Objective To explore the inputs and outputs of areas with different anti-HAY prevalence rates on universal childhood vaccination,and to provide a scientific basis for the formulation of the immunization strategy.Methods Since hepatitis A vaccination was scheduled at 12 and 18 months of age for all the healthy children,a single cohort including 1 000 000 individuals was formed in 2009,using the Chinese inactivated vaccine.Decision analysis was used to build Markov-decision tree model.The universal childhood hepatitis A vaccination was compared with nonvaccination group to evaluate the number of symptomatic infection,hospitalization,death,qualityadjusted life years (QALYs) lost,and the incremental cost-utility from the health system and the societal perspectives.Outcomes of the vaccination for the next 70 years were also predicted.The process of analysis was run separately in five regions defined by the anti-HAV prevalence rates (around 50％,50％-69％,70％-79％,80％-89％ and ＞90％ ).Sensitivity analysis was performed to test the stability or reliability of the results,and to identify sensitive variables.Results The study projected that,in the lowest,lower,and intermediate infection regions,the cost and output indicators of universal childhood hepatitis A vaccination were all lower than non-vaccinated group.Universal vaccination could gain QALYs and save both costs from the health systen or the society.In the regions with higher infection rate,the output indicators of universal childhood hepatitis A vaccination were lower than in those non-vaccinated groups,except for the number of death due to hepatitis A,which had a 20 cases of increase.The model also predicted that in the highest infected region,universal vaccination would increase 4 560 814 and 5 840 430 RMB Yuan in the total costs from both the health system and the societies,respectively,when compared to the non-vaccination groups.Universal vaccination would also decrease the numbers of symptomatic infection,hospitalization,and QALYs lost,but would increase 51 deaths due to hepatitis A,and 1507,1929 more RMB Yuan for each QALY gained from the health system and societal respectively,in the regions with highest infection rate.Sensitivity analyses discovered that the infection rate among those susceptible population and the proportion of those who initially under protection but subsequently lost their immunity every year,were the two main sensitive variables in the model.Conclusion Our research discovered that the universal vaccination strategy should be based on the protective period of the vaccine and the anti-HAV prevalence in different endemic areas.

OBJECTIVETo investigate the effect of polysaccharide nucleic acid of BCG (BCG-PSN) injection on immune and pulmonary function in asthmatic children complicated with allergic rhinitis.

METHODSThirty-seven cases were separated at random into two groups, the BCG-PSN group (17 cases) was treated with BCG-PSN plus inhaled glucocortisteriods, and the control group (20 cases) was treated with inhaled glucocortisteriods only. The children in both groups were followed up for 6 months to record their lung function, allergic rhinitis scores, frequency of asthmatic attacks and respiratory infection. The levels of interleukin (IL)-4, interferon-gamma (IFN-g) and plasma total IgE were detected by using double antibody sandwich ELISA at the beginning and the end of treatment.

RESULTSIn comparison with the control group, after treatment, the levels of IFN-g and the ratio of IFN-g/IL4 in the BCG-PSN group significantly increased, whereas the level of IL-4 and the plasma total IgE significantly decreased (P less than 0.05), while those of the control group had no significant change. The lung function of both groups had significant improvement (p less than 0.05). The frequencies of asthmatic attacks in BCG-PSN and control groups were 0.81 +/- 0.20 vs. 1.72 +/- 0.80, and the difference was statistically significant. The frequencies of respiratory tract infection in BCG-PSN and control groups were 1.15 +/- 0.55 vs. 3.21 +/- 0.73, the difference was significant.

CONCLUSIONBCG-PSN may be able to correct the imbalance of Th1/Th2 and improve the lung function of children with asthma complicated with allergic rhinitis, which suggest that the immune adjusting treatment should be emphasized besides anti-inflammation therapy.

Adjuvants, Immunologic ; chemistry ; therapeutic use ; Adolescent ; Asthma ; blood ; complications ; drug therapy ; BCG Vaccine ; chemistry ; therapeutic use ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; methods ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Male ; Nucleic Acids ; chemistry ; Polysaccharides, Bacterial ; chemistry ; Rhinitis, Allergic, Perennial ; blood ; complications ; drug therapy ; Treatment Outcome

OBJECTIVETo investigate the effects of leukotriene receptor antagonist on the levels of Th1 and Th2 cytokines and the serum cysteinyl leukotrenes (CysLTs) in infants and young children with respiratory syncytial virus (RSV) pneumonia.

METHODSThirty-seven infants and young children with RSV pneumonia were divided into two groups after discharge. The cases in group 1 (n=24) were treated with a leukotriene receptor antagonist, Singulair 4 mg once daily for 12 weeks; the cases in group 2 (n=13) were treated with budesonide aerosol 200 ug once or twice daily for 12 weeks. The serum CysLTs, IFN-gamma and IL-4 were detected with enzyme_linked immunosorbent assays (ELISA) for all the 37 cases, and 10 healthy infants of the same age served as controls.

RESULTSThe serum CysLTs level in the cases with RSV pneumonia was significantly higher than that in controls (P<0.05). There was an imbalance in expression of Th1 and Th2 cytokines (IFN-gamma and IL-4 ) in these cases. Both Singulair and budesonide aerosol could correct the imbalance of Th1 and Th2 cytokines. The serum CysLTs level declined after treatment with Singulair in 24 cases, but no significant change occurred after treatment with budesonide aerosol in the remaining 13 cases.

CONCLUSIONSThe serum CysLTs level in children with RSV pneumonia was higher than that in healthy children, and there was an imbalance of Th1 and Th2 cytokines in these infants, which was similar to those with asthma. Leukotriene receptor antagonist may be effective in preventing children with RSV pneumonia from evolving into asthma.

Child, Preschool ; Cytokines ; blood ; Female ; Humans ; Infant ; Leukotriene Antagonists ; administration & dosage ; pharmacology ; Male ; Pneumonia, Viral ; drug therapy ; immunology ; virology ; Respiratory Syncytial Virus Infections ; drug therapy ; immunology ; virology ; Respiratory Syncytial Viruses ; drug effects ; immunology ; Th1 Cells ; drug effects ; immunology ; Th2 Cells ; drug effects ; immunology

OBJECTIVETo assess the value of immunoregulants in improving the prognosis of infants with wheezing.

METHODSForty-three infants with wheezing with given oxygen support, injection or inhalation of glucocorticosteroids or bronchodilatator to relieve the symptoms. Of these infants, 24 received immunoregulant treatment with bronchovaxom at the daily dose of 3.5 mg for 10 days every a month for a treatment course of 3 months. The other 19 infants were managed with budesonide aerosol at 200 microg once or twice daily for 3 months (basic treatment group). All the infants were followed up for 1 year to record the number of wheezing episode and infections. Ten healthy infants were also included in this study as the control group.

RESULTSIn infants with bronchovaxom treatment, 25% reported more than 3 wheezing episodes within the 1-year follow-up, a rate significantly lower than that in the control group (63.2%, Chi(2)=6.344, P<0.05). The episodes of respiratory infection were similar between bronchovaxom group and the healthy control group (t=0.72, P>0.05), but significantly higher in the basic treatment group than in bronchovaxom and the healthy control group (t=3.11 and 3.92, respectively. P<0.05).

CONCLUSIONSBronchovaxom can effectively reduce the recurrence of wheezing and respiratory infections in the infants with wheezing attack to reduce the risks of asthma development.

Asthma ; diagnosis ; drug therapy ; prevention & control ; Bacteria ; Cell Extracts ; administration & dosage ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Immunologic Factors ; therapeutic use ; Infant ; Male ; Prognosis ; Respiratory Sounds ; drug effects

OBJECTIVETo investigate changes of T lymphocytes subsets in children with infectious mononucleosis (IM) and the effects of different interventions.

METHODSForty-eight children with IM were enrolled, 28 cases were assigned to the group treated with intravenous immunoglobulin (IVIG) 400 mg/(kg x d) for 5 continuous days or IVIG 1 g/(kg x d) for 2 continuous days, the remaining 20 cases were treated with ganciclovir (GCV) 5-10 mg/(kg x d) for 5 consecutive days. All these children were given general supportive therapies. Twenty healthy children from healthcare clinic serviced as control group.

RESULTSCD4 (%), CD8 (%) and the CD4/CD8 ratio in healthy control group were (34.12 +/- 3.53)%, (26.22 +/- 4.43)% and (1.41 +/- 0.3), in IVIG group were (24.2 +/- 4.3)%, (36.4 +/- 6.8)% and (0.72 +/- 0.12), and in GCV group were (23.7 +/- 5.1)%, (37.3 +/- 7.8)% and (0.67 +/- 0.13), respectively. CD4 (%), CD8 (%) and the ratio CD4/CD8 in the control group were significantly different from those in both groups with IM (P < 0.05). Compared with pre-treatment levels, the 28 cases treated with IVIG had significant improvement, the CD4 (%) increased, CD8 (%) decreased and the ratio of CD4/CD8 increased after treatment (P < 0.05). However, 20 cases in GCV treatment group made less changes (P > 0.05) . Meanwhile, the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group (P < 0.05). The rate of remission in IVIG group was 88.7% vs. 59.2% of GCV group (P < 0.05); the hospital days in IVIG group were (9.2 +/- 4.3) days vs. (13.8 +/- 5.1) days in the GCV (P < 0.05).

CONCLUSIONIt is indicated that the subsets of T lymphocytes in peripheral blood are obviously abnormal in children with IM caused by EBV infection in acute phase. IVIG can regulate the immunological derangements of T lymphocytes subsets, on which anti-viral therapy alone may have little impact.

CD4-CD8 Ratio ; Child ; Child, Preschool ; Female ; Ganciclovir ; administration & dosage ; Humans ; Immunoglobulins ; administration & dosage ; Infant ; Infectious Mononucleosis ; drug therapy ; immunology ; Male ; T-Lymphocyte Subsets ; drug effects ; immunology

OBJECTIVETo investigate changes in the levels of Th2 cytokine interleukin-4 (IL-4), Th1 cytokine interferon-gamma (IFN-gamma), and TNF-alpha in serum of newborn infants with cytomegalovirus (CMV) pneumonia.

METHODSTwenty-five neonatal cases who were positive for serum IgM antibody to CMV by ELISA were divided into IVIG intervention group and ganciclovir intervention group, and 15 healthy neonates were enrolled into the control group. The levels of IL-4, IFN-gamma, and TNF-alpha were detected by using double antibody ELISA for the control group and the intervention groups at the beginning and end of treatment.

RESULTSThe levels of IFN-gamma and TNF-alpha in patients with CMV pneumonia were higher than that in the healthy neonates, while the levels of IL-4 were lower(t= 2.65 and 3.16, p less than 0.05). The level of IL-4 in patients with CMV pneumonia was significantly lower than that of the healthy neonates (t= 2.49, p less than 0.05). There was no significant difference in the levels of IFN-gamma, IL-4 and TNF-alpha between IVIG intervention group and ganciclovir intervention group at the beginning of treatment (t= 1.85, 1.71, 1.76, p greater than 0.05). In IVIG intervention group, the levels of IFN-gamma and TNF-alpha significantly decreased after treatment (t=3.98, 5.16, p less than 0.01), the level of IL-4 in this group was higher than that before treatment (t= 2.55, p less than 0.05). In ganciclovir group, the level of IFN-gamma and TNF-alpha did not change after treatment (t=1.75, 1.16, p greater than 0.05), the level of IL-4 in this group was higher than that before treatment (t= 2.39, p less than 0.05).

CONCLUSIONThere seems to be an imbalance of Th1 and Th2 cytokines secretion in the infants with CMV pneumonia and, which may lead to immune-inflammation injury. IVIG can regulate imbalanced Th1/Th2 activities, therefore, immunomodulatory treatment should be applied besides antiviral therapy.

Cytokines ; blood ; Cytomegalovirus Infections ; immunology ; Female ; Humans ; Infant, Newborn ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Male ; Pneumonia, Viral ; immunology ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Tumor Necrosis Factor-alpha ; blood

BACKGROUNDAirway remodeling is the specific pathological characteristics of asthma, which is related to the clinical symptoms, pulmonary function, and airway hyperreactivity. This study aimed at exploring the effects of dermatophagoides pteronyssinus allergen-specific immunotherapy (SIT) on the serum interleukin (IL)-13 and pulmonary functions in asthmatic children.

METHODSFifty-eight pediatric asthma patients allergic to dust mite participated in this study. Thirty-five children received SIT with a standardized dermatophagoides pteronyssinus extract for one year (SIT group), and the other 23 children treated with inhaled corticosteroids (ICS group) according to the Global Initiative for Asthma (GINA) for one year. Serum levels of IL-13, IL-4 and interferon (IFN)-gamma were examined and the pulmonary functions were checked before and after the treatment.

RESULTSAfter the treatment, the number of emergency visiting for asthma attack in SIT group was significantly less than that in ICS group. The serum levels of IL-4 and IL-13 were clearly reduced, IFN-gamma and the ratio of IFN-gamma/IL-4 were significantly increased, the pulmonary functions (forced vital capacity (FVC), forced expiratory volume in one second percentage (FEV(1)%) and peak expiratory flow percentage (PEF%) were significantly improved in the SIT group. Meanwhile, IFN-gamma and the ratio of IFN-gamma/IL-4 were greatly increased, but serum levels of IL-4 and IL-13 had less changes, the pulmonary functions (FVC, FEV(1)% and PEF%) were poorly improved in ICS group. The basic pulmonary functions in both groups were at the same level, which had made more improvement in SIT group than in ICS group one year later.

CONCLUSIONSOne year of dermatophagoides pteronyssinus SIT can significantly reduce the frequencies of emergency visiting for asthma attack and improve the pulmonary functions of children with allergic asthma, and that is attributed to SIT, which can reduce the levels of IL-4 and IL-13 and regulate the imbalance of the Th1/Th2 cells in asthmatic children. All of these might be effective in preventing the asthmatic airway from remodeling.

Adolescent ; Animals ; Antigens, Dermatophagoides ; immunology ; Asthma ; blood ; immunology ; therapy ; Child ; Child, Preschool ; Dermatophagoides pteronyssinus ; immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunotherapy ; methods ; Interferon-gamma ; blood ; Interleukin-13 ; blood ; Interleukin-4 ; blood ; Male

OBJECTIVETo evaluate the efficacy of 3 commonly used protocols for management of acute exacerbation of asthma in children.

METHODSTotally 113 asthmatic children were randomized into 3 groups. In group A (53 cases), the children were treated with inhalation of nebulized budesonide suspension plus salbutamol and ipratropium bromide twice daily for 5 days; in group B (41 cases), budesonide plus salbutamol and ipratropium aerosol was administered, and in group C (29 cases), dexathmisone plus aminophylline injection was given once daily for 5 days. All the children received basic treatment with fluid infusion, antibiotics or/and anti-virus medications.

RESULTSThe children in both groups A and C showed effectively controlled asthma attack, with significant differences in the therapeutic effects (P>0.05). In contrast, only a few children showed improvement in group B, suggesting the ineffectiveness of the treatment.

CONCLUSIONNebulized medicine is one of the best means for management of acute asthma exacerbation in children, and inhalation of budesonide suspension plus salbutamol and ipratropium bromide can effectively relieve the asthmatic symptoms in these children with good compliance and convenient administration.

Acute Disease ; Adolescent ; Aerosols ; Albuterol ; administration & dosage ; therapeutic use ; Asthma ; drug therapy ; Bronchodilator Agents ; administration & dosage ; therapeutic use ; Budesonide ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Drug Therapy, Combination ; Female ; Humans ; Infant ; Ipratropium ; administration & dosage ; therapeutic use ; Male ; Treatment Outcome

OBJECTIVETo investigate the effects of Dermatophagoides pteronyssinus allergen-specific immunotherapy (SIT) on the prognosis of asthmatic children.

METHODSSixty-five children with established diagnosis of allergic asthma to dust mite were enrolled in this study, of whom 42 children received treatment with standardized SIT for 12 month and the other 23 served as the control group with inhaled corticosteroids according to Global Initiative for Asthma (GINA). The serum levels of interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) were detected and the pulmonary functions examined before and after the one-year treatment in all the patients.

RESULTSAfter the one-year treatment with SIT, the asthmatic children showed obviously reduced serum levels of IL-4, significantly increased IFN-gamma levels and the IFN-gamma/IL-4 ratio (P<0.05), and markedly improved pulmonary functions (FVC, pre-FEV1% and pre-PEF%) (P<0.05). In the control group, the children exhibited significantly increased IFN-gamma levels and IFN-gamma/ IL-4 ratio (P<0.05) without obvious reduction of serum IL-4 levels or pulmonary function improvement (P>0.05). With comparable basic pulmonary functions in the two groups before the treatment, the children in SIT group showed significantly greater improvement in the pulmonary functions than those in the control group after the one-year treatment.

CONCLUSIONThe one-year treatment with SIT can significantly improve the pulmonary functions of children with allergic asthma, and this effect is attributed to the regulation of Th1/Th2 cell balance and inhibition of asthmatic airway remodeling by SIT.

Adolescent ; Allergens ; immunology ; Antigens, Dermatophagoides ; immunology ; Asthma ; immunology ; therapy ; Child ; Child, Preschool ; Desensitization, Immunologic ; methods ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Male ; Prognosis ; Respiratory Function Tests ; Th1 Cells ; immunology ; Th2 Cells ; immunology

OBJECTIVETo determine the influence of sperm morphology on the outcomes and status of the neonates in in vitro fertilization and embryo transfer (IVF-ET).

METHODSStrictly based on the WHO criteria, we divided semen samples into a moderately abnormal group (sperm of normal morphology 5% - 10%), a mildly abnormal group (10% < sperm of normal morphology < 15%) and a normal group (sperm of normal morphology > or = 15%) , and compared the rates of fertilization, cleavage, quality embryos, implantation, clinical pregnancy and live births among the three groups.

RESULTSThere were not significant differences in the patients' age among the three groups (P > 0.05). The fertilization rate was markedly lower in the moderately abnormal than in the mildly abnormal group (63.70% vs 73.74%, P < 0.05), but not significantly different from the normal group (63.70% vs 68.05%, P > 0.05). The rate of quality embryos of the normal group was the highest, significantly higher than that of the moderately abnormal group (44.83% vs 35.75%, P < 0.05), but no statistically significant differences were observed in the rates of cleavage, implantation and clinical pregnancy among the three groups (P > 0.05). A total of 125 babies were born from the 280 ET cycles, including 73 singletons and 26 twins, of whom none showed any congenital birth defects. No statistically significant differences were found in the rates of abortion, ectopic pregnancy and premature delivery, nor in the mean gestational period and average body weight of the neonates among the three groups (P > 0.05).

CONCLUSIONModerately abnormal sperm morphology did not affect the fertility rate of IVF, but significantly decreased the quality of embryos; mildly abnormal sperm morphology had no obvious influence on the rates of fertilization, cleavage, quality embryos, implantation, clinical pregnancy and live births; while normal sperm morphology played a limited role in predicting the outcomes and status of the neonates in IVF-ET.

Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infant, Newborn ; Male ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Semen Analysis ; Sperm Motility ; Spermatozoa ; pathology