One year treatment with Alutard SQ house dust mite immunotherapy significantly reduced symptoms and medication use in asthmatic subjects. This was associated with a greater subjective improvement in asthma control.

Chinese measured spirometry data. The present study also compared with other published Chinese equations for spirometry. Results: A total of 7,115 eligible individuals aged 4 to 80 years (50.9% females) were recruited. Reference equations against age and height by gender were established, including predicted values and lower limits of normal (LLNs). Validated with Chinese data, the mean percentage differences of Caucasian reference values adjusted with ethnic conversion factors were −10.2% to 1.8%, and the percentages of total subjects under LLNs were 0.1% to 8.9%. Compared with this study, the percentage differences of previous Chinese studies ranged from −17.8% to 11.4%, which were found to significantly overestimate or underestimate lung IntroductionSpirometry has been widely used for diagnosing respiratory diseases, quantifying disease severity, and assessing disease prognosis (1,2). Accurate interpretation of spirometry requires appropriate reference values derived from its own ancestry population (3), including lower limits of normal (LLNs), which could be helpful for assessment of abnormal pulmonary function in patients with pulmonary diseases.There are over 40 million overseas Chinese (4) and 1.3 billion mainland Chinese (5) in the world (about 22% of the global population), indicating the huge medical demand (6). Embarrassingly, standardized nationwide spirometric reference values for Chinese were unavailable.In 2012, Global Lung Function Initiative (3) recommended multi-ethnic reference values for African-Americans, Southeast Asians (SEA-GLI2012) and Northeast Asians (NEA-GLI2012), which were largely established with Caucasian data and adjusted with fixed ethnic conversion factors in the whole age range. In addition, other Caucasian reference values adjusted with fixed ethnic conversion factors were also applied in China (7,8), such as European Committee of Steel and Coal equations adjusted for Chinese with the suggestion of Zheng et al. (Chinese-ECSC1993) (9,10), and the third national health and nutrition examination surveys equations adjusted with 0.88 times for Asian-American (Asian-NHANESIII 0.88) (11,12). Given the dynamic changes of gene, economic, environment, nutrition and et al., it remains unknown whether those fixed ethnic conversion factors reliably reflect the difference of spirometry between Caucasians and Chinese.Although several spirometric reference values for Chinese have been published (13-22), the major disadvantages in these studies limited the nationwide use, including small samples, limited age ranges, small local regions, as well as different study protocols and quality control. Without LLNs for nationwide Chinese, a fixed 0.7 of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) instead of LLNs was frequently applied for the diagnosis of "airflow limitation" in previous studies (7,23,24), leading possible underdiagnosis in younger subjects and over diagnosis in elderly. Moreover, In the nationwide questionnaire surveys on clinical application of pulmon...

BackgroundCo-infections are common in childhood community acquired pneumonia (CAP). However, their etiological pattern and clinical impact remains inconclusive.MethodsEight hundred forty-six consecutive children with CAP were evaluated prospectively for the presence of viral and bacterial pathogens. Nasopharyngeal aspirates were examined by direct immunofluorescence assay or polymerase chain reaction (PCR) for viruses. PCR of nasopharyngeal aspirates and enzyme-linked immunosorbent assays were performed to detect M. pneumoniae. Bacteria was detected in blood, bronchoalveolar lavage specimen, or pleural fluid by culture.ResultsCausative pathogen was identified in 70.1% (593 of 846) of the patients. The most commonly detected pathogens were respiratory syncytial virus (RSV) (22.9%), human rhinovirus (HRV) (22.1%), M. pneumoniae (15.8%). Coinfection was identified in 34.6% (293 of 846) of the patients. The majority of these (209 [71.3%] of 293) were mixed viral-bacterial infections. Age < 6 months (odds ratio: 2.1; 95% confidence interval: 1.2–3.3) and admission of PICU (odds ratio: 12.5; 95% confidence interval: 1.6–97.4) were associated with mix infection. Patients with mix infection had a higher rate of PICU admission.ConclusionsThe high mix infection burden in childhood CAP underscores a need for the enhancement of sensitive, inexpensive, and rapid diagnostics to accurately identify pneumonia pathogens.

of cough was added; (V) the etiology and management of chronic cough in children was introduced; (VI) a section on uncommon causes of chronic cough; and (VII) added unexplained cough [refractory cough, cough hypersensitivity syndrome (CHS)]. Introduction of methodology (I) The target population: patients with cough. (II) The target users: respiratory specialists from all levels of hospitals, physicians of internal medicine and TCM, general practitioners, pediatricians, and other health-care providers.

Background Early distinction between refractory M. pneumoniae pneumonia (RMPP) and non-RMPP (NRMPP) is still difficult. The community-acquired respiratory distress syndrome (CARDS) toxin can induce inflammatory and histopathological phenotypes associated with M. pneumoniae infection. This study aimed to investigate the clinical significance of CARDS toxin and pro-inflammatory cytokines in children with RMPP and to explore whether CARDS toxin can induce TNF-α expression. Methods Levels of CARDS toxin and cytokines in BALF from control and children with MPP were determined by real-time PCR and ELISA, respectively. A receiver-operating characteristic (ROC) analysis was performed to assess the diagnostic values of CARDS toxin, TNF-α, and IL-6 in RMPP. The recombinant CARDS toxin was constructed and prepared at different concentrations for stimulation of RAW264.7 cells. After co-culture with CARDS toxin, cytokines were detected by ELISA and the mRNA levels were measured by real-time PCR. Effects of CARDS toxin and TNF-α on inflammatory cell infiltration and mucus secretion in mouse lungs were also evaluated. Results Levels of CARDS toxin, TNF-α and IL-6 in bronchoalveolar lavage fluid (BALF) were significantly higher in RMPP cases compared with NRMPP cases. Furthermore, TNF-α had better diagnostic ability for differentiation of RMPP with AUC of 0.824 and Youden index of 0.692 compared with CARDS toxin and IL-6. Moreover, CARDS toxin was positively correlated with TNF-α level in MPP cases. In vitro assay revealed that CARDS toxin induced RAW264.7 macrophages to secrete TNF-α. Further in vivo assay showed that TNF-α deletion partially abrogated the CARDS toxin-mediated induction of inflammatory cell infiltration and mucus secretion in mouse lungs. Conclusions The high co-expression of TNF-α and CARDS toxin in BALF is a good diagnostic biomarker for differentiating children with RMPP and NRMPP.

Neutrophil infiltration is the characteristic pathological feature of M. pneumoniae pneumonia (MPP). This study aimed to explore the associations among neutrophil activity, clinical presentation, and role of the M. pneumoniae/interleukin-8 (IL-8)/neutrophil axis in the pathogenesis of MPP. A total of 42 patients with MPP were prospectively enrolled in the study. Neutrophil activity, including matrix metalloproteinase-9 (MMP-9), myeloperoxidase (MPO), and neutrophil elastase (NE), were measured. Clinical information was collected for all patients and control group. In vitro, IL-8 production was measured at different time points after M. pneumoniae infection of bronchial epithelial cells, and neutrophil activity was analyzed after IL-8 stimulation. The percentage of neutrophil in the bronchoalveolar lavage fluid was higher in the group of patients with high levels of M. pneumoniae DNA than in those with low levels of M. pneumoniae DNA (P < 0.05). IL-8, MMP-9, and NE in patients with MPP significantly increased compared with controls and decreased after treatment (P < 0.05). MPO and MMP-9 were associated with duration of fever (r = 0.332, P < 0.05) and length of stay (r = 0.342, P < 0.05), respectively. In vitro, M. pneumoniae induced IL-8 production by bronchial epithelial cells in a time dependent manner. MPO, MMP-9 and NE production by neutrophils significantly increased compared with medium controls after IL-8 stimulation. In summary, the M. pneumoniae/IL-8/neutrophil axis likely plays a vital role in the pathogenesis of MPP.

To analyze the clinical characteristics of corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the related factors that predict corticosteroid-resistant RMPP. Retrospective analysis of 183 children with RMPP in our hospital admitted between January 1, 2012, and December 31, 2014 was performed. Of the 183 RMPP cases, 36 (19.7%) were corticosteroid-resistant RMPP cases. Corticosteroid-resistant RMPP cases had a longer duration of fever and hospitalization compared with corticosteroid-sensitive RMPP cases (P < 0.05). The radiographic findings of 123 (83.7%) cases of corticosteroid-sensitive RMPP apparently resolved after one week of corticosteroid treatment compared with 4 (11.1%) corticosteroid-resistant RMPP cases that had apparently resolution (P < 0.01). Twenty-four (75%) corticosteroid-resistant RMPP patients who received bronchoscopy had mucus plug formation while none of the corticosteroid-sensitive RMPP patients had mucus plug formation (P < 0.05). Multiple logistic regression analysis showed that duration of fever ≥11 days, percentage of lymphocytes ≤32%, CRP ≥48.73 mg/L and LDH ≥ 545.7 U/L were significant predictors of corticosteroid-resistant RMPP. Patients with corticosteroid-resistant RMPP had more severe presentations and more serious radiological findings. Clinicians might use the parameters of duration of fever, CRP, LDH and proportion of lymphocytes to identify children at higher risk of corticosteroid-resistant RMPP.

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