Coinfection of viruses in children with community-acquired pneumonia.

BACKGROUND: Virus, particularly respiratory tract virus infection is likely to co-occur in children with community-acquired pneumonia (CAP). Study focusing on the association between common viruses coinfection and children with CAP is rare. We aimed to study the association between seven common viruses coinfection and clinical/laboratory indexes in children with CAP. METHODS: Six hundred and eighty-four CAP cases from our hospital were enrolled retrospectively. Seven common viruses, including influenza A (FluA), influenza B (FluB), human parainfluenza virus (HPIV), Esptein-Barr virus (EBV), coxsackie virus (CoxsV), cytomegalovirus (CMV), and herpes simplex virus (HSV) were investigated for their associations with CAP. We analyzed the differences of hospitalization days, white blood cell (WBC), c-reactive protein (CRP), platelet (PLT), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), urine red blood cell (uRBC), blood urea nitrogen (BUN), serum creatinine (Scr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CKMB) among different viruses coinfection groups by using one-way ANOVA analysis. The differences of clinical/laboratory indexes between ordinary and severe pneumonia groups, as well as non-virus vs multi co-infection viruses groups, and single vs multi co-infection viruses groups by using independent samples T test. Receiver operating characteristic (ROC) curve analyses were applied to test the the predictive value of the clinical/laboratory parameters for the risk of viruses coinfections among CAP. Binary logistic analysis was performed to test the association between various indexes and viruses co-infection. RESULTS: Eighty-four multiple viruses coinfections yielded different prognosis compared with that in 220 single virus coinfection. CMV coinfection was associated with longest hospitalization days, highest ALT, AST and CKMB level. HSV coinfection was associated with highest WBC count, CRP, ESR, and BUN. EBV coinfection was associated with highest PLT and PCT level. FluB coinfection was associated with highest Scr level. CoxsV coinfection was associated with highest uRBC, LDH and CK level. ROC curve analyses showed that CK had the largest area under the curve (AUC: 0.672, p < 10-4) for the risk of viruses coinfections risk in CAP. Significant association between PLT, uRBC, BUN, CK, and CKMB and virus coinfection risk in CAP was observed. CONCLUSIONS: Multiple viruses coinfections indicated different prognosis. Different viruses coinfection yielded varying degrees of effects on the cardiac, liver, kidney and inflamatory injury in CAP. The alterations of clinical/laboratory parameters, particularly CK may be associated with the risk of viruses coinfections in CAP.

Prevalence and distribution patterns of allergens among children with asthma and asthma-like symptoms in Shanghai, China.

OBJECTIVE: We aimed to identify the prevalence and distribution patterns of allergens among Chinese children with asthma/asthma-like symptoms (ALS). METHODS: A total of 3479 children with asthma/ALS were enrolled. Skin prick test (SPT) was used to test the allergen-specific IgE. We analysed allergens prevalence and distribution, and its relationship with demographic characteristics. RESULTS: Aeroallergens prevalence was higher than that of food allergens (p < 10- 4). Boys had higher aeroallergens prevalence than that in girls (p < 10- 4). Significant difference of aeroallergens prevalence among cases with different parental allergy history was observed (p < 10- 4). Age was positively associated with aeroallergens prevalence before the age of 11.5 (P < 10- 4), particularly before the age of 2.42 (P < 10- 4). Age was negatively associated with aeroallergens prevalence after the age of 11.5 (P = 0.021). Age was negatively associated with food allergens prevalence before the age of 3.42 (P < 10- 4). Age was associated with the intensity of dermatophagoides farinae (DF)/house dust mite (HDM) allergens (P < 10- 4). Age was negatively associated with the intensity of shrimp, and crab allergens before the age of 3.3 and 3.3, respectively (P = 0.012, < 10- 4). Boys had higher intensity of DF and HDM allergens than that in girls (P < 10- 4, P < 10- 4). Significant differences of the intensity of DF and HDM allergens among groups with different parental allergy history were noted (P < 10- 4, P < 10- 4). CONCLUSIONS: Boys and parental allergy history were associated with higher prevalence and intenstity of aeroallergens. Age was positively and negatively associated with aeroallergens prevalence before and after the age of 11.5, respectively. Age was negatively associated with food allergens prevalence before the age of 3.42.

Onset of asthma-like symptoms in children with lower respiratory tract infections.

BACKGROUND: Asthma-like symptoms (ALS) often occur among children with lower respiratory tract infections (LRTIs). We aimed to determine the potential risk factors for ALS onset in LRTIs children. METHODS: A total of 102 LRTIs with ALS and 474 without ALS were enrolled. The relative risk (RR) was used to test the influence of the clinical factors on the ALS risk. We compared the differences of birth data, wheezing history, disease severity, inflammatory markers, infectious pathogens, allergic markers, cardiac, liver, and kidney injury markers between LRTIs with and without ALS onset. Receiver operating curve (ROC) analysis was applied to determine the predictive value of various markers in the ALS risk in LRTIs. Multivariate logistic regression analysis was performed to evaluate the association between various clinical and laboratory parameters and ALS onset in LRTIs. RESULTS: The RRs of boys/girls ratio and wheezing history for ALS compared with non-ALS was 1.263 and 2.850, respectively (P = .026, <10-4 ). There were significant differences of age, WBC, PLT, EOS, and CK between LRTIs with and without ALS onset (P = .004, .041, .006, .049, and .035). ROC analysis showed that significant associations between the parameters of age, WBC, and PLT and ALS risk among LRTIs were observed. Multivariate logistic regression analysis showed that the clinical and laboratory parameters were not independently associated with the risk of ALS onset among LRTIs. CONCLUSIONS: Lower age, male, inflammation, and allergic state were risk factors for ALS onset in LRTIs. Comprehensive monitoring and evaluation of these factors may be helpful for ALS prevention.

Association between the PAI-1 4G/5G Gene Polymorphism and the Risk of Systemic Lupus Erythematosus/Lupus Nephritis.

Plasminogen activator inhibitor type 1 (PAI-1) correlates with the risk and progression of systemic lupus erythematosus (SLE). We aimed to assess the relationship between the PAI-1 4G/5G gene polymorphism and SLE/lupus nephritis risk. We identified the eligible studies regarding the association between the PAI-1 4G/5G gene polymorphism and the risk of SLE/lupus nephritis. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a fixed-effects model or, in the presence of heterogeneity, a random-effects model. A total of six studies were enrolled in our pooled analysis. The PAI-1 4G/5G gene polymorphism had no significant association with the risk of SLE among overall populations, Asians and Caucasians. Nor was it associated with susceptibility to lupus nephritis among overall populations, Asians and Caucasians. Sensitivity analysis yielded similar results. No marked publication bias was noted. In conclusion, the PAI-1 4G/5G gene polymorphism is not associated with susceptibility to SLE/lupus nephritis among overall populations, Asians and Caucasians. However, more studies should be conducted in the future.

Diagnostic and Prognostic Value of Red Blood Cell Distribution Width in Children with Respiratory Tract Infections.

BACKGROUND: Respiratory tract infections (RTIs) are the most common disorders among children. Red blood cell distribution width (RDW) was proven to be associated with the prognosis of many diseases, including chronic obstructive pulmonary disease. METHODS: We aimed to evaluate the diagnostic and prognostic value of RDW level in children with RTIs. A total of 1,044 RTI cases and 115 healthy controls in our center were involved in this study. We compared the differences of RDW level among different groups of RTI cases and controls. Receiver operating curve (ROC) analysis was applied to determine the predictive value of RDW level in the risk of various groups of RTIs. Clinical and laboratory parameters were compared between RTIs with RDW > 14% and ≤ 14%. Correlation analyses were conducted to investigate the relationship between RDW and RTIs' clinical and laboratory parameters. RESULTS: Significant differences of RDW levels between tonsillitis without suppression and with suppression (p = 0.024), bronchitis and pneumonia (p = 0.008), non-mycoplasma pneumonia and mycoplasma pneumonia (p < 10-4), and total RTIs and healthy controls (p < 10-4) were observed. Significant associations between RDW level and pneumonia, mycoplasma pneumonia, and total RTI risk were observed (ROC = 0.560, p = 0.022; ROC = 0.537, p = 0.043; ROC = 0.863, p < 10-4). Significant differences of WBC, PLT, ESR, Scr, and CK levels were observed between RTIs with RDW > 14% and ≤ 14%. RDW level was significantly associated with WBC, PLT, Scr, ALT, LDH, and CKMB. CONCLUSIONS: RDW was a non-invasive, low-cost, and widely available predictor for the risk and progression of RTIs. RDW level may reflect the disease course among RTIs.

Leptin and chronic kidney diseases.

Chronic kidney diseases (CKD), a common outcome of various kidney diseases, cause a series of refractory complications, which lead to great economic burdens on patients. The clinical outcomes of CKD depend on various factors, including metabolic disorders. Leptin, a peptide hormone, produced in adipose tissues, plays an important role in regulating food consumption and energy expenditure. Leptin also influences the immune system and hematopoiesis. Increased leptin status is observed in CKD, leptin deficiency attenuates the immune response in nephritis. Conversely, leptin inhibits the development of obesity, which is closely associated glomerular disorder. Now, the precise role of leptin in CKD remains elusive. This review will give an integrated understanding of the potential role of leptin and its interactions with other signal molecules in CKD.

Association Between Vitamin D Status and Sepsis.

BACKGROUND: It is well-established that vitamin D status is closely associated with the susceptibility to infections. We aimed to study the association between vitamin D status and sepsis risk and death, and also analyzed the correlation between vitamin D level and sepsis-related factors. METHODS: We searched the articles regarding the association between vitamin D level and sepsis through May 2017 in electronic databases. We pooled the data and analyzed the association between vitamin D level and sepsis risk, death, and albumin (ALB), mortality, body mass index (BMI), procalcitonin (PCT), male/female ratio, interleukin-6 (IL-6), platelet (PLT), c-reactive protein (CRP) and white blood cell (WBC). RESULTS: Twenty-four studies were included. The pooled results demonstrated that sepsis cases had significantly lower levels of vitamin D than non-sepsis cases in overall populations, Caucasians, and Africans (p < 0.05). Vitamin D status was not correlated with ALB, PLT, WBC, mortality, PCT, BMI, male/female ratio, IL-6 and CRP levels (p > 0.05) in sepsis cases. Sepsis death was not associated with vitamin D deficiency (p > 0.05). CONCLUSIONS: Lower status of vitamin D may be a biomarker of sepsis risk in overall populations, Caucasians, and Africans. Vitamin D level has no impact on the biochemical indexes and prognosis of sepsis. However, further studies should be performed in the future.

Effects of recombinant IL-17F intranasal inoculation against Streptococcus pneumoniae infection in a murine model.

Interleukin-17F (IL-17F) is an important member of IL-17 cytokine family, which plays important roles in host defense against microbial infections. Streptococcus pneumoniae is a common pathogen associated with several invasive and noninvasive pneumococcal diseases, and mucosal immune response plays crucial roles in defenses against pneumococcal infection. Thus, intranasal inoculation may be an alternative approach against pneumococci. In this study, BALB/c mice were intranasally inoculated with recombinant IL-17F (rIL-17F) prior to S. pneumoniae (American Type Culture Collection 6303, serotype 3) infection. As compared with the control group, numbers of total leukocyte, neutrophil, and macrophage in lungs were significantly increased in mice inoculated with rIL-17F. The levels of macrophage inflammatory protein 1α (MIP-1α), MIP-2ß, and interferon γ were significantly increased in bronchoalveolar lavage fluid and culture supernatant of splenocytes from mice inoculated with rIL-17F. rIL-17F inoculation also significantly elevated ß-defensin-2 expression in lung tissues. Furthermore, compared with S. pneumoniae infection group, rIL-17F inoculation prior to infection significantly reduced S. pneumoniae colonization in lungs. These findings demonstrated that rIL-17F intranasal inoculation strengthened host defense against pneumococci, which may be developed to prevent pneumococcal infection.

Changing trend of neonatal Ca/P/Mg status in a Chinese population.

Background: Calcium (Ca), phosphorus (P), and magnesium (Mg) are essential elements for keeping the body homeostasis. We aimed to investigate the changing trend of serum levels of Ca/P/Mg in neonates. Methods: We enrolled 82 premature newborns, 173 neonatal sepsis, 50 neonatal hypoglycemia, 254 neonatal jaundice, 43 neonatal haemolytic disease, and 59 healthy controls in our retrospective study. Serum levels of Ca/P/Mg were collected and expressed in quarters. We analysed the association between neonatal disorders and Ca/P/Mg levels (fourth quarter vs. first quarter) using binary logistic regression analysis. Smooth curve analysis was performed to analyze the non-linear association between birthweight/procalcitonin (PCT) and Ca/P levels. Threshold effect analysis was also performed to yield the turning point of birthweight/PCT in their associations with Ca/P levels. Results: Binary logistic regression analyses showed that neonatal haemolytic disease, hypoglycemia, sepsis, jaundice, and prematurity were all significantly associated with the fourth quarter of Ca level (P<10-4; P<10-4; P<10-4; P=0.001; and P<10-4, respectively). Neonatal hypoglycemia and prematurity were significantly associated with the fourth quarter of P level (P=0.004; and P=0.003, respectively). Neonatal haemolytic disease, hypoglycemia, sepsis, jaundice and prematurity were not associated with Mg level. Birthweight was significantly associated with Ca level before and after the turning point of 3,220 grams. PCT was significantly associated with Ca level before and after the turning point of 16.8 µg/L. Birthweight was significantly associated with P level before the turning point of 2,990 gram. PCT was significantly associated with P level before the turning points of 3.5 and 34.21 µg/L. Conclusions: Neonatal disorders demonstrated a decreasing trend of serum Ca/P level. A significantly non-linear association was observed between birthweight/PCT and serum Ca/P levels.

Risk prediction for liver injury in Epstein-Barr virus infection in pediatric respiratory tract infections.

BACKGROUND: Epstein-Barr virus (EBV) infection is likely to co-occur in pediatric respiratory tract infections (RTIs). Liver injury is the common complication of EBV infection. The detailed risk factors for liver injury in EBV infection remain elusive. We aimed to investigate the incidence, characteristics and potential risk factors for liver injury in EBV infection for early risk prediction. METHODS: We retrospectively recruited the pediatric RTIs cases with EBV infection according to a predefined criteria from our hospital between January 2015 and December 2017. We extracted the clinical and laboratory data from the electronical medical records. The impact of age, gender, and various parameters on the liver injury risk was investigated. Univariate logistic regression analysis was performed to analyse the association between clinical/laboratory parameters and liver injury. The related indexes were enrolled in the multivariate logistic regression analysis. Decision curve analysis was used to yield the value of related parameters in predicting liver injury. Receiver operating curve (ROC) analysis was applied to produce the C-index of white blood cell (WBC) count for liver injury. We also tested the non-linear association between WBC count and alanine aminotransferase (ALT). RESULTS: A total of 216 pediatric RTIs with EBV infection were enrolled. EBV infection is more likely to occur during the winter season. Cytomegalovirus infection was independently associated with liver injury in EBV infection (OR = 6.972, 95% CI = 1.648-29.490, p = 0.008). WBC count was independently associated with liver injury in EBV infection (OR = 1.169, 95% CI = 1.051-1.301, p = 0.004). The P interaction value between WBC count and cytomegalovirus was 0.149. The decision curve analysis showed that WBC count had larger area under curve compared with platelet (PLT) and birthweight (BW). ROC analysis yielded the c-index of WBC count: 0.75 and cut-point of 8.3. The turning point of WBC count in its association with ALT was 16.8. The p value before and after the turning point was < 0.001 and 0.123, respectively. CONCLUSIONS: Cytomegalovirus co-infection demonstrated 5.972 more times of liver injury risk in EBV infection. WBC count was an independent biomarker for liver injury before the turning point of 16.8 in EBV infection. More attention should be paid to the risk of EBV infection in the winter. Cytomegalovirus infection and WBC count merit attention in the monitoring of possible liver injury in EBV infection among pediatric RTIs.

Calcium, phosphorus, magnesium levels in frequent respiratory tract infections.

BACKGROUND: It was well documented that calcium (Ca), phosphorus (P), and magnesium (Mg) participate in many physiological processes. We aimed to study the changing trend of serum levels of Ca, P, and Mg in frequent respiratory tract infections (FRTI) in children. METHODS: A retrospective study was performed in our centre. A total of 213 FRTI cases and 33 controls were enrolled in our study. We analyzed the correlation between serum Ca/P/Mg levels and inflammatory indexes by using Spearman correlation analysis. Standard mean difference (SMD) was applied to test the differences of serum Ca/P/Mg levels between FRTI subgroups and controls. In terms of the findings of SMD between Ca/P/Mg status between FRTI subgroups and controls, receiver operating characteristics (ROC) curve analysis was further applied to test the association between serum Ca level and bronchitis, parainfluenza virus infection, influenza B virus infection and cytomegalovirus infection. RESULTS: Serum Ca level was significantly associated with white blood cell (WBC), platelet (PLT) and procalcitonin (PCT) (p = 0.006; p < 10-4; p = 0.004). Serum P level was markedly associated with eryhtrocyte sedimentation rate (ESR) and PCT (p = 0.018; p < 10-4). Controls showed significantly lower serum Ca level than that among bronchitis (p = 0.001), parainfluenza virus infection (p = 0.027), influenza B virus infection (p = 0.017), cytomegalovirus infection (p = 0.029), and two pathogens infected (p = 0.020). ROC curve analysis showed that serum Ca level was significantly associated with bronchitis (p = 0.047) and influenza B virus infection (p = 0.049). CONCLUSIONS: Serum levels of Ca and P may reflect the inflammatory status in children with FRTI. Alteration of serum Ca level may predict the risk of bronchitis and influenza B virus infection. Keeping the homeostasis of Ca, P, and Mg may be important for the prevention and treatment of FRTI.

Serum status of Ca and P was closely associated with the inflammatory status in children with frequent respiratory tract infections.Changes of serum Ca status may predict the susceptibility to bronchitis and influenza B virus infection in children with frequent respiratory tract infections.Homeostasis of Ca, P, and Mg status may be important for the prevention and treatment of frequent respiratory tract infections in children.

[Effects of andrographolide on the expression of eosinophil granulocytes and possible mechanisms].

OBJECTIVE: Andrographolide, the active component in andrographis paniculata, has potent anti-inflammatory actions. This study aimed to evaluate the effects of andrographolide on eosinophil granulocytes (EOS) and the expression of eotaxin and IL-5 in mice with asthma. METHODS: BALB/c mice were randomly assigned into normal control, asthma, budesonide treatment and andrographolide treatment groups (n=8 each). Mice in the latter three groups were sensitized and challenged with ovalbumin (OVA) to induce asthma. ELISA was used to detect the concentrations of eotaxin and IL-5 in bronchoalveolar lavage fluid (BALF) and peripheral blood. The expression of eotaxin mRNA and IL-5 mRNA in lung tissues was detected by real-time quantitative PCR. RESULTS: Andrographolide treatment significantly decreased EOS count in BALF (P<0.05) and the effect of andrographolide was better than the effect of budesonide. Andrographolide treatment significantly down-regulated the expression of eotaxin and IL-5 in BALF, lung eotaxin mRNA expression and blood IL-5 expression (P<0.05), but the effects of andrographolide were poorer than the effects of budesonide. Andrographolide treatment resulted in a decrease in blood eotaxin expression and lung IL-5 mRNA expression and the effects of andrographolide were similar to budesonide. CONCLUSIONS: Andrographolide can down-regulate the expression of IL-5 and eotaxin and thus suppress the inflitration of EOS in a mouse model of asthma.

A prediction study of IL-18 and IFN-γ in glucocorticoid treatment response in infants and young children with severe Mycoplasma pneumoniae pneumonia.

Background: In infants and young children, the clinical decision to apply glucocorticoids to severe Mycoplasma pneumoniae pneumonia (SMPP) is more an empirical choice with reference to clinical symptoms, but the effect is not satisfying. We aimed to explore and identify early predictive indicators of ideal response to glucocorticoids treatment in SMPP in infants and young children. Methods: We retrospectively reviewed the data of 59 patients, which met the age range and diagnostic criteria, admitted to Department of Pediatrics, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University, from January to December 2017. Patients were divided into a glucocorticoid treatment group and a normal treatment group according to whether glucocorticoid treatment was used, and the difference in therapeutic effectiveness was compared between two groups. The glucocorticoid treatment group was further subdivided into effective versus ineffective treatment groups dependent on the difference of glucocorticoid treatment effect in main clinical symptoms improvement. We obtained the test value of biomarkers by ELISA, and identified several specific indicators with significantly different expressions in the early stage by independent sample t-tests and calculated their cut-off values by ROC curve. Results: Thirty-one SMPP patients who received glucocorticoid treatment were divided into effective and ineffective treatment groups according to the clinical improvements shown on different days of glucocorticoid use. The expression of two markers, interleukin-18 (IL-18) and interferon-γ (IFN-γ), were significantly different in cases showing improvement in the early stage of SMPP (P<0.05), and the cut-off values for IL-18 (218.19 pg/mL, AUC =0.581, sensitivity =0.909, 1-specificity =0.786) and IFN-γ (11.24 pg/mL, AUC =0.566, sensitivity =0.905, 1-specificity =0.795) were identified. Conclusions: The expressions of IL-18 and IFN-γ in the early stage of SMPP might suggest their predictive effect of early application of glucocorticoid for effective treatment of SMPP in infants and young children. Further study with larger sample size will be carried on in the future.

[Pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia].

OBJECTIVE: To investigate the changes of pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia (SMPP). METHODS: A total of 55 children with SMPP were recruited into this study. Pulmonary functions were measured at both acute and recovery phases, including FVC, FEV1, FEV1/FVC, PEF, FEF25%, FEF50%, FEF75% and FEF25%-75%. RESULTS: FVC, FEV1, FEV1 /FVC, PEF, FEF25%, FEF50%, FEF75%, and FEF25%-75% were reduced in all of the 55 cases at the acute phase. FEF25%, FEF50%, FEF75% and FEF25%-75% decreased more significantly. The indexes above mentioned were improved significantly at the recovery phase compared with the acute phase (P<0.05). During the acute phase FVC and FEV1 decreased more significantly in the group with multiple area lesions than in the group with single area lesions (P<0.05). CONCLUSIONS: Both large and small airway functions are damaged in different degrees in children with SMPP during the acute phase. More cases show restrictive ventilatory disorders and the injury of small airway function is more severe. The pulmonary function is markedly improved at the recovery phase, suggesting that the pulmonary function impairments are reversible. The pulmonary function impairments are more severe in children with multiple area lesions.

Penehyclidine hydrochloride alleviates lipopolysaccharide­induced acute respiratory distress syndrome in cells via regulating autophagy­related pathway.

Acute progressive hypoxic respiratory failure caused by various predisposing factors is known as acute respiratory distress syndrome (ARDS). Although penehyclidine hydrochloride (PHC), an anticholinergic drug, is widely applied in clinical practice, the specific mechanisms underlying PHC in the treatment of ARDS are not completely understood. In the present study, BEAS­2B cells were treated with 10 ng/ml lipopolysaccharide (LPS) to establish an ARDS cell model and a rat model of acute lung injury (ALI). The influences of PHC and/or autophagy inhibitor (3­methyladenine (3­MA)) on the morphology, autophagy, proliferation and apoptosis of cells and tissues were evaluated using hematoxylin and eosin staining, Cell Counting Kit­8 assays, Hoechst staining, TUNEL staining, flow cytometry, immunofluorescence assays, ELISAs and scanning electron microscopy. The expression levels of apoptosis­ and autophagy­related proteins were measured via western blotting. The results indicated that PHC enhanced proliferation and autophagy, and decreased apoptosis and the inflammatory response in LPS­induced BEAS­2B cells and ALI model rats. In addition, 3­MA reversed the effects of PHC on proliferation, inflammation, apoptosis and autophagy in LPS­induced BEAS­2B cells. Therefore, the present study suggested that PHC demonstrated a protective effect in LPS­induced ARDS by regulating an autophagy­related pathway.

Traditional Chinese medicine injection for the treatment of viral pneumonia in children: A protocol for systematic review and meta-analysis.

BACKGROUND: In recent years, more and more reports are focused on the application of traditional Chinese medicine injection (TCMJ) for the treatment of viral pneumonia. There are about 200 million cases of viral pneumonia worldwide every year, half of which are children. At present, many kinds of TCMJ are created for the treatment of viral pneumonia in children, with good therapeutic effects. However, there are many kinds of TCMJ, and the treatment advantages are different, thus bringing difficulties to the selection of clinical drugs. In order to provide evidence-based evidence support for the clinical selection of TCMJ for the treatment of viral pneumonia in children, this study selected the commonly used TCMJ for clinical treatment of viral pneumonia for meta-analysis to evaluate its efficacy. METHODS: The Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, Viper information databases, Cochran library Web of Science, PubMed, MEDLINE and EMBASE will be searched. The literature will be searched, with language restriction in English and Chinese. The related reference will be retrieved as well. Two reviewers will independently extract data and perform quality assessment of included studies. Review Manager 5.3 will be applied to conduct this meta-analysis. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal once we finish this study. CONCLUSIONS: This study provides reliable evidence-based evidence for the efficacy of TCMJ in the treatment of viral pneumonia in children. ETHICS AND DISSEMINATION: We will not be allowed to publish private information from individuals. This kind of systematic review should not harm the rights of participants. No ethical approval was required. The results can be published in peer-reviewed journals or at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/795MB.

Association between MCP-1 2518 A>G gene polymorphism and chronic kidney disease.

Monocyte chemoattractant protein-1 (MCP-1) is involved in the pathogenesis of chronic kidney diseases (CKD). MCP-1 2518 A>G gene polymorphism is associated with MCP-1 status. We performed a meta-analysis to assess the association between MCP-1 2518 A>G gene polymorphism and CKD risk. The eligible studies regarding the relationship between MCP-1 2518 A>G gene polymorphism and CKD risk were searched through electronic databases. The pooled odds ratios (ORs) and its 95% confidence intervals (CIs) were calculated by using a fixed-effects model, or in the presence of heterogeneity, a random-effects model. A total of 2415 cases and 2011 controls were recruited in our investigation. A allele/GG genotype was not associated with CKD risk in overall populations, Asians, Caucasians, and Africans. AA/AG genotype was not associated with the risk of CKD in overall populations, Asians, Caucasians, and Africans. AA genotype was associated with a lower risk of CKD in Caucasians (OR 0.816, 95% CI 0.703-0.947). AG genotype was associated with a higher risk of CKD in Caucasians (OR 1.230, 95% CI 1.042-1.452). There was no marked publication bias. In conclusion, AA genotype may be a protective factor against CKD susceptibility in Caucasians. AG genotype may be a risk factor for CKD risk in Caucasians. However, more studies are needed in the future.

Association between trace elements levels and asthma susceptibility.

BACKGROUND: It is well-documented that the dysregulation of trace elements may be involved in the pathogenesis of asthma. However, the precise changes of trace elements levels in asthma cases remain elusive. We established whether trace elements levels were associated with asthma susceptibility by pooling case-control studies. METHODS: 34 studies were included. We extracted the standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs). A pooled-analysis was performed. RESULTS: No marked difference (95% CI: -1.437-0.218, p = 0.149) of Se level between asthma and controls. Significant difference (95% CI: 0.112-1.032, p = 0.015; 95% CI: 0.376-1.331, p < 10-4) of Cu level between asthma and controls was noted among overall populations and Asians. No marked difference of Zn level between asthma and controls was observed among overall populations, Asians, Caucasians and Africans. Significant difference (95% CI: -0.567 to -0.238, p < 10-4) of Mg level between asthma and controls was noted among Asians. Marked difference (95% CI: 0.258-2.864, p = 0.019; 95% CI: 0.270-3.282, p = 0.021) of Fe level between asthma and controls was noted among overall populations and Asians. Age had no impact on the pooled SMDs of Se, Cu, Zn, Mg and Fe between asthma and controls. Sensitivity analyses did not change the overall results. No publication bias was noted for overall populations. CONCLUSIONS: Alterations of Cu, Mg and Fe levels may be a biomarker of asthma risk among specific populations. Further studies should be performed to clarify the strength of these elements in asthma.

Association between klotho expression and malignancies risk and progression: A meta-analysis.

BACKGROUND: We assessed the association between tissue klotho protein expression and the risk and progression of malignancies. METHODS: We searched the electronic databases for the studies regarding the relationship between tissue klotho protein expression and risk/progression of malignancies through January 2018. We calculated the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) to evaluate the impact of tissue klotho protein expression on malignancies. A fixed-effect model, or in the presence of heterogeneity, random- effect model was applied to calculate the combined ORs. RESULTS: Eighteen studies were recruited in our pooled-analysis. Overall malignancies including liver cancer, pancreatic ductal adenocarcinoma (PDAC), ovarian cancer, esophageal squamous cell carcinoma (ESCC), neuroendocrine cancer, oral cancer and bladder cancer demonstrated significantly lower ORs than those in controls (p < 0.05). Malignancies with tissue klotho protein expression showed a pooled hazard ratio (95% CI 0.784-2.479). Malignancies with tissue klotho protein expression showed a similar OR (95% CI 0.732-1.335) of male/total to cases without tissue klotho protein expression. Malignancies with tissue klotho protein expression showed a markedly lower OR (95% CI 0.454-0.941) of metastasis compared with those without tissue klotho protein expression. Malignancies with tissue klotho protein expression showed a markedly higher OR (95% CI 1.041-1.800) of stage I-II/III-IVcompared with those without tissue klotho protein expression. Malignancies with tissue klotho protein expression showed a similar OR (95% CI 0.948-3.407) of differentiation to cases without tissue klotho protein expression. Sensitivity analysis did not change the overall results significantly. No marked publication bias was noted. CONCLUSIONS: Tissue klotho protein expression was associated with a lower risk and progression of malignancies. Klotho may be a protective factor against malignancies risk/progression.

Intranasal Administration of Recombinant Mycobacterium smegmatis Inducing IL-17A Autoantibody Attenuates Airway Inflammation in a Murine Model of Allergic Asthma.

Asthma is a chronic inflammatory disorder, previous studies have shown that IL-17A contributes to the development of asthma, and there is a positive correlation between the level of IL-17A and the severity of disease. Here, we constructed recombinant Mycobacterium smegmatis expressing fusion protein Ag85A-IL-17A (rMS-Ag85a-IL-17a) and evaluated whether it could attenuate allergic airway inflammation, and further investigated the underlying mechanism. In this work, the murine model of asthma was established with ovalbumin, and mice were intranasally vaccinated with rMS-Ag85a-IL-17a. Autoantibody of IL-17A in sera was detected, and the airway inflammatory cells infiltration, the local cytokines and chemokines production and the histopathological changes of lung tissue were investigated. We found that the administration of rMS-Ag85a-IL-17a induced the autoantibody of IL-17A in sera. The vaccination of rMS-Ag85a-IL-17a remarkably reduced the infiltration of inflammatory cells and the secretion of mucus in lung tissue and significantly decreased the numbers of the total cells, eosinophils and neutrophils in BALF. Th1 cells count in spleen, Th1 cytokine levels in BALF and supernatant of splenocytes and mediastinal lymph nodes, and T-bet mRNA in lung tissue were significantly increased with rMS-Ag85a-IL-17a administration. Meanwhile, rMS-Ag85a-IL-17a vaccination markedly decreased Th2 cells count, Th2 cytokine and Th17 cytokine levels in BALF and supernatant of splenocytes and mediastinal lymph nodes, and chemokines mRNA expression in lung tissue. These data confirmed that recombinant Mycobacterium smegmatis in vivo could induce autoantibody of IL-17A, which attenuated asthmatic airway inflammation.