Cytomegalovirus infection in infants with biliary atresia in China: a multi-center investigation study

Background and objectivesBiliary atresia (BA) with concurrent cytomegalovirus (CMV) is a distinct subtype that is linked to a poorer prognosis. Currently, there are no standardized criteria for the diagnosis or antiviral treatment (AVT) of this condition. It has a high prevalence in China. The aim was to investigate the infection, diagnosis and treatment of CMV infection in infants with BA through a multicenter questionnaire survey conducted in China.MethodsA multicenter investigation was performed through online questionnaire survey. It investigated the diagnosis and treatment of infants with CMV-infected BA in tertiary-level pediatric centers from January 1st, 2018, to January 1st, 2020. The centers were categorized into low and high-volume groups based on number of infants with BA (≤50 or >50) and were also grouped geographically into south and north groups. Afterward, 100 cases were randomly selected from these infants for a retrospective analysis.ResultsA total of 22 questionnaires were collected, and 20 were included in the analysis. The questionnaire survey encompassed 1,276 infants with type III BA. 31.3% of the infants of BA had CMV detected. According to the survey results, a large proportion of centers preferred using CMV-DNA (75.0%) and CMV-IgM (95.0%) as their preferred methods for CMV detection. In the high-volume group, more centers opted for CMV-DNA detection (100.0% vs. 66.7%) and administered AVT (87.5%). In the retrospective analysis of 100 infants with BA, 39 were found to be CMV-positive and among these, 74.4% received AVT.ConclusionAmong the 1,276 infants with BA in this cohort, 31.3% (399 cases) had concomitant CMV infection, representing a decrease compared to previous data. CMV-IgM played a crucial role in the detection of the infection. The retrospective analysis indicated that AVT had a beneficial impact on the prognosis of infants with BA who were infected with CMV

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Point to multi-point physical-layer key generation and distribution in passive optical networks

A point to multi-point physical-layer secure key generation and distribution (SKGD) scheme is proposed and demonstrated in passive optical networks (PONs), where the optical line terminal (OLT) broadcasts optical lights with fast fluctuating states of polarization (SOPs) to the optical network units (ONUs). The highly correlated key waveforms are shared between OLT and ONUs, and the high-level security of the SKGD scheme is guaranteed by the high sensitivity of SOP dynamics associated with the specific fiber links. As a proof of concept, a 3.9 Gb/s SKGD is achieved over 11 km single-mode fiber, where a Sagnac interferometer-based polarization scrambler is constructed as the high-speed random source. Moreover, the generated key sequences are verified to be error free and truly random. The proposed SKGD scheme offers a flexible solution for security enhancement in PONs, and is also compatible with the current PON infrastructure.</jats:p

Contribution of Quercetin to the Composition and Antioxidant Properties of Monascus Exopolysaccharides

Exopolysaccharides are important metabolites of Monascus with healthy activities. However, the low production level limits their applications. Hence, the aim of this work was to increase the yield of exopolysaccharides (EPS) and optimize liquid fermentation by adding flavonoids. The EPS yield was optimized via both medium composition and culture conditions. The optional fermentation conditions achieved for EPS production of 7.018 g/L were 50 g/L sucrose, 3.5 g/L yeast extract, 1.0 g/L MgSO4·7H2O, 0.9 g/L KH2PO4, 1.8 g/L K2HPO4·3H2O, 1 g/L quercetin, and 2 mL/L Tween-80, with pH 5.5, inoculum size 9%, seed age 52 h, shaking speed 180 rpm, and fermentation culture 100 h, respectively. Furthermore, the addition of quercetin increased EPS production by 11.66%. The results also showed little citrinin residue in the EPS. The exopolysaccharides’ composition and antioxidant capacity of quercetin-modified exopolysaccharides were then preliminarily investigated. The addition of quercetin changed the composition of the exopolysaccharides and the molecular weight (Mw). In addition, the antioxidant activity of Monascus exopolysaccharides was monitored using 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-Azinobis-(3-ethylbenzthiazoline-6-sulphonate) (ABTS+), and -OH. Monascus exopolysaccharides have good scavenging ability of DPPH and -OH. Furthermore, quercetin increased the scavenging ABTS+ ability. Overall, these findings provide a potential rationale for the application of quercetin in improving the EPS yield.</jats:p

Research and Application of Full-Link Management Intellectual Inspection Robot with Remote Pre-Control and Information Digitization

Abstract With the development of intelligent power grid maintenance, inspection robot has been widely used for its integrated perception and remote pre-control. Aiming at the problems of the weak information interaction capacity and the low correlation with digital requirements of inspection operation, a kind of Full-Link Management Intellectual Inspection Robot is proposed. The article introduces the system structure, function modules, engineering application and debugging process. It is with low response delay and strong anti-interference ability. The correct recognition rate of violations reached 88.2 %, meanwhile provided with the function of evaluation and early warning of workers’ unsafe behavior. The Full-Link Management Intellectual Inspection Robot has a broad application foreground in power grid maintenance.</jats:p