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Frontiers in Pediatrics 2023To analyze survival and morbidity among very preterm infants (VPIs) in Shenzhen and explore factors associated with survival without major morbidity.
OBJECTIVE
To analyze survival and morbidity among very preterm infants (VPIs) in Shenzhen and explore factors associated with survival without major morbidity.
METHODS
Between January 2022 and December 2022, 797 infants were admitted to 25 neonatal intensive care units in Shenzhen with gestational age (GA) < 32 weeks, excluded discharged against medical advice, insufficient information, and congenital malformation, 742 VPIs were included. Comparison of maternal and neonate characteristics, morbidities, survival, and survival without major morbidities between groups used Mann Whitney test and test, multivariate logistic regression was used to analyze of risk factors of survival without major morbidities.
RESULTS
The median GA was 29.86 weeks (interquartile range [IQR], 28.0-31.04), and the median birth weight was 1,250 g (IQR, 900-1,500). Of the 797 VPIs, 721 (90.46%) survived, 53.52% (38 of 71) at 25 weeks' or less GA, 86.78% (105 of 121) at 26 to 27 weeks' GA, 91.34% (211 of 230) at 28 to 29 weeks' GA, 97.86% (367 of 375) at 30 to 31 weeks' GA. The incidences of the major morbidities were moderate-to-severe bronchopulmonary dysplasia,16.52% (113 of 671); severe intraventricular hemorrhage and/or periventricular leukomalacia, 2.49% (17 of 671); severe necrotizing enterocolitis, 2.63% (18 of 671); sepsis, 2.34% (16 of 671); and severe retinopathy of prematurity, 4.55% (27 of 593), 65.79% (450 of 671) survived without major morbidities. After adjustment for GA, birth weight, and 5-min Apgar score, antenatal steroid administration (OR = 2.397), antenatal magnesium sulfate administration (OR = 1.554) were the positivity factors to survival without major morbidity of VPIs, however, surfactant therapy (OR = 0.684,), and delivery room resuscitation (OR = 0.626) that were the negativity factors.
CONCLUSIONS
The present results indicate that survival and the incidence of survival without major morbidities increased with GA. Further, antenatal administration of steroids and magnesium sulfate, surfactant therapy, and delivery room resuscitation were pronounced determinants of survival without morbidities.
PubMed: 38464983
DOI: 10.3389/fped.2023.1298173 -
The Science of the Total Environment May 2024This study proposed and examined a new process flowsheet for treating neutral mine drainage (NMD) from an open-pit gold mine. The process consisted of three sequential...
This study proposed and examined a new process flowsheet for treating neutral mine drainage (NMD) from an open-pit gold mine. The process consisted of three sequential stages: (1) in situ hydrotalcite (HT) precipitation; (2) low-cost carbon substrate driven microbial sulfate reduction; and (3) ferrosol reactive barrier for removing biogenic dissolved hydrogen sulfide (HS). For concept validation, laboratory-scale columns were established and operated for a 140-days period with key process performance parameters regularly measured. At the end, solids recovered from various depths of the ferrosol column were analysed for elemental composition and mineral phases. Prokaryotic microbial communities in various process locations were characterised using 16S rRNA gene sequencing. Results showed that the Stage 1 HT-treatment substantially removed a range of elements (As, B, Ba, Ca, F, Zn, Si, and U) in the NMD, but not nitrate or sulfate. The Stage 2 sulfate reducing bioreactor (SRB) packed with 70 % (v/v) Eucalyptus woodchip, 1 % (w/v) ground (<1 mm) dried Typha biomass, and 10 % (w/v) NMD-pond sediment facilitated complete nitrate removal and stable sulfate removal of ca. 50 % (50 g-SO m d), with an average HS generation rate of 10 g-HS md. The HS-removal performance of the Stage 3 ferrosol column was compared with a synthetic amorphous Fe-oxyhydroxide-amended sand control column. Although both columns facilitated excellent (95-100 %) HS removal, the control column only enabled a further ca. 10 % sulfate reduction, giving an overall sulfate removal of 56 %. In contrast, the ferrosol enabled an extra 99.9 % sulfate reduction in the SRB effluent, leading to a near complete sulfate removal. Overall, the process successfully eliminated a range of metal/metalloid contaminants, nitrate, sulfate (2500 mg-SO L in the NMD to <10 mg-SO L in the final effluent) and HS (>95 % removal). Further optimisation is required to minimise release of ferrous iron from the ferrosol barrier into the final effluent.
Topics: Hydrogen Sulfide; RNA, Ribosomal, 16S; Nitrates; Sulfates; Bioreactors; Aluminum Hydroxide; Magnesium Hydroxide
PubMed: 38460684
DOI: 10.1016/j.scitotenv.2024.171537 -
Shoulder & Elbow Feb 2024Single injection ropivacaine interscalene anesthesia (ISA) is frequently used in Latarjet reconstruction to enhance post-operative analgesia. A potential limitation is...
BACKGROUND
Single injection ropivacaine interscalene anesthesia (ISA) is frequently used in Latarjet reconstruction to enhance post-operative analgesia. A potential limitation is the occurrence of severe rebound pain on block resolution. We investigated the effect of intravenous magnesium on post-operative pain, particularly at the transition of block resolution to multimodal analgesia.
METHODS
Elective patients ( = 40) having Latarjet open shoulder reconstruction were randomised to receive either intravenous magnesium sulphate 50 mg/kg (M) or normal saline (S) before induction. Post-operatively, a standardised analgesic regimen was used, and post-operative pain was recorded using a verbal numerical rating assessment (VNRA) score. Requirement for injected opioid analgesia was recorded.
RESULTS
ISA provided longstanding analgesia in all patients with block duration slightly prolonged in the magnesium group (16.7(1.0) (S), 17.8(1.3) h (M), = 0.049). Magnesium resulted in less rebound pain following ISA resolution (VNRA 4.0 (0.6) M, 6.2 (0.8) S, = 0.03) and lower pain intensity at 24 h. Four patients had nausea and two required rescue opioid injection.
CONCLUSION
Magnesium before Latarjet surgery results in less rebound pain following ropivacaine block and improves post-operative analgesia. Magnesium may be indicated in major upper limb surgery, where significant pain intensity is anticipated.
LEVEL OF EVIDENCE
Treatment study; Randomised blinded; Level 2.
PubMed: 38435030
DOI: 10.1177/17585732231158805 -
Frontiers in Pediatrics 2024Extremely preterm infants (EPIs) have high morbidity and mortality, and are recommended to be born in a tertiary perinatal center (inborn). However, many EPIs in central...
INTRODUCTION
Extremely preterm infants (EPIs) have high morbidity and mortality, and are recommended to be born in a tertiary perinatal center (inborn). However, many EPIs in central China are born in lower-level hospitals and transferred postnatally, the outcomes of which remain to be investigated.
METHODS
EPIs admitted to the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province from January 2013 to December 2022 were retrospectively recruited and divided into the control (inborn) and transfer groups (born in other hospitals). The neonatal and maternal characteristics, neonatal outcomes, and the treatment of survival EPIs were analyzed.
RESULTS
A total of 174 and 109 EPIs were recruited in the control and transfer groups, respectively. EPIs in the transfer group have a higher birth weight and a lower proportion of multiple pregnancies than the control group (all < 0.05). The proportions of antenatal steroids, magnesium sulfate, cesarean delivery, premature rupture of membranes ≥18 h, gestational diabetes, and amniotic fluid abnormalities were lower in the transfer group (all < 0.05). Survival rates (64.22% vs. 56.32%), proportions of severe periventricular-intraventricular hemorrhage (PIVH) (11.93% vs. 11.49%), severe bronchopulmonary dysplasia (sBPD) (21.05% vs. 20%), and severe retinopathy of prematurity (ROP) (24.77% vs. 20.11%) were similar in the transfer and control groups (all > 0.05). However, the transfer group had higher proportions of severe birth asphyxia (34.86% vs. 13.22%, < 0.001), PIVH (42.20% vs. 29.89%, = 0.034), and extrauterine growth retardation (EUGR) (17.43% vs. 6.32%, = 0.003). Less surfactant utilization was found in the transfer group among survival EPIs (70.00% vs. 93.88%, < 0.001).
CONCLUSION
EPIs born outside a tertiary perinatal center and transferred postnatally did not have significantly higher mortality and rates of severe complications (severe PIVH, severe ROP, and sBPD), but there may be an increased risk of severe asphyxia, PIVH and EUGR. This may be due to differences in maternal and neonatal characteristics and management. Further follow-up is needed to compare neurodevelopmental outcomes, and it is recommended to transfer the EPIs to reduce the risk of poor physical and neurological development.
PubMed: 38415211
DOI: 10.3389/fped.2024.1287232 -
PLOS Global Public Health 2024The quality of medicines for the prevention and management of hypertensive disorders of pregnancy globally is a critical challenge in the reduction of maternal mortality...
The quality of medicines for the prevention and management of hypertensive disorders of pregnancy globally is a critical challenge in the reduction of maternal mortality rate. We aimed to conduct a systematic review of available studies on the quality of the eight medicines recommended globally for the prevention and management of hypertensive disorders of pregnancy. We searched five electronic databases- Ovid MEDLINE, EMBASE, CINAHL, ProQuest and Cochrane Library, and also grey literature, without year or language limitations. Any study assessing the quality parameters (Active Pharmaceutical Ingredients, pH, sterility, solubility, impurities) of medicines by using any valid laboratory methods was eligible. Two reviewers independently screened the studies, extracted data and applied Medicine Quality Assessment Reporting Guidelines tool for quality assessment. Results were narratively reported and stratified by the drug types. Of 5669 citations screened, 33 studies from 27 countries were included. Five studies reported on the quality of magnesium sulphate-two (Nigeria and USA) found substandard medicine due to failing API specification and contaminants, respectively. Another study from Nigeria and a multi-country study (10 lower-middle- and low-income countries) found poor-quality due to failing the pH criteria. Seven of eight studies evaluating aspirin found quality issues, including degraded medicines in five studies (Brazil, USA, Yugoslavia and Pakistan). Five studies of calcium supplements found quality issues, particularly heavy metal contamination. Of 15 antihypertensives quality studies, 12 found substandard medicines and one study identified counterfeit medicines. This systematic review identified pervasive issues of poor-quality medicines across all recommended medicines used to prevent or treat hypertensive disorders of pregnancy, raising concerns regarding their safety and effectiveness.
PubMed: 38412179
DOI: 10.1371/journal.pgph.0002962 -
Pregnancy Hypertension Jun 2024To determine the utility of using total peripheral systemic vascular resistance assessed using non-invasive cardiac monitor for individualizing the duration of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the utility of using total peripheral systemic vascular resistance assessed using non-invasive cardiac monitor for individualizing the duration of postpartum magnesium sulfate in individuals with preeclampsia with severe features.
STUDY DESIGN
Single center pilot randomized controlled trial in which singleton pregnant individuals with preeclampsia with severe features were randomized to 24 h of postpartum magnesium sulfate per standard of care (control group) or individualized duration of postpartum magnesium sulfate based on reduction in post-delivery systemic vascular resistance (intervention group). Systemic vascular resistance was assessed with non-invasive cardiac monitoring using the Cheetah® system. A 30 % reduction (maintained for 1 h) from baseline post-delivery systemic vascular resistance was used as a cutoff for discontinuation of postpartum magnesium sulfate. Our primary outcome was duration of postpartum magnesium sulfate use in hours. Secondary outcomes included a composite of maternal morbidities associated with preeclampsia.
RESULTS
Of 53 individuals enrolled, we excluded 6 from this analysis due to insufficient data to assess primary outcome. Baseline characteristics of the control (n = 26) and intervention (n = 21) groups were similar. Six (28.6 %) individuals in intervention group met the systemic vascular resistance criteria and had their postpartum magnesium sulfate discontinued before 24 h. The duration of postpartum magnesium sulfate infusion was shorter in the intervention group (21.6 ± 4.7 h; range: 7-24 h) compared with control group (24 h, p = 0.02). There was no difference in secondary outcomes between the two groups. There was no difference in adverse outcomes in individuals that had magnesium discontinued earlier than 24 h.
CONCLUSION
Non-invasive monitoring of systemic vascular resistance can be a valuable tool to individualize the duration of postpartum magnesium sulfate for preeclampsia with severe features. These findings should be conformed in a larger trial.
Topics: Humans; Female; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Adult; Postpartum Period; Vascular Resistance; Pilot Projects; Monitoring, Physiologic
PubMed: 38401325
DOI: 10.1016/j.preghy.2024.101112 -
Pharmaceuticals (Basel, Switzerland) Feb 2024Magnesium sulfate (MagSul) is used clinically to prevent eclamptic seizures during pregnancy and as a tocolytic for preterm labor. More recently, it has been implicated...
Magnesium sulfate (MagSul) is used clinically to prevent eclamptic seizures during pregnancy and as a tocolytic for preterm labor. More recently, it has been implicated as offering neural protection in utero for at-risk infants. However, evidence is mixed. Some studies found that MagSul reduced the incidence of cerebral palsy (CP) but did not improve other measures of neurologic function. Others did not find any improvement in outcomes. Inconsistencies in the literature may reflect the fact that sex effects are largely ignored, despite evidence that MagSul shows sex effects in animal models of neonatal brain injury. The current study used retrospective infant data to assess differences in developmental outcomes as a function of sex and MagSul treatment. We found that on 18-month neurodevelopmental cognitive and language measures, preterm males treated with MagSul (n = 209) had significantly worse scores than their untreated counterparts (n = 135; < 0.05). Female preterm infants treated with MagSul (n = 220), on the other hand, showed a cognitive benefit relative to untreated females (n = 123; < 0.05). No significant effects of MagSul were seen among females on language ( > 0.05). These results have tremendous implications for risk-benefit considerations in the ongoing use of MagSul and may explain why benefits have been hard to identify in clinical trials when sex is not considered.
PubMed: 38399433
DOI: 10.3390/ph17020218 -
Open Research Europe 2023Contaminants and water-soluble salts present in mechanically recycled gypsum from refurbishment and demolition (post-consumer) plasterboard waste limit its use as a...
BACKGROUND
Contaminants and water-soluble salts present in mechanically recycled gypsum from refurbishment and demolition (post-consumer) plasterboard waste limit its use as a secondary raw material in plasterboard manufacturing. This research addresses this limitation, developing a novel acid leaching purification technology combined with an improved mechanical pre-treatment for post-consumer gypsum valorization.
METHODS
Laboratory-scale acid leaching purification was performed with a borosilicate beaker, hot plate, and overhead stirrer. Stuccos were produced after calcination of gypsum at 150 °C for 3 hours. Samples were characterized through X-ray fluorescence, X-ray diffraction, thermal gravimetric analysis, scanning electron microscopy and particle size analysis.
RESULTS
Acid leaching at 90 °C for 1 h using a 5 wt% sulfuric acid solution was revealed to be the optimum purification conditions. Stuccos produced from purified gypsum under optimum conditions had similar initial setting times to that of a commercial stucco but with higher water demand, which could be reduced by optimizing the calcination conditions. A magnesium-rich gypsum was precipitated from the wastewater.
CONCLUSIONS
Purified post-consumer gypsum with > 96 wt% chemical purity and calcium sulfate dihydrate content was produced. The research recommends acid neutralization prior filtration, use of gypsum particles < 2 mm in size, and stirring speed of 50 rpm to reduce the economic and environmental impacts of the acid leaching purification process at industrial scale. The magnesium-rich gypsum could potentially be marketed as soil fertilizer.
PubMed: 38370027
DOI: 10.12688/openreseurope.16583.2 -
Heliyon Feb 2024Acid-sulfate soils and overuse of chemical fertilizers have been obstacles to sustainable agriculture. The variation of fertilization due to poor soil fertility has...
Acid-sulfate soils and overuse of chemical fertilizers have been obstacles to sustainable agriculture. The variation of fertilization due to poor soil fertility has remarkably affected the yield gap and the quality of the environment, so an optimal fertilizing rate should be formulated. Therefore, this study aimed at (i) detecting obstacles in soil characteristics reducing pineapple yield between farms and (ii) assessing the effects of NPKCaMg fertilizers on soil fertility, uptakes, and pineapple yield. The on-farm experiment was carried out according to site-specific nutrient management (SSNM) arranging in acid-sulfate soil for pineapple, including (i) no fertilizers used; (ii) NPKCaMg: fully fertilizing with nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), and magnesium (Mg); (ii) PKCaMg: fertilizing without N; (iii) NKCaMg: fertilizing without P; (iv) NPCaMg: fertilizing without K; (v) NPKMg: fertilizing without Ca; (vi) NPKCa: fertilizing without Mg; and (vii) FFP: farmers' fertilizing practice. The result of the principal component analysis revealed that the soil had low availability of N, P, and K nutrients. Available P concentration was negatively correlated with concentrations of Al, Fe, and total Mn, whose correlation coefficients were -0.34 to -0.59, -0.52 to -0.74, and -0.63 to -0.70, respectively. Fertilizing NPKCaMg obtained the highest result in the uptakes of N, P, K, Ca, and Mg, which were 289.1-327.4, 25.4-29.3, 137.4-166.0, 41.9-48.9, and 39.8-43.1 kg ha, respectively. Fertilizing by SSNM has increased pineapple yield by 22.9 %-44.9 % compared to the FFP. This fertilizer formula should be transferred to the local farmers in order not only to enhance productivity, but also to limit the damage of chemical fertilizers on the environment. Moreover, this formula should be tested globally in other places that share similar soil characteristics.
PubMed: 38356576
DOI: 10.1016/j.heliyon.2024.e25541 -
Acta Obstetricia Et Gynecologica... Apr 2024
Correction to "Barna T, Szucs KF, Schaffer A, Mirdamadi M, Hajagos-Toth J, Gaspar R. Combined uterorelaxant effect of magnesium sulfate and terbutaline: Studies on late pregnant rat uteri in vitro and in vivo. Acta Obstet Gynecol Scand. 2023; 102(4): 457-464. PMID: 36808376; PMCID: PMC10008284".
PubMed: 38339871
DOI: 10.1111/aogs.14809