Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses

Abstract Introduction The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. Objectives This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. Methods This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. Results A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio = 1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23 mm (84.6% sensitivity, 77.3% specificity). Conclusion The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.</div

Image_3_Indoleamine 2,3-dioxygenase 1 signaling orchestrates immune tolerance in Echinococcus multilocularis-infected mice.tif

The cestode Echinococcus multilocularis larva infection causes lethal zoonotic alveolar echinococcosis (AE), a disease posing a great threat to the public health worldwide. This persistent hepatic tumor-like disease in AE patients has been largely attributed to aberrant T cell responses, of which Th1 responses are impeded, whilst Th2 and regulatory T cell responses are elevated, creating an immune tolerogenic microenvironment in the liver. However, the immune tolerance mechanisms are not fully understood. Dendritic cells (DCs) are key cellular components in facilitating immune tolerance in chronic diseases, including AE. Here, we demonstrate that indoleamine 2,3-dioxygenase 1-deficient (IDO1-/-) mice display less severe AE as compared to wild-type (WT) mice during the infection. Mechanistically, IDO1 prevents optimal T cells responses by programming DCs into a tolerogenic state. Specifically, IDO1 prevents the maturation and migration potential of DCs, as shown by the significantly enhanced expression of the antigen-presenting molecule (MHC II), costimulatory molecules (CD80 and CD86), and chemokine receptors (CXCR4 and CCR7) in infected IDO1-/- mice as compared to infected wild-type mice. More importantly, the tolerogenic phenotype of DCs is partly reverted in IDO1-/- mice, as indicated by enhanced activation, proliferation, and differentiation of both CD4+ and CD8+ - T cells upon infection with Echinococcus multilocularis, in comparison with WT mice. Interestingly, in absence of IDO1, CD4+ T cells are prone to differentiate to effector memory cells (CD44+CD62L-); in contrast, CD8+ T cells are highly biased to the central memory phenotype (CD44+CD62L+). Overall, these data are the first to demonstrate the essential role of IDO1 signaling in inducing immunosuppression in mice infected with Echinococcus multilocularis.</p

Image_2_Indoleamine 2,3-dioxygenase 1 signaling orchestrates immune tolerance in Echinococcus multilocularis-infected mice.tif

The cestode Echinococcus multilocularis larva infection causes lethal zoonotic alveolar echinococcosis (AE), a disease posing a great threat to the public health worldwide. This persistent hepatic tumor-like disease in AE patients has been largely attributed to aberrant T cell responses, of which Th1 responses are impeded, whilst Th2 and regulatory T cell responses are elevated, creating an immune tolerogenic microenvironment in the liver. However, the immune tolerance mechanisms are not fully understood. Dendritic cells (DCs) are key cellular components in facilitating immune tolerance in chronic diseases, including AE. Here, we demonstrate that indoleamine 2,3-dioxygenase 1-deficient (IDO1-/-) mice display less severe AE as compared to wild-type (WT) mice during the infection. Mechanistically, IDO1 prevents optimal T cells responses by programming DCs into a tolerogenic state. Specifically, IDO1 prevents the maturation and migration potential of DCs, as shown by the significantly enhanced expression of the antigen-presenting molecule (MHC II), costimulatory molecules (CD80 and CD86), and chemokine receptors (CXCR4 and CCR7) in infected IDO1-/- mice as compared to infected wild-type mice. More importantly, the tolerogenic phenotype of DCs is partly reverted in IDO1-/- mice, as indicated by enhanced activation, proliferation, and differentiation of both CD4+ and CD8+ - T cells upon infection with Echinococcus multilocularis, in comparison with WT mice. Interestingly, in absence of IDO1, CD4+ T cells are prone to differentiate to effector memory cells (CD44+CD62L-); in contrast, CD8+ T cells are highly biased to the central memory phenotype (CD44+CD62L+). Overall, these data are the first to demonstrate the essential role of IDO1 signaling in inducing immunosuppression in mice infected with Echinococcus multilocularis.</p

Image_1_Indoleamine 2,3-dioxygenase 1 signaling orchestrates immune tolerance in Echinococcus multilocularis-infected mice.tif

The cestode Echinococcus multilocularis larva infection causes lethal zoonotic alveolar echinococcosis (AE), a disease posing a great threat to the public health worldwide. This persistent hepatic tumor-like disease in AE patients has been largely attributed to aberrant T cell responses, of which Th1 responses are impeded, whilst Th2 and regulatory T cell responses are elevated, creating an immune tolerogenic microenvironment in the liver. However, the immune tolerance mechanisms are not fully understood. Dendritic cells (DCs) are key cellular components in facilitating immune tolerance in chronic diseases, including AE. Here, we demonstrate that indoleamine 2,3-dioxygenase 1-deficient (IDO1-/-) mice display less severe AE as compared to wild-type (WT) mice during the infection. Mechanistically, IDO1 prevents optimal T cells responses by programming DCs into a tolerogenic state. Specifically, IDO1 prevents the maturation and migration potential of DCs, as shown by the significantly enhanced expression of the antigen-presenting molecule (MHC II), costimulatory molecules (CD80 and CD86), and chemokine receptors (CXCR4 and CCR7) in infected IDO1-/- mice as compared to infected wild-type mice. More importantly, the tolerogenic phenotype of DCs is partly reverted in IDO1-/- mice, as indicated by enhanced activation, proliferation, and differentiation of both CD4+ and CD8+ - T cells upon infection with Echinococcus multilocularis, in comparison with WT mice. Interestingly, in absence of IDO1, CD4+ T cells are prone to differentiate to effector memory cells (CD44+CD62L-); in contrast, CD8+ T cells are highly biased to the central memory phenotype (CD44+CD62L+). Overall, these data are the first to demonstrate the essential role of IDO1 signaling in inducing immunosuppression in mice infected with Echinococcus multilocularis.</p

Table_1_Environmental Compensation Effect and Synergistic Mechanism of Optimized Nitrogen Management Increasing Nitrogen Use Efficiency in Indica Hybrid Rice.DOCX

Modern rice cultivation relies heavily upon inorganic nitrogen fertilization. Effective fertilizer management is key to sustainable agricultural development. Field and pot trials were conducted in 2014–2016, including a 15N-labeled urea pot experiment (2014) to investigate mechanism by which optimized nitrogen fertilizer application (OFA) increases nitrogen utilization efficiency (NUE). Results showed that the applied nitrogen recovery efficiencies with OFA were 71.71%, 110.17%, and 51.38% higher than those obtained with traditional nitrogen fertilizer application (TFA) in 2014, 2015, and 2016, respectively. These improvements are attributed mainly to the high recovery efficiency rates derived from spikelet-developing and spikelet-promoting fertilizer applications at the jointing stage and 15–20 d after jointing. Under OFA, the amount of nitrogen fertilizer applied at the early stages was half that used in TFA, which not only promoted the absorption of soil nitrogen, but also reduced nitrogen loss to the environment, as the NUE of basal and tillering fertilizer was only about 22%. Nitrogen applied during the panicle differentiation stage increased the expression of ATM1;1, a NH4+ transporter in roots. This effect significantly improved the uptake of nitrogen derived from fertilizer from jointing to heading stage. Up-regulation of the expression and activity of GS and GOGAT at the panicle differentiation and grain-filling stages promoted nitrogen translocation from vegetative organs to reproductive organs. The uptake of nitrogen derived from fertilizer increased from 22.51% in TFA to 35.58% in OFA. Nevertheless, rice absorbs most of the nitrogen it requires from the soil. The OFA treatment could effectively utilize the environmental compensation effect, promote the absorption and transport of nitrogen, and ultimately lead to improvement in NUE. Future research should aim to understand the soil nitrogen supply capacity in order to apply nitrogenous fertilizer in such a way that it sustains the nitrogen balance.</p

Image2_The buffering of a riverine carbonate system under the input of acid mine drainage: Example from a small karst watershed, southwest China.JPEG

In a karstic area affected by acid mine drainage (AMD), hydrochemical conditions, such as temperature, salinity, alkalinity, DIC, dissolved oxygen, and nutrients, may affect the buffering capacity of carbonate systems in freshwater systems. The resulting pH fluctuation is larger than that of a marine system. Therefore, this study focuses on the buffering of a riverine carbonate system under the input of AMD and discusses the variations in a series of buffering factors, including the Revelle factor, γDIC, γAlk βDIC, βAlk, ωDIC, and ωAlk. The results revealed that the Revelle factor could reflect the buffering process effectively; in addition, the maximum value of the Revelle factor appeared at pH = 8.5. The data points for pH greater than this value indicated that the Huatan River had the ability to absorb atmospheric CO2 in spring. Conversely, the data for pH less than this value reflected the buffering of H+ during CO2 degassing in summer and autumn. In winter, the data were around the maximum value, indicating the weakest buffering capacity. As a result, the dynamics of the carbonate system caused the most sensitive response to pH. In addition, the maximum Revelle factor value did not always indicate the carbonate system had reached equilibrium; the presence of strong CO2 degassing was still a possibility. Under acidic conditions, as CO2(aq) increased, the absolute values of γDIC, βDIC, ωDIC, and γAlk increased correspondingly, indicating the enhanced buffering capacity of H+ during CO2 degassing. Under the four Representative Concentration Pathways scenarios (RCPs) included in the IPCC’s fifth assessment report, the degassing rate of the Huatan River would decrease by 5%, 15%, 26%, or 48%, depending on the scenario. Even though the Huatan River revealed CO2 degassing characteristics in winter and spring under current conditions, it will eventually become a sink for atmospheric CO2 as atmospheric CO2 concentration increases. In this light, the carbon sink effect in karst areas will become increasingly important.</p

Image1_The buffering of a riverine carbonate system under the input of acid mine drainage: Example from a small karst watershed, southwest China.JPEG

In a karstic area affected by acid mine drainage (AMD), hydrochemical conditions, such as temperature, salinity, alkalinity, DIC, dissolved oxygen, and nutrients, may affect the buffering capacity of carbonate systems in freshwater systems. The resulting pH fluctuation is larger than that of a marine system. Therefore, this study focuses on the buffering of a riverine carbonate system under the input of AMD and discusses the variations in a series of buffering factors, including the Revelle factor, γDIC, γAlk βDIC, βAlk, ωDIC, and ωAlk. The results revealed that the Revelle factor could reflect the buffering process effectively; in addition, the maximum value of the Revelle factor appeared at pH = 8.5. The data points for pH greater than this value indicated that the Huatan River had the ability to absorb atmospheric CO2 in spring. Conversely, the data for pH less than this value reflected the buffering of H+ during CO2 degassing in summer and autumn. In winter, the data were around the maximum value, indicating the weakest buffering capacity. As a result, the dynamics of the carbonate system caused the most sensitive response to pH. In addition, the maximum Revelle factor value did not always indicate the carbonate system had reached equilibrium; the presence of strong CO2 degassing was still a possibility. Under acidic conditions, as CO2(aq) increased, the absolute values of γDIC, βDIC, ωDIC, and γAlk increased correspondingly, indicating the enhanced buffering capacity of H+ during CO2 degassing. Under the four Representative Concentration Pathways scenarios (RCPs) included in the IPCC’s fifth assessment report, the degassing rate of the Huatan River would decrease by 5%, 15%, 26%, or 48%, depending on the scenario. Even though the Huatan River revealed CO2 degassing characteristics in winter and spring under current conditions, it will eventually become a sink for atmospheric CO2 as atmospheric CO2 concentration increases. In this light, the carbon sink effect in karst areas will become increasingly important.</p

Table1_The buffering of a riverine carbonate system under the input of acid mine drainage: Example from a small karst watershed, southwest China.DOCX

In a karstic area affected by acid mine drainage (AMD), hydrochemical conditions, such as temperature, salinity, alkalinity, DIC, dissolved oxygen, and nutrients, may affect the buffering capacity of carbonate systems in freshwater systems. The resulting pH fluctuation is larger than that of a marine system. Therefore, this study focuses on the buffering of a riverine carbonate system under the input of AMD and discusses the variations in a series of buffering factors, including the Revelle factor, γDIC, γAlk βDIC, βAlk, ωDIC, and ωAlk. The results revealed that the Revelle factor could reflect the buffering process effectively; in addition, the maximum value of the Revelle factor appeared at pH = 8.5. The data points for pH greater than this value indicated that the Huatan River had the ability to absorb atmospheric CO2 in spring. Conversely, the data for pH less than this value reflected the buffering of H+ during CO2 degassing in summer and autumn. In winter, the data were around the maximum value, indicating the weakest buffering capacity. As a result, the dynamics of the carbonate system caused the most sensitive response to pH. In addition, the maximum Revelle factor value did not always indicate the carbonate system had reached equilibrium; the presence of strong CO2 degassing was still a possibility. Under acidic conditions, as CO2(aq) increased, the absolute values of γDIC, βDIC, ωDIC, and γAlk increased correspondingly, indicating the enhanced buffering capacity of H+ during CO2 degassing. Under the four Representative Concentration Pathways scenarios (RCPs) included in the IPCC’s fifth assessment report, the degassing rate of the Huatan River would decrease by 5%, 15%, 26%, or 48%, depending on the scenario. Even though the Huatan River revealed CO2 degassing characteristics in winter and spring under current conditions, it will eventually become a sink for atmospheric CO2 as atmospheric CO2 concentration increases. In this light, the carbon sink effect in karst areas will become increasingly important.</p

Image4_The buffering of a riverine carbonate system under the input of acid mine drainage: Example from a small karst watershed, southwest China.JPEG

In a karstic area affected by acid mine drainage (AMD), hydrochemical conditions, such as temperature, salinity, alkalinity, DIC, dissolved oxygen, and nutrients, may affect the buffering capacity of carbonate systems in freshwater systems. The resulting pH fluctuation is larger than that of a marine system. Therefore, this study focuses on the buffering of a riverine carbonate system under the input of AMD and discusses the variations in a series of buffering factors, including the Revelle factor, γDIC, γAlk βDIC, βAlk, ωDIC, and ωAlk. The results revealed that the Revelle factor could reflect the buffering process effectively; in addition, the maximum value of the Revelle factor appeared at pH = 8.5. The data points for pH greater than this value indicated that the Huatan River had the ability to absorb atmospheric CO2 in spring. Conversely, the data for pH less than this value reflected the buffering of H+ during CO2 degassing in summer and autumn. In winter, the data were around the maximum value, indicating the weakest buffering capacity. As a result, the dynamics of the carbonate system caused the most sensitive response to pH. In addition, the maximum Revelle factor value did not always indicate the carbonate system had reached equilibrium; the presence of strong CO2 degassing was still a possibility. Under acidic conditions, as CO2(aq) increased, the absolute values of γDIC, βDIC, ωDIC, and γAlk increased correspondingly, indicating the enhanced buffering capacity of H+ during CO2 degassing. Under the four Representative Concentration Pathways scenarios (RCPs) included in the IPCC’s fifth assessment report, the degassing rate of the Huatan River would decrease by 5%, 15%, 26%, or 48%, depending on the scenario. Even though the Huatan River revealed CO2 degassing characteristics in winter and spring under current conditions, it will eventually become a sink for atmospheric CO2 as atmospheric CO2 concentration increases. In this light, the carbon sink effect in karst areas will become increasingly important.</p

Image3_The buffering of a riverine carbonate system under the input of acid mine drainage: Example from a small karst watershed, southwest China.JPEG

In a karstic area affected by acid mine drainage (AMD), hydrochemical conditions, such as temperature, salinity, alkalinity, DIC, dissolved oxygen, and nutrients, may affect the buffering capacity of carbonate systems in freshwater systems. The resulting pH fluctuation is larger than that of a marine system. Therefore, this study focuses on the buffering of a riverine carbonate system under the input of AMD and discusses the variations in a series of buffering factors, including the Revelle factor, γDIC, γAlk βDIC, βAlk, ωDIC, and ωAlk. The results revealed that the Revelle factor could reflect the buffering process effectively; in addition, the maximum value of the Revelle factor appeared at pH = 8.5. The data points for pH greater than this value indicated that the Huatan River had the ability to absorb atmospheric CO2 in spring. Conversely, the data for pH less than this value reflected the buffering of H+ during CO2 degassing in summer and autumn. In winter, the data were around the maximum value, indicating the weakest buffering capacity. As a result, the dynamics of the carbonate system caused the most sensitive response to pH. In addition, the maximum Revelle factor value did not always indicate the carbonate system had reached equilibrium; the presence of strong CO2 degassing was still a possibility. Under acidic conditions, as CO2(aq) increased, the absolute values of γDIC, βDIC, ωDIC, and γAlk increased correspondingly, indicating the enhanced buffering capacity of H+ during CO2 degassing. Under the four Representative Concentration Pathways scenarios (RCPs) included in the IPCC’s fifth assessment report, the degassing rate of the Huatan River would decrease by 5%, 15%, 26%, or 48%, depending on the scenario. Even though the Huatan River revealed CO2 degassing characteristics in winter and spring under current conditions, it will eventually become a sink for atmospheric CO2 as atmospheric CO2 concentration increases. In this light, the carbon sink effect in karst areas will become increasingly important.</p