Retrospective analysis of infliximab in the treatment of Kawasaki disease / 中华儿科杂志

Objective: To investigate the efficacy and safety of infliximab (IFX) therapy for children with Kawasaki disease. Methods: Sixty-eight children with Kawasaki disease who received IFX therapy in Children's Hospital of Fudan University from January 2014 to April 2021 were enrolled. The indications for IFX administration, changes in laboratory parameters before and after IFX administration, response rate, drug adverse events and complications and outcomes of coronary artery aneurysms (CAA) were retrospectively analyzed. Comparisons between groups were performed with unpaired Student t test or Mann-Whitney U test or chi-square test. Results: Among 68 children with Kawasaki disease, 52 (76%) were males and 16 (24%) were females. The age of onset was 2.1 (0.5, 3.8) years. IFX was administered to: (1) 35 children (51%) with persistent fever who did not respond to intravenous immunoglobulin (IVIG) or steroids, 28 of the 35 children (80%) developed CAA before IFX therapy; (2) 32 children (47%) with continuous progression of CAA; (3) 1 child with persistent arthritis. In all cases, IFX was administered as an additional treatment (the time from the onset of illness to IFX therapy was 21 (15, 30) days) which consisted of second line therapy in 20 (29%), third line therapy in 20 (29%), and fourth (or more) line therapy in 28 (41%). C-reactive protein (8 (4, 15) vs. 16 (8, 43) mg/L, Z=-3.38, P=0.001), serum amyloid protein A (17 (10, 42) vs. 88 (11, 327) mg/L, Z=-2.36, P=0.018) and the percentage of neutrophils (0.39±0.20 vs. 0.49±0.21, t=2.63, P=0.010) decreased significantly after IFX administration. Fourteen children (21%) did not respond to IFX and received additional therapies mainly including steroids and cyclophosphamide. There was no significant difference in gender, age at IFX administration, time from the onset of illness to IFX administration, the maximum coronary Z value before IFX administration, and the incidence of systemic aneurysms between IFX-sensitive group and IFX-resistant group (all P>0.05). Infections occurred in 11 cases (16%) after IFX administration, including respiratory tract, digestive tract, urinary tract, skin and oral infections. One case had Calmette-Guérin bacillus-related adverse reactions 2 months after IFX administration. All of these adverse events were cured successfully. One child died of CAA rupture, 6 children were lost to follow up, the remaining 61 children were followed up for 6 (4, 15) months. No CAA occurred in 7 children before and after IFX treatment, while CAA occurred in 54 children before IFX treatment. CAA regressed in 23 (43%) children at the last follow-up, and the diameter of coronary artery recovered to normal in 10 children. Conclusion: IFX is an effective and safe therapeutic choice for children with Kawasaki disease who are refractory to IVIG or steroids therapy or with continuous progression of CAA.

A follow-up study on the post-traumatic stress disorders among middle school students in Wenchuan earthquake region / 中华预防医学杂志

<p><b>OBJECTIVE</b>This study was to identify the post-traumatic stress disorder (PTSD) changes and the relative risk factors within one year after Wenchuan earthquake among middle school students in the disaster area.</p><p><b>METHODS</b>A total of 1966 students from 3 schools in Wenchuan earthquake region were selected as the target population. For each student, personal basic information and standard psychological scale (PCL-C, PSSS) were investigated by a self-administrated questionnaire in the 3rd, the 6th, the 9th and the 12th month after the earthquake, respectively. PTSD trends over the time and the associated risk factors were analyzed through the establishment of multi-level random coefficient model.</p><p><b>RESULTS</b>There were 1677 middle school students fully participated in the PTSD follow-up study by turning in the valid questionnaires. The averaged scores of PTSD at the time of the 3rd, the 6th, the 9th and the 12th month after the earthquake were 35.14 ± 11.08, 32.90 ± 11.03, 30.67 ± 11.28 and 29.75 ± 11.22, respectively. Meanwhile, the general incidences of PTSD were 36.6% (613/1677), 30.7% (515/1677), 24.8% (416/1677)and 22.2% (373/1677), respectively. The median score of perceived social support system was 60.00 and the general incidences of PSS was 17.20% (289/1677). The PTSD scores for the students had a decreasing trend during the period of our observation (β(time) = -1.879, χ(2) = 47.03, P < 0.05). The averaged scores for boys for the 4 follow-up studies were 33.71, 31.61, 29.66, 28.83; for girls were 36.33, 33.98, 31.51, 30.52; for junior school students were 35.46, 33.28, 30.18, 29.22; for senior school students were 34.89, 32.62, 31.04, 30.15. Moreover, two factors, gender and grade, were related with the decreasing trend (the trend for girls and senior school students was sharper than that for boys and junior school students) (β(gender-time) = -0.354, χ(2) = 4.83, P < 0.05; β(grade-time) = 0.622, χ(2) = 11.30, P < 0.05).</p><p><b>CONCLUSIONS</b>The prevalence of PTSD was high. Meanwhile, there was a trend of self-recovery for adolescent's PTSD during the first year of post-earthquake, but boys and junior school students recovered more slowly.</p>

A study of Kaschin-Beck disease perception among residents in Aba Kaschin-Beck disease areas in 2009 / 中国地方病学杂志

Objective To find out the perception status of Kaschin-Beck disease(KBD)-related knowledge among residents in Aba KBD areas. Methods In 2009, hierarchical clustering random sampling method was used to select 13 villages as survey points in Aba KBD areas, general demographic characteristics, KBD prevalence and KBD-related knowledge of residents were investigated. Results Of the residents investigated, the understanding rate of KBD-related knowledge was 36.7% (7361/20 080), understanding rate among female [40.2% (4427/11012) ]was high than that of male[32.3%(2934/9084), x2 = 134.80, P ＜ 0.05];50-year group[42.5%(2789/6562] was higher than others;Tibetan [42.8% (6775/15829)] was higher than other nationals;residents in Semi-agricultural and semi-pastoral areas [47.2% (5777/12239)] was higher than people in other areas ;farmer [42.6% (4585/10762) ],people who lost labor ability [42.7% (1487/3482)] and the unemployed [42.8% (941/2199) ] was higher;married people[41.6%(6067/14584)] was higher;KBD patients[47.6%(4585/9632)] was higher[x2 = 92.41,148.04,578.56,116.35,36.96,371.29 respectively, all P ＜ 0.05]. Sixty three point nine persent (978/1530) acquired KBD knowledge through explaination by medical and health personnel. Conclusions The current situation of perception of KBD-related knowledge among residents in Aba KBD areas is not optimistic. Understanding rate among residents with different demographic characteristics is significantly different. Targeted health education strategies and measures should be developed among different population groups.