Evidence-based guidelines for food allergy of children in China / 中华实用儿科临床杂志

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

Experts proposal and frequently asked questions of rapid screening and prevention of novel coronavirus pneumonia in children / 中华实用儿科临床杂志

The outbreak of novel coronavirus pneumonia (NCP) has become the most severe public health issue at the moment, threatening people′s lives.Pediatricians in Shanghai have recently launched a discussion on the focused questions of NCP, including the incidence situation, epidemiological features, essentials of early screening, treatment and nosocomial infection prevention of children′s novel coronavirus infection (2019-nCoV), and further put forward the experts proposal upon the patterns of disease occurrence, development, diagnosis and control, for the reference of frontline pediatricians.

Experts proposal and frequently asked questions of rapid screening and prevention of novel coronavirus pneumonia in children / 中华实用儿科临床杂志

The outbreak of novel coronavirus pneumonia (NCP) has become the most severe public health issue at the moment, threatening people′s lives. Pediatricians in Shanghai have recently launched a discussion on the focused questions of NCP, including the incidence situation, epidemiological features, essentials of early screening, treatment and nosocomial infection prevention of children′s novel coronavirus infection (2019-nCoV), and further put forward the experts proposal upon the patterns of disease occurrence, development, diagnosis and control, for the reference of frontline pediatricians.

Effects of environmental exposure on allergic diseases in children / 中华实用儿科临床杂志

The prevalence of allergic diseases is rising in children as a result of complex gene-environment interactions.Environmental exposures can dramatically influence the phenotype of allergic diseases, including atopic eczema, asthma, and allergic rhinitis.Environmental factors associated with allergic diseases include chemical pollutants and allergens in the air, as well as other environmental exposures such as the microbiome.Indoor and outdoor air pollutants and allergens play an important role in the inflammatory response and clinical manifestations of allergic reactions caused by allergens.Strengthening environmental control and controlling environmental exposure is an important way to prevent allergic diseases.

Effects of environmental exposure on allergic diseases in children / 中华实用儿科临床杂志

The prevalence of allergic diseases is rising in children as a result of complex gene-environment interactions.Environmental exposures can dramatically influence the phenotype of allergic diseases,including atopic eczema,asthma,and allergic rhinitis.Environmental factors associated with allergic diseases include chemical pollutants and allergens in the air,as well as other environmental exposures such as the microbiome.Indoor and outdoor air pollutants and allergens play an important role in the inflammatory response and clinical manifestations of allergic reactions caused by allergens.Strengthening environmental control and controlling environmental exposure is an important way to prevent allergic diseases.

Some problems in control therapy of asthma in children / 中华实用儿科临床杂志

Asthma is the most common chronic respiratory diseases in children. Within the recent decades, prevalence of childhood asthma has increased gradually in China,but the clinical control level is out of expectation. How to use the anti-inflammatory drugs correctly plays a key role in the long-term management of childhood asthma, which directly affects the outcome of disease. Epidemiological survey in China showed that there was a coexistence of in-sufficient controllers use and excessive controllers use in the management of childhood asthma in China. Now,the opti-mal selection of medications,dosage,course of treatment,safety,compliance and other concerns needing attention in the management of childhood asthma,were described based on the current research progress in the treatment of children with controllers,and current status of long-term asthma control in practice.

Efficacy and safety of nebulized hypertonic saline in different concentration in infants with moderate to severe bronchiolitis / 中国小儿急救医学

Objective To evaluate the efficacy and safety of frequently nebulized hypertonic saline(HS) in different concentration with Terbutaline in infants with moderate to severe bronchiolitis.Methods A total of 195 infants were randomly enrolled to either Group A(5% HS 4ml+Terbutaline 2.5mg,n=65),Group B(3% HS 4ml + Terbutaline 2.5mg,n=65) or Group C[0.9% normal saline(NS) 4ml + Terbutaline 2.5mg,n=65].All the infants were given inhalation treatment q6h after admission for 4 times,and then q8h till the remission of wheezing.The primary outcome was the hospital length of stay(LOS),and the secondary outcomes were the clinical severity score(CSS),remission time of wheezing,cost and side effects.

Effect of bacteria lysates and 1,25-dihydroxy vitamin D3 on airway inflammation in asthmatic mice models / 中华实用儿科临床杂志

Objective To discuss the effects of bacteria lysates (OM-85BV),1,25-dihydroxy vitamin D3 [1,25-(OH)2-VitD3],two immune regulators on airway inflammation in asthmatic mice models,and its pathways of action on airway inflammation were discussed.Methods Forty male BALB/c mice graded 4-6 weeks were randomly divided into 5 groups.Group A:control group;group B:asthmatic model group;group C:1,25-(OH)2-VitD3 group;group D:OM-85BV group;group E:combination group.On days 0 to 14,mice in C,D and E groups were given 1,25-(OH)2-VitD3,OM-85BV and 1,25-(OH)2-VitD3 + OM-85 BV,and mice in A,B groups were given 9 g/L saline instead.On days 15,22 and 29,mice in B,C,D,E groups were intraperitoneally with injection of ovalbumin(OVA)-aluminum hydroxide [Al(OH)3].Group A were given 9 g/L saline instead.On days 36 to 40,mice of B,C,D,E groups were given an aerosol challenge of 10 g/L OVA for 0.5 h once a day.Mice in the control group were given the same amount of 9 g/L saline.Animals were sacrificed 24 hours after the final inhalational challenge,and for the recovered bronchoalveolar lavage fluid(BALF) of the left lung was used for differential inflammatory cell counts and for detecting the level of inflammatory cytokine interleukin-17 (IL-17).Right lung samples were used for pathological investigation and detecting the expression of the IL-17 mRNA and RORγt mRNA by real time-PCR.Results Compared with the control group,the asthma models expressed more serious expression in bronchospasm contraction,hyperplasia disorders of bronchial epithelial cells,infiltration of inflammatory cells in lung,and so on.Compared with the control group,the total number of inflammatory cells counts[(104.04 ±5.51) 107/L vs (22.79 ± 1.91) 107/L] and eosinophils proportion [(37.63 ± 3.64) ％ vs (2.37 ± 1.55) ％] in BALF in group B were significantly increased (all P ＜ 0.05),the levels of IL-17 [(85.13 ± 5.77) 103 pg/L vs (47.44 ± 4.57) 103 pg/L] in BALF were significantly higher(P ＜ 0.05),the relative expressions of IL-17 mRNA (13.68 ± 1.59 vs 1.00 ± 0.00) and RORγt mRNA (4.53 ± 0.51 vs 1.00 ± 0.00) in lung were higher,which had a statistical significance (all P ＜ 0.05).The situations of group C,D,E were obviously improved compared with group B,and those of group D were improved remarkably.Conclusions Oral OM-85BV and 1,25-(OH)2-VitD3 intervention could relieve the airway inflammation of asthmatic mice models,and its effect can be remarkable by oral OM-85BV.The two immune regulators could relieve the degree of airway inflammation on asthmatic mice models by reducing the expression of Th17 cells differentiation.Therefore the two immune regulators could be the choices for preventing the happening and the development of the asthmatic airway inflammation.

A systematic review of the therapy for Mycoplasma pneumoniae infections in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin (IVIG) in treating Mycoplasma pneumoniae(MP) infections.</p><p><b>METHOD</b>The literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis.</p><p><b>RESULT</b>(1) Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was-1.10 (95% CI: -1.60,-0.60) and the mean difference of cough duration was-1.56 (95% CI: -2.10,-1.03). (2) Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was-1.77(95% CI: -2.44,-1.10) and the mean difference of cough duration was-2.47 (95% CI: -2.86,-2.08); for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was-3.41 (95% CI: -4.10,-2.73) and the mean difference of cough duration was-2.25 (95%CI: -4.38,-0.12). (3) Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG.</p><p><b>CONCLUSION</b>There was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adjuvant therapy. IVIG as an adjuvant therapy is at an exploration stage.</p>

Impact of pollution on asthma in childhood / 中华实用儿科临床杂志

Pollution has been widely recognized as a serious public health problem,which has a negative effect on many aspects of asthma in childhood.This paper mainly expounds the impact of pollution on asthma in childhood,emphatically introduces the possible mechanisms of pollution on the susceptibility to asthma and disease control.

The impact of bacterial lysate on asthma prevention in mouse / 临床儿科杂志

Objective To establish mouse allergic asthma model and observe the effect of bacterial lysates (OM-85BV) on airway inlfammation. Methods Forty-eight 4 to 6 weeks healthy male BALB/c mice were used as research subjects and randomly divided into six groups, a:control group;b:OM-85BV contral group;c:allergic asthma model;d:dexamethasone group (Dex group);e:OM-85BV A group;f:OM-85BV B group (the intervention time was prolonged 10 days than group e). BALB/c mice were sensitized and challenged with ovalbumin (OVA). Mice in groups c, d, e and f were intraperitoneally administered with antigen (OVA)-Al(OH)3 on days 1, 8 and 15, others were administered by PBS. From the 17th day to the 26th day, Mice in group f were treated with OM-85BV and others were treated with normal saline. In the next days, mice in groups c, d, e and f were intranasal given OVA for 5 consecutive days. Additionally, mice in groups b, e and f were treated with OM-85BV before challenge, while mice in the group d were administered by Dex, others were treated with normal saline at the same dose. Twenty four hours after the last intranasal administration, mice were anesthetized and dissected. Lungs were lavaged with PBS and bronchoalveolar lavage lfuid (BALF) was obtained. The total inlfammatory cells and eosinophils in BALF were counted. The total IgE levels of blood serum and IFN-γ/IL-4 levels of lavage were detected. The removed parts of lung tissue were collected for histological examination. Results Compared with groups a and b, lung tissue biopsies by HE staining from the asthma group showed obvious airway inlfammation. The situation of groups d and f was signiifcantly improved than group c, while the differences between groups e and c were not evident. Total cells and the number of eosinophils in BALF of group c (90.3±13.94×104/ml) were signiifcantly higher than that in groups a and b. Compared with the control group, levels of IL-4 in BALF (119.03±19.92 pg/ml) and IgE in serum (15.86±1.97 ng/ml) increased and levels of IFN-γin BALF (90.50±13.51 pg/ml) reduced signiifcantly. The corresponding levels of groups d, e and f were signiifcantly improved than group c (P<0.01). Conclusions Administered by OM-85BV helps regulate the balance between Th1/Th2 in asthmatic mice, reduce airway inlfammation, and prevent the occurrence and development of airway inlfammation.

The revision points for Chinese guideline of childhood asthma / 临床儿科杂志

The current guideline for the diagnosis and optimal management of asthma in children, published in 2008, has played a positive role in promoting the clinical practice level on the management of childhood asthma in China. With the deepening of understanding of the disease, there have been some new technologies on the management of child-hood asthma in recent years. It is necessary to revise the existing guidelines accordingly for better use in clinical practice. This paper puts forward some exploratory points of view on the revision of childhood asthma guideline. The main con-tents are involved in disease diagnosis, monitoring and evaluation, and treatment.

Relationship of 25 (OH) D levels in cord and maternal peripheral blood / 临床儿科杂志

Object To explore the relationship of 25 (OH) D levels in cord and maternal peripheral blood to understand the maternal and neonatal vitamin D status in Songjiang District of Shanghai. Methods One hundred newborns delivered at the First People’s Hospital afifliated to Shanghai Jiaotong University and 20 pregnant women during November 2010 to January 2011 in Songjiang district were enrolled in the study. The levels of 25 (OH) D in cord and maternal blood were measured by ELISA and compared. Results Mean materna1 serum levels of 25 (OH) D was (23.42±5.23) nmol/L, and cord blood 25 (OH) D was (29.77±12.51) nmol/L. Maternal serum 25 (OH) D was positively correlated with cord blood 25 (OH) D (r=0.84, P<0.001). Conclusions This study shows that the prevalence of vitamin D deifciency in pregnant women is high in Shanghai Songjiang District, which could have adverse effects on newbowns.

A multi-center trial for the efficacy of nebulized budesonide inhalation in infants and young children with asthma exacerbations / 中国小儿急救医学

Objective To observe the efficacy and safety of different initial doses of nebulized budesonide inhalation (BI) in infants and young children with moderate to severe asthma exacerbations.Methods A multi-center,parallel controlled clinical trial was performed during Sep 2008 to Apr 2010 in three hospitals,which were Department of Pediatrics,Shanghai Jiaotong University Affiliated Shanghai First People's Hospital,Department of Pediatrics,Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital,and Department of Respiratory,Fudan University Affiliated Children's Hospital.One hundred and fifty children aged 6 to 36 month with moderate to severe asthma exacerbations were randomly divided into two groups.The high-starting-dose group was treated with a dose of 1 mg nebulized BI every 8 h for 2 days,while the conventional-starting-dose group was treated with a dose of 0.5 mg cvcry 8 h for 4 days.The terbutaline sulfate aerosol liquid was administered with a dose of 2.5 mg each time as needed.The primary outcome measures were severity scores,which were assessed at admission (0 h),and 8 h,16 h,24 h,48 h,72 h after treatment separately.The secondary outcome measures included the use of β2 receptor agonist,the systemic use of corticosteroids,average length of hospital stay and total cost.The data was analyzed with SPSS 13.0.Results (1) The clinical severity scores were significantly decreased at all time points after treatment in both groups (P ＜ 0.05).Compared with conventional starting-dose of BI,high starting-dose of 3.25 ± 1.82,P ＜ 0.01).(2) The terbutaline doses and the systemic corticosteroids do-ses were significantly reduced in high-starting-dose group compared with conventional-starting-dose group [(16.27 ± 12.99) mg vs (22.90 ± 18.27) mg,P ＜ 0.05 ; (4.54 ± 18.18) mg vs (11.16 ± 21.34) mg,P ＜ 0.05).The average length of hospital stay and the total cost of the two groups showed no significant differences (P ＞ 0.05).(3) There were no side effects associated with BI.Conclusion Compared with conventional treatment,high-starting-dose of BI can control symptoms fast and reduce the use of systemic corticosteroid without any side effects.BI improved symptoms more quickly at 8 h (2.87 ± 1.60 vs 4.48 ± 2.24,P ＜ 0.01) and 16 h (2.48 ± 1.56 vs

A Three-Month Non-Interventional Study of Asthma Treatment with Budesonide/Formoterol / 中国呼吸与危重监护杂志

Objective To evaluate the efficacy of Budesonide/formoterol to control asthma under real-life conditions.Methods A muhi-center, open label, non-interventional study was conducted.Asthma control after 12 week therapy with Budesonide/formoterol was assessed by Asthma Control Questionnaire (ACQ) and modified Asthma Control Questionnaire (ACQ5).Results A total of 360 asthma patients were recruited,including 228 adult patients and 132 child patients.After 12 weeks' therapy,all the patients' medium value of ACQ was decreased significantly from 2.03 (adults 2.20, children 1.74) at baseline to 0.60 (adults 0.78, children 0.29) (P < 0.0001), and the medium value of ACQ5 was also decreased significantly from 2.4 (adults 2.24, children 1.76) at baseline to 0.47 (adults 0.62, children 0.20) (P < 0.0001).Conclusion Budesonide/formoterol is effective in asthma treatment, by which most asthma patients obtain and maintain clineal control.