Objective
Community-acquired pneumonia (CAP) is the primary cause of death for children under five years of age globally. Hence, it is essential to investigate new early biomarkers and potential mechanisms involved in disease severity.
Methods
Proteomics combined with metabolomics was performed to identify biomarkers suitable for early diagnosis of severe CAP. In the training cohort, proteomics and metabolomics were performed on serum samples obtained from 20 severe CAPs (S-CAPs), 15 non-severe CAPs (NS-CAPs) and 15 healthy controls (CONs). In the verification cohort, selected biomarkers and their combinations were validated using ELISA and metabolomics in an independent cohort of 129 subjects. Finally, a combined proteomics and metabolomics analysis was performed to understand the major pathological features and reasons for severity of CAP.
Results
The proteomic and metabolic signature was markedly different between S-CAPs, NS-CAPs and CONs. A new serum biomarker panel including 2 proteins [C-reactive protein (CRP), lipopolysaccharide (LBP)] and 3 metabolites [Fasciculol C, PE (14:0/16:1(19Z)), PS (20:0/22:6(4Z, 7Z, 10Z, 13Z, 16Z, 19Z))] was developed to identify CAP and to distinguish severe pneumonia. Pathway analysis of changes revealed activation of the cell death pathway, a dysregulated complement system, coagulation cascade and platelet function, and the inflammatory responses as contributors to tissue damage in children with CAP. Additionally, activation of glycolysis and higher levels of nucleotides led to imbalanced deoxyribonucleotide pools contributing to the development of severe CAP. Finally, dysregulated lipid metabolism was also identified as a potential pathological mechanism for severe progression of CAP.
Conclusion
The integrated analysis of the proteome and metabolome might open up new ways in diagnosing and uncovering the complexity of severity of CAP.
Objective: The number of children on prolonged mechanical ventilation (PMV) in pediatric intensive care units (PICU) has increased markedly, but little is known about the situation in mainland China. We carried out a multicenter retrospective investigation to describe the clinical characteristics and prognosis of Chinese children receiving long-term ventilation in the PICU.Methods: A retrospective study was performed in 11 PICUs. All participating patients with prolonged mechanical ventilation in the study were retrospectively
While Wilms tumors are the most frequently detected kidney cancer type in children, extrarenal Wilms tumors (ERWTs) remain rare. This report is the first to describe hypertension and dilated cardiomyopathy in a patient with an ERWT. A 6-month-old male infant presented with an abdominal mass and paroxysmal hypertension; echocardiography revealed dilated cardiomyopathy with an ejection fraction of 34%, as well as substantially increased plasma renin activity. Pathology yielded a definitive diagnosis of ERWT. Cardiac function and blood pressure gradually returned to normal after tumorectomy. The early diagnosis of such a tumor together with efficient oncologic treatment are vital to optimal patient outcomes.
Background Human rhinovirus (HRV) infections were confirmed in severe acute lower respiratory infections (ALRI) . Methods To evaluate the diversity and circulation pattern of HRVs species, specimens were collected from pediatric patients with ALRI during Dec 2016 to Feb 2019 and screened by RVP FAST Assay. Specimens positive for HRVs/ Enteroviruses (EVs) were then tested for HRVs and EVs by PCR. Then the capsid protein gene of HRVs was amplified and sequenced for species identification, and clinical data of HRV infections were analyzed. The chi-square (χ 2 ) test and rank sum test was used for statistical analysis using SPSS Statistics 22.0 version. In order to test and evaluate the relationship between patients positive for different HRV species and the outcome of Intensive Care Unit (ICU) (ICU group) or Department of Respiratory admission (Respiratory group), a logistic model was constructed using multiple logistic regression analysis. Results Among 1835 specimens tested, 363 (19.8%) were positive for EVs/HRVs, and 314 (86.5%, 314/363) were positive for HRVs, including 177 (56.4%, 177/314) HRV A, 29 (9.2%, 29/314) HRV B, and 108 (34.4%, 108/314) HRV C. Using HRV C as the control species, HRV A was a dangerous factor for severe clinical outcome (OR=1.983, 95% CI=1.091-3.605) ( p =0.025). Patients positive for HRVs from ICU group were significantly younger than those from Respiratory group (0.39 years: 1.80 years, p =0.000) and age was confirmed as a protective factor for severe ALRI. In August and September, HRV A and B are the dominant species, then HRV C in October and December. Among 96 types confirmed in the study, the predominant types usually showed in no consecutive years. Conclusions HRVs were important viral pathogens for ALRI in children. HRV A and C are more popular. Compared to HRV C, HRV A were associated more powerful with severe ALRI. The risk of severe ALRI by HRVs infections is decreased with the increasing of age.
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