Predictive model of curative effect of mite subcutaneous immunotherapy in 5-18 years of age patients with allergic asthma / 中华儿科杂志

Objective: To analyze the factors affecting the efficacy of mite subcutaneous immunotherapy (SCIT) in allergic asthma patients aged 5-18 years, and to find the best predictive model for the curative effect. Methods: The data of 688 patients aged 5-18 years with allergic asthma who completed more than 3 years of mite SCIT from December 2006 to November 2021 in the Department of Respiratory Medicine, Children's Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Male, results of skin prick test (SPT), age, daily medication score (DMS), visual analogue scale (VAS) score, and enrollment season were defined as independent variables. R language models, including Logistic regression model, random forest model and extreme gradient boosting (XGboost) model, were used to analyze the impact of these independent variables on the outcomes. The receiver operating characteristic curve was applied to compare the predictive ability of the models. Hypothesis testing of the area under curve (AUC) of the 3 models was performed using DeLong test. Results: There were 435 males and 253 females in the 688 patients. There were 349 patients aged 5-<8 years, 240 patients aged 8-<11 years, and 99 patients aged 11-18 years. SPT showed that 429 cases (62.4%) were only allergic to mite, and 259 cases (37.7%) were also allergic to other allergens. According to the efficacy after 3 years of SCIT, 351 cases (51.0%) discontinued the treatment and 337 cases (49.0%) required continued treatment. The DMS was 4 (3, 6) at initiation, 3 (2, 5) at 3 months, 3 (2, 5) at 4 months, 2 (1, 3) at 12 months, and 0 (0, 1) at 3 years of SCIT treatment. The VAS was 3.5 (2.5, 5.2) at initiation, 3.2 (2.2, 4.8) at 3 months, 2.6 (1.4, 4.1) at 4 months, 1.0 (0.6, 1.8) at 12 months, and 0.5 (0, 1.2) at 3 years of treatment. At 3, 4, and 12 months, the rate of decline in DMS was 0 (0, 20%), 16.7% (0, 33.3%), and 50.0% (31.0%, 75.0%), respectively; and the VAS decreased by 7.1% (3.2%,13.8%), 27.6% (16.7%,44.4%), and 70.2% (56.1%, 82.3%), respectively. Regarding the enrollment season, 99 cases were in spring, 230 cases in summer, 171 cases in autumn, and 188 cases in winter. The R language Logistic regression model found that DMS>3 points at 3 months (OR=-3.5, 95%CI:-4.3--2.7, P<0.01), male (OR=-1.7, 95%CI:-2.3--1.0), P<0.01), DMS decline rate>16.7% at 4 months (OR=-1.6, 95%CI:-2.3--0.8, P<0.01) and DMS decline rate>0 at 3 months (OR=-0.7, 95%CI:-1.3--0.2, P<0.05) had higher possibility of drug discontinuation; whereas, the decline rate of DMS at 12 months>50.0% (OR=0.7, 95%CI: 0.1-1.3, P<0.05), VAS at 12 months>1.0 points (OR=0.9, 95%CI: 0.3-1.6, P<0.05), and initial VAS<4.0 points (OR=1.0, 95%CI: 0.4-1.6, P<0.01) had lower possibility of drug discontinuation. Both the random forest model and the XGboost model showed that DMS>3 points at 3 months (mean decrease accuracy=30.9, importance=0.45) had the greatest impact on drug discontinuation. The AUC of the random forest model was the largest at 0.900, with an accuracy of 78.2% and a sensitivity of 84.5%. Logistic regression model had AUC of 0.891, accuracy of 80.0%, and sensitivity of 80.0%; XGboost model had AUC of 0.886, accuracy of 76.9%, and sensitivity of 84.5%. The AUC of the pairwise comparison model by DeLong test found that all three models could be used for the prediction of this data set (all P>0.05). Conclusions: The more drugs used to control the primary disease, and the more careful reduction of the control medicine after starting SCIT treatment, the more favorable it is to stop all drugs after 3 years. The random forest model is the best predictive model for the efficacy of mite SCIT in asthmatic children.

Indoor Allergen Levels and Household Distributions in Nine Cities Across China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Chinese allergic subjects have high levels of sensitization to house dust mite (HDM) and other indoor allergens. This study quantifies common indoor allergen levels in Chinese households.</p><p><b>METHODS</b>Dust samples were collected from nine cities. Major allergens Der p 1 and Der f 1 from Dermatophagoides pteronyssinus and D. farinae, and specific antigens of Blomia tropicalis, Tyrophagus putrescentiae, Acarus siro, and cockroach species Blattella germanica and Periplaneta americana were measured by ELISA.</p><p><b>RESULTS</b>HDM allergens were found in dust samples from bedding in 95% of the Chinese households. The median levels varied from <0.006 to 9.2 µg/g of dust, depending on the city. The percentages of households having HDM allergen levels associated with the risk of developing allergy sensitization and asthma were 65% and 25%, respectively. Specific antigens of the storage mite and cockroach were only found in samples from the southern and tropical regions of China. Levels of mite allergens were generally higher in samples from bedding compared to samples from the living room, even for storage mites, whereas levels of cockroach antigens were higher in the living room samples.</p><p><b>CONCLUSION</b>HDM allergens are present in bedding dust samples from most Chinese households. Cities in southern and central China have relatively high levels of HDM major allergens compared to cities in northern and western China. Antigens of storage mites and cockroaches are not as common as HDM allergens.</p>

Significance of fiberoptic bronchoscopy in diagnosis of congenital airway dysplasia in children / 中华实用儿科临床杂志

Objective To investigate the role and significance of fiberoptic bronchoscopy in diagnosis of congenital airway dysplasia.Methods The clinical data of 606 children with bronchoscopy who were admitted to Department of Respiratory Medicine,Nanjing Children's Hospital Affiliated to Nanjing Medical University from Mar.2008 to Mar.2012 were retrospectively analyzed.Results Among the 606 children,airway dysplasia were found in 120 cases,duded tracheobronchomalacia in 47 cases,racheobronchial stenosis in 31 cases,tracheal bronchus in 27 cases,laryngomalacia in 9 cases,abnormalities or variations at the bronchi opening in 16 cases,airway diverticulum in 8 cases,tracheal esophageal fistula in 5 cases,and 23 children in the 120 cases had 2 or more deformity.Conclusions The fiberoptic bronchoscopy plays a decisive role in diagnosis of congenital airway dysplasia.Fiberoptic bronchoscopy should be performed in suspicious children as soon as possible to determine the cause.

Bronchiolitis obliterans in 28 children / 中华实用儿科临床杂志

Objective To recognize the clinical characteristics and treatment of bronchiolitis obliterans (BO) in children.Methods Clinical analysis was done on data of 28 patients with BO diagnosed in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Dec.2001 to Aug.2012.Clinical manifestation,etiology,chest X-ray,computed tomography (CT),pulmonary function,flexible bronchoscopy,treatment and prognosis of the children were analyzed.Results Boys were common in all 28 children (20 boys and 8 girls) aged from 4 months to 7 years.All cases presented with persistent cough and wheezing for more than 6 weeks,and crackles as well as wheezing were heard.Twenty-three cases were post-infectious BO (PBO),and 5 cases occurred after Steven-Johnson syndrome(SJS).Pulmonary CT showed mosaic perfusion in all cases,atelectasis in 7 cases,and bronchiectasis in 4 cases.Lung function revealed obstructive ventilatory dysfunction in 16 cases,and mixed ventilatory dysfunction in 3 cases.Thirteen cases received flexible bronchoscopy,and the cell of the bronchoalveolar lavage fluid showed increased level of neutrophils.All the cases received oral corticosteroid,azithromycin and inhalation of corticosteroid and bronchodilator,or oral leukotrienes receptor antagonists.After a follow-up in 23 cases for 5 months to 7 years,there was no death occurred.Besides 7 cases experienced regular treatment were ameliorated in clinical presentation,pulmonary imaging and function,the rests experenced persistent symptoms.Conclusions BO in children mostly follows lower respiratory tract infection and SJS.Diagnosis is made according to clinical productive cough and wheezing,mosaic perfusion in pulmonary CT and airway obstructions in pulmonary function.Corticosteroid is mainly used in treatment of BO,and its overall prognosis is poor.

Clinical analysis of plastic bronchitis in 7 children / 中华实用儿科临床杂志

Objective To analyze 7 cases of plastic bronchitis in children,review the literature,and improve the understanding of the clinical features,diagnosis and treatment of the disease.Methods Seven children (6 male and 1 female) aged from 2 to 12 years with plastic bronchitis presenting cough,wheezing and dyspnea,who were treated in Nanjing Children's Hospital Afiliated to Nanjing Medical University from Sep.2006 to Mar.2012,were analyzed,respectively.The treatment of the 7 cases included flexible bronchoscopy or rigid bronchoscopy,supplemented by oxygen therapy,antibiotics,and atomizing inhalation.Results All 7 children had acute onset,in which 6 cases presented cough and polypnea,1 case presented emptysis.With the development of the disease,hypoxemia occurred.The chest Xray and Computerized Tomography examination showed pulmonary atelectasis in all 7 cases,while atelectasis and emphysema coexisted in 3 cases,pleural effusion in 3 cases.According to the obstructive site,1 case was in left bronchus and 6 cases in right.One case received rigid bronchoscopy,and 1 case received flexible bronchoscopy after taking rigid bronchoscopy,while 5 cases received flexible bronchoscopy.Five cases were cured after first operation,2 cases had second flexible bronchoscopy,and endogenous bronchial-shaped casts were removed under bronchoscopy.Pathological results showed the casts were classified as 6 cases of type Ⅰ,inflammatory,and 1 case of type Ⅱ,acellular.Four cases improved markedly,and 3 cases were cured.Conclusions Plastic bronchitis in children is a life-threatening disorder.Flexible bronchoscopy or rigid bronchoscopy extraction of branching plastic casts must be performed urgently for early diagnosis and good therapeutic result.

Four cases of lung abscess related to Mycoplasma pneumoniae infection / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics of pediatric Mycoplasma pneumoniae (MP)complicated with lung abscess.Methods Data of 4 cases suffering from pulmonary abscess associated with MP from Jan.2000 to Jun.2011,including manifestations,imaging,laboratory examinations and therapies,were collected and analyzed.Related literatures were reviewed.Results Two female and 2 male cases were included in this study.The age ranged from 3 to 6 years old,and all patients had a history of acute onset,severe cough and little sputum.Three cases had remittent fever,and 3 cases had fixed small and medium-sized blisters sound in the lung.The levels of MP antibody M (MP-IgM) in the serum were higher than 1:160 and sputum fluorescence quantitative-mycoplasma pneumonia (FQ-MP DNA) tests were positive in 4 patients.The white blood cells (WBC),polymorphonuclear leukocyte (PMN),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR) in 3 cases were significantly higher than the normal level,and the FQ-MP DNA tests in the bronchoalveolar lavage fluid (BALF) were positive in 3 cases.The FQ-MP DNA in both blood and chest water were positive in 1 case.Cultures of sputum,blood,chest water,BALF and procalcitionin tests were negative,except for 1 case with positive sputum culture of Branhamellacatarrhalis.The imaging examinations on admission of 4 cases strongly suggested that the interstitial and parenchymal lung disease and subsequently appeared the different sized cystic shadow,liquid fiat cystic shadow,thickened wall empty tissue image during the course of 5 to 20 days.All cases were sequentially treated with azithromycin after full erythromycin,3 cases received intravenous glucocorticoid,1 case received intravenous gamma globulin.The bronchial mucosal hyperemia and edema,submucosal scattered small nodules,pathological changes of bronchial sticky phlegm jam were observed in 3 cases by flexible bronchoscopy.After 3 to 5 days of admission,all patients' temperature returned to normal,the cough was reduced,and the characteristics of the lung were gradually improved.After 3 to 4 weeks,the chest radiograph showed that most pneumonia was absorbed.The 6 to 18 month follow-up indicated that absorption was good.The upper left lung limited atelectasis was found in 1 case.Conclusions Pulmonary abscess is a rare complication of MP.The major clinical manifestations are high fever,significantly higher levels of blood WBC,PMN,CRP and ESR,and high density of shadow in chest Xray.The regular dose of erythromycin doesn't work well.However,the prognosis is good after conservative therapy with the sufficient macrolide antibiotics with glucocorticoid and immunoglobulin.

Risk factors of extrapulmonary complications after Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective To identify the risk factors of extrapulmonary complications in children with Mycoplasma pneumoniae pneumonia (MPP),in order to provide evidence for the correct clinical diagnosis and effective treatment to reduce the incidence of extrapulmonary complications.Methods The clinical data of 234 hospitalized children with MPP from Jan.2008 to Jan.2010 were retrospectively reviewed.Based on the findings of extrapulmonary complications,the subjects were divided into 2 groups:the extrapulmonary complications group (107 cases) and non-extrapulmonary complications group (127 cases).The comparison was made between the 2 groups in age,gender,fever,the manifestation of pneumonia on X-ray or CT scan,white blood cell count,erythrocyte sedimentation rate (ESR),C reaction protein (CRP) and application of macrolide medicine etc.Results All the systems were involved in extrapulmonary complications,the most 2 involved systems were circulatory system and digestive system,ranking 11.1 1％ and 10.68％ respectively.The other involved systems were the blood system(8.12％),skin (5.56％),urinary (1.71％),and nervous system (2.14％),11 cases (4.70％)had two or more organ damages.The results of analysis indicated that the related risk factors included CRP(P ＜ 0.05),ESR(P ＜ 0.05),lung patchy shadow(P ＜ 0.01)and application of macrolide medicine more than 7 days of sickness(P ＜0.01).But there was no significant difference between the 2 groups in age,gender,fever,pleural effusion,white blood cell count (all P ＞ 0.05).Conclusions Extrapulmonary complications with MPP can be involved in every system.In severe cases,multi-system organ can be suffered.CRP,ESR,lung patchy shadow and application of Macrolide medicine within 7 days of sickness are factors associated with extrapulmonary complications.

Long-term efficacy of sublingual immunotherapy with Dermatophagoides Farianae Drops in children with allergic asthma sensitized to dust mites / 中华儿科杂志

<p><b>OBJECTIVE</b>To observe the efficacy of sublingual immunotherapy (SLIT) in children with allergic asthma during the treatment and 1 year after the treatment.</p><p><b>METHOD</b>This is an open and retrospective study; 80 children with mild-moderate allergic asthma between 4 and 14 years of age were chosen from the Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated to Nanjing Medical University from May to August, 2009. All children were sensitized to Dermatophagoides Farianae and/or Dermatophagoides Pteronyssinus and have received anti-asthma drug therapy for 3 months (baseline). Thirty-nine children in SLIT group underwent 2-year SLIT and combined with anti-asthma drug, these children were then followed up for 1 year. Forty-one children in drug group only received anti-asthma drug and were followed up for 3 years. The scores of asthma symptom, scores of asthma medication and the number of discontinuation of anti-asthma drug were compared between the SLIT group and drug group for the baseline, end of the 2nd year and 3rd year treatment. The frequency of acute attack of asthma was also compared between the two groups for 1 year before the treatment and the 3rd year treatment.</p><p><b>RESULT</b>(1) At baseline, the asthma symptom scores, the medication scores and the frequency of acute attack of asthma in 1 year before the treatment of the two groups showed no significant difference. (2) After 2-year SLIT, the daytime asthma symptom scores of SLIT group were lower than the drug group (0.18 ± 0.06,0.93 ± 0.12,Z = -4.873, P < 0.05), the night asthma symptom scores of the two groups showed no significant difference. One year after SLIT, the daytime and night asthma symptom scores of SLIT group were both lower than those of the drug group (daytime SLIT group vs. Drug group: 0.18 ± 0.06 vs. 1.46 ± 0.72,Z = -5.082, P < 0.05;night SLIT group vs. Drug group: 0.05 ± 0.04 vs. 0.66 ± 0.14,Z = -4.019, P < 0.05). (3) At the end of SLIT and 1 year after SLIT, the medication scores of SLIT group were both lower than those of the drug group (End of SLIT SLIT group vs. Drug group: 0.31 ± 0.07 vs. 0.75 ± 0.12,Z = -2.813, P < 0.05;1 year after SLIT SLIT group vs. Drug group: 0.17 ± 0.06 vs. 0.87 ± 0.17,Z = -4.106, P < 0.05), the number of discontinuation of anti-asthma drug of SLIT group were both more than the drug group (End of SLIT SLIT group vs. Drug group: 20 vs. 10,χ(2) = 6.167, P < 0.05;1 year after SLIT SLIT group vs. Drug group: 29 vs.13,χ(2) = 14.581, P < 0.05).(4) In the 3rd year, the frequency of acute attack of asthma in SLIT group was significantly lower than that of drug group (0.69 ± 1.20, 1.20 ± 1.44,Z = -1.968, P < 0.05) .</p><p><b>CONCLUSION</b>SLIT can significantly improve the symptoms of asthma, reduce the use of anti-asthma drug and reduce the frequency of the acute attack of asthma. Meanwhile, the efficacy could still maintain 1 year after the SLIT treatment.</p>

Isolated pulmonary Langerhans cell histiocytosis in a two-year-old child: case report and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the recognition of the clinical features and results of laboratory examination for isolated pulmonary Langerhans cell histiocytosis (PLCH) in children.</p><p><b>METHOD</b>The information of one case with isolated PLCH was analyzed and reports of 11 cases with isolated PLCH were reviewed.</p><p><b>RESULT</b>The patient we report is only 2 years old with 1 month of course of disease, manifesting with prominent pulmonary involvement: cough and short of breath; CT scan of the chest showed punctiform, nodular and reticular high density opacities involving all lobes of both lungs. Biopsy of the lung tissue showed expression of CD1a, CD68, S-100, consistent with the diagnosis of LCH. He received prednisolone, VP16 and Vindesine with good response. Ten of 11 cases of isolated PLCH reported before manifesting with cough and dyspnea, CT scan of the chest showed interstitial lung changes (5/8), cystic changes (5/8), small nodules (2/8) and pneumothorax (2/8). Langerhans cells were found in 9 cases on lung biopsy, part of biopsy lung tissues were stained with anti-CD1a, the alveolar lavage fluid of the other 2 cases were stained with S-100 and anti-CD1a.</p><p><b>CONCLUSION</b>Isolated PLCH is rarely reported in children. It manifested with prominent pulmonary involvement: cough and short of breath, and CT scan of the chest showed interstitial lung changes, small nodules or cysts involving the lung, Langerhans cell could be found in lung biopsy, and the immunohistochemical staining in lung biopsy lung and alveolar lavage fluid stained with S-100 and anti-CD1a antibodies.</p>

Studies on the core functional region of antimicrobial peptide LL-37 for inhibition of RSV replication / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the core functional region of antimicrobial peptide LL-37, which inhibites RSV replication and could be developed for theraputic aplication.</p><p><b>METHODS</b>A panel of 6 partial LL-37 peptides (referred to as P1 to P6) was synthesized according to LL-37 amino acide sequence. Hep-2 cells were infected with RSV, treated with LL-37 or partial peptides respectively. Cells were collected after 24 hours incubation at 37 degrees C, CO2 5%. Total RNA was obtained from the cells. Expression level of RSV N gene was quantified by real-time PCR. Meanwhile enzyme-linked immunosorbent assay (ELISA) was used to quantify the chemokines RANTES, IL-8, MCP1 in the supernatants of Hep-2 cultures after 24 h incubation with or without LL-37 and partial peptide P6.</p><p><b>RESULTS</b>N-terminal partial LL-37 peptide (corresponding to residues 1-12 of LL-37) had no significant effects on RSV replication (P > 0.05). In contrast, C-terminal (corresponding to residues 13-37) and a panel of 4 overlapping 22-mer partial peptides (from the peptide incorporating aa 13-34 through that spanning aa 16-37) showed significant inhibitory effect on RSV replication to some extent (P < 0.05 or P < 0.01). LL-37 induced significant expression of chemokine RANTES, IL-8 and MCP-1 in Hep-2 cells. In contrast, partial peptide P6 had no significant effect on expression of the chemokines in Hep-2 cells.</p><p><b>CONCLUSION</b>The LL-37 C-terminal 22-mer partial peptide P6 was putative core functional region for inhibition of RSV replication. The partial peptide didn't induce significant expression of chemokine RANTES, IL-8 and MCP-1.</p>

Molecular epideiological and clinical feature of human metapneumovirus in children with acute respiratory tract infection in Nanjing City / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the molecular epideiological and clinical feature of human metapneumovirus in children with acute respiratory tract infection in Nanjing city, China.</p><p><b>METHOD</b>Nasopharyngeal aspirates and nasopharyngeal swab were taken from 642 outpatients or hospitalized pediatric patients with acute at the Children Hospital of Nanjing, Jiangsu Province, China, between August 2009 and July 2010. Respiratory speciments were tested for the M gene of hMPV by reverse-transcription polymerase chain reaction (RT-PCR). All RT-PCR positive products were sequenced and phlogenetic analysis was conducted.</p><p><b>RESULT</b>hMPV was detected in 35 (5.5%) of the 642 children. Phylogenetic analysis revealed that 51.4% of the hMPV were B1, 31.4% were A2b. The peak of the positive rate was in April. The majority of the hMPV-positive patients(71.4%) were 0-1 years old. Of the 35 hMPV-positive patients, 15 (42.8%) were co-infected with other respiratory viruses, and human rhinovirus (HRV) were the most common additional respiratory virus. The most common clinical diagnosis was pneumonia (48.6%).</p><p><b>CONCLUSION</b>Human metapneumovirus is an important pathogen of acute respiratory tract infection in children in Nanjing city. The subtype B1 was the predominating lineage in 2009-2010 in Nanjing city. No significant differences were found for clinical characteristics between genotype A and genotype B human metapneumovirus infection in children in Nanjing.</p>

Allergen micro-array detection of specific IgE-reactivity in Chinese allergy patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Allergen micro-arrays are powerful tools for screening of serum IgE-reactivity. In this study allergen micro-arrays were used to identify dominating IgE-binding allergens and cross-reactivity patterns among selected Chinese allergy patients.</p><p><b>METHODS</b>The study was conducted using patient sera from the cities of Guangzhou, Nanjing, Chengdu and Shenyang. In total 100 sera with Dermatophagoides pteronyssinus (Der p) specific IgE-levels higher than 50 kU/L were selected for testing against 103 individual allergens.</p><p><b>RESULTS</b>Among 100 selected patients, 95% showed IgE-reactivity towards house-dust mite allergens Dermatophagoides farinae (Der f) 1, Der f 2 and Der p 2 and 94% were IgE positive against Der p 1, and 60% of sera contained IgE reacting against allergen Euroglyphus maynei (Eur m) 2. IgE against cat allergen, Felisdomesticus (Fel d) 1, was seen in 20%. Only 2% showed specific IgE-reactivity to Der p 10, a panallergen belonging to the tropomyosin family. Serum IgE-reactivity towards other allergens was in general low. IgE-reactivity against pollen allergens showed geographic differences.</p><p><b>CONCLUSIONS</b>This study clearly confirms that group 1 and group 2 are major allergens of house dust mites. These selected house-dust mite allergy patients are close to being mono-sensitized. Der p 10 is not an important allergen for cross-reactivity. Specific IgE-sensitization towards pollen allergens is low in southern China compared to other regions. The prevalence of food and stinging insect allergens known to give rise to IgE-mediated cross-reactivity is 2% or less.</p>

Effect of maternal vitamin D deficiency on lung morphogenesis and platelet-derived growth factor-A expression in rat offspring / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of maternal vitamin D deficiency on lung morphogenesis and platelet-derived growth factor-A (PDGF-A) expression in rat offspring.</p><p><b>METHODS</b>Sprague-Dawley (SD) female rats were randomly divided into two groups: normal control and vitamin D deficiency, with 6 rats in each group. The vitamin D deficiecy group was kept away from light and fed with the forage without vitamin D. After 2 weeks, the rats were mated with normal SD male rats. The morphological changes of fetal rat lungs on day 20 of gestation and 1-day-old neonatal rat lungs were observed by light microscope and electronic microscope. The levels of PDGF-A mRNA and protein in fetal and neonatal rat lungs were measured by reverse transcriptase-polymerase chain reaction (RT-PCR) technique and Western blot method respectively.</p><p><b>RESULTS</b>Under the light microscope, smaller alveolar space, smaller diameter of the respiratory membrane and thicker alveolus mesenchyma were observed in lungs of fetal and neonatal rats from the vitamin D deficiency group compared with the controls (P<0.05). Under the electronic microscope, fewer lamellar bodies but more glycogen deposition in intracytoplasm were observed in the lungs of fetal rats from the vitamin D deficiency group compared with the controls. There was an increased number of empty lamellar bodies in neonatal rats from the vitamin D deficiency group. The levels of PDGF-A mRNA and protein in lungs of fetal and neonatal rats from the vitamin D deficiency group were significantly lower than the controls (P<0.05).</p><p><b>CONCLUSIONS</b>Maternal vitamin D deficiency during pregnancy may inhibit the development of lung morphogenesis and PDGF-A expression in late fetal and neonatal rats. The low expression of PDGF-A may be involved in the inhibitory effect of vitamin D deficiency on the lung development.</p>

Application of flexible bronchoscopy in diagnosis and treatment of 104 children with pulmonary atelectasis / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the value of flexible fiberoptic bronchoscopy in diagnosis and treatment of pulmonary atelectasis in children.</p><p><b>METHOD</b>Totally 104 patients with pulmonary atelectasis, who were admitted to this department, received flexible fiberoptic bronchoscopy from January 2006 to May 2010, were enrolled in a retrospective analysis.</p><p><b>RESULT</b>The analysis on causes of pulmonary atelectasis showed that 76 cases (73%) of the 104 patients had sputum obstructions, which was the main cause of atelectasis. Thirteen cases (13%) had bronchopulmonary dysplasia, 9 cases among these were infants. Twelve cases (12%) had foreign body aspiration, 8 cases among these were under the age of 3-year. After flexible fiberoptic bronchoscopy, 100 cases got expansion of pulmonary atelectasis. Sixty-five of the sputum obstruction cases got atelectasis reexpansion after one time of flexible fiberoptic bronchoscopy. Eight of the sputum obstruction cases got atelectasis reexpansion after two times of flexible fiberoptic bronchoscopy. Two of the sputum obstruction cases got atelectasis reexpansion after three times of flexible fiberoptic bronchoscopy. The rate of atelectasis reexpansion after one time of alveolus lavement was higher in the cases whose courses of disease were under 3 weeks, than in the cases whose courses of disease were beyond 3 weeks.</p><p><b>CONCLUSION</b>Etiology of pulmonary atelectasis varied at different age. The morbidity of bronchopulmonary dysplasia was high in infants. Foreign body aspiration was the common cause of pulmonary atelectasis in children from 1 to 3-year of age. Sputum obstruction was the main cause of pulmonary atelectasis in over 3-year-old children. Most cases got atelectasis reexpansion after alveolar lavage. The patients who had shorter course of disease might have higher rate of atelectasis reexpansion after alveolar lavage once. Flexible fiberoptic bronchoscopy plays an important role in diagnosis and treatment of pulmonary atelectasis.</p>

The correlation factor about respiratory syncytial virus bronchiolitis and post-bronchiolitis wheezing in infant / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To observe the correlation factor about early-life RSV bronchiolitis and sequential recurrent wheezing for two years.</p><p><b>METHODS</b>Follow up the RSV bronchiolitis patients for two years in order to analyze the occurrence of wheezing post-bronchiolitis. Single and multiple logistic regression analysis were used to determined the risk factors such as individual atopy history and familial atopy history, pet feeding, breast milk, secondhand smoke for RSV bronchiolitis and subsequent wheezing.</p><p><b>RESULTS</b>(1) Not breast feeding, exposure to cigarette smoke and the deficiency of VitA, D were the significant risk factors contributed to the RSV branchiolitis. (2) Exposure to cigarette smoke, the deficiency of VitA, D, the personal history of atopy and the family history of atopy were the significant risk factors contributed to the post-bronchiolitis wheezing in children. (3) Those patients who eosinophilia, high serum IgE, RANTES and decreased TH1 to TH2 Ratio were more likely to have wheezing after RSV bronchiolitis.</p><p><b>CONCLUSION</b>(1) Not breast feeding, exposure to cigarette smoke and the deficiency of VitA, D were the significant risk factors contributed to the RSV bronchiolitis. (2) Exposure to cigarette smoke, the deficiency of VitA, D, the personal history of atopy and the family history of atopy were the significant risk factors contributed to the post-bronchiolitis wheezing in children.</p>

Association of RANTES gene promoter -28C/G polymorphism with respiratory syncytial virus bronchiolitis / 中华儿科杂志

<p><b>OBJECTIVE</b>Respiratory syncytial virus (RSV) infects nearly all children under two years of age. It is poorly understood why a few children who were infected with RSV develop bronchiolitis that require hospital admission while most have a relatively minor illness. Several recent studies have obtained some indications for the involvement of genetic heterogeneity in RSV bronchiolitis, implying that the clinical outcome of RSV infection perhaps is determined by genetic factors. Regulated on activation, normal T cell expressed and secreted RANTES plays a key role in the pathophysiology of RSV bronchiolitis. The purpose of this study was to explore the genetic association between the RANTES gene promoter -28C/G polymorphism and RSV bronchiolitis in Chinese Han ethnic group population.</p><p><b>METHODS</b>The study recruited 238 hospitalized patients (186 male and 52 female) under 12 months of age, with a clinical diagnosis of bronchiolitis due to RSV, the sex, age, hospital stay, SaO2 at the time of admission, personal and family history of atopy were recorded. The 288 healthy control subjects (206 male and 82 female), who had no evidence of personal or familial history of atopy and no history of wheezing, were chosen at the same time. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify the polymorphism at position -28C/G of the RANTES promoter. The total IgE concentrations in serum samples were measured by enzyme-linked immunosorbent assay (ELISA). The absolute peripheral blood eosinophil counts were measured by using an automated hematology analyzer.</p><p><b>RESULTS</b>The distribution of RANTES -28C/G gene polymorphism was in accordance with Hardy-Weinberg equilibrium. Compared to control subjects, significant difference was demonstrated for genotypes and allele frequencies of the RANTES -28C/G polymorphism in patients with RSV bronchiolitis (G = 10.22, P < 0.01; chi2 = 9.708, P < 0.01). Compared with the wild type CC, the -28G allele carriers demonstrated a 2.09-fold increased risk of RSV bronchiolitis (OR = 2.09, 95% CI = 1.32 - 3.30, P < 0.01). Interestingly, both the percentage of personal history of atopy and the percentage of family history of atopy for the -28G allele carriers were significantly higher (P < 0.05) than that for those CC homozygotes carriers in RSV bronchiolitis. Compared with the wild type CC, the -28G allele carriers demonstrated a 1.85-fold increased risk of the personal history of atopy (OR = 1.85, 95% CI = 1.01 - 3.38, P = 0.045) and a 1.91-fold increased risk of the family history of atopy (OR = 1.91, 95% CI = 1.03 - 3.54, P = 0.037), and the absolute peripheral blood eosinophil counts for the -28G allele carriers were significantly higher (P < 0.05).</p><p><b>CONCLUSION</b>The RANTES gene promoter -28C/G polymorphism is associated with the susceptibility to RSV bronchiolitis, and the -28G allele is an important predisposing factor for the personal history of atopy and the family history of atopy in RSV bronchiolitis.</p>

Effects of dexamethasone on lung morphogenesis in rats and the expression of Wnt signal transduction pathway in the lung of offspring / 中华儿科杂志

<p><b>OBJECTIVE</b>Multiple signal transduction pathways, for example, Wnt signal transduction pathway, fibroblast growth factor (FGF), bone morphogenetic protein (BMP) etc, are involved in rat fetal lung development. Wnt signal has been shown to play important roles in regulating cell differentiation and proliferation. It is demonstrated that antenatal dexamethasone (DEX) use can induce lung dysplasia. A rat premature delivery model was developed in this study to compare the effects of DEX on antenatal rat fetal lung morphogenesis and the expressions of Wnt7b, beta-catenin and glycogen synthase kinase 3beta (GSK-3beta) genes in the lung of offspring on 19th day of embryo.</p><p><b>METHODS</b>Twelve pregnant rats were divided into three groups randomly: small dose DEX group, large dose DEX group and control group with 4 rats in each group. The rats in the control group were injected with saline 0.5 ml/d; those in small dose DEX group were injected with DEX 0.4 mg/(kg.d), the rats in large dose DEX group were injected with DEX 0.8 mg/(kg.d), DEX was diluted to 0.5 ml by saline. On the 19th day of gestation, the fetuses were surgically taken out and the histologic structures of fetal rat lungs were observed with light microscope. The RT-PCR and Western-blot methods were used to detect the expressions of Wnt7b, GSK-3beta and beta-catenin genes mRNA and protein.</p><p><b>RESULTS</b>(1) Changes of histologic structure included alveolar numbers: small dose DEX group (15.6 +/- 2.1), large dose DEX group (13.2 +/- 1.6), control group (20.8 +/- 2.0); thickness of alveolar septum: small dose DEX group (11 +/- 5) microm, large dose DEX group (11 +/- 4) microm, control group (13 +/- 7) microm; alveolar space: small dose DEX group (2483 +/- 1336) microm2, large dose DEX group (2924 +/- 1705) microm(2), and control group (1913 +/- 764) microm(2). All the parameters showed significant difference between DEX groups and control group. (P < 0.01 for all comparisons). (2) The expressions of Wnt7b (0.55 +/- 0.19, 0.64 +/- 0.54) and beta-catenin (2.03 +/- 0.58, 2.40 +/- 0.89) genes mRNA of the study groups were significantly higher as compared with those of the control group [Wnt7b (0.18 +/- 0.10), beta-catenin (1.77 +/- 0.54)] (P < 0. 05 for all comparisons) while the expressions of GSK-3beta (1.0 +/- 0.5) were lower than those of the control group (1.1 +/- 0.6) (P < 0. 05). The expressions of GSK-3beta protein in cytoplasm of the study groups [(26.6 +/- 19.7) microg, (10.7 +/- 7.4)microg] reduced gradually while beta-catenin's [(79.5 +/- 1.2) microg, (148.3 +/- 30.4) microg] in the nucleus enhanced simultaneously compared with the control group [(50.0 +/- 00.0) microg ].</p><p><b>CONCLUSIONS</b>Small dose of antenatal DEX usage can improve the fetal lung development, larger dose of DEX may have negative effect on rat fetal lung morphogenesis. Antenatal DEX usage can change the expressions of Wnt7b, GSK-3beta and beta-catenin genes mRNA and protein, these changes may result in paramorphia during pregnancy.</p>

Association between interleukin-8 gene-251 locus polymorphism and respiratory syncytial virus bronchiolitis and post-bronchiolitis wheezing in infants / 中华儿科杂志

<p><b>OBJECTIVE</b>Respiratory syncytial virus (RSV) infects nearly all children under two years of age. It is not understood why some develop serious bronchiolitis. Whether there is a genetic component is not known. The nature of the association between RSV bronchiolitis and subsequent wheezing remains unknown. interleukin-8 (IL-8) is a potent neutrophil chemokine and activator, which plays a role in virus-induced wheezing diseases. The purpose of this study was to assess the genetic association between the IL-8 gene promoter -251A/T polymorphism and RSV bronchiolitis and post-bronchiolitis wheezing in children.</p><p><b>METHODS</b>Totally 320 children who were hospitalized for bronchiolitis together with positive immunofluorescence for RSV were recruited in this study from Jan. 2002 to Jan. 2004. A group of 272 healthy children were enrolled as controls. The age of these children ranged from 1 to 12 months. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify the polymorphism at position-251 of the IL-8 promoter in RSV bronchiolitis and control groups. The total IL-8 and IgE concentrations in serum samples were measured by enzyme-linked immunosorbent assay (ELISA). The patients with RSV bronchiolitis were followed up in order to analyze the occurrence of wheezing post-bronchiolitis.</p><p><b>RESULTS</b>(1) Both A allele and T allele were detected at -251 of the IL-8 promoter; the prevalence of the A allele in RSV bronchiolitis group was 45.6%, as compared with 37.7% in normal group. The prevalence of IL-8-251A allele was significantly different between the two groups (P < 0.05). (2) For genotypes T/T, A/T, A/A in RSV bronchiolitis, level of serum IL-8 were (17 +/- 6) ng/L, (21 +/- 7) ng/L, (24 +/- 9) ng/L, respectively, the difference was significant among the three genotypes (P < 0.01). (3) The prevalence of the A allele in the group who wheezed after the episode of RSV bronchiolitis was 54.6%, as compared with 35.8% in the group who had bronchiolitis but did not go on to wheeze. The prevalence of IL-8-251A allele was significantly different between the two groups (P < 0.05).</p><p><b>CONCLUSION</b>Polymorphism of IL-8 promoter-251A/T was associated with susceptibility to RSV bronchiolitis in children. The association of IL-8-251A with severe RSV bronchiolitis is most marked in the children who go on to wheeze.</p>

Effects of 1,25-Dihydroxyvitamin D_3 on Cell Proliferation,Differentiation and Expression of Vitamin D Receptor in Mouse Osteoblast / 实用儿科临床杂志

Objective To study the effect of different concentration of 1,25-dihydroxyvitamin D3[1,25(OH)2D3] on cell proliferation,differentiation and the expression of vitamin D receptor (VDR) in mouse MC3T3E1 osteoblast.Methods Osteoblast were cultured in medium with different concentrations of 1,25(OH)2D3.Incubated for 48 h,cell proliferation of osteoblast were examined by MTT reduction assay (mono-nuclear cell direc cytotoxicity assay),the osteocalcin (OC) levels in cell medium were detected by ELISA,and the expression of VDR mRNA and protein were examined by using SYBR Green real-time PCR and Western blot,respectively.Results 1.After incubation with 1,25(OH)2D3 for 48 h,the number of MC3T3E1 osteoblast was significantly less than that in control group(P0.05).3.SYBR Green real-time PCR and Western blot results showed that the expression of VDR mRNA as well as VDR protein of osteoblast in 10-8,10-9 mol/L experimental groups were significantly higher than those in control group (Pa0.05).Conclusions Cell proliferation of mouse osteoblast can be inhibited,while the cell differentiation was promoted by 1,25(OH)2D3.1,25(OH)2D3 up-regulated the expression of VDR in mouse osteoblast,which suggested that the VDR signal pathway may play some role in proliferation and differentiation of osteoblast.

Effects of Various Dosage and Multiple Course of Dexamethasone on Expression of WNT Signal Transduction Pathway in Lung of Premature Rats / 实用儿科临床杂志

Objective To explore the effects of various dosage and multiple course of Dexamethasone(DEX) on the expressions of WNTs,?-catenin and glycogen synthase kmase-3?(GSK-3?) genes in the lung of premature rats on the 19th day of embryo.Methods Twelve pregnant SD rats were divided into 3 groups randomly:small dose DEX group,large dose DEX group and control group with 4 rats in each group.The rats in control group were injected with saline 9 g/L;rats in small dose DEX group were injected with DEX 0.4 mg/(kg?d),and the rats in large dose DEX group were injected with DEX 0.8 mg/(kg?d) after DEX was diluted to 0.5 mL with saline.On the 19th day of gestation,fetuses were surgically taken out.The reverse transcription polymerase chain reaction PCR method was used to detect expressions of WNT7b,WNT5a,WNT2,GSK-3? and ?-catenin genes mRNA.Results The expressions of WNT7b(0.55?0.19,0.64?0.54)and ?-catenin(2.03?0.58,2.40?0.89)genes mRNA in small dose DEX group and large dose DEX group were significantly higher than those of control group(WNT7b:0.18?0.10,?-catenin:1.77?0.54)(Pa