Mild Infection Group Research Articles

Genome-wide identification and functional analysis of dysregulated alternative splicing profiles in sepsis

BackgroundAn increasing body of evidence now shows that the long-term mortality of patients with sepsis are associated with various sepsis-related immune cell defects. Alternative splicing (AS), as a sepsis-related immune cell defect, is considered as a potential immunomodulatory therapy target to improve patient outcomes. However, our understanding of the role AS plays in sepsis is currently insufficient.AimThis study investigated possible associations between AS and the gene regulatory networks affecting immune cells. We also investigated apoptosis and AS functionality in sepsis pathophysiology.MethodsIn this study, we assessed publicly available mRNA-seq data that was obtained from the NCBI GEO dataset (GSE154918), which included a healthy group (HLTY), a mild infection group (INF1), asepsis group (Seps), and a septic shock group (Shock). A total of 79 samples (excluding significant outliers) were identified by a poly-A capture method to generate RNA-seq data. The variable splicing events and highly correlated RNA binding protein (RBP) genes in each group were then systematically analyzed.ResultsFor the first time, we used systematic RNA-seq analysis of sepsis-related AS and identified 1505 variable AS events that differed significantly (p <= 0.01) across the four groups. In the sepsis group, the genes related to significant AS events, such as, SHISA5 and IFI27, were mostly enriched in the cell apoptosis pathway. Furthermore, we identified differential splicing patterns within each of the four groups. Significant differences in the expression of RNA Binding Protein(RBP) genes were observed between the control group and the sepsis group. RBP gene expression was highly correlated with variant splicing events in sepsis, as determined by co-expression analysis; The expression of DDX24, CBFA2T2, NOP, ILF3, DNMT1, FTO, PPRC1, NOLC1 RBPs were significant reduced in sepsis compared to the healthy group. Finally, we constructed an RBP-AS functional network.ConclusionAnalysis indicated that the RBP-AS functional network serves as a critical post-transcriptional mechanism that regulates the development of sepsis. AS dysregulation is associated with alterations in the regulatory gene expression network that is involved in sepsis. Therefore, the RBP-AS expression network could be useful in refining biomarker predictions in the development of new therapeutic targets for the pathogenesis of sepsis.

Real-time PCR versus traditional and Nano-based ELISA in early detection of murine trichinellosis.

Trichinellosis is a serious foodborne zoonosis. It poses a serious risk to public health worldwide. Early serological diagnosis of trichinellosis is influenced by an immunological 'silent' phase following infection. This highlights the necessity for developing sensitive diagnostic approaches to be employed when antibodies cannot be detected. In this work, the validity of traditional ELISA, Nano-ELISA and real time polymerase chain reaction (PCR) were evaluated in early diagnosis of Trichinella spiralis. Swiss albino mice were orally infected with 100 and 300 muscle larvae/mouse. Mice were sacrificed 4, 6, 8, 10, 15, and 28 days post-infection (dpi). Blood samples were tested for circulating antigen by traditional ELISA and Nano-ELISA using anti-rabbit polyclonal IgG conjugated with AgNPs and for Rep gene by SYBR green real-time PCR. Rep gene detection by SYBR green real-time PCR could detect T. spiralis with 100% sensitivity in the mild infection group at 8 dpi, while in the severe infection group it reached 100% sensitivity at 4 dpi. Nano-ELISA could detect T. spiralis circulating antigen from 4 dpi in both mild and severe infection and reached 100% sensitivity at 8 dpi and 6 dpi in mild and severe infection, respectively. However, traditional ELISA could detect T. spiralis circulating antigen from 6 dpi and reached maximum sensitivity at 15 dpi in the mild infection group, while in the severe infection group detection began at 4 dpi and reached 100% sensitivity at 8 dpi. Nano-ELISA and real time PCR, using Rep gene, are useful tools for the detection of early T. spiralis infection even in its mild infection state.

TMEM173 rs7447927 genetic polymorphism and susceptibility to severe enterovirus 71 infection in Chinese children.

This study was designed to explore the association between the TMEM173 polymorphism (rs7447927) and the severity of enterovirus 71 (EV71) infection among Chinese children. The TMEM173 polymorphism was identified in EV71-infected patients (n = 497) and healthy controls (n = 535) using the improved multiplex ligation detection reaction (iMLDR). The interferon-α (IFN-α) serum levels were detected using enzyme linked immunosorbent assay (ELISA). The frequencies of the GG genotype and G allele of TMEM173 rs7447927 in the mild EV71 infection and severe EV71 infection groups were markedly higher than those in the control group. The GG genotype and G allele frequencies in severely infected EV71 patients were significantly higher than those in mildly infected EV71 patients. Severely infected EV71 patients with the GG genotype had higher white blood cell counts (WBC), and C-reactive proteins (CRP), and blood glucose (BG) levels, longer fever duration, higher vomiting frequency, spirit changes, and electroencephalography (EEG) abnormalities. IFN-α serum concentration in severely infected patients was significantly higher than in the mildly infected group. The IFN-α concentration in the GG genotype was significantly higher compared with those in the GC and CC genotypes in severe cases. The TMEM173 rs7447927 polymorphism was associated with EV71 infection susceptibility and severity. The G allele and GG genotype are susceptibility factors in the development of severe EV71 infection in Chinese children.

Correlation between Platelet miRNA Expression and Coagulation Function in Children with Severe Pneumonia.

Objective To investigate the relationship between expression levels of platelet miRNAs and severe pneumonia (SP) in children. Methods A randomized controlled trial was conducted in 129 children with SP hospitalized from May 2018 to May 2020. All children joined the study group and were divided into the mild infection group, moderate infection group, and severe infection group according to the diagnostic criteria, 43 cases in each group. Besides, 129 healthy children were selected as the control group. The expression levels of platelet miR-223 and miR-192 were detected by real-time quantitative polymerase chain reaction (qPCR). The prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) were detected by the Sysmex CA-1500 System (Sysmex Corporation, Japan). The Pearson analysis was conducted to evaluate the correlation between coagulation function and the levels of miR-223 and miR-192. Results Compared with the control group, miR-223 in the study group was significantly higher and miR-192 was significantly lower (P < 0.05). Compared with the mild infection group, miR-223 was significantly higher and miR-192 was significantly lower in the moderate infection group and severe infection group (P < 0.05). Compared with the control group, PT and APTT were significantly lower and FIB was significantly higher in the study group (P < 0.05). Pearson correlation analysis revealed that miR-223 was positively correlated with PT and APTT (P < 0.05) and negatively correlated with FIB (P < 0.05); miR-192 was negatively correlated with PT and APTT (P < 0.05) and positively correlated with FIB (P < 0.05). Conclusion miR-223 and miR-192 can reflect coagulation function in children with SP, which can provide a certain reference basis for clinical guidance and treatment and prognosis.

Effects of lymphocyte, C-reactive protein and prealbumin levels on clinical typing and course of disease in children infected with novel coronavirus.

Objectives:To investigate the effects of lymphocyte (LY), C-reactive protein (CRP) and prealbumin (PA) levels on the clinical typing and course of disease in children infected with novel coronavirus (2019-nCoV) at the early stage.Methods:A total of 140 children with 2019-nCoV infection diagnosed in Shijiazhuang People’s Hospital and Hebei Provincial Chest Hospital from January 2021 to February 2021 were selected for this study. According to the clinical symptoms, laboratory results and imaging examination, the children were divided into asymptomatic infection group, mild infection group and common infection group. The levels of white blood cell (WBC), LY, CRP, PA, albumin (ALB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine kinase (CK) and creatine kinase MB isoenzyme (CKMB) in the children were recorded on the 2nd d after the positive detection of 2019-nCoV nucleic acid.Results:There were 73(52.1%) children in the asymptomatic infection group, 35(25.0%) children in the mild infection group and 32(22.9%) children in the common infection group. LY level in the common infection group was lower than that in the asymptomatic infection group and the mild infection group (F= 3.152, both p< 0.05). CRP level in the common infection group was higher than that in the asymptomatic infection group and the mild infection group (F= 6.343, both p< 0.05). CRP level in the mild infection group was higher than that in the asymptomatic infection group (t= 2.052, p< 0.05). PA level in the common infection group and the mild infection group was lower compared with the asymptomatic infection group (F= 5.229, both p< 0.05). WBC, ALB, AST, ALT, CK and CKMB levels in the three groups showed no statistical significance (F= 1.803, F= 1.208, F= 2.391, F= 1.973, F= 0.401, F= 1.332, respectively, all p> 0.05). Correlation analysis demonstrated that LY and PA levels were negatively correlated with hospital stay (r= -0.265, r= -0.325, both p< 0.050), but CRP level was not correlated with hospital stay (r= -0.039, p> 0.05).Conclusion:CRP is correlated with the clinical typing of children with 2019-nCoV infection, while LY and PA levels may be closely correlated with the clinical typing and course of treatment of children with 2019-nCoV infection.

Relationship between the Presence of Anisakis Parasite in Some Local Marine Water Fish Flesh and Some Quality Parameters in Alexandria Governorate

Background: Fish meat represents an essential source of animal protein worldwide and possesses a significant nutritive value, especially in Egypt. Anisakid nematodes are the most abundant parasites among various species of marine fishes. These worms could alter the chemical properties of fish tissue reducing their quality. Objective: The current study aimed to analyze the presence of larvae in marine fish frequently consumed in Egyptian supermarkets, and to measure the chemical traits of fish, inferring the risk of infection and its impact on the fish quality. Materials and methods: In total 435 specimens of three of the most consumed marine fish species in Alexandria, Egypt; chub mackerel (Scomber japonicus), Spanish mackerel (Scomber commerson), and Atlantic herring (Clupea harengus) were examined for Anisakid nematodes. The degree of infestation was categorized into a control group (completely free from Anisakis), a mild infection group (up to 15 larvae/100 g), a medium infection group (&gt;15-30 larvae/100 g), and the high or heavy infection group (&gt;30-50 larvae/100 g). The larvae were isolated, counted then fish tissues were subjected to chemical and molecular analysis. Results: Analysis showed that the overall Anisakis infestation among the examined fish species was 27.1% (118/435). The Atlantic herring represented the highest parasitic infection with Anisakis larvae (37.3%), then came the chub mackerel (23.8%), and lastly the Spanish mackerel (23.5%). Regarding the chemical quality parameters of fish samples, Trimethylamine values of the heavy Anisakis-infested samples of all chub, Spanish and herring samples were higher (mean values 11.38, 10.61, and 11.52 mg/100g, respectively) than the control and other groups with different degrees of Anisakis infestation. Also, histamine values followed the same manner in the highest infection group (mean values 4.38, 3.78, and 5.73 mg/100g, respectively). Conclusion: The degree of Anisakis infestation in marine water fish should be considered by marketers and consumers, as it has a crucial impact on the quality parameters of fish flesh.

COVID-19 in Children: Experience from a Tertiary Care Hospital in Bangladesh

Background: Children are generally at low risk of infection and data on COVID-19 in children are scarce. This study was undertaken to document data from a tertiary care hospital in Bangladesh on the incidence, presentation and immediate outcome of COVID-19 in children. Methodology: It was a cross-sectional study conducted in the fever clinic and the department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of one year from July 2020 to June 2021. All the RT–PCR positive pediatric cases (1 month to 18 years) were enrolled. Data were collected by a structured, predesigned and pre-tested questionnaire. Data were analyzed using Microsoft Excel spreadsheet software 2010. Frequency, percentage and chi-square tests were done for statistical analysis. Result: Among 8203 suspected pediatric COVID-19 cases, 850 (10.36%) was RT PCR positive. The highest number of RT-PCR positive COVID-19 cases was found in April 2021. More than 63% of cases were in the age group of 10 to 18 years. Male: female ratio was 0.97:1. Fever was the most common (75.9%) presenting feature followed by breathing difficulty and chest pain in 9.6% and 7% of patients respectively. Mild infection group was predominant (56.7%). Among the symptomatic cases, 16.7% were hospitalized. Oxygen inhalation and bronchodilators were needed in 75% of hospitalized patients. All the severe and critical cases were managed in the inpatient department and in pediatric PICU when indicated. Most of the patients (99.4%) improved with or without any complication. Four critically ill patients (0.75%) developed multi-organ dysfunction and expired in PICU. Conclusion: The majority of COVID-19 cases belonged to the older age group. More than 75% cases were symptomatic. History of contact was present in 78% cases. More than 99% children recovered with or without sequelae and 0.8% children with pre-existing co-morbidities expired.

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced T1 mapping to evaluate liver damage caused by Clonorchis sinensis

OBJECTIVE: The objective of the study is to explore the feasibility of Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) T1 mapping for evaluating liver damage caused by Clonorchis sinensis infection in rabbit models. MATERIALS AND METHODS: Forty-two rabbits were randomly divided into a control group (n = 10), mild infection group (n = 12), moderate infection group (n = 9), and severe infection group (n = 11). All rabbits underwent an magnetic resonance imaging scan and pathological examination to obtain the relaxation time before Gd-EOB-DTPA enhancement and the relaxation time after Gd-EOB-DTPA enhancement at intervals of 10, 15, 20, 25, 30, 35, and 40 min. The Ishak score was used to evaluate the inflammation and fibrosis of the liver. RESULTS: The severity of C. sinensis infection was positively correlated with liver inflammation. The T1 relaxation time of liver increased with increasing inflammation. The highest correlation was recorded between inflammation and the T1 relaxation time at 30 min (P = 0.001). After enhancement, The T1 relaxation time has a significant difference between the severe infection group and control group and between the severe infection group and mild infection group. The area under the receiver operating characteristics curve showed that the T1 relaxation time was the most effective parameter for diagnosing the degree of inflammation at 30 min. CONCLUSIONS: Gd-EOB-DTPA-enhanced T1 mapping can be used to evaluate the liver damage caused by C. sinensis infection.

Association between the HLA genotype and the severity of COVID-19 infection among South Asians.

Regional variations are found in the incidence and severity of the COVID‐19 infection. Human leukocyte antigen (HLA) polymorphism is one of the genetic factors that might have an impact on the outcome of the disease. This study explored the association between the HLA genotype and the severity of COVID‐19 among patients from South Asia. Blood samples from 95 Asians (Bangladeshis, Indians, and Pakistanis) with COVID‐19 were collected. The patients were divided according to the severity of their infection: mild (N = 64), severe (N = 31), and fatal (N = 20). DNA was extracted from all samples, and HLA genotyping was performed for both class I (A, B, and C) and class II (DRB1, DQA1, and DQB1) using the PCR‐rSSO (polymerase chain reaction–reverse sequence‐specific oligonucleotide) molecular method. The frequency of HLA‐B*51 was significantly higher among patients in the fatal group than among those in the mild infection group (15% vs. 4.7%, p = 0.027). Additionally, the frequency of HLA‐B*35 was significantly higher in the mild infection group than in the fatal group (21.1% vs. 7.5%, p = 0.050 [a borderline p‐value]). In terms of HLA class II, DRB1*13 was significantly observed in the fatal group than in the mild infection group (17.5% vs. 11.3%, p = 0.049). However, the p‐value for all alleles became insignificant after a statistical correction for the p‐values (pc = 0.216, pc = 0.4, and pc = 0.49, respectively). Compared with all published data, this study highlights that the association between the HLA system and the COVID‐19 outcome might be ethnic‐dependent. Genetic variation between populations must be examined on a wider scale to assess infection prognosis and vaccine effectiveness.

Eye drops and eye gels of levofloxacin: comparison of ocular absorption characterizations and therapeutic effects in the treatment of bacterial keratitis in rabbits

The aim was to reveal the characteristic profiles of the marketed levofloxacin eye drops (5 mg/ml) and levofloxacin eye gel (3 mg/g) from the pharmacokinetics and pharmacodynamics views of rabbits’ eyes. A mild and a heavy bacterial keratitis models in rabbits were established. Different regimens of levofloxacin eye drops and eye gel, including phosphate buffer solution (the PBS group), the 4-Sol + 1-Gel group (rabbits were treated with 4 doses of levofloxacin eye drops and 1 dose levofloxacin eye gel per day), the 3-Sol + 1-Gel group (3 doses drops and 1 dose gel), the 4-Sol group (4 doses drops), the 4-Gel group (4 doses gel), the 3-Sol group (3 doses drops), and the 3-Gel group (3 doses gel), were applied to evaluate their efficacies. The ocular pharmacokinetics of levofloxacin eye drops and gel were also investigated. The results of mild infection groups showed that all treatment regimens significantly relieved the infection symptoms, and the treatment effect followed this order: 4-Gel > 4-Sol + 1-Gel > 3-Sol + 1-Gel > 4-Sol > 3-Gel > 3-Sol. In the heavy infection groups, all the treatment regimens significantly relieved the infection symptoms, and the treatment effect also followed the order with the mild infection results. All treatment regimens lowered the number of corneal colony forming units (CFU). Levofloxacin eye gel significantly increased intraocular penetration in rabbits’ eyes. It can be concluded that the levofloxacin eye gel was more effective in treating bacterial keratitis than the levofloxacin eye drops in rabbit keratitis model with a proper treatment regimen such as 4-Gel.

Clinical characteristics and risk factors of severe infections in hospitalized adult patients with primary nephrotic syndrome.

ObjectiveInfection is a common condition in patients with nephrotic syndrome. The objective of the present study is to investigate the clinical characteristics and risk factors of infections in adult patients with primary nephrotic syndrome (PNS).MethodsMedical charts of 138 consecutive patients with PNS and infections who were admitted to hospital from April 2013 to April 2016 were systematically reviewed.ResultsPatients were divided into three groups according to the degree of infections: mild infection group (n = 45), moderate infection group (n = 60), and severe infection group (n = 33). In the severe infection group, most patients (96.9%) had pulmonary infections with opportunistic pathogens. There were significant differences in cumulative prednisone dose, immunosuppressor use, and CD4+ T cell count among the three groups. A lower CD4+ T cell count (<300 cells/mm3) (odds ratio = 4.25 [95% confidence interval 1.680–10.98]) and higher cumulative dose of prednisone (odds ratio = 1.38 [95% confidence interval 1.05–3.26]) were risk factors for severe infections in adult patients with PNS.ConclusionsCD4+ T cell count (<300 cells/mm3) and a higher cumulative dose of prednisone are important risk factors for severe infections in adult patients with PNS.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study

AimClinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. MethodsThe Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). ResultsA total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. ConclusionsBased on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Precursors of adrenomedullin, endothelin and atrial natriuretic peptide as diagnostic markers of neonatal infection

To evaluate the serum levels of three precursors of vasoactive peptide as diagnostic markers for neonatal infections. Overall, 356 neonates (160 without infection, 114 with mild infections and 82 with severe infections) were enrolled in this study. Their serum levels of mid-regional pro-adrenomedullin (MR-pro-ADM), C-terminal pro-endothelin-1 (CT-pro-ET-1) and mid-regional pro-atrial natriuretic peptide (MR-pro-ANP) were measured by immunoassay, and receiver operating curve analysis was performed for each biomarker to evaluate their diagnostic values for neonatal infection. The serum levels of MR-pro-ADM (2.079 ± 1.195 nM), CT-pro-ET-1 (109.4 ± 62.9 pM) and MR-pro-ANP (1221.4 ± 725.0 pM) in the severe infection group were significantly higher than those in the mild infection group (1.025 ± 0.421 nM, 86.7 ± 51.8 pM, and 687.6 ± 575.7 pM, respectively) and in the non-infection group (0.853 ± 0.488 nM, 51.3 ± 40.6 pM, and 943.3 ± 847.3 pM, respectively) (p < 0.01-0.001). Their areas under the curve were 0.72, 0.76 and 0.61, respectively. Among them, CT-pro-ET-1 had the highest sensitivity (82.65%), whereas MR-pro-ADM had the highest specificity (86.25%). MR-pro-ADM, CT-pro-ET-1 and MR-pro-ANP may serve as useful laboratory markers to indicate bacterial infection in neonates.

Expression of serum soluble form of triggering receptors expressed on myeloid cell-1 in full term neonates with bacterial infection

Objective To observe the changes of serum soluble form of triggering receptors expressed on myeloid cell-1 (sTREM-1) level in full-term newborns with infection and to investigate the relationship between serum sTREM-1 and neonatal bacterial infection.Methods Eighty-five full-term newborns admitted to the neonatal ward of Shanghai Children s Hospital of Shanghai Jiaotong University were selected into this study.According to the locations and severity of infection,patients were divided into 3 groups: severe infection group (n = 27),mild infection group (n = 28),non-infection group (n = 30).The samples of infection groups were collected before using antibiotics and within 48 h after infection symptom occurred; others were collected during hospitalization.For the neonates with organ dysfunction in the severe infection group,samples were also collected at the third and seventh day of infection.Serum sTREM-1 was measured by enzyme-linked immunosorbent assay.Analysis of variance was used to compare the difference between groups.Receiver operating characteristic (ROC) curve was used to calculate the sensitivity,specificity,positive and negative predictive value and Youden index.Results (1) Serum sTREM-1 level of severe infection group[(91.2±47.3) pg/ml] was significantly higher than that of mild infection group[(68.8 + 30.4) pg/ml] and non-infection group[(35.5±17.6) pg/ml],respectively (P＜0.05).(2) Serum sTREM-1 level of the survival newborns (n= 17) in the severe infection group was lower than that of dead ones[(73.1±34.9) pg/ml vs (121.6±49.3) pg/ml,t= - 2.995,P = 0.006].(3) For the survival patients,the serum sTREM-1 level decreased in the first week of infection,while that of dead patients increased,the cut-off value was 100.6 pg/ml.(4) Based on the ROC analysis,43.8 pg/ml was selected as the the cut-off value,area under the curve was 0.868,and sensitivity was 85.5%,specificity 80.0%,positive predictive value 0.887,negative predictive value 0.750,Youden index 0.655.Conclusions Serum sTREM-1 level increases in neonatal infection.The change of serum sTREM-1 level in patients with severe infection is correlated to the prognosis. Key words: Bacterial infections; Membrane glycoproteins; Receptors,immunologic; Infant,newborn

Analysis of early-stage infection risk factors after living donor liver transplantation in 25 children

Living donor liver transplantation (LDLT), which was first demonstrated in 1989, has now been widely used to cure many late-stage hepatic diseases and has achieved huge success, especially in the pediatric field. However, accumulated studies indicate that early-stage infection after LDLT is the main cause leading to its failure and the death of the patient. Here, we retrospectively analyzed 25 cases (from 2006 to 2009) of infections of children in our hospital, underwent LDLT and their correlated factors. To identify the factors most closely related to early stage infection, we categorized early stage infection levels as either mild, moderate or severe and we compared their related risk factors, including total length of stay in hospital (TLSH), length of stay in the intensive care unit (LSI), duration of catheterization (DC), length of pre-/post-operative antimicrobial agent application, length of immuno-suppressant agent application (LISA) and underlying diseases postoperatively. The results revealed the following. (i) Of 25 patients, 24 recipients were infected to various extents: 6 cases of mild infection, 14 cases of moderate infection and 4 cases of severe infection (one patient died). (ii) TLSH, LSI and durations of preoperative (DPAA) and postoperative (DPOAA) antimicrobial agent application were statistically different between the severe and moderate infection groups (P = 0.03 (TLSH), 0.004 (LSI), 0.003 (LAPP), 0.005 (DPOAA). (iii) Between the severe and mild infection groups, the TLSH (P = 0.016), LSI (P = 0.015), DAPP (P = 0.007) and DPOAA (P = 0.001) were also significantly different. (iv) In the case of LISA, only methylprednisolone (P = 0.01) and the calcineurin inhibitor ciclosporin A (P = 0.009) showed statistically significant differences between the moderate and mild infection groups. (v) Biliary atresia is the predominant underlying liver disease. (vi) In contrast to previous findings, there was no significant difference in DC among the three infection groups. (vii) Of all the 25 patients, 24 survive till now and the only one died was diagnosed as portal vein thrombosis (PVT) combined with high white blood count (>30 x 109/l) in venous blood. DPAA, DPOAA and biliary atresia are the risk factors most closely related to infection during liver transplantation in children, an observation worthy of future investigation. To avoid long term DPAA and long term DPOAA induced early severe infection, nosocomial infection control and drug resistant bacteria monitoring are worthy to be concerned after LDLT in children. Key words: Living donor liver transplantation, risk factor, children.

Variation and clinical significance of plasma pro-adrenomedullin in neonates with infection

Objective To investigate the changes and significance of pro-adrenomedullin (pro-ADM) in neonatal infection and to analyze its value in predicting the severity of the infection. Methods From April to December in 2007, data from 356 neonates admitted to our hospital were included in the study. Patients were divided into non-infection group (n=160), mild infection group (n= 114) and severe infection group (n = 82). Plasma levels of pro-ADM were determined with chemiluminescence immunoassay. Procalcitonin (PCT) and C-reactive protein (CRP) levels were measured also. Cut-off value, sensitivity and specificity of pro-ADM in diagnosing infection were calculated by receiver operator characteristic curve(ROC) and area under the ROC curve(AUC) ,then compared with those of CRP. One way ANOVA and Wilcoxon test were applied as the statistical methods. Results The level of pro-ADM in severe infection group were (2. 079±1. 195) nmol/L, higher than that of mild infection group and non-infection group [(1. 025 ±0. 421) nmol/L and (0. 853±0. 488) nmol/L](P<0. 01). Infection was the independent influencing factor of pro-ADM level (r=0. 78, P<0. 01). Pro-ADM showed better diagnostic efficiency compared to CRP with the sensitivity of 71. 95% and the specificity of 87. 23%. The level of pro-ADM in critically infected neonates was (2. 498 ±1. 140) nmol/L, significantly higher than that of non-critically infected neonates [1.810±1.162) nmol/L] among those in the severe infection group (P<0. 05) , while PCT showed no significant difference. Conclusions The level of pro-ADM increases in neonates with infection, especially those with severe infection. Pro-ADM has potential value in early diagnosis of severe infection and severity assessment in infected newborns. Key words: Protein precursors; Adrenomedullin; Infant, newborn; Sepsis