Construction and Validation of a Nomogram Model to Predict the Severity of Mycoplasma pneumoniae Pneumonia in Children.

Background: This study aimed to develop a nomogram model for early prediction of the severe Mycoplasma pneumoniae pneumonia (MPP) in children. Methods: A retrospective analysis was conducted on children with MPP, classifying them into severe and general MPP groups. The risk factors for severe MPP were identified using Logistic Stepwise Regression Analysis, followed by Multivariate Regression Analysis to construct the nomogram model. The model's discrimination was evaluated using a receiver operating characteristic curve, its calibration with a calibration curve, and the results were visualized using the Hosmer-Lemeshow goodness-of-fit test. Results: Univariate analysis revealed that age, duration of fever, length of hospital-stay, decreased sounds of breathing, respiratory rate, hypokalemia, and incidence of co-infection were significantly different between severe and general MPP. Significant differences (p < 0.05) were also observed in C-reactive protein, procalcitonin, peripheral blood lymphocyte count, neutrophil-to-lymphocyte ratio, ferritin, lactate dehydrogenase, alanine aminotransferase, interleukin-6, immunoglobulin A, and CD4+ T cells between the two groups. Logistic Stepwise Regression Analysis showed that age, decreased sounds of breathing, respiratory rate, duration of fever (OR = 1.131; 95% CI: 1.060-1.207), length of hospital-stay (OR = 1.415; 95% CI: 1.287-1.555), incidence of co-infection (OR = 1.480; 95% CI: 1.001-2.189), ferritin level (OR = 1.003; 95% CI: 1.001-1.006), and LDH level (OR = 1.003; 95% CI: 1.001-1.005) were identified as risk factors for the development of severe MPP (p < 0.05 in all). The above factors were applied in constructing a nomogram model that was subsequently tested with 0.862 of the area under the ROC curve. Conclusion: Age, decreased sound of breathing, respiratory rate, duration of fever, length of hospital-stay, co-infection with other pathogen(s), ferritin level, and LDH level were the significant contributors for the establishment of a nomogram model to predict the severity of MPP in children.

Environmental exposure to per- and polyfluoroalkyl substances mixture and asthma in adolescents.

BACKGROUND: Previous epidemiological studies about the relationship between per- and polyfluoroalkyl substances (PFAS) concentrations and adolescent asthma have typically examined single PFAS, without considering the mixtures effects of PFAS. METHODS: Using data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES), 886 adolescents aged 12-19 years were included in this study. We explored the association between PFAS mixture concentrations and adolescent asthma using weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models, respectively. RESULTS: After adjusting for confounders, the results of the WQS regression and BKMR models were consistent, with mixed exposure to the five PFAS not significantly associated with asthma in all adolescents. The association remained nonsignificant in the subgroup analysis by sex. CONCLUSIONS: Our study demonstrated no significant association between mixed exposure to PFAS and adolescent asthma, and more large cohort studies are needed to confirm this in the future.

Invasive pulmonary and central nervous system aspergillosis in a child: A case report and literature review.

RATIONALE: Children with haematological malignancies have a higher risk of developing aggressive pulmonary aspergillosis and a higher mortality rate. The most common site of extrapulmonary aspergillosis in children is the central nervous system (CNS), and the death rate is higher when CNS is affected. Therefore, early diagnosis and treatment of invasive aspergillosis are essential for reducing mortality. PATIENT CONCERNS: We report a case of an 8-year-old girl with acute lymphoblastic leukaemia who developed invasive pulmonary aspergillosis complicated by CNS aspergillosis. Aspergillus was confirmed by metagenomic sequencing of pathogenic microorganisms. DIAGNOSES: Invasive pulmonary and central nervous system aspergillosis. INTERVENTIONS: The patient was treated with combined systemic antifungal agents (voriconazole and liposomal amphotericin B) and intrathecal injection of amphotericin B. OUTCOMES: The treatment was well tolerated and resulted in remarkable clinical and radiological head improvements. LESSONS: Invasive aspergillosis has a high mortality rate and requires early diagnosis and treatment. Pathogenic microbial metagenomic sequencing is a convenient method to assist in the early diagnosis of aspergillosis. Voriconazole is the drug of choice for the treatment of invasive aspergillosis. When CNS aspergillosis occurs, it can be combined with other systemic antifungal drugs and intrathecal injection of amphotericin B.

Serum perfluoroalkyl substances and growth and development in US adolescents: a nationally representative cross-sectional study.

Per- and polyfluoroalkyl substances (PFAS), synthetic organic chemicals, have been discovered in the blood of both humans and animals throughout the world. This has raised widespread concerns about its toxicity, especially for growing children and adolescents. Most research on growth and development to date has concentrated on children at birth and during the first two years, while few studies have analyzed weight, height, and Body Mass Index (BMI) changes in children later in life. The present study aims to assess the association between serum PFAS levels and growth and development in adolescents. Through multiple linear regression, we explored the relationship between serum PFAS levels and weight, height, and BMI in adolescents (aged 12 to 19 years) participating in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). After covariate adjustment, serum perfluorooctane sulfonic acid (PFOS) was associated with decreased weight-for-age z-score in females (tertile 2 of PFOS: ß = - 0.22, 95% CI: -0.68, 0.23; tertile 3 of PFOS: ß = - 0.78, 95% CI: -1.20, - 0.36; P for trend = 0.009), while serum perfluorononanoic acid (PFNA) was associated with decreased weight-for-age z-score in males (tertile 2 of PFNA: ß = 0.09, 95% CI: -0.40, 0.58; tertile 3 of PFNA: ß = - 0.44, 95% CI: -0.86, - 0.03; P for trend = 0.018).In addition, serum PFOS was associated with decreased BMI z-score in all participants (tertile 2 of PFOS: ß = - 0.15, 95% CI: -0.46, 0.16; tertile 3 of PFOS: ß = - 0.63, 95% CI: -1.06, - 0.20; P for trend = 0.013). CONCLUSION: Our findings indicate a negative association between serum PFAS levels and weight, and BMI among adolescents, and we observed that the negative association was sex-specific in weight. WHAT IS KNOWN: • Wide exposure to PFAS has led to concerns about its adverse effects, especially for children during their growth and development. • So far, much research has evaluated the effects of prenatal PFAS exposures on children, and the current results are mixed, with some research showing that there are sex differences. WHAT IS NEW: • This study investigated the relationship between serum PFAS levels and height and weight in adolescents and is a good addition to current research. • Our study found that exposure to PFAS negatively affects adolescent growth and development and that this effect is sex-specific.

Experimental Study on the Physicochemical Properties of Asphalt Modified by Different Anti-Stripping Agents and Their Moisture Susceptibility with Aggregates.

Erosion and the stripping effect of moisture on asphalt mixtures is one of the main reasons for the shortened service life of asphalt pavements. The common mean of preventing asphalt pavements from being damaged by moisture is adding anti-stripping agents (ASAs) to asphalt mixtures. However, the effect regularity and mechanism of anti-stripping agents on the physicochemical properties of asphalt is not exactly defined. This study compared the physical properties of ASA-modified asphalt (AMAs) to determine the optimal dosage and investigated the rheological and adhesion properties. Based on the roller bottle method and water immersion method, the moisture susceptibility of AMAs with three particle sizes was investigated. The results showed that the modification of asphalt using anti-stripping agents was a physical modification. At the optimum dosage of anti-stripping agents (0.3%), the basic physical properties of AMA1 were the most desirable. ASA2 increased the resistance of asphalt for deformation at high temperature by 46%, and AMA3 had the best low-temperature performance. ASAs enhanced the dispersed and polar components in the asphalt binder, improving the adhesion energy of asphalt. AMA3 had the strongest adhesion to the aggregate, with an increase in adhesion work by 2.8 times and a 45% of increase in ER value. This was attributed to ASA3 containing with a large number of metal cations and polar functional groups. It was shown that ASAs provided the most improvement in the anti-stripping performance of asphalt mixtures with 9.5-13.2 mm particles. The amide ASA, phosphate ASA and aliphatic amine ASA improved the water damage resistance of asphalt by 65%, 45% and 78%, respectively. This study can help engineers realize the effects of different types of ASAs on the physicochemical properties of asphalt and select the most suitable type of ASAs according to the service requirements.

Association between PFAS congeners exposure and asthma among US children in a nationally representative sample.

Over the past few decades, contamination with perfluorinated and polyfluoroalkyl substances (PFAS) has gradually become a worldwide problem. Now that common PFAS such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are being phased out and replaced, people may be exposed to other PFAS congeners, and their potential hazards should be fully studied. We assessed the association of serum PFAS levels (as biomarkers of exposure) with asthma, including 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH), pefluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), using data from participants aged 3-11 from the 2013-2014 National Health and Nutrition Examination Surveys (n = 525), where PFAS was modeled as a binary variable.Me-PFOSA-AcOH (1.36; 95% CI 0.77, 2.38), PFDA (1.33; 95% CI 0.76, 2.33), and PFUnDA (1.89; 95% CI 0.83, 4.35) were nonsignificantly associated with increased odds of asthma. Age, sex, and race/ethnicity modified associations between serum PFUnDA, not other serum PFAS congeners exposure, and odds of asthma. Specifically, for male participants, the OR = 3.06 and 95% CI 1.23-7.62 for serum PFUnDA exposure; for participants aged 3-7 years old, the OR = 3.55 and 95% CI 1.04-12.10 for serum PFUnDA exposure; for non-Hispanic White participants, the OR = 3.44 and 95% CI 1.14-10.36 for serum PFUnDA exposure, all of which exhibited a significantly positive relationship. This cross-sectional study provides some evidence for associations between exposure to PFAS congeners and asthma in children. We believe this relationship deserves further exploration. More large-scale epidemiologic studies are needed to evaluate the association of serum PFAS congeners, especially for PFUnDA exposure, with asthma among children.

Swelled Mechanism of Crumb Rubber and Technical Properties of Crumb Rubber Modified Bitumen.

Crumb rubber modified bitumen (CRMB) has excellent high-temperature performance and fatigue resistance, and is widely used in asphalt pavement to cope with increasing traffic axle load and changing climate. Under conventional preparation conditions, the swelling degree of CR can directly impact the comprehensive properties of CRMB; however, physical and chemical properties research on swelling crumb rubber (SCR) and crumb rubber recycled bitumen (CRRB) in CRMB is relatively lacking. In this paper, the working performance of CRMB and CRRB in high-temperature and low-temperature conditions were studied through physical and working performance testing of bitumen. The CR and SCR were tested by scanning electron microscope (SEM), Fourier transform infrared spectrometer (FTIR), gel permeation chromatography (GPC), and particle size distribution (PSD) tests to study the physicochemical behavior and microscopic effects before and after CR swelling. The results showed that CR dosage was in the range of 10%, 15%, and 20%, as well as that CR dosages have a positive effect on the high- and low-temperature performance, storage stability, and elastic recovery of bitumen. The high-temperature PG grades of bitumen were directly improved by four grades, and the elastic recovery rate increased by 339.9%. CR improved the ultra-low temperature crack resistance of bitumen. Due to the absorption of lighter components by CR, the relative content of the heavy component of bitumen increased; however, its low-temperature performance decreased significantly. After swelling, the CR particle size increased and the range became wider, the surface complexity of CR became higher, and the specific surface area was larger. At the same time, CR carried out the transformation process from large and medium molecules to small molecules. During the swelling process, a new benzene ring structure appeared in the CR, and the C-C bond and C-S bond of CR broke, forming part of the C=C bond.

Investigation of the Rheological Properties and Chemical Structure of Asphalt under Multiple Aging Conditions of Heat, UV and Aqueous Solution.

During the service period, asphalt materials are affected by various natural factors, including heat, ultraviolet light, oxygen and moisture, etc., resulting in the reduction of pavement performance, the increase of pavement distress and shortening of service life. This study aims to investigate the aging performance of asphalt under multiple aging conditions of heat, UV and aqueous solution. Thermal-oxygen aging, UV aging and hydrostatic erosion tests were carried out sequentially on asphalt. The rheological properties, chemical structure and element composition of asphalt were characterized before and after aging, and the effect mechanism of multiple conditions was discussed. The results show that the multiple conditions of heat and UV can increase the rutting resistance and weaken the cracking resistance of asphalt. However, the effect degree of UV decreases gradually with the deepening of aging degree. Additionally, the effect of water on the physicochemical properties is less than that of UV; however, water can increase the sensitivity of physicochemical properties to UV. In summary, this study explored the short-term cycling effect of heat, light and water on asphalt and provided an idea for simulation test of asphalt under multiple aging condition.

Optimization of Asphalt-Mortar-Aging-Resistance-Modifier Dosage Based on Second-Generation Non-Inferior Sorting Genetic Algorithm.

The use of steel slag powder instead of filler to prepare asphalt mortar was beneficial to realize the effective utilization of steel slag and improve the performance of asphalt concrete. Nevertheless, the anti-aging properties of steel-slag powder-asphalt mortar need to be further enhanced. This study used antioxidants and UV absorbers in steel-slag powder-asphalt mortar to simultaneously improve its thermal-oxidation and UV-aging properties. The dosage of modifier was optimized by second-generation non-inferior sorting genetic algorithm. Fourier-Transform Infrared Spectroscopy, a dynamic shear rheometer and the heavy-metal-ion-leaching test were used to evaluate the characteristic functional groups, rheological properties and heavy-metal-toxicity characteristics of the steel-slag-powder-modified asphalt mortar, respectively. The results showed that there was a significant correlation between the amount of modifier and G*, δ, and the softening point. When the first peak appeared for G*, δ, and the softening point, the corresponding dosages of x1 were 2.15%, 1.0%, and 1.1%, respectively, while the corresponding dosage of x2 were 0.25%, 0.76%, and 0.38%, respectively. The optimal value of the modifier dosage x1 was 1.2% and x2 was 0.5% after weighing by the NSGA-II algorithm. The asphalt had a certain physical solid-sealing effect on the release of heavy-metal ions in the steel-slag powder. In addition, the asphalt structure was changed under the synergistic effect of oxygen and ultraviolet rays. Therefore, the risk of leaching heavy-metal ions was increased with the inferior asphalt-coating performance on the steel-slag powder.

Mycoplasma pneumoniae among Chinese Outpatient Children with Mild Respiratory Tract Infections during the Coronavirus Disease 2019 Pandemic.

Mycoplasma pneumoniae is a common pathogen causing respiratory disease in children. We sought to investigate the epidemiology of M. pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the coronavirus disease 2019 (COVID-19) pandemic. Eligible patients were prospectively enrolled from January 2020 to June 2021. Throat swabs were tested for M. pneumoniae RNA. M. pneumoniae IgM was tested by a colloidal gold assay. Macrolide resistance and the effect of the COVID-19 countermeasures on M. pneumoniae prevalence were assessed. Symptom scores, treatments, and outcomes were evaluated. Eight hundred sixty-two eligible children at 15 centers in China were enrolled. M. pneumoniae was detected in 78 (9.0%) patients. Seasonally, M. pneumoniae peaked in the first spring and dropped dramatically to extremely low levels over time until the next summer. Decreases in COVID-19 prevalence were significantly associated with decreases in M. pneumoniae prevalence (r = 0.76, P = 0.001). The macrolide resistance rate was 7.7%. The overall sensitivity and specificity of the colloidal gold assay used in determining M. pneumoniae infection were 32.1% and 77.9%, respectively. No more benefits for improving the severity of symptoms and outcomes were observed in M. pneumoniae-infected patients treated with a macrolide than in those not treated with a macrolide during follow-up. The prevalences of M. pneumoniae and macrolide resistance in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs. IMPORTANCE This is the first and largest prospective, multicenter, active, population-based surveillance study of the epidemiology of Mycoplasma pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the COVID-19 pandemic. Nationwide measures like strict face mask wearing and restrictions on population movement implemented to prevent the spread of COVID-19 might also effectively prevent the spread of M. pneumoniae. The prevalence of M. pneumoniae and the proportion of drug-resistant M. pneumoniae isolates in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for screening and diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.

CARE: an observational study of adherence to home nebulizer therapy among children with asthma.

BACKGROUND: The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China. METHODS: The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0-14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers). RESULTS: The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control. CONCLUSIONS: Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma.Trial registrationClinicalTrials.gov identifier: NCT03156998The reviews of this paper are available via the supplemental material section.

[Efficacy and safety of vitamin D as adjuvant therapy for childhood pneumonia: a Meta analysis].

OBJECTIVE: To study the efficacy and safety of vitamin D as an adjuvant therapy for childhood pneumonia through a systematic review. METHODS: Cochrane Library, PubMed, EMbase, CNKI, Wanfang Data, and Weipu Data were searched for randomized controlled trials (RCTs) of vitamin D as the adjuvant therapy for childhood pneumonia published up to August 2019. Literature screening, quality assessment, and data extraction were performed based on inclusion and exclusion criteria. Revman 5.3 was used to perform the Meta analysis of outcome indicators. RESULTS: A total of 7 RCTs with 1 527 children were included, with 762 children in the vitamin D adjuvant therapy group and 765 children in the control group. The results of the Meta analysis showed that vitamin D adjuvant therapy had no effect on recovery time (P=0.67), length of hospital stay (P=0.73), and time to relief of fever (P=0.43). Furthermore, it did not reduce the recurrence rate (P=0.14), rate of adverse events (P=0.20), and mortality rate (P=0.98) of childhood pneumonia. CONCLUSIONS: Current evidence shows that vitamin D adjuvant therapy has no marked efficacy in the treatment of childhood pneumonia.

Diagnosis and treatment of herpangina: Chinese expert consensus.

BACKGROUND: Herpangina is a common infectious disease in childhood caused by an enterovirus. This consensus is aiming to standardize and improve herpangina prevention and clinical diagnosis. METHODS: The Subspecialty Group of Infectious Diseases, the Society of Pediatric, Chinese Medical Association and Nation Medical Quality Control Center for Infectious Diseases gathered 20 experts to develop the consensus, who are specialized in diagnosis and treatment of herpangina. RESULTS: The main pathogenic serotypes of herpangina include Coxsackievirus-A, Enterovirus-A and Echovirus. Its diagnosis can be rendered on the basis of history of epidemiology, typical symptoms, characteristic pharyngeal damage and virological tests. The treatment is mainly symptomatic, and incorporates topical oral spray with antiviral drugs. The course of herpangina generally lasts 4-6 days with a good prognosis. CONCLUSION: The consensus could provide advices and references for the diagnosis, treatment and management of herpangina in children.

Phenotypes of the inflammatory cells in the induced sputum from young children or infants with recurrent wheezing.

BACKGROUND: To identify inflammatory cell types by phenotypic analysis of the inflammatory cells in the induced sputum. METHODS: This retrospective study included 1232 children and infants, who were assigned into mild/moderate groups (326) and severe group (602) by clinical symptom scores. Phenotypes of sputum inflammatory cells were analyzed using liquid-based thin-cytologic test and eosinophil-derived neurotoxin (EDN) was quantified by ELISA. RESULTS: Blood eosinophil count, serum total IgE level, and allergen detection rate were significantly higher in the severe group. In the 905 cases of qualified sputum, 526 cases exhibited at least one type of inflammatory cells, including neutrophil (343, 65.2%), eosinophil (161, 30.6%), and mixed granulocytes (22, 4.2%). Levels of neutrophils and eosinophils were significantly higher in the severe group than mild/moderate group, and eosinophil was predominant in the severe group. Serum EDN was 104.8 ± 39.4 µg/l in the eosinophil phenotype group, 112.6 ± 41.2 µg/l in the mixed group, 88.2 ± 36.6 µg/l in the neutrophil phenotype group, and 60.9 ± 34.6 µg/l in the paucigranulocytic phenotype group. CONCLUSION: Induced-sputum inflammatory cell count may be used to determine phenotype of wheezing. The criteria of classifying adult asthma could be applicable for children and infants.

Analysis of the predicting factors of recurrent wheezing in infants.

BACKGROUND: Clinically, asthma in children under 5 years old is under estimated because lack of diagnostic criteria. The current study was, therefore, designed to identify the predicting factors for recurrent wheezing in infants. METHODS: One hundred forty-five infants under 3-year old hospitalized with respiratory diseases were enrolled into this study. Patients were followed up for one-year period after being discharged from the hospital and were, then, divided into recurrent wheezing group and non-recurrent wheezing group based on whether there was recurrent wheezing or not. Wheezing or recurrent wheezing was specifically monitored in addition to blood tests for allergic and respiratory diseases. RESULTS: The prevalence of eczema and respiratory syncytial virus (RSV) infection were significantly higher in recurrent wheezing group than in control group (74.2% vs 45.8%; 32.3% vs. 13.3%, respectively, both P < 0.05); the percentage of blood eosinophil and serum eosinophil-derived neurotoxin (EDN) concentration at admission were also higher in recurrent wheezing group than in control group (3.10 ± 2.54% vs. 1.31 ± 1.15%; 68.67 ± 55.05 ng/mL vs. 27. 36 ± 19.51 ng/mL; respectively, both P < 0.001). Multivariate logistic regression analysis on eosinophil count and serum EDN concentration in predicting recurrent wheezing revealed that the eosinophil count showed the lowest sensitivity (51.6%) and highest specificity (90.4%), with the area under the ROC curve (AUC) of 0.752 ± 0.041; and that, in contrast, the serum EDN showed the highest sensitivity (88.7%) and lowest specificity (56.6%), with AUC of 0.795 ± 0.037. CONCLUSION: Combination of eosinophil count and serum EDN measurement may be better to predict the risk of recurrent wheezing in early life of childhood.

Refractory Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction in a child: A case report and literature review.

RATIONALE: Mycoplasma pneumoniae pneumonia, a common cause of community-acquired pneumonia in children, is rarely complicated with acute cerebral infarction. PATIENT CONCERNS: We present a 7-year-old boy with severe M pneumoniae pneumonia who developed impaired consciousness, aphasia, and reduced limb muscle power 7 days postadmission. DIAGNOSES: Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction. INTERVENTIONS: The patient recovered with aggressive antibiotic therapy, antiinflammation therapy with methylprednisolone, and gamma immunoglobulin and anticoagulation therapy with aspirin and low molecular weight heparin along with rehabilitation training. OUTCOMES: At 8 days postadmission, his consciousness was improved and at the 6-month follow-up visit, his muscle power of bilateral upper and lower limbs was normal except still poor right handgrip power. LESSONS: Stroke or cerebral infarction should be considered and promptly managed in rare cases of M pneumoniae pneumonia with neurologic manifestations.

Risk factors for and expression of immune and inflammatory factors in atopic dermatitis in Chinese population: A birth cohort study.

OBJECTIVE: To explore the risk factors for atopic dermatitis (AD) and disclose the relationship between immune inflammatory factors (Immunoglobulin E (IgE), interleukin (IL)-4, IL-18) and the prevalence of AD in a Chinese population. METHODS: To evaluate the risk factors for infant AD, a total of 921 mother-newborn pairs were recruited through a questionnaire survey conducted during 2009-2011. Venous blood was collected from the mothers during birth hospitalization and umbilical cord blood was collected during delivery. Thirty-five infants with AD paired with their mothers served as the patient group. Thirty-five non-AD pairs were selected randomly and were used as the control group. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IgE, IL-4, and IL-18. The relationship between the prevalence of AD and the levels of IgE, IL-4, and IL-18 was analyzed. The risk factors for allergy were assessed in IgE positive cases. RESULTS: Family income, parental history of atopy, age of menarche, performing housing renovation before pregnancy, instance of a virus infection during pregnancy, and calcium supplementation during pregnancy were potential factors determining the incidence rate of infant AD. Compared with the control group, the AD patient group showed higher levels of IgE and IL-4 in both the maternal serum and umbilical cord blood (P < 0.01). In the cases with AD, IL-8 was increased only in the maternal serum (P < 0.01). In addition, the allergens dust mite, mugwort pollen, and mycete spores were risk factors for the incidence of IgE-positive AD. CONCLUSION: IgE and IL-4 levels in the maternal serum and umbilical cord blood as well as IL-18 level in the maternal serum are related to the occurrence of childhood AD. Potential factors for infant AD include family income, parental history of atopy, age of menarche, housing renovation before pregnancy, virus infection, and calcium supplementation during pregnancy.