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Effects of SARS‑CoV‑2 infection on neuroimaging and neurobehavior in neonates
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Kai Yan, Fei‑Fan Xiao, Yu‑Wei Jiang, Tian‑Tian Xiao, Da‑Jiang Zhang, Wen‑Hao Yuan, Jian‑Bo Shao, Guo‑Qiang Cheng, Ling‑Kong Zeng |
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Background: We collected neonatal neurological, clinical, and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019 (COVID-19).
Methods: This case-control study included newborns diagnosed with COVID-19 in Wuhan, China from January 2020 to July 2020. All included newborns had complete neurological evaluations and head magnetic resonance imaging. We normalized the extracted T2-weighted imaging data to a standard neonate template space, and segmented them into gray matter, white matter, and cerebrospinal fluid. The comparison of gray matter volume was conducted between the two groups.
Results: A total of five neonates with COVID-19 were included in this study. The median reflex scores were 2 points lower in the infected group than in the control group (P = 0.0094), and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group (P = 0.0008). There were also significant differences between the two groups in the total scale score (P = 0.0426). The caudate nucleus, parahippocampal gyrus, and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination (HNNE) score, and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5. Conclusions: We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods. Considering the limited numbers of patients, more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future. |
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Clinical and molecular characteristics of Staphylococcus aureus isolated from Chinese children: association among the agr groups and genotypes, virulence genes and disease types
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Yan Xu, Su‑Yun Qian, Kai‑Hu Yao, Fang Dong, Wen‑Qi Song, Chen Sun, Xin Yang, Jing‑ Hui Zhen, Xi‑Qing Liu, Zhi‑Yong Lv, Xi Yang |
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Background: This study was aimed to investigate the clinical and molecular epidemiology of Staphylococcus aureus ( S. aureus) isolated from Chinese children and determine the possible relationship among the accessory gene regulator ( agr) groups and genotypes, as well as among the virulence genes and disease types.
Methods: S. aureus strains were isolated from Beijing Children’s Hospital between October 2017 and October 2019. The isolates and 19 virulence genes were characterized using multi-locus sequence typing, staphylococcal protein A (spa), staphylococcal cassette chromosome mec, and agr typing.
Results: A total of 191 non-repetitive S. aureus clinical isolates were divided into 33 sequence types (STs), 18 clonal complexes (CCs), and 59 spa types. ST59 (39.8%), t437 (37.7%), and agr I (84.8%) were the predominant types. CC59, CC25, CC22, CC951, CC8, and CC398 belonged to agr I. CC5 and CC15 were assigned to agr II, and CC30 was characterized as agr III. CC121 was classified under agr IV. The eta, etb, and bbp genes were more prevalent in agr IV (P < 0.001 for each), while tst was more prevalent in agr group III compared to the other groups (P < 0.001). Nearly all isolates that harbored lukS/F-PV belonged to agr I (P = 0.005). However, the correlation between disease types and agr groups was not significant (P > 0.05). Conclusions: An association among the agr groups and genotypes, as well as specific toxin genes, was observed among the S. aureus strains isolated from Chinese children. However, a statistical correlation was not found among the agr groups and disease types. |
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Continuous positive airway pressure acutely increases exercise duration in children with severe therapy‑resistant asthma: a randomized crossover trial
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Cláudia Silva Schindel, Daniele Schiwe, João Paulo Heinzmann‑Filho, Natália Evangelista Campos, Paulo Márcio Pitrez, Márcio Vinícius Fagundes Donadio |
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Background: Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA.
Methods: We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH2O and FiO2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH2O also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one.
Results: Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV 1) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference ( P = 0.59) between groups at peak exercise for oxygen consumption—VO 2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg −1 min −1). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly ( P = 0.01) longer than the CG (11.5 ± 1.3). Conclusion: The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA. |
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Association between gestational anemia in different trimesters and neonatal outcomes: a retrospective longitudinal cohort study
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Chang‑Fa Sun, Han Liu, Yan‑Hui Hao, Hong‑Tao Hu, Zhi‑Yang Zhou, Ke‑Xin Zou, Xin‑Mei Liu, Jian‑Zhong Sheng, Guo‑Lian Ding, He‑Feng Huang |
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Background: Previous studies investigated the association between gestational anemia and neonatal outcomes. However, few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy. This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes.
Methods: The study was conducted in Shanghai, China, with a sample of 46,578 pregnant women who delivered between January 1, 2016 and July 1, 2019. A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes.
Results: The incidence of gestational anemia was 30.2%, including 4.4% in the first trimester, 9.6% in the second trimester, and 16.2% in the third trimester. Only 24.5% (507/2066) of anemia that occurred in the first trimester and 29.6% (1320/4457) that occurred in the second trimester could be corrected in the later stages of pregnancy. Anemia occurring in the first trimester was associated with small for gestational age [odds ratio (OR) 1.46; 95% confidence interval (CI) 1.20-1.78] and with fetal distress (OR 1.23; 95% CI 1.08-1.40). Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age. Conclusions: Gestational anemia is a public health problem in China impacting neonatal health. Anemia in pregnancy could be corrected in only about a quarter of the women. Anemia in the first trimester, whether corrected or not, still led to lower birth weight; therefore, the prevention of anemia prior to pregnancy is important. |
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Prevalence of Epstein–Barr virus infection and characteristics of lymphocyte subsets in newly onset juvenile dermatomyositis
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Qi Zheng, Kun Zhu, Cai‑Na Gao, Yi‑Ping Xu, Mei‑Ping Lu |
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Background: The underlying etiology of juvenile dermatomyositis (JDM) is unknown. T cell deficiency as well as Epstein-Barr virus (EBV) infection had been suspected to be involved in the pathogenesis, but it has been poorly evaluated in JDM patients.
Methods: This study described the traits of T and B lymphocyte subsets in newly onset JDM patients and the incidence of EBV infection in JDM patients compared with match controls. Newly developed JDM patients from 2014 to 2018 were included in the study. Lymphocytes with different markers (CD3 +, CD3 +CD4 +, CD3 +CD8 +, CD3 −CD19 + and CD3 −CD16 +CD56 +) were tested with flow cytometry in the first admission or after 6 months of treatment. Statistical analysis was conducted to compare the EBV infection in the group of JDM patients and controls.
Results: We observed that JDM patients had higher positive rate of Epstein-Barr nuclear antigen-immunoglobulin G (IgG) (P < 0.0001) as well as EBV capsid antigen-IgG (P < 0.05) than normal controls. CD3−CD16+CD56+ lymphocyte was found to be extremely low in early stage of JDM patients, but increased after 6 months of treatment (P = 0.0091). Conclusions: The level of CD3−CD16+CD56+ cells may associate with the clinical course of JDM. EBV may act as an environmental factor predisposing patients to the development of JDM. |
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