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Objective:To evaluate the effects of smart stethoscope on the monitoring childhood asthma exacerbation, so as to assist family management in childhood asthma.Methods:A prospective randomized controlled study was carried out.A total of 80 children with asthma who were treated at Department of Pediatric Respiratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine and Shanghai Tonxin Pediatric Clinic from November 2020 to May 2021 were enrolled and randomly divided into a test group of 40 cases (used the smart stethoscope) and a control group of 40 cases(not used the smart stethoscope). Medical history data were collected.The control group received monthly routine follow-up, while the test group was followed up both routinely and by smart stethoscope.In the test group, hearing wheezing sound was regarded as asthma exacerbation, and in the control group, the asthma exacerbation was reported by the parents themselves.The frequency of asthma exacerbation, asthma control level and quality of life were compared between the two groups.The recognition, diagnosis, treatment and outcomes of acute asthma exacerbation in two groups of children were described and analyzed.Measurement data were analyzed by t test or Mann- Whitney U test.Numeration data were analyzed by χ2 test. Results:Respiratory sounds collected by smart stethoscope in the test group were assessed by 3 specialist physicians.There were 12 wheezing rales (42.86%), 1 moist rale (3.57%) and 1 rhonchi rale (3.57%). Besides, 12 files (42.86%) were difficult to distinguish, and 2 files (7.14%) induced inconsistent identification.The number of asthma exacerbation was 12 in the test group and 5 in the control group.In the test group, 12 were recognized by the smart stethoscope, and only 6 were recognized by the parents.Comparing the diagnosis and treatment measures between two groups, it was found that there were more children in the test group (38.1%) receiving home treatment through telemedicine than those in the control group (20.0%). Besides, there were less children (61.9%) in the test group receiving unplanned hospital treatment (including unplanned outpatient, emergency and hospitalization) than those in the control group (80.0%). There was no statistically significant difference between the two groups of children during acute asthma exacerbation ( χ2=4.67, P=0.097). Parents were satisfied with the common functions, convenience and stability of smart stethoscope. Conclusions:Smart stethoscope can acquire the respiratory sounds of children with asthma in real time, achieving timely detection, diagnosis and treatment of asthma exacerbation in children.What′s more, smart stethoscope reduces the incidence of unplanned hospital diagnosis and treatment, and assists parents with better family management of children asthma.
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Intestinal microbiota plays an important role in the establishment and maturation of the host immune system.In recent years, it has been found that the disorder of intestinal microecology is related to the occurrence and development of allergic diseases in children.Probiotics can improve intestinal microecological disorders, and its relationship with the prevention and treatment of allergic diseases is currently a research hotspot.In this review, we review the research progress on the relationship between intestinal microbiota and allergic diseases in children, the immunomodulatory mechanisms of probiotics rebalancing intestinal microecology, and the relationship between Lactobacillus paracei and allergic diseases such as atopic dermatitis, allergic rhinitis, and bronchial asthma.
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Epidemiology suggests an increasing incidence of peanut allergy and is usually associated with severe allergic reactions.A variety of inflammatory mechanisms are involved in peanut allergy.The specific diagnosis of peanut allergy is particularly difficult due to the co-sensitization between peanut and other components, but the use of component-resolved diagnostic can greatly improve the diagnostic level, especially the distinction between primary and secondary peanut allergy.Basophil activation tests are also thought to be helpful in diagnosis.In terms of treatment, instead of avoiding all nuts, specific immunotherapy and the introduction of peanuts early in life have been proposed.This paper reviews the latest research progress on peanut allergy in children.
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Objective:To understand the present situation of the construction of standardized asthma clinic for children in China, to explore the problems existing in the process of construction, and to promote the healthy development of standardized clinic construction.Methods:The process and current situation of the construction of standar-dized asthma clinics for children in China were reviewed and investigated, and the practical significance of the China Children′s Asthma Action Plan (CCAAP) in the construction of standardized asthma clinics for children was explored.Results:(1)By December 2020, 1 289 standardized asthma clinics for children and 135 regional demonstration centers had been built; 56 training sessions had been held, with a total of 2 560 doctors and 650 nurses trained, covering 2 560 hospitals across the country; and 4 518 patient education sessions were held.Online publicity covers a total of 1 million person-times, with an annual average of 1.33 million patients.(2)CCAAP improved the quality control level of standardized asthma clinic and promoted the standardized management of children.Conclusions:Through process optimization, professional evaluation, individual health education and real-time disease monitoring, standardized asthma clinic for children with asthma can effectively enhance asthma management awareness of children and their parents, improve disease awareness, and promote better control of asthma.It is an effective management model of asthma in children at present, and it is worthy of clinical promotion.CCAAP plays a good role in the construction of standardized outpatient clinic for asthma in children.The construction of standardized asthma clinic for children in China has achieved remarkable results, and the development trend is good in the future.
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There is a wide spectrum of rheumatic diseases which manifest in children′s connective tissue disease(CTD). Lung involvement is common within the spectrum of CTD.And interstitial lung disease (ILD) is among the most serious complications.The early diagnosis and treatment is vital to improve the prognosis.In this article, the mechanisms, subtypes, clinical manifestations and management of children′s CTD-ILD are reviewed.
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In recent years, the prevalence of childhood asthma has been increasing globally.As a common indoor pollutant, formaldehyde is involved in the pathogenesis of asthma, which has drawn increasing attention.However, the results of the current research have not been unified.Some studies have shown that asthma children live in indoor environments where the concentration of formaldehyde is significantly higher than that of healthy children.There are also reports showing that formaldehyde is not an independent risk factor for asthma.The exact results need to be further studied with a larger sample size.In addition, the article concludes the possible mechanism of formaldehyde on asthma from the perspectives of airway inflammation, acquired allergies, and enzymology, providing new ideas for the prevention and treatment of asthma.
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The prevalence of allergic diseases in children have increased year by year recently.Although the clinical manifestations of childhood allergic diseases are various, their pathogenesis is nearly the same.In the meantime, childhood allergic diseases are combined with nutritional, psychological, spiritual and family social problems, which if not solved properly will affect the allergic diseases themselves.Therefore, it is necessary to apply the concept of holistic integrated medicine and integrate multiple related departments to solve the problem of allergy, which is patient-oriented.This article introduces the necessity and approaches for integration of childhood allergic diseases.
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Bronchial asthma(asthma for short)is a complex heterogeneous disease,which is caused by multi-ple gene-environmental interaction. With the progress of asthma gene research,some new childhood asthma suscepti-bility genes have been found,and the influence of genes interaction with environment on asthma is being widely atten-ded;different genetic loci combination can predict the onset of childhood asthma. Now,the history of asthma gene re-search and some newly discovered childhood asthma susceptibility genes in recent years and different genetic loci com-bination prediction effect and so on were introduced.
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The prevalence of allergic diseases in children have increased year by year recently.Although the clinical manifestations of childhood allergic diseases are various,their pathogenesis is nearly the same.In the meantime,childhood allergic diseases are combined with nutritional,psychological,spiritual and family social problems,which if not solved properly will affect the allergic diseases themselves.Therefore,it is necessary to apply the concept of holistic integrated medicine and integrate multiple related departments to solve the problem of allergy,which is patient-oriented.This article introduces the necessity and approaches for integration of childhood allergic diseases.
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Children under 6 years old are high-risk group for wheezing,and it is difficult but essential for these particular group to be diagnosed with asthma. In the past 30 years,researches based on asthma prediction models have been raised,but with no specific diagnostic criteria. Experts of childhood asthma in China had established empiri-cal diagnostic criteria since 1998 and optimized it continuously,but it was denied due to lack of further research of evi-dence-based medicine. Independent and operative diagnostic criteria was out of range since 2008,therefore diagnosis might be a great challenge for clinical physicians. Now,it is necessary to explore and establish diagnostic criteria based on evidence-based medicine as well as experience of experts. Scholars of childhood asthma in China have obtained 38 asthma-related parameters after massive search of related literatures,and obtained 5 parameters ultimately through Delphi method,single factor analysis and multi-factor regression analysis,and have valued them according to relevant intensity. The diagnostic criteria for cumulative integration of children under 6 years of age has been established initia-lly,which is still in the verification stage,but is expected to provide timely and accurate diagnosis for early childhood asthma.
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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 To evaluate the efficacy and safety of Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup on eliminating or relieving the symptoms of acute upper respiratory infections in children, by comparing with Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup. Methods Random, blind and parallel control method was adopted. A total of 253 pediatric patients were recruited in 11 clinical research centers; 127 patients were assigned in experimental group and finally 118 patients were included in the program set analysis (PPS); 126 patients were assigned into control group and finally 116 patients were included in PPS. The experimental group took Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup and control group took Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup. All of the patients took as prescribed at least for 3 days but not more than 7 days. Results There was no significant differences in age, sex, and acute upper respiratory tract infection scores between the two groups (P?>?0.05). PPS showed the median time of symptom relief of acute upper respiratory tract infection in experimental group was 51.0 h (95%CI: 43.0-62.0 h) and 56.0 h (95%CI: 48.0-64.0 h) in control group. There was no difference between two groups (P?>?0.05). After calibration of center and baseline effects, the experimental group was not worse than the control group. There was no difference in the score of acute upper respiratory tract infection between two groups (F=0.14, P=0.710). The individual symptoms disappear rate of acute upper respiratory tract infection and the compliance between two groups were similar (P all?>?0.05). Both groups had 7 cases of adverse events, and one case of adverse drug reactions each. Thus, the adverse reaction rates in two groups were 0.8% each. Conclusions Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup can effectively relieve symptoms rapidly in the treatment of children with acute upper respiratory tract infection, and its efficacy and safety were non worse than traditional Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup.
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Animal models are of great value in the study of allergic bronchial asthma.There are a varie-ty of methods to build asthma models,and model evaluation lacks standardized criteria.By retrieval analyzing the recent articles about asthma animal experiments at home and abroad,we conduct a comprehensive assessment on the experimental animal selection,model preparation,especially establishment and evaluation of ovalbumin-in-duced models,to help on the application and optimization about asthma models.
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ObjectiveTo investigate the effect of montelukast on the secretion of mucus protein in lipopolysaccharide (LPS) induced human bronchial epithelial cells.MethodsPrimary human bronchial epithelial cells were isolated and identiifed in vitro. LPS (1μg/mL) was used to induce cell inlfammatory response. Montelukast (50 μmol/L, 20μmol/L, 10μmol/L) was used as intervention. The concertration of mucin-5 subtype AC (MUC5AC) in cell supernatants was measured by ELISA. The expression levels of MUC5AC mRNA and protein were determined by RT-PCR and Western-blot. DCFH-DA lfuorescent probe was used to detect reactive oxygen species (ROS). To further elucidate the mechanism, NF-κB (p65)、IκBα、ERK1/2 phosphorylation be-fore and after montelukast intervention were determined by Western-blot.ResultsMontelukast decreases the expression levels of MUC5AC mRNA and protein in a dose-dependent manner in LPS induced human bronchial epithelial cells. Meanwhile, mon-teluskast suppresses ROS generation and NF-κB (p65)、IκBα、ERK1/2 phosphorylation.Conclusions In response to LPS in-duced inlfammation, montelukast decreases the expression level of MUC5AC in vitro, which may be related to NF-κB and ERK activation.
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ObjectiveTo understand the relationship between mycoplasm load in bronchoalveolar lavage lfuid (BALF) with the status of Th1/Th2 immune response in children withMycoplasma pneumoniae pneumonia (MPP).MethodsThe levels of IL-4, IFN, IL-8 , TNF-α in BLAF and total IgE, ECP in serum from 90 children with MPP were measured by ELISA.MP DNA in BALF was detected quantitatively by lfuorescent real-time PCR. Children with MPP (n=90) were divided into two groups of low MP-DNA load (n=24) and high MP-DNA load (n=26) according to the copies of MP DNA in BALF. The cytokines in BALF, and total IgE and ECP in serum were compared between the two groups. The relationship between the levels of cytokines in BLAF and the copies was evaluated.ResultsThe levels of IL-4 and the IL-4/IFN ratio in BALF from the high DNA-load group were signiifcantly higher than that of the low group (t=4.280, 2.076, allP<0.05). The level of IL-4 was signiifcantly correlated with the copies of MP-DNA in BALF from children with MPP (r=0.509,P<0.05). The percentage of total IgE and ECP positive result in serum from the high DNA-load group is higher than that of the low group. (χ2=24.638, 6.392,allP<0.05).Conclusion Infection with high-load MP in children may cause the imbalance of Th1/Th2. And the Th2 cytokines response seems predomi-nant.
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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 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
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Objective To investigate the association of single nucleotide polymorphisms(SNPs)in regulated upon activation normal T cell expressed and secreted (RANTES) gene C-28G(RANTES C-28G),RANTES A-403G and Eotaxin-3 gene C +77T(Eotaxin-3 C+77T) with asthma in Han ethnic children. Methods The buccal mucosa swabs of 192 Han ethnic children with asthma (asthma group) were collected,and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was employed to detect the SNP loci of RANTES A-403G,C-28G and Eotaxin-3 C+77T.Besides,another 192 healthy subjects (aged 18 to 22 years) without sibship with those in asthma group were served as controls.Genotype and genotypic distribution between these two groups were analysed. Results There was no significant differences in genotype and genotypic distribution of SNP loci of RANTES A-403G and RANTES C-28G between asthma group and control group (P>0.05),while there were significant differences in genotypic distribution of Eotaxin-3 C+77T between these two groups.The frequency of Eotaxin-3 C+77T T/T genotype in asthma group was significantly higher than that in control group (32.3% vs 12.5%,OR=3.44,P=0.000). Conclusion Eotaxin-3 C+77T may be the asthma susceptible SNP loci for Han ethnic children,and Eotaxin-3 C+77T T/T is significantly related with the development of childhood asthma
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Objective: To explore the molecular mechanism of HMC-1 cell apoptosis on exposure to tripterine. Methods: After the HMC-1 cells were incubated with tripterine, the expression of bcl-2, bax, bcl-X,c-myc and ICE were assayed by using immunohistochemical staining and RT-PCR. Results: The expression of bax,c-myc were up-regulated and bcl-2 down-regulated at protein level.The expression of bax,bcl-X L, especially bcl-2 were down-regulated, and ICE was up-regulated at mRNA level. Conclusion: These results suggest that apoptosis of HMC-1 cells induced by tripterine is regulated by different expression of apoptosis-related genes.