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Objective To investigate the treatment of infant wheezing during acute phase in the pediatric out-patient departments of two tertiary hospitals and two secondary hospitals in Shanghai.Methods Simple random sam-pling method was adopted.Standardized questionnaires were given to the parents and physicians of infants who suffered wheezing during the acute phase to survey the treatment methods in the pediatric outpatient departments of two tertiary hospitals(Xinhua Hospital,Shanghai Children's Medical Center)and two secondary hospitals(Putuo District People's Hospital,Renhe Hospital)from February to May 2015 in Shanghai area.All data were analyzed by using SPSS 20.0 software.The enumeration data were used to describe the frequency distribution,composition ratio,and the rates among different groups were compared by the χ2test.Results The survey questionnaires were withdraw from 264 cases,of which 166 were boys and 98 were girls.In the treatment of acute exacerbation,the rate of antibiotic use was 94.7%(250/264 cases),in which 67.0%(177/264 cases)were intravenous drugs;62.1%(164/264 cases)patients were using inhaled glucocorticoid and short-acting beta-agonists as the main drugs for treatment;the ratio of systemic glu-cocorticoid using was 52.3%(138/264 cases),and the ratio of intravenous method was 43.2%(114/264 cases) among the cases.The usage ratio of systemic beta-agonist,anti-leukotrienes and antihistamines were 83.0%(219/264 cases),30.3%(80/264 cases)and 41.3%(109/264 cases),respectively.Of the 206 cases with respiratory in-fection,the rate of antibiotics use reached 98.5%(203/206 cases),and among the 58 cases without respiratory infec-tion,and the rate of antibiotics use acounted to 84.5%(49/58 cases).The difference between the two groups was sta-tistically significant(χ2=20.6,P<0.01). There were 200 cases of children with atopic physique background,of whom,42.5%(85/200 cases)were treated with antihistamine and 34%(68/200 cases)were treated with anti-leu-kotriene drugs.There were 64 cases without atopic physique background,of whom,37.5%(24/64 cases)were treated with antihistamine and 18.8%(12/64 cases)were treated with anti-leukotriene drugs.The proportion of anti-leuko-triene drug use in children with atopic physique background was significantly higher than that in children without atopic physique background,and the difference between two groups was statistically significant(χ2=5.34,P<0.05).Except for antihistamine treatment,the distribution of other treatments in different hospitals or outpatient departments was simi-lar(all P>0.05).Conclusions Nebulized glucocorticoid and beta-agonist therapy has become the routine treatment for infant wheezing in the acute phase in the tertiary and secondary level hospitals in Shanghai.The treatment of infant wheezing needs to be further standardized since the use of antibiotics,systemic glucocorticoids and intravenous drugs is excessive.
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Objective Early studies had confirmed that the combine-sequential therapy in the treatment of acute attacks of wheezing infants was safe and effective,this study aims to further explore the role of oral azithromycin in the combine-sequential therapy.Methods According to the principles of randomized,56 wheezing infants were divided into Azithromycin group and control group from Aug.2012 to Apr.2013,and there were 29 children in the Azithromycin group and 27 children in the control group.The treatment protocol of Azithromycin group were oral Azithromycin 10 mg/(kg · d),3 days; oral prednisone 5 mg/d,3 days; Tulobuterol Patch 0.5 mg/d,7 days;oral Ioratadine 3 mL/d,7 days; oral Montelukast 4 mg/d,7 days.Control group was without Azithromycin,and the rest of drugs were the same as Azithromycin group.The symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration in the 1 st day,the 3rd day,and the 7th day were recorded.Results 1.The Azithromycin group and the control group could both improve the children's symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration,the 2 groups of children before and after treatment of the symptom scores differences were statistically significant (5.41 ± 1.40,4.85 ± 1.13 vs 1.14 ± 0.78,2.93 ± 1.00) (S =217.5,147.0,all P ＜ 0.05).2.The Azithromycin group had more improvement at the symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration than those of the control group in the third day (0.52 ±0.51,0.28 ±0.45,0.24 ±0.44,0.38 ±0.49 vs 0.89 ± 0.42,0.74 ±0.45,0.62 ±0.69,0.67 ±0.48)and the 7th day (0.24 ±0.44,0.21 ±0.41,0.07 ±0.26,0.21 ±0.41 vs 0.52 ±0.51,0.48 ±0.51,0.37 ±0.49,0.48 ±0.51),and the symptom score differences were statistically significant(Z =2.75,3.44,2.90,2.12,2.11,2.13,2.71,2.13,all P ＜ 0.05).Conclusions Azithromycin + Tulobuterol patch + Prednisone + Loratadine + Montelukast combination consisting of sequential therapy can improve children with acute wheezing cough,wheezing,wheezing,difficulty of the expectoration symptoms,azithromycin is an effective component of infants wheezing combined sequential treatment regimen.
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10.3969/j.issn.1000-3606.2013.06.014
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Objective To establish a method of isolation, purification and identification of type Ⅱ alveolar epithelial cells (AEC- K ) from neonate piglet lungs of 1 ～ 3 days old and to investigate effects of proinflammatory cytokines on expression of growth factors (GFs). The yield, viability and purity of AEC- Ⅱ obtained using different enzyme digestion and purifying methods were compared. Methods After the first 24-hour culture of AEC- Ⅱ ,the media containing interleukin (IL)-1β,IL-6 and IGF-Ⅰ at different concentrations were used to culture AEC-Ⅱ for another 48 hours. And then the cells were counted and the expressions of insulin-like growth factor (IGF-Ⅰ ), platelet-derived growth factor ( PDGF), surfactant proteins (SP) -A and SP-B mRNA were determined by real time PCR. Results A significantly higher yield of AEC-Ⅱ was achieved by digesting the lung with 30 unit/ml elastase and 0.1 % trypsin at 37 t for 20 min, the yield was (5.33 ±0.54) × 106 after adjusted by the weight of lung and heart (P <0.01). The number of purified AEC-II obtained by immune adherence method was (38.0 ±28.0) × 106 perpiglet which was higher than by the method of percoll. The optimal phenotype maintenance time of AEC- Ⅱ was the first 24～96 hours in the primary culture. With increasing concentrations of IL-1 β and IL-6, there were decreased proliferation and expression of SP-A and IGF-Ⅰ mRNA in the cultured AEC- Ⅱ ,but SP-B mRNA expression was not affected. Both AEC-Ⅱ proliferation and expression of SP-A, SP-B mRNA decreased significantly after cultured with anti-IGF-Ⅰ. Conclusion In a new model of cultured AEC-Ⅱ from neonate piglets, IL-1β and IL-6 inhibited AEC- Ⅱ proliferation and SP-A mRNA expression through IGF-Ⅰ -dependent mechanisms.