[Congenital pulmonary alveolar proteinosis in a neonate]. / æ–°ç”Ÿå„¿å ˆå¤©æ€§è‚ºæ³¡è›‹ç™½æ²‰ç§¯ç—‡1例.

The male patient was referred to the hospital at 44 days old due to dyspnea after birth and inability to wean off oxygen. His brother died three days after birth due to respiratory failure. The main symptoms observed were respiratory failure, dyspnea, and hypoxemia. A chest CT scan revealed characteristic reduced opacity in both lungs with a "crazy-paving" appearance. The bronchoalveolar lavage fluid (BALF) showed periodic acid-Schiff positive proteinaceous deposits. Genetic testing indicated a compound heterozygous mutation in the ABCA3 gene. The diagnosis for the infant was congenital pulmonary alveolar proteinosis (PAP). Congenital PAP is a significant cause of challenging-to-treat respiratory failure in full-term infants. Therefore, congenital PAP should be considered in infants experiencing persistently difficult-to-treat dyspnea shortly after birth. Early utilization of chest CT scans, BALF pathological examination, and genetic testing may aid in early diagnosis.

[Effects of prolonged exposure of high concentration of oxygen on expression of vascular endothelial growth factor and its receptors in neonatal rat lungs].

OBJECTIVE: To study the effects of prolonged 75% oxygen exposure on the expression of vascular endothelial growth factor (VEGF) and its receptors (VEGFR1 and VEGFR2) in the neonatal rat lungs and to elucidate the effects of prolonged exposure of high concentration of oxygen on lung vascular development and its relationship with bronchopulmonary dysplasia (BPD). METHODS: Forty eight Sprague-Dawley rat pups were randomly exposed to air (control group) and 75% oxygen (experimental group) 12 hrs after birth. The rats were sacrificed 7, 14 and 21 days after exposure and their lungs were sampled. The lung sections were stained with hematoxylin and eosin for histological evaluation. Expression of VEGF, VEGFR1 and VEGFR2 protein and mRNA was detected by immunohistochemistry and RT-PCR. RESULTS: After being exposed to 75% oxygen for 21 days, lung tissues had pathological changes as 'new' BPD. Expressions of VEGF protein (10.9 + or - 2.7 vs 30.8 + or - 6.4), VEGFR1 protein (5.4 + or - 1.4 vs 15.6 + or - 3.4) and VEGFR2 protein (11.3 + or - 2.6 vs 21.7 + or - 4.5) on day 21 in the experimental group decreased significantly as compared with the control group (p<0.05). The expression of VEGF mRNA (1.6 vs 3.3), VEGFR1 mRNA (0.4 vs 6.6) and VEGFR2 mRNA (0.5 vs 4.9) on day 21 in the experimental group also decreased significantly as compared with the control group (p<0.05). CONCLUSIONS: Prolonged exposure of high concentration of oxygen may cause BPD possibly by inhibiting lung vascular development in neonatal rats.

Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment.

BACKGROUND: Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treatment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clinical, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis. METHODS: Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized. RESULTS: Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P < 0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment. CONCLUSIONS: Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifestations identified in the children. New prospective and controlled studies are required to confirm this proposition.

Diagnostic Value of Nasopharyngeal Aspirates in Children with Lower Respiratory Tract Infections.

BACKGROUND: The accuracy of nasopharyngeal aspirate (NPA) specimens in detecting lower respiratory pathogens remains controversial. The objective of this study was to evaluate the diagnostic accuracy of aspirates (NPAs) specimen in lower respiratory tract infections (LRTIs) in children. METHODS: The prospective study was designed to collect the data of paired NPAs and bronchoalveolar lavage fluids from children with acute LRTIs from January 2013 to December 2015. All specimens were subjected to pathogen detection: bacterial detection by culture, Mycoplasma pneumoniae (Mp) detection by polymerase chain reaction assay and virus (influenza A and B viruses, parainfluenza virus [PIV] Types 1 and 3, respiratory syncytial virus, and adenovirus) detection by immunofluorescence assay. The diagnostic accuracy analysis of NPAs was stratified by age ≤3 years (n = 194) and >3 years (n = 294). RESULTS: We collected paired specimens from 488 children. The positive rate of pathogen was 61.6%. For Streptococcus pneumoniae, NPA culture had the specificity of 89.9% and negative predictive value of 100% in age ≤3 years, the specificity of 97.2% and negative predictive value of 98.9% in age >3 years. For Mp, the positive predictive values of NPA was 77.4% in children ≤3 years, and 89.1% in children >3 years. For PIV III, NPA specimen had the specificity of 99.8% and negative predictive value of 96.5% in children ≤3 years. For adenovirus, NPA had the specificity of 97.8% and negative predictive value of 98.4% in age ≤3 years, the specificity of 98.9% and negative predictive value of 99.3% in age >3 years. CONCLUSIONS: NPAs are less invasive diagnostic respiratory specimens, a negative NPA result is helpful in "rule out" lower airway infection; however, a positive result does not reliably "rule in" the presence of pathogens.

[Diagnostic value of fluorescent quantitation PCR for Mycoplasma pneumoniae infection].

OBJECTIVE: Mycoplasma pneumoniae (Mp) infection is one of major causes of community-acquired pneumonia. Isolation and culture of Mp are very difficult, fluorescent quantitative PCR is a new technique to detect Mp. The aim of this study was to explore the diagnostic value of fluorescent quantitation PCR for Mp infection. METHOD: Mp-DNA from the deep respiratory tract secretion of children suffering from pneumonia was tested by a fluorescent quantitative PCR. Totally 256 cases who were positive for Mp DNA were enrolled into this study, 164 (64.1%) were male, 92 (35.9%) were female; the age ranged from 9 days to 16 years. All the patients also had results of Mp-IgM test. These patients were divided into 2 groups according to the result of Mp-IgM detection, namely, Mp-IgM positive and negative groups. Area under the roc curve (Az) was used as the index to evaluate the diagnostic value of fluorescent quantitation PCR for Mp detection. The number of Mp-DNA copies, age and course of disease of the 2 groups were also compared. RESULTS: (1) Diagnostic accuracy of fluorescent quantitative PCR for detecting Mp infection was that Az = 0.641. (2) The number of copies of the cases in Mp-IgM positive group was 5.42 +/- 1.26 [log(Mp-DNA copy/ml)], while that of Mp-IgM-negative group was 4.87 +/- 1.29 [log(Mp-DNA copy/ml), t = 3.43, P < 0.05]. (3) The age of Mp-IgM positive group was dramatically younger than Mp-IgM negative group (P < 0.001). CONCLUSION: The diagnostic accuracy of fluorescent quantitative PCR for mycoplasma pneumoniae (Mp) infection is low; however for children whose immunologic systems are not fully developed, this technique has some diagnostic value, and higher number of Mp-DNA copies may support diagnosis of Mp infection.

[Association of interleukin 8 single nucleotide polymorphisms with the susceptibility to respiratory syncytial virus infection].

OBJECTIVE: To explore the association of interleukin 8 (IL-8)-251T/A and 781 C/T single nucleotide polymorphisms (SNPs) with the susceptibility of infants and young children to respiratory syncytial virus (RSV) infection. METHOD: This study included 101 hospitalized patients under 2 years of age who suffered from RSV pneumonia, 108 hospitalized patients under 2 years of age with non-RSV pneumonia and 35 core families with a child hospitalized for RSV pneumonia. Genotypes of 2 SNP loci in all enrolled persons were defined by allele specific polymerase chain reaction (AS-PCR), and confirmed by gene sequencing. The allele's frequencies of SNPs were analyzed with case-control study and transmission disequilibrium test (TDT), linkage of 2 loci and haplotypes composed of the 2 loci were also studied. RESULTS: (1) The frequency of IL-8-251T in cases was dramatically high (OR = 2.08, P = 0.0002, case-control study; LRT = 14.31, P = 0.0008, TDT). (2) IL-8-251T and 781C was linkaged (D' = 0.607 +/- 0.03, r(2) = 0.2861, P = 0.0000). (3) Haplotype of TC was significantly high in cases (P = 0.01). CONCLUSION: These findings support that haplotype of TC composed of IL-8-251T and 781C is associated with the susceptibility to RSV, namely, some RSV predisposing genes are located in the gene fragment including TC haplotype or linked tightly with this gene fragment.