Hospitalized children with 2009 influenza A (H1N1) infection can have a wide range of presentation and clinical complications including neurologic complications. The severe cases and deaths concentrate in previously healthy older children.
Objective To summarize the clinical features of primary nephrotic syndrome (PNS) complicated by plastic bronchitis (PB) in children to provide guidance for treatment. Methods We conducted a retrospective review of the clinical data of 25 children hospitalized with NS complicated by PB in our Hospital between 10/2016 and 03/2019, and summarized the clinical manifestations, imaging and fiberoptic bronchoscopy (FOB) examinations, treatment course and outcome of them. Results 1). The 25 children, with a nephrotic syndrome (NS) course of one to 36 months, were all diagnosed with PB after FOB, among which 8 cases (32%) had respiratory failure and required ventilatory support. All of them started with respiratory symptoms such as fever and cough, and then suffered from dyspnea and progressive aggravation after 1–3 day(s) of onset, with rapid occurrence of bidirectional dyspnea and even respiratory failure in severe cases. 2). Laboratory test for pathogens: influenza A virus H1N1 (11 cases), influenza B virus (9 cases), adenovirus (3 cases) and mycoplasma pneumoniae (2 cases). There was no statistically significant difference (P>0.05) between children with common NS complicated by influenza virus (IV) infection (not accompanied by dyspnea) and those with kidney disease who developed PB in the white blood cell count, lymphocyte count, the inflammatory biomarkers C-reactive protein (CRP), procalcitonin (PCT) and humoral immunity (IgG level), yet the total IgG level was found significantly higher and the blood albumin level lower in the latter (P<0.05). 3). The 25 children were all examined with the FOB and treated with lavage, 15 of which had typical bronchial tree-like casts and 10 broken and stringy casts. Based on histopathological classification, all children were of Type I. 4). Twenty children (80%) with influenza were administered the antiviral drug Oseltamivir, 20 (80%) were treated with antibiotics, oral hormones were replaced with the same dosage of intravenous Methylprednisolone for 5 cases (20%), and 20 (80%) were intravenously administered gamma globulins (400–500 mg/kg x 3 days). These children showed a remarkable improvement after treatment and there were no deaths. Conclusion NS children are at high risk of influenza virus infection. Children with a severe case of NS are more susceptible to PB. If symptoms like shortness of breath, wheezing and progressive bidirectional dyspnea occur, FOB examination and lavage treatment should be performed as early as possible. Hyper-IgE-emia and hypoproteinemia may be the high risk factors for PNS complicated by PB in children.
Realizing the coupled coordination between urban welfare (UW) and tourism development (TD) is an important guarantee to achieve healthy and orderly socioeconomic development and move towards a high-quality life. On the basis of constructing the evaluation system of UW and TD, this study explored the interactive response relationship and spatio-temporal coupled coordination characteristics between UW and TD in the Yangtze River Delta urban agglomeration using the entropy weight TOPSIS method, panel vector autoregression (PVAR) model and coupled coordination degree model. The main findings are as follows: (1) UW and TD in the Yangtze River Delta presented an upward trend from 2001 to 2020, while the development level and growth rate of tourism lagged behind urban welfare, and there was obvious spatial heterogeneity at the provincial level. (2) There was a long-run equilibrium and reciprocal feedback relationship between UW and TD, and the contribution of TD was greater than that of UW to TD. (3) There existed a significantly positive spatial association between UW and TD, and their local spatial association pattern was dominated by High-High and Low-Low clustering. (4) The coupled coordination degree between UW and TD in the Delta region generally showed a spatial pattern decreasing from southeast to northwest, with the regional gap diminishing and the coupled coordination type in most cities gradually evolving from mild and near disordered to bare and primary coordination. This study can form a useful reference for the harmonious improvement of UW and TD in the Yangtze River Delta.
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