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Background: Between 10 and 20% of Kawasaki disease (KD) patients are resistant to treatment with initial intravenous immunoglobulin (IVIG) and have a high risk of developing coronary artery lesions. Some studies have been conducted to identify predictive factors. However, the results are controversial. This study aims to identify the risk factors for IVIG-resistant KD patients in a Chinese population.Methods: We performed a retrospective analysis of medical records of consecutive KD patients from two medical centers in South China from January 2015 to December 2017. A total of 1281 KD patients were eligible for inclusion in this study and maintained follow-up for over 12 months. The KD patients were divided into two groups based on IVIG response. Clinical characteristics and laboratory variables were compared between the two groups. Multivariate logistic regression analysis was performed to identify the risk factors of IVIG resistance in KD patients.Results: Of the 1281 KD patients, 141 (11.0%) cases who were IVIG resistant to adjunctive therapies for primary treatment were classified as group 1. The remaining patients were in group 2 (n = 1140), classified as the control group. There was a significant difference in male to female ratio and the length of hospital stay between the two groups (P < 0.05). Group 1 had a higher white blood cell count (P=0.01) and C-reactive protein level (P < 0.01) before IVIG treatment than in group 2. Group 1 had a significantly higher white blood cell count and percentage of neutrophils after the IVIG infusion than in group 2 (P < 0.001). In addition, the mean values of C-reactive protein level and neutrophil percentage before and after treatment difference comparison were significantly different. Multivariate analysis showed that patients presenting with coronary artery lesions in the acute phase and a C-reactive protein level >100 mg/L at diagnosis were associated with IVIG resistance in KD. During the 12-month follow-up period, group 1 had an obviously higher incidence of coronary artery lesions than group 2, and the difference between the groups was statistically significant (P < 0.001).Conclusions: Patients presenting with coronary artery lesions in the acute phase and elevated C-reactive protein levels before IVIG treatment might be a useful and important value for predicting IVIG resistance in KD. Risk assessment based on coronary artery lesions and C-reactive protein levels prior to the treatment may improve the outcome of IVIG resistance. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effects of substituting soybean oil (SO) for fish oil (FO) on the performance, tissue fatty acid (FA) composition, plasma components, liver metabolic enzyme activity and mRNA levels of genes related to lipid metabolism in the liver of groupers (Epinephelus coioides). We formulated five isolipidic and isoproteic diets with increasing SO levels (0, 250, 500, 750 and 1000 g/kg, respectively). Triplicate groups of 30 groupers (initial mean body weight of 12.6 g/fish) were fed one of the diets twice daily, to apparent satiety across a feeding period of 56 days. The growth performance, whole‐body composition, and protein and lipid muscle contents did not differ across the dietary treatments. In contrast, the liver lipid content had positive linear and quadratic responses to the increasing dietary SO levels, but the liver protein content had the opposite trend, and the highest lipid value and lowest protein value occurred in the 250 and 1000 g/kg SO diets, respectively. There were no significant effects of increasing dietary SO inclusion levels on any of the plasma components and parameters of liver metabolic enzyme activity, except for acetyl coenzyme A carboxylase and hepatic lipase, which showed linear and quadratic responses to increasing dietary SO inclusion levels and peaked at 1000 and 250 g/kg SO inclusion level, respectively. However, the FA profiles of the dorsal muscle and liver generally reflected the FA profile of the diet. Furthermore, the mRNA levels of fas, acc, g6pd, lpl, pparα, cpt‐1, srebp‐1c, δ6fad and elovl5 in the liver exhibited positive linear and/or quadratic responses to dietary SO inclusion levels. However, negative linear and/or quadratic responses were observed for the mRNA levels of hsl and atgl in the liver, with increasing dietary SO inclusion levels. The mRNA levels of scd and fabp in the liver were not affected by the dietary SO inclusion level. These results indicate that FO could be replaced completely by SO without affecting growth. However, the inclusion of SO at levels higher than 500 g/kg could compromise the FA profile in the liver and flesh of the fish species. These results provide a novel insight into the potential utilization of SO in grouper feeds. [ABSTRACT FROM AUTHOR]