Detection of viral pathogens and allergens in infants and young children at high risk of asthma during a wheezing episode / 中国当代儿科杂志

OBJECTIVE@#To investigate the viral etiology and allergen distribution in infants and young children at high risk of asthma during a wheezing episode.@*METHODS@#A total of 135 infants and young children at high risk of asthma were enrolled who were admitted due to asthmatic bronchitis or asthmatic bronchopneumonia between April 2016 and August 2017. Fluorescent probe PCR was used to measure influenza A (Flu A), respiratory syncytium virus (RSV), adenovirus (ADV), parainfluenza virus (PinF), human rhinovirus (HRV), human partial lung virus (hMPV) and human bocavirus (HBoV) in nasopharyngeal aspirates. ImmunoCAP was used to measure inhaled allergens, food allergens, and total IgE concentration.@*RESULTS@#Among the 135 patients, the overall virus detection rate of nasopharyngeal aspirates was 49.6%, and HRV had the highest detection rate of 25.2%, followed by HBoV (9.6%), RSV (8.1%), PinF (5.9%), Flu-A (3.7%), ADV (1.5%) and hMPV (0.7%). The 1-3 years group had a significantly higher detection rate of HRV than the <1 year group (P<0.05). The positive rate of allergen screening was 59.3%, with 44% for inhaled allergens and 89% for food allergens. Among the inhaled allergens, dust mites had the highest positive rate of 77%, followed by mould (37%), pollen (26%) and animal dander (9%). Among the food allergens, egg white had a positive rate of 73% and milk had a positive rate of 68%. The <1 year group had a significantly higher positive rate of inhaled allergens than the 1-3 years group (P<0.05). The 1-3 years age group had a significantly higher level of T-IgE than the <1 year group (P<0.05). The positive virus group had a significantly higher positive rate of inhaled allergens than the non-virus group (P<0.05). The children with the second wheezing episode had significantly higher positive rates of inhaled allergens and food allergens and level of T-IgE than those with the first wheezing episode (P<0.05). The children with the second wheezing episode also had significantly higher positive rates of dust mites and mould than those with the first wheezing episode (P<0.05).@*CONCLUSIONS@#Early HRV infection and inhaled allergen sensitization are closely associated with the development of wheezing in infants and young children at high risk of asthma.

Effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease / 肠外与肠内营养

Objective:To investigate the effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease.Methods:A retrospective survey of 41 cases of post pylorus feeding (post pylorus feeding group,n =41) in respiratory intensive care unit (RICU) was carried out,and 41 patients who received nasogastric feeding (nasogastric feeding group,n =41) were investigated in the same RICU.The incidence of ventilator-associated pneumonia (VAP),the incidence of hospital-acquired pneumonia (HAP,excluding VAP) and the in-hospital mortality of RICU were observed and compared between the two groups.Vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral feeding were observed and compared as well.Results:The incidence of HAP in the post pylorus feeding group was 2.4％,which was significantly lower than that in the nasogastric feeding group (22％,P ＜ 0.05).The incidences of VAP in the post pylorus feeding group and nasogastric tube feeding group were 16.7％ and 8.7％ individually,which was no significant difference between the two groups (P ＞ 0.05).The mortality in RICU in the post pyloric feeding group was 36.6％,which was similar to that in the nasogastric feeding group (41.5％) (P ＞ 0.05).There was no difference in terms of vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral nutrition.Conclusion:Compared with nasogastric feeding,post pyloric feeding reduces the incidence of HAP in critical respiratory patients.Nevertheless,post pyloric feeding fails to affect the incidence of VAP and in-hospital mortality in RICU.

Distribution and change in antimicrobial resistance of bacteria from sputum of patients in respiratory intensive care unit / 中国感染控制杂志

Objective To investigate the distribution and antimicrobial resistance of bacteria isolated from sputum of patients in respiratory intensive care unit (RICU).Methods Non-repetitive bacteria isolated from sputum specimens of 557 hospitalized patients in RICU of a tertiary first-class hospital between January 2013 and December 2015 were collected,antimicrobial resistance of bacteria was analyzed.Results A total of 1 131 bacterial strains were isolated,212 (18.8 ％) were gram-positive bacteria and 919 (81.2 ％) were gram-negative bacteria.The top five species were Acinetobacter baumannii (30.2 ％),Pseudomonas aeruginosa (21.1 ％),Staphylococcus aureus (18.2％),Klebsiella pneumoniae (9.8％),and Serratia marcescens (8.3％).In 2013-2015,isolation rate of Staphylococcus aureus and non-fermentative bacteria showed no obvious changing tendency,but isolation rate of Enterobacteriaceae strains had increasing tendency.Antimicrobial susceptibility testing results showed that Acinetobacter baumannii and Pseudomonas aeruginosa exhibited high resistance rates to imipenem,levofloxacin,and gentamicin (all ＞ 60％),resistance rate of Pseudomonas aeruginosa to ceftazidime showed a downward trend (from 59.4％ to 37.5％);isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) was 96.1％,susceptibility to tigecycline,vancomycin,linezolid,compound sulfamethoxazole,quinupristin/dalfopristin were almost 100％;resistance rates of Enterobacteriaceae strains to sulfonamide decreased from 55.6％ to 14.3 ％,but resistance rates to ceftazidime,cefotaxime,imipenem,levofloxacin,and gentamicin were all ＞60％.Conclusion The major bacteria isolated from sputum of patients in RICU are Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,antimicrobial resistance of isolated bacteria is serious.

Association of T lymphocyte subsets and allergens with Mycoplasma pneumoniae infection complicated by wheezing in infants and young children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the percentage of T lymphocyte subsets and allergen screening results in infants and young children with Mycoplasma pneumoniae (MP) infection complicated by wheezing.</p><p><b>METHODS</b>Flow cytometry was used to measure the percentage of peripheral blood T cell subsets in 354 infants and young children with MP infection complicated by wheezing (MP wheezing group), 336 infants and young children with MP infection but without wheezing (MP non-wheezing group), and 277 children with recurrent wheezing (recurrent wheezing group). Allergen screening was also performed for these children.</p><p><b>RESULTS</b>Both the MP wheezing group and recurrent wheezing group had significantly lower percentages of CD3and CD3CD8lymphocytes than the MP non-wheezing group (p<0.05). The MP groups with or without wheezing had a significantly higher percentage of CD3CD4lymphocytes than the recurrent wheezing group (p<0.05). Both the MP wheezing group and recurrent wheezing group had significantly higher percentages of CD3CD19and CD19CD23lymphocytes than the MP non-wheezing group (p<0.05), and the recurrent wheezing group had the highest percentages (p<0.05). The overall positive rate of food allergens was significantly higher than that of inhaled allergens (30.3% vs 14.7%; p<0.05). The positive rates of food and inhaled allergens in the recurrent wheezing group and MP wheezing group were significantly higher than in the MP non-wheezing group (p<0.05), and the recurrent wheezing group had the highest rates.</p><p><b>CONCLUSIONS</b>Imbalance of T lymphocyte subsets and allergic constitution play important roles in the pathogenesis of MP infection complicated by wheezing in infants and young children.</p>

Etiology of acute respiratory tract infection in hospitalized children in Suzhou from 2005 to 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To elucidate the etiology of acute respiratory tract infection (ARI) in hospitalized children in Suzhou from 2005 to 2011.</p><p><b>METHODS</b>A total of 10 243 hospitalized children with ARI in Children's Hospital Affiliated to Soochow University from September 2005 to October 2011 were enrolled in the study. The clinical information was collected; and the nasopharyngeal aspiration fluid and serum samples were sent for multi-pathogen detection. Respiratory syncytial virus (RSV), influenza virus type A and B (IV-A, IV-B), parainfluenza virus type 1-3 (PIV-1-PIV-3) and adenovirus (ADV) were detected by direct immunofluorescence assay. Human bocavirus (HBoV), mycoplasma pneumoniae (MP) and chlamydia pneumoniae (CP) were detected by fluorescent quantitative PCR while human metapneumovirus (hMPV) was detected by reverse transcription PCR (RT-PCR). Sputum culture was applied to detect bacterial infection and quantitative ELISA was adopted to detect the specific antibodies of MP and CP. The results of the above detections were analyzed, and thereby to explore the prevalent pathogens among different aging children and the seasonal distribution and characteristics of the disease.</p><p><b>RESULTS</b>At least one type of pathogen was detected in 5871 out of 10 243 hospitalized children and the overall positive rate was 57.32%; including 3326 virus samples with positive rate at 32.47% (3326/10 243), 2870 bacteria samples with positive rate at 28.02% (2870/10 243) and 2759 atypical pathogen samples,with positive rate at 26.94% (2759/10 243). MP was the most common pathogen,whose detected rate was 25.74% (2637/10 243). The median age of children with RSV (6 months) or PIV-3(8 months) infection was younger than the median age of all hospitalized children (12 months) (χ(2) = 380.992, 34.826, P < 0.05). While the median age of children with ADV (42 months), HBoV (14 months) or IV-A (24 months) infection was older than it of all hospitalized children (χ(2) = 83.583, 13.169, 18.012, P < 0.05). The median age of children with MP (30 months),streptococcus pneumoniae (17 months) or haemophilus parainfluenzae (21 months) infection was older than it of all hospitalized children (χ(2) = 728.299, 60.463, 8.803, P < 0.05). The detected rate of RSV in the groups of children aging less than 6 months, 7-12 months, 2-3 years, 4-5 years and over 6 years was separately 25.59% (840/3283), 17.05% (333/1953), 11.85% (310/2615), 6.68% (90/1347), and 2.87% (30/1045); which decreased while the age grew (χ(2) = 178.46, P < 0.01). Conversely, the positive rate of MP increased with the age growing (χ(2) = 379.21, P < 0.01). The rate in the above groups was 8.25% (271/3283), 19.46% (380/1953), 33.00% (863/2615), 41.43% (558/1347), 54.07% (565/1045), respectively. RSV and IV-A were prevalent in winter, whose detected rates were 35.73% (941/2634) and 4.44% (117/2634) respectively.hMPV infection was common in spring, with the detected rate at 10.55% (278/2634); while HBoV infection was common in summer and autumn, with the positive rate at 9.99% (149/1491) and 9.71% (98/1009). MP and CP were frequently detected in summer, up to 31.27% (819/2619) and 10.07% (43/427) respectively. RSV was the most common pathogen in bronchiolitis (33.27% (866/2603)) and MP was the most common pathogen in bronchopneumonia (26.05% (1152/4422)) and lober pneumonia (52.25% (267/511)).</p><p><b>CONCLUSION</b>MP and RSV were the most common pathogens in respiratory tract infection in hospitalized children. The novel virus included hMPV and HBoV, which also played an important role in ARI. Different pathogens were prevalent in different ages; with respective seasonal distribution and characteristics.</p>

Antithrombin-III without concomitant heparin improves endotoxin-induced acute lung injury rats by inhibiting the activation of mitogen-activated protein kinase / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Antithrombin-III (AT-III), the major inhibitor of thrombin in plasma, also has anti-inflammation property and might have positive effect on sepsis. The present study aimed to investigate the effects of AT-III on inflammatory reaction and pulmonary protection in endotoxin-induced acute lung injury (ALI) rat.</p><p><b>METHODS</b>Sixty male Sprague-Dawley rats were randomly assigned equally to normal control group, ALI group, AT-III treatment group, AT-III + heparin treatment group, and heparin treatment group. The pulmonary vascular permeability index (PVPI) was measured by single nuclide tracer technique. The activity of AT-III in plasma was determined by the method of synthetic chromogenic substrata. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels in serum were determined by enzyme-linked immunosorbent assay. The expressions of lung tissue mitogen-activated protein kinases (ERK1/2, P38 and JNK MAPK) were determined by Western blotting.</p><p><b>RESULTS</b>Rats had significantly improved lung histopathology in the AT-III treatment group and heparin treatment group compared with the ALI group. The PVPI of the ALI group was 0.38 + or - 0.04, significantly higher than that of the normal control group (0.20 + or - 0.02, P < 0.01), AT-III treatment group (0.30 + or - 0.04, P < 0.01) and heparin treatment group (0.28 + or - 0.04, P < 0.01) respectively. There were no significant differences of PVPI in the ALI group and AT-III + heparin treatment group. The activity of AT-III in plasma in the ALI group was (76 + or - 8)%, significantly lower than that of the normal control group ((96 + or - 11)%, P < 0.05) and AT-III treatment group ((105 + or - 17)%, P < 0.05) respectively. The serum levels of TNF-alpha and IL-6 of the ALI group were (2.770 + or - 0.373) microg/L and (1.615 + or - 0.128) ng/ml respectively, significantly higher than those of the normal control group ((0.506 + or - 0.093) microg/L and (0.233 + or - 0.047) ng/ml respectively, all P < 0.01), AT-III treatment group ((1.774 + or - 0.218) microg/L and (1.140 + or - 0145) ng/ml respectively, all P < 0.01) and heparin treatment group ((1.924 + or - 0.349) microg/L and (1.223 + or - 0.127) ng/ml respectively, all P < 0.01). The lung tissue levels of phospho-ERK1/2 and phospho-P38 MAPK expressions were markedly higher in the ALI group than in the normal control group, AT-III treatment group and heparin treatment group respectively.</p><p><b>CONCLUSIONS</b>AT-III without concomitant heparin inhibited the activation of ERK1/2 and P38 MAPK, down-regulated the levels of downstream cytokines TNF-alpha and IL-6, relieved endothelial permeability, and improved the ALI in endotoxin-induced rats. It might be helpful to administrate AT-III alone, not with concomitant heparin, to those patients with ALI and sepsis.</p>