Sputum signatures for invasive pulmonary aspergillosis in patients with underlying respiratory diseases (SPARED): study protocol for a prospective diagnostic trial.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) has been increasingly reported in patients with underlying respiratory diseases (URD). Early diagnosis of IPA is crucial for mortality reduction and improved prognosis, yet remains difficult. Existing diagnostic tools for IPA largely rely on the detection of biomarkers based on serum or bronchoalveolar lavage fluid (BALF), both of which have their limitations. The use of sputum sample is non-invasive, and Aspergillus detection is feasible; however, the usefulness of sputum biomarkers for the diagnosis of IPA, especially in patients with URD, has not been systematically studied. METHODS: This is a prospective diagnostic trial. At least 118 participants will be recruited from respiratory wards and intensive care units. IPA is defined according to the EORTC/MSG criteria modified for patients with URD. Induced sputum and blood will be collected, and BALF will be obtained by bronchoscopy. Sputum biomarkers, including galactomannan, Aspergillus DNA, triacetylfusarinine and bis(methylthio)gliotoxin will be determined, and the presence of a JF5 antigen will be examined with a lateral fluid device. The sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratio will be computed for different biomarkers and compared using the McNemar χ2 test. Receiver operating characteristic analyses will be performed, and the cut-off values will be established. Participants will receive follow-up evaluations at 3 months and 6 months after recruitment. The difference in hospital stay and survival will be analysed, and the relationships between the levels of biomarkers and hospital stay and survival will be analysed via regression models. DISCUSSION: We have developed and verified the feasibility of Aspergillus-related biomarker assays for sputum. The study findings will contribute to a novel look at the diagnostic performance of sputum biomarkers in IPA and provide important insight into the improvement of the early diagnosis of IPA, particularly in patients with URD. TRIAL REGISTRATION: This study has been registered with the Chinese Clinical Trial Registry ( ChiCTR-DPD-16009070 ) on 24th of August 2016.

Tanreqing Injection Attenuates Lipopolysaccharide-Induced Airway Inflammation through MAPK/NF-κB Signaling Pathways in Rats Model.

Background. Tanreqing injection (TRQ) is a commonly used herbal patent medicine for treating inflammatory airway diseases in view of its outstanding anti-inflammatory properties. In this study, we explored the signaling pathways involved in contributions of TRQ to LPS-induced airway inflammation in rats. Methods/Design. Adult male Sprague Dawley (SD) rats randomly divided into different groups received intratracheal instillation of LPS and/or intraperitoneal injection of TRQ. Bronchoalveolar Lavage Fluid (BALF) and lung samples were collected at 24 h, 48 h, and 96 h after TRQ administration. Protein and mRNA levels of tumor necrosis factor- (TNF-) α, Interleukin- (IL-) 1ß, IL-6, and IL-8 in BALF and lung homogenate were observed by ELISA and real-time PCR, respectively. Lung sections were stained for p38 MAPK and NF-κB detection by immunohistochemistry. Phospho-p38 MAPK, phosphor-extracellular signal-regulated kinases ERK1/2, phospho-SAPK/JNK, phospho-NF-κB p65, phospho-IKKα/ß, and phospho-IκB-α were measured by western blot analysis. Results. The results showed that TRQ significantly counteracted LPS-stimulated release of TNF-α, IL-1ß, IL-6, and IL-8, attenuated cells influx in BALF, mitigated mucus hypersecretion, suppressed phosphorylation of NF-κB p65, IκB-α, ΙKKα/ß, ERK1/2, JNK, and p38 MAPK, and inhibited p38 MAPK and NF-κB p65 expression in rat lungs. Conclusions. Results of the current research indicate that TRQ possesses potent exhibitory effects in LPS-induced airway inflammation by, at least partially, suppressing the MAPKs and NF-κB signaling pathways, in a general dose-dependent manner.

[Analysis on the current situation of neglected rural children aged 0 - 6 years and its impact factors in the western areas of China].

OBJECTIVE: To learn the current neglected situation and its impact factors on rural children in two provinces in Western China. METHODS: The investigation was conducted by using multistage stratified cluster sampling method in some parts of the Shanxi province and the city of Chongqing. RESULTS: 1488 subjects, aged from 0 to 6, were recruited in the present study. Results showed that the total prevalence rates of neglected rural children in the two research sites were 31.59% and 48.32 respectively. No significant difference was found on the prevalence of neglected for boys and girls (χ(2) = 0.86, U = 1.51, P > 0.05). The degrees of negligence in the older children showed a significant increase than in the younger children (χ(2) = 13.36, F = 33.45, P < 0.05). The prevalence and degree of negligence in families with three generations were lower than that of a single-parent families and remarried families (H = 10.03, F = 2.83, P < 0.05). The one-child-families were significantly lower than multiple children families, both in terms of prevalence and degree of negligence. Our data demonstrated the degrees of negligence in children whose parents were away from home, were higher than the children whose parents stayed with them (χ(2) = 30.30, U = 6.76, P < 0.05). The degree of negligence in Shanxi was lower than that in Chongqing (χ(2) = 9.42, U = 8.40, P < 0.05). Based on multivariate non-conditional logistic regression analysis, the determinants of stunting among the stranded children were as follows: parents were away from home (OR = 1.54, 95%CI: 1.20 - 1.97); structure of the family (OR = 1.38, 95%CI: 1.16 - 1.65); father's occupation (OR = 0.87, 95%CI: 0.78 - 0.97); schooling of the children's mother (OR = 1.27, 95%CI: 1.07 - 1.52); relationship between children and their fathers (OR = 1.43, 95%CI: 1.07 - 1.91) etc. CONCLUSION: The situation of negligence in children living in the rural areas, were serious in Shanxi and Chongqing provinces, which called for the strengthening on the publicity and education of the issue. School and the society should also pay more attention to this problem.

[The current situation of children neglect and its influencing factors for rural children aged 0 - 6 years in Chongqing].

OBJECTIVE: To learn the current situation of children neglect and its influencing factors among children aged from 0 - 6 years in rural Chongqing. METHODS: Scales and evaluation methods in the "Chinese rural child neglected evaluation model" were used in this study. The investigation was conducted by using multistage stratified cluster sampling method in December 2010, and 822 rural children aged 0 to 6 years of three districts in Chongqing were randomly select for the survey, with neglect rate and the neglect degree to describe their neglect status, using logistic regression analysis to analyze factors affecting children neglect. RESULTS: The total neglect rate and the neglect degree in the rural children were 35.64% (293/822) and 49.69 ± 6.45, respectively. The neglect degree in boys was higher than that of girls (boys: 50.23 ± 6.40 vs girls: 49.09 ± 6.47, P < 0.05). Further, Our data demonstrated both the neglect rate and the neglect degrees in children whose parents away from home were higher than that of the children whose parents stayed with them (neglect rate: 40.48% (202/499) vs 28.17% (91/323), P < 0.05; neglect degree: 50.64 ± 6.29 vs 48.23 ± 6.44, P < 0.05). Based on multivariate unconditional logistic regression analysis, the determinants of children neglect were: parents were away from home (OR = 1.61, 95%CI: 1.17 - 2.21), single mother and remarried family (OR = 1.39, 95%CI: 1.10 - 1.76), maternal occupation(OR = 0.81, 95%CI: 0.73 - 0.90), estrangement relationship between children and their mothers (OR = 1.42, 95%CI: 1.02 - 1.97). CONCLUSION: The neglect situation of rural children is serious in Chongqing, and the main factors are parents away from home, single mother and remarried family, maternal occupation, and estrangement relationship between children and their mothers.

[The situation of children neglect between left-behind children and living-with-parents children in rural areas of two western provinces of China].

OBJECTIVE: To understand the children neglect situation of left-behind children (children who do not grow up with their parents) and non-left-behind children in China's western rural and its influencing factors. METHODS: Scales and evaluation methods in the "Chinese rural child neglected evaluation model" were used in this study. The investigation was conducted by using multistage stratified cluster sampling method; three countries were sampled randomly in Shanxi and Chongqing in November 2010, respectively. And, in every county, children from rural area aged from zero to six were randomly selected, with neglect rate and degree to describe their neglected status, using logistic regression analysis to analyze factors affecting the neglect rate. RESULTS: Among 1568 subjects (859 left-behind and 709 living-with-parents), the total neglect rates were 29.78% (467/1568), and the total neglect degrees were 48.51 ± 6.49; the neglect rates for left-behind ones and living-with parents ones were 34.34% (295/859) and 24.26% (172/709) (P < 0.05); the neglect degree were 49.59 ± 6.54 and 47.19 ± 6.18 (P < 0.05). The neglect degree among left-behind ones and living-with parents ones between 0 to 2 years old were 48.59 ± 6.33 and 45.78 ± 5.94 (P < 0.05); in 3 to 6 years old group, which were 50.43 ± 6.60 and 48.25 ± 6.16(P < 0.05). The degrees in boy's group of these two kinds of children were 49.83 ± 6.67, 47.36 ± 6.28(P < 0.05) and girl's were 49.32 ± 6.38, 47.01 ± 6.08 (P < 0.05). On the other side, the neglect rate of left-behind and non-left-behind children between 0 to 2 years old were 39.33% (153/389) and 18.54% (56/302) (P < 0.05). The rates of boy's group were 34.91% (162/464) and 25.13% (94/374) (P < 0.05), and girl's were 33.67% (133/395) and 23.28% (78/335) (P < 0.05). Results showed that if the left-behind child's father was with lower education background, and the child and his mother feel stranger to each other, which led to the conclusion there was more chance for them to be neglected (OR values were 1.29 and 1.55, P < 0.05). If the non-neglected child's father was farmer or migrant worker and the relationship between the mother and father was poor, then there was more chance for them to be neglected (OR values were 0.85 and 1.92, P < 0.05). CONCLUSION: The situation of children neglect in the western rural regions in China is serious. Both the neglect rate and degree among left-behind children are higher than those living-with-parents children. The influencing factors of neglect rate are different in the two groups.