BACKGROUND Plastic bronchitis(PB)frequently occurs in children after the surgical repair of congenital cardiac defects or in the presence of inflammatory or allergic diseases of the lung.Accurate epidemiological data ...BACKGROUND Plastic bronchitis(PB)frequently occurs in children after the surgical repair of congenital cardiac defects or in the presence of inflammatory or allergic diseases of the lung.Accurate epidemiological data of this condition are still lacking.CASE SUMMARY A 5-year-old boy,with a clear medical history,presented to our hospital with persistent cough and pneumonia with segmental atelectasis on chest computerized tomography.He showed no significant improvement after 1 wk of amoxicillin-clavulanate potassium treatment.Bronchial casts were extracted using flexible bronchoscopy.Pathological examination of the dendritic cast confirmed the diagnosis of type I PB.Botrytis cinerea was detected by next-generation sequencing of the bronchoalveolar lavage fluid.After the removal of the airway obstruction and fluconazole treatment,the patient recovered and was discharged 14 d after admission without the recurrence of cough.CONCLUSION Botrytis cinerea pneumonia should be considered in children with PB who still have prolonged cough and atelectasis after a regular course of antibiotic therapy.Flexible bronchoscopy and etiological examination should be performed in a timely manner to determine the diagnosis,clear the airway obstruction,and target etiological treatment.展开更多
The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in ...The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in conscious rats;to determine whether tolerance develops to these responses;and to determine the potential roles of peripheral μ-opioid receptors (μ-ORs) in these responses. Ventilatory parameters were monitored via unrestrained whole-body plethysmography. Conscious male Sprague-Dawley rats received an intravenous injection of vehicle or the peripherally-restricted μ-OR antagonist, naloxone methiodide (NLXmi), and then three successive injections of morphine (1 mg/kg) given 30 min apart. The first injection of morphine in vehicle-treated rats elicited an array of ventilatory excitant (i.e., increases in frequency of breathing, minute volume, respiratory drive, peak inspiratory and expiratory flows, accompanied by decreases in inspiratory time and end inspiratory pause) and inhibitory (i.e., a decrease in tidal volume and an increase in expiratory time) responses. Subsequent injections of morphine elicited progressively and substantially smaller responses. The pattern of ventilatory responses elicited by the first injection of morphine was substantially affected by pretreatment with NLXmi whereas NLXmi minimally affected the development of tolerance to these responses. Low-dose morphine elicits an array of ventilatory excitant and depressant effects in conscious rats that are subject to the development of tolerance. Many of these initial actions of morphine appear to involve activation of peripheral μ-ORs whereas the development of tolerance to these responses does not.展开更多
The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood g...The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood gas (ABG) chemistry, Alveolar-arterial (A-a) gradient and minute ventilation (Vm) had completely subsided. In vehicle-treated rats, each episode of hypoxia stimulated ventilatory function and the responses generally subsided during each normoxic period. Morphine (5 mg/kg, i.v.) induced an array of depressant effects on ABG chemistry, A-a gradient and Vm (via decreases in tidal volume). Despite resolution of these morphine-induced effects, the first episode of hypoxia elicited substantially smaller increases in Vm than in vehicle-treated rats, due mainly to smaller increases in frequency of breathing. The pattern of ventilatory responses during subsequent episodes of hypoxia and normoxia changed substantially in morphine-treated rats. It is evident that morphine haslatent deleterious effects on ventilatory responses elicited by hypoxic challenge.展开更多
This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses eli...This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses elicited by hypoxic-hypercapnic challenge in conscious rats at a time when the effects of morphine (10 mg/kg) on arterial blood-gas chemistry and minute ventilation had subsided. Morphine induced pronounced changes in arterial blood-gas chemistry (e.g., an increase in pCO2, decreases in pO2 and sO2) and decreases in minute ventilation. Despite the complete resolution of the morphine-induced changes in arterial blood-gas chemistry and minute ventilation and almost complete resolution of the effects on peak inspiratory flow and peak expiratory flow, subsequent exposure to hypoxic-hypercapnic challenge elicited markedly blunted increases in minute ventilation and in peak inspiratory and expiratory flows. These findings demonstrate that 1) the changes in arterial blood-gas chemistry elicited by morphine parallel changes in minute ventilation rather than PIF and PEF, and 2) morphine has latent untoward effects on the ventilatory responses to hypoxic-hypercapnic challenge. These novel findings raise the possibility that patients deemed to have recovered from the acute ventilatory depresssant effects of morphine may still be susceptible to the latent effects of this opioid analgesic. The mechanisms underlying these latent effects remain to be elucidated.展开更多
神经病理学研究表明,血清素(即5-羟色胺[5-hydroxytryptamine,5-HT])通路在婴儿猝死综合征(sudden infant death syndrome,SIDS)中发挥着关键作用。Panigrahy等在对美国SIDS病例进行观察后报告说,患者弓状核、中缝隐核以及其他...神经病理学研究表明,血清素(即5-羟色胺[5-hydroxytryptamine,5-HT])通路在婴儿猝死综合征(sudden infant death syndrome,SIDS)中发挥着关键作用。Panigrahy等在对美国SIDS病例进行观察后报告说,患者弓状核、中缝隐核以及其他含有5-HT细胞的髓区均出现5-HT受体结合减少的现象。无独有偶,Ozawa和Okado也在日本SIDS病例中发现迷走神经背核、弧核和延髓腹外侧部5-HT受体结合减少的现象。后来,Kinney等。证实了其既往研究结果,即美国印第安人(SIDS高危人群)髓区5-HT受体结合情况确实发生了改变。展开更多
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 repor...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.展开更多
Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children.OSA and NE are thought to be interrelated,but the exact pathophysiological mechanisms are not yet clear.Thi...Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children.OSA and NE are thought to be interrelated,but the exact pathophysiological mechanisms are not yet clear.This review aims to explain the possible pathogenesis of NE in children with OSA.Date sources We have retrieved all relevant original articles from Database that have been published so far,including the prevalence studies of NE and OSA in children,sleep characteristic studies that use polysomnography (PSG) to focus on children with NE,and studies on the relationship between OSA and NE.Results Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers.This increased risk may be associated with sleep disorders,bladder instability,detrusor overactivity,nocturnal polyuria,endocrine and metabolic disorders,and inflammation.Conclusions Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA,but this remains to be confirmed by animal studies.Other causes such as oxidative stress and inflammatory responses need to be further researched.展开更多
New pH-responsive saccharide hydrogels were designed and prepared using curdlan derivatives(curdlan-Bochistidine, CUR-HIS). The CUR-HIS hydrogels possessed highly porous structures. The swelling ratios of CUR-HIS hy...New pH-responsive saccharide hydrogels were designed and prepared using curdlan derivatives(curdlan-Bochistidine, CUR-HIS). The CUR-HIS hydrogels possessed highly porous structures. The swelling ratios of CUR-HIS hydrogels increased with the degree of substitution of Boc-histidine groups. And the addition of 0.5 mol/L Na Cl provoked a sharp reduction of swelling ratio of CUR-HIS hydrogels. Bovine serum albumin(BSA) can be efficiently encapsulated into CUR-HIS hydrogels. Moreover, the release profiles of BSA at different p H values from CUR-HIS hydrogels were significantly different. These hydrogels showed good biocompatibility in the cytotoxicity assays. The CUR-HIS hydrogels are of great potential in biomedical applications such as protein delivery systems.展开更多
Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the c...Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the clinical findings regarding 2009 influenza A(H1N1)-associated pediatric deaths in China,including the risk factors for death.Methods:The definition of 2009 influenza A(H1N1)-associated pediatric death is death in a child who is younger than 14 years and has laboratory-confirmed influenza.We collected data of total 810 hospitalized patients with 2009 influenza A(H 1N 1)infection from September 2009 to February 2010 in 17 hospitals across China.The clinical characteristics,laboratory abnormalities,and treatment course were retrospectively studied.Results:Of the 810 patients hospitalized with 2009 influenza A(H1N1)infection,19(2.3%)died.Ten patients died from severe pneumonia and acute respiratory distress syndrome;eight died from encephalopathy/encephalitis;one died from secondary fungal meningitis.Patients who died were more likely than patients who survived to have neutrophilia,lymphopenia,elevated C-reactive protein,and elevations of lactate dehydrogenase,creatine kinase,creatine kinase-MB,aspartate aminotransferase and alanine aminotransferase.There were no significant differences in the median age,median time from onset of illness to admission,underlying chronic disease,and initiation of antiviral therapy within 48 hours of illness onset,between patients who died and those who survived.Interpretation:The risk factors for pediatric death associated with 2009 influenza A(H 1N 1)infection are different from those of seasonal influenza.The most common causes of death are viral pneumonia,acute respiratory distress syndrome,and encephalopathy/encephalitis.展开更多
文摘BACKGROUND Plastic bronchitis(PB)frequently occurs in children after the surgical repair of congenital cardiac defects or in the presence of inflammatory or allergic diseases of the lung.Accurate epidemiological data of this condition are still lacking.CASE SUMMARY A 5-year-old boy,with a clear medical history,presented to our hospital with persistent cough and pneumonia with segmental atelectasis on chest computerized tomography.He showed no significant improvement after 1 wk of amoxicillin-clavulanate potassium treatment.Bronchial casts were extracted using flexible bronchoscopy.Pathological examination of the dendritic cast confirmed the diagnosis of type I PB.Botrytis cinerea was detected by next-generation sequencing of the bronchoalveolar lavage fluid.After the removal of the airway obstruction and fluconazole treatment,the patient recovered and was discharged 14 d after admission without the recurrence of cough.CONCLUSION Botrytis cinerea pneumonia should be considered in children with PB who still have prolonged cough and atelectasis after a regular course of antibiotic therapy.Flexible bronchoscopy and etiological examination should be performed in a timely manner to determine the diagnosis,clear the airway obstruction,and target etiological treatment.
文摘The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in conscious rats;to determine whether tolerance develops to these responses;and to determine the potential roles of peripheral μ-opioid receptors (μ-ORs) in these responses. Ventilatory parameters were monitored via unrestrained whole-body plethysmography. Conscious male Sprague-Dawley rats received an intravenous injection of vehicle or the peripherally-restricted μ-OR antagonist, naloxone methiodide (NLXmi), and then three successive injections of morphine (1 mg/kg) given 30 min apart. The first injection of morphine in vehicle-treated rats elicited an array of ventilatory excitant (i.e., increases in frequency of breathing, minute volume, respiratory drive, peak inspiratory and expiratory flows, accompanied by decreases in inspiratory time and end inspiratory pause) and inhibitory (i.e., a decrease in tidal volume and an increase in expiratory time) responses. Subsequent injections of morphine elicited progressively and substantially smaller responses. The pattern of ventilatory responses elicited by the first injection of morphine was substantially affected by pretreatment with NLXmi whereas NLXmi minimally affected the development of tolerance to these responses. Low-dose morphine elicits an array of ventilatory excitant and depressant effects in conscious rats that are subject to the development of tolerance. Many of these initial actions of morphine appear to involve activation of peripheral μ-ORs whereas the development of tolerance to these responses does not.
文摘The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood gas (ABG) chemistry, Alveolar-arterial (A-a) gradient and minute ventilation (Vm) had completely subsided. In vehicle-treated rats, each episode of hypoxia stimulated ventilatory function and the responses generally subsided during each normoxic period. Morphine (5 mg/kg, i.v.) induced an array of depressant effects on ABG chemistry, A-a gradient and Vm (via decreases in tidal volume). Despite resolution of these morphine-induced effects, the first episode of hypoxia elicited substantially smaller increases in Vm than in vehicle-treated rats, due mainly to smaller increases in frequency of breathing. The pattern of ventilatory responses during subsequent episodes of hypoxia and normoxia changed substantially in morphine-treated rats. It is evident that morphine haslatent deleterious effects on ventilatory responses elicited by hypoxic challenge.
文摘This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses elicited by hypoxic-hypercapnic challenge in conscious rats at a time when the effects of morphine (10 mg/kg) on arterial blood-gas chemistry and minute ventilation had subsided. Morphine induced pronounced changes in arterial blood-gas chemistry (e.g., an increase in pCO2, decreases in pO2 and sO2) and decreases in minute ventilation. Despite the complete resolution of the morphine-induced changes in arterial blood-gas chemistry and minute ventilation and almost complete resolution of the effects on peak inspiratory flow and peak expiratory flow, subsequent exposure to hypoxic-hypercapnic challenge elicited markedly blunted increases in minute ventilation and in peak inspiratory and expiratory flows. These findings demonstrate that 1) the changes in arterial blood-gas chemistry elicited by morphine parallel changes in minute ventilation rather than PIF and PEF, and 2) morphine has latent untoward effects on the ventilatory responses to hypoxic-hypercapnic challenge. These novel findings raise the possibility that patients deemed to have recovered from the acute ventilatory depresssant effects of morphine may still be susceptible to the latent effects of this opioid analgesic. The mechanisms underlying these latent effects remain to be elucidated.
文摘神经病理学研究表明,血清素(即5-羟色胺[5-hydroxytryptamine,5-HT])通路在婴儿猝死综合征(sudden infant death syndrome,SIDS)中发挥着关键作用。Panigrahy等在对美国SIDS病例进行观察后报告说,患者弓状核、中缝隐核以及其他含有5-HT细胞的髓区均出现5-HT受体结合减少的现象。无独有偶,Ozawa和Okado也在日本SIDS病例中发现迷走神经背核、弧核和延髓腹外侧部5-HT受体结合减少的现象。后来,Kinney等。证实了其既往研究结果,即美国印第安人(SIDS高危人群)髓区5-HT受体结合情况确实发生了改变。
基金supported by the grants from Key R&D Projects of Zhejiang Province(2023C03009 and 2024C03177).
文摘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.
基金the Natural Science Foundation of China(no.81870075)National Key Clinical Specialist Open Project no.20130211+1 种基金Zhejiang Province Natural Science Funding Project(no.LY17H010003)Zhejiang Province Health Department Project(no.2017185046).
文摘Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children.OSA and NE are thought to be interrelated,but the exact pathophysiological mechanisms are not yet clear.This review aims to explain the possible pathogenesis of NE in children with OSA.Date sources We have retrieved all relevant original articles from Database that have been published so far,including the prevalence studies of NE and OSA in children,sleep characteristic studies that use polysomnography (PSG) to focus on children with NE,and studies on the relationship between OSA and NE.Results Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers.This increased risk may be associated with sleep disorders,bladder instability,detrusor overactivity,nocturnal polyuria,endocrine and metabolic disorders,and inflammation.Conclusions Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA,but this remains to be confirmed by animal studies.Other causes such as oxidative stress and inflammatory responses need to be further researched.
基金financially supported by the National Natural Science Foundation of China(Nos.51028301 and 21174146)the Special Funds for National Basic Research Program of China(No.2009CB930100)
文摘New pH-responsive saccharide hydrogels were designed and prepared using curdlan derivatives(curdlan-Bochistidine, CUR-HIS). The CUR-HIS hydrogels possessed highly porous structures. The swelling ratios of CUR-HIS hydrogels increased with the degree of substitution of Boc-histidine groups. And the addition of 0.5 mol/L Na Cl provoked a sharp reduction of swelling ratio of CUR-HIS hydrogels. Bovine serum albumin(BSA) can be efficiently encapsulated into CUR-HIS hydrogels. Moreover, the release profiles of BSA at different p H values from CUR-HIS hydrogels were significantly different. These hydrogels showed good biocompatibility in the cytotoxicity assays. The CUR-HIS hydrogels are of great potential in biomedical applications such as protein delivery systems.
文摘Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the clinical findings regarding 2009 influenza A(H1N1)-associated pediatric deaths in China,including the risk factors for death.Methods:The definition of 2009 influenza A(H1N1)-associated pediatric death is death in a child who is younger than 14 years and has laboratory-confirmed influenza.We collected data of total 810 hospitalized patients with 2009 influenza A(H 1N 1)infection from September 2009 to February 2010 in 17 hospitals across China.The clinical characteristics,laboratory abnormalities,and treatment course were retrospectively studied.Results:Of the 810 patients hospitalized with 2009 influenza A(H1N1)infection,19(2.3%)died.Ten patients died from severe pneumonia and acute respiratory distress syndrome;eight died from encephalopathy/encephalitis;one died from secondary fungal meningitis.Patients who died were more likely than patients who survived to have neutrophilia,lymphopenia,elevated C-reactive protein,and elevations of lactate dehydrogenase,creatine kinase,creatine kinase-MB,aspartate aminotransferase and alanine aminotransferase.There were no significant differences in the median age,median time from onset of illness to admission,underlying chronic disease,and initiation of antiviral therapy within 48 hours of illness onset,between patients who died and those who survived.Interpretation:The risk factors for pediatric death associated with 2009 influenza A(H 1N 1)infection are different from those of seasonal influenza.The most common causes of death are viral pneumonia,acute respiratory distress syndrome,and encephalopathy/encephalitis.