The impact of the COVID-19 pandemic on RSV outbreaks in children: A multicenter study from China.

OBJECTIVE: The aim of the study is to describe the season of RSV prevalence in China during the COVID-19 pandemic. METHODS: This multicenter retrospective study analyzed the epidemiology of pediatric RSV infections and the possible factors contributing to its variations in China from January 1, 2019, to October 31, 2022. RESULTS: A total of 872,565 children were included. During the pandemic, RSV detection rate increased across various regions, including South China, East China, Central China, and Northeast China. From 2019 to 2021, the detection rates of RSV showed an increasing trend among children aged <1 year, 1-2 years, and 3-5 years, but decreased in 2022. Among those tested positive for RSV, the proportion of children under 1 year old significantly decreased during the pandemic. The spring season of RSV in China in 2020 was shortened, and most regions experienced a summer season of RSV in 2021. This shift led to a year-round RSV outbreak throughout 2021. After April 2022, RSV positive rate significantly decreased, and no clear seasonal pattern was observed. CONCLUSION: Our study found that the COVID-19 pandemic has disrupted the seasonal pattern of RSV outbreaks in China, leading to increased RSV positive rate and off-season outbreaks.

Effect of High-Intensity vs Low-Intensity Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: The HAPPEN Randomized Clinical Trial.

Importance: The effect of high-intensity noninvasive positive pressure ventilation (NPPV) on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) is unknown. Objective: To determine whether the use of high-intensity NPPV vs low-intensity NPPV reduces the need for endotracheal intubation in patients with an acute exacerbation of COPD and hypercapnia. Design, Setting, and Participants: Randomized clinical trial conducted at 30 general respiratory non-intensive care unit wards of Chinese hospitals from January 3, 2019, to January 31, 2022; the last 90-day follow-up was on April 22, 2022. The included patients had an acute exacerbation of COPD and a Paco2 level greater than 45 mm Hg after receiving 6 hours of low-intensity NPPV. Interventions: Patients were randomized 1:1 to receive high-intensity NPPV with inspiratory positive airway pressure that was adjusted to obtain a tidal volume 10 mL/kg to 15 mL/kg of predicted body weight (n = 147) or to continue receiving low-intensity NPPV with inspiratory positive airway pressure that was adjusted to obtain a tidal volume of 6 mL/kg to 10 mL/kg of predicted body weight (n = 153). Patients in the low-intensity NPPV group who met the prespecified criteria for the need for endotracheal intubation were allowed to crossover to high-intensity NPPV. Main Outcomes and Measures: The primary outcome was the need for endotracheal intubation during hospitalization, which was defined by prespecified criteria. There were 15 prespecified secondary outcomes, including endotracheal intubation. Results: The trial was terminated by the data and safety monitoring board and the trial steering committee after an interim analysis of the first 300 patients. Among the 300 patients who completed the trial (mean age, 73 years [SD, 10 years]; 68% were men), all were included in the analysis. The primary outcome of meeting prespecified criteria for the need for endotracheal intubation occurred in 7 of 147 patients (4.8%) in the high-intensity NPPV group vs 21 of 153 (13.7%) in the low-intensity NPPV group (absolute difference, -9.0% [95% CI, -15.4% to -2.5%], 1-sided P = .004). However, rates of endotracheal intubation did not significantly differ between groups (3.4% [5/147] in the high-intensity NPPV group vs 3.9% [6/153] in the low-intensity NPPV group; absolute difference, -0.5% [95% CI, -4.8% to 3.7%], P = .81). Abdominal distension occurred more frequently in the high-intensity NPPV group (37.4% [55/147]) compared with the low-intensity NPPV group (25.5% [39/153]). Conclusions and Relevance: Patients with COPD and persistent hypercapnia in the high-intensity NPPV group (vs patients in the low-intensity NPPV group) were significantly less likely to meet criteria for the need for endotracheal intubation; however, patients in the low-intensity NPPV group were allowed to crossover to high-intensity NPPV, and the between-group rate of endotracheal intubation was not significantly different. Trial Registration: ClinicalTrials.gov Identifier: NCT02985918.

Clinical features and recurrence predictors of histiocytic necrotizing lymphadenitis in Chinese children.

OBJECTIVES: To characterize the clinical features and to identify the predictors of recurrence of histiocytic necrotizing lymphadenitis (HNL) in Chinese children. STUDY DESIGN: This study retrospectively analyzed the clinical characteristics, laboratory and pathological findings, and recurrence status of children diagnosed with HNL at a single center in China from January 2018 to May 2023. Logistic regression analysis was employed to identify predictors of HNL recurrence. RESULTS: 181 Chinese children with histopathologically confirmed HNL were enrolled (121 males and 60 females). The mean age was 9.3 ± 2.9 years. The most prominent clinical features were fever (98.9%) and cervical lymphadenopathy (98.3%). Aseptic meningitis was the most frequent complication (38.5%), while hemophagocytic lymphohistiocytosis and autoimmune disease were rare (1.7% and 1.2%, respectively). Recurrence occurred in 12.7% of patients. Erythrocyte sedimentation rate (> 30 mm/h) was the significant predictors of HNL recurrence, with odds ratios of 6.107, respectively. CONCLUSION: Our study demonstrates that fever and cervical lymphadenopathy are the most frequent clinical manifestations of HNL in Chinese children, which often coexist with aseptic meningitis. HNL patients with risk factors require follow-up for recurrence.

Pulmonary Thrombotic Complication of Mycoplasma pneumoniae Pneumonia in Chinese Children: Clinical Feature and Risk Factor Analysis.

BACKGROUND: Thrombotic disease is a rare but severe complication of Mycoplasma pneumoniae pneumonia in children, with pulmonary thrombosis (PT) being the most frequent type. This study aims to describe the clinical features of pediatric severe Mycoplasma pneumoniae pneumonia (SMPP) patients with PT, and to identify risk factors predictive of PT development in this population. METHODS: We retrospectively enrolled 60 children with SMPP complicated by PT who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2019 to October 2023. We reviewed their demographic data, laboratory tests and imaging examinations to describe their clinical features. We used multivariate logistic regression analysis to identify significant risk factors for PT in SMPP. RESULTS: The PT group exhibited higher incidences of chest pain, hemoptysis, inflammation and elevated D-dimer levels, as well as more severe pulmonary damage and transaminitis complication, compared to the non-PT group. The left pulmonary artery was the predominant location of PT in SMPP children. A multivariate analysis revealed that C-reactive protein (CRP) and D-dimer were significant predictors of PT in SMPP patients, with odds ratios of 1.10 and 3.37, respectively. The optimal cutoff values of CRP and D-dimer for predicting PT in SMPP were 76.73 mg/L and 3.98 µg/mL, respectively. CONCLUSIONS: In SMPP, CRP >76.73 mg/L and D-dimer >3.98 µg/mL are independent predictors of PT. These findings suggest that SMPP-induced excessive inflammation may contribute to PT pathogenesis. Early and intensive anticoagulant, anti-inflammatory and antimycoplasma therapy may improve the disease course and prognosis.

Efficacy and safety of aerosol inhalation of recombinant human interferon α1b (IFNα1b) injection for noninfluenza viral pneumonia, a multicenter, randomized, double-blind, placebo-controlled trial.

BACKGROUND: To investigate the efficacy and safety of aerosol inhalation of recombinant human interferon α1b (IFNα1b) injection for noninfluenza viral pneumonia. METHODS: One hundred sixty-four patients with noninfluenza viral pneumonia were divided into IFNα1b and control groups. The IFNα1b group received routine treatment + aerosol inhalation of recombinant human IFNα1b injection (50 µg × 2 injections, bid). The control group received routine treatment + IFN analog (two injections, bid). Overall response rate (ORR) of five kinds clinical symptoms. Further outcomes were daily average score and the response rate of each of the symptoms above. RESULTS: A total of 163 patients were included in the full analysis set (FAS) and 151 patients were included in the per-protocol set (PPS). After 7 days of treatment, ORR of clinical symptoms was higher in IFNα1b group than that in control group for both the FAS and PPS. Moreover, after 7 days of treatment, the daily score of three efficacy indexes including expectoration, respiratory rate, and pulmonary rales were improved. The ORRs for expectoration and pulmonary rales were higher in the IFNα1b group than in the control group (P < 0.05). There were no significant differences of the ORRs for coughing, chest pain and respiratory rate between the two groups (P > 0.05). The incidence of adverse events was 6.5% (n = 5) in IFNα1b group and 3.5% (n = 3) in control group (P > 0.05). CONCLUSION: Aerosol inhalation of recombinant human IFNα1b is safe and it can improve the clinical symptoms of noninfluenza viral pneumonia.

Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network.

Although broad knowledge of influenza viral pneumonia has been established, the significance of non-influenza respiratory viruses in community-acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in the non-immunocompromised adult population.Hospitalised immunocompetent patients with CAP were prospectively recruited from 34 hospitals in mainland China. Respiratory viruses were detected by molecular methods. Comparisons were conducted between influenza and non-influenza viral infection groups.In total, 915 out of 2336 adult patients with viral infection were enrolled in the analysis, with influenza virus (28.4%) the most frequently detected virus, followed by respiratory syncytial virus (3.6%), adenovirus (3.3%), human coronavirus (3.0%), parainfluenza virus (2.2%), human rhinovirus (1.8%) and human metapneumovirus (1.5%). Non-influenza viral infections accounted for 27.4% of viral pneumonia. Consolidation was more frequently observed in patients with adenovirus infection. The occurrence of complications such as sepsis (40.1% versus 39.6%; p=0.890) and hypoxaemia (40.1% versus 37.2%; p=0.449) during hospitalisation in the influenza viral infection group did not differ from that of the non-influenza viral infection group. Compared with influenza virus infection, the multivariable adjusted odds ratios of CURB-65 (confusion, urea >7 mmol·L-1, respiratory rate ≥30 breaths·min-1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years) ≥3, arterial oxygen tension/inspiratory oxygen fraction <200 mmHg, and occurrence of sepsis and hypoxaemia for non-influenza respiratory virus infection were 0.87 (95% CI 0.26-2.84), 0.72 (95% CI 0.26-1.98), 1.00 (95% CI 0.63-1.58) and 1.05 (95% CI 0.66-1.65), respectively. The hazard ratio of 90-day mortality was 0.51 (95% CI 0.13-1.91).The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza respiratory viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza respiratory viruses.

Synthesis of [H22·Zr5·WO4·10 P2O7]n·26n H2O by response surface methodology to adsorb Ca(II) in manganiferous wastewater.

The presence of calcium challenges the manganese recovery from manganiferous wastewater. In this paper, a kind of mesoporous material named [H22·Zr5·WO4·10 P2O7]n·6n H2O is investigated as an ion exchanger to remove calcium ion from manganese slag percolate. The synthesis of zirconium tungstopyrophosphate (ZWPP) was optimized by response surface methodology , and its adsorption capacity and equilibrium were tested. The adsorption data have been confirmed by the use of various techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy and Brunauer, Emmett and Teller. An empirical formula of ZWPP was obtained by X-ray diffraction and thermal analysis. The adsorption process conformed to pseudo-second-order kinetics and the Langmuir isotherm, which described the equilibrium powerfully. Furthermore, different thermodynamic parameters were evaluated. And it was found that Gibbs free energy change is negative, indicating the adsorption process was spontaneous, whereas the enthalpy change and entropy change are positive indicating endothermy and increased randomness nature of the adsorption process. As a result, ZWPP could be a possible ion exchanger material in the area of removing Ca2+ from processing water or wastewater.

Construction of adsorptive nanorods from polyoxometalates and ionic liquid and their adsorption properties for silver ion from AMD.

A new structure of hybrid nanorods adsorbent ([n-BBIM]9PW9O34) was synthesized by a simple molecular assembly of polyoxometalates with ionic liquids (ILs). The nanocomposite was characterized by Fourier transform infrared (FT-IR), ultraviolet-visible (UV-Vis), scanning electron microscope, energy dispersive X-ray and X-ray diffractometer. Adsorption of silver from acid mine drainage (AMD) was studied using batch experiments. The impact of several parameters, like ion concentration, pH, adsorbent dosage, and temperature was elucidated and optimization was carried out by single-factor experiment and response surface methodology. Analysis of variance of the quadratic model suggested that experimental data were excellently fitted to the quadratic model. Optimum conditions for removal of Ag(+) from AMD were determined to be an initial concentration 143 mg/L, adsorbent dosage 2.69 g/L, temperature 35 °C to achieve the maximum adsorption of Ag(+) 99.03%, which was very close to the predicted value (100%). The adsorption was confirmed as oxidation-reduction mechanism following a complexation process, and has been verified according to results from FT-IR and UV-vis spectra. The selective experiment suggested that the nanorods adsorbent could adsorb silver ions in AMD well. Based on the adsorption/desorption study result, the adsorbent can be efficiently recovered.

Magnolol reduces bleomycin-induced rodent lung fibrosis.

Magnolol, a compound extracted from the Chinese medicinal herb Magnolia officinalis, has been proved to exert multiple pharmacological effects, including anti-oxidant and anti-inflammation activities. In this study, how it influenced bleomycin-induced lung fibrosis of rats was investigated. A single intratracheal instillation of bleomycin (5 mg/Kg, sacrificed 7 and 28 days post bleomycin instillation) caused body weight decrease and lung indices increase. Hodroxyproline content, myeloperoxidase (MPO) activity, tumor necrosis factor-α (TNF-α) and transforming growth factor-ß (TGF-ß) levels increased in the rat lung tissues after bleomycin administration, while superoxide dismutase (SOD) activity decreased in the rat lung tissues. Collagen were excessively deposited in rat lung tissues after bleomycin treatment. However, oral administration of magnolol (10 mg/Kg, 20 mg/Kg, 30 mg/Kg) apparently and significantly inhibited the fibrotic process. It partly reversed the bleomycin-induced increase of hydroxyproline content, MPO activity, TNF-α and TGF-ß levels in the lung tissues, significantly inhibited the bleomycin-induced decrease of SOD activity, Excessive collagen deposition was also inhibited by magnolol administration. In summary, our results suggested that magnolol might be a potent anti-inflammatory and anti-fibrotic agent against bleomycin-induced lung fibrosis.

Magnetic Zn (II) ion-imprinted polymer prepared by the surface imprinting technique and its adsorption properties.

A novel magnetic Zn (II) ion-imprinted polymer was prepared by the surface ion-imprinted technique by using magnetic Fe3O4@SiO2 microspheres as supporter, methacrylic acid and salicylaldoxime as monomers, ethylene glycol dimethacrylate as the crosslinker. The products were characterized by Fourier transform infrared, X-ray photoelectron spectrometer, vibrating sample magnetometer and scanning electron microscope. The adsorption experiments showed that the imprinted polymer was employed successfully in comparison with non-imprinted polymer. When the temperature was in a range of 291-297 K, the maximum adsorption was about 52.69 mg g(-1) with an optimal pH 6.0 for an equilibrium time of 40 min. The imprinted polymer possessed high selectivity and specific recognition towards Zn (II). The Langmuir adsorption model was more favourable than the Freundlich or the Temkin adsorption model. Thermodynamic experiment showed that the adsorption was a spontaneous and endothermic process for Zn (II). The mechanism for Zn (II) adsorption on the imprinted polymer was investigated.

[Etiologic characteristics of adult patients with community-acquired pneumonia in Beijing].

OBJECTIVE: To explore the etiologic characteristics of adult patients with community-acquired pneumonia (CAP) in Beijing. METHODS: A multicenter cohort of 510 adult CAP patients were enrolled from Beijing during the period of November 2010 to May 2012. Multiplex polymerase chain reaction (PCR), real-time fluorescence quantitative PCR and legionella urinary antigen were used to detect common respiratory viruses, Mycoplasma pneumoniae and legionella respectively. Bacteria were detected by sputum culture, blood culture and Streptococcus pneumoniae urinary antigen. Statistical analyses were performed for the etiologic characteristics and seasonal distribution of detected pathogens. RESULTS: Pathogens were detected in 240/500 (47.1%) study patients. The mixed infection of different pathogens was present in 42 cases (8.2%), viruses in 164 (32.2%), Mycoplasma pneumoniae in 91 (17.8%), bacteria in 26 (5.1%) and Legionella in 3 (0.6%). Among 164 patients infected with viruses, 194 viral strains were detected. Influenza virus represented the greatest proportion with 105 (54.1%) in viral infections. Between November 2010 to October 2011, Influenza A infections increased gradually in November 2010, peaked in February 2011 and declined by March 2011 in China. Mycoplasma pneumoniae was predominant in winter and spring. CONCLUSIONS: There is a high detection rate of virus and Mycoplasma pneumoniae in adult CAP patients in Beijing. And more consideration should be given to influenza virus and Mycoplasma pneumoniae infections in winter and early spring.

Chromium removal with cross-linked chitosan adsorption and base-precipitation combination.

A novel technique for a complete removal of both Cr(VI) and Cr(III) ions, namely cross-linked chitosan (CCTS) adsorption and base-precipitation combination, was studied in this work in great detail. The optimum conditions for Cr(VI) adsorption onto CCTS were determined as a function of pH, CCTS dosage and contact time, while Cr(III) precipitation was investigated as a function of pH value. The Langmuir, Freundlich and Dubinin-Radushkevich (D-R) models were applied to describe the Cr(VI) adsorption isotherm on CCTS. The Langmuir model agreed much better with experimental data than the Freundlich and D-R by a correlation coefficient (R²) of 0.994. The capacity and ΔG° of CCTS for Cr(VI) were 70.4 mg/g and -26.6 kJ/mol respectively, indicating the feasible and spontaneous nature of the Cr(VI) sorption process. This combined technique was applied for real wastewater treatment from the electroplating industry and obtained a one-off retention in solution not more than 0.5 mg/L for both Cr(VI) and Cr total. These results meet the Chinese standards for effluent discharge.