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BACKGROUND: Ventilator management for children with hypoxemic respiratory failure may benefit from ventilator protocols, which rely on blood gases. Accurate noninvasive estimates for pH or PaCO2 could allow frequent ventilator changes to optimize lung-protective ventilation strategies. If these models are highly accurate, they can facilitate the development of closed-loop ventilator systems. We sought to develop and test algorithms for estimating pH and PaCO2 from measures of ventilator support, pulse oximetry, and end-tidal carbon dioxide pressure (PETCO2). We also sought to determine whether surrogates for changes in dead space can improve prediction. METHODS: Algorithms were developed and tested using 2 data sets from previously published investigations. A baseline model estimated pH and PaCO2 from PETCO2 using the previously observed relationship between PETCO2 and PaCO2 or pH (using the Henderson-Hasselbalch equation). We developed a multivariate gaussian process (MGP) model incorporating other available noninvasive measurements. RESULTS: The training data set had 2,386 observations from 274 children, and the testing data set had 658 observations from 83 children. The baseline model predicted PaCO2 within ± mm Hg of the observed PaCO2 80% of the time. The MGP model improved this to ± 6 mm Hg. When the MGP model predicted PaCO2 between 35 and 60 mm Hg, the 80% prediction interval narrowed to ± 5 mm Hg. The baseline model predicted pH within 0.07 of the observed pH 80% of the time. The MGP model improved this to ± 0.05. CONCLUSIONS: We have demonstrated a conceptual first step for predictive models that estimate pH and PaCO2 to facilitate clinical decision making for children with lung injury. These models may have some applicability when incorporated in ventilator protocols to encourage practitioners to maintain permissive hypercapnia when using high ventilator support. Refinement with additional data may improve model accuracy. [ABSTRACT FROM AUTHOR]

Aim: The most serious form of urinary tract infection (UTI) is acute pyelonephritis (APN), which can result in bacteremia and renal scarring. This study aims to show the roles that the systemic immune-inflammation index (SII) and the immature granulocyte (IG) percentage play in predicting APN in pediatric patients by comparing them with traditional infection markers. By illustrating a significant relationship between APN, the IG percentage, and the SII, the study's contributions to the differential diagnosis of UTI can promote a rapid and appropriate treatment of APN., Material and Methods: The present study included 522 pediatric patients. The patients were divided into two groups: (I) an APN group (n = 236) and (II) a lower UTI group (n = 286)., Results: The mean age of the sample was 5.05 ± 4.7 years. According to the most appropriate cutoff values, the findings showed that among all the parameters, C-reactive protein (CRP) and the IG percentage had the highest sensitivities, specificities, and predictive values for predicting APN., Conclusion: This study emphasizes the support features of the IG percentage and the SII in the diagnosis of APN in pediatric patients, a topic that has recently attracted attention. The findings indicated that among all of the parameters behind CRP, the IG percentage and the SII had the highest sensitivities, specificities, and predictive values for forecasting APN. It is worth noting that these methods can be applied without additional costs or burdens to the patient.

Since previous research suggests a role of a circulating factor in the pathogenesis of steroid-sensitive nephrotic syndrome (NS), we speculated that circulating plasma extracellular vesicles (EVs) are a candidate source of such a soluble mediator. Here, we aimed to characterize and try to delineate the effects of these EVs in vitro. Plasma EVs from 20 children with steroid-sensitive NS in relapse and remission, 10 healthy controls, and 6 disease controls were obtained by serial ultracentrifugation. Characterization of these EVs was performed by electron microscopy, flow cytometry, and Western blot analysis. Major proteins from plasma EVs were identified via mass spectrometry. Gene Ontology classification analysis and Ingenuity Pathway Analysis were performed on selectively expressed EV proteins during relapse. Immortalized human podocyte culture was used to detect the effects of EVs on podocytes. The protein content and particle number of plasma EVs were significantly increased during NS relapse. Relapse NS EVs selectively expressed proteins that involved actin cytoskeleton rearrangement. Among these, the level of RAC-GTP was significantly increased in relapse EVs compared with remission and disease control EVs. Relapse EVs were efficiently internalized by podocytes and induced significantly enhanced motility and albumin permeability. Moreover, relapse EVs induced significantly higher levels of RAC-GTP and phospho-p38 and decreased the levels of synaptopodin in podocytes. Circulating relapse EVs are biologically active molecules that carry active RAC1 as cargo and induce recapitulation of the NS phenotype in podocytes in vitro. NEW & NOTEWORTHY Up to now, the role of extracellular vesicles (EVs) in the pathogenesis of steroid-sensitive nephrotic syndrome (NS) has not been studied. Here, we found that relapse NS EVs contain significantly increased active RAC1, induce enhanced podocyte motility, and increase expression of RAC-GTP and phospho-p38 expression in vitro. These results suggest that plasma EVs are biologically active molecules in the pathogenesis of NS.

Background: Increased ultrasonography (US) use has been correlated with an increased incidence of pediatric renal cysts. For simple and stage II cysts, the malignancy risk is low in adulthood, no follow up is recommended; but there is no consensus on childhood management. Given that pediatric renal cysts may be manifestations of hereditary cystic diseases, a different approach and follow up should be taken for these patients. Herein we present the clinical characteristics and follow-up data of pediatric patients with simple and stage II renal cysts., Methods: This cross-sectional study involved 57 children (mean age, 12.44 ± 3.65 years) with simple (n = 35) and stage II cysts (n = 22) who were diagnosed and followed at the present institution for ≥2 years., Results: The median follow-up period was 2.84 years for simple and 3.10 years for stage II cysts. None of the patients developed complications. No change in cyst diameter was detected in 65.7% of simple or in 45.5% of stage II cysts, whereas 13 simple cysts (37.1%) and eight stage II cysts (36.4%) increased in diameter. The diameter change per year was significantly higher in the stage II cysts than in the simple cysts (P = 0.017). Overall, 13 patients (22%) had an estimated glomerular filtration rate <90 mL/min/1.73 m 2 , and two patients had hypertension., Conclusion: Although the malignancy risk of simple and stage II kidney cysts is low for this age group, potential complications such as renal dysfunction, hypertension and hereditary cystic disease should be closely monitored., (© 2018 Japan Pediatric Society.)

Background: Ventilator management for children with hypoxemic respiratory failure may benefit from ventilator protocols, which rely on blood gases. Accurate noninvasive estimates for pH or P(aCO2) could allow frequent ventilator changes to optimize lung-protective ventilation strategies. If these models are highly accurate, they can facilitate the development of closed-loop ventilator systems. We sought to develop and test algorithms for estimating pH and P(aCO2) from measures of ventilator support, pulse oximetry, and end-tidal carbon dioxide pressure (P(ETCO2)). We also sought to determine whether surrogates for changes in dead space can improve prediction., Methods: Algorithms were developed and tested using 2 data sets from previously published investigations. A baseline model estimated pH and P(aCO2) from P(ETCO2) using the previously observed relationship between P(ETCO2) and P(aCO2) or pH (using the Henderson-Hasselbalch equation). We developed a multivariate gaussian process (MGP) model incorporating other available noninvasive measurements., Results: The training data set had 2,386 observations from 274 children, and the testing data set had 658 observations from 83 children. The baseline model predicted P(aCO2) within ± 7 mm Hg of the observed P(aCO2) 80% of the time. The MGP model improved this to ± 6 mm Hg. When the MGP model predicted P(aCO2) between 35 and 60 mm Hg, the 80% prediction interval narrowed to ± 5 mm Hg. The baseline model predicted pH within ± 0.07 of the observed pH 80% of the time. The MGP model improved this to ± 0.05., Conclusions: We have demonstrated a conceptual first step for predictive models that estimate pH and P(aCO2) to facilitate clinical decision making for children with lung injury. These models may have some applicability when incorporated in ventilator protocols to encourage practitioners to maintain permissive hypercapnia when using high ventilator support. Refinement with additional data may improve model accuracy.

The aim of this study is to prepare rifampicin-loaded poly (D,L-lactide)/poly(ethylene golycol) (PDLLA/ PEG) copolymer microspheres as an injectable drug delivery system. PDLLA homopolymers with three different molecular weights (9,760, 14,540, and 23,050 daltons) were synthesized and then transesterified with PEG (with a molecular weight of approximately 3,300-4,000 daltons). By changing the ratio of PEG to PDLLA, block copolymers with different chain structures were synthesized. PDLLA and PDLLA/PEG microspheres in the size range of 2-10 microns were prepared by a modified solvent evaporation technique with the use of methylene chloride as the solvent and methyl cellulose as the emulsifier within the aqueous dispersion medium. Rifampicin was loaded within the microspheres during particle formation. Effects of the solvent/polymer and drug/polymer ratios, PDLLA molecular weight, and PEG content on drug loading and release were investigated. High drug loadings up to 100 mg rifampicin/g polymer were achieved. Both size and drug loadings were decreased by an increase in the solvent/polymer ratio and PEG content and by a decrease in the drug/polymer ratio and PDLLA molecular weight. High release rates were observed in the first 5 days after which constant and slow release rates were noted. Drug release was decreased by a decrease in the solvent/polymer ratio and PEG content and by an increase in the drug/polymer ratio and PDLLA molecular weight.