Evaluation of disease severity and prediction of severe cases in children hospitalized with influenza A (H1N1) infection during the post-COVID-19 era: a multicenter retrospective study.

BACKGROUND: The rebound of influenza A (H1N1) infection in post-COVID-19 era recently attracted enormous attention due the rapidly increased number of pediatric hospitalizations and the changed characteristics compared to classical H1N1 infection in pre-COVID-19 era. This study aimed to evaluate the clinical characteristics and severity of children hospitalized with H1N1 infection during post-COVID-19 period, and to construct a novel prediction model for severe H1N1 infection. METHODS: A total of 757 pediatric H1N1 inpatients from nine tertiary public hospitals in Yunnan and Shanghai, China, were retrospectively included, of which 431 patients diagnosed between February 2023 and July 2023 were divided into post-COVID-19 group, while the remaining 326 patients diagnosed between November 2018 and April 2019 were divided into pre-COVID-19 group. A 1:1 propensity-score matching (PSM) was adopted to balance demographic differences between pre- and post-COVID-19 groups, and then compared the severity across these two groups based on clinical and laboratory indicators. Additionally, a subgroup analysis in the original post-COVID-19 group (without PSM) was performed to investigate the independent risk factors for severe H1N1 infection in post-COIVD-19 era. Specifically, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select candidate predictors, and logistic regression was used to further identify independent risk factors, thus establishing a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were utilized to assess discriminative capability and accuracy of the model, while decision curve analysis (DCA) was used to determine the clinical usefulness of the model. RESULTS: After PSM, the post-COVID-19 group showed longer fever duration, higher fever peak, more frequent cough and seizures, as well as higher levels of C-reactive protein (CRP), interleukin 6 (IL-6), IL-10, creatine kinase-MB (CK-MB) and fibrinogen, higher mechanical ventilation rate, longer length of hospital stay (LOS), as well as higher proportion of severe H1N1 infection (all P < 0.05), compared to the pre-COVID-19 group. Moreover, age, BMI, fever duration, leucocyte count, lymphocyte proportion, proportion of CD3+ T cells, tumor necrosis factor α (TNF-α), and IL-10 were confirmed to be independently associated with severe H1N1 infection in post-COVID-19 era. A prediction model integrating these above eight variables was established, and this model had good discrimination, accuracy, and clinical practicability. CONCLUSIONS: Pediatric H1N1 infection during post-COVID-19 era showed a higher overall disease severity than the classical H1N1 infection in pre-COVID-19 period. Meanwhile, cough and seizures were more prominent in children with H1N1 infection during post-COVID-19 era. Clinicians should be aware of these changes in such patients in clinical work. Furthermore, a simple and practical prediction model was constructed and internally validated here, which showed a good performance for predicting severe H1N1 infection in post-COVID-19 era.

Development and validation of a nomogram for predicting occurrence of severe case in children hospitalized with influenza A (H1N1) infection during the post-COVID-19 era.

Background: The significant rebound of influenza A (H1N1) virus activity, particularly among children, with rapidly growing number of hospitalized cases is of major concern in the post-COVID-19 era. The present study was performed to establish a prediction model of severe case in pediatric patients hospitalized with H1N1 infection during the post-COVID-19 era. Methods: This is a multicenter retrospective study across nine public tertiary hospitals in Yunnan, China, recruiting pediatric H1N1 inpatients hospitalized at five of these centers between February 1 and July 1, 2023, into the development dataset. Screening of 40 variables including demographic information, clinical features, and laboratory parameters were performed utilizing Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression to determine independent risk factors of severe H1N1 infection, thus constructing a prediction nomogram. Receiver operating characteristic (ROC) curve, calibration curve, as well as decision curve analysis (DCA) were employed to evaluate the model's performance. Data from four independent cohorts comprised of pediatric H1N1 inpatients from another four hospitals between July 25 and October 31, 2023, were utilized to externally validate this nomogram. Results: The development dataset included 527 subjects, 122 (23.1 %) of whom developed severe H1N1 infection. The external validation dataset included 352 subjects, 72 (20.5 %) of whom were eventually confirmed as severe H1N1 infection. The LASSO regression identified 19 candidate predictors, with logistic regression further narrowing down to 11 independent risk factors, including underlying conditions, prematurity, fever duration, wheezing, poor appetite, leukocyte count, neutrophil-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α). By integrating these 11 factors, a predictive nomogram was established. In terms of prediction of severe H1N1 infection, excellent discriminative capacity, favorable accuracy, and satisfactory clinical usefulness of this model were internally and externally validated via ROC curve, calibration curve, and DCA, respectively. Conclusion: Our study successfully established and validated a novel nomogram model integrating underlying conditions, prematurity, fever duration, wheezing, poor appetite, leukocyte count, NLR, ESR, LDH, IL-10, and TNF-α. This nomogram can effectively predict the occurrence of serious case in pediatric H1N1 inpatients during the post-COVID-19 era, facilitating the early recognition and more efficient clinical management of such patients.

Terpenoids as anti-inflammatory substances inhibiting COX-2 isolated from the fibrous roots of Alangium chinense (Lour.) Harms.

A new sesquiterpene, 1-carbonyl-2,8-dihydroxy-11-oxabicyclo [4,4,1] germacra- 2(3),4(5),6(7),8(9)-tetraene (1) and four known compounds (3E, 23E)-3-caffeoyl-23-coumaroylhederagenin (2), (3E, 23E)-dicoumaroylhederagenin (3), morettinone (4), 24-ehylcholesta-3,6-dione (5) were isolated from the ethyl acetate layer of the fibrous root of Alangium chinense (Lour.) Harms. The structure of compound 1 was characterized by its 1H-NMR, 13C-NMR, DEPT, HMBC, HSQC spectrums, and the structures of the known compounds were determined by comparison of their spectroscopic data with those reported by the literatures. The obtained compounds were evaluated for their anti-inflammatory against cyclooxygenase (COX-2). Compound 1 has a good inhibitory effect against COX-2 with IC50 20.43 ± 4.72 µM. The compounds 2-5 have inhibitory effect against COX-2 with IC50 49.19 ± 0.76, 23.29 ± 0.99, 47.78 ± 1.33, and 44.44 ± 0.12 µM, respectively.

Evaluation of febrile seizures in children infected with SARS-CoV-2 Omicron variant in Yunnan, China: a multi-center, retrospective observational study.

Background: The SARS-CoV-2 Omicron variant was reported to be linked to febrile seizures (FSs), but studies on FSs in children with Omicron infection remain relatively scarce, especially in the Chinese population. This study aimed to investigate the characteristics of children diagnosed with Omicron infection with FSs in Yunnan, China, and evaluate the potential association between FSs and Omicron infection. Methods: This study was conducted at four hospitals in Yunnan from December 8, 2022, to January 8, 2023, and consisted of 590 pediatric subjects. According to clinical characteristics, 85, 129 and 376 subjects were divided into the FS-only, Omicron-FS, and Omicron-only groups, respectively. Demographic, clinical and laboratory data were retrospectively collected for analysis. Results: The incidence of FSs in children with Omicron infection was 25.5% (129/505). Older age, stronger male predominance, as well as lower proportions of prior history and family history of seizures were observed in Omicron-FS and Omicron-only groups than in FS-only group, but there were no differences in these four above-mentioned events between these two Omicron-related groups. Compared to FS-only group, Omicron-FS group also had a shorter fever-to-seizure onset duration and more frequent seizures during a single course of fever. Moreover, higher levels of IL-6, TNF-α and ferritin as well as decreased counts of leukocytes and lymphocytes were confirmed in Omicron-FS group than in FS-only and Omicron-only groups. Regarding COVID-19 vaccination status, Omicron-FS group revealed a higher proportion of unvaccinated children and a lower proportion of three-dose vaccination than Omicron-only group. As for clinical outcomes, proportions of mechanical ventilation and intensive care unit admission observed in the two Omicron-related groups were notably higher than those in FS-only group. Meanwhile, Omicron-FS group showed the longest length of hospital stay, followed by Omicron-only group and FS-only group, in order. Finally, all patients but one who died of fulminant myocarditis had been successfully discharged. Conclusions: The incidence of FSs in children with Omicron infection was 25.5% in Yunnan. FSs might be a clinical sign deserving more attention in children with Omicron infection. Furthermore, COVID-19 vaccination is likely to provide effective protection against Omicron-related FSs in children.

New triterpenes from Salacia hainanensis Chun et How with α-glucosidase inhibitory activity.

Fractionation of the methanol extract from the roots of Salacia hainanensis Chun et How showing the potent inhibitory activity on α-glucosidase afforded two new lupane derivatives, 3α,28-dihydroxy-lup-20(29)-en-2-one (1) and 3α-hydroxy-lup-20(29)-en-2-one (2), a new friedelane derivative, D:A-friedo-oleanane-7α,30-dihydroxy-3-one (3), and a novel natural product, 2,3-seco-lup-20(29)-en-2,3-dioic acid (4), along with four known compounds (5-8). Their structures were established on the basis of spectral analysis, especially on the data afforded by 2D NMR and high-resolution mass spectra experiments. All of them showed a much stronger inhibiting activity on α-glucosidase than the positive control (acarbose, IC50 = 5.83 µM). Constituents with α-glucosidase inhibitory activity from this plant are reported for the first time.

[A new trincallane derivative from Salacia hainanensis Chun et How].

Chemical constituents of the roots and stem of Salacia hainanensis Chun et How were isolated and purified with column chromatography on silica gel, Sephadex LH-20 and preparative HPLC. Their structures were elucidated based on physicochemical and spectral spectroscopic analysis. Depending on the activities of anti-alpha-glucosidase and inhibiting AGEs (advanced glycation end products, AGEs) formation in vitro, nine compounds were identified as 26, 27-dihydroxy-7, 24-tirucalladien-3-one (1), abruslactone A (2), lupeol (3), 21alpha, 30-dihydroxy-D: A-friedooleanan-3-one (4), 15alpha-hydroxyfriedelan-3-one (5), friedelin (6), mangiferin (7), epicatechin (8) and beta-sitosterol (9), separately. Among them, compound 1 is a new compound, and compound 2 was isolated from the Salacia genus for the first time, while, compounds 3, 4, 5, 8 were obtained from this plant for the first time.

New inhibitors of α-glucosidase in Salacia hainanensis Chun et How.

The methanol extract from roots of Salacia hainanensis Chun et How afforded three new compounds, 24,26-dihydroxy-25-methoxy-tirucall-9-en-3-one (1), 2ß,3ß,22α-trihydroxy-lup-20(29)-ene (2) and 3ß-hydroxy-2-carbonyl-lupan-29-oic acid (3), along with six known triterpenoids (4-9). Their structures were established on the basis of spectral analysis, in particular according to the data obtained by two-dimensional-NMR and high-resolution mass spectra experiments. Some of them showed much stronger inhibitory activity towards α-glucosidase than the positive control (acarbose, IC50 10.2 µM).