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A clinical study to determine the threshold of bronchodilator response for diagnosing asthma in Chinese children
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Xiao-Hui Kang, Wan Wang, Ling Cao |
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Background: There is few objective, clinically feasible and inexpensive test for diagnosing childhood asthma. We want to find an ideal way to solve it.
Methods: The control group was 301 non-asthmatic children, and the asthma group was 286 asthmatic children. The asthmatic children were divided into three groups according to the severity of their disease. Pre- and post-bronchodilator spirometer tests were performed, and the main spirometer parameters were compared. The bronchodilator response (BDR) [BDR is used to determine the reversibility of airway obstruction by measuring the changes of forced expiratory volume in the first second (FEV 1) before and after inhalation of bronchodilators] was then determined, and the optimal threshold of BDR for diagnosing childhood asthma was found.
Results: 301 non-asthmatic children and 286 asthmatic children participated in the study, the demographics were similar. FEV1 for pre-bronchodilator of asthmatic children was significantly lower than that of non-asthmatic children (P ≒ 0.01). BDR of non-asthmatic children was 3.30 ㊣ 3.85%. BDR of asthmatic children was 9.45 ㊣ 9.15%. There was no significant difference in BDR for patients with different severities of asthma within the group. BDR had no statistical correlation with gender, age, height, weight in neither non-asthmatic children nor asthmatic children. On the receiver-operating characteristic curve, a BDR threshold of ≡ 7.5% offered an optimal balance in asthma diagnosis with a sensitivity rate of 50.7% and specificity rate of 87.7%. Meanwhile, with a BDR threshold of ≡ 12%, the sensitivity rate was 28.7% and the specificity rate was 96.3%. Conclusion: A BDR threshold of ≡ 7.5% has more value in childhood asthma diagnosis as compared to ≡ 12%. |
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[Abstract] [Full Text] [PDF]
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Adropin and glucagon-like peptide-2 are associated with glucose metabolism in obese children
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Rui-Min Chen, Xin Yuan, Qian Ouyang, Xiang-Quan Lin, Zhuan-Zhuan Ai, Ying Zhang, Xiao-Hong Yang |
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Background: The interaction of adropin, glucagon-like peptide-2 (GLP2), angiopoietin-like protein 4 (ANGPTL4), and with childhood obesity and glucose metabolism is inconsistent. This study is to evaluate the association of the three cytokines and glucose homeostasis.
Methods: This was a cross-sectional study of children with obesity ranging from 5 to 14 years compared to age- and sex-matched children of normal weight. Fasting plasma glucose (FPG), oral glucose tolerance test 2-hour plasma glucose (OGTT2hPG), and insulin (INS) were measured, and serum adropin, GLP2, and ANGPTL4 levels were measured by enzymelinked immunosorbent assay. The body mass index (BMI), BMI-Z scores, waist-to-hip ratio (WHR), and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.
Results: Thirty-nine children (9.70 ㊣ 1.71 years, 18 females) with obesity and 29 normal weight children (8.98 ㊣ 1.98 years, 16 females) were assessed. The levels of INS, HOMA-IR and GLP2 of the obesity group were significantly higher than the controls (P < 0.05). Pearson correlation analysis showed that serum GLP2 was positively associated with WHR, FPG, and OGTT2hPG, and adropin was negatively associated with BMI, BMI-Z, WHR, INS, and HOMA-IR (all P < 0.05). Furthermore, GLP2 were negatively associated with adropin and ANGPTL4 (both P < 0.05). By binary logistic regression, adropin and GLP2 were found to be independent markers of obesity. Multiple linear regression showed that GLP2 was associated with OGTT2hPG, and adropin was associated with INS and HOMA-IR (all P < 0.05). Conclusions: Obese children had elevated GLP2 concentrations, and adropin and GLP2 associated with both childhood obesity and glucose homeostasis. Furthermore, there may be a physiologic interplay between adropin and GLP2 in obese children. |
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[Abstract] [Full Text] [PDF]
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Association of image-defined risk factors, tumor resectability, and prognosis in children with localized neuroblastoma
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An-An Zhang, Ci Pan, Min Xu, Xiao-Xia Wang, Qi-Dong Ye, Yi-Jin Gao, Jing-Yan Tang |
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Background: Although localized neuroblastoma has a good prognosis, some cases have undergone treatment failure or recurrence. Apart from biologic features such as MYCN status, we wondered whether some characteristics of growing tumors are prognostic, such as a well-encapsulated mass without infiltration of vital organs. We analyzed the diagnostic utility of image-defined risk factors (IDRFs) to predict successful treatment and prognosis. The overall goal was to achieve maximum cure rates for patients with localized neuroblastoma through a better understanding of clinical characteristics.
Methods: We retrospectively reviewed the images of patients with localized neuroblastoma who were enrolled between June 1998 and December 2012 at a single institution in Shanghai, China. Unequivocal categorization regarding IDRFs was available in 67 patients. IDRF was assessed at diagnosis and after four cycles of neoadjuvant chemotherapy, on average. The median follow-up period was 84 months (range: 48每132 months) after diagnosis.
Results: MRI and CT indicated a total of 177 IDRFs in these 67 patients. Logistic regression analysis revealed a highly significant negative correlation between the numbers of IDRFs and the possibility of complete removal of neuroblastoma. Intraspinal extension of the tumor, compression of the trachea, and encasement of the main artery in localized neuroblastoma were predictors for incomplete tumor resection. According to univariate analysis, ≡ 4 IDRFs and intraspinal extension of the tumor were significant indicators of poor prognosis. Conclusions: The number of IDRFs was useful in predicting surgical outcome and event-free survival. The number of IDRFs should be considered in protocol planning, instead of IDRF presence or absence. |
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[Abstract] [Full Text] [PDF]
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Community-acquired serious bacterial infections in the first 90 days of life: a revisit in the era of multi-drug-resistant organisms
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Dawood Yusef, Tamara Jahmani, Sajeda Kailani, Rawan Al-Rawi, Wasim Khasawneh, Miral Almomani |
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Background: Infants in the first 90 days of life are more prone to develop serious bacterial infections (SBIs). Multi-drug-resistant organisms (MDROs) are emerging as important pathogens causing SBIs. We reviewed the epidemiology of SBIs in infants 0每90 days old and compared the clinical features, laboratory values and final outcome for SBIs due to MDROs vs. non-MDROs.
Methods: Episodes of culture-proven SBIs (bacteremia, urinary tract infections, or meningitis) with age at onset of 0每90 days during a 7-year period were retrospectively reviewed. Health care-associated infections were excluded. We collected demographics, clinical features, and laboratory and microbiology data. We compared clinical characteristics, laboratory data, microbiologic results and final outcome for SBIs due to MDROs vs. non-MDROs.
Results: Ninety-four episodes (88 patients) including bacteremia (42.6%), urinary tract infections (54.3%) and meningitis (3.1%) were caused by Gram-negative bacteria (67%), and Gram-positive bacteria (33%). Escherichia coli, Klebsiella pneumoniae and GBS were the most common causes. MDROs caused SBIs in 39 patients (44.3%). SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs (74.4% vs. 0%, P ≒ 0.001), but no difference in case-fatality rate (12.8% vs. 12.2%, P = 1.0). Clinical features or basic laboratory values were not statistically different between the two groups. Conclusions: The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs, which causes more delay in providing targeted antimicrobial therapy. Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner. |
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[Abstract] [Full Text] [PDF]
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Inpatient use of racemic epinephrine for children admitted with croup
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Elaine Chiang, Omar Afandi, Sang Hoon Lee, Srinivasan Suresh, Raymond D. Pitetti, Sriram Ramgopal |
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Background: Pediatric patients with croup are frequently admitted if they require two doses of racemic epinephrine (RE) in the emergency department (ED). We aimed to identify factors associated with the need for additional therapy (> 2 RE doses) among pediatric patients with croup.
Methods: We performed a single-center retrospective study of consecutive patients admitted from the ED with a diagnosis of croup between January 1, 2011 and December 31, 2015. Primary outcome was need for > 2 doses of RE. Secondary outcomes included time to third RE and 72-hour return visits. We performed logistic regression to identify factors associated with use of > 2 RE doses during hospitalization, and survival analysis to identify time to dosing of 3rd RE from 2nd RE.
Results: Of 353 included admissions [250 (70.8%) males, median age 1.48, interquartile range 0.97每2.51 years], 106/353 (30.0%) required > 2 RE. In univariate logistic regression, only recent use of steroids within 1 day prior to presentation (4.18, 1.48每11.83; P = 0.007) was associated with need for > 2 RE. Survival from third RE was 0.74 (95% CI 0.69每0.78), which was similar to the survival at 12 hours (0.70, 95% CI 0.65每0.75). Return visits occurred in 19 (5.4%) patients, of whom 12/19 (63.2%) were given RE. Conclusions: Patients hospitalized for croup with recent use of steroids prior to ED presentation have a greater need for > 2 RE during hospitalization. The majority who require inpatient RE will do so within 8每12 hours. These data provide information for risk stratification and duration of monitoring for patients hospitalized with croup. |
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[Abstract] [Full Text] [PDF]
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Efficacy and safety of interferon alpha-2b versus pegylated interferon alpha-2a monotherapy in children with chronic hepatitis B: a real-life cohort study from Shanghai, China
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Yao Hu, Ying-Zi Ye, Li-Jing Ye, Xiao-Hong Wang, Hui Yu |
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Background: Interferon alpha (IFN-汐) is a preferred therapy for antiviral treatment of children with chronic hepatitis B (CHB) aged > 1 year currently. Peginterferon alpha-2a (Peg-IFN 汐-2a) is a recommended international guideline for treatment of CHB children, which is limited to children aged > 3 years. But the exact efficacy and safety of IFN-汐 and Peg-IFN 汐-2a for treating CHB are not sufficient.
Methods: Clinical manifestations, baseline characteristics, related laboratory tests and adverse events were retrospectively analyzed in children with CHB, who visited Children*s Hospital of Fudan University and were treated with IFN 汐-2b or Peg-IFN 汐-2a monotherapy and followed up from January 2003 to October 2018.
Results: A total of 36 immune-active patients without advanced fi brosis were enrolled to be treated with IFN 汐-2b (group A, n = 18) or Peg-IFN 汐-2a (group B, n = 18). IFN 汐-2b or Peg-IFN 汐-2a was administered for a median of 48 weeks subcutaneously by body surface area (BSA) category at a dose of 3 MU/m2 or 104 米g/m2, respectively. HBV e antigen (HBeAg) seroconversion rates at 48 weeks post-treatment were higher in group A than group B (92.9% vs. 87.5%), so as the rates of HBsAg clearance (22.2% vs. 11.1%), and hepatitis B virus (HBV)-DNA < 1000 IU/mL (88.9% vs. 83.3%). Only mild flu-like symptoms and transient neutropenia appeared in some children at the early stage of treatment. No severe abnormal results was observed in other laboratory assessments. Conclusion: The antiviral monotherapy of 48-week IFN 汐-2b or Peg-IFN 汐-2a in children with CHB is well tolerated and effective, which is associated with higher rates of HBeAg seroconversion and HBsAg clearance than in adults and previously pediatric patients. |
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[Abstract] [Full Text] [PDF]
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Factors associated with exclusive breastfeeding in relation to knowledge, attitude and practice of breastfeeding mothers in Rabigh community, Western Saudi Arabia
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Moustafa A. Hegazi, Mousa Allebdi, Mohammed Almohammadi, Abdulelah Alnafie, Lama Al-Hazmi, Shahad Alyoubi |
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Background: There is much concern about declining rates of exclusive breastfeeding (EBF) all over the world including Saudi Arabia which deprives infants from many immunological, nutritional, and psychosocial benefits. This study was performed to determine EBF prevalence and factors influencing EBF in relation to knowledge, attitude and practice (KAP) of breastfeeding mothers (BFM) in Rabigh, Western Saudi Arabia.
Methods: Data about factors that could be associated with EBF and KAP of BFM were collected by cross-sectional questionnaire-based study from 420 BFM.
Results: Prevalence of EBF for 6 months was 27.6% which is far below World Health Organization recommendations. Demographic, socioeconomic, biomedical as well as most studied variables of KAP of 50% to over 90% of participating mothers were adequate to account for low EBF rate. Proper knowledge about benefits of colostrum and continuation of breastfeeding for 2 years was given by only 86.2% and 36.7% of BFM, respectively. The most significant independent factors associated with EBF were perception of sufficient human milk [adjusted odds ratio (AOR) 2.89; 95% confidence interval (CI) 1.72每4.89], absence of nipple pain (AOR 2.77; 95% CI 1.72每4.45) and mothers without university education (AOR 1.86; 95% CI 1.15每3.01). Early introduction of formula in hospital after birth was the main inappropriate feeding practice in 76.2% of infants of BFM. Conclusion: Findings of this study should be utilized by Rabigh community and other national or worldwide communities with similar characters to promote EBF by targeted educational programs after identification of significant factors influencing EBF and gaps in KAP of BFM. |
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[Abstract] [Full Text] [PDF]
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