Knockdown of fibrillin-1 suppresses retina-blood barrier dysfunction by inhibiting vascular endothelial apoptosis under diabetic conditions

AIM:To investigate the effects of fibrillin-1(FBN1)deletion on the integrity of retina-blood barrier function and the apoptosis of vascular endothelial cells under diabetic conditions.METHODS:Streptozotocin(STZ)-induced diabetic mice were used to simulate the diabetic conditions of diabetic retinopathy(DR)patients,and FBN1 expression was detected in retinas from STZ-diabetic mice and controls.In the Gene Expression Omnibus(GEO)database,the GSE60436 dataset was selected to analyze FBN1 expressions in fibrovascular membranes from DR patients.Using lentivirus to knock down FBN1 levels,vascular leakage and endothelial barrier integrity were detected by Evans blue vascular permeability assay,fluorescein fundus angiography(FFA)and immunofluorescence labeled with tight junction marker in vivo.High glucose-induced monkey retinal vascular endothelial cells(RF/6A)were used to investigate effects of FBN1 on the cells in vitro.The vascular endothelial barrier integrity and apoptosis were detected by trans-endothelial electrical resistance(TEER)assay and flow cytometry,respectively.RESULTS:FBN1 mRNA expression was increased in retinas of STZ-induced diabetic mice and fibrovascular membranes of DR patients(GSE60436 datasets)using RNA-seq approach.Besides,knocking down of FBN1 by lentivirus intravitreal injection significantly inhibited the vascular leakage compared to STZ-DR group by Evans blue vascular permeability assay and FFA detection.Expressions of tight junction markers in STZ-DR mouse retinas were lower than those in the control group,and knocking down of FBN1 increased the tight junction levels.In vitro,30 mmol/L glucose could significantly inhibit viability of RF/6A cells,and FBN1 mRNA expression was increased under 30 mmol/L glucose stimulation.Down-regulation of FBN1 reduced high glucose(HG)-stimulated retinal microvascular endothelial cell permeability,increased TEER,and inhibited RF/6A cell apoptosis in vitro.CONCLUSION:The expression level of FBN1 increases in retinas and vascular endothelial cells under diabetic conditions.Down-regulation of FBN1 protects the retina of early diabetic rats from retina-blood barrier damage,reduce vascular leakage,cell apoptosis,and maintain vascular endothelial cell barrier function.

Dysfunctional attitudes,social support,negative life events,and depressive symptoms in Chinese adolescents:A moderated mediation model

BACKGROUND Depression is a prevalent psychological issue in adolescents that is significantly related to negative life events(NLEs)and dysfunctional attitudes.High levels of social support can significantly buffer NLEs’effect on depression.Currently,there is limited research on how social support moderates the relationship between NLEs,dysfunctional attitudes,and depression in adolescents in China.It is imperative to investigate this moderating effect to mitigate dysfunctional attitudes in adolescent undergoing depressive mood,ultimately enhancing their overall mental health.AIM To investigate the relationship and underlying mechanisms between specific dysfunctional attitudes,social support,and depression among Chinese adolescents.METHODS This is a cross-sectional study which selected five middle schools in Shandong Province for investigation in March 2022.Participants included 795 adolescents(49.87%male,mage=15.15,SD=1.84,age range=11-18 years old).All participants completed the Dysfunctional Attitude Scale,Adolescent Life Event Scale,Beck Depression Inventory,and Social Support Rating Scale.A moderated mediation model was conducted to examine the relationship between specific dysfunctional attitudes,social support,and depression.RESULTS Results indicated that NLEs affected depression through the mediating role of specific dysfunctional attitudes(autonomy attitudesβ=0.21;perfectionismβ=0.25).Moreover,social support was found to moderate the mediating effect between NLEs,specific dysfunctional attitudes,and depressive symptoms(autonomy attitudes b2=-0.08;perfectionism b2=-0.09).CONCLUSION Dysfunctional attitudes mediated and social support moderated the relationship between NLEs and depression.Social support can buffer depression symptoms among adolescents with autonomy attitudes and perfectionism.

T形钩预劈核联合囊膜精细处理技术在高度近视合并白内障术中的应用

目的:探讨T形钩预劈核联合囊膜精细处理技术治疗高度近视合并白内障的临床疗效。方法:选取2016-03/2019-02期间在河北省眼科医院就诊的合并高度近视的白内障患者56例80眼,随机进行分组,A组患者40眼行白内障超声乳化联合T形钩预劈核及囊膜精细处理手术。B组患者40眼行单纯白内障超声乳化术。比较两组患者术中超声累积释放能量,术后随访6mo以上,观察最佳矫正视力(BCVA)、前囊口收缩变化量、后囊膜混浊程度、人工晶状体居中性及手术并发症情况。结果:A组患者术中超声累积释放能量少于B组(12.23±3.61 vs 20.46±4.61,P<0.01)。术后6mo,A组患者BCVA优于B组(Z=5.328,P=0.002),前囊口收缩变化量、人工晶状体偏中心量(0.18±0.14、0.02±0.007mm)小于B组(0.82±0.23、0.65±0.240mm)(均P<0.05),且A组患者均可见后囊膜中央3mm大小圆孔,视轴区保持透明,而B组患者中13眼(32%)出现后囊膜中央区混浊。A组患者未出现术中后囊膜意外破裂及术后视网膜脱离情况,B组患者术中发生后囊膜意外破裂2眼(5%),术后视网膜脱离1眼(2%)。结论:采用T形钩预劈核联合囊膜精细处理技术治疗合并高度近视的白内障可减少术中超声能量的使用,降低后囊膜破裂的风险,有效避免后发性白内障的发生,可以取得满意的临床疗效。

清除LECs对高度近视合并白内障患者囊袋稳定性的影响

目的:探讨清除晶状体上皮细胞(LECs)对高度近视合并白内障患者囊袋稳定性的影响。方法:回顾性分析2018-03/2019-04河北省眼科医院白内障科收治的合并高度近视的白内障患者98例120眼,根据术中是否进行囊膜LECs清除分为两组,A组患者50例60眼术中对前后囊膜进行抛光,B组患者48例60眼术中未对囊膜抛光。术后使用眼前节OCT检测两组患者有效人工晶状体位置(ELP)变化量、人工晶状体(IOL)偏心量、前囊口缩小程度,应用裂隙灯观察PCO发生情况及程度。结果:两组患者术后1d,3mo ELP变化量(0.16±0.06mm vs0.55±0.07mm)、前囊口收缩变化量(0.18±0.16mm vs0.92±0.13mm)及术后3mo IOL偏心量(0.02±0.005mm vs0.69±0.23mm)均有差异(P<0.05)。术后3mo,A组患者PCOⅠ级4眼,Ⅱ级2眼,Ⅲ级1眼;B组患者PCOⅠ级16眼,Ⅱ级8眼,Ⅲ级4眼,Ⅳ级3眼,两组患者发生PCO程度差异明显(Z=-4.765,P<0.01)。结论:囊膜LECs清除可减少前囊膜收缩程度,降低ELP改变量,增强囊袋-IOL复合体的稳定性,对减少术后PCO起得了良好的作用。

Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey

Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.

Primary intratracheal neurilemmoma in a 10-year-old girl:A case report

BACKGROUND Tracheal tumors are relatively rare in adults and uncommon in children.Tracheal neurilemmoma is a rare condition in adults that usually affects middle-aged people,but it can also occur in children.Because the clinical presentation is nonspecific and insidious,diagnosis is often delayed.The most common symptoms in these patients are stridor or wheezing(especially positional)and cough.A few patients are misdiagnosed and mistakenly treated for asthma.CASE SUMMARY A 10-year-old girl was admitted to our unit with a 2-mo history of recurrent cough,dyspnea,and tachypnea.Her condition was more severe after exercise.Her symptoms progressed despite treatment with inhaled fluticasone/salmeterol.Flexible electronic laryngoscopy showed a red,smooth,and round mushroomshaped mass in the trachea,about 1 cm below the vocal cords.The surface of the mass was covered with several small and discontinuous blood vessels.About 90%of the tracheal lumen was occupied by the mass.A multidisciplinary operation was performed.The surgically resected mass was diagnosed as benign neurilemmoma by immunohistochemical analysis.CONCLUSION Intratracheal neurilemmoma is fairly rare in children.The main symptoms include coughing,wheezing,and dyspnea.The tumor’s size,location,and degree of intratracheal and extratracheal invasion can be measured by chest computed tomography.The main treatment strategies used for tracheal neurilemmoma are surgical resection and endoscopic excision.Long-term follow-up is warranted for the evaluation of outcomes and complications.

Expert consensus on the diagnosis, treatment, and prevention of respiratory syncytial virus infections in children

Background Respiratory syncytial virus(RSV)is the leading global cause of respiratory infections and is responsible for about 3 million hospitalizations and more than 100,000 deaths annually in children younger than 5 years,representing a major global healthcare burden.There is a great unmet need for new agents and universal strategies to prevent RSV infections in early life.A multidisciplinary consensus development group comprising experts in epidemiology,infectious diseases,respiratory medicine,and methodology aims to develop the current consensus to address clinical issues of RSV infections in children.Data sources The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Library,using variations in terms for"respiratory syncytial virus","RSV","lower respiratory tract infection","bronchiolitis","acute","viral pneumonia","neonatal","infant""children",and"pediatric".Results Evidence-based recommendations regarding diagnosis,treatment,and prevention were proposed with a high degree of consensus.Although supportive care remains the cornerstone for the management of RSV infections,new monoclonal antibodies,vaccines,drug therapies,and viral surveillance techniques are being rolled out.Conclusions This consensus,based on international and national scientific evidence,reinforces the current recommendations and integrates the recent advances for optimal care and prevention of RSV infections.Further improvements in the management of RSV infections will require generating the highest quality of evidence through rigorously designed studies that possess little bias and sufficient capacity to identify clinically meaningful end points.

Lewis Base Catalyzed Selenofunctionalization of Alkynes with Acid-Controlled Divergent Chemoselectivity

Lewis base catalyzed and Brønsted acid controlled chemodivergent electrophilic selenofunctionalizations of alkynes were developed for the first time.Various selenium-containing tetrasubstituted alkenes were readily obtained in moderate to excellent yields with complete E/Z selectivities.As the substrates were 1-ethynyl naphthol derivatives,linear selenium-containing tetrasubstituted alkenes were produced via intermolecular oxygen nucleophilic attack in the absence of acid additive;in contrast,cyclic selenium-containing tetrasubstituted alkenes were generated through intramolecular carbon nucleophilic capture with the addition of Brønsted acid.

Chiral Lewis Base/Achiral Acid Co-Catalyzed Atroposelective Sulfenylation of Pyrrole Derivatives: Construction of C-N Axially Chiral Sulfides

Chiral BINAM-derived selenide/achiral acid co-catalyzed atroposelective electrophilic sulfenylation of pyrrole derivatives has been realized for the first time.A variety of C-N axially chiral sulfur-containing pyrrole derivatives were readily obtained in moderate to good yields with moderate to excellent enantioselectivities.This catalytic system involves sequential desymmetrization and kinetic resolution.

Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

Background Mycoplasma pneumoniae(M.pneumoniae)is a significant contributor to community-acquired pneumonia among children.Since 1968,when a strain of M.pneumoniae resistant to macrolide antibiotics was initially reported in Japan,macrolide-resistant M.pneumoniae(MRMP)has been documented in many countries worldwide,with varying incidence rates.MRMP infections lead to a poor response to macrolide antibiotics,frequently resulting in prolonged fever,extended antibiotic treatment,increased hospitalization,intensive care unit admissions,and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics.Since 2000,the global incidence of MRMP has gradually increased,especially in East Asia,which has posed a serious challenge to the treatment of M.pneumoniae infections in children and attracted widespread attention from pediatricians.However,there is still no global consensus on the diagnosis and treatment of MRMP in children.Methods We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world’s first consensus on the diagnosis and treatment of pediatric MRMP pneumonia,based on evidence collection.The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,CNKI,Medline,and the Cochrane Library.We used variations in terms for“macrolide-resistant”,“Mycoplasma pneumoniae”,“MP”,“M.pneumoniae”,“pneumonia”,“MRMP”,“lower respiratory tract infection”,“Mycoplasma pneumoniae infection”,“children”,and“pediatric”.Results Epidemiology,pathogenesis,clinical manifestations,early identification,laboratory examination,principles of antibiotic use,application of glucocorticoids and intravenous immunoglobulin,and precautions for bronchoscopy are highlighted.Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens.Although the resistance rate to macrolide remains high,it is fortunate that M.pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones,making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.Conclusions This consensus,based on international and national scientific evidence,provides scientific guidance for the diagnosis and treatment of MRMP in children.Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development.Additionally,developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

Catalytic asymmetric synthesis of sulfur-containing atropisomers by C-S bond formations

Chiral organosulfur compounds are not only widely distributed in bioactive natural products and pharmaceuticals,but also play a significant role in chiral ligands/catalysts.Throughout the history of synthetic organic chemistry,chemists have been absorbed in the construction of centrally chiral organosulfur compounds.Nevertheless,there are relatively few reports on installing sulfur functional groups into axially chiral compounds.Atropisomerism is one of the fundamental phenomena in nature,which ubiquitously exists in natural products.After more than a century of development,atropisomers have been designed and extensively applied to pharmaceuticals,functional materials and chiral ligands/catalysts.Due to the importance of chiral sulfurcontaining atropisomers,there is an increasing demand for enantioselective synthesis of them.Recently,a diversity of approaches by C-S bond formations have been established for the construction of enantioenriched sulfur-containing atropisomers,however,there is no comprehensive review to summarize this great progress.In this mini-review,we summarize recent progress in catalytic asymmetric synthesis of sulfur-containing atropisomers by C-S bond formations,which includes sulfur nucleophilic reactions,sulfur electrophilic reactions and sulfur radical reactions.Furthermore,the reaction mechanisms are also discussed.We hope that this mini-review will enable more researchers to further explore this field.

新型冠状病毒院内感染调研与分析工具的开发与验证

目的制定2019-nCoV院内感染调研与分析工具,并行初步验证。方法研究小组基于前期循证制定的"新型冠状病毒医护感染过程及防控调研问卷",主要通过细化问卷调研目的、建立问卷条目池、评估问卷的效度三个步骤进行改编。结果形成了新型冠状病毒院内感染调研与分析工具,包括行政后勤感染组、医护对照组、行政后勤对照组3个问卷。问卷内容与研究目标具有较高的一致性。行政后勤感染组问卷包括"确诊前"、"确诊后"2个领域的调查,其中,"确诊前"涉及感染原因分析、确诊前防控方案、确诊前防控知识、确诊前心理上对疫情的应对状态4个部分,共计16个条目;"确诊后"包括确诊后症状、确诊后治疗、感染后对周围环境和人造成的影响、确诊后心理、感染后防护认识5个方面,共计21个条目。医护对照组问卷涉及与是否感染有关的工作或生活行为、防控相关行为、防控相关知识、心理上对疫情的应对状态4个方面,共计29个条目。行政后勤对照组问卷涉及的领域与医护对照组问卷相同,共计20个条目。结论本研究完成了2019-nCoV院内感染调研与分析工具的制定,共涉及2019-nCoV感染医院非医护工作人员感染过程及防控调研——行政、后勤人员专用,2019-nCoV感染医护感染对照组调研问卷——医护对照组,2019-nCoV感染医护感染对照组调研问卷——行政后勤对照组3个问卷,问卷的信度和效度均可靠、可行性良好。

Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children

Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed. Results Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0–7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion;and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention;and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0–6.0) months. Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.

Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus

Since December 2019,an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China.As of 8 pm,31 January 2020,more than 20 pediatric cases have been reported in China.Of these cases,ten patients were identified in Zhejiang Province,with an age of onset ranging from 112 days to 17 years.Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCo V (the 4th edition) and current status of clinical practice in Zhejiang Province,recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health,the National Children's Regional Medical Center,Children's Hospital,Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.

Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs.montelukast in China

Background There are limited studies comparing budesonide inhalation suspension(BIS)with montelukast in real-world settings where treatment adherence and persistency may be suboptimal.This real-world study aims to investigate the control effectiveness of montelukast or BIS as a monotherapy in Chinese children with mild asthma.Methods Data were derived from a retrospective questionnaire-based analysis of 2-14-year-old children with mild persistent asthma,who received either 500 pg of BIS(n=153)or 4-5 mg of montelukast(n=240)once daily.The indicators of asthma control,the Asthma Control Test(ACT)/Childhood ACT(C-ACT)score,and the asthma-related medical costs were assessed.The differences between the two groups were compared using an unpaired-t-test(normally distributed).Mann-Whitney U test(non-normally distributed)or chi-squared test(categorical variables).Results Medication compliance in the past 3-month period was better in the montelukast group than in the BIS group(P=0.042).The montelukast group exhibited better asthma control in the past 4-week period,including lower percentages of asthmatic children with symptoms more than twice a week(P=0.021),had night waking or night coughing(P=0.022),or required reliever medication more than twice a week(P<0.001).The montelukast group had a lower percentage of children with an ACT/C-ACT score≤19(P=0.015).Caregivers reported a significantly better exercise tolerance in the children who received montelukast vs.BIS in the past 12 months(P<0.001).Significantly higher medical expenditures attributable to asthma in the past 12 months were observed in the BIS group vs.montelukast group(P<0.001).Conclusion Both treatments provided acceptable overall asthma control in children with mild persistent asthma;however,more reliever medication and more medical expenditures attributable to asthma were needed for BIS vs.montelukast in real-world settings,where factors such as compliance were also taken into account.

Biologic Targeting： New and Effective Therapeutic Approaches against Severe Asthma

Asthma is defined as a chronic airway inflammation characterized by bronchial hyperresponsiveness, reversible restriction in airflow, and structural remodeling of airway. Patients often present with coughing, wheezing, dyspnea, and chest tightness, Applications of inhaled corticosteroid （ICS） and long-acting β2 agonist （LABA） relieve most of the symptoms in the majority of asthma patients, yet an estimated 3.6% of the patients fail to benefit from existing treatment regimens, which increases the patient burden and negatively affects their life quality. In the process of asthma, IgE plays an important role. As the first monoclonal anti-IgE antibody, omalizumab has been confirmed to improve the asthma symptom score, reduce the acute attack of asthma, lower the dosage of oral or inhaled glucocorticoid, and ameliorate life quality of asthma patients. Omalizumab marks the beginning of a new era in treating severe asthma. Besides IgE, eosinophils are also intimately involved in the pathogenesis of asthma and are associated with disease severity, exacerbation frequency, and mortality. Many of the proinflammatory factors, such as interleukin （IL）-5, IL-4, IL-13, and IL-17, play important roles in the pathological processes of the maturation, activation, survival, and recruitment of eosinophils in severe asthma [Figure 1]. These can impact inflammation and structural changes in the respiratory tract. Therefore, it is plausible to block key factors that contribute to eosinophilia in the treatment of severe asthma.

New coronavirus: new challenges for pediatricians

The 2019-nCoV epidemic has become a major challenging public health problem in China.For standardizing the diagnosis and treatment strategies of 2019-nCoV pneumonia,National Health Commission of the People's Republic of China has released the Diagnosis and Treatment Standards of 2019-nCoVpneumonia,and updated the standards to the 4th edition based on the status of epidemic and accumulated experiences in clinical practice now [1].

Chiral Sulfide/Phosphoric Acid Cocatalyzed Enantioselective Intermolecular Oxysulfenylation of Alkenes with Phenol and Alcohol O-Nucleophiles

Enantioselective intermolecular three-component oxysulfenylations of alkenes with phenols and alcohols as O-nucleophiles were achieved using chiral BINAM-derived sulfide/phosphoric acid as the cocatalyst.Notably,chiral BINAM-derived sulfide/phosphoric acid co-catalysis was first explored to successfully catalyze highly enantioselective transformation.A variety of sulfur-containing benzylic aryl ethers and benzylic alkyl ethers,which contained two contiguous chiral stereocenters,were obtained readily in moderate to excellent yields with high to excellent enantioselectivities.

Clonorchiasis Complicated with Diffuse Parenchymal Lung Disease in Children

To the Editor： Clonorchiasis is a biliary tract disease caused by Clonorchis sinensis, which is widely distributed in East Asia, including China. Diffuse parenchymal lung diseases （DPLDs） comprise a large and heterogeneous group of disorders characterized by diffuse infiltrates, restrictive functional defect, and disordered gas exchange. C. sinensis infection is seldom associated with pulmonary manifestation. Here, we report a case of clonorchiasis complicated with DPLD in a child.

Reply to ＂Clonorchiasis or Paragonimiasis？＂

As mentioned in our previous admitted to our hospilal with article, a 23-month-old girl was a 1-month history of progressive cough and a 3-week history of wheezing. Both her chest X-ray and computed tomography showed bilateral ground-glass attenuation and reticular opacities. Clonorchis sinensis-specific IgG in serum was positive in a dot immunogold filtration assay established by Wang et al using soluble C. sinensis antigen, lgG to other parasites including Paragonimus westermani, Paragonimiasis sichuanensis, Schistosoma japonicum, and Spirometra mansoni were all negative. We failed to find any parasites＇ eggs in the patient＇s feces. For patients with slight infection or in early stage, it is not easy to detect C. sinensis eggs in feces.