Objective:To summarize the effects of disease-modifying drugs for spinal muscular atrophy (SMA) on the ventilation support of type 1 children after acute respiratory failure.Methods:A case-control study was conducted, including the data of clinical characteristics, medication and ventilation supports of 38 SMA patients of type 1 with pneumonia and acute respiratory failure hospitalized in Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2020 to July 2023. Children were divided into the treatment group and the untreated group based on whether they started and persisted in using Nusinersen or Risdiplam or not before hospitalization. The differences of ventilation support between the 2 groups were analyzed. The children of the treatment group were divided into the improved group and the unimproved group based on whether they could be avoid of prolonged dependence on continuous mechanical ventilation in the next six months after discharge. The differences in clinical characteristics between the two groups were analyzed. T-test and χ2 test were used for comparison. Results:Among the enrolled children, 19 were male and 19 were female. The age was 1.3 (0.6, 2.0) years at the time of hospitalization due to pneumonia. There were 26 cases in the treatment group and 12 cases in the untreated group. The treatment group had a higher proportion of patients without prolonged dependence on continuous mechanical ventilation in the next six months after discharge (69% (18/26) vs. 2/12, χ2=9.10, P<0.05). Eighteen children were improved among the treated group, while 8 children were not. The improved group had a larger age of first onset of acute respiratory failure (1.6 (0.4, 3.4) vs. 0.5 (0.3, 0.7) years, Z=2.07, P<0.05), a longer duration of medication taken before hospitalization (3.6 (2.4, 8.7) vs. 1.2 (1.2, 2.4) months, t=2.74, P<0.05), and a smaller proportion with underlying diseases (1/18 vs. 6/8, χ2=13.58, P<0.05). Conclusions:SMA disease-modifying drugs are useful for type 1 children to avoid of prolonged dependence on continuous mechanical ventilation after acute respiratory failure. The patients who take medication longer, or have acute respiratory failure for the first-time at an older age, or without underlying diseases are more likely to avoid of.

Objective:To summarize the risk factors of tracheal extubation failure in children with spinal muscular atrophy (SMA) combined with pneumonia.Methods:In this retrospective study, clinical data of 34 children with SMA combined with pneumonia who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2018 to December 2021 were analyzed. According to whether the extubation was successful or not, they were divided into the success group and the failure group. The risk factors that may affect the success of extubation between two groups were derived by comparing the clinical characteristics by Mann-Whitney U test and Chi-square test, followed by multivariate Logistic regression. Results:Among the 34 cases, there were 14 males and 20 females, aged 10.8 (6.0,25.2) months at the time of hospitalization, 31 cases were type 1 SMA and 3 cases were type 2. Eleven children were unable to eat independently before intubation, 22 were treated with airway clearance techniques and 28 had multiple pulmonary infections. There were 21 cases in the success group and 13 cases in the failure group. The failure group had higher maximum partial pressure of arterial carbon dioxide level during intubation and higher rate of consolidation changes in chest images before extubation (81 (49,86) vs. 48 (43,56) mmHg (1 mmHg=0.133 kPa), 6/13 vs. 10%(2/21), Z=-2.55, χ 2=5.99, both P<0.05). Multivariate Logistic regression analysis showed that tube feeding before intubation ( OR =39.88, 95% CI 3.36-473.29, P=0.003) and not receiving airway clearance therapy ( OR =14.55, 95% CI 1.35-156.78, P=0.027) were independent risk factors for extubation failure. Conclusions:The independent risk factors of tracheal extubation failure in children with SMA combined with pneumonia are unable to eat independently before intubation and not receiving airway clearance therapy. Therefore, the conditions to improve the success of extubation consist of having the ability to eat independently before intubation, using airway clearance techniques to improve ventilation and to make the chest images as clear as possible.

This paper aims to explore the effects of chicken interferon-γ (ChIFN-γ) and interleukin-2 (ChIL-2) on type 1 helper (Th1) T lymphocyte differentiation. To be specific, ChIFN-γ and ChIL-2 were first expressed in Escherichia coli competent cells and then purified by Ni-NTA affinity chromatography. Different concentration of ChIFN-γ and ChIL-2 were employed to stimulate the lymphocytes in chicken peripheral blood which had been activated by concanavalin A (Con A), and the mRNA levels of cytokines related to Th1 cell differentiation were detected by real-time quantitative PCR (RT-qPCR). The results showed that both ChIFN-γ and ChIL-2 can significantly up-regulate mRNA levels of cytokines related to Th1 cell differentiation and the optimal concentration was 12.5 μg/mL and 25.0 μg/mL, respectively. In addition, specific-pathogen-free (SPF) chickens were immunized with ChIL-2 or ChIFN-γ together with H9N2 vaccine, or H9N2 vaccine alone by oral administration or intramuscular injection, respectively. The mRNA levels of cytokines related to Th1 cell differentiation were detected after immunization. The results showed that ChIFN-γ and ChIL-2 significantly up-regulated the mRNA levels of cytokines related to Th1 cell differentiation induced by H9N2 vaccine compared with H9N2 vaccine alone, and that the intramuscular injection was better than oral administration. In this study, we verified that ChIFN-γ and ChIL-2 can significantly enhance mRNA levels of cytokines related to Th1 cell differentiation induced by ConA or H9N2 vaccine in vitro and in vivo. The results of this study can lay a theoretical basis for using ChIFN-γ and ChIL-2 as vaccine adjuvants.
Animals ; Cell Differentiation ; Chickens ; Concanavalin A ; Cytokines/genetics* ; Influenza A Virus, H9N2 Subtype/genetics* ; Interferon-gamma/metabolism* ; Interleukin-2/genetics* ; RNA, Messenger

Objective:To analyze the clinical and laboratory features of patients with Coronavirus Disease 2019(COVID-19), for providing reference for the diagnosis and treatment of the disease.Methods:The clinical data of 72 patients confirmed as COVID-19 in Qishan hospital during January 23, 2020 to February 13, 2020 were collected. The data included the general information, clinical manifestations, laboratory tests and CT findings of the lungs. According to the severity of the disease, the patients were divided into the non-severe group and the severe group, and the laboratory tests characteristics of the two groups were compared. SPSS 22.0 statistical software was used for data analysis.Results:In the 72 patients, 40 were males and 32 females, the average age was (46.0±14.8) years. The main clinical manifestations were fever (84.7%) and cough (77.8%). Among them, 45 cases (62.5%) had expectoration with a small amount of white sticky sputum. The main laboratory results showed that lymphocyte count decreased in 26 cases (36.1%), the absolute number of T lymphocytes decreased in 18 cases (25.0%), CD4 + T cell count decreased in 8 cases (11.1%), CD8 + T cell count decreased in 14 cases (19.4%), ESR increased in 42 cases (58.3%), and CRP increased in 31 cases (43.1%). Peripheral blood lymphocyte (L), albumin, CD4 + T cell, CD8 + T cell, T-lymphocyte in severe group (n=61) were lower than those in non-severe group (n=11), while C-reactive protein (CRP), serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), fibrin (FIB), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH) in severe group were higher than those in non-severe group ( P<0.05). In 72 patients, the negative time of the twice nucleic acid detection from nasopharyngeal swabs and sputum specimens were (21.48±7.9) days and (27.79±7.4) days, there were significant differences between the two groups of specimens for two consecutive negative times ( t=-4.532, P=0.000). The main pulmonary imaging manifestations of COVID-19 patients: two lungs in 58 cases, patchy opacities in 51 cases and ground glass shadows in 61 cases. Conclusions:Most of the COVID-19 patients in Yantai and Weihai were common type. The abnormal T lymphocyte, subcohorte and other laboratory indicators may indicate that the patients are more serious.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Objective:To investigate the clinical effect of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction.Methods:32 young permanent teeth with pulp and periapical lesions were randomly divided into two groups ( n=32): experimental group was treated with ultrasonic root canal intermittent irrigation and the control group was rinsed with sodium hypochlorite root canal. The changes of periapical lesions and root development were evaluated by preoperative and postoperative clinical symptom observation and radiograph examination, and the clinical effect of endodontic vascular reconstruction was discussed. The time of inflammation control was discussed by analyzing the starting point from the first diagnosis to the date of mineral trioxide aggregate (MTA) coverage. Results:The clinical symptoms of the 16 affected teeth in the experimental group and the control group disappeared, the periapical lesions were eliminated, and the root continued to develop. In the experimental group, root formation was observed in 13 of the affected teeth, with a success rate of 81.25% and a reduction rate of 18.75%. In the control group, root formation was observed in 10 of the affected teeth, with a success rate of 62.5% and a reduction rate of 37.5%. There was no difference in the effective rate between the experimental group and the control group ( P>0.05). The control time of inflammation was (28.44±5.98)days in the experimental group and (34.13±7.17)days in the control group, with statistically significant differences ( P<0.05). Conclusions:Ultrasonic root canal intermittent swabbing applied to pulp revascularization can achieve good clinical effect and shorten the time of inflammation control.

Objective:To investigate the clinical manifestations of hospitalized patients with spinal muscular atrophy (SMA) combined with pneumonia and compare outcomes of different plans based on the manifestations, so as to improve the diagnosis and treatment of this disease.Methods:The clinical data of 13 SMA children with pneumonia hospitalized in the Department of Respiratory in Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2015 to June 2019 were retrospectively analyzed.General information including the age of patients, the classification of their diseases, the type of respiratory failure and complications was collected.For the pneumonia, the pathogens, complications, related respiratory failure type, and the treatments for SMA children during hospitalization were documented.The pathogen of pulmonary infection and treatment were described.The mode, duration, and outcome of mechanical ventilation for the SMA children during hospitalization and after discharge from the hospital were also analyzed.Results:There were 8 SMA patients with type 1 suffering from more severe conditions, most of whom had type Ⅱ respiratory failure and pneumonia complications.The average duration of hospitalization for type 1 patients [(39.8±30.3) d] was longer than that of type 2 patients [(7.8±2.2) d]( t=2.318, P=0.041). Six SMA children underwent tracheal intubation and tracheotomy, who had multiple drug-resistant bacterial infections and needed long-term treatments with rotated multiple antibiotics.The average duration of hospitalization of these 6 children [(51.3±25.3) d] was longer than that of other 4 children with non-invasive ventilation [(7.5±2.4) d]( t=3.391, P=0.009). In contrast, 3 patients who underwent tracheal intubation achieved a stable condition (normal body temperature; percutaneous oxygen saturation condition >94% under air condition; chest radiography without inflammation; sputum suction frequency less than 4 hours) after active application of airway clearance technique.They were successfully extubated and shifted to non-invasive ventilation.Three children who got rid of mechanical ventilation in daytime still took long-term application of nighttime non-invasive ventilation after discharge since their polysomnography indicated sleeping disorders.None of those 3 patients were hospitalized again due to severe pneumonia. Conclusions:In order to avoid infection of multi-resistant bacteria, SMA children with pneumonia receiving tracheal intubation should be extubated and shift to non-invasive ventilation as soon as their condition is stable.Children who get rid of non-invasive ventilation should take polysomnography before being discharged from hospital.Long-term application of nighttime non-invasive ventilation should be taken at home if the polysomnography suggests sleeping disorders, so as to reduce the risk of re-hospitalization due to recurrent pneumonia.

Objective: To study the short-term and long-term efficacy of the non-invasive ventilation treatment in children with spinal muscular atrophy (SMA) and sleep-disordered breathing. Methods: This was a prospective research to study the effect of night-time non-invasive ventilation in children with SMA and moderate to severe sleep-disordered breathing during March 2016 to January 2018, from the Pulmonary Department of Capital Institute of Pediatrics Affiliated Children's Hospital. Patients were divided into the treated group (with night-time non-invasive ventilation) and the control group (without ventilator). Sleep breathing pressure titration was suggested to the patients who were prepared to receive non-invasive ventilation. All cases were followed up for one year. Parameters′changes in polysomnography were assessed (paired t-test) in titration patients. Frequency of respiratory tract infection during the next year in the patients with and without ventilation was collected and compared (Mann-Whitney U-test). Results: Seventeen cases were recruited. The average age was (5.1±2.9) years, 10 cases were boys and 7 cases were girls. In the titration group (8 patients), after non-invasive ventilation, the average apnea hypopnea index was (3.8±2.5) times/h (t=4.086, P=0.005), hypopnea index was (2.4±1.2) times/h (t=2.779, P=0.027), average oxygen saturation during total sleep time was 0.966±0.007 (t=-5.292, P=0.001), and the minimum oxygen saturation was 0.906±0.023 (t=-3.938, P=0.006). All the above parameters were significantly improved after treatment. Than before, which was (16.6±9.7) times/h, (7.2±4.7) times/h, 0.946±0.015, 0.786±0.092 respectively. Ventilator mode for the 9 children with long time non-invasive ventilation at home was Bi-level positive airway pressure S/T. The positive airway pressure was set at 8-14 cmH₂O (1 cmH₂O=0.098 kPa) in inspiratory phase and 4-6 cmH₂O in expiratory phase. In the treated group (9 patients), the average frequency of upper respiratory tract infection was 1.0 (0, 3.0) times/year (Z=-2.245, P=0.023), the lower respiratory tract infection was 0 (0, 0) times/year (Z=-3.189, P=0.001), hospitalization was 0 (0, 0) times/year (Z=-3.420, P<0.01), and admission to intensive care unit was 0 (0, 0) times/year (Z=-3.353, P=0.029). All the above indexes were significantly decreased compared with the control group (8 patients), which was 3.0 (2.3, 7.0) times/year, 2.0 (1.3, 4.5) times/year, 1.0 (1.0, 4.3) times/year, 0.5 (0, 1.0) times/year respectively. Conclusion Non-invasive ventilation is efficient to SMA children with sleep-disordered breathing, and also can reduce the incidence of respiratory tract infections for children with SMA.