Chronic lung allograft dysfunction post-lung transplantation:The era of bronchiolitis obliterans syndrome and restrictive allograft syndrome

Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.

Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans(ASO)remains limited.AIM To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.METHODS A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled.They were randomly allocated into two groups using a double-blind approach.The control group was treated using a warming meridian with a cold-dispersing formula,while the study group received additional treatment with ear acupoint embedding beans.The clinical efficacy,ankle-brachial artery pressure ratio,hemorheological indicators,and traditional Chinese medicine symptom scores were compared between the two groups.RESULTS The clinical efficacy rate in the study group was significantly higher(94.00%)than that in the control group(72.00%,P<0.05).Moreover,the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment(P<0.05).Hemorheological parameters,including whole blood viscosity,plasma viscosity(1.83±0.11)mPa/s,fibrinogen levels(3.30±0.21)g/L,platelet adhesion rate(49.87%±10.51%),and erythrocyte aggregation index(1.79±0)were improved in the study group compared to the control group.In addition,the scores for decreased skin temperature(1.41±0.26),intermittent claudication(1.30±0.20),and resting pain(1.23±0.31)were significantly lower in the study group than those in the control group(all P<0.05).The level of oxidative stress in the study group also exhibited significant improvement(P<0.05),and the levels of inflammatory factors were considerably lower than those in the control group.CONCLUSION The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment

Background Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treat-ment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clini-cal, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis. Methods Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized. Results Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P<0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment. Conclusions Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifesta-tions identified in the children. New prospective and controlled studies are required to confirm this proposition.

3aired Capacity of Fibroblasts to Support Airway Epithelial Progenitors in Bronchiolitis Obliterans Syndrome

Background： Bronchiolitis obliterans syndrome （BOS） often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of BOS is currently an area of intensive research. Studies have shown that injury to the respiratory epithelium results in dysregulation of epithelial repair. Airway epithelial regeneration is supported by stromal cells, including fibroblasts. This study aimed to investigate whether the supportive role of lung fibroblasts is altered in BOS. Methods： Suspensions of lung cells were prepared by enzyme digestion. Lung progenitor cells （LPCs） were separated by fluorescence-activated cell sorting. Lung fibroblasts from patients with BOS or healthy controls were mixed with sorted mouse LPCs to compare the colony-forming efficiency of LPCs by counting the number of colonies with a diameter of_〉50/.tln in each culture. Statistical analyses were pertbrmed using the SPSS 17.0 software （SPSS Inc., USA）. The paired Student＇s t-test was used to test tbr statistical significance. Results： LPCs were isolated with the surface phenotype ofCD31-CD34-CD45- EpCAMtSca- I . The colony-lbrming efficiency of LPCs was significantly reduced when co-cultured with fibroblasts isolated from patients with BOS. The addition ofSB431542 increased the colony-forming efficiency of LPCs to 1.8%; however, it was still significantly less than that in co-culture with healthy control fibroblasts （P 〈 0.05）. Conclusion： The epithelial-supportive capacity offibroblasts is impaired in the development of BOS and suggest that inefficient repair of airway epithelium could contribute to persistent airway inflammation in BOS.

Risk factors for bronchiolitis obliterans syndrome in allogeneic hematopoietic stem cell transplantation

Background The occurrence of bronchiolitis obliterans syndrome （BOS） after allogeneic hematopoietic stem cell transplantation （alIo-HSCT） is rare but severe. We examine the role of pre-HSCT chemotherapeutic exposure, pre-HSCT comorbidities, and transplant-related complications in the development of BOS after alIo-HSCT. Methods A nested case-control study was designed. Cases with BOS and controls matched for the year of alIo-HSCT and length of the follow-up were identified from a cohort of 1646 patients who underwent alIo-HSCT for treatment of hematologic malignancies between 2006 and 2011. Antithymocyte globulin was used in the partial matched related and unrelated matched donor HSCT, or patients with severe aplastic anemia. Results Thirty-six patients suffered from BOS; the mean age at the time of presentation was （32.7±2.4） years, and the mean time to presentation was （474±350） days post-HSCT. A pre-HSCT cyclophosphamide dose of 〉3.2 g/m2 （OR=8.74, P=0.025）, chronic graft-versus-host disease （moderate to severe） （OR=12.02, P=0.000）, and conditioning regimens without antithymocyte globulin （OR=2.79, P=0.031） were independently associated with BOS. Conclusions We found that higher pre-HSCT cyclophosphamide exposure, a conditioning regimen without antithymocyte globulin, and moderate to severe chronic graft-versus-host disease are significantly and independently associated with BOS. Based on these results, we can identify patients who are at a higher risk of developing BOS after alIo-HSCT, select a more appropriate therapeutic strategy, and improve the outcome of HSCT recipients.

Lung transplantation for bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation

Bronchiolitis obliterans syndrome （BOS） after hematopoietic stem cell transplantation （HSCT） is a major cause of morbidity and mortality with limited treatment options. Lung transplantation （LTX） has been rarely reported as a treatment option for selected HSCT recipients with this problem. In the present study, we reported six patients who underwent LTX due to BOS after HSCT （two females, four males） from January 2012 to December 2014 in our center. The median time from HSCT to diagnosis of BOS was 2.5 years （ranging from 1 to 5 years）. At a median time of 4 years （ranging from 2 to 5 years） after diagnosis of BOS, four patients received bilateral sequential LTX, and two patients received single LTX. One of the recipients suffered from mild acute rejection after LTX, another suffered from primary lung graft dysfunction on post-operation day 2, and three experienced fungal infections. The median time for follow-up after LTX was 19.5 months （ranging from 12 to 39 months）. At present, all patients are alive with good functional capacity and no relapse of BOS and hematologic malignancy conditions. Patients who received bilateral LTX have better pulmonary functions than patients who received single LTX.

Significance of platelet count in children admitted with bronchiolitis

AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis.Clinical outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or death.They also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with age.There was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care unit.No death,thrombotic or hemorrhagic events occurred.CONCLUSION Thrombocytosis is common in children under two years of age admitted with bronchiolitis.It is not associated with disease severity or thromboembolic complications.

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

Background: Patients with arteriosclerosis obliterans (ASO) often have co-existing atherosclerotic diseases. The purpose of this study was to examine the clinical features of patients with ASO, including the overlap of atherosclerotic risk factors, characteristics of car-diovascular events, and clinical prognosis. Method: We enrolled 205 consecutive patients who had ankle brachial index (ABI) of ?0.9 between January 2008 and December 2009. Fontaine (F) classification and clinical background were evaluated and clinical events including mortality and major adverse cardiocerebro-vascular events (MACCEs) were determined. Results: There was a high prevalence of each risk factor. Sixty- five percent of subjects had three or more of the four overlapping risk factors, including hypertension, dia- betes, dyslipidemia, and smoking. After a maximum follow-up of 800 days, the incidence of MACCEs and mortality was 46% and 10%, respectively. We divided the patients into two groups according to the presence of ASO symptoms (F1 and F2-4) and compared the incidence of events. The incidence of MACCEs and mortality in the F2-4 group was significantly higher than that in the F1 group (P = 0.048, P = 0.044, respectively). After excluding lower extremity revascularization, coronary artery disease was a common cause of MACCEs, and the mortality rates after MACCEs increased in a stepwise manner according to F classification severity (P = 0.028). Conclusion: Patients with ASO had overlapping coronary risk factors and a high incidence rate of cardiovascular events. The incidence of coronary events was common, especially in symptomatic patients, and the mortality rates after MACCEs were high in accordance with F classification severity.

Application of Xiao’er Kechuanling Oral Liquid Combined with Tulobuterol Patch in Children with Bronchiolitis

[Objectives]To explore the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch on the basis of comprehensive treatment,compare it with the combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide which are commonly used in clinic,and observe the curative effect in the treatment of acute bronchiolitis and the effect on serum IL-4 and IL-8.[Methods]80 children with acute bronchiolitis were randomly divided into observation group(n=40)and control group(n=40),and both groups were given routine comprehensive treatment.The observation group was treated with Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch and budesonide,while the control group was treated with combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide.The curative effect of the two groups was observed;the remission duration of cough,wheezing,dyspnea and nocturnal wheezing,and the disappearance time of wheezing rales and moist rales were observed in the two groups;the treatment course of intravenous infusion of methylprednisolone sodium succinate,oxygen inhalation time,sputum suction times and hospitalization time were observed in the two groups;the changes of serum IL-4 and IL-8 were observed before and after treatment in the two groups;the adverse drug reactions were observed.[Results](i)The total effective rate of the two groups was 100%(P>0.05),but the cure rate of the observation group(72.5%)was significantly higher than that of the control group(42.5%)(P<0.01).(ii)The disappearance time of cough,wheezing rales and moist rales and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.01),the remission duration of nocturnal wheezing in the observation group was shorter than that in the control group(P<0.05),and the remission duration of wheezing and dyspnea in the control group was slightly longer than that in the control group(P>0.05).(iii)There was no significant difference(P>0.05)in serum IL-4 and serum IL-8 between the two groups before and after treatment.After treatment,the levels of serum IL-4 and IL-8 in the observation group and the control group were significantly lower than those before treatment in the observation group and the control group.[Conclusions]On the basis of comprehensive treatment,the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch in the treatment of acute bronchiolitis could reduce the effect of nocturnal wheezing on sleep,reduce the levels of serum IL-4 and IL-8,and significantly improve adverse symptoms.

From bronchiolitis guideline to practice: A critical care perspective

Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.

Clinical analysis of 114 cases of bronchiolitis in infants

BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infants and young children.Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline.AIM To summarize the clinical features,standard diagnosis,and treatment of bronchi-olitis.METHODS This is a retrospective analysis of 114 pediatric patients(74 males,40 females)who were first diagnosed as having bronchioles at the Department of Pediatrics of Tongling Maternal and Child Health Hospital from January 2019 to December 2019.The clinical features,imaging features,treatment,and other clinical data were recorded and analyzed.RESULTS The age of onset of the disease was mainly from 1 mo to 6 mo(75.4%),and the time to hospital visit was mostly from the 2nd day to the 4th day of the course of the disease(75.4%).Lung imaging examination showed increase in lung texture,fuzzy(93.8%).The main treatment was atomization therapy:Budesonide combined with terbutaline(45.6%)and budesonide combined with salbutamol(38.5%).The average hospitalization time was 7.1±2.4 d,and the overall cure rate was 94.7%.In patients without bacterial infection,the use of antibiotics significantly prolonged the length of hospital stay(7.8±2.5 d vs 5.7±1.8 d)and improved the cure rate(98.3%vs 87.9%,P<0.05).CONCLUSION Infants with bronchiolitis are mainly male and tend to have a good prognosis.However,the unneeded use of antibiotics may prolong the length of hospital stay significantly,which imposes the burden both on the patients and hospital system.CONCLUSION Bronchiolitis is a common acute respiratory infectious disease in infants and young children.It mainly affects male children and the age onset is between 1 to 6 mo.The standard use of antibiotics should be emphasized in view of the prolonged average length of hospital stay between the antibiotic treatment group and the non-antibiotic treatment group.When the course of disease is more than 7 d or the treatment effect is poor,active anti-infective treatment is needed to improve the long-term prognosis.Very few children have recurrent cough and wheezing symptoms within 1 year,which may be related to the risk of later asthma attack.FOOTNOTES Author contributions:Shi C and Wu MH contributed to study conception and design,and provision of study materials or patients;Shi C contributed to administrative support;Zuo A,Yang MM,and Jiang RR contributed to data collection and assembly;Shi C contributed to data analysis and interpretation,and manuscript writing;all authors contributed to the final approval of the manuscript.Institutional review board statement:The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013).The study was approved by Institutional Review Board of Tongling Maternal and Child Health Hospital.

Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis

BACKGROUND Tidal breathing flow-volume(TBFV)analysis provides important information about lung mechanics in infants.AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.METHODS In this cross-sectional study,TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge.The ratio of time to peak expiratory flow to total expiratory time(tPEF/tE)at baseline and after the administration of 400 mcg salbutamol was evaluated.RESULTS A total of 56 infants(35 boys),aged 7.4±2.8 mo,were included.Of them,12.5%were exposed to tobacco smoke and 41.1%were breastfed less than 2 mo.There were no differences in baseline TBFV measurements between the breastfeeding groups;however,those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation(12%±10.4%vs 0.9%±7.1%;P<0.001).Moreover,there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding(P<0.001).In multivariate regression analysis,infants who breastfed less(regression coefficient-0.335,P=0.010)or were exposed to cigarette smoke(regression coefficient 0.353,P=0.007)showed a greater change in tPEF/tE after bronchodilation,independent of sex,prematurity,and family history of asthma or atopy.CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke,have TBFV measurements indicative of obstructive lung disease.

TCM Treatment of Thromboangiitis Obliterans—A Report of 64 Cases

Thromboangiitis Obliterans (TAO), a common peripheral vascular disease with a long illness course and grave sufferings, can cause acromelic gangrene, ulcer and even amputation at the late stage. We have for many years used TCM syndrome differentiation to diagnose and treat the disease with good therapeutic results. The treatment of 64 TAO cases from 2001 to 2002 is reported as follows.

Association of the plasminogen activator inhibitor-1(PAI-1) gene 4G/5G promoter polymorphism in Buerger's disease (Tromboangiitis obliterans)

Thromboangiitis obliterans (TAO) is an unusual tobacco-associated vasculopathy that is a non- atherosclerotic inflammatory disorder of unkn- own etiology that affects small and medium- sized vessels of the extremities. The single guanosine nucleotide deletion/insertion polym- orphism (4G/5G) at -675 bp in promoter region of the PAI-1 gene is the major genetic determi- nant of PAI-1 expression. Plasma PAI-1 level is higher in people with the homozygous 4G genotype than in those with the 5G/5G genotype and renders higher transcription activity. The aim of this study was to determine the status and the role of PAI-1 gene 4G/5G promoter polymorphism in patients with Buerger's disease (Thromboangiitis obliterans—TAO). The current case-control study included 30 consecutive pat- ients with Buerger's disease (mean age 42.9 ± 14.3 years, 28 men and 2 women), and 30 healthy volunteers (mean age 40.9 ± 4.79 years, 27 men and 3 women) between January 2006 and September 2009. Patients and control cases were genotyped for the 4G/5G polymorphism using the multiplex PCR based stripassay reverse hybridisation technique. It was found that heterozygote PAI-1 gene polymorphisms (p < 0.05) was significantly more frequent in patients with TAO in the current results. There was a significant difference in genotype distribution between the two groups (P < 0.001). The 4G allele occurred more frequently in the patient group of heavy smokers (P = 0.05). The current study shows the higher prevalence of of 4G allele in TAO patients in Sivas population means gene may predispose to TAO.

Hyponatremia is Associated with Increased Severity of Disease in Critically Ill Children with Bronchiolitis

INTRODUCTION: Hyponatremia is the most common electrolyte abnormality seen in the intensive care unit (ICU), and is associated with increased morbidity and mortality. Critically ill children with bronchiolitis are at risk of developing hyponatremia, due to impaired renal free water excretion and exogenous sources of excess free water intake. We hypothesize that the development of hyponatremia is associated with a more complicated clinical course in critically ill children with bronchiolitis. METHODS: A retrospective case-control study was conducted that included all children admitted to the ICU with bronchiolitis over a two year period (n = 59). Patients were divided into two clinical groups: those that were hyponatremic (serum sodium < 136 mmol/L) during their ICU stay and those that remained normonatremic (serum sodium ≥ 136 mmol/L). RESULTS: Forty-three children (73%) developed hyponatremia while in the ICU. Hyponatremic children were intubated more often than normonatremic children (OR 16.7;95% CI 4.1-68.5);however, hyponatremia rarely developed before intubation (2%). Hyponatremic children also had a longer ICU length of stay (209 ± 137 hrs vs. 130 ± 85 hrs, p = 0.01). In a subset of intubated children (n = 44), thirty-eight (88%) developed hyponatremia. These intubated children had a lower mean serum sodium concentration (132.8 mmol/L vs. 137.3 mmol/L, p < 0.0001) than non-intubated children. CONCLUSIONS: Hyponatremia is a common comorbidity in children admitted to the ICU with bronchiolitis, and is associated with increased illness severity, as evidenced by a higher frequency of intubation and a longer ICU length of stay.

The Bronchiolitis in Paediatric Emergencies at the University Teaching Hospital of Gabriel Touré

Introduction: Bronchiolitis is a generally benign condition characterised by acute inflammation, oedema and necrosis of the epithelial cells lining the small airways, and increased mucus production. Symptoms usually begin with rhinitis and cough, which may progress to tachypnoea, wheezing, and rales. The most common etiology is a respiratory syncytial virus (RSV). Bronchiolitis occupies an important place among Acutes Respiratory Infections (ARI) and represented the fifth cause of hospitalisation in the paediatric emergency department of the Gabriel Touré University Hospital in 2008 with a frequency of 10% and a mortality rate of 3.2%. This shows that we are constantly confronted with the management of this pathology. The objective of our study was to study the epidemiological, clinical, and therapeutic aspects of bronchiolitis in the paediatric emergency room of the Gabriel Touré University Hospital. Materials and Method: This was a prospective cross-sectional and descriptive study from April 1, 2018, to March 31, 2020, i.e. 2 years in infants aged 1 to 23 months. Data were collected using an individual survey form by questioning parents and physically examining patients. Results: During the study period, we were able to collect 342 patients meeting our inclusion criteria out of 4207 hospitalized patients, or a frequency of 8.1%. The age range of 1 to 5 months represented 64.9%. The sex ratio was 1.2. The most common reason for consultation was respiratory discomfort (86.8%). Most patients (46%) were hospitalised during the period from September to November. In the majority of cases (74%), patients consulted within five days of the onset of symptoms. The physical examination was mainly dominated by signs of respiratory struggle, fever (51.8%), and sibilants (37%) on auscultation. Complications associated with bronchiolitis were mainly respiratory infections with 57.6% of cases. The main management steps were: nasopharyngeal decontamination (78.9%), oxygen therapy (72.5%), nebulisation with β2 mimetics (69%), and infusion of solution (76.3%). However, 89% of patients received antibiotic therapy using Amoxicillin + clavulanic acid in 37% of cases. The average stay of the patients was 5.5 days. The evolution was marked by 12% of deaths and respiratory infections were the main cause of death (41.5%). Conclusion: Bronchiolitis is a frequent pathology whose peak is in September in our country. Its seriousness lies in the complications it causes, which can lead to death in the absence of early and adequate treatment.

Hepatic involvement in children with acute bronchiolitis

BACKGROUND Respiratory syncytial virus(RSV)is a prevalent cause of lower respiratory tract infections.It may be associated with hepatocellular involvement,as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase(ALT).AIM To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical,laboratory,and radiological variables.METHODS The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department,Salmaniya Medical Complex,the Kingdom of Bahrain,between 2019 and 2020.We collected the demographic data,the clinical presentation,the laboratory and radiological findings,and the clinical outcomes.We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.RESULTS We included 166(57.8%)of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria.Ninety-three(56%)patients were males.The median age at presentation was 3.4(interquartile range 1.1 to 12.4)mo.Fifty-four(28%)patients tested positive for RSV,which was confirmed in 15 of them(28%)by PCR.Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14(8.7%)patients and normal ALT in 147(91.3%).Coagulation profiles were measured in 46(27.7%)of 166 patients.High prothrombin time was present in 15(32.6%),a high international normalized ratio was present in 13(28.3%),and high activated partial thromboplastin time was present in three(6.5%).Thrombin time was elevated in nine(27.3%)of 33 patients.Five(21.7%)of 23 patients with available radiological data had hepatomegaly;one of them had findings suggestive of fatty infiltration.High ALT had a significant association with lengthy hospital stays(P<0.05)and positive urine culture(P<0.05).Seventy(42.2%)patients had documented follow-up with liver function tests over a median follow-up period of 10.2(IQR,2.4-23.3)mo.Total serum protein and serum globulin levels were normalized at the follow-up time,with a significant P value of<0.05.CONCLUSION This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course.However,there was a rising trend in ALT during follow-up.Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.

Use of flow cytometry to investigate the cytokine response pattern in infants with respiratory syncytial virus infection and bronchiolitis

Objective: To investigate the cytokine response pattern (IL 4/IFN γ ) in infants with RSV infections and bronchiolitis during the acute phase. Methods: Four color flow cytometry was used to measure intracellular IL 4 and IFN γ expressions in peripheral blood CD3+ and CD8+ lymphocytes from RSV infected and bronchiolitis infants. Serum IL 4 and IFN γ levels were also determined. Results: RSV infected and bronchiolitis infants showed no statistical differences from not RSV infected or pneumonia infants and control in the frequency of IL 4 and IFN γ expressions in CD3+CD8 lymphocytes, showed no obvious Th1/Th2 imbalance, while IFN γ was expressed much more frequently in CD3+CD8+ lymphocytes. Systematically, RSV infected and bronchiolitis infants showed much lower levels of serum IL 4 and IL 4/IFN γ ratios and much higher serum IFN γ levels than control. However, there were no statistical differences in the above three indices between RSV infected and not RSV infected infants or between bronchiolitis and pneumonia infants, except that bronchiolitis infants had a higher level of serum IFN γ than pneumonia infants statistically. Conclusions: There is no type 2 cytokine response predominance in the acute phase of RSV infection and bronchiolitis. IL 4 production is suppressed and IFN γ production upregulated, the latter being most prominent in bronchiolitis infants.

Mechanism of Danggui Sini Decoction(当归四逆汤)for Atherosclerosis Obliterans Based on Network Pharmacology and Molecular Docking

Objective:Based on network pharmacology and molecular docking,we want to explore the pharmacological effects and mechanism of Danggui Sini Decoction in the treatment of lower extremity arteriosclerosis obliterans.Methods:Using TCMSP database to search the main active components of Danggui Sini Decoction(当归四逆汤,DSD)and their related targets,Cytoscape3.8.1 software was used to construct a"component-disease-target"interaction network.Meanwhile,DAVID database was used to enrich the key target genes with GO and KEGG functions.And we used Auto Dock Tools 1.5.6 for molecular docking.Results:A total of 45 candidate active molecules and 250 potential target proteins related to ASO were screened.Key genes such as TNF,IL6,VEGFA,MMP9,IL1B,CCL2,CXCL8,ICAM1,VCAM1,and IL10 are mainly through TNF signaling pathway,HIF-1 signaling pathway,cytokine-cytokine receptor interaction,Toll-like receptor signaling pathway,NF-kappa B signaling pathway,MAPK signaling pathway and other biological pathways exert their effects.The results of molecular docking showed that 5UUI-sesamin,5UUI-paeoniflorin,4XCT-sesamin,and 4XCT-sesamin have extremely strong binding ability.Conclusion:Danggui Sini Decoction(当归四逆汤,DSD)can synergistically exert pharmacological effects through multiple components,multiple targets,and multiple pathways.On the basis of regulating immunity and inhibiting smooth muscle proliferation,it can prevent the occurrence and development of ASO.