ABSTRACT
OBJECTIVE: To summarize the clinical features of spinal muscular atrophy complicated with pulmonary infection in children,and to improve clinicians' understanding of the disease and improve the prognosis. METHODS: The clinical data of 36 children with SMA complicated with pulmonary infection,who were admitted to Yuying Children's Hospital of the Second Affiliated Hospital of Wenzhou Medical University from January 1,2008 to December 31,2017,were retrospectively analyzed. RESULTS: Among of the 36 patients,19 were typeⅠ,9 were typeⅡ,and 8 were typeⅢ. The common clinical manifestations and signs were fever,cough,shortness of breath,laborious breathing,three-concave signs,and crackles in the lungs. Respiratory failure occurred in 11 children,including 7 children(63.6%)with typeⅠSMA,2 children(18.2%)with typeⅡ SMA and 2 children(18.2%)with typeⅢ SMA. Imaging findings showed 5 cases of scoliosis,3 cases being typeⅡ SMA,and 2 being typeⅢ SMA. Pathogenic tests were positive in 18 children:10 cases(55.5%)of type Ⅰ SMA,4 cases(22.2%)of typeⅡ SMA,4 cases(22.2%)of typeⅢ SMA;nosocomial mixed infection with conditioned pathogens was common,among which Burkholderia cepacia was the most common. Three patients died in the hospital,22 patients improved and discharged,and the remaining 11 patients gave up treatment. The number of hospitalizations,the incidence of severe pneumonia and respiratory failure was significantly different between the first 5 years(2008-2012)and the last 5 years(2013-2018)(P<0.05). CONCLUSION: SMA is verysusceptible to pulmonary infection. We should be alert to opportunistic pathogenic bacteria infection and use mechanical ventilation in time for respiratory failure patients. Active and effective respiratory care can reduce the incidence of pulmonary infection and improve the prognosis of SMA children.
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AIM:To explore the effect of curcumin(Cur)and curcuminoids(Y20 and 6B)on the expression of secretory leukocyte protease inhibitor(SLPI), tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)induced by Streptococcus pneumoniae(SP)and the possible mechanism.METHODS:BEAS-2B cells incubated with SP were set up as an inflammation model of pneumonia.The mRNA levels of SLPI at 1 h,3 h,6 h and 9 h,and the mRNA expression of TNF-αand IL-1βat 3 h,6 h and 9 h in control group,SP infection group,Cur treatment group,Y20 treatment group and 6B treatment group were measured by qPCR.The protein levels of TNF-αand IL-1βin the culture supernatant were measured by ELISA.The protein levels of Toll-like receptor 2(TLR2)and phosphorylated nuclear factor-κB(p-NF-κB) p65 at 3 h,6 h and 9 h were determined by Western blot.RESULTS:The mRNA level of SLPI was increased in Cur, Y20 and 6B treatment groups compared with SP group(P<0.05).The protein levels of TLR2 and p-NF-κB p65 were sig-nificantly increased after SP stimulation.After treatment with Cur,Y20 and 6B,the protein levels of TLR2 and p-NF-κB p65 were significantly decreased(P<0.05).The levels of TNF-αand IL-1βwere significantly increased after SP stimula-tion.Cur,Y20 and 6B significantly decreased the levels of TNF-αand IL-1βin the supernatant(P<0.05).CONCLU-SION: Cur, Y20 and 6B increase SLPI expression, reduce the expression of inflammatory cytokines TNF-αand IL-1β. The possible mechanism might be associated with inhibiting TLR 2 expression and down-regulating the transcriptional activity of NF-κB.
ABSTRACT
<p><b>OBJECTIVE</b>To study the clinical characteristics of children who suffered from Streptococcus pneumoniae (SP) septicemia and the drug sensitivity of SP strains.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 25 children with SP septicemia between January 2009 and December 2012.</p><p><b>RESULTS</b>Of the 25 cases, 16 (64%) were aged under 2 years, 5 (20%) were aged 2-5 years, and 4 (16%) were aged over 5 years. Fourteen cases (56%) were complicated by infection of other organs, and 5 cases (20%) had underlying chronic diseases. Fever was the most common clinical manifestation, and the majority presented with remittent fever. Eight patients with pneumonia or pyothorax had pulmonary symptoms. Five patients with purulent meningitis had neurological symptoms, five cases had hepatosplenomegaly and two cases had septic shock. Nineteen cases (76%, 19/25) had significantly elevated white blood cell (WBC) counts, twenty-one cases (84%, 21/25) had significantly elevated serum C-reactive protein (CRP) levels, and eight cases (50%, 8/16) had significantly elevated serum procalcitonin (PCT) levels. The drug sensitivity analysis showed that invasive SP had high resistance rates to penicillin (96%), clindamycin hydrochloride (88%) and erythromycin (84%), and it was completely sensitive to imipenem, vancomycin, levofloxacin and linezolid. The multi-drug resistance rate of invasive SP was up to 88%. Twenty-three cases (92%) were cured or improved after active treatment.</p><p><b>CONCLUSIONS</b>SP septicemia is commonly seen in children aged under 2 years. The most common clinical manifestation is fever, accompanied by elevated WBC count, CRP level and PCT level, and it is usually complicated by pulmonary or brain infection. Resistance to multiple antibiotics is very common in SP strains, so it is important to properly use antibiotics according to drug sensitivity test results. Patients who receive active treatment have a good clinical outcome.</p>