Syncytial Research Articles

Monitoring of viral pathogens in pediatric intensive care unit and analysis of clinical significance

To study the characteristics of viral spectrum and clinical features of children in pediatric intensive care unit (PICU). Nasopharyngeal aspirate specimens (NPA) from 349 patients(1 from each) and 130 cerebrospinal fluids (CSF) specimens were collected from children who were admitted to the PICU of Second Affiliated Hospital of Shantou University Medical College. Additional 87 NPA specimens were collected from healthy children for routine examination on the physical examination center, and the clinical data were collected. Multiplex PCR was applied to detect 16 kinds of viruses from NPA and CSF. Fluorescence quantitative PCR was applied to detect 13 viruses from CSF and to analyze the clinical data of positive cases. There were 209 samples (59.9%) of the 349 NPA specimens were positive for viruses, which included 117 cases positive for human rhinovirus (HRV), 60 for respiratory syncytial virus (RSV), 20 for influenza virus A (Inf A), 10 for adenovirus (ADV), 6 for parainfluenza virus type 3(PIV-3), 6 for human Boca virus (HBoV), 5 for influenza virus C(Inf C), 4 for parainfluenza virus type 4(PIV-4), 4 for human coronavirus-HKU1/OC43, 3 for influenza virus B (Inf B), 3 for WU Polyomavirus (WUPyV), 2 parainfluenza virus type 1(PIV-1), 2 human metapneumovirus (HMPV) and 1 human coronavirus-NL63/229E. But none from 87 healthy controls were positive for any respiratory virus. Among the 130 CSF specimens, in 58 cases the diagnosis was viral encephalitis. There were 22 samples (37.9%) among the 58 CSF specimens positive for viruses, which included 14 enterovirus (EV), 3 human cytomegalovirus (HCMV), 2 mumps virus, 1 coxsackie virus A16 (Cox-A16), 1 herpes simplex virus (HSV) and 1 human rhinovirus (HRV). The total positive rate was 63.3% (221/349) . Co-infection by at least 2 viral pathogens under study was observed in 45 of the 349 patients (12.9% of the total number of cases, 20.4% of the positives cases). The commonest pathogens in co-infected samples were WUPyV (100%) and HMPV(100%). The positive rate of virus peaked in the first 6 months of life, the rate in boys were higher than in girls and the peak season was summer. The numbers of none serious cases in the virus positive group were less than those in the virus negative group while the numbers of extremely serious cases in the virus positive group were higher than in the virus negative group. Viral pathogen is a major cause of infectious disease in pediatric critical illnesses and virus infection may lead to severe illness.

Progress in Understanding the Link Between RSV Infection and Recurrent Wheezing

Severe respiratory syncytial virus (RSV) bronchiolitis is associated with subsequent wheezing and childhood asthma, but the pathogenesis is poorly

Epidemiological characteristics of influenza virus and respiratory syncytial virus among children in Wuhan area from 2008 to 2012

To investigate the infection status and epidemiological characteristics of influenza virus and respiratory syncytial virus (RSV) in influenza-like illness (ILI) of children ( ≤ 14 years) in Wuhan area from 2008 to 2012. A total of 2854 cases of ILI patients ( ≤ 14 years) in a hospital of Wuhan were recruited in the study from July 2008 to June 2012. The sample of pharyngeal swab was collected from each patient, to extract the virus nucleic acids. Real-time fluorescent quantitation reverse transcription PCR (RT-PCR) method was applied to detect the subtypes of influenza virus and RSV, and then analyzed the time and age characteristics. Out of the 2854 cases, 758 (26.6%) were positive for influenza virus,including 547 (19.2%) influenza A virus positive samples and 211 (7.4%) influenza B virus positive samples. Usually, there were two peaks present in the annual curve of influenza virus, namely summer peak and winter/spring peak. The positive rate of influenza virus in 6-14 years old children (48.0%, 275/573) was significantly higher than that in 3-5 years old children (26.6%, 213/801) and that under 3 years old children (18.3%, 270/1480). The difference showed statistical significance (χ(2) = 187.432, P < 0.01). A total of 219 (7.7%) cases were positive for RSV,including 108 RSV-A positive samples and 112 RSV-B positive samples (1 co-infection). The epidemic of RSV showed an obvious seasonal pattern with peaks in autumn,winter and spring,which accounted for 96.8% (212/219) of all the cases; however, the annual incidence of RSV fluctuated greatly. The predominant subtype shifted every 2 years. RSV-B predominated during September 2008 and May 2009, December 2009 and March 2010, accounting for 76.6% (36/47) and 96.9% (62/64) respectively. RSV-A predominated during November 2010 and March 2011, September 2011 and April 2012, accounting for 92.5% (37/40) and 100.0% (48/48) respectively. With the increase of the age, the positive rate of RSV-A and RSV-B decreased gradually (RSV-A: χ(2) = 36.223, P < 0.01; RSV-B: χ(2) = 36.281, P < 0.01). The positive rates of RSV-A in children < 1,1,2,3,4,5-9 and 10-14 years old were 7.0% (26/373), 5.9% (39/662), 4.0% (18/445), 3.2% (13/406), 1.3% (3/236), 1.4% (7/517) and 0.9% (2/215) respectively; while, the positive rates of RSV-B in each age group were 6.4% (24/373), 6.0% (40/662), 4.5% (20/445), 4.4% (18/406), 1.3% (3/236), 1.0% (5/517) and 0.9% (2/215) respectively. The children aged 0-3 years old were more susceptible for RSV infection,accounting for 90.0% (197/219) of the total positive samples. During the outbreak of influenza A H1N1 in November 2009, the positive rate of RSW was 3.0% (3/100), lower than that in the same month of 2008, 2010 and 2011,which were separately 18.2% (6/33), 10.8% (10/93) and 10.0% (4/40). The difference showed statistical significance (χ(2) = 8.450, P < 0.05). During the outbreak of influenza A (H1N1) in January 2011,the positive rate of RSV was 5.7% (3/53), lower than those in the same month of 2009, 2010 and 2012, which was separately 21.7% (5/23), 28.6% (22/77) and 16.0% (8/50). The difference showed statistical significance (χ(2) = 11.233,P < 0.05). During the period of less influenza happened in September 2011, the RSV positive rate was 25.0% (10/40), higher than those in the same month of 2008, 2009 and 2010, which was separately 11.4% (4/35), 1.7% (2/118) and 0.0% (0/109). The difference showed statistical significance (χ(2) = 32.521, P < 0.01). Both influenza virus and RSV were important etiological agents of ILI of children in Wuhan. The characteristics of seasonal and age distributions of the two viruses were notably different; meanwhile, a certain inhibitional effect of influenza virus on RSV could be observed.

Advancement of T helper17 cells in bronchiolitis

Bronchiolitis is a common lower respiratory infection disease in children younger than two years old.The main pathogen of bronchiolitis is respiratory syncytial virus,which is also associated with the asthma.By now,it is still unknown about the pathogenesis of bronchiolitis.Recent findings provide that T helper17(Th17) cells play an important role in bronchiolitis.This review summarizes the progresses of regulation of Th17 cells development,Th17 cells function,and the relationship between Th17 cells and bronchiolitis. Key words: Bronchiolitis; T helper17 cell ; Respiratory syncytial virus

Muscle atrophy in vitro: a lesson from cisplatin

Adult skeletal muscle cells are multinucleated syncytia with a peculiar cytoskeletal apparatus, relatively resistant to apoptosis but susceptible to atrophy when catabolic inputs exceed. Among molecular mechanisms involved in muscle atrophy induced in vitro by cisplatin (CisPt), a widely used chemotherapic drug, dysfunctional autophagy emerged as an important contributing factor. Macroautophagy is a physiological process, necessary in skeletal muscles to clear abnormal proteins and organelles, mainly mitochondria, and to maintain an efficient mass (Sandri, 2011). Here we sought to morphologically characterize macroautophagy in vitro in C2C12 myotubes, at 5 days of differentiation, exposed to CisPt from 4h up to 24h, and its dependence on tubulin cytoskeleton. Furthermore we tested taurine, a 2-aminoethanesulfonic acid, previously beneficial in CisPt exposed renal cells (Rovetta et al., 2012). Confocal, transmission and scanning electron microscopy were adopted to solve these points. Main findings were that 10-50 microM CisPt stimulated macroautophagy very early in myotubes but it persisted even at 24h, when autophagolysosomes increased and LC3-positive puncta accumulated beneath sarcolemma. At this time, nucleolar segregation, mitochondria damage, disaligned myotubes and sarcolemma blebbings were observed. Taurine plus 50 microM CisPt reduced autophagolysosomes density, ameliorated mitochondria and rescued atrophy. We suggest that taurine, by modulating proper autophagy, might be considered a reliable strategy to control muscle wasting.

Analysis of infection status and pathogenic features of human metapneumovirus among children in Hangzhou between year 2009 and 2011

To study the infection status and pathogenic features of human metapneumovirus (hMPV) among children with acute respiratory tract infection in Hangzhou. A total of 372 children less than 14 years old with acute respiratory tract infections were recruited as subjects from the pediatric clinic or intensive care unit (ICU) of 3 hospitals in Hangzhou during November 2009 to January 2010, and November 2010 to January 2011. A total of 372 specimens were collected, including 351 respiratory swab, 9 nasopharyngeal aspirate material, 8 endotracheal aspirate material and 4 sputum. The total nucleic acid was then extracted from the specimens, and the nucleoprotein (N) gene of hMPV was amplified by RT-PCR, whose positive products were sequenced and analyzed. Africa green monkey kidney cells (Vero-E6) were applied to culture hMPV among the positive samples; meanwhile fluorescence quantitative RT-PCR was adopted to test other respiratory virus infection. Out of 372 patients, 42 (11.2%) were positive for N gene of hMPV. The positive rate of hMPV among boys was 11.5% (26/226), and correspondingly 10.9% (16/146) among girls. The difference showed no statistical significance (χ(2) = 0.026, P > 0.05). The youngest patient was only 2 month-old and the eldest patient was 14 years old. The median of the patients' age was 24 months. Fifteen positive samples amplified by RT-PCR were sequenced, and all turned out to be subtype B1; whose similarity to GD165 found in Guangdong was 98.1% - 99.5% and similarity to BJ1897 in Beijing was 87.8% - 89.2%. The co-infection rate between hMPV and other respiratory virus was 45.2% (19/42); most of which was between hMPV and respiratory syncytial virus, whose rate at 26.1% (11/42). hMPV was the single genotype relevant with the acute respiratory tract infection disease among children in Hangzhou district; however, the co-infection with other respiratory virus did exist.

Homodimeric pregnancy-associated plasma protein-A in normal human placenta of first and third trimester of pregnancy: Biochemical and morphological observations

Insulin-like growth factors (IGFs) become bio-available following hydrolysis of binding proteins by homodimeric PAPP-A (dPAPP-A); this is a metzincin associated with the membranes of trophoblast phenotypes, the precise placental localization of which was unknown. Our study on placental samples of the first trimester shows the immunohistochemical localization of proMBP and dPAPP-A in the same cells. In contrast, dPAPP-A is mainly negative in the syncytium (ST) and positive in the villous cytotrophoblast (VCT) while htPAPP-A is strongly expressed in the ST and negative in the VCT at term, suggesting a progressive deactivation of the enzyme with gestational age. In agreement with the above, dPAPP-A is released only by first trimester placental explants in culture.

Vitamin D is a friend of younger children.

Many younger children are commonly affected by acute lower respiratory infection (ALRI) requiring hospitalization. ALRI occurs in the winter season associated with a reduction of ultraviolet-B radiation. Generally, low birth weight, non-exclusive breast feeding, parental smoking, and chronic diseases etc. are thought to be risk factors of ALRI. On the other hand, there is a potential preventive measure for respiratory syncitial virus, such as palivizumab. However, the indications for palivizumab are limited to low birth weight infants and congenital heart diseases in many countries, and its extreme expense restricts its usefulness.

Studies of the influences of bronchiolitis on development of asthma

Asthma is one of the most chronic airway inflammatory disease,threating the children's health.Bronchiolitis significantly increased the risk of childhood asthma,and many studies have focused on looking for the related factors between bronchiolitis and asthma in recent years.It may be helpful to understand the pathogenesis of the asthma,so as to find new measures for asthma's prevention and treatment.In present studies,bronchiolitis influenced the development of asthma in genetics,immunity,environmental factors and so on.So far,whether bronchiolitis directly causes the development of the childhood asthma,the prevention of bronchiolitis could reduce the asthma morbidity or not,both need more evidences yet. Key words: Bronchiolitis; Asthma; Respiratory syncytial virus; Rhinovirus; Treatment

Viral Etiology Affects Length of Stay in Children with Bronchiolitis

Bronchiolitis is most often caused by respiratory syncytial virus (RSV), but other respiratory viruses, including human rhinovirus (HRV), can cause the

Analysis of 75 cases lower respiratory tract infection by respiratory syncytial virus

Objective To summarize the clinical features of neonatal lower respiratory tract infection of respiratory syncytial virus (RSV). Methods Data of newborns admitted into Deparrment of Neonatology of Yuying Children Hospital of Wenzhou Medical College from January to December 2010 with RSV lower respiratory tract infection were retrospectively analyzed. The characteristics of clinical manifestation,examination,treatment and prognosis were studied.Factors affecting the duration of hospitalization were analyzed with x2 test. Results Of 354 cases of neonatal lower respiratory tract infection,75 (21.2％) were RSV positive,whose attack time was from 5 to 25 days with an average of 13.2 days; and there were two preterm infants (2.7％).The chief clinical manifestations were cough (100.0％,75/75),followed by shortness of breath (56.0％,42/75),spittle (52.0％,39/75) and fever with temperature ≥38.0 ℃ (25.3％,19/75).The white blood cell count of one newborn was higher than 20.0× 109/L; 52 cases (69.3％) had higher blood lymphocyte percentage (＞ 0.48) ; eight cases (10.7％) had higher level of C-reactive protein (≥ 8 mg/L).Among the 58 patients who underwent blood gas analysis,28 (48.3％) had carbon dioxide retention (partial pressure of carbon dioxide≥ 45 mm Hg). Chest X-ray results within 48 hours after hospitalization suggested that 52.0％ patients (n =39) had pneumonia and 20.0％ (n=15) had bronchitis.Among 69 patients who had sputum cultures,20 cases were positive.And for the 11 cases who had blood cultures,three were positive for Staphylococcus epidermidis.Finally,73 cases were cured,two were improved and no death was reported.The duration of hospitalization was from 3 to 17 days with an average of 8.4 days.Neonates with RSV lower respiratory tract infection who had higher C-reactive protein (≥8 mg/L),carbon dioxide retention,nasal oxygen catheter or assisted ventilation had higher percentage of longer hospital stay (≥7 days). Conclusions Compared with infants,the clinical characteristics of RSV lower respiratory tract infections in neonates are atypical,which are mainly menifested by cough,shortness of breath,spittle,but rare wheezing.There are no effective interventions against RSV infection except for supportive therapy. Key words: Respiratory syncytial virus infections ; Respiratory tract infections; Infant, newborn

The antiviral role of Toll-like receptor 3 in human lung epithelial cells infected with respiratory syncytial virus

In order to understand the production mechanism of interferon and provide a scientific basis for preventionand clinical therapy, the expression changes of Toll-like receptor (TLR3) mRNA and the role of TLR3 in human lung epithelial cells (A549 cells) infected with respiratory syncytial virus (RSV) were investigated in this study. RSV infected A549 cells were treated with or without specific antibodies of TLR3 and collected at the selected timepoints after RSV infection (4, 8, 12, 16 and 24h). The expressions of TLR3, IFN-alpha, IFN-beta and RSV F mRNA were evaluated by RT-PCR. It was found that RSV infection could markedly up-regulate the mRNA expression of TLR3, IFN-alpha, IFN-beta and RSV F protein in a time-dependent manner as the 24h mRNA expressions of them were 4 times, 3 times, 3 times and 0.7 times more than the basic expression, respectively. Treatment of TLR3 specific antibodies, whereas, significantly down-regulated the activation of TLR3. The mRNA expression of IFN-alpha and IFN-1beta also decreased accordingly and that of IFN-beta reduced more obviously than IFN-alpha, but that of RSV F protein rose significantly. Above data indicate that RSV infection could induce an apparent increase of antiviral genes of IFN-alpha and IFN-beta by activating TLR3 in human lung epithelial cells and the activated cells mediated Type I interferon is antiviral, which suggesting that TLR3 might play an important role in antiviral activity of RSV-infected human lung epithelial cells.

Υδ T cells play an important role in the development of RSV-influenced allergic airway inflammation

Objective To investigate whether γδ T cells act as a regulatory factor during respiratory syncytial virus (RSV) infections was responsible for the subsequent changes in asthmatic-type inflammation in allergic mice.Methods Mice were sensitized and challenged with OVA,and infected intranasaly with RSV before or after OVA sensitization.Lung sections were stained with HE for determination of inflammatory reaction.Real-time RT-PCR was used to analyze the expression of cytokine mRNA of γδ T cells in the lung and spleen of tested mice.The number of γδ T cells in the spleen and lung of BALB/c mice was determined by flow cytometry.Adoptive transfer of γδ T cells was performed to identify the role of γδ T cells in allergic asthma.Results OVA-sensitized and challenged mice exhibited significantly peribronchial inflammation with larger number of mononuclear cells and granulocytes in the lung tissue sections.RSV infection before OVA-sensitization diminished the grade of inflammatory responses induced by OVA treatment.The expression of IFN-γ mRNA was increased siguificantly in RSV-infected,OVA-sensitized mice.In contrast,the level of IL-4 mRNA was diminished.The number of total γδ T cells as well as activated γδ T cells was decreased in the spleen and lung of OVA-sensitized mice by prior RSV infection.Adoptive transfer of γδ T cells obtained from OVA-sensitized and challenged mice induced a slight inflammation in the lung of normal mice,and enhanced inflammatory responses in RSV-infected OVA-sensitized mice.Conclusion γδ T cells may play an important role in the development of allergen-induced allergic airway inflammation. Key words: Asthma; γδ T cell; Respiratory syncytial virus; Inflammation

Mixed infections in children with Mycoplasma pneumoniae pneumonia

To investigate the incidence and clinical features of mixed infections in children with Mycoplasma pneumoniae (MP) pneumonia. A total of 201 cases diagnosed as MP pneumonia were investigated for mixed infections by sputum bacterial culture, respiratory virus antigen detection and serum Chlamydia pneumoniae antibody test. For those with the indications for bronchoscopy, we also did bronchoalveolar lavage and lavage bacterial culture. A high incidence (103/201, 51.2%) of mixed infections in children with MP pneumonia was revealed. The most frequent co-infected pathogen was Chlamydia pneumoniae (52, 25.9%), followed by viruses (29, 14.4%), and bacteria (22, 10.9%). Among viruses, respiratory syncytial virus was the most common (17, 8.5%), followed by adenovirus (6, 3.0%), parainfluenza virus type III (4, 2.0%) and influenza virus type B (2, 1.0%). Sputum bacterial culture was positive in 14/201 (7.0%) cases, Streptococcus pneumonia being most common (6, 3.0%). BALF culture yielded positive results in 11.6% (8/69), Streptococcus pneumonia was also common (5, 7.3%). Among 29 cases with MP and virus coinfection, 26 were younger than 3 years (89.7%), while for MP and Chlamydia pneumoniae coinfection, most of them were older than 3 years (40/52, 76.9%). Compared with non-mixed infections, those with mixed infections had longer fever duration (24.5% and 40.8% longer than 10 d), more frequently developed pleural effusion (11.2%, 23.3%) and large area of shadow in chest imaging (35.7%, 51.5%). White blood cell [(14.28 ± 4.99) × 10(9)/L], C-reactive protein (CRP) [69(32.5 - 99.5) mg/L] and neutrophil ratio in BALF [0.86 (0.63 - 0.91)] were much higher in children with mixed bacterial infections than that in non-mixed infections [(9.06 ± 3.47) × 10(9)/L, 3 (0 - 31.0) mg/L, 0.44 (0.03 - 0.88)]. But no significant difference was found in peripheral blood neutrophil proportion between mixed bacterial infections (0.38 ± 0.25) and non-mixed infections (0.51 ± 0.19). More than half of cases with MP pneumonia had mixed infections, most commonly caused by Chlamydia pneumonia followed by viruses. The incidence of mixed infections with bacteria was low. Mixed infections with virus were more common in young children, while mixed infection with Chlamydia pneumoniae was more common in older ones. Bacterial infections should be paid more attention, especially those caused by Streptococcus pneumoniae, for those with high peripheral white blood cell counts, high CRP levels and high proportion of neutrophils in BALF.

Curative effect analysis on ribavirin ultrasound aerosolized treatment to 80 pediatric respiratory infections patients

Objective To analyze and evaluate the curative effect of ribavirin ultrasound aerosolized in treating pediatric respiratory syncytial virus (RSV) infection.Methods 80 cases of RSV infection from Oct 2008 to Dec 2010 were randomly divided into control group and experiment group,with 40 cases for each group.The experiment group used ribavirin ultrasound treatment,while the control group took ribavirin intravenous drip treatment.Results The effective rate in experiment group total was 80.0％,significantly higher than that of the control group (42.5％) ( x2=26.02,P＜ 0.01 ),with statistical significance.The fever duration,break time,and lung sound duration in control group were significantly longer than those of experiment group (P ＜ 0.01).Conclusion The clinical curative effects of the method of ribavirin ultrasound aerosolized in the treatment for RSV infection are obviously better than ribavirin intravenous drip treatment. Key words: Ribavirin; Ultrasound atomization inhalation; Resiiratory infections; Respiratory syncytial virus (RSV)

Clinical characteristics of bronchiolitis obliterans in pediatric patients

To analyze the clinical characteristics, image findings, laboratory examination, the therapeutic methods and clinical outcomes of bronchiolitis obliterans (BO) in pediatric patients. Twenty-six pediatric patients with BO were reported. All data were collected from cases who were hospitalized in the Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical College from June 1(st), 2009 to the April 30(th), 2011, and infectious agents, clinical manifestations, risk factors, changes in imageology, laboratory examination, therapeutic methods and treatment responses were analyzed. The ranges of age at onset was 4.5 months-8 years in 26 cases (18 boys and 8 girls). The course of disease was (6.2 ± 3.5) months. The period of followed-up ranged from 2 to 24 months. The common clinical characteristics were persistent wheezing of different severity (26 cases, 100%), cough (24 cases, 92%), intolerance to exercise (22 cases, 85%), short of breath (21 cases, 81%), retraction (20 cases, 77%), wheezy phlegm (16 cases, 62%), keeping with crackles (10 cases, 38%), cyanosis around the mouth (3 cases, 12%) and no clubbed fingers (toes). In 18 cases the etiology was detected, mycoplasma (11 cases, 42%), respiratory syncytial virus (4 cases, 15%), parainfluenza virus (2 cases, 8%), influenza virus A (2 cases, 8%) and influenza virus B (2 cases, 8%), human bocavirus (HBoV) (1 case, 4%). There were 8 cases (31%) with combined infection. Chest X-ray in 10 cases indicated changes suggestive of bronchopneumonia (38%), in only 1 case there was an image of interstitial pneumonia disease (4%). All the patients were diagnosed by high-resolution computerized tomography (HRCT). All cases were demonstrated to have air retention, poor blood perfusion in lung, just like "Westemark sign" with HRCT. In 19 cases antineutrophil cytoplasmic antibody (ANCA) was determined and 10 patients (53%) were positive for P-ANCA, and 8 cases (42%) were positive for C-ANCA. All patients received oral corticosteroid and low doses azithromycin. In 13 cases (50%) the treatment effectively reduced the severity of disease and the frequency of cough and wheezing. The average number of days for symptom improvement was (7.1 ± 4.8) days. Respiratory infection plays an important role in BO in children. The chronic and persistent wheezing, cough, intolerance to exercises, short breath, retraction were the main clinical manifestations. But these symptoms are non-specific. Chest X-ray can not provide enough information for diagnosis. Classical "Westemark sign" with HRCT is an important sign. ANCA with a high positive rate (approximately 50%) suppose immuno-lesion in BO. Oral corticosteroid and methotrexate may relieve clinical symptoms.

Increased Nasal Interleukin-33 in the Infants with Acute Respiratory Syncytial Virus Bronchiolitis

목 적 : Interleukin (IL)-33은 IL-1 계열에 속하는 사이토카인으로 호흡기 점막의 선천 면역에 기여하며 Th2 면역반응을 유도하는 것으로 알려져 있다. 본 연구에서는 RSV감염에 의한 급성 세기관지염으로 입원하였던 소아들에서 IL-33이 기도 염증 반응의 기전에 관여하는지 알아보고자 하였다. 방 법: 출생 이후 처음으로 respiratory syncytial virus(RSV) 감염에 의한 급성 세기관지염으로 입원 치료하였던 38명의 24개월 미만 연령의 소아들을 대상으로 하였다. 아토피는 최소한 1개 이상의 혈청 내 알레르겐 특이 immunoglobulin E 항체를 가지고 있거나 알레르겐에 대한 피부 반응 검사에서 1 개 이상의 양성 반응을 보였던 경우로 정의하였고 입원 중 산소 포화도가 92% 이하인 상태가 있었거나 , 빈호흡이 있었거나, 천명의 지속 기간이 1주일 이상이었던 경우들 중 2가지 이상의 소견을 나타내었던 경우를 심한 호흡기 증상을 나타내었던 경우로 정의하였다. IL-33과 IL-33 수용체(sST2)는 입원 당시 채취한 비분비물에서 enzyme-linked immunosorbent assay 방법으로 측정하여 대조군과 비교하였으며 또한 소아들의 아토피 상태 및 증상의 심한 정도에 따른 차이가 있는지 조사하였다. 결 과 : 비분비물의 IL-33 측정치는 RSV 세기관지염 환자군에서 대조군에 비해 유의하게 증가되어 있었으나(P＜0.05), IL-33 수용체는 두 군간에 차이를 보이지 않았다. IL-33과 IL-33 수용체는 모두 소아들의 아토피나 증상의 심한 정도와는 관련성을 보이지 않았다. 결 론 : 본 연구의 결과는 RSV 감염에 의한 호흡기 염증반응의 기전에 IL-33이 중요하게 관여할 가능성을 시사하는 것으로 생각된다.

How skeletal muscle cells die after chemical treatments

Apoptosis deregulation is pathogenetic in several skeletal muscle disorders characterised by muscle mass loss, myofiber number decrease, apoptotic myonuclei increase and an elevated DNA fragmentation (Dupont-Versteegden, 2006). The aim of this work is to study in vitro, in C2C12 myoblasts and myotubes, the apoptotic behavior induced byetoposide, staurosporine and H2O2. Cell response was investigated by means of cytofluorimetric and morphological analyses, as well as by confocal microscopy of TUNEL reaction. Myotubes appeared more resistant than myoblasts to apoptotic induction in all experimental conditions. In particular, in myoblasts treated with etoposide and staurosporine apoptotic nuclei with chromatin margination and condensation were observed, in the presence of a diffuse DNA fragmentation evidenced after TUNEL reaction. The latter was observed also in myotubes, where apoptotic and normal nuclei inside the same syncytium appeared (D’Emilio et al., 2010). After H2O2 exposure, myotubes, differently from myoblasts, showed a poor cell sensitivity to cell death even if a certain DNA cleavage was observed. Intriguingly, autophagic granules diffusely appeared in myotubes after each treatment. In myoblasts all chemicals induced ROS increase. When their production exceeds cellular antioxidant capability, oxidative stress results and apoptosis is triggered. On the other hand, in myotubes mitochondria appeared better preserved than myoblasts, and, if damaged, they are probably degradated by autophagic processes. Finally, myotube resistance to apoptotic stimuli could be correlated to the fact that myogenic cells acquire an apoptosis-resistant phenotype during differentiation (Xiao et al., 2011).

Pathogenic analysis in children with community acquired pneumonia in Jiaxing city

Objective To study the etiology of comumunity acquired pneumonia (CAP) in children of Jiaxing city and provide the basis for the clinical diagnosis and treatment.Methods An etiological study was performed on 800 young children with CAP in Jinxing First Hospital from Jan 2008 to Dec 2010.Sputum samples were collected for isolating bacteria and checking the antigen of respiratory syncytial virus ( RSV),adenovirus ( ADV),influenza virus (IV) and parainfluenza virus ( PIV ).IgM antibodies of mycoplasma pneumoniae (MP),ADV,W and PIV paired serum samples were detected.The 202 cases with positive etiology were divided into three groups:bacteria group ( 109 cases),virus group (54 cases) and MP group (39 cases).The leukocyte,C-reactive protein (CRP) and procalcitonin (PCT) were detected.Results The etiology of CAP was identified in 202 (25.25％) children of all the 800 cases,the distribution of causal agents was as follows:Streptococcus pneumoniae in 46 cases (22.77％,46/202 ),Haemophilus influenzae in 32 cases (15.84％,32/202),Staphylococcus in 5 cases (2.48％,5/202),Klebsiella pneumoniae in 8 cases (3.96％,8/202),Escherichia coli in 12 cases (5.94％,12/202),MP in 39 cases ( 19.31％,39/202),RSV in 48 cases (23.76％,48/202),ADV in 1 case (0.50％,1/202),IV in 3 cases ( 1.49％,3/202),and PIV in 2 cases ( 0.99％,2/202 ),Streptococcus pneumoniae and RSV mixed infection in 3 cases ( 1.49％,.3/202),Streptococcus pneumoniae and MP mixed infection in 3 cases ( 1.49％,3/202).RSV infection occured mainly in infants less than 1-year-old,Streptococcus pneumoniae oceured in all ages but was mostly in 1 ～ 3years,Haemophilus influenzae infection occured mainly in infants less than 3-year-old,MP infection occured mainly in infants more than six years.The PCT levels of the three groups were (7.78 ±6.14) ng/ml,(0.39 ±0.56) ng/ml,and (0.20 ±0.34) ng/ml,respectively.There were significant differences among the three groups ( P ＜ 0.05 ).Conclusion RSV infection occurs mainly in infants of age less than 1 year,Streptococcus pneumoniae and Haemophilus influenzae infection occur mainly in infants of age 1 ～3 years,while MP is the leading cause of pneumonia in children of age more than 6 years in Jiaxing city.We can decide pathogen on ages,clinical manifestation and PCT level to guide the rational use of drugs. Key words: Community acquired pneumonia; Pathogenic analysis ; Procaicitonin; Children

Progress in prevention and treatment of respiratory syncytial virus infection

Progress in prevention and treatment of respiratory syncytial virus infection