Etiology and clinical characteristics of fever of unknown origin in 357 pediatric patients / 中华儿科杂志

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.

Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes.</p><p><b>METHODS</b>According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded.</p><p><b>RESULTS</b>Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (P<0.05). Compared with the MR and LR groups, the HR group had a significantly higher proportion of children admitted to the intensive care unit and a significantly longer duration of mechanical ventilation (P<0.05). The HR group had a significantly longer mean hospital stay and a significantly higher incidence rate of complications compared with the LR and MR groups (P<0.05).</p><p><b>CONCLUSIONS</b>Nutritional risk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.</p>

Effect of apigenin on microglia in penumbra after acute transient focal cerebral ischemia-reperfusion injury in rats / 中草药

Objective: To study the effect of apigenin on the expression of microglia in penumbra and cerebral water content after acute transient focal cerebral ischemia-reperfution injury in rats. Methods: The acute transient focal cerebral ischemia-reperfusion models in rats were established with the modified suture method. Male Sprague-Dawley rats were randomly divided into Sham group, model group, and apigenin groups (there were 6, 24, 48, 72 h, and 7 d reperfusion treatments in the model and apigenin groups, n = 12). All of them are 11 groups. The neurological behavior scores were valued. By FITC labeled isolectin B4 (FITC-ILB4) histochemistry staining, the infiltration of monocytes and the changes of cell morphology and number of brain-derived microglia in penumbra of six rats in every group were observed under laser scanning confocal microscope (LSCM). Water content was measured in isolated brain tissue of other six rats. Results: The positive cells of ILB4 (ILB4+) including microglia cells (Rhod 6G-) and infiltration of monocytes (Rhod 6G+) were found in cerebral ischemic area around penumbra of rats after 6 h ischemia-reperfusion in model group; The morphology changed to Amoeba-like; Microglia increased significantly after 48 h and reached to peak in 72 h, which mainly belonged to the proliferation of brain-derived microglia in Amoeba-like morphology. Microglia cell decreased in 7 d, and microglia in apigenin group obviously decreased more than that in model group (P<.05, 0.01) with the similar morphological change in corresponding time points. In 48 and 72 h of cerebral ischimia, the water content in brain tissue of rats in apigenin group was markedly lower than that in model (P<0.01). There was negative line correlation between the neurological behavior score and the number of ILB4 + cells in penumbra of model group (r=-0.415, P<.05). Apigenin could reduce the degree of neurological deficiency in model group and mitigate the brain injury effectively. Conclusion: A part of microglia cells inpenumbra are associated with brain injury; Apigenin shows the protection on acute transient focal cerebral ischemia-reperfution injury in rats, which maybe relates with down-regulating the microglia cell number and inhibiting the excessive activation of microglia cell.