Efficacy of sirolimus in an infant with Kasabach-Merritt phenomenon

Biofouling behaviors of reverse osmosis membrane in the presence of trace plasticizer for circulating cooling water treatment: Characteristics and mechanisms

Reverse osmosis (RO) system has been increasingly applied for circulating cooling water (CCW) reclamation. Plasticizers, which may be dissolved into CCW system in plastic manufacturing industry, cannot be completely removed by the pretreatment prior to RO system, possibly leading to severe membrane biofouling. Deciphering the characteristics and mechanisms of RO membrane biofouling in the presence of trace plasticizers are of paramount importance to the development of effective fouling control strategies. Herein, we demonstrate that exposure to a low concentration (1 - 10 μg/L) of three typical plasticizers (Dibutyl phthalate (DBP), Tributyl phosphate (TBP) and 2,2,4-Trimethylpentane-1,3-diol (TMPD)) detected in pretreated real CCW promoted Escherichia coli biofilm formation. DBP, TBP and TMPD showed the highest stimulation at 5 or 10 μg/L with biomass increasing by 55.7 ± 8.2 %, 35.9 ± 9.5 % and 32.2 ± 14.7 % respectively, relative to the unexposed control. Accordingly, the bacteria upon exposure to trace plasticizers showed enhanced adenosine triphosphate (ATP) activity, stimulated extracellular polymeric substances (EPS) excretion and suppressed intracellular reactive oxygen species (ROS) induction, causing by upregulation of related genes. Long-term study further showed that the RO membranes flowing by the pretreated real CCW in a polypropylene plant exhibited a severer biofouling behavior than exposed control, and DBP and TBP parts played a key role in stimulation effects on bacterial proliferation. Overall, we demonstrate that RO membrane exposure to trace plasticizers in pretreated CCW can upregulate molecular processes and physiologic responses that accelerate membrane biofouling, which provides important implications for biofouling control strategies in membrane-based CCW treatment systems.

Sirolimus for vascular anomalies in the first year of life: a systematic review

Evidence on effectiveness and safety of sirolimus in congenital vascular anomalies in infancy is lacking. We aim to systematically review the efficacy and safety of sirolimus in treating congenital VA in infancy. We searched for and included all studies evaluating sirolimus for VA in the first year of life. The primary outcome was effectiveness. The secondary outcome was safety. We included 84 case series and reports (172 participants). Sirolimus decreased the size of the VA in >50% of participants, most of whom had minor transient side effects, and 27% had no adverse effects at all. When categorized by age (<1 month, 1-5 months and 6-12 months), the effectiveness was similar in all age groups. Available evidence suggests that sirolimus is effective and well tolerated. The effectiveness of sirolimus should be evaluated in a well-designed randomized controlled or observational studies.

A case of neonate effectively treated with everolimus for giant hepatic hemangioma complicated with congenital duodenal atresia and Kasabach-Merritt syndrome

BACKGROUND

Disseminated intravascular coagulation (DIC) with Kasabach-Merrit syndrome from a large hepatic hemangioma is life-threatening. We report a case of giant hepatic hemangioma of the newborn with KMS.

RESULTS

The patient was born at 37 gestational weeks and 2 days via cesarean section; weight at birth was 2952 g. Congenital duodenal atresia was noted during the fetal period. DIC developed after delivery and a giant liver hemangioma was diagnosed via abdominal CT. The cause of DIC was Kasabach-Merritt syndrome owing to a giant hepatic hemangioma. First, combination therapy of 2 mg/kg/day of prednisolone and 0.2 mg/kg/day of propranolol was initiated form enterostomy. However, the size of the hepatic hemangioma did not alter, as observed via image evaluation. Therefore, 0.3 mg/kg/day of everolimus was administered frorm enterostomy. Subsequently, the size of the hepatic hemangioma was assessed via image evaluation. Although it did not alter, blood flow to the hepatic hemangioma decreased and thrombocytopenia was also suppressed. We performed hepatic lateral segmentectomy, radical operation for duodenal atresia. The pathological diagnosis of the removed tumor was infantile hemangioma.

CONCLUSION

We report everolimus may be useful when PSL and propranolol are ineffective.

Sirolimus for Kaposiform Hemangioendothelioma With Kasabach-Merritt Phenomenon in Two Infants

Kaposiform hemangioendothelioma is an aggressive vascular tumor with infiltrative growth that commonly occurs in infancy and is associated with a life-threatening consumptive coagulopathy, as well as Kasabach-Merritt phenomenon. Recently, promising results have shown that sirolimus had been successfully used to treat Kasabach-Merritt phenomenon without significant toxicity. However, the situation the authors encountered in treating infants was not so satisfactory. Here, the authors present 2 patients younger than 3 months with refractory Kaposiform hemangioendothelioma treated with sirolimus and experienced severe pneumonia. The outcomes suggest that it is necessary to keep an eye on any symptoms indicate the infection of respiratory tract and use the antibiotics in time. The 2 cases also remind us of the potential sign that indicate the recurrence of KMP, which refers to firmer lesion with deepen color, especially when it comes with complications.

Limb Salvage in an Extensive, Complicated Vascular Lesion of the Arm in an Infant

When a vascular lesion involving a limb poses a hazard to the life, treatment options are excision or amputation of the limb. Although excision can be hazardous, limb salvage with vascular control is the best treatment option. We report limb salvage in an infant with an extensive infected congenital hemangioma complicated with consumptive coagulopathy.