Progress in diagnosis and treatment of allergic fungal airway disease in children / 中华实用儿科临床杂志

Fungus is one of common allergens in allergic disease that affects the susceptibility, severity, and disease control of allergic airway disease in children.A spectrum of respiratory diseases associated with fungal sensitization has been described as allergic fungal airway disease (AFAD), including severe asthma with fungal sensitization, allergic bronchopulmonary aspergillosis, thunderstorm asthma, and allergic fungal rhinosinusitis.Glucocorticoids, biologics, antifungal therapy, and immunotherapy can reduce the airway inflammation, fungal burden, and tissue damage associated with AFAD.This review introduced fungus, the mechanism of fungal sensitization and the detection, as well as the scope and treatment of AFAD in children, aiming to improve the understanding of AFAD among pediatricians.

Trained immunity and its influence on children′s health / 中华实用儿科临床杂志

Trained immunity has been a novel term in immunology for over a decade, referring to the memory immunity produced by the innate immune system upon re-stimulation.Non-specific training of the immune system enhances the immune defense function and is also involved in allergic inflammation and autoimmune diseases.An increasing number of researchers are focusing on the role of immune training in the prevention, treatment, onset and progression of diseases.This review explains the definition, mechanism, and inducers of immune training and its impact on children′s health and disease, in order to enhance pediatricians′ comprehension of trained immunity.

A cross-sectional survey on the prevalence and risk factors of sarcopenia in the elderly in some areas of the Yunnan-Guizhou Plateau / 中国组织工程研究

BACKGROUND:Epidemiological research data on sarcopenia in China are concentrated in some provincial capitals and developed areas,while research on sarcopenia in the elderly in the Yunnan-Guizhou Plateau is at the initial stage,and there is still a lack of understanding of the development mechanism,influencing factors and prevention methods of sarcopenia. OBJECTIVE:Based on the 2019 Asian Sarcopenia Working Group Standard(AWGS2019),to assess sarcopenia in the elderly in the Yunnan-Guizhou Plateau,while analyzing the prevalence and risk factors of sarcopenia in the elderly. METHODS:A total of 1 327 elderly study subjects(650 males and 677 females)were recruited and their socio-demographic characteristics,clinical data and physical activity levels were collected.The prevalence of sarcopenia was screened using the AWGS2019 criteria.The possible influencing factors for sarcopenia were screened by univariate analysis,including χ2 test for comparing count data and t-test for comparing measurement data,and the indicators through univariate screening were included in the binary logistic regression model to assess the risk factors for sarcopenia,and then the odds ratio(OR)and 95%confidence interval(CI)were calculated. RESULTS AND CONCLUSION:The prevalence of sarcopenia in the elderly in the Yunnan-Guizhou Plateau was 14.62%(12.73%male and 16.49%female).Aging(OR=1.158,95%CI:1.133-1.185),female(OR=2.416,95%CI:1.629-3.586),fasting blood glucose≥7.0 mmol/L(OR=1.653,95%CI:1.071-2.551),smoking(OR=1.595,95%CI:1.043-2.438)and a low physical activity level(OR=1.778,95%CI:1.154-2.737)were all independent risk factors for sarcopenia,while body mass index was a protective factor for sarcopenia(OR=0.708,95%CI:0.583-0.859).These findings indicate that aging,female,fasting glucose≥7.0 mmol/L,smoking and low physical activity levels all increase the risk of sarcopenia,while increased body mass index can decrease the risk of sarcopenia.To conclude,the elderly(especially women)should maintain a healthy lifestyle and slightly higher body mass index levels during the aging process,thus reducing the risk of sarcopenia.

Current situation and strategies of asthma self-management in adolescents / 国际儿科学杂志

Asthma is a common chronic respiratory disease in children.Adolescent asthma is characterized by high prevalence rate, high mortality and poor disease control.The optimal adolescent asthma management is crucial to improve asthma control, as well as reduce the burden of asthma including mortality.The key of the management in adolescents with asthma is the self-management, which involves individual, family and social aspects.The imbalance between physical development and psychological development in adolescents leads to many challenges in the self-management in adolescents with asthma.This review elaborates the current situation, influence factors and promotional strategies of self-management in adolescents with asthma so as to achieve the optimal asthma self-management.

Immune debt and its impact in children during severe acute respiratory syndrome coronavirus 2 epidemic / 中华实用儿科临床杂志

Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.

Interpretation of adolescent asthma management in the Global Initiative for Asthma (GINA) 2022 Update / 中华实用儿科临床杂志

Asthma is the most common chronic respiratory disease in children, and its prevalence has shown an obvious upward trend in recent years.Adolescence is a critical stage when adolescents undergo rapid psychological and physical developmental changes.The management of asthma in adolescents is different from that in childhood and adulthood.Further attention should be paid to the diagnosis and management of asthma in adolescents.The Global Initiative for Asthma 2022 (GINA 2022) had updated the content of evaluation and treatment of severe asthma in adolescents.In this article, the contents related to the diagnosis, assessment, initial treatment and adjustment, severe asthma management and self-management of adolescent asthma in GINA 2022 were interpreted, in order to provide reference for the diagnosis and treatment of adolescent asthma and improve the management of asthma in adolescents.

Interpretation of managing food allergy: Global Allergy and Asthma European Network guideline (2022) / 中华实用儿科临床杂志

Food allergy is one of the most common chronic non-infectious diseases in many countries and regions, which affects 2%-4% of children and adults.Its prevalence is on the rise worldwide.In 2022, the Global Allergy and Asthma European Network (GA 2LEN) proposed recommendations on managing food allergy to people at different age groups.This review aims to interpret the recommendations, clinical practice, precautions, evidence gaps and research priorities of food allergy management based on the GA 2LEN guideline 2022, thus providing reference for clinical management of food allergy.

Focus on thunderstorm asthma in children / 中华实用儿科临床杂志

Recently, the number of children with asthma reported after thunderstorm weather in China has increased rapidly, which has aroused the public concern.At present, there are 28 documented episodes of epidemic thunderstorm asthma in the world, which can be life-threatening in severe cases.Children with allergic rhinitis or uncontrolled asthma were more susceptible to thunderstorm asthma.This article introduces the epidemiology, mechanism, risk factors, manifestations, management strategies and prevention of thunderstorm asthma, in order to improve pediatricians′ understanding of thunderstorm asthma and reduce the impact of it.

Type 2 inflammation in children and advances in its biotherapy / 中华实用儿科临床杂志

Type 2 immunity involves Th2 cells, type 2 innate lymphoid cells(ILC2), and type 2 cytokines such as interleukin (IL)-4, IL-5, and IL-13.Invasion by allergens or harmful substances can cause an excessive type 2 immune response, resulting in type 2 inflammation characterized by the increase in type 2 cytokines, eosinophils, and serum total IgE/specific IgE.Type 2 cytokines are the core of type 2 inflammation, of which production and secretion involve Th2 cells and ILC2.Disruption of barrier function can activate type 2 inflammation and contribute to the vicious cycle.Type 2 inflammation is a common pathophysiological mechanism in many diseases, especially allergic diseases.Type 2 inflammatory disease in children mostly affects the skin, respiratory tract, and gastrointestinal tract.Multiple type 2 inflammatory diseases often co-exist, increasing the disease burden in children.With deepening research on the mechanism of type 2 inflammation, the biotherapy has gained more and more attention.This paper focused on the mechanism, identification and biologics of type 2 inflammation in order to improve clinicians′ understanding of type 2 inflammatory diseases in children.

Value of brain functional connectivity density in differentially diagnosing different motor subtypes of Parkinson's disease and its correlation with clinical symptom scores / 中华神经医学杂志

Objective:To investigate the value of brain functional connectivity density (FCD) derived from resting-state functional magnetic resonance imaging (rs-fMRI) in differentially diagnosing 2 subtypes of Parkinson's disease (PD): tremor dominant (TD) and non-tremor dominant (nTD), as well as its correlation with clinical symptom scores.Methods:A retrospective analysis was performed; 45 PD patients (25 with TD and 20 with nTD), admitted to Department of Neurology, Drum Tower Hospital Affiliated to Medical School of Nanjing University were chosen; and 24 middle-aged and elderly volunteers matched in age, gender and years of education at the same time were chosen as normal controls (NCs). The rs-fMRI data were collected and FCD map of the whole brain was computed. The FCD differences in whole brain and brain regions enjoying different FCD were compared among the 3 groups. ROC curve was used to analyze the differential diagnostic efficacy of FCD in brain regions enjoying different FCD in TD and nTD. Correlations of FCD in brain regions enjoying different FCD with disease course, Hoehn-Yahr (H-Y) grading, unified Parkinson's disease rating scale (UPDRS) III scores, tremor scores and non-tremor scores were analyzed by Pearson or Spearman correlation analyses.Results:Brain regions enjoying different FCD among the TD, nTD, and NC groups were the right lingual gyrus, right orbital medial frontal gyrus, right insula, left superior temporal gyrus, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus, and left angular gyrus. FCD in the right orbital medial frontal gyrus and left angular gyrus of TD group was significantly higher than that in the nTD group ( P<0.05); while FCD in the right insula, right anterior central gyrus, left posterior central gyrus and right medial and paracingulate gyrus of TD group was significantly lower than that in the nTD group ( P<0.05). Area under the curve of combined application of FCD in brain regions enjoying different FCD in differentially diagnosing TD and nTD was 0.842, with sensitivity and specificity of 80.0%. FCD in the left superior temporal gyrus and left posterior central gyrus was positively correlated with H-Y grading ( P<0.05), while FCD in the left angular gyrus was negatively correlated with H-Y grading ( P<0.05). FCD in the left superior temporal gyrus was positively correlated with UPDRS III scores ( P<0.05). FCD in the right lingual gyrus, right insula, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus was negatively correlated with tremor scores ( P<0.05). FCD in the left superior temporal gyrus, right medial and paracingulate gyrus was positively correlated with non-tremor scores ( P<0.05), whereas that in the left angular gyrus was negatively correlated with non-tremor scores ( P<0.05). Conclusion:Abnormalities in FCD exist in certain brain regions of PD patients, with disparities between TD and nTD. Combined application of FCD in brain regions enjoying different FCD can effectively differentiate TD and nTD, and this FCD is also partially correlated with the symptom scores of PD patients.

Study on the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo by SRM-vertigo diagnosis system / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo（HC-BPPV） by SRM-vertigo diagnosis system. Methods:A total of 406 patients diagnosed with HC-BPPV from Nov 2021 to Nov 2022 were enrolled by rapid axial roll test and Dix-Hallpike in the department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. The patients were divided into two groups by hospital card numbers, in which the numbers that were odd were considered as group A, and the numbers that were even were considered as group B. The group A underwent two circles of Barbecure repositioning procedure by SRM-vertigo diagnosis system, while the group B underwent two circles Barbecure combined with Epley repositioning procedure by SRM-vertigo diagnosis system. The treatment was stopped on the next day when two groups of patients were cured, and those who were not cured will continue treatment with the same method. Results:The cure rate of group A was 83.41%, and the cure rate of group B was 80.51%, the difference between the two groups was not-statistically significant difference（P>0.05）. The rate of residual dizziness of group A was 23.30%, the rate of residual dizziness of group B was 11.46%, the difference between the two groups was statistically significant（P<0.05）. Conclusion:The Barbecure combined with Epley otoliths repositioning maneuver by SRM-vertigo diagnosis system can significantly reduce the rate of residual dizziness after the treatment of HC-BPPV, and improve the quality of life of patients.

Recent progress in vestibular prosthesis / 临床耳鼻咽喉头颈外科杂志

Bilateral vestibulopathy（BVP） is one of the common diseases in the vestibular nervous system, with an incidence rate of about 4%-7% in the population, which can lead to a variety of body dysfunctions. At present, there are two main treatment methods for BVP. One is vestibular rehabilitation. However, only part of BVP patients can finally benefit from vestibular rehabilitation, and most patients will remain with permanent vestibular dysfunction. Benefiting from the maturity of cochlear implant technology, European and American countries took the lead in the development of vestibular prosthesis（VP） technology to restore the vestibular function in patients with BVP. This review will focus on the development history, principles, future applications and the related research progress of VP in China.

The influence of additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery，the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory（DHI） and the pittsburgh sleep quality（PSQI）. Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%，the difference between the two groups was statistically significant（P<0.05）; The DHI score of patients after the repositioning was significantly lower than that before the repositioning（P<0.05）. The PSQI score after the repositioning was significantly lower than that before the repositioning（P<0.05）. The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference （P< 0.05）. The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference（P<0.05）. The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference （P< 0.05）. Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.

Strategies for targeting and remodeling tumor microenvironment / 药学学报

Tumor microenvironment (TME) is composed of abnormal tumor vasculature, extracellular matrix components, endothelial cells, pericytes, tumor associated fibroblasts, smooth muscle cells and immune cells, which is characterized by hypoxia, acidosis and high interstitial fluid pressure. Hypoxia and acidosis within the TME trigger an adjustment of the extracellular matrix (ECM), a response from neighbor stromal cells (e.g., fibroblasts) and immune cells (lymphocytes and macrophages), inducing tumor growth, angiogenesis, and ultimately, resulting in metastasis. What's more, the components of TME including abnormal tumor vasculature, rich composition of the ECM, and abundant stroma cells impair tumoral distribution and penetration of the drugs. At the same time, this stromal microenvironment plays a vital role in creating an immunosuppressive environment.Over the past years, more and more researches focus on targeting and remolding TME to improve therapeutic effects against tumors. Herein, we reviewed current strategies developed to target and remodel TME, including modulating tumor hypoxia, tumor vasculature, tumor associated fibroblasts, extracellular matrix components, tumor associated macrophage phenotypes and dendritic cells. Also, potential problems and future directions are pointed out in this review.

Effects of different courses of moxibustion treatment on intestinal flora and inflammation of a rat model of knee osteoarthritis / 中西医结合学报

OBJECTIVE@#This study was done to determine the effects of different courses of moxibustion on a rat knee osteoarthritis (KOA) model, and explore the dose-effect relationship of moxibustion on KOA from the perspectives of intestinal flora and inflammatory factors.@*METHODS@#Wistar rats were randomly divided into five groups: normal, model, moxibustion for 2 weeks, moxibustion for 4 weeks and moxibustion for 6 weeks groups (n = 5 each group). A KOA rat model was induced by monosodium iodoacetate, and moxibustion intervention was performed at the acupoints "Dubi" (ST35) and "Zusanli" (ST36), once every other day. Pathologic changes in the cartilage of rat knee joints were assessed after intervention, and fecal samples were subjected to 16S rRNA high-throughput sequencing for microbial diversity analysis.@*RESULTS@#Damage to the knee articular cartilage was obvious in the model group, which also had increased levels of pro-inflammatory factors, decreased levels of anti-inflammatory factors, and intestinal flora disorders with decreased diversity. The degree of cartilage damage in the 4 and 6 weeks of moxibustion groups was significantly improved compared with the model group. The 4 and 6 weeks of moxibustion groups also demonstrated reduced levels of interleukin-1β and tumor necrosis factor-α and increased levels of interleukin-10 (P < 0.05). Both the abundance and diversity of the intestinal flora were increased, approaching those of the normal group. Abundances of probiotics Eubacterium coprostanoligenes group and Ruminococcaceae UCG-014 increased, while that of the pathogenic bacteria Lachnospiraceae NK4A136 group decreased (P < 0.05). Although the abundance of Lachnospiraceae NK4A136 group decreased in the 2 weeks of moxibustion group compared with the model group (P < 0.05), there was no statistically significant difference in serum inflammatory factors, flora species diversity or degree of pathological damage compared with the model group.@*CONCLUSION@#Moxibustion treatment led to significant improvements in the intestinal flora and inflammatory factors of rats with KOA. Moxibustion treatment of 4 and 6 weeks led to better outcomes than the 2-week course. Moxibustion for 4 and 6 weeks can regulate intestinal flora dysfunction with increased probiotics and reduced pathogenic bacteria, reduce pro-inflammatory factors and increase anti-inflammatory factors. No significant differences were seen between the effects of moxibustion for 4 weeks and 6 weeks.

Non-pharmaceutical interventions for respiratory virus infection in children and its effect / 中华实用儿科临床杂志

With the emergence of new respiratory virus, it is more apparent for the vulnerability of population to respiratory viral infection.Non-pharmaceutical interventions (NPIs) for respiratory virus infection have become the main way to prevent corona virus disease 2019.Some studies had proven its effectiveness.In addition, the NPIs also significantly reduced the incidence and hospitalization rate of other respiratory disease in children.NPIs for respiratory virus infection in children have its particularity and challenge.In daily life, it is important to guide children how to do the NPIs, so as to protect susceptible children and reduce the disease burden in children′s health system.Therefore, the aerosol transmission, the specificity of the NPIs in children, and the impact on childhood respiratory diseases are described in this article, to improve the prevention of common respiratory diseases in children.

Management of asthma in adolescents / 中华实用儿科临床杂志

Asthma is the most common chronic respiratory disease in children and requires long-term medical management.Adolescence has unique physical and psychological characteristics, which challenge the management of asthma in adolescents.A personalized transition strategy can achieve a successful asthma transition from childhood into adulthood and improve long-term outcomes of asthma.In this paper, the characteristics of adolescence, burden of adolescent asthma, challenges to adolescent asthma, adolescent asthma management system, and successful transition of adolescent asthma were reviewed.

Identification of serological biomarkers for diagnosis of rheumatoid arthritis using a protein array-based approach / 南方医科大学学报

OBJECTIVE@#To study the cytokine patterns in patients with rheumatoid arthritis (RA) and healthy individuals and identify candidate serum biomarkers for clinical diagnosis of RA.@*METHODS@#This study was conducted among 59 patients diagnosed with RA in our hospital from 2015 to 2019 with 46 age- and gender-matched healthy subjects who received regular physical examinations in our hospital as the control group. Serological autoimmune profiles of 5 RA patients and 5 healthy control subjects were obtained from human cytokine microarrays. We selected 4 differentially expressed cytokines (LIMPII, ROBO3, Periostin and IGFBP-4) and 2 soluble cytokine receptors of interest (2B4 and Tie-2) and examined their serum levels using enzyme-linked immunosorbent assay in 54 RA patients and 41 healthy control subjects. Spearman correlation test was performed to assess the correlation of serum cytokine and soluble receptor expression levels with the clinical features including rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity score (DAS28) and health assessment questionnaire (HAQ). Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic capability of these cytokines.@*RESULTS@#We identified 6 dysregulated cytokines and soluble receptors (2B4, LIMPII, Tie-2, ROBO3, periostin and IGFBP-4) in RA patients (P < 0.01). The serum levels of LIMPII, ROBO3 and periostin were significantly correlated with the disease activity indicators including RF (P < 0.001), CRP (P < 0.001), DAS28 (P < 0.001) and HAQ (P < 0.001) in RA patients. Among the 6 candidate cytokines, 2B4 showed the largest area under the curve (AUC) of 0.861 for RA diagnosis (P < 0.001), followed then by LIMPII, ROBO3, periostin, Tie-2 and IGFBP-4.@*CONCLUSION@#Serum levels of LIMPII, ROBO3 and periostin can be indicative of the disease activity of RA, and serum 2B4, LIMPII, periostin, ROBO3, IGFBP-4 and Tie-2 levels may serve as biomarkers for the diagnosis of RA.

Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging / 南方医科大学学报

OBJECTIVE@#To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions.@*METHODS@#We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed.@*RESULTS@#There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ2=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively.@*CONCLUSION@#MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

Interpretation of European Academy of Allergy and Clinical Immunology Biologicals Guidelines-Recommendations for severe asthma / 中华实用儿科临床杂志

Severe asthma imposes a significant burden on patients, families, and healthcare systems.Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems.Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals.However, there are still many issues that require further clarification.These include selection of a certain biological, the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen.