Final Mortality Research Articles

Final diagnoses and mortality rates in ambulance patients administered nebulized β2-agonists bronchodilators.

To assess final diagnoses and mortality rates (30day and 1year) in patients treated with the inhaled bronchodilator salbutamol by ambulance personnel, and to establish its role as an identifier of moderate to severe respiratory distress in the prehospital phase of treatment. In a descriptive retrospective observational study, patients experiencing respiratory distress and treated with inhaled bronchodilators, specifically salbutamol, in the prehospital setting within the Central Denmark Region during 2018-2019 were included. The study included 6318 ambulance transports, comprising 3686 cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 234 with community-acquired pneumonia (CAP), 320 with heart disease (HD), 233 adults with asthma, 1674 with various other primary ICD-10 diagnoses (other ≥ 18years), and 171 patients under 18years. The 30day mortality rate for all patients was 10.7% (95% CI 9.8-11.6), with zero deaths within 30days among adults with asthma and those under 18. Excluding low mortality groups, AECOPD patients had the lowest 30day mortality at 10.2% (95% CI 9.1-11.3), and HD patients the highest at 15.3% (95% CI 10.6-19.9). The 1-year overall mortality rate increased to 32.1% (95% CI 30.2-34.0), with mortality staying low for asthma and under-18 groups, while differences between other groups lessened and became insignificant. Patients requiring inhaled bronchodilator treatment in ambulances exhibit notably high mortality rates at 30days and 1year, except for those with asthma or under 18. The need for prehospital bronchodilators could serve as a clear and unmistakable marker for moderate to severe respiratory distress, enabling early intervention.

Synthesis of Novel 4-Acyloxy-2'-Bromo-6'-Chloropodophyllotoxin Derivatives Displaying Significant Insecticidal Activity Against Mythimna Separata.

In order to explore novel natural product-based insecticidal agent, two important intermediates (2 and 3) and 4-acyloxy-2'-bromo-6'-chloropodophyllotoxin derivatives (4 a-f and 5 a-f) were designed and prepared, and their structures were confirmed by 1H-NMR, 13C NMR, HRMS, ESI-MS, optical rotation and melting point (mp). The stereochemical configuration of compound 4 b was unambiguously confirmed by single-crystal X-ray diffraction. Moreover, we evaluated the insecticidal activity of target compounds 4 a-f and 5 a-f against a serious agricultural pest of Mythimna separata by using the leaf-dipping method. Among all tested compounds, compounds 4 d, 5 d and 5 f exhibited stronger insecticidal activity with a final mortality rate exceeding 60 %. Especially compound 5 d exhibited the best insecticidal activity, with a final mortality rate of 74.1 %. It has been proven that introducing bromine or chlorine atoms at the C-2', C-2' and C-6' positions of the E ring of podophyllotoxin can produce more potent compounds. In addition, the configuration of the C-4 position is important for insecticidal activity, and 4β-configuration is optimal. This will pave the way for further design, structural modification, and development of derivatives of podophyllotoxin as insecticidal agents.

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis.

Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.

Data analytics-based evaluation of blood indices and adaptation of medicated and non-medicated broiler chickens under humid tropical conditions.

The growth performance and blood indices of medicated and non-medicated broiler chickens have been the subject of this research coupled with a paucity of comparative information on what can actually happen to broiler chickens if not medicated when reared under humid tropical conditions. One hundred unsexed day-old broilers were randomly and equally allotted into two treatment groups of TM (medicated) and TN (non-medicated) in a completely randomized design each treatment with five replicates having ten birds each. The birds were reared on deep litter system for 56 d which was divided into two phases of 28 d each (starter and finisher), during which data were collected with respect to daily feed intake, final body weight, body weight gained (BWG), mortality rate while blood analysis was carried out on 28th and 56th d for starter and finisher phases, respectively. Non-medicated group served as control. Feed conversion ratio (FCR) and feed conversion efficiency (FCE), were later calculated. Data collected were subjected to analysis of variance statistically. There was no significant difference between the medicated and non-medicated broilers for daily feed intake, final body weight, and BWG and also for the blood parameters investigated at starter phase. However, at finisher phase, no significant difference was observed in the daily feed intake of Tm and Tn but there was significant (P < 0.05) difference in the final body weight, BWG, FCR, FCE, and mortality rate between the two groups. Birds on Tm attained higher weight significantly (P < 0.05) than those on TN. BWG, FCR, and FCE followed the same trend and also the mortality rate. White blood cells count of TN was higher significantly (P < 0.05) than TM while TM birds recorded higher packed cell volume, red blood counts, and hemoglobin concentration (Hb) significantly (P < 0.05) than TM birds. Effect of medication was much noticeable at finisher phase as it improved the growth rate though mortality rate was close to that of TN group. These results suggest that broilers can be produced free of medication with good feeding without loss of birds while the growth rate can be enhanced with the use of prebiotics and prebiotics.

Effects of temperature on fertility in hybrid hermaphroditic Argopecten scallops

Temperature is a critical factor affecting the growth, development and reproduction of aquatic organisms. The interspecific F1 hybrids between hermaphroditic bay scallops (Argopecten irradians) and Peruvian scallops (Argopecten purpuratus) exhibited significant heterosis in yield, but sterility in most hybrids hindered large scale interspecific hybridization and speciation. We first explored the physiological effect of temperature on the fertility of hybrid hermaphroditic Argopecten scallops with F1 hybrids treated at 6 different temperatures (18 °C, 20 °C, 22 °C, 24 °C, 26 °C, and 28 °C). The results showed that the final mortality rates from 18 °C to 22 °C were significantly lower than those from 24 °C to 28 °C. With the decrease of the temperature, the size, gonadal index, ATP content, and expression of most genes related to fertility regulation gradually decreased in F1 hybrids treated at 22 °C, 20 °C and 18 °C, and the apoptosis rate of oocytes gradually increased, but the activity of SOD (superoxide dismutase) and CAT (catalase) first increased and then decreased. The fertility of hybrids treated at 22 °C, 20 °C and 18 °C gradually decreased with the decrease of the temperature. According to gene expression, temperature may regulate the fertility of Argopecten F1 hybrids by affecting apoptosis, meiosis, ATP production and damage repair to inhibit the genesis and maturation of germ cells. Our findings suggest that temperature can affect the hybrid fertility of hermaphroditic Argopecten scallops and provide the basis for further research on the mechanism of temperature on sterility.

Biological control of Cimex lectularius with Beauveria bassiana: Effects of substrate, dosage, application strategy, and bed bug physiology.

Cimex lectularius L. (bed bug) (Hemiptera: Cimicidae) is a serious indoor pest worldwide, and this nuisance needs to be controlled using different methods in integrated pest management (IPM). Beauveria bassiana (Bals.-Criv.) Vuill. (Hypocreales: Cordycipitaceae) kills bed bugs, and insect pathogenic fungi may be utilized to control bed bugs in IPM. To increase knowledge of this methodology, forced exposure experiments were conducted with different formulations, doses, and substrates, using bed bugs in variable physiological states. Both oil- and water-formulated fungal products showed significant improvement when conidial concentrations were raised in five steps from 0.02 to 2.0%. At low concentrations (0.02% in water) effects from substrate and application strategy were observed. Application on soft substrates (cotton and polyester) yielded significantly higher bed bug mortality rates than on harder substrates (paper, wood, and linoleum) with a final mortality of 35-63% against 8-10%. Multiple applications over time also improved B. bassiana's ability to kill bed bugs, and at low concentrations only a triple application on cotton showed 100% final mortality. Bed bug age and reproductive status significantly affected survival. Older and reproducing individuals showed higher mortality compared to newly emerged adults. Differences in feeding status also yielded differences in mortality timing, but only minor differences in final mortality rates. Egg production and hatching success were significantly reduced by some treatments. B. bassiana appears to be an asset in the fight against bed bugs. Substrate, dosage, application strategy, and bed bug physiology are important factors to consider for optimal efficacy and safe indoor control with insect pathogenic fungi. © 2023 Society of Chemical Industry.

The Clinical Characteristics, Microbiology and Risk Factors for Adverse Outcomes in Neonates with Gram-Negative Bacillary Meningitis.

Background: We aimed to describe the clinical features of Gram-negative bacillary (GNB) meningitis in neonates and investigate the risk factors associated with final adverse outcomes of neonatal GNB meningitis. Methods: From 2003 to 2020, all neonates (aged ≤ 90 days old) with bacterial meningitis who were hospitalized in four tertiary-level neonatal intensive care units (NICUs) of two medical centers in Taiwan were enrolled. Neonates with GNB meningitis were compared with those with Streptococcus agalactiae (group B streptococcus, GBS) meningitis. Results: During the study period, a total of 153 neonates with bacterial meningitis were identified and enrolled. GNB and GBS accounted for 40.5% (n = 62) and 35.3% (n = 54) of all neonatal bacterial meningitis, respectively. In neonates with GNB meningitis, the final mortality rate was 6.5% (4 neonates died); 48 (77.4%) had neurological complications, and 26 (44.8%) of 58 survivors had neurological sequelae at discharge. Although the final outcomes were comparable between neonates with GNB meningitis and those with GBS meningitis, neonates with GNB meningitis were more likely to have more severe clinical manifestations initially and have ventriculomegaly at follow-up. After multivariate logistic regression analysis, neonates with seizure at onset, early onset sepsis, and requirement of surgical intervention for neurological complications were independently associated with final adverse outcomes. Conclusions: GNB meningitis was associated with a high risk of neurological complications and sequelae, although it did not significantly increase the final mortality rate. Close monitoring of the occurrence of neurological complications and advanced therapeutic strategies to optimize the outcomes are urgently needed in the future.

Optimization of Osthole in the Lactone Ring as an Agrochemical Candidate: Synthesis, Characterization, and Pesticidal Activities of Osthole Amide/Ester Derivatives and Their Effects on Morphological Changes of Mite Epidermis

Structural modification of natural products is one of the important ways in the discovery of novel pesticides. Based on a diversity-oriented synthesis strategy, herein, two series of amide/ester derivatives (52 compounds) were obtained by opening the lactone of osthole. Interestingly, the effect of different concentrations of aq. sodium hydroxide on the ratio of two isomers (cis- and trans-2) was investigated, and a magical phenomenon of ultraviolet (UV) light irradiation on intertransformation of two isomers (cis- and trans-2) was observed. Against Mythimna separata, when compared with the precursor osthole, compounds 4b, 4l, 5l, 5m, 7h, 7l, and 7m displayed more pronounced growth inhibitory activity with the final mortality rates of 62.0-68.9%. Compounds 4b, 4i, and 5m showed 5.7-6.6 times stronger acaricidal activity against Tetranychus cinnabarinus than osthole, and notably, control effects of compounds 4i and 5m were 2.4- and 2.7-fold that of osthole in the management of T. cinnabarinus in the greenhouse. Scanning electron microscopy (SEM) images of the epidermis of 5m-treated T. cinnabarinus indicated that compound 5m can destroy the mite cuticle layer. Compounds 4b and 5m can be used as leads to further explore more promising pesticidal agents.

1035: GEOSPATIAL FACTORS INTERACT WITH BASELINE HEALTH TO IMPACT COVID-19 MORTALITY (COMMUNITY HOSPITAL)

Introduction: Social determinants of health have been under-reported in critically ill patients during the pandemic. We hypothesized that geospatial factors and baseline health status in our community would significantly impact outcomes from Covid-19 infection. Methods: We conducted an urban, single-center, observational study of patients with Covid-19 infection admitted to our adult ICU over ten months (March 23, 2020 to January 21, 2021, after approval by our hospital’s Institutional Review Board. Weekly prospective data on the Covid-19 study population were entered in our ICU’s quality assurance database. Data specific to test our hypothesis—zip code of residence, functional status, and Canadian Frailty Score (1-7)—were collected from retrospective chart review. The studied population was dichotomized to access patients who resided in long-term care facilities or home residence. Five zip code regions based on sample size and the distance from the patient’s residence to the hospital allowed random sampling. Statistical significance was determined using ANOVA and T-test as indicated. Results: A total of 300 patients were enrolled. Across the designated cohort-based zip code regions, the mean frailty score of patients who resided at home differed significantly (2.9± SE.98 vs. 3.8± SE. 1.28, p< 0.01). Favorable frailty scores of 1-2 had a combined death and hospice rate of 23%. Of the survivors, 30% were transferred to skilled nursing facilities (SNF) and 26% were discharged to home. Patients with frailty scores of 6-7 had a final mortality rate of 83%. Of the survivors, only 2% were transferred to a SNF and 6% were discharged to home. Compared to admitting frailty scores between 1-3, a frailty score of 4 or greater (which represented 35% of all Covid ICU patients admitted from home) had a 1.8 relative risk of death (p< 0.0001). Conclusions: In our adult Covid-19 population, geospatial factors were associated with significant variances in frailty determined on ICU admission. Worsening frailty scores were associated with marked differences in both survival and final disposition, with combined death and hospice rates as high as 80%. We recommend that these metrics be added to routine data reporting to help better characterize ICU populations and stimulate efforts to improve frailty in vulnerable populations.

Evolution of the larvicidal effects of secondary metabolites produced by Bacillus subtilis (Ehrenberg, 1835) Cohn, 1872 wild type UTB1 and mutant M419 against Plutella xylostella (L., 1758) (Lep.: Plutellidae)

The effects of Bacillus subtilis, wild type bacterium UTB1 and mutant M419, on two larval instar groups of the diamondback moth, Plutella xylostella L. (Lep.: Plutellidae) until three days after treatment have been investigated. Larval mortality rate increased with increasing the concentration and over the days after treatment. Increasing the larval instar resulted in elevating the LC50 value for both types of biosurfactants. In terms of lethality, there was no significant difference between the two bacteria in the final mortality rate after three days.

Mortality risk evaluation methods for total dissolved gas supersaturation to fish based on a mitigation measure of utilizing activated carbon

The proper water chemical composition of aquaculture water is very important for fish farming in reservoirs or fish multiplication stations. Gas bubble disease (GBD) is mainly caused by total dissolved gas supersaturation (TDGS) in water and is a common problem that affects the healthy growth of fish. Extensive measures have been taken to mitigate TDGS levels in water where fish live, while methods for quantitatively evaluating the mitigation effect of the proposed measures on fish exposed to TDGS are still lacking. In this paper, an activated carbon (AC) adsorption experiment for supersaturated total dissolved gas (TDG) dissipation was conducted, and the experimental results indicated that AC addition could effectively accelerate supersaturated TDG dissipation. Based on fish tolerance experiments conducted by Huang (2010), two models, including a mortality risk degree evaluation model and a mortality rate calculation model, were developed to quantitatively evaluate the mortality risk mitigation effect of AC addiction on fish exposed to unsteady TDGS levels. Application of the results of the mortality risk degree evaluation model has shown that AC addition can help alleviate the mortality risk of fish suffering from TDGS. Application of the results of the mortality rate calculation model has also demonstrated that the final mortality rate of the fish group in the case with AC addition was lower than that of the case without added AC, and the final mortality rate decreased as the specific surface area and dosage of AC increased. Furthermore, an equation that related the required AC mass and a given harvested fish mass was established. This paper provides a reference for evaluating the effects of various mitigation measures to alleviate the risk posed to fish by TDGS.

Effects of Probiotics on Gut Microbiomes of Extremely Preterm Infants in the Neonatal Intensive Care Unit: A Prospective Cohort Study.

Background: Probiotics have been previously reported to reduce the incidence of necrotizing enterocolitis (NEC) in extremely preterm infants, but the mechanisms by which the probiotics work remain unknown. We aimed to investigate the effects of probiotics on the gut microbiota of extremely preterm infants. Methods: A prospective cohort study was conducted on 120 extremely preterm neonates (gestational age ≤ 28 weeks) between August 2019 and December 2021. All neonates were divided into the study (receiving probiotics) and the control (no probiotics) groups. Multivariate logistic regression analysis was performed to investigate the significantly different compositions of gut microbiota between these two groups. The effects of probiotics on the occurrence of NEC and late-onset sepsis were also investigated. Results: An increased abundance of Lactobacillus was noted in neonates who received the probiotics (AOR 4.33; 95% CI, 1.89–9.96, p = 0.009) when compared with the control group. Subjects in the probiotic group had significantly fewer days of total parenteral nutrition (median [interquartile range, IQR]) 29.0 (26.8–35.0) versus 35.5 (27.8–45.0), p = 0.004) than those in the control group. The probiotic group had a significantly lower rate of late-onset sepsis than the control group (47.1% versus 70.0%, p = 0.015), but the rate of NEC, duration of hospitalization and the final in-hospital mortality rates were comparable between these two groups. Conclusions: Probiotic supplementation of extremely preterm infants soon after the initiation of feeding increased the abundance of Lactobacillus. Probiotics may reduce the risk of late-onset sepsis, but further randomized controlled trials are warranted in the future.

Acaricidal and insecticidal efficacy of new esters derivatives of a natural coumarin osthole

To discover non-food bioactive natural-product-based pesticides for crop protection, new osthole esters ((2′E)− 4′-(isoxazolin-5''-yl)carbonyloxyosthole derivatives) containing the isoxazoline fragment were constructed by structural modification of a natural coumarin osthole isolated from Cnidium monnieri. The configurations of three compounds were confirmed by X-ray crystallography. Their agricultural activities were evaluated against two typically crop-threatening pests Mythimna separata Walker and Tetranychus cinnabarinus Boisduval. Against T. cinnabarinus, compounds 4 (LC50: 0.75 mg/mL) and 5h (LC50: 0.76 mg/mL) displayed ≥ 1.5-fold acaricidal activity of osthole and good control effects in the greenhouse. Against M. separata, compounds 5a (final mortality rate (FMR): 55.1%), 5c (FMR: 62.0%), and 5o (FMR: 55.1%) at 1 mg/mL showed 1.5–1.6 folds growth inhibitory activity of osthole. It suggested that introduction of the acryloyloxy group at the C-4′ position of osthole was important for insecticidal and acaricidal activities, and compound 4 can be further structurally modified as pesticidal agents.

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes.

Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases. Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia. Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes. Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.

Impact of TDG supersaturation on native fish species under different hydropower flood discharge programs.

Total dissolved gas (TDG) supersaturation caused by the operation of hydropower stations can threaten the survival and swimming performance of fish species. Different modes of hydropower flood discharges (regular vs. intermittent) from the Dagangshan hydropower station in China were studied in July and September 2017 to study the impact of TDG supersaturation on two native fish species in the downstream Dadu River. The average TDG supersaturation value was 114.3% in July under the regular discharge mode. In September, the supersaturation of TDG fluctuated in response to the intermittent discharge mode with an average TDG of 119.3%. Apparent gas bubble trauma was found on young-of-the-year (YOY) Prenant's schizothoracin and elongate loach in cages at different water depths during the flood discharge period. The mortality rate of YOY Prenant's schizothoracin and elongate loach in cages with water depths of 0-1m were 16.25% and 2.5%, respectively, in July. The fluctuating TDG levels with higher peaks in September caused higher fish mortality rates. The final mortality rates of YOY Prenant's schizothoracin and elongate loach in cages with water depths of 0-1m were 75% and 33.75%, respectively. Fish in the cages at a 0-3m water depth survived better than those in the cages at a 0-1m water depth. The critical swimming speeds (Ucrit) of YOY Prenant's schizothoracin and elongate loach without exposure to TDG supersaturation were 11.64 and 16.76 BL s-1, respectively. Ucrit decreased significantly after experiencing the flood discharge period and recovered to the normal level after experiencing the corresponding interval period.

Treatment of Intracranial Aneurysms Using the New Silk Vista Flow Diverter: Safety Outcomes at Short-Term Follow-Up.

Background: Flow diverters are widely used as the first endovascular treatment option for complex brain aneurysms due to their high percentage of occlusion and low morbi-mortality. The Silk Vista device is a new generation of flow diverters designed to facilitate full visibility, improve apposition to the vessel wall, and enhance navigability. Indeed, its greatest advantage is that it enables the easier navigation of stents between 3.5 and 4.75 mm through a 0.021 microcatheter. The objective of this study was to evaluate the safety and effectiveness of Silk Vista systems for treating cerebral aneurysms.Methods: This prospective observational study included 25 consecutive patients with 27 wide-necked unruptured aneurysms treated with SILK Vista who were retrospectively analyzed for safety and efficacy.Results: Endovascular treatment was successfully performed in all patients. The final morbidity and mortality rates were both 0.0%. Short-term (3–5 months) angiographic follow-up revealed 21 complete occlusions and 6 near-complete occlusions. No significant parent artery stenosis was observed.Conclusions: This report demonstrates the efficacy of Silk Vista in treating brain aneurysms, although longer experiences should be carried out to confirm our results.

Identification, Virulence, and Molecular Characterization of a Recombinant Isolate of Grass Carp Reovirus Genotype I.

The hemorrhagic disease of grass carp (HDGC) caused by grass carp reovirus (GCRV) still poses a great threat to the grass carp industry. Isolation and identification of the GCRV genotype I (GCRV-I) has been rarely reported in the past decade. In this study, a new GCRV was isolated from diseased fish with severe symptoms of enteritis and mild hemorrhages on the body surface. The isolate was further identified by cell culture, transmission electron, indirect immunofluorescence, and SDS-PAGE electrophoretic pattern analysis of genomic RNA. The results were consistent with the new isolate as a GCRV-I member and tentatively named GCRV-GZ1208. Both grass carp and rare minnow infected by the GCRV-GZ1208 have no obvious hemorrhagic symptoms, and the final mortality rate was ≤10%, indicating that it may be a low virulent isolate. GZ1208 possessed highest genomic homology to 873/GCHV (GCRV-I) and golden shiner reovirus (GSRV). Additionally, it was found a 90.7–98.3% nucleotide identity, a 96.4–100% amino acid identity, and <50% identity with GCRV-II and III genotypes. Interestingly, the sequences of some segments of GZ1208 were similar to GCRV-8733/GCHV, whereas the remaining segments were more closely related to GSRV, suggesting that a recombination event had occurred. Bootscan analysis of the complete genomic sequence confirmed this hypothesis, and recombination events between 873/GCHV and other GSRV-like viruses were also accompanied by gene mutations.

Therapeutic effects and outcomes of rescue high-frequency oscillatory ventilation for premature infants with severe refractory respiratory failure

Despite wide application of high frequency oscillatory ventilation (HFOV) in neonates with respiratory distress, little has been reported about its rescue use in preterm infants. We aimed to evaluate the therapeutic effects of HFOV in preterm neonates with refractory respiratory failure and investigate the independent risk factors of in-hospital mortality. We retrospectively analyzed data collected prospectively (January 2011–December 2018) in four neonatal intensive care units of two tertiary-level medical centers in Taiwan. All premature infants (gestational age 24–34 weeks) receiving HFOV as rescue therapy for refractory respiratory failure were included. A total of 668 preterm neonates with refractory respiratory failure were enrolled. The median (IQR) gestational age and birth weight were 27.3 (25.3–31.0) weeks and 915.0 (710.0–1380.0) g, respectively. Pre-HFOV use of cardiac inotropic agents and inhaled nitric oxide were 70.5% and 23.4%, respectively. The oxygenation index (OI), FiO2, and AaDO2 were markedly increased after HFOV initiation (all p < 0.001), and can be decreased within 24–48 h (all p < 0.001) after use of HFOV. 375 (56.1%) patients had a good response to HFOV within 3 days. The final in-hospital mortality rate was 34.7%. No association was found between specific primary pulmonary disease and survival in multivariate analysis. We found preterm neonates with gestational age < 28 weeks, occurrences of sepsis, severe hypotension, multiple organ dysfunctions, initial higher severity of respiratory failure and response to HFOV within the first 72 h were independently associated with final in-hospital mortality. The mortality rate of preterm neonates with severe respiratory failure remains high after rescue HFOV treatment. Aggressive therapeutic interventions to treat sepsis and prevent organ dysfunctions are the suggested strategies to optimize outcomes.

Study of the effect of added bronchoscopic suction to routine treatment of ventilator associated pneumonia patients in surgical ICU.

Comparing BAL and antibiotic therapy with antibiotic therapy itself for treating VAP patients in ICU. In this randomized clinical trial, the first group was treated using antibiotics and closed-suction was performed daily, using 50 cc of sterile normal saline. The second group was treated with antibiotics and daily closed-suction with 50 cc of sterile normal saline, plus bronchoscopic suction every other day. Patients of both groups were followed and investigated one, 3, 7, and 10 days after initial diagnosis. Mean blood leukocyte count and body temperature was measured in groups one (no bronchoscopy) and two (with bronchoscopy) in first, 3rd, 7th, and 10th days which was higher in the second group. Mean treatment status was also measured using APACHE II index. There was also a statistically significant difference in 3rd day (p-value < 0.05). There was also no difference in final culture result or mortality rate between two groups. According to the results of this study like lower body temperature, higher leukocyte count reduction, and lower APACHE II scores in the second group, treated with bronchoscopic suction, adding bronchoscopy seems to be more useful than normal method.

Effectiveness and safety of ICA stenting in conjunction with mechanical thrombectomy (antegrade approach) in acute ischaemic stroke patients due to tandem occlusion.

We investigated the effectiveness and safety of an antegrade approach consisting of emergency ICA stenting in conjunction with mechanical thrombectomy (MT) in a one-stage procedure as a treatment for Tandem Occlusion (TO). We here describe our experience in the treatment of TO with an antegrade approach with long-term results. We also discuss the advantages and drawbacks of this treatment modality with special attention to possible haemorrhagic complications that can be encountered in patients with ischaemic stroke who receive antiplatelet treatment. We believe that our study adds to the limited number of reports on this topic. We selected 34 patients diagnosed with acute ischaemic stroke due to ICA and ipsilateral intracranial occlusion treated with ICA stenting in conjunction with MT. We analysed the short- and long-term results as well as investigating complications with special regard to haemorrhagic transformation associated with the need for antiplatelet treatment after stent implantation in patients after acute ischaemic stroke treatment. A favourable angiographic outcome was defined as mTICI 2b-3. This was achieved in 33/34 patients (97%). On average, NIHSS at 24 hours after the procedure was 8.5 ± 7, which indicates a significant clinical improvement. Four cases of symptomatic ICH were observed (11.8%). One re-occlusion in stent was noted. At three-month follow-up, mRS scores were 0 in 11 (34.3%), 1 in 5 (16%), 2 in 1 (3%), 3 in 3 (9.3%), 4 in 3 (9.3%), and 5 in 2 (6%) patients. Seven patients did not survive (22%). Overall, a favourable outcome (mRS 0-2) was achieved in 17/34 patients (50%). The final mortality rate was 26.5% (9/34 patients). We conclude that an antegrade approach is a feasible and effective method for treating acute TO stroke, giving the patient the chance to regain his or her full independence in everyday life, with low overall complication and final mortality rates.