Clinical analysis of 978 children with influenza / 中华实验和临床病毒学杂志

Objective@#To study the clinical features and treatment of children with influenza, and provide evidence for clinical screening and appropriate treatment timely.@*Methods@#Epidemiology, clinical manifestations, laboratory features and drug therapy of 978 pediatric patients with influenza in Beijing New Century International Children's Hospital in 2014 were analyzed retrospectively.@*Results@#Among the 978 pediatric patients with influenza, 90.8%were outpatients, while 9.92% were inpatients. The incidence was the highest in winter (85.28%). The age of most cases ranged from 1 to 5 years (57.16%). The cases with type A influenza accounted for 81.29%. High fever (99.59%) and cough (85.89%) were the two main symptoms. The average count of WBC was 6.86±2.68×109/L, lymphocyte percentage was lower than the proportion of neutrophils. CRP was normal (66.16%) or slightly-increased (19.00± 15.12 mg/l). Compared with type A influenza, digestive tract symptoms were more common in cases with type B (P=0.000). Analysis of 97 hospitalized cases: the main diagnosis was lower respiratory tract infection (71.13%). Nearly 23.71% cases had been detected to have combined infection with other pathogenic agents. Course of fever in cases who started taking oseltamivir after fever of 48 hours was significantly longer than those who took within 48 hours (P=0.000). Seven severe pneumonia cases were mainly in young children, cases with underlying disease or mixed infection, they were all cured by active and comprehensive therapy.@*Conclusions@#Influenza in children is characterized by high fever and cough, digestive tract symptoms frequently occurred in patients with type B influenza. Early application of oseltamivir could signficantly shorten the period of fever. Severe cases should be given active and comprehensive treatments.

Congenital pulmonary vein atresia / 中华实用儿科临床杂志

Congenital pulmonary vein atresia (PVA) is a rare anomaly in clinic.Patients with congenital PVA are usually symptomatic and present with recurrent episodes of pneumonia or haemoptysis in infancy or childhood.Because PVA often occurs in the setting of other congenital heart lesions,so repeated infection of lung might be considered to associate with left-to-right intracardiac shunt with increased pulmonary blood,but ignore further examination of more rare cause.Diagnosis of PVA is based primarily on imaging test,chest radiograph,lung CT and fiberoptic bronchoscopy might reveal some indirect characteristic changes of the disease.Three dimensional contrast enhanced cardiac CT can make a definite diagnosis.The disease is difficult to cure at present,the aim of the treatment is to preserve lung function.The prognosis is associated with the number of involved pulmonary veins.

Clinical analysis and follow-up of neonatal lower respiratory tract infection with respiratory syncytial virus / 中华实用儿科临床杂志

Objective To investigate the clinical features of neonatal lower respiratory tract infection (LRTI)with respiratory syncytial virus(RSV),and to explore the relationship between clinical features and recurrcnt cough or wheezing after discharge.Methods From May 2008 to May 2013,the data of 41 neonates diagnosed as LRTI with RSV infection in New Century International Children's Hospital were analyzed retrospectively.The clinical features and follow-up results were observed.Results All the neonates had cough,92.7％ (38/41 cases) had choking,85.4％ (35/41 cases) had runny nose and nasal obstruction,31.7％ (13/41 cases) had fever,65.9％ (27/41 cases) had wheezing sound during physical examination,29.3％ (12/41 cases)of the neonates were accompanied with bacterial infection(n=29),in which 50.0％ (6/12 cases) were infected by staphylococcus aureus.Compared to the neonates only with RSV infection,the proportion of fever was higher in those with RSV combined with bacterial infection (n =12)(x2 =6.034,P ＜ 0.05),and there were no statistical differences between the neonates with or without bacterial infection in white blood cell count and with or without shadow in chest X-ray(x2 =0.859,2.064,P =0.485,0.202).Compared with the neonates without family history of atopy,the neonates with the family history of atopy were more likely to get wheezing (88.2％ vs 57.1％,x2 =4.871,P ＜ 0.05) during primary infection.During the follow-up,there was higher proportion of children with family history of atopy in the group with subsequent recurrent cough and/or wheezing than in the group without subsequent recurrent cough and/or wheezing (71.4％ vs 26.3％,x2 =6.388,P ＜ 0.05).Conclusions Cough,choking are most common symptoms in neonatal LRTI with RSV,and there is no wheezing sound during phy-sical examination in some neonates.LRTI with RSV is likely combined with bacterial infection.Wheezing is more common in the neonates with family history of atopy.The RSV LTRI neonates with family history of atopy incline to get subsequent recurrent cough or wheeze after discharge.

Contrast ultrasound in the assessment of renal cortical perfusion in rabbits / 中国医学影像技术

Objective To explore the value of the ultrasound contrast agent in conjunction with advanced contrast imaging techniques in the evaluation of the renal cortical perfusion. Methods The animal model was established with ligating renal artery to cause the renal cortical perfusion decrease of rabbits. Real-time harmonic gray scale imaging was performed to visualize the contrast enhancement of the renal cortex. After bolus injection of contrast agent SonoVue, dynamic image was observed and recorded during the first three minutes. According to the time-intensity curve (TIC), accelerating time (AT),Peak intensity (A), time to half of peak intensity (T), difference between peak and base (PBD), slope rate of the curve (β) and the product of A and β (A·β) were obtained before and after the renal artery operation. The t test and correlation analysis was used to examine the above parameters. Results Before the renal artery operation, renal cortex enhanced rapidly and obviously, the way of the enhancement was renal artery-cortex-pyramids. After ligation of renal artery, AT prolonged evidently (P<0.001), A decreased obviously (P<0.001), T obviously shortened (P<0.001), PBD decreased markedly (P<0.001), while the decline of βinduced (P<0.002) and A·βobvious dropped(P<0.001). AT, BPD and A·βcorrelated with stenosis level of renal artery. Compared with 31%－69% group, AT prolonged evidently (P<0.001). A decreased obviously (P<0.029), PBD decreased obviously (P<0.001), A·β was dropped markedly (P<0.02) in 70%-93% stenosis group. Conclusions Contrast agent combining with developed contrast specific imaging is able to detect changes of renal cortical microcirculation sensitively with the help of analysis of TIC.

Changes of cerebral blood flow and carbon dioxide reactivity of cerebral vessels in children after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To observe the changes of cerebral blood flow velocities and carbon dioxide (CO_2) reactivity of cerebral vessels in children after cardiopulmonary resuscitation,and the relationship between the changes of cerebral blood flow and outcome.Methods The waveforms,cerebral blood flow velocities of left middle cerebral artery and extracranial internal carotid artery were monitored by Transcranial Doppler (TCD) in 35 post-resuscitation children. Glasgow coma score (GCS) was estimated at the same time.They were divided into three groups according to the diastolic blood flow velocities:low perfusion group,high perfusion group and near-normal perfusion group.CO_2 reactivity of cerebral vessels was induced by hyperventilation in 26 children under ventilation.Results In both low and high perfusion groups,GCS and CO_2 reactivity of cerebral vessels were significantly lower than that of near-normal perfusion group (P＜0.05);the numbers of died and withdrawing treatment patients were significantly higher than that of near-normal perfusion group (P＜0.01).Conclusion TCD monitoring is a useful technique for estimating cerebral perfusion,outcome and CO_2 reactivity of cerebral vessels of children after cardiopulmonary resuscitation.A secondary ischemic event may be caused by a forced hyperventilation therapy in the condition without TCD monitoring in post-resuscitation patients.