Analysis of safety and efficacy of propofol used as anesthesia and deep sedation during flexible bronchoscopy in children / 中国实用儿科杂志

OBJECTIVE: To investigate the efficacy and safety of propofol used as anesthesia and deep sedation during flexible bronchoscopy in children. METHODS: The clinical data of 206 children with atelectasis who underwent flexible bronchoscopic alveolar lavage in the Endoscopy Room of the Respiratory Department of Hebei Children's Hospital from January 2016 to January 2017 were retrospectively analyzed. Children for ASAⅠ/Ⅱ level were divided into two groups according to the sedation method :there were 106 cases in the propofol group(2 mg/kg)and 100 cases in the midazolam group(0.1 mg/kg).To compare the onset time of anesthetict,heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),percutaneous oxygen saturation(SPO2)before and after anesthesia induction(T0,T1),during endoscopy placement(T2)and after awakening(T3)at 4 time points,operative duration,the waked duration of postoperation,the rate of adverse reactions(hiccups,respiratory depression)in the operation and Ramsay score between two groups. All data were analyzed by SPSS 20.0 statistical software.RESULTS:(1)There were statistically significant differences at the onset time of anestheticts,operative duration and the rate of side-effects between the two groups(P0.05).(2)There was no significant difference in MAP or SPO2 at time points of T0,T1,T2,T3(P>0.05),whereas the difference in HR and RR at time points of T1,T2,T3 between the two groups was statistically significant(P<0.05).(3)The sedative effect of propofol group was significantly better than that of midazolam group in Ramsay sedative scoring. CONCLUSION: Propofol used for anesthesia and deep sedation works fast,safely and effectively in flexible bronchoscopy for children;the time to gain consciousness is short,the operation time is short and there is fewer side effects,which is worth promoting.

Detection of respiratory viruses in children with acute lower respiratory tract infection: an analysis of 5,150 children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the distribution of respiratory viruses on throat swabs in hospitalized children with acute lower respiratory tract infection (ALRTI).</p><p><b>METHODS</b>A total of 5,150 children with ALRTI who were admitted to Hebei Children's Hospital between March 2014 and February 2015 were enrolled to investigate the distribution of respiratory viruses in children with ALRTI. Direct immunofluorescence assay was performed for throat swabs from these children to detect influenza virus A (FA), influenza virus B (FB), adenovirus (ADV), respiratory syncytial virus (RSV), and parainfluenza virus types 1, 2, and 3 (PIV-1, PIV-2, and PIV-3).</p><p><b>RESULTS</b>Of all the 5,150 throat swabs from hospitalized children, 2,155 (41.84%) had positive virus detection results. RSV had the highest detection rate (1,338 cases/25.98%), followed by PIV-3 (439 cases/8.52%) and FA (166 cases/3.22%), and 29 patients had mixed infection with 2 viruses. With the increasing age, the detection rates of viruses tended to decrease (χ2=279.623; P<0.01). The positive rate of RSV increased gradually from September, and reached the peak value (60.09%) in November; the lowest positive rate occurred in June (1.51%). The positive rate of PIV-3 was the highest in May (21.38%) and the lowest in November (1.77%).</p><p><b>CONCLUSIONS</b>The distribution of viruses in children with ALRTI varies with age and season, with RSV prevalence in autumn and winter and PIV-3 prevalence in spring and summer. RSV is the most common viral pathogen that causes ALRTI in hospitalized children.</p>

Utility of fractional exhaled nitric oxide in children with asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the utility of fractional exhaled nitric oxide (FeNO) in young children at different stages of asthma.</p><p><b>METHODS</b>Fifty-eight children with newly diagnosed asthma (aged 1-3 years) at the acute exacerbation stage between April and June, 2014 were recruited. After 3 months' treatment, the children switched into the chronic persistent stage (n=34) or remission stage (n=24). Thirty aged-matched healthy children served as controls. FeNO levels and lung function were measured for all subjects. The best cut-off value of FeNO for the diagnosis of asthma was evaluated by receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>The FeNO levels in children with asthma at various stages were higher than controls (P<0.05). The FeNO levels in the acute exacerbation stage were highest, followed by the chronic persistent stage (P<0.05). FeNO level was correlated to the stages of asthma (r=-0.382, P<0.001). The cut-off value of FeNO for the diagnosis of asthma was 22.75 ppb by ROC curve, with the sensitivity of 0.933 and the specificity of 0.388.</p><p><b>CONCLUSIONS</b>The children with asthma at different stages have different FeNO levels. Measurement of FeNO is useful in the diagnosis of asthma in young children.</p>

Correlation of fractional exhaled nitric oxide with peripheral blood eosinophils and lung function in 1-3-year-old children with asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine fractional exhaled nitric oxide (FeNO) values in 1-3-year-old children with asthma and analyze the correlation of FeNO with peripheral blood eosinophils (EOS) and lung function in these children.</p><p><b>METHODS</b>A total of 111 children aged 1-3 years with asthma were enrolled. The children were classified into acute exacerbation (n=62) and remission groups (n=49) according to their symptoms. FeNO values, lung function, and peripheral blood EOS count were measured in these children. Sixty age-matched healthy children were enrolled as the control group.</p><p><b>RESULTS</b>FeNO values were significantly higher in the acute exacerbation group (24.4 ppb) than in the remission group (18.0 ppb) and the control group (13.7 ppb) (P<0.05). The FeNO values in the remission group were significantly higher than in the control group (P<0.05). FeNO values were not significantly correlated with peripheral blood EOS count and lung function parameters (PEF, TEF25, TEF50, and TEF75).</p><p><b>CONCLUSIONS</b>Measurement of FeNO is useful to evaluate the disease activity in children with asthma aged 1 to 3 years, but the FeNO values are not correlated with peripheral blood EOS count and lung function.</p>

Prognostic judgment of children with Mycoplasma pneumoniae pneumonia associated with airway mucous plug formation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and treatment defects in slow-to-recover children with Mycoplasma pneumoniae pneumonia (MPP) associated with airway mucous plug formation, and to provide a basis for prognostic judgment and therapeutic guidance.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 67 children with MPP who were admitted between May 2012 and May 2014 and showed airway mucous plug formation in fiberoptic bronchoscope examinations. Based on the results of re-examinations using imaging methods, all patients were classified into a slow-to-recover group (n=30) and a control group (n=37). Comparisons of clinical outcomes, laboratory indices, imaging findings, and treatment methods were performed between the two groups. The receiver operating characteristic (ROC) curves were drawn to analyze the indices with significant differences.</p><p><b>RESULTS</b>The percentage of neutrophils, levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), fibrinogen (FIB), and IgM in peripheral blood, and incidence of pleural effusion were significantly higher in the slow-to-recover group than in the control group (P<0.05). The fever duration and treatment time of azithromycin and fiberoptic bronchoscope for the first time were significantly longer in the slow-to-recover group than in the control group (P<0.05). The results of ROC curve analysis showed that the optimal cut-off points of fever duration, percentage of neutrophils, levels of CRP and FIB, and treatment time of fiberoptic bronchoscope for the first time were 11.5 days, 70.7%, 57 mg/L, 4.7 g/L, and 13.5 days, respectively, with sensitivity and specificity higher than 0.643 and 0.727.</p><p><b>CONCLUSIONS</b>The fever duration, percentage of neutrophils, level of CRP, level of FIB, and treatment time of fiberoptic bronchoscope for the first time can predict a recovery time longer than two months in children with MPP associated with mucous plug formation.</p>

Comparative analysis of conventional pulmonary function test results in children with asthma or cough variant asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To compare the conventional pulmonary function test results of children with asthma or cough variant asthma (CVA).</p><p><b>METHODS</b>A total of 140 children, who were diagnosed with asthma or CVA from May 2010 to May 2011, were divided into acute asthma attack (n=50), asthma remission (n=50) and CVA groups (n=40); 30 healthy children were included as a control group. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow after 25% of vital capacity has been expelled (FEF25), forced expiratory flow after 50% of vital capacity has been expelled (FEF50), forced expiratory flow after 75% of vital capacity has been expelled (FEF75) and maximal midexpiratory flow (MMEF75/25) were measured.</p><p><b>RESULTS</b>The mean percent predicted values of all the above indices were lower than 80% in the acute asthma attack group, with FEF50, FEF75 and MMEF75/25 declining markedly; the mean percent predicted values of FEF75 and MMEF75/25 were lower than 80% in the CVA group. All the pulmonary function indices in the acute asthma attack group were lower than those in the control group. The mean percent predicted values of FVC, FEV1, FEF25 and MMEF75/25 in the asthma remission and CVA groups were lower than in the control group. All the pulmonary function indices in the acute asthma attack group were lower than in the asthma remission and CVA groups, but there were no significant differences between the asthma remission and CVA groups.</p><p><b>CONCLUSIONS</b>There is small and large airway dysfunction, particularly small airway dysfunction, in children with acute asthma attack. Children with CVA present mainly with mild small airway dysfunction, as do those with asthma in remission.</p>

Role of flexible bronchoscopy in the diagnosis and treatment of refractory pneumonia in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the flexible bronchoscopy in the diagnosis and treatment of refractory pneumonia among children.</p><p><b>METHODS</b>Sixty children with refractory pneumonia were randomly divided into two groups: lavage and control (n=30 each). The control group received conventional medical treatment. The lavage group was given flexible bronchoscopy besides conventional medical treatment. The therapeutic effects were compared between the two groups. The results of bacterial culture and detection of antibodies against Mycoplasma pneumoniae in bronchoalveolar lavage fluid (BALF) were observed.</p><p><b>RESULTS</b>The coincidence of bacterial culture results between BALF and sputum samples was 63.3%, and there were no significant differences in the positive bacterial culture results between them. The coincidence of PCR test for antibodies against Mycoplasma pneumoniae between BALF and serum samples was 73.3%. The results of Fisher's exact test showed the positive rate of Mycoplasma pneumoniae antibodies of BALF was higher than that of serum (P<0.05). The effective rate in the lavage group was significantly higher than that in the control group (97% vs 73%; P<0.01).</p><p><b>CONCLUSIONS</b>The flexible bronchoscopy is useful for the diagnosis and treatment of refractory pneumonia in children.</p>

Protection of mdr1 transfected cord blood mononuclear cell graft against anticancer agents in vivo / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the myelo-protection effect of mdr1 transfected cord blood cells (CBMNCs) graft against high-dose homoharringtonine leukemia-bearing severe combined immunodeficient (SCID) mice model.</p><p><b>METHODS</b>Multidrug resistant (mdr1)gene was transferred into CBMNCs by a retrovirus vector, containing full-length cDNA of human mdr1 gene. CBMNCs and high-titer retrovirus supernatant were cocultured with cytokine combinations for 5 - 6 days. The SCID mouse models bearing human HL-60 cell leukemia were divided into three groups. Group A received tail vein injection of 2 x 10(6) mdr1 gene transduced CBMNCs at day 1 and 3, groups B and C 2 x 10(6) un-transduced CBMNCs and same volume of normal saline, respectively. The 3 groups of the mouse model were treated with weekly escalated doses of homoharringtonine. The peripheral white blood cell (WBC) counts, the human leukemia cells percentage in peripheral blood, the histological findings of main organs were assayed. The CD33 positive HL-60 cells in bone marrow were determined by flow cytometry. The function and expression of mdr1 gene were examined by PCR, immunochemistry (IC) and DNR extrusion test in vivo.</p><p><b>RESULTS</b>(1) mdr1 gene was transferred into CBMNCs successfully and the transfection frequency was 30%. (2) Leukemia SCID mice were xenotransplanted with mdr1-transfected BMMNCs by a programmed procedure and could be used as a valuable model for in vivo evaluating myelo-protection effects. (3) The transfected mice could tolerate homoharringtonine 5 approximately 6 folds higher than conventional dose and kept peripheral WBC count at a mean of 3 x 10(9)/L, with the peripheral human myeloid leukemia cells percentage decreasing to less than 5%. Histological examination showed that there was no leukemia infiltration in the main organs, the CD33 positive HL-60 cells in bone marrow were less than 5%. (4) The repopulation frequency of the transfected CBMNs in marrow were 9.13%. DNR extrusion test confirmed that the P-gp product maintained its biological function in the marrow.</p><p><b>CONCLUSION</b>mdr1 transferred-human CBMNC can xenotransplanted and repopulated in leukemia-bearing SCID mouse and are protected from chemotherapy-induced myelosuppression.</p>