[Clinical application of plasma exchange combined with continuous veno-venous hemofiltration dialysis in children with refractory Kawasaki disease shock syndrome]. / 血浆置换联合连续性静脉-é™è„‰è¡€æ¶²æ»¤è¿‡é€æžæ²»ç–—åœ¨å„¿ç«¥å·å´Žç— ä¼‘å ‹ç»¼åˆå¾ä¸­çš„ä¸´åºŠåº”ç”¨.

OBJECTIVES: To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS). METHODS: A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis. RESULTS: Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment. CONCLUSIONS: Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.

Integrin α4ß1/VCAM-1 Interaction Evokes Dynamic Cell Aggregation Between Immune Cells and Human Lung Microvascular Endothelial Cells at Infectious Hemolysis.

Bacterial and viral infection is a common cause of pneumonia, respiratory failure, and even acute respiratory distress syndrome. Increasing evidence indicates that red blood cells (RBCs) may contribute to immune response and inflammation. However, the precise molecular mechanisms that link RBC and hemolysis to the development and progression of inflammatory pathologies are not entirely understood. In this study, we used bacterial endotoxin, lipopolysaccharide (LPS), to mimic an infectious hemolysis and found that RBCs dynamically regulated cell aggregation between immune cells and human lung microvascular endothelial cells (HLMVEC). When RBCs were treated with LPS, integrin α4ß1 was increased and was accompanied by cytokines and chemokines release (TNF-α, IL-1ß, IL-6, IL-8, IFN-γ, CXCL12, CCL5, CCL7 and CCL4). Upon α4ß1 elevation, RBCs not only facilitated mature monocyte derived dendritic cell (mo-DCs) adhesion but also promoted HLMVEC aggregation. Furthermore, co-culture of the supernatant of LPS pre-treated RBCs with mo-DCs could promote naïve CD4 T cell proliferation. Notably, the filtered culture from LPS-lysed RBCs further promoted mo-DCs migration in a concentration dependent manner. From a therapeutic perspective, cyclic peptide inhibitor of integrin α4ß1 combined with methylprednisolone (α4ß1/Methrol) remarkably blocked RBCs aggregation to mo-DCs, HLMVEC, or mo-DCs and HLMVEC mixture. Moreover, α4ß1/Methrol dramatically reduced mo-DCs migration up-regulated glucocorticoid-induced leucine zipper in mo-DCs, and ultimately reversed immune cell dysfunction induced by hemolysis. Taken together, these results indicate that integrin α4ß1 on RBCs could mediate cell-cell interaction for adaptive immunity through influencing cell adhesion, migration, and T cell proliferation.

Penicilliosis marneffei in HIV negative children: three case reports.

This study aimed to report the clinical characteristics of penicilliosis marneffei (PSM) in three children negative to HIV. Three children were diagnosed with PSM in the Department of Emergency Medicine, Hunan Children's Hospital between February 2016 to July 2020. The clinical characteristics, laboratory findings, and concomitant diseases were recorded, and the related literatures were reviewed. The clinical characteristics and treatment of PSM were reported according to our experience and literature review. The initial symptom was right lower limb mass in 1 child (first) who developed fever and cough about 1 month later and then was misdiagnosed with tuberculosis. The other child (second) had a fever, reductions in red blood cells, white blood cells and platelets, hepatosplenomegaly and lymphadenectasis. The third child had fever, jaundice, multiple organ dysfunction syndrome (MODS), hepatosplenomegaly and lymphadenectasis. The first child (Case 1) had STAT1 gene mutation on genetic examination, and the second child (Case 2) had history of onychomycosis and oral ulcer, the third child (Case 3) had STAT3 gene mutation on genetic examination, diagnosed with Hyperimmunoglobulin E syndromes (HIES). PSM was confirmed in all cases by the culture bone marrow. All three cases were diagnosed through medulloculture. Case 1 and Case 2 also had lymph node biopsy. Case 3 had sputum culture and bronchoalveolar lavage fluid (BALF). The first child was intravenously administered with voriconazole and amphotericin B liposomes, and orally administered with itraconazole for maintenance therapy, which was discontinued 1 year later. The second child was administered with voriconazole intravenously and thereafter orally for a total of 7 months. Recurrence was not observed. The third child was given amphotericin B for 2 days (discontinued due to liver dysfunction), and intravenous voriconazole for 4 days. The patient gave up therapy finally. In conclusion, HIV negative children can also develop PSM, and may be related to the STAT1/STAT3 gene mutation. For children having no response to antibiotic or antiviral therapy, bacterial/fungal culture or biopsy should be performed as soon as possible to confirm the diagnosis, and physicians should actively identify the underlying diseases of PSM patients, which is beneficial for the early diagnosis, early treatment and improvement of prognosis.

[Impact of continuous blood purification on T cell subsets in children with severe sepsis].

OBJECTIVE: To investigate the impact of continuous blood purification (CBP) on T-cell subsets and prognosis in children with severe sepsis. METHODS: A total of 42 children with severe sepsis were randomly divided into a control group (n=22) and a CBP group (n=20). The patients in the control group received conventional treatment, while those in the CBP group underwent continuous veno-venous hemofiltration daily 12-24 hours for 3 days besides conventional treatment. Changes in clinical variables and in peripheral blood regulatory T cell subsets were assessed 3 and 7 days after treatment. RESULTS: The pediatric intensive care unit length of stay and duration of mechanical ventilation were significantly shortened and the 28-day mortality rate was significantly lower in the CPB treatment group as compared with the control group (P<0.05). In the CBP treatment group, the percentage of CD3(+), CD4(+), CD8(+) T cell populations and PCIS scores were significantly higher at 3 and 7 days after treatment than before treatment (P<0.05). At 7 days after treatment, the percentage of CD3(+), CD4(+), CD8(+) T cell populations, CD4(+)/CD8(+) ratio and PCIS scores were significantly higher in the CBP group than in the control group (P<0.05). CONCLUSIONS: The CBP treatment may counteract the suppression of immune function and thus improve prognosis in children with severe sepsis.

[Clinical risk factors for capillary leak syndrome in children with sepsis].

OBJECTIVE: To investigate the clinical features of capillary leak syndrome (CLS) in children with sepsis, and to analyze its risk factors. METHODS: Clinical data of 384 children with sepsis was studied retrospectively. They included 304 cases of general sepsis, 54 cases of severe sepsis and 26 cases of septic shock, and were divided into non-CLS (n=356) and CLS groups (n=28). Univariate analysis was performed for each of the following variables: sex, age, malnutrition, anemia, coagulation disorders, white blood cell count, C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor (TNF), interleukin (IL)-1, IL-6, blood glucose, lactic acid, Pediatric Risk of Mortality (PRISM) III score, pediatric critical illness score (PICS), severe sepsis and number of failed organs≥3. The statistically significant variables (as independent variables) were subjected to multivariate logistic regression analysis. RESULTS: The incidence rate of CLS in children with septic shock, severe sepsis and general sepsis were 42.3%, 20.1% and 1.3%, respectively, with significant differences among them (P<0.01). There were significant differences in anemia, coagulation disorders, CRP, PCT>2 ng/mL, TNF, IL-1, IL-6, blood glucose, lactic acid, PRISM III score, PICS and number of failed organs≥3 between the non-CLS and CLS groups (P<0.05). Severe sepsis/shock and PRISM III score were the independent risk factors for CLS in children with sepsis. CONCLUSIONS: The severity of sepsis and PRISM III score are positively correlated with the incidence of CLS in children with sepsis. Early monitoring of such factors as infection markers and blood glucose in children with severe sepsis and high PRISM III score may contribute to early diagnosis and effective intervention, thus reducing the mortality from CLS in children with sepsis.

[Relationship between blood lactate level and disease severity in critically ill children].

OBJECTIVE: To study the relationship between blood lactate level and disease severity in critically ill children. METHODS: The clinical data of 232 children who were critically ill between September and December, 2010 were retrospectively studied. According to blood lactate levels within 24 hrs of admission, the 232 patients were classified into three groups: normal (n=146), high lacticemia (n=72) and lactic acidosis (n=14). The circulation functions, pediatric critical illness scores and prognosis were compared among the three groups. RESULTS: The degree of sepsis among the three groups was different (χ2 = 13.592, P<0.01). The occurrence of septic shock in the lactic acidosis group (42.9%) was significant compared with that in the normal (7.5%) and the high lacticemia groups (11.1%). The pediatric critical illness scores were different among the three groups (χ2 = 12.854, P<0.05). The blood lactate level was significantly negatively correlated with the pediatric critical illness scores (r=-0.405, P=0.002). The prognosis among the three groups was also varied (χ2 = 25.599, P<0.01). The curative rate (7.1% vs 23.3%; P<0.05) and the improvement rate (28.6% vs 58.2%; P<0.05) in the lactic acidosis group were significantly lower than in the normal group, and the mortality (28.6%) was significantly higher than in the normal (5.5%) and the high lacticemia groups (6.9%). CONCLUSIONS: A higher blood lactic acid level is associated with a more severe illness state and a worse prognosis.

[Correlation of hypoproteinemia with C-reactive protein and procalcitonin in children with sepsis].

OBJECTIVE: To investigate the correlation of hypoproteinemia with inflammation parameters C-reactive protein (CRP), procalcitonin (PCT) and WBC in children with sepsis. METHODS: Seventy-three children with sepsis (including 22 severe sepsis) and 40 non-sepsis children (control group) were enrolled. Serum albumin levels were measured on admission. Based on the level of serum albumin, 73 cases of sepsis were classified into three groups: mild hypoproteinemia, severe hypoproteinemia and normal albumin. Blood CRP, PCT and WBC levels were compared in the three groups. The correlation of CRP, PCT and WBC with serum albumin level was evaluated. RESULTS: Serum albumin levels in the sepsis groups (severe or non-severe) were significantly lower than those in the control group (P<0.05), and the severe sepsis group showed more decreased albumin levels compared with the non-severe sepsis group (P<0.05). Blood CRP, PCT and WBC levels in the mild hypoproteinemia group were higher than those in the normal albumin group (P<0.05), and the severe hypoproteinemia group showed more increased blood CRP, PCT and WBC levels compared with the mild hypoproteinemia group (P<0.05). The incidence of multiple organ failure in the severe hypoproteinemia group was significantly higher than that in the normal albumin group (P<0.05). Serum albumin levels were negatively correlated with blood CRP, PCT and WBC levels. CONCLUSIONS: Serum albumin levels decrease in children with sepsis, and the more serious the illness, the lower serum albumin levels, resulting in a worse prognosis. CRP, PCT and WBC are negatively correlated to serum albumin levels in children with sepsis.