Ultrasound imaging of diaphragm motion is a useful, quick, noninvasive, portable, and direct anatomic method for assessment of ET tube position. We think it should be considered the method of choice for the secondary confirmation of the ET tube position.
ABSTRACT. Objective. To evaluate the effect of treatment without aspirin in the acute phase of Kawasaki disease (KD) and to determine whether it is necessary to expose children to high-or medium-dose aspirin.Methods. A total of 162 patients who fulfilled the established criteria of acute KD between 1993 and 2003 were included in this retrospective study. All patients were treated with high-dose intravenous immunoglobulin (IVIG; 2 g/kg) as a single infusion without concomitant aspirin treatment. Low-dose aspirin (3-5 mg/kg per day) was subsequently prescribed when fever subsided. Patients who had defervescence within 3 days after the completion of IVIG treatment were classified as the IVIG-responsive group, and those whose fever persisted for >3 days were classified as the IVIG-nonresponsive group. The 162 patients were divided further into 2 groups: those who were treated with IVIG before illness day 5, and those who were treated after illness day 5. We compared the response rate of IVIG therapy, duration of fever, and incidence of coronary artery abnormalities (CAAs) between these groups.Results. A total of 153 patients were classified into the IVIG-responsive group, and 128 (83.66%) of them had defervescence within 24 hours after completion of IVIG therapy. Nine (5.56%) patients were classified into the IVIG nonresponsive group, and all received additional IVIG (2 g/kg) without aspirin. Six (66.67%) had defervescence within 3 days after additional therapy. Patients in the IVIG-nonresponsive group had a significantly higher incidence of CAAs than those in the IVIG-responsive group (25% vs 2.92%). In the group that was treated before illness day 5 (n ؍ 16), all patients had defervescence within 3 days after IVIG therapy and 13 (81.25%) had defervescence within 24 hours. In the group that was treated after illness day 5 (n ؍ 146), 137 (93.84%) patients had defervescence within 3 days and 115 (78.77%) had defervescence within 24 hours. One (6.67%) patient in the group that was treated before illness day 5 got a new onset of CAAs, as did 5 (3.85%) in the group that was treated after illness day 5. There was no statistically significant difference in the response rate of IVIG therapy, duration of fever, and incidence of CAAs between these 2 groups. Conclusion.The results of our study indicate that the treatment without aspirin in acute stage of KD had no effect on the response rate of IVIG therapy, duration of fever, or incidence of CAAs when children were treated with high-dose (2 g/kg) IVIG as a single infusion, despite treatment before or after day 5 of illness. We conclude that it seems unnecessary to expose children to high-or medium-dose aspirin therapy in acute KD when the available data show no appreciable benefit in preventing the failure of IVIG therapy, formation of CAAs, or shortening the duration of fever. K awasaki disease (KD) is an acute systemic vasculitis of unknown origin that occurs predominantly in children who are Ͻ5 years old. The most significant complication is coronary arteritis, and an...
Capsule Summary 22Diagnosing Kawasaki disease (KD) currently relies on physicians' experience, 23 making it difficult to accurately diagnose KD. Using NGS, qPCR and machine 24 learning algorithm, we identified a miRNA-based biomarker panel with high 25 accuracy. 26 27 Kawasaki disease (KD) is an autoimmune disease preferentially attacking 32 children younger than five years old. Symptoms of KD include fever for at least 33 five days, oral mucosal inflammation, non-supportive conjunctivitis, 34 lymphadenopathy, edema of the extremities and a polymorphous rash. If left 35 untreated, almost 20-25% of the KD patients may develop severe coronary artery 36 aneurysms, making KD the leading cause of acquired heart disease in young 37 children in developed countries 1 . The successful detection of KD within the first 38 10 days of fever onset followed by treatment with high dose intravenous 39 immunoglobulin (IVIG) can greatly reduce the risk of severe coronary artery 40 lesions 1-3 . Therefore, early and successful detection is critical for treating KD. 41 So far, few cytokine-based biomarker platform was developed 4 . Therefore, the 42 detection of KD still mainly relies on the judgment of clinical physicians based on 43 patients' symptoms. However, infectious diseases by pathogens, may also result in 44 similar symptoms to those of KD, making it difficult to accurately diagnose KD and 45 leading to a delay in optimal and timely treatment of KD. 46 Previous studies showed that it is applicable to use blood miRNAs as disease 47 biomarkers 5-7 . So, we enrolled 70 fever control (FC, denoting non-KD patients with 48 fever) and 50 KD subjects (see Supplementary Methods). Among them, 37 FC and 49 31 KD subjects comprised the training set, used for developing KD biomarker panel 50 with NGS and/or qPCR assays. The remaining 33 FC and 19 KD subjects comprised 51 the blind test set, used for examining the performance of the developed KD 52biomarker panel. Table 1 shows that the most prevalent diagnosis of FC subjects was 53 upper or lower respiratory infection (28 and 27 patients, respectively). In KD 54 patients, bilateral conjunctivitis, oral mucosa changes and rash were the most 55 prevalent clinical features. 56We extracted RNA samples from white blood cells (see Supplementary 57 Methods). Then, we had two pooled FC and two pooled KD RNA libraries 58 sequenced with Illumina NGS platform, followed by miRSeq 8 analysis for 59 determining miRNA expression profiles (Supplementary Table 1). According to 60 miRSeq result, almost 80% of the initial reads belonged to clean read, the sequence 61 read with 3' adaptor recognized and trimmed. In addition, the majority of the clean 62 reads was 22-nt long (Supplementary Figure 1), reflecting high performance of the 63 sample preparation procedures and implying the dominance of miRNAs, which was 64 proven by Supplementary Figure 2. 65 To examine whether the FC and KD samples were distinguishable based on 66 miRNA expression profiles, we conducted clustering analysis. The heat map...
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