Objective:Chronic urticaria presents a chronic process of recurrent attacks,and its first-line treatment is second-generation antihistamine with limited treatment options.The efficacy of antihistamine varies among individuals and cannot meet the needs of all patients.This study aims to explore the clinical efficacy and safety of Zhiyang Xiaozhen granules combined with antihistamine in the treatment of chronic urticaria patients. Methods:We retrospectively analyzed the clinical data of patients with chronic urticaria who visited the Xiangya Hospital of Central South University from April 2020 to March 2021.The patients who received conventional second-generation antihistamine treatment were selected as a control group,while the patients who received combined treatment with Zhiyang Xiaozhen granules on the basis of conventional second-generation antihistamine treatment were selected as an observation group.The differences in the Weekly Urticaria Activity Score(UAS7)and Dermatology Life Quality Index(DLQI)between the 2 groups before and 4 weeks after treatment were compared.The Symptom Score Reduce Index(SSRI)was used to evaluate and compare the efficacy of the 2 treatment regimens. Results:After 4 weeks of treatment,the UAS7 levels in both groups were significantly reduced(P=0.001 and P<0.001,respectively).The effective rates of the control group and the observation group were 61.11%and 59.38%,respectively when converting UAS7 to SSRI for efficacy evaluation,and there was no statistically significant difference in efficacy between the 2 groups(P>0.05);however,when converting DLQI to SSRI for efficacy evaluation,the effective rates of the control group and the observation group were 33.33%and 46.88%,respectively,and the difference in efficacy between the 2 groups was statistically significant(P<0.001).There were 3 patients with adverse drug reactions related to drowsiness in both groups. Conclusion:The combination of Zhiyang Xiaozhen granules and second-generation antihistamine can effectively improve disease activity in patients with chronic urticaria,and the improvement in quality of life is better than that with the second-generation antihistamine alone.

Objective:To evaluate the efficacy of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) in children, and to analyze its influencing factors.Methods:A retrospective analysis was carried out on the demographic and clinical data collected from children with moderate to severe AD, who were treated with dupilumab in the Department of Dermatology, Xiangya Hospital, Central South University from October 2020 to October 2022. The initial dose (200 - 600 mg) of dupilumab was administered based on children's age and weight, followed by 200 - 300 mg every 2 - 3 weeks. The curative efficacy and quality of life were evaluated using the Investigator's Global Assessment (IGA), Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Peak Pruritus Numerical Rating Scale (PP-NRS), Patient-Oriented Eczema Measure (POEM), and the Children's Dermatology Life Quality Index (CDLQI) /Infants' Dermatitis Quality of Life Index (IDQoL) before treatment, and at weeks 4, 12, and 16 after treatment. Adverse events during the treatment period were also recorded. The main outcome indicators were the proportion of patients achieving IGA0/1 and EASI75 (≥ 75% improvement from baseline in EASI score) at week 16. Changes in the clinical scores and laboratory parameters at different time points after the treatment with dupilumab were analyzed using generalized estimating equations, and a logistic regression model was used to identify the influencing factors for EASI75 response at week 16.Results:A total of 136 children aged 2 - 11 years met the diagnosis of moderate to severe AD and received at least one dose of dupilumab, among whom 123 children met the inclusion criteria for this analysis. IGA, EASI, SCORAD, POEM, CDLQI/IDQoL, and PP-NRS scores were significantly improved at weeks 4, 12, and 16 after dupilumab therapy compared with baseline scores (all P < 0.01). At week 16, the proportions of patients achieving IGA0/1, EASI50, EASI75, EASI90, CDLQI/IDQoL improvement ≥ 4 points, and PP-NRS improvement ≥ 4 points were 44.6% (33/74), 86.5% (64/74), 70.3% (52/74), 48.7% (36/74), 56.8% (42/74), and 77.0% (57/74), respectively; the eosinophil counts significantly decreased compared with the baseline level ( P = 0.001). The total IgE levels at different time points after treatment did not differ from the baseline level ( P > 0.01). At week 16, the related factors for the response to dupilumab were relatively low ages (compared with the children aged 6 - 11 years, those aged 2 - 5 years showed lower EASI75 response rates: OR = 0.148, 95% CI: 0.027 - 0.823, P = 0.029) and having a family history of urticaria ( OR = 0.033, 95% CI: 0.002 - 0.601, P = 0.021), while gender, AD duration, subtypes and main clinical phenotypes of AD, allergic history, family history of atopic diseases, presence of serum allergen-specific IgE antibodies, serum total IgE levels, or eosinophil counts did not affect the efficacy of dupilumab (all P > 0.05). During the 16-week treatment, 3 children discontinued the dupilumab treatment due to disease exacerbation, and 1 child developed conjunctivitis. Conclusions:Dupilumab could effectively improve the symptoms and signs of children with moderate to severe AD whose condition was poorly controlled by conventional treatments, with a low incidence rate of adverse reactions. Relatively low ages and having a family history of urticaria may be negative factors influencing the efficacy of dupilumab in children with moderate to severe AD at week 16.

Objective:To evaluate the efficacy of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) in children, and to analyze its influencing factors.Methods:A retrospective analysis was carried out on the demographic and clinical data collected from children with moderate to severe AD, who were treated with dupilumab in the Department of Dermatology, Xiangya Hospital, Central South University from October 2020 to October 2022. The initial dose (200 - 600 mg) of dupilumab was administered based on children's age and weight, followed by 200 - 300 mg every 2 - 3 weeks. The curative efficacy and quality of life were evaluated using the Investigator's Global Assessment (IGA), Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Peak Pruritus Numerical Rating Scale (PP-NRS), Patient-Oriented Eczema Measure (POEM), and the Children's Dermatology Life Quality Index (CDLQI) /Infants' Dermatitis Quality of Life Index (IDQoL) before treatment, and at weeks 4, 12, and 16 after treatment. Adverse events during the treatment period were also recorded. The main outcome indicators were the proportion of patients achieving IGA0/1 and EASI75 (≥ 75% improvement from baseline in EASI score) at week 16. Changes in the clinical scores and laboratory parameters at different time points after the treatment with dupilumab were analyzed using generalized estimating equations, and a logistic regression model was used to identify the influencing factors for EASI75 response at week 16.Results:A total of 136 children aged 2 - 11 years met the diagnosis of moderate to severe AD and received at least one dose of dupilumab, among whom 123 children met the inclusion criteria for this analysis. IGA, EASI, SCORAD, POEM, CDLQI/IDQoL, and PP-NRS scores were significantly improved at weeks 4, 12, and 16 after dupilumab therapy compared with baseline scores (all P < 0.01). At week 16, the proportions of patients achieving IGA0/1, EASI50, EASI75, EASI90, CDLQI/IDQoL improvement ≥ 4 points, and PP-NRS improvement ≥ 4 points were 44.6% (33/74), 86.5% (64/74), 70.3% (52/74), 48.7% (36/74), 56.8% (42/74), and 77.0% (57/74), respectively; the eosinophil counts significantly decreased compared with the baseline level ( P = 0.001). The total IgE levels at different time points after treatment did not differ from the baseline level ( P > 0.01). At week 16, the related factors for the response to dupilumab were relatively low ages (compared with the children aged 6 - 11 years, those aged 2 - 5 years showed lower EASI75 response rates: OR = 0.148, 95% CI: 0.027 - 0.823, P = 0.029) and having a family history of urticaria ( OR = 0.033, 95% CI: 0.002 - 0.601, P = 0.021), while gender, AD duration, subtypes and main clinical phenotypes of AD, allergic history, family history of atopic diseases, presence of serum allergen-specific IgE antibodies, serum total IgE levels, or eosinophil counts did not affect the efficacy of dupilumab (all P > 0.05). During the 16-week treatment, 3 children discontinued the dupilumab treatment due to disease exacerbation, and 1 child developed conjunctivitis. Conclusions:Dupilumab could effectively improve the symptoms and signs of children with moderate to severe AD whose condition was poorly controlled by conventional treatments, with a low incidence rate of adverse reactions. Relatively low ages and having a family history of urticaria may be negative factors influencing the efficacy of dupilumab in children with moderate to severe AD at week 16.

Objective To explore the safety and efficacy of intrathecal administration of adipose stem cells de-rived from bioactive secretome (ASCBS)in treatment of whiter matter injury (WMI)in the preterm infants. Methods Sixty - three cases of WMI were recruited according to the uniform standards from multiple medical centers and they were divided into 3 gestational age (GA)subgroups,which were 21 cases in group A (GA 24 - 28 + 6 ),20 cases in group B (GA 29 - 32 + 6 ),and 22 cases in group C (GA 33 - 36 + 6 ). The patients were randomly divided into treatment groups and control groups by tossing coins. The treatment groups received lumbar puncture followed with ASCBS intra-thecal injection once daily for 3 consecutive days. Follow - up study included Neonatal Behavioral Neurological Assess-ment (NBNA)at term - equivalent age and neurodevelopment at corrected age of 6 - month. Neurodevelopment was assessed by using the Bayley Scales of Infant Development and Peabody Developmental Motor Scale. The survival rates, NBNA scores,mental development index (MDI),psychomotor develop index (PDI),total motor development quotient, gross motor development quotient and fine motor development among each subgroup were compared. Results Sixty -three cases were recruited,including 31 in the treatment group and 32 in the control group. Only 1 case in the treatment groups lost in the follow - up. No clinical side effects were found in the treatment groups. There was no significant diffe-rence in the survival rate and complication in the preterms in all subgroups of the treatment group and control group (all P > 0. 05). The gross and total motor development quotient in the treatment group A was higher than that in the control group A(gross motor development quotient:98. 330 ± 6. 282 in treatment group A,90. 330 ± 3. 777 in control group A, P = 0. 040;total motor development quotient:97. 330 ± 4. 803 in treatment group A,91. 000 ± 4. 472 in control group A,P = 0. 023). The rest findings showed no significant difference between groups. Conclusion The treatment of WMI in preterm infants with ASCBS is safe and can promote the motor development of preterm infants with GA in 24 - 28 weeks.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.