INTRODUCTION

Despite universal agreement on the application of antimicrobial prophylaxis, the optimum administration period of antibiotics for percutaneous nephrolithotomy (PCNL) remains controversial and the risk for antimicrobial resistance due to prolonged antibiotic use as well as financial burden that may prove to be challenging for both the patient and the physician. This study therefore aims to determine the safety and effectiveness of a single dose antibiotic prophylaxis in patients undergoing PCNL.

A randomized controlled trial was conducted in PCNL patients between 2021-2023. The patients were randomly assigned to three groups: single dose prophylaxis 30 minutes before surgery arm (Group A), 30 minutes before and 12 hours after surgery arm (Group B), and continued antibiotics until removal of nephrostomy tube arm (Group C), respectively.

A total of 81 patients were included (Group A=27, Group B=28, and Group C=26). The rate of comorbidities did not differ significantly in the three groups: HTN (p=0.166), DM (p=0.121), and Others (p=0.405). The presence of hydronephrosis was seen in 70.4% of patients. About half had solitary stone type (54.3%) and had left area affected (51.8%). Also, 14.8% had history of UTI. The patient groups did not differ in clinical and operative characteristics (all p > 0.05) except in history of previous stone surgeries. Significantly more patients had previous history of stone surgeries in Group A (37.0%) than in Group B (3.6%) and Group C (15.4%) (p=0.006). The following proportion of no growth in preoperative urine culture was observed: Group A (92.6%), Group B (89.3%), and Group C (80.8%) (p=0.174). The estimated blood loss was significantly lower in Group A (130.7ml) than in Group B (235.7ml) and Group C (261.5ml) (p=0.032). Significantly less patients in Group A were free from stone (74.1%) compared to Group B (92.9%) and Group C (96.2%) (p=0.030). After surgery, only two patients (2.5%) had criteria consistent with SIRS and both belonged in Group C. No significant difference in incidence of SIRS was observed among the three groups (p=0.067).

Single dose antibiotic prophylaxis for the prevention of post-operative bacterial infection in patients undergoing PCNL is as effective as multiple dose antibiotic prophylaxis. Consistent with existing guidelines on PCNL, single dose antibiotic prophylaxis is highly recommended as it is more cost-effective and may lower the risk for antibiotic resistance in the future. More RCTs with larger sample size which can determine the effectiveness of single dose antibiotic prophylaxis in patients at high-risk for post-operative PCNL infections are recommended.

Objective: To analyze the clinical characteristics of children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 in China, and to improve the understanding of MIS-C among pediatricians. Methods: Case series study.Collect the clinical characteristics, auxiliary examinations, treatment decisions, and prognosis of 64 patients with MIS-C from 9 hospitals in China from December 2022 to June 2023. Results: Among the 64 MIS-C patients, 36 were boys and 28 were girls, with an onset age being 2.8 (0.3, 14.0) years. All patients suffered from fever, elevated inflammatory indicators, and multiple system involvement. Forty-three patients (67%) were involved in more than 3 systems simultaneously, including skin mucosa 60 cases (94%), blood system 52 cases (89%), circulatory system 54 cases (84%), digestive system 48 cases (75%), and nervous system 24 cases (37%). Common mucocutaneous lesions included rash 54 cases (84%) and conjunctival congestion and (or) lip flushing 45 cases (70%). Hematological abnormalities consisted of coagulation dysfunction 48 cases (75%), thrombocytopenia 9 cases (14%), and lymphopenia 8 cases (13%). Cardiovascular lesions mainly affected cardiac function, of which 11 patients (17%) were accompanied by hypotension or shock, and 7 patients (12%) had coronary artery dilatation.Thirty-six patients (56%) had gastrointestinal symptoms, 23 patients (36%) had neurological symptoms. Forty-five patients (70%) received the initial treatment of intravenous immunoglobulin in combination with glucocorticoids, 5 patients (8%) received the methylprednisolone pulse therapy and 2 patients (3%) treated with biological agents, 7 patients with coronary artery dilation all returned to normal within 6 months. Conclusions: MIS-C patients are mainly characterized by fever, high inflammatory response, and multiple organ damage. The preferred initial treatment is intravenous immunoglobulin combined with glucocorticoids. All patients have a good prognosis.
Male ; Child ; Female ; Humans ; Immunoglobulins, Intravenous/therapeutic use* ; Blood Coagulation ; COVID-19 ; China/epidemiology* ; Connective Tissue Diseases ; Coronary Aneurysm ; Fever ; Systemic Inflammatory Response Syndrome/therapy*

Sepsis-induced uncontrolled systemic inflammatory response syndrome (SIRS) is a critical cause of multiple organ failure. Acute kidney injury (AKI) is one of the most serious complications associated with an extremely high mortality rate in SIRS, and it lacked simple, safe, and effective treatment strategies. Leontopodium leontopodioides (Willd.) Beauv (LLB) is commonly used in traditional Chinese medicine for the treatment of acute and chronic nephritis. However, it remains unclear whether lipopolysaccharide (LPS) affects LPS-induced AKI. To identify the molecular mechanisms of LLB in LPS-induced HK-2 cells and mice, LLB was prepared by extraction with 70% methanol, while a lipopolysaccharide (LPS)-induced HK-2 cell model and an AKI model were established in this study. Renal histopathology staining was performed to observe the morphology changes. The cell supernatant and kidney tissues were collected for determining the levels of inflammatory factors and protein expression by ELISA, immunofluorescence, and Western blot. The results indicated that LLB significantly reduced the expression of IL-6 and TNF-α in LPS-induced HK-2 cells, as well as the secretion of IL-6, TNF-α, and IL-1β in the supernatant. The same results were observed in LPS-induced AKI serum. Further studies revealed that LLB remarkably improved oxidative stress and apoptosis based on the content of MDA, SOD, and CAT in serum and TUNEL staining results. Notably, LLB significantly reduced the mortality due to LPS infection. Renal histopathology staining results supported these results. Furthermore, immunofluorescence and Western blot results confirmed that LLB significantly reduced the expression of the protein related to the NF-κB signaling pathway and NLRP3, ASC, and Caspase-1 which were significantly increased through LPS stimulation. These findings clearly demonstrated the potential use of LLB in the treatment of AKI and the crucial role of the NF-κB/NLRP3 pathway in the process through which LLB attenuates AKI induced by LPS.
Animals ; Mice ; NF-kappa B/metabolism* ; Lipopolysaccharides/adverse effects* ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Interleukin-6/metabolism* ; Acute Kidney Injury/metabolism* ; Kidney ; Systemic Inflammatory Response Syndrome/pathology*

Child ; Humans ; Systemic Inflammatory Response Syndrome

OBJECTIVES: To investigate the clinical features and treatment strategies of multisystemic inflammatory syndrome in children (MIS-C) after severe acute respiratory syndrome coronavirus 2 infection. METHODS: A retrospective analysis was performed on the medical data of four children with MIS-C who were admitted to the Department of Cardiology, Xuzhou Children's Hospital, Xuzhou Medical Universityfrom January to February 2023. RESULTS: All four children had multiple organ involvements and elevated inflammatory markers, with a poor response to standard therapy for Kawasaki disease after admission. Two children were treated with intravenous immunoglobulin therapy pulse therapy twice, and all four children were treated with glucocorticoids. The children had a good prognosis after the treatment. CONCLUSIONS MIS-C often appears within 4-6 weeks or a longer time after severe acute respiratory syndrome coronavirus 2 infection, and anti-inflammatory therapy in addition to the standard treatment regimen for Kawasaki disease can help to achieve a favorable treatment outcome.
Child ; Humans ; COVID-19/complications* ; SARS-CoV-2 ; Mucocutaneous Lymph Node Syndrome/drug therapy* ; Retrospective Studies ; Systemic Inflammatory Response Syndrome/therapy*

Multisystem inflammatory syndrome in children (MIS-C) is a type of hyperinflammatory symptoms similar to Kawasaki disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is commonly observed in children aged 8-10 years. Primary therapeutic medications for MIS-C are intravenous immunoglobulins and glucocorticoids. It has been reported that biologics, such as IL-1 receptor antagonist anakinra, IL-6 receptor antagonist tocilizumab, and TNF-α receptor antagonist infliximab, can be used as an option for critically ill patients. This article elaborates on the mechanism of action of the above biologics and discusses the efficacy and safety biologics in the treatment of MIS-C after SARS-CoV-2 infection, in order to provide methods for the treatment of MIS-C with severe symptoms.
Biological Products ; COVID-19/complications* ; Child ; Humans ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome

COVID-19/epidemiology* ; Child ; Humans ; Infectious Disease Transmission, Vertical ; SARS-CoV-2 ; Singapore/epidemiology* ; Systemic Inflammatory Response Syndrome/virology*

Background: Sepsis is a leading cause of mortality both locally and worldwide. Despite this, early diagnosis of sepsis remains challenging, with a significant number not fulfilling SIRS (Systemic Inflammatory Response Syndrome) criteria. In 2016, the Sepsis-3 guidelines modified its definition to include the qSOFA (Quick Sequential Organ Failure Assessment) score in an attempt to include a significant number of SIRS-negative septic patients.

Methods: To compare the two, 295 adult patients in the emergency room with suspected infection were included in the study and simultaneously determined their qSOFA score and SIRS criteria. Three infection specialists adjudicated the presence of sepsis, and outcomes within the first 48 hours were acquired. Sensitivity, specificity, positive predictive and negative predictive values for qSOFA and SIRS were computed using constructed confusion matrices, and overall predictive accuracy was measured by the Area under the Receiver Operating Characteristic (AUROC) curve.

Results: Of the 295 patients included in the study, 95 (32.2%) were deemed sepsis positive via adjudication. The qSOFA score was a specific (95.5%) but a poorly sensitive (46.3%) test compared to the SIRS criteria (sensitivity 73.7% and specificity 60%). Both qSOFA and the SIRS criteria significantly correlated with sepsis positivity, but the qSOFA score had superior overall predictive accuracy at 70.9% compared to the SIRS criteria. The adjudicators had moderate strength in agreement (Fleiss' kappa = 0.39) and a percentage agreement of 60%.

Conclusion: We concluded that the qSOFA score was a more accurate predictor of sepsis and a reliable pre-dictor of in-hospital mortality, but should not be used as a sepsis screening tool due to the low sensitivity. We recommend that the SIRS criteria be maintained as a screening tool and to use the qSOFA score concurrently for time management.

Key Words: Sepsis, qSOFA, SIRS

To systematically review the efficacy of Xuebijing Injection combined with western medicine in the treatment of systemic inflammatory response syndrome(SIRS). In this study, CBM, CNKI, Wanfang, VIP, PubMed and EMbase databases were retrieved for clinical randomized controlled trials on the effect of Xuebijing Injection combined with western medicine in the treatment of SIRS from the establishment of the database to July 31, 2020. After screening, Meta-analysis was conducted by RevMan 5.3 software, trial sequential analysis was conducted by TSA 0.9.5.10 beta software, and the evidence quality level was evaluated by GRADEprofiler 3.6.1 software. Meta-analysis showed that Xuebijing Injection combined with western medicine could reduce white blood cell count(MD=-2.32, 95%CI[-2.44,-2.21], P<0.000 01), C-reactive protein count(MD=-22.70, 95%CI[-29.61,-15.79], P<0.000 01), APACHE Ⅱ score(MD=-2.15, 95%CI[-2.43,-1.87], P<0.000 01), tumor necrosis factor alpha count(SMD=-1.23, 95%CI[-1.48,-0.99], P<0.000 01) and interleukin-6 count(SMD=-0.92, 95%CI[-1.15,-0.69], P<0.000 01), improve treatment efficiency(RR=1.39, 95%CI[1.23, 1.56], P<0.000 01), reduce incidence of multiple organ dysfunction(RR=0.47, 95%CI[0.35, 0.64], P<0.000 01) and mortality(RR=0.22, 95%CI[0.13, 0.37], P<0.000 01), which were better than western medicine treatment alone. Trial sequential analysis showed that in terms of reducing the incidence of multiple organ dysfunction and C-reactive protein count, the cumulative Z value passed through the traditional threshold, TSA threshold and expected information value, and reached the required number of cases. GRADE evaluation showed that the level of evidence was low or very low. According to the findings, Xuebijing Injection combined with western medicine is effective in treating SIRS. However, as the low quality of the included studies may affect the reliability of the conclusion, more high-quality studies shall be included for further verification in the future, so as to provide better suggestions for clinical medication.
Drugs, Chinese Herbal ; Humans ; Injections ; Randomized Controlled Trials as Topic ; Reproducibility of Results ; Systemic Inflammatory Response Syndrome/drug therapy*

OBJECTIVE: To compare the value of intraoperative stone culture (IOSC) and intraoperative pelvic urine culture (IOPUC) versus pre-operative urine culture (POBUC) in the early detection of systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: This is a prospective clinical study which includes all adult patients undergoing PCNL. All patients who were operated on should have a negative preoperative urine culture (POBUC) results. Intraoperative pelvic urine culture (IOPUC) and stone culture (IOSC) were extracted and results were interpreted if they were contributory in acquiring SIRS post operatively. RESULTS: The demographics of each patient such as age, sex, having diabetes, laterality, location of calculi had no correlation to the development of SIRS. Patients with positive IOPUC and IOSC results yielded a significant value with odds of having SIRS 4.71 and 13.74, respectively. CONCLUSION In the study, all patients underwent PCNL with negative preoperative urine culture findings. Having intraoperative cultures, IOPUC and IOSC, can definitely help predict the occurrence of SIRS and ultimately be one step ahead in the management of these patients to decrease overall morbidity and mortality.
Nephrolithotomy, Percutaneous ; Systemic Inflammatory Response Syndrome ; Postoperative Period