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Background: Glucocorticoid-induced tumor necrosis factor receptor family-related protein ligand (GITRL) plays an important role in tumors, autoimmunity and inflammation. However, GITRL is not known to modulate the pathogenesis of allergic asthma. In this study, we investigated whether regulating GITRL expressed on dendritic cells (DCs) can prevent asthma and to elucidate its mechanism of action.Methods: In vivo, the role of GITRL in modulating house dust mite (HDM)-induced asthma was assessed in adeno-associated virus (AAV)-shGITRL mice. In vitro, the role of GITRL expression by DCs was evaluated in LV-shGITRL bone marrow dendritic cells (BMDCs) under HDM stimulation. And the direct effect of GITRL was observed by stimulating splenocytes with GITRL protein. The effect of regulating GITRL on CD4+ T cell differentiation was detected. Further, GITRL mRNA in the peripheral blood of asthmatic children was tested.Results: GITRL was significantly increased in HDM-challenged mice. In GITRL knockdown mice, allergen-induced airway inflammation, serum total IgE levels and airway hyperresponsiveness (AHR) were reduced. In vitro, GITRL expression on BMDCs was increased after HDM stimulation. Further, knocking down GITRL on DCs partially restored the balance of Th1/Th2 and Th17/Treg cells. Moreover, GITRL stimulation in vitro inhibited Treg cell differentiation and promoted Th2 and Th17 cell differentiation. Similarly, GITRL mRNA expression was increased in the peripheral blood from asthmatic children.Conclusions: This study identified a novel role for GITRL expressed by DCs as a positive regulator of CD4+ T cells responses in asthma, which implicates that GITRL inhibitors may be a potential immunotherapy for asthma. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical manifestation of children with occult bronchial foreign body, to analyze the reasons of misdiagnosis, to summarize the way of diagnosis and to emphasize the value of bronchoscopy in diagnosis and treatment of children with such disease., Method: A retrospective analysis of 22 cases of occult bronchial foreign body diagnosed and treated with bronchoscopy in Children's Hospital of Chongqing Medical University during the period from March 1, 2009 to February 28, 2014., Result: Of the 22 cases, 15 were male and 7 female. Their age ranged from nine months and eight days to fourteen years and six months. The course of disease ranged in length from six days to one year. It took us one to thirty-three days in diagnosing the problem. They or their parents all denied aspirating foreign body and the patients did not have irritating chokes. They did not have tracheal displacement or flapping sound. There were no direct signs of bronchial foreign body in their imaging examination. Twenty-one patients were diagnosed as pneumonia before bronchoscopy, and the remaining one was diagnosed as tuberculosis. All of the patients were complicated with infection; atelectasis was found in 15 cases/times, lung consolidation in 10 cases/times, emphysema in 4, pleural effusion in 5, bronchiectasis in 4, one case had respiratory failure, one case had septicemia. The clinical symptoms were relieved in the patients after bronchoscopy, 3 cases were cured, 19 cases were improved., Conclusion: Occult bronchial foreign body with certain complications and great harm is hard to diagnose. We should pay more attention to the important clues, such as a child with repeated pulmonary infection, indirect signs of airway obstruction and difficult to treat. Early bronchoscopy will be useful to improve diagnostics once the vital clue is found.

Aim: To investigate the clinical features of airway malacia in children., Material and Methods: A comprehensive analysis was done on information of 459 young patients with airway malacia., Results: Number of children with tracheomalacia, tracheobronchomalacia, and bronchomalacia was 7 (1.5%), 17 (3.7%), and 435 (94.8%), respectively. Incidence of bronchomalacia in left lung was 11.0% (n=48), while that of right lung was 53.3% (n=232). Meanwhile, bronchomalacia of both lungs were noticed in 155 children (35.6%). With regards to the extent of malacia, number of children with slight, moderate and severe malacia was 226, 195, and 38, respectively. All the children enrolled in this study were diagnosed with pulmonary infection, among which 376 were diagnosed with ordinary pneumonia, 83 were diagnosed with severe pneumonia. 227 children showed a disease course of less than 1 month, while 201 children reported a disease course of 1~3 months, and 31 children reported a disease course of more than 3 months. Statistical difference was noticed in the disease condition of respiratory tract infection of patients with various malacia extent (P < 0.05). Re-check of fiberoptic bronchoscopy was performed in 19 patients, among which 14 patients (73.7%) showed improvement compared with the previous conditions., Conclusion: Airway malacia has been frequently noticed in male children aged ≤ 2 years old. Patients with severe airway malacia were apt to develop severe pneumonia compared with those with slight or moderate malacia. Improvements or even elimination of malacia were noticed with the aging of the children and the anti-infection therapy.