PM and leaves: r = 0.52, p < 0.05) which depended on the plant species. Total Cr, Cd and Pb concentrations in vegetables were therefore above or just under the maximum limit levels for foodstuffs according to Chinese and European Commission regulations. High metal bioaccessibility in the vegetables (60-79 %, with maximum value for Cd) was also observed. The bioaccessible hazard index was only above 1 for site B, due to moderate Pb and Cd pollution from the highway. In contrast, site A was considered as relatively safe for urban agriculture.

Kinetic study of phytotoxicity induced by foliar lead uptake for vegetables exposed to fine particles and implications for sustainable urban agriculture

At the global scale, foliar metal transfer occurs for consumed vegetables cultivated in numerous urban or industrial areas with a polluted atmosphere. However, the kinetics of metal uptake, translocation and involved phytotoxicity was never jointly studied with vegetables exposed to micronic and sub-micronic particles (PM). Different leafy vegetables (lettuces and cabbages) cultivated in RHIZOtest® devices were, therefore, exposed in a greenhouse for 5, 10 and 15days to various PbO PM doses. The kinetics of transfer and phytotoxicity was assessed in relation to lead concentration and exposure duration. A significant Pb accumulation in leaves (up to 7392mg/kg dry weight (DW) in lettuce) with translocation to roots was observed. Lead foliar exposure resulted in significant phytotoxicity, lipid composition change, a decrease of plant shoot growth (up to 68.2% in lettuce) and net photosynthesis (up to 58% in lettuce). The phytotoxicity results indicated plant adaptation to Pb and a higher sensitivity of lettuce in comparison with cabbage. Air quality needs, therefore, to be considered for the health and quality of vegetables grown in polluted areas, such as certain megacities (in China, Pakistan, Europe, etc.) and furthermore, to assess the health risks associated with their consumption.

Foliar uptake and metal(loid) bioaccessibility in vegetables exposed to particulate matter

At the global scale, high concentrations of particulate matter (PM) enriched with metal(loid)s are currently observed in the atmosphere of urban areas. Foliar lead uptake was demonstrated for vegetables exposed to airborne PM. Our main objective here was to highlight the health risk associated with the consumption of vegetables exposed to foliar deposits of PM enriched with the various metal(loid)s frequently observed in the atmosphere of urban areas (Cd, Sb, Zn and Pb). Leaves of mature cabbage and spinach were exposed to manufactured mono-metallic oxide particles (CdO, Sb2O3 and ZnO) or to complex process PM mainly enriched with lead. Total and bioaccessible metal(loid) concentrations were then measured for polluted vegetables and the various PM used as sources. Finally, scanning electronic microscopy coupled with energy dispersive X-ray microanalysis was used to study PM-phyllosphere interactions. High quantities of Cd, Sb, Zn and Pb were taken up by the plant leaves. These levels depended on both the plant species and nature of the PM, highlighting the interest of acquiring data for different plants and sources of exposure in order to better identify and manage health risks. A maximum of 2% of the leaf surfaces were covered with the PM. However, particles appeared to be enriched in stomatal openings, with up to 12% of their area occupied. Metal(loid) bioaccessibility was significantly higher for vegetables compared to PM sources, certainly due to chemical speciation changes. Taken together, these results confirm the importance of taking atmospheric PM into account when assessing the health risks associated with ingestion of vegetables grown in urban vegetable crops or kitchen gardens.

Environmental and health impacts of fine and ultrafine metallic particles: assessment of threat scores

This study proposes global threat scores to prioritize the harmfulness of anthropogenic fine and ultrafine metallic particles (FMP) emitted into the atmosphere at the global scale. (Eco)toxicity of physicochemically characterized FMP oxides for metals currently observed in the atmosphere (CdO, CuO, PbO, PbSO(4), Sb(2)O(3), and ZnO) was assessed by performing complementary in vitro tests: ecotoxicity, human bioaccessibility, cytotoxicity, and oxidative potential. Using an innovative methodology based on the combination of (eco)toxicity and physicochemical results, the following hazard classification of the particles is proposed: CdCl2~CdO>CuO>PbO>ZnO>PbSO(4)>Sb(2)O(3). Both cadmium compounds exhibited the highest threat score due to their high cytotoxicity and bioaccessible dose, whatever their solubility and speciation, suggesting that cadmium toxicity is due to its chemical form rather than its physical form. In contrast, the Sb(2)O(3) threat score was the lowest due to particles with low specific area and solubility, with no effects except a slight oxidative stress. As FMP physicochemical properties reveal differences in specific area, crystallization systems, dissolution process, and speciation, various mechanisms may influence their biological impact. Finally, this newly developed and global approach could be widely used in various contexts of pollution by complex metal particles and may improve risk management.