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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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With the further understanding and the accumulation of experiences in diagnosis and treatment for chronic cough, a growing number of evaluation scales about chronic cough are used in clinical practice.Medical workers try to quantitatively evaluate chronic cough and accurately guide clinical practices with evaluation scales.At present, the evaluation scales of chronic cough mostly focus on health-related quality of life, because chronic cough will seriously affect the quality of life for patients, and further affect the psychology, daily life and family members of patients.
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OBJECTIVE@#To study the detection rate, epidemic pattern, and clinical features of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory infection (ALRI).@*METHODS@#Nasopharyngeal aspirates were collected from children with ALRI, aged < 2 years, who were hospitalized in Children's Hospital of Chongqing Medical University from June 2013 to May 2018. Multiplex PCR was used to detect 16 common respiratory viruses. The epidemiological characteristics of RSV were analyzed.@*RESULTS@#A total of 2 066 hospitalized children with ALRI were enrolled. Among the children, 1 595 (77.20%) tested positive for virus and 826 (39.98%) tested positive for RSV [410(49.6%) positive for RSV-A, 414 (50.1%) positive for RSV-B, and 2 (0.2%) positive for both RSV-A and RSV-B]. RSV-B was the main subtype detected in 2013-2014 and 2016-2017, while RSV-A was the main subtype in 2014-2015 and 2017-2018, and these two subtypes were prevalent in 2015-2016. The highest detection rate of RSV was noted in winter. RSV + human rhinovirus was the most common combination of viruses and was detected in 123 children. These children were more likely to develop wheezing than those with single RSV detected (@*CONCLUSIONS@#In Chongqing in 2013-2018, RSV-A and RSV-B not only can predominate alternately, but also can co-circulate during a season. RSV is the major viral pathogen of hospitalized children with ALRI and can cause severe lower respiratory tract infection. There are no differences in clinical manifestations between children with RSV-A infection and those with RSV-B infection, but boys are more susceptible to RSV-A infection.
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Child , Child, Preschool , Female , Humans , Infant , Male , Child, Hospitalized , China/epidemiology , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus, Human , Respiratory Tract Infections/epidemiologyABSTRACT
Objective:To understand the present situation of the construction of standardized asthma clinic for children in China, to explore the problems existing in the process of construction, and to promote the healthy development of standardized clinic construction.Methods:The process and current situation of the construction of standar-dized asthma clinics for children in China were reviewed and investigated, and the practical significance of the China Children′s Asthma Action Plan (CCAAP) in the construction of standardized asthma clinics for children was explored.Results:(1)By December 2020, 1 289 standardized asthma clinics for children and 135 regional demonstration centers had been built; 56 training sessions had been held, with a total of 2 560 doctors and 650 nurses trained, covering 2 560 hospitals across the country; and 4 518 patient education sessions were held.Online publicity covers a total of 1 million person-times, with an annual average of 1.33 million patients.(2)CCAAP improved the quality control level of standardized asthma clinic and promoted the standardized management of children.Conclusions:Through process optimization, professional evaluation, individual health education and real-time disease monitoring, standardized asthma clinic for children with asthma can effectively enhance asthma management awareness of children and their parents, improve disease awareness, and promote better control of asthma.It is an effective management model of asthma in children at present, and it is worthy of clinical promotion.CCAAP plays a good role in the construction of standardized outpatient clinic for asthma in children.The construction of standardized asthma clinic for children in China has achieved remarkable results, and the development trend is good in the future.
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Objective To identify the role of IL-17A during respiratory syncytial virus (RSV) in-fection in a mouse model. Methods Female wild-type C57BL/6 mice and IL-17A knockout ( IL-17A-/-) mice at the age of 6 to 8 weeks were both randomly divided into two groups:control and RSV groups. Mice in the control groups were given the supernatant of Hep-2 cell culture, while those in the RSV groups were treated with RSV A2 through intranasal administration. Leukocytes in bronchoalveolar lavage fluid ( BALF) samples were counted. Left lung tissues were stained with hematoxylin and eosin ( HE ) to evaluate his-topathological scores. Airway hyperresponsiveness ( AHR) was measured by whole-body plethysmography. The concentrations of IFN-γ were determined with ELISA. RSV titers were measured by plaque assay. To assess the effects of IL-17A on IFN-γproduction and its role in RSV infection, IL-17A-/- mice were treated with exogenous recombinant murine IFN-γ or IL-17A, while wild-type mice were given IFN-γ neutralizing antibody intervention. Results The counts of inflammatory cells and neutrophils in BALF, lung tissue his-topathological scores, AHR, IFN-γlevels and virus titers of the wild-type group were higher than those of the IL-17A-/-group after RSV infection. IFN-γlevels, inflammatory cell counts in BALF, AHR and lung tissue histopathological scores were significantly increased in RSV-infected IL-17A-/- mice after the intervention of recombinant murine IL-17A or IFN-γ. RSV titers were much higher in the recombinant murine IL-17A-trea-ted group, but not affected by the recombinant murine IFN-γ intervention. Inflammatory cell counts in BALF, AHR and lung tissue histopathological scores were significantly decreased in RSV-infected wild-type mice following IFN-γ neutralizing antibody treatment, but no significant changes were found in RSV titers. Conclusions IL-17A might be involved in the pathogenesis of pulmonary diseases during RSV infection through promoting IFN-γ production and inhibiting viral clearance in mice.
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Studies in Australia,England and New Zealand demonstrated protracted bacterial bronchitis (PBB)is the most common cause of chronic cough in children.While Chinese pediatrician don't have sufficient understanding of PBB,which may be associated with misdiagnosis and mismanagement.This article interpret foreign guidelines of PBB so as to supply a comprehensive understanding of it's pathogens,clinical manifestations,diagnosis,treatment recommendations and prognosis.
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Objective To discuss the role of teachers in the integrated PBL teaching of pediatrics in the light of the investigation of students after PBL teaching.Method The multidisciplinary integrated PBL course established by the Department of Pediatrics of Chongqing Medical University has been implemented for more than two years in the teaching of the five year program in the Department of clinical medicine (pediatric direction).From September 28,2016 to October 25th,the researchers conducted a survey of 26 undergraduate students in the college who received PBL teaching at the professional probation stage.After the end of each PBL class,the teaching evaluation questionnaire recommended by Fudan University and Qian Ruizhe was distributed through the network teaching platform of Chongqing Medical University.The questionnaire was retrieved by students without a name,and the survey was carried out 3 times.The data of the questionnaire were summarized with Excel 2007.Result 77 questionnaires were issued and 77 were recovered,with a recovery rate of 100%.In the multidisciplinary integrated PBL class,94.8%-97.4% students gave high score evaluation,and all the evaluation of teachers reached "excellent" level.In response to open-ended questions,students believed that teachers in teaching could inspire students to think positively,encourage students to express different views,create a mutually trusted environment for students,and cultivate students' interpersonal communication,communication and cooperation ability.Conclusion In pediatric multidisciplinary integrated PBL teaching,teachers should teach students correct learning methods,judge each student's knowledge and thinking level,and individualize teaching for each student's problems and characteristics.
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Objective To explore the clinical features of protracted bacterial bronchitis (PBB)and provide clinical data for its diagnosis and treatment.Methods The clinical data of children with PBB who were admitted to the Respiratory Department of Children's Hospital of Chongqing Medical University from January 2012 to December 2015 were retrospectively collected,including the total information,clinical feature,auxiliary tests and treatment data.One year follow-ups were carried out to record cough relapse.Results In 30 patients with PBB,the ratio of boy and girl was 18:12,the median age were 14.5 (7-49.5) months,and the median duration of cough was 9.7 (5.7-17.1) weeks.All children had chronic wet cough,in which 22/30 (73.3%)had wheezing reported by their parents,and 14/30 cases (46.7%) had wheezing observed by doctors.Chest X ray showed increased and thickened of lung texture in 9/30 cases (30.0%);chest CT showed uneven inflation in 8/28 cases (28.6%),and 2 patients had suspected bronchiectasis.Sinusitis and allergic rhinitis were seen in 16/30 cases (53.3%) who underwent nasal endoscopy.Bronchoscopy showed a chronic bronchitis accompanied with superior secretions in all patients,in which 11/30 cases (36.7%)showed a purulent bronchitis,5/30 cases(16.7%) had tracheobronchial stenosis,and 3/30 cases (10.0%) had tracheomalacia.The major pathogens identified by bronchial alveolar lavage fluid (BALF)were Streptococcus pneumoniae (12 cases),Haemophilus parainfluenzae (10 cases) and Moraxella catarrhalis (7 cases).All PBB patients had cough remission after (10.0 ± 2.5) days of intravenous antibiotics followed by oral antibiotics therapy.Two out of twenty-three cases (8.7%) had a recurrent PBB,and 1 patient developed into irreversible bronchiectasis by 1 year follow-up with the missing follow-up rate of 23.3 %.Conclusions Children with PBB are typically younger (≤ 3 years) with prolonged wet cough and wheezing,and some cases are accompanied with sinusitis and allergic rhinitis.Bronchoscopy can detect chronic bronchitis with superior secretions,which is often be purulent with respiratory malformation in elderly children.An appropriate therapy with antibiotics is effective,but some patients may will experience recurrent PBB,which might even progress into bronchiectasis.
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Objective To understand the etiology and clinical features of childhood bronchiectasis in China. Methods Data of 182 children diagnosed with bronchiectasis admitted in Children's Hospital of Chongqing Medical University from 1991 to May, 2015, and more than 20 cases in the Chinese literatures since 1990 were reviewed. Results The top three causes of bronchiectasis in 182 children (114 boys, 68 girls, median age:118 months) in Chongqing were post-infection, primary immunodeficiency and foreign body, with frequency of 29.7%, 7.7%, and 7.1%, respectively. Chronic wet cough was the most frequent feature. Diagnosis of bronchiectasis usually need to combine with chest CT findings, which showed that the lesions were at left lower lobe, right middle lobe and right lower lobe. The choice of antibiotics was based on bacterial cultures of respiratory secretions, and Streptococcus pneumoniae was the most frequently isolated bacteria in Chongqing. The most common three causes of bronchiectasis in children according to data of 572 cases ( 347 boys, 225 girls) in 7 cities of China including Chongqing were the same with that of Chongqing, 45.5%, 7.3%, and 5.6%, respectively. Conclusion Early diagnosis, identification of etiology and comprehensive management of bronchiectasis in children are benefitial for prognosis.
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Objective@#To identify the role of interferon (IFN)-γ during respiratory syncytial virus (RSV) re-infection in mice.@*Method@#Female wild type C57BL/6 mice and IFN-γ knockout mice (IFN-γ-/- mice) at the age of 6 to 8 weeks were randomly divided into two groups: control group and RSV group, according to random number table.Each group was further divided into primary infection group and re-infection group.There were 8 groups.Mice were sacrificed on days 5, 7, 14 to collect samples.There were 5-8 mice in each group at each time point.And experiment was repeated twice. Leukocytes in bronchoalveolar lavage fluid (BALF) were counted, left lung tissues were stained with HE and histopathological scoring (HPS) was performed.The concentrations of IFN-γ, IL-5, IL-13 were determined with ELISA.T test or single factor analysis of variance was used to compare between groups.@*Result@#(1) Mice infected or reinfected with RSV showed pale hair, weight loss, decreased activity and anorexia.(2) IFN-γ levels significantly increased on days 5 and 7 following RSV primary infection and reinfection as compared to control groups in wild type mice ((192±44) vs.(36±8) and (531±161) vs.(23±4) pg/ml on day 5, (100±23) vs.(36±8) and (862±186) vs.(23±4) pg/ml on day 7, t=2.654, 2.513, 2.654, 3.968, all P<0.05). (3) Compared to the RSV-reinfected IFN-γ-/- mice, RSV-reinfected wild type mice had less body weight loss ((13.6±2.6)% vs.(22.7±2.9)% on day 5, (18.0±3.1)% vs.(26.5±1.8)% on day 7, t=2.314, 2.308, both P<0.05), lower lung tissue histopathological score ((1.50±0.09) vs.(2.07±0.11) on day 5, (1.53±0.11) vs.(2.08±0.09) on day 7, (1.10±0.06) vs.(1.59±0.08) on day 14, t=3.916, 3.890, 4.837, all P<0.01), less BALF inflammatory cells count ((11.6±2.0) vs.(44.2±10.6)×105/ml on day 5, (18.2±3.9) vs.(38.3±2.2)×105/ml on day 7, t=2.818, 4.786, both P<0.05), and lower levels of IL-5 and IL-13 ((24±3) vs.(148±23), (23±4) vs.(169±26) pg/ml on day 5, (30±8) vs.(233±44), (20±5) vs.(182±19) pg/ml on day 7, (91±6) vs.(129±19), (62±8) vs.(132±5) pg/ml on day 14, t=5.252, 5.445, 4.517, 7.326, 3.816, 7.577, all P<0.01).@*Conclusion@#IFN-γ can alleviate airway inflammation following RSV reinfection in mice.
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<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin (IVIG) in treating Mycoplasma pneumoniae(MP) infections.</p><p><b>METHOD</b>The literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis.</p><p><b>RESULT</b>(1) Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was-1.10 (95% CI: -1.60,-0.60) and the mean difference of cough duration was-1.56 (95% CI: -2.10,-1.03). (2) Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was-1.77(95% CI: -2.44,-1.10) and the mean difference of cough duration was-2.47 (95% CI: -2.86,-2.08); for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was-3.41 (95% CI: -4.10,-2.73) and the mean difference of cough duration was-2.25 (95%CI: -4.38,-0.12). (3) Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG.</p><p><b>CONCLUSION</b>There was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adjuvant therapy. IVIG as an adjuvant therapy is at an exploration stage.</p>
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Child , Humans , Anti-Bacterial Agents , Therapeutic Uses , Azithromycin , Therapeutic Uses , Cough , Erythromycin , Therapeutic Uses , Glucocorticoids , Therapeutic Uses , Immunoglobulins, Intravenous , Therapeutic Uses , Macrolides , Therapeutic Uses , Mycoplasma Infections , Drug Therapy , Mycoplasma pneumoniae , Randomized Controlled Trials as TopicABSTRACT
Objective To evaluate the efifcacy and inlfuencing factors of 3%hypertonic saline (HS) inhalation in treatment of bronchiolitis. Methods Clinical data together with the detection of 16 types of respiratory tract virus from hospitalized pediatric patients with primary diagnosis of bronchiolitis from June 2009 to December 2012 were retrospectively analyzed. The endpoint indicators for evaluation on the efifcacy of nebulized 3%HS inhalation were the percent decrease of clinical severity (CS) score after 2 days' treatment and the hospitalization time. Factors affecting efifcacy were further explored. Results The CS score in nebulized 3%HS treated group decreased in average of 42.86%(11.11%-66.67%), signiifcantly higher than that (26.79%, 0.00%-50.00%) in the untreated group (P=0.006). No difference of between the two groups (P=0.26). Multiple linear regression analysis showed that nebulized 3%HS inhalation has better efifcacy on the patients older than 3 months having breastfeeding, respiratory synthetic syncytial virus (RSV) infection and extensive wheezing sound auscultation of the lungs. The multiple linear regression analysis model was statistically signiifcant (R2=0.58, P<0.001). Conclusions After 2 days' treatment with 3%hypertonic saline inhalation, the CS score of bronchiolitis patients was decreased. The treatment can be recommended in hospitalized patient older than 3 months with breastfeeding, RSV infection, and extensive wheezing sound auscultation of the lungs.
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Human bocavirus 1 ( HBoV1 ) is closely related to lower respiratory infections in children. Respiratory symptoms elicited by HBoV1 include cough, tachypnea, wheezing and dyspnea, which are of mild degree and haven′t found to be distinguished. Few single infected patients with dyspnea needing mechanical ven-tilation were reported,however,the number of severe cases caused by HBoV1 is increasing in recent years. Here we reviewed the epidemiological characteristics, clinical manifestations, treatment and prognosis of HBoV1 in-duced severe lower respiratory infections.
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In order to optimize the curriculum structure, improve the quality of the traditional med-ical curriculum which separates the theory teaching and clinical teaching in medical education; give full play to the advantages of the multiple disciplines application to guide students to establish a holistic view of medicine; cultivate students'! independent thinking and team cooperation ability, we explore the reform model of the pediatric teaching courses from the following five aspects:curriculum design, class hour arran-gement, teaching team building, teaching carrier production and application of problem-based learning (PBL) teaching method. Preliminarily establish the teaching mode in multi disciplines integration which is characterized by taking a certain symptom or sign as leading clue.
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Primary ciliary dyskinesia (PCD) is an autosomal recessive or x-linked disorder of cilia structure and (or) function, with a morbidity of 1:10 000–1:50 000 from foreign reports, while epidemic data of PCD in China is not available yet. PCD is due to cilia biallelic gene mutations leading to impaired tissue structure and organ function. Clinical phenotypes include chronic infections of the respiratory tract, fertility problems, disorders of organ laterality, etc, and the percent age of Kartagener syndrome is about 50%. The frequently used diagnostic methods are nasal NO examination, high-speed video microscopy, electron microscopy, genetic tests, chest high-resolution computed tomography and spirometry at present. Each method has its highlights and disadvantages, meanwhile, effective diagnostic algorithm and therapeutic protocols are needed for further research.
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OBJECTIVE:To analyze the pathological characteristics and therapy method for influenza A(H1N1/H3N2)in-fection complicated with plastic bronchitis (PB). METHODS:Clinical information of 3 children with influenza A (H1N1/H3N2) infection complicated with PB were reported to summarize the experience of aerosol inhalation of Budesonide suspen-sion combined with fiber bronchoscope lavage. Based on literatures,this rare disease were analyzed. RESULTS:Among 3 chil-dren,2 children suffered from influenza A H1N1 infection and one child influenza A H3N2 infection complicated with PB;2 of them got basic disease,i.e. bronchial asthma and primary renal syndrome. 3 children were diagnosed as severe pneumonia,re-spiratory failure and pulmonary atelectasis;2 of them suffered from mediastinal emphesema and subcutaneous emphysema. The branchlike foreign bodies,removed by fiber bronchoscope,were fibrin complicated with neutrophile granulocyte,eosinophile granulocyte and leukomonocyte infiltration by pathological examinations. It was diagnosed as PB. 3 children received symptom-atic support treatment as assisted respiration,respiratory tract management and anti-infective treatment,and aerosol inhalation of Budesonide suspension combined with fiber bronchoscope lavage. And then they were cured and discharged from the hospi-tal. CONCLUSIONS:PB is one complication of influenza A pneumonia and severe. Fiber bronchoscope must be carried out as soon as possible based on aerosol inhalation of Budesonide suspension once PB is suspected,so as to diagnose early and treat promptly.
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Bronchiolitis is the most common lower respiratory tract disease in infants. There is no speciifc treatment for it and the treatment is mainly supportive. The management of bronchiolitis is the clinical hotspot recently. Continuous positive airway pressure (CPAP) has gained more attention in clinical application as it is a safe, effective, and noninvasive method and can effectively relieve symptoms of bronchiolitis and improve prognosis. This paper reviews the clinical application of CPAP in infants with severe bronchiolitis.
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Objective To explore the clinical manifestations and epidemiological profiles of hospitalized infants with Bordetella pertussis infection and to improve the knowledge for its early diagnosis and treatment.Methods Using a retrospective analysis method,the data of 142 hospitalized infants with Bordetella pertussis infection in Shenzhen Children's Hospital from 2011 to 2013 were collected,which was confirmed by a real-time polymerase chain reaction(PCR) of nasopharyngeal secretion.The SPSS 16.0 software was used for statistical analysis.Results Of the 142hospitalized infants with Bordetella pertussis infection,the ratio of male to female was 2.1∶ 1.0 (96/41 cases).Ninetythree (65.5%) cases were aged less than 3 months old,26 cases (18.3%) were 3-6 months old and 23 cases (16.2%) were 6-36 months old.One hundred and twenty-six (88.7%) patients were unvaccinated or incompletely vaccinated.The most common clinical manifestation was paroxysmal cough which accounts for 104/142 (73.2%) cases,and 6 cases of which had roaring(4.2%).Peripheral blood WBC level of 83 cases increased,and 75 (90.4%) cases were lymphocytosis.The positive rate of X-ray was 60.6%.Eighty-one cases were complicated with bacteria,respiratory virus or mycoplasma pneumonia infection.There were significant differences in symptom of fever and infection of respiratory tract pathogen among 3 groups.The symptom of fever in the group aged less than 3 months old group was significantly lower than the other 2 groups (x2 =11.45,P < 0.01 ;x2 =34.56,P < 0.01),and 6-36 months old group was significantly higher than the other 2 groups(x2 =7.590,P < 0.01 ;x2 =6.928,P < 0.01).Conclusions Bordetella pertussis is an important pathogen for the infants with persistent cough,especially in unvaccinated or incompletely vaccinated infants,but the clinical manifestation and signs of pertussis are atypical,which may lead to a misdiagnosis and delay proper treatment.As a rapid and sensitive method of detecting Bordetella pertussis,PCR may be used for early diagnosis.
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The irrational drug use is one of the major public health issues. As children are in growth, their drug absorption, distribution, metabolism, excretion and pharmacodynamic characteristics are different from those in adults, thus more challenges on how to make rational use of drugs in children are seen. In this paper, by analyzing current situation of irrational drug use in children, the definition and standards of the rational drug use, and the measures adopted by WHO and China in promoting rational use of drugs in children, we emphasize here and call for a promotion of the awareness of rational use of drugs in children, and activities in forms of propaganda and health education, popularization of medical science and the medication safety knowledge, guidance for the development of good medication beliefs and habits in public, improvement of the social security administration, maximization of the protection of children's medication safety, and maintenance of children's health rights and interests.
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<p><b>OBJECTIVE</b>To investigate the association of ATP-binding cassette transporter A3 (ABCA3) gene mutations with severe neonatal respiratory distress syndrome (NRDS) and lung disease in children.</p><p><b>METHOD</b>Thirty-eight children hospitalized with respiratory disorders in Children's Hospital of Chongqing Medical University from January 2010 to December 2011 were screened. Two mutations (E292V, G1221S) in the ABCA3 gene were identified. Interstitial lung disease (ILD) was present in 10 cases, NRDS was found in 23 and congenital pulmonary dysplasia in 5 cases. There were 24 males and 14 females, with an age range of 1 hour to 15 years. Genomic DNA was prepared from blood samples and sequences were analyzed by polymerase chain reaction (PCR). Clinical feature, imaging characteristics and the results of gene detection were retrospectively analyzed.</p><p><b>RESULT</b>Four cases with ABCA3 gene mutations were found; 2 patients (case 2 and case 4) had the heterozygous mutation of ABCA3 E292V. One was a 3-hour-old girl and another was a 52-day-old boy, 2 patients (case 1 and case 4) had the heterozygous mutation of ABCA3 G1221S. One was a 78-day-old boy and another was a girl, 15 years and one month old. The family history was negative for respiratory disease. Three patients (case 1, 2, 4 ) had NRDS and 2 (case 1, 2) of them were premature. One patient (case 3) had normal growth and development. She was diagnosed clinically as interstitial lung disease (ILD) after admission. The clinical outcomes of 4 cases were various. Case 1 had recurrent wheezing and inhaled corticosteroid was needed. Case 2 died because she failed to wean from mechanical ventilator. Case 3 was discharged with improvement but lost to follow-up. Case 4 grows normally.</p><p><b>CONCLUSION</b>Genetic variants within ABCA3 may be the genetic causes or background of a contributor to some unexplained refractory NRDS, and chronic lung disease developed in latter childhood. Identification of ABCA3 genetic variants in NRDS infants is important to offer genetic counseling, as well as early prognosis estimation and intervention in pediatric chronic lung disease.</p>