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Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.
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Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.
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Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.
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Streptococcus pneumoniae is a common infectious pathogen in children and the main cause of death in children under 5 years of age.It can lead to non-invasive pneumococcal diseases such as sinusitis and otitis media, as well as invasive pneumococcal diseases(IPD) such as meningitis, sepsis and pneumonia.IPD is a serious infectious disease in children, with high morbidity and mortality.However, the incidence of IPD in children varies significantly among different ages, genders and regions.Penicillin used to be the first choice for the treatment of IPD.With the widespread use of antibiotics in clinical practice, the problem of drug resistance of Streptococcus pneumoniae continues to increase.The situation of antibiotic resistance of Streptococcus pneumoniae in China has been very serious, and some data show that the multiple drug resistance rate of Streptococcus pneumoniae is as high as 88.7%.As a result, streptococcus pneumococcal vaccines have emerged as the primary means of reducing the incidence of IPD, in addition, it is effective in reducing the spread of drug-resistant strains.This article reviews the epidemiological characteristics, pathogenesis, common invasive pneumococcal disease in children, laboratory diagnosis, treatment and prevention of IPD in children.
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Bronchial asthma is one of the most common childhood chronic respiratory diseases characterized by airway hyperresponsiveness and reversible airflow limitation.Air pollution, especially PM2.5(fine particle size ≤2.5 microns)has a significant effect on asthma, through oxidative stress, immune inflammatory injury, airway hyperresponsiveness and other mechanisms.This paper describes the source, composition, physical and chemical properties of PM2.5, the mechanism of PM2.5 induced asthma, and its effects on acute bronchial asthma attack, acute outpatient consultation rate, hospitalization rate, lung function and exhaled nitric oxide(FeNO).
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Objective To understand the recent transmission of Mycobacterium tuberculosis (MTB),and to identify the influencing factors of recent transmission among pulmonary tuberculosis (TB) patients in Jing'an district,Shanghai.Methods The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing'an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)(QUB1 lb,QUB18,Mtub21,Mira26,QUB26,Mtub04,Miru31,Miru40,VNTR2372,VNTR3820,3232,4120),and tested for drug susceptibility as well.With the results of field epidemiological investigation,univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission.Results This study enrolled 80 TB patients,23 (28.75％) had a resistance to at least one anti-TB drug,and the prevalence of multidrug-resistant tuberculosis (MDR-TB) was 16.25％.A total of 65 genotypes were identified with 58 (72.50％,58/80) being unique and 7 clusters with 2-10 isolated in each cluster.The proportion of clustering was 27.50％ (22/80).Results from the multivariate analysis revealed that multidrug-resistance (OR=35.799,95％CI:4.239-302.346) and having comorbidity with TB (0R=7.695,95％CI:1.421-41.658) were independently associated with the clustering,which suggesting a recent transmission.The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links,one was between family members,and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them.Conclusion Recent transmission of tuberculosis happened among TB patients in Jing'an district,with high risks among the MDR-TB patients.
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Objective To understand the recent transmission of Mycobacterium tuberculosis (MTB),and to identify the influencing factors of recent transmission among pulmonary tuberculosis (TB) patients in Jing'an district,Shanghai.Methods The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing'an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)(QUB1 lb,QUB18,Mtub21,Mira26,QUB26,Mtub04,Miru31,Miru40,VNTR2372,VNTR3820,3232,4120),and tested for drug susceptibility as well.With the results of field epidemiological investigation,univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission.Results This study enrolled 80 TB patients,23 (28.75％) had a resistance to at least one anti-TB drug,and the prevalence of multidrug-resistant tuberculosis (MDR-TB) was 16.25％.A total of 65 genotypes were identified with 58 (72.50％,58/80) being unique and 7 clusters with 2-10 isolated in each cluster.The proportion of clustering was 27.50％ (22/80).Results from the multivariate analysis revealed that multidrug-resistance (OR=35.799,95％CI:4.239-302.346) and having comorbidity with TB (0R=7.695,95％CI:1.421-41.658) were independently associated with the clustering,which suggesting a recent transmission.The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links,one was between family members,and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them.Conclusion Recent transmission of tuberculosis happened among TB patients in Jing'an district,with high risks among the MDR-TB patients.
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Objective@#To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children′s Hospital.@*Method@#E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test.@*Result@#A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ2=13.266, P<0.05), and the values of MIC50, MIC90 and the maximum values of MIC(mg/L) of penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ2=1.172, 1.198, both P>0.05). On the other hand, the values of MIC50, MIC90 and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0.750, 4.000, 32.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to the rest antibiotic. Based on the same examining standard of CSF, the antimicrobial sensitivity(isolates(%)) of the non-invasive isolates to ceftriaxone, cefotaxime, SMZ-TMP were respectively 281(46.3%), 278(45.8%), 78(12.9%), were significantly lower than the susceptibility rate of the invasive isolates from non-CSF (28(70%), 28(70%), 14(35%), χ2=8.453, 8.817, 15.094, all P<0.012 5), and lower than the invasive isolates from CSF (18(75%), 18(75%), χ2=7.631, 7.905, P<0.012 5; 11(45.8%), P=0.001). The sensitivity of the isolates to the rest antibiotics were similar(P>0.05).@*Conclusion@#More than 95.0% strains of the streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital were sensitive to vancomycin, linezolid, levofloxacin, and the susceptibility rate of penicillin, ceftriaxone, cefotaxime were 88.7%, 76.9%, 76.3%. However, less than 20.0% of streptococcus pneumoniae were sensitive to erythromycin, clindamycin, SMZ-TMP and tetracycline. The susceptibility rate of penicillin of non-invasive Streptococcus pneumoniae declined by these years, and the differences to ceftriaxone and cefotaxime can be neglected, but the values of MIC50, MIC90 and the maximum value of MIC of all were linearly rising. The susceptibility rate of antibiotics to ceftriaxone and cefotaxime of the non-invasive isolates was lower than the invasive isolates.
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Objective To observe the clinical efficacy and safety of GINA regimen and GINA regimen combined with oral Huaiqihuang granule in the treatment of children with bronchial asthma.Methods A ran-domized,single blind,multicenter,parallel controlled clinical trial wascarried out.A total of 1 128 patients with bronchial asthma in children were randomized into two groups.The observation group were treated with GINA regimen combined with oral Huaiqihuang granule.The GINA regimen treatment group was treated by GINA reg-imen.Clinical assessment and C-ACT scores was observed in first month,third month,sixth month after treat-ment.Clinical assessment included the times of upper respiratory tract infection occurrence,bronchitis and pneu-monia,asthmatic attacks,application of emergency medicine,hospitalizations due to asthmatic.Drug adverse effect in the two groups was compared.Results The times of upper respiratory tract infection,bronchitis and pneumonia,asthmatic was significantly decreased(P 0.05).Conclusion The treatment of bronchial asthma in children with GINA regimen combined with oral Huaiqihuang granule can significantly reduce the incidence of respiratory infections and the number of asthmatic attacks dramatically and safely improve clinical curative effect,asthma control.
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Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.