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 featu...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.展开更多
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 retrospectiv...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.展开更多
[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 bro...[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.展开更多
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 respira...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.展开更多
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...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.展开更多
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 ...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.展开更多
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 intracellu...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.展开更多
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 aminotransfe...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.展开更多
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 ...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.展开更多
Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hos...Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hospital from March 2018 to March 2020 were selected and divided into 2 groups with 50 cases in each group by using random number table.Both groups received conventional treatment.Based on this,the control group was given Pulmicort Respules and Ventolin,and the observation group was given methylprednisolone in combination with the conventional regimens on the basis of the control group treatment,the course of treatment was 5 days.The levels of inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin 6(IL-6)]and the time to symptom disappearance before and after treatment were compared and analyzed between the two groups.Results:After treatment,the levels of serum TNF-a and IL-6 in the two groups decreased,and the observation group was lower than the control group,the difference was statistically significant(P<0.05);the disappearance of pulmonary moist rales,lung wheezing,cough and wheezing in the observation group were all earlier than the control group,the difference was statistically significant(P<0.05).Conclusion:Pulmicort Respules,Ventolin combined with methylprednisolone is effective in adjuvant treatment of bronchiolitis in children,which can reduce inflammation and promote the recovery of children.展开更多
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 b...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.展开更多
Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and ...Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and other countries. Chronic bronchiolitis has not been previously attributed to EV D68. We documented EV D68 in open lung biopsies of a young adult patient who was frequently admitted to the hospital for severe exacerbation of respiratory infections and subsequently developed progressive respiratory insufficiency. The difficulty of diagnosis and potential economic impact of this illness is discussed.展开更多
Background Bronchiolitis is a common acute lower respiratory tract infection(ALRTI)and the most frequent cause of hospitalization of infants and young children with ALRTI.Respiratory syncytial virus is the main pathog...Background Bronchiolitis is a common acute lower respiratory tract infection(ALRTI)and the most frequent cause of hospitalization of infants and young children with ALRTI.Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis.The disease burden is relatively high.To date,few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available.This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China.Methods This study included the face sheet of discharge medical records collected from 27 tertiary children’s hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords(FUTURE)database.The sociodemographic variables,length of stay(LOS)and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests.Results In total,42,928 children aged 0–3 years were hospitalized due to bronchiolitis from January 2016 to December 2020,accounting for 1.5%of the total number of hospitalized children of the same age in the database during the period and 5.31%of the hospitalizations for ALRTI.The male to female ratio was 2.01:1.Meanwhile,more boys than girls were observed in different regions,age groups,years,and residences.The 1–2 year age group had the greatest number of hospitalizations for bronchiolitis,while the 29 days–6 months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group.In terms of region,the hospitalization rate of bronchiolitis was the highest in East China.Overall,the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016.Seasonally,the peak hospitalizations for bronchiolitis occurred in winter.Hospitalization rates in North China in autumn and winter were higher than those in South China,while hospitalization rates in South China were higher in spring and summer.Approximately,half of the patients with bronchiolitis had no complications.Among the complications,myocardial injury,abnormal liver function and diarrhea were more common.The median LOS was 6 days[interquartile range(IQR)=5–8],and the median hospitalization cost was 758 United States dollars(IQR=601.96–1029.53).Conclusions Bronchiolitis is a common respiratory disease in infants and young children in China,and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children.Among them,children aged 29 days–2 years are the main hospitalized population,and the hospitalization rate of boys is significantly higher than that of girls.The peak season for bronchiolitis is winter.Bronchiolitis causes few complications and has a low mortality rate,but the burden of this disease is heavy.展开更多
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 o...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.展开更多
Background:Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood.The present study assessed prevalence,clinical manifestaffons and risk factors for recurrent wheezing ...Background:Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood.The present study assessed prevalence,clinical manifestaffons and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchioliffs.展开更多
Background:The influence of Mycoplasma pneumoniae(MP)infection on bronchiolitis remains unclear.Additionally,reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been in...Background:The influence of Mycoplasma pneumoniae(MP)infection on bronchiolitis remains unclear.Additionally,reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive.Methods:Children with respiratory syncytial virus(RSV)-induced bronchiolitis were divided into two groups:RSV+MP group and RSV group.Each group was randomly divided into two subgroups:one received routine and placebo treatment,while the other received routine and montelukast treatment for 9 months.The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded.Blood parameters were determined.Results:Patients in the RSV+MP group exhibited an older average age,fever,more frequent flaky and patchy shadows in chest X-rays,more frequent extrapulmonary manifestations,and longer hospital stays compared with patients in the RSV group.Additionally,higher baseline blood eosinophil counts,eosinophil cationic protein(ECP),total immunoglobulin E(IgE),interleukin(IL)-4,IL-5,IL-4/interferon-γratios,leukotriene(LT)B4,and LTC4,and lower baseline lipoxin A4(LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group.Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months.This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts,ECP and total IgE,as well as the montelukast-dependent recovery in T helper(Th)1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis.Conclusions:RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection.Add-on therapy with montelukast for 9 months was benefi cial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.展开更多
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 ...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.展开更多
Background:Bronchiolitis is a common lower respiratory tract infection in infancy.The aim of this review is to present the clinical profile of viral bronchiolitis,the different culprit viruses and the disease severity...Background:Bronchiolitis is a common lower respiratory tract infection in infancy.The aim of this review is to present the clinical profile of viral bronchiolitis,the different culprit viruses and the disease severity in relation to the viral etiology.Data sources:Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology.The most relevant articles to the scope of this review were analyzed.Results:Currently there are two main definitions for bronchiolitis which are not identical,the European definition and the American one.The most common viral pathogen that causes bronchiolitis is respiratory syncytiai virus which was identified in 1955;now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus,adenovirus,metapneumovirus,and bocavirus.Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses.However,the results were not consitent.Conclusions:For the time being,the diagnosis of bronchiolitis remains clinical.The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.展开更多
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 exposu...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.展开更多
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...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.展开更多
文摘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.
文摘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.
基金Supported by Scientific Research Project of the Department of Health of Guangxi Zhuang Autonomous Region(Z2015215)Development,Popularization and Application Project of Appropriate Medical and HealthTechnology in Guangxi(S2018015).
文摘[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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hospital from March 2018 to March 2020 were selected and divided into 2 groups with 50 cases in each group by using random number table.Both groups received conventional treatment.Based on this,the control group was given Pulmicort Respules and Ventolin,and the observation group was given methylprednisolone in combination with the conventional regimens on the basis of the control group treatment,the course of treatment was 5 days.The levels of inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin 6(IL-6)]and the time to symptom disappearance before and after treatment were compared and analyzed between the two groups.Results:After treatment,the levels of serum TNF-a and IL-6 in the two groups decreased,and the observation group was lower than the control group,the difference was statistically significant(P<0.05);the disappearance of pulmonary moist rales,lung wheezing,cough and wheezing in the observation group were all earlier than the control group,the difference was statistically significant(P<0.05).Conclusion:Pulmicort Respules,Ventolin combined with methylprednisolone is effective in adjuvant treatment of bronchiolitis in children,which can reduce inflammation and promote the recovery of children.
文摘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.
文摘Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and other countries. Chronic bronchiolitis has not been previously attributed to EV D68. We documented EV D68 in open lung biopsies of a young adult patient who was frequently admitted to the hospital for severe exacerbation of respiratory infections and subsequently developed progressive respiratory insufficiency. The difficulty of diagnosis and potential economic impact of this illness is discussed.
基金XZD was supported by the CAMS Innovation Fund for Med‑ical Sciences(2019-I2M-5-026)the National Major Science&Technology Project(2017ZX10103004-004).
文摘Background Bronchiolitis is a common acute lower respiratory tract infection(ALRTI)and the most frequent cause of hospitalization of infants and young children with ALRTI.Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis.The disease burden is relatively high.To date,few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available.This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China.Methods This study included the face sheet of discharge medical records collected from 27 tertiary children’s hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords(FUTURE)database.The sociodemographic variables,length of stay(LOS)and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests.Results In total,42,928 children aged 0–3 years were hospitalized due to bronchiolitis from January 2016 to December 2020,accounting for 1.5%of the total number of hospitalized children of the same age in the database during the period and 5.31%of the hospitalizations for ALRTI.The male to female ratio was 2.01:1.Meanwhile,more boys than girls were observed in different regions,age groups,years,and residences.The 1–2 year age group had the greatest number of hospitalizations for bronchiolitis,while the 29 days–6 months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group.In terms of region,the hospitalization rate of bronchiolitis was the highest in East China.Overall,the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016.Seasonally,the peak hospitalizations for bronchiolitis occurred in winter.Hospitalization rates in North China in autumn and winter were higher than those in South China,while hospitalization rates in South China were higher in spring and summer.Approximately,half of the patients with bronchiolitis had no complications.Among the complications,myocardial injury,abnormal liver function and diarrhea were more common.The median LOS was 6 days[interquartile range(IQR)=5–8],and the median hospitalization cost was 758 United States dollars(IQR=601.96–1029.53).Conclusions Bronchiolitis is a common respiratory disease in infants and young children in China,and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children.Among them,children aged 29 days–2 years are the main hospitalized population,and the hospitalization rate of boys is significantly higher than that of girls.The peak season for bronchiolitis is winter.Bronchiolitis causes few complications and has a low mortality rate,but the burden of this disease is heavy.
文摘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.
文摘Background:Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood.The present study assessed prevalence,clinical manifestaffons and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchioliffs.
基金supported by a grant from the Priority Academic Program Development of Jiangsu Higher Education Institution(JX10231801).
文摘Background:The influence of Mycoplasma pneumoniae(MP)infection on bronchiolitis remains unclear.Additionally,reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive.Methods:Children with respiratory syncytial virus(RSV)-induced bronchiolitis were divided into two groups:RSV+MP group and RSV group.Each group was randomly divided into two subgroups:one received routine and placebo treatment,while the other received routine and montelukast treatment for 9 months.The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded.Blood parameters were determined.Results:Patients in the RSV+MP group exhibited an older average age,fever,more frequent flaky and patchy shadows in chest X-rays,more frequent extrapulmonary manifestations,and longer hospital stays compared with patients in the RSV group.Additionally,higher baseline blood eosinophil counts,eosinophil cationic protein(ECP),total immunoglobulin E(IgE),interleukin(IL)-4,IL-5,IL-4/interferon-γratios,leukotriene(LT)B4,and LTC4,and lower baseline lipoxin A4(LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group.Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months.This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts,ECP and total IgE,as well as the montelukast-dependent recovery in T helper(Th)1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis.Conclusions:RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection.Add-on therapy with montelukast for 9 months was benefi cial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.
基金grants from the National Natural Science Foundation of China，the Natural Science Foundation of Tianjin City
文摘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.
文摘Background:Bronchiolitis is a common lower respiratory tract infection in infancy.The aim of this review is to present the clinical profile of viral bronchiolitis,the different culprit viruses and the disease severity in relation to the viral etiology.Data sources:Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology.The most relevant articles to the scope of this review were analyzed.Results:Currently there are two main definitions for bronchiolitis which are not identical,the European definition and the American one.The most common viral pathogen that causes bronchiolitis is respiratory syncytiai virus which was identified in 1955;now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus,adenovirus,metapneumovirus,and bocavirus.Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses.However,the results were not consitent.Conclusions:For the time being,the diagnosis of bronchiolitis remains clinical.The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.
基金This work was partly supported by grants of the National High Technology Research and Development Program of China （Program 863） （No. 2011AA020105）, the National Natural Science Foundation of China （No. 30971292）, and the Key Program of National Natural Science Foundation of China （No. 81230013）.
文摘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.
文摘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.
