Brucella meningoencephalitis in children with status epilepticus A case report and literature review / 中国热带医学

@#Abstract: Objective　To investigate the clinical characteristics and incidence of Brucella encephalitis and meningitis in children. Methods We report the clinical data of a child with Brucella melitensis meningitis in children, and summarize the incidence, diagnosis methods and treatment of Brucella encephalitis or meningitis in children, taking into account the relevant domestic and foreign literature from January 2014 to December 2020. Results　A 4-year-old girl was admitted to the hospital with status epilepticus on March 15, 2021 because of interrupted right limb numbness for 16 hours and convulsions for 2 hours. She had 2 non-febrile convulsions three months before admission and was diagnosed with epilepsy. This incident was acute, accompanied by low fever, with epilepsy as the main manifestation. Cerebrospinal fluid test suggested central nervous system infection, but the nature of infection could not be determined by routine and biochemistry of cerebrospinal fluid.The cerebrospinal fluid next generation sequencing confirmed that the pathogen of the infection was B. melitensis, which was further verified by the peripheral blood antibody test. After effective antibiotics combined with a full course of treatment, the patient recovered after six months of treatment. A total of 60 articles were retrieved in the database, including 29 in Chinese. During this period, a total of 7 cases of brucellosis in children with nervous system involvement were reported, one of which was a case report, and the other 6 cases were mentioned in the comprehensive analysis of children with brucellosis. Conclusions　Brucella encephalitis or meningitis in children has a low incidence and various clinical features, which are easy to be misdiagnosed or missed.

Plasma MASP-1 concentration and its relationship to recovery from coronary artery lesion in children with Kawasaki disease.

BACKGROUND: This study investigated prognostic factors for early recovery of coronary artery lesion (CAL) in children with Kawasaki disease (KD). METHODS: Patients hospitalized for KD were enrolled less than 2 wk from the onset of illness and divided into two groups: KD with CAL and KD without CAL. The CAL group was further divided into two subgroups according to the degree of CAL: mild (n = 31) and moderate/severe (n = 6) and further divided into two subgroups according to the age: younger than 1 y (n = 9) and older than 1 y (n = 28). Lectin pathway-related factors MASP-1, CD59, and C5b-9 were measured, along with C-reactive protein, white blood cell counts, erythrocyte sedimentation rate, and platelet count. Patients were followed up for 3 mo. Correlation between the measured factors and the length of time of recovery from CAL was analyzed. RESULTS: Plasma concentrations of MASP-1 in the CAL group were significantly lower than those without CAL. MASP-1 and gender positively correlated with the recovery time of CAL. There was no difference in MASP-1 between mild and moderate/severe CAL. At 3-mo follow-up, there was a positive correlation between plasma MASP-1 concentration and recovery time of the patients with CAL older than 1 y. CONCLUSION: Plasma MASP-1 concentration at the early stage of KD is predictive of length of time of recovery from CAL.

A Meta-Analysis and Indirect Comparison of Endothelin A Receptor Antagonist for Castration-Resistant Prostate Cancer.

BACKGROUND: Endothelin A (ET-A) receptor antagonists including zibotentan and atrasentan, have been suggested as a treatment for castration-resistant prostate cancer (CRPC). Our aim was to conduct a meta-analysis and indirect comparison to assess the efficacy and safety of ET-A receptor antagonists for treatment of CRPC. METHODS: We systematically searched PubMed, EMBASE, the Cochrane Library, and Web of Science from inception to November 2014 to identify randomized controlled trials (RCTs) which assessed ET-A receptor antagonists for treatment of CRPC. Meta-analysis was conducted by STATA version 12.0 software. RESULTS: Eight RCTs were identified, involving 6,065 patients. The results of direct comparison showed that compared with placebo, there was no statistically significant difference in the improvement of progression-free survival (PFS), overall survival (OS), time to disease progression (TTP), and total adverse events (AEs) with ET-A receptor antagonist treatment for CRPC. The results of ET-A receptor antagonists plus docetaxel versus docetaxel alone were similar. The indirect comparisons showed that there were no significant differences between zibotentan plus docetaxel versus atrasentan plus docetaxel when compared with docetaxel alone or zibotentan versus atrasenta compared with placebo in the improvement of PFS, OS, TTP, and total adverse events. CONCLUSIONS: There were no significant benefits for ET-A receptor antagonists with or without docetaxel in the improvement of PFS, OS, TTP, and overall AEs. And there were no significant differences between zibotentan and atrasentan. Single-agent docetaxel should remain as one of the standard treatments.

Early decreased plasma levels of factor B and C5a are important biomarkers in children with Kawasaki disease.

BACKGROUND: The mechanisms underpinning Kawasaki disease (KD) are incompletely understood. There is an unmet need for specific biomarkers for the early diagnosis of KD. METHODS: Eighty-five KD patients suffering from acute-phase and subacute-phase KD, 40 healthy children, and 40 febrile children comprised the study cohort. An enzyme-linked immunosorbent assay was used to measure plasma levels of C1q, C1q-circulating immune complex (C1q-CIC), mannan-binding lectin-associated serine protease (MASP)-1, factor B, C4d, C3d, C5a, C5b-9 and CD59. RESULTS: Plasma concentrations of factor B and C5a in the acute phase were lower than those in healthy and febrile control groups (all P < 0.05). Compared with acute-phase KD patients, plasma concentrations of C1q, factor B, and C3d in KD patients were increased significantly (P < 0.05), but those of C4d, MASP-1 and CD59 decreased significantly (P < 0.05), in patients with sub-acute KD. CONCLUSION: These data suggest that more than one pathway in the complement system is activated in KD. Importantly, decreased plasma concentrations of factor B and C5a in the acute phase (6-10 d) could be employed as biomarkers for the early diagnosis of KD.

[Clinical research on treatment of migraine with pine needle moxibustion].

OBJECTIVE: To observe the clinical effect and mechanism of migraine treated with pine needle moxibustion. METHODS: Forty-three patients were randomly divided into 2 groups of pine needle moxibustion group (group A, 21 cases) and medicated thread moxibustion of Zhuang medicine group (group B, 22 cases). Same acu-points were selected as the main points for both groups, namely Fengchi (GB 20), Baihui (GV 20), Taiyang (EX-HN 5), Shuaigu (GB 8), Cuanzhu (BL 2), Sizhukong (TE 23), Yanglingquan (GB 34), Waiguan (TE 5) and Ashi points. Pine needle moxibustion was applied for the group A. Processed lighted pine needles were banded together with one even head to do moxibustion on acupoints or pain points. While, lighted medicated thread was adopted for the group B to do moxibustion. Therapeutic effects, the content of high-sensitivity C-reactive protein (hs-CRP), Mg2+ in the serum and the degree of pain of the two groups were compared. RESULTS: (1) In the group A, the complete remission rate was 47.6% (10/21) and the effective rate was 90.5% (19/21). In the group B, the complete remission rate was 13.6% (3/22) and the effective rate was 50.0% (11/22). The two rates in the group A were superior to those in the group B (both P < 0.01); (2) In the group A, the content of hs-CRP was decreased from (4.29 +/- 0.98) mg/L to (2.11 +/- 0.87) mg/L, and Mg2+ was increased from (0.67 +/- 0.28) mmol/L to (1.07 +/- 0.16) mmol/L. In the group B, the contents of the above mentioned indices were respectively decreased from (4.30 +/- 1.07) mg/L to (3.38 +/- 1.15) mg/L and increased from (0.68 +/- 0.21) mmol/L to (0.88 +/- 0.25) mmol/L. There were significant differences between the two groups after treatment (both P < 0.05). (3) The degree of pain in the group A after treatment was much lower than that in the group B (P < 0.05). CONCLUSION: The clinical effect of migraine treated with pine needle moxibustion is better than that with the medicated thread moxibustion of Zhuang medicine. And it has obvious regulation effect on the levels of hs-CRP and Mg2+ in the serum of patients.