Search

Shuxian Li,1,* Jinling Liu,1,* Junfen Zhou,1,2 Yingshuo Wang,1 Fang Jin,1 Xiaoyang Chen,3 Jun Yang,4,5 Zhimin Chen1 1Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang 310052, China; 2Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang 317500, China; 3Developmental and Behavioral Department, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang 310052, China; 4Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310013, China; 5Department of Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, Zhejiang 310016, China*These authors contributed equally to this workCorrespondence: Zhimin ChenDepartment of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, Zhejiang 310052, ChinaTel +86 571 8887 3731Fax +86 571 8703 3296Email zmchen@zju.edu.cnJun YangDepartment of Toxicology, Hangzhou Normal University, Hangzhou, Zhejiang 310016, ChinaTel/Fax + 86 571 8820 8141Email gastate@zju.edu.cnBackground: Despite considerable efforts, the pathogenic mechanisms of asthma are still incompletely understood, due to its heterogeneous nature. However, metabolomics can offer a global view of a biological system, making it a valuable tool for further elucidation of mechanisms and biomarker discovery in asthma.Methods: GC-MS–based metabolomic analysis was conducted for comparison of urine metabolic profiles between asthmatic children (n=30) and healthy controls (n=30).Results: An orthogonal projections to latent structures discriminant–analysis model revealed a clear separation of the asthma and control groups (R2x=0.137, R2y=0.947, Q2=0.82). A total of 20 differential metabolites were identified as discriminant factors, of which eleven were significantly increased and nine decreased in the asthma group compared to the control group. Pathway-enrichment analysis based on these differential metabolites indicated that sphingolipid metabolism, protein biosynthesis, and citric acid cycle were strongly associated with asthma. Among the identified metabolites, 2-hydroxybutanoic acid showed excellent discriminatory performance for distinguishing asthma from healthy controls, with an AUC of 0.969.Conclusion: Our study revealed significant changes in the urine metabolome of asthma patients. Several perturbed pathways (eg, sphingolipid metabolism and citric acid cycle) may be related to asthma pathogenesis, and 2-hydroxybutanoic acid could serve as a potential biomarker for asthma diagnosis.Keywords: asthma, metabolomics, sphingolipid metabolism, citric acid cycle, biomarker

The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and Mycoplasma pneumoniae infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.

Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis, is a systemic necrotizing vasculitis of the small and medium vessels. It typically occurs in conjunction with a history of asthma, eosinophilia, pulmonary infiltrates, and vasculitis, but cases without asthma have also been reported (1-2). CSS has rarely been reported in pediatric patients. Here, we report a nine-year-old boy with a possible diagnosis of CSS who presented with prominent pulmonary involvement accompanied by eosinophilia, rash, abdominal pain, and hepatomegaly but without anti-neutrophil cytoplasmic antibody (ANCA). The present case indicates that physicians should consider CSS when eosinophilia is noted in bronchoalveolar lavage, serum, or a tissue specimen. The clinical features and treatment for childhood CSS are reviewed.