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Objective:To analyze the clinical characteristics of pulmonary vein stenosis (PVS) in children, and to explore its treatment and prognostic factors.Methods:The clinical data of 19 children with PVS treated in Beijing Children′s Hospital, Capital Medical University from October 2016 to March 2022 were analyzed retrospectively.There were 16 males and 3 females.The median age at diagnosis was (2.81±1.95) years.A descriptive analysis of clinical characteristics of children was made.Results:Of the 19 children, 14 cases (73.7%) had primary PVS and 5 cases (26.3%) had secondary PVS after surgery of anomalous pulmonary venous connection (APVC). Thirteen children (68.4%) had hemoptysis.In the hemoptysis children, 5 cases had life-threatening massive hemoptysis, and 11 cases (57.9%) had a history of recurrent respiratory tract infection or pneumonia.Other manifestations of hemoptysis included failure to thrive (6 cases), cyanosis (5 cases), and dyspnea (3 cases). Complications were pulmonary hypertension (6 cases) and right heart failure (3 cases). There were 16 cases (84.2%) of unilateral PVS and 3 cases of bilateral PVS.Interlobular septal thickening, grid shadow and ground glass opacities were found on CT of all PVS cases.Ten cases underwent surgery, and 2 cases of them received angioplasty, but restenosis occurred in both of them.Eight children underwent pulmonary lobectomy, and their clinical symptoms were all relieved after operation.Nine patients were treated conservatively, and 3 cases of them died of bilateral PVS secondary to APVC.The remaining 6 alive cases still had intermittent clinical symptoms during follow-up.Conclusions:Hemoptysis and recurrent respiratory tract infection are the main clinical manifestations of PVS in children, and life-threatening massive hemoptysis can occur.Lobectomy is an effective treatment for unilateral PVS.The prognosis of secondary PVS after APVC is poorer and its mortality is higher, compared with primary PVS.
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Food allergy is one of the most common chronic non-infectious diseases in many countries and regions, which affects 2%-4% of children and adults.Its prevalence is on the rise worldwide.In 2022, the Global Allergy and Asthma European Network (GA 2LEN) proposed recommendations on managing food allergy to people at different age groups.This review aims to interpret the recommendations, clinical practice, precautions, evidence gaps and research priorities of food allergy management based on the GA 2LEN guideline 2022, thus providing reference for clinical management of food allergy.
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Asthma is a common chronic respiratory disease in children.Adolescent asthma is characterized by high prevalence rate, high mortality and poor disease control.The optimal adolescent asthma management is crucial to improve asthma control, as well as reduce the burden of asthma including mortality.The key of the management in adolescents with asthma is the self-management, which involves individual, family and social aspects.The imbalance between physical development and psychological development in adolescents leads to many challenges in the self-management in adolescents with asthma.This review elaborates the current situation, influence factors and promotional strategies of self-management in adolescents with asthma so as to achieve the optimal asthma self-management.
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Recently, the number of children with asthma reported after thunderstorm weather in China has increased rapidly, which has aroused the public concern.At present, there are 28 documented episodes of epidemic thunderstorm asthma in the world, which can be life-threatening in severe cases.Children with allergic rhinitis or uncontrolled asthma were more susceptible to thunderstorm asthma.This article introduces the epidemiology, mechanism, risk factors, manifestations, management strategies and prevention of thunderstorm asthma, in order to improve pediatricians′ understanding of thunderstorm asthma and reduce the impact of it.
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Objective:To analyze the clinical characteristics, treatment course and prognosis of children with intermediate-high risk pulmonary embolism.Methods:The clinical data of 48 children with pulmonary embolism treated in Beijing Children′s Hospital, Capital Medical University from January 2017 to December 2021 were analyzed retrospectively.Including 12 intermediate-high risk cases and 36 low-risk cases.The clinical manifestations, laboratory results, treatment and prognosis were compared between groups by the t-test, rank sum test and Chi- square test with the yates continuity correlation or Fisher′ s exact test. Results:There were no significant differences in the sex and age between the intermediate-high risk group and the low-risk group.The proportions of patients with shortness of breath, dyspnea, cyanosis or hypoxemia were higher in the intermediate-high risk group than those of in low-risk group.Twelve children in the low-risk group did not have specific symptoms of pulmonary embolism.There were no significant differences in the D-dimer level, and the distribution of pulmonary embolism between the two groups (all P>0.05). However, the proportion of children with other thromboembolism in the intermediate-high risk group was significantly higher than that of the low-risk group, among which heart thrombosis was the most common (7 cases). There were no significant differences in the underlying diseases and thrombophilia between the two groups (all P>0.05). The treatment of the intermediate-high risk group was more active: 6/12(50.00%) patients in the intermediate-high risk group received reperfusion treatment, including 3 cases of systemic thrombolysis, 1 case of catheter thrombolysis, and 2 cases of thrombectomy.In the low-risk group, only 1 case was treated with systematic thrombolysis.Unfavorable outcomes were reported in 3/48 (6.25%) patients, including 1 death of massive bleeding after catheter-directed thrombolysis in the acute phase, 1 case of recurrent pulmonary embolism after self-decided withdrawal and 1 case of progression of pulmonary embolism that was managed by surgical thrombectomy, all of whom were in the intermediate-high risk group. Conclusions:Shortness of breath, dyspnea, cyanosis or hypoxemia and co-existed venous thromboembolism were more common in intermediate-high risk cases.The treatment regimen of was more aggressive, but the incidence of unfavorable outcomes was higher in intermediate-high risk group; further research is needed to determine the risk factors for intermediate-high risk pulmonary embolism in children.
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As a common respiratory disease in children, asthma affects children′s physical and mental health and increases the burden on families and society.Patients with asthma can have one or more comorbidities, and these asthma comorbidities not only make the diagnosis of asthma more difficult, but also affect the control and treatment and outcome of the disease.However, asthma comorbidities are often under-recognized and poorly-managed.Therefore, it is important to improve the understanding of asthma comorbidities and to correctly identify, diagnose and treat them.Asthma in children contains a variety of comorbidities.This article reviews the research progress of epidemiology, impact on asthma and the treatment of these common comorbidities of asthma in children.
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Bronchial asthma and anaphylaxis are two conditions related to the sensitization state of the body that can coexist with each other in children.Asthma is a common chronic respiratory disease in children, while anaphylaxis is a rapid onset emergency involving multiple systems of the body.The two diseases can affect each other.Poor asthma control can increase the risk of anaphylaxis, and there is a risk of misdiagnosis during symptom onset.Both diseases need prompt and appropriate acute treatment as well as long term management.This review summarizes the various associations and differences between asthma and anaphylaxis, as well as management tools and strategies, in order to provide reference for enhancing disease awareness and optimizing disease management.
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Mucus plugs is a feature of fatal asthma, which is the abnormally thick mucus accumulated in the airway of patients.The study of airway mucus plugs in asthmatic patients began 100 years ago.In addition to the manifestation of primary disease, asthma patients with mucus plugs may have acute exacerbation of asthma or poor treatment effect.At this time, we should pay attention to the existence of mucus plugs.Multidetector computed tomography can be used to identify and evaluate mucus plugs.This article briefly describes the generation of airway mucus, and introduces the formation mechanism, clinical characteristics, identification and scoring system of mucus plugs in asthmatic patients, and reviews the differential diagnosis and treatment of mucus plugs.
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Objective:To explore the effect of Bushen Huoxue Decoction on ventricular remodeling and myocardial nuclear factor-kappaB (NF-κB) protein in rats with chronic heart failure.Methods:60 male SD rats were randomly divided into sham operation group (15 rats) and experimental group (45 rats). The rats of the experimental group was established CHF model by ligating the left anterior descending coronary artery combined with exhaustive swimming and starvation. Rats with chronic heart failure were randomly divided into model group, Bushen Huoxue group and lisinopril group.The Bushen Huoxue group was perfused with 15.75 g/(kg·d) Bushen Huoxue Decoction, the lisinopril group was perfused with 1.8 mg/(kg·d) of lisinopril suspension, and the sham operation group and model group were perfused with equal volume of distilled water. After 4 weeks of administration, the general mental state of rats was observed. The left ventricular internal systolic diameter (LVIDs) and internal diastolic diameter (LVIDd) were measured by cardiac color Doppler ultrasound, and the left ventricular ejection fraction (LVEF) and short axis shortening fraction (LVFS) were calculated. The expression of NF-κB protein in rat myocardium was detected by Western blot, and the morphology of left ventricular myocytes was observed by hematoxylin eosin staining.Results:Compared with the model group, the myocardial fibers of rats in Bushen Huoxue group and lisinopril group were arranged orderly, with few pyknosis, a small amount of inflammatory cell infiltration. Compared with the model group, the levels of LVIDs [(6.00±0.58)mm vs. (6.99±0.90)mm] and LVIDd [(3.96±0.51)mm vs. (5.14±0.57)mm] significantly decreased, LVEF [(54.48±6.75)% vs. (30.28±4.85)%] and LVFS [(33.86±4.27)% vs. (26.10±4.96)%] significantly increased, as well as the expression of myocardial NF-κB (1.06±0.10 vs. 1.58±0.29) protein significantly decreased ( P<0.05). Conclusion:Bushen Huoxue Decoction can resist ventricular remodeling,improve cardiac function and treat heart failure of CHF rats and the possible mechanism might be it could down-regulate myocardial NF-κB expression.
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Objective:To analyze the clinical manifestations, genetic variations, diagnosis and treatment of children with inherited thrombophilia(IT).Methods:Retrospective study.Children with IT treated in Department of Respiratory Diseases 1 of Beijing Children′s Hospital, Capital Medical University from October 2016 to August 2021 were included in the study and followed up.Results:A total of 5 children met the inclusion criteria, with 3 boys and 2 girls; the age of diagnosis ranged from 7 years to 13 years and 6 months.There were 2 cases of protein C deficiency, 1 case of congenital protein S deficiency, 1 case of activated protein C resistance and 1 case of congenital afibrinogenemia.All 5 cases had pulmonary embolism, 2 cases had deep venous thrombosis of lower limbs, and 1 case had cardiac thrombosis and arterial embolism.The level of protein C was significantly decreased in 1 case, and the level of protein S in 1 case was significantly decreased in the laboratory test of thrombophilia; 2 cases were positive for antiphospholipid antibodies in the acute phase, but negative after 3-6 months of re-examination.Genetic analysis showed 2 cases of PROC gene mutation, 1 case of PROSI gene mutation, 1 case of F5 gene mutation, and 1 case of FGA gene mutation.All children were treated with anticoagulation drugs for long-term, including 4 patients with Warfarin and 1 patient with Rivaroxaban.The follow-up time ranged from 3 months to 5 years.During the follow-up, 1 patient experienced thrombosis recurrence due to infection incentives 1 month after discontinuing anticoagulant drugs on his own. Conclusions:The clinical manifestations of children with IT are the same as those of adults, mainly including venous thromboembolism(VTE); there are limitations in laboratory detection of thrombophilia, and gene analysis is of great significance.Children diagnosed with IT need long-term anticoagulant therapy to reduce the recurrence of VTE.
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Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.
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With the emergence of new respiratory virus, it is more apparent for the vulnerability of population to respiratory viral infection.Non-pharmaceutical interventions (NPIs) for respiratory virus infection have become the main way to prevent corona virus disease 2019.Some studies had proven its effectiveness.In addition, the NPIs also significantly reduced the incidence and hospitalization rate of other respiratory disease in children.NPIs for respiratory virus infection in children have its particularity and challenge.In daily life, it is important to guide children how to do the NPIs, so as to protect susceptible children and reduce the disease burden in children′s health system.Therefore, the aerosol transmission, the specificity of the NPIs in children, and the impact on childhood respiratory diseases are described in this article, to improve the prevention of common respiratory diseases in children.
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Asthma is the most common chronic respiratory disease in children and requires long-term medical management.Adolescence has unique physical and psychological characteristics, which challenge the management of asthma in adolescents.A personalized transition strategy can achieve a successful asthma transition from childhood into adulthood and improve long-term outcomes of asthma.In this paper, the characteristics of adolescence, burden of adolescent asthma, challenges to adolescent asthma, adolescent asthma management system, and successful transition of adolescent asthma were reviewed.
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The clinical data of a cystic fibrosis (CF) child with allergic bronchopulmonary aspergillosis (ABPA) and hemoptysis in the Department of Respiratory Disease Ⅰ, Beijing Children′s Hospital, Capital Medical University in May 2021 were retrospectively analyzed.Meanwhile, relevant literature was reviewed to analyze the clinical characteristics, diagnosis and treatment of CF patients with ABPA.This patient was a 15 years and 4 months old boy and complained of recurrent cough with sputum.The test showed increased blood eosinophils, total serum IgE higher than 500 IU/mL, positive aspergillus fumigatus specific IgE and IgG antibodies.Chest CT revealed central bronchiectasis and high-density mucus thrombus, and the patient was initially diagnosed with ABPA.Further examinations suggested the sweat chloride concentration was 89 mmol/L, and the genetic results showed a compound heterozygous mutation of CFTR (c.2909G>A from his father, c.3310G>T from his mother). Then, he was diagnosed with CF complicated with ABPA and treated with glucocorticoid and antifungal therapy.The disease was repeated after drug withdrawal.Due to hemoptysis, the right upper lobe lobectomy was performed.Unfortunately, ABPA occurred again 2 years later.The child is being followed up at present.CF is a rare monogenetic disease with poor prognosis.It is difficult to treat CF patients with ABPA and the disease repeats easily.Early identification and treatment will improve the prognosis.
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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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Bronchial asthma is the most common chronic respiratory disease in children.With the increasing use of inhaled corticosteroids, asthma deaths in the world have decreased by nearly two thirds.Mortality of childhood asthma is very low, ranging from 0 to 0.7/100 000, however, most of risk factors of asthma death could be avoidable.Risk factors of asthma death include poor asthma control, poor treatment compliance, insufficient medicine prescribed by doctors, insufficient monitoring of lung function, mental and psychological problems, food allergy, insufficient recognition and treatment of asthma exacerbation, improper use of β 2-receptor agonist, insufficient application of asthma action plan, et al.The mortality and risk factors of asthma in children were reviewed, which could support further improving asthma management strategies.
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Objective:To analyze the death rate of asthma among Chinese people aged 0-19 years in 2018 and the trend of asthma mortality between 2008 and 2018, in order to guide the research of asthma control management and prevention strategy, and reduce the mortality of childhood asthma in China.Methods:Data from the national disease surveillance points system (DSPs) was adopted.The mortality rates of 0-19-year-old people in different age groups, genders, places of residence and geographical regions from 2008 to 2018 were calculated, and the national death toll of asthma was estimated as well.The annual percentage change (APC) and average annual percentage change (AAPC) were calculated, and the death rate of asthma among Chinese people aged 0-19 years in 2018 and change trend of asthma mortality from 2008 to 2018 were analyzed.Results:In 2018, there was no significant gender diffe-rence in asthma mortality among Chinese people aged 0-19 years among different age groups, places of residence and geographical regions(all P>0.05). From 2008 to 2018, the mortality rate of people aged 0-19 fluctuated from 0.023/100 000 to 0.046/100 000, the highest mortality rate was in 2009 and 2012, and the lowest was in 2018. It was estimated that the total number of deaths among people aged 0-19 years reached the highest in 2009 (148 cases) and the lowest in 2018 (70 cases). It is estimated that the total number of deaths among people aged 0-19 years in China from 2008 to 2018 was 1 158 cases.From 2008 to 2018, the total mortality rate of asthma in Chinese population aged 0-19 years decreased significantly (AAPC=-7.6%, 95% CI: -10.4%--4.7%). There was a significant decrease in male group(AAPC=-7.4%, 95% CI: -12.5%--2.0%), female group(AAPC=-7.5%, 95% CI: -12.7%--2.0%), 1-<5 years old group(AAPC=-11.4%, 95% CI: -17.9%--4.5%), 15-19 years old group(AAPC=-14.4%, 95% CI: -24.8%--2.6%), rural group(AAPC=-9.0%, 95% CI: -13.1%--4.8%) and central areas(AAPC=-13.1%, 95% CI: -24.0%--0.5%), with statistical significance(all P<0.05). Conclusions:The total mortality of asthma in 0-19-year old population decreased significantly from 2008 to 2018.The mortality rate of asthma in 0-19-year old people in China is at the low level around the world.
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Anaphylaxis is increasingly in children, which is currently undernotified, underdiagnosed, and undertreated in China.In order to further improved the understanding and management of anaphylaxis, this issue reviews the pathogenesis, triggers and risk factors, clinical diagnosis and management of anaphylaxis, thus offers the recommedations of anaphylaxis in Chinese children based on previous published evidence-based guidelines and practice parameters.Recommendation aims to develop guiding principles for the diagnosis and management of anaphylaxis in children, and provide a framework for the development of new guidelines.
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Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions.The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies.This updated position document keep guidance aligned with the current state of the art of knowledge in anaphylaxis management including definition, diagnostic criteria, severity grading, elicitors and cofactors, acute treatment and long-term management of anaphylaxis.Intramuscular Adrenaline continues to be the first-line treatment for anaphylaxis.After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management.
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Objective:To analyze the long-term prognosis and prognostic factors of allergic bronchopulmonary aspergillosis(ABPA) in children suffering from cystic fibrosis (CF).Methods:An observational study was performed.All children who were admitted to the Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from August 2014 to June 2018, with more than 2 years of followed up for the diagnosis of CF accompanied by ABPA were involved.Results:Three children met the inclusion criteria, with 2 boys and 1 girl, and their diagnostic age were 14, 8 and 9 years old, respectively.The follow-up duration ranged from 2 to 6 years.All the 3 cases were treated with systemic corticosteroids and antifungal agent.In case 1, the initial dose of prednisone was 0.75 mg/(kg·d), and the course of treatment was more than 5 years.The corticosteroid-dependent patient suffered from expectoration and chest pain, and radiographic findings indicated exacerbation, while his lung function was normal.Treating with initial dose of prednisone 2 mg/(kg·d) for 9 months, case 2 had normal serum immunoglobulin E(IgE) concentration, but his pulmonary artery was infiltrated by lesions, thus leasing to lobectomy.In case 3, the initial dose of prednisone was 0.6 mg/(kg·d), and the course of treatment was 18 months.And she developed persistent hypoxemia, and decreased pulmonary function, so lung transplantation was necessary 2 years after diagnosis.Conclusions:Systemic glucocorticoid combined with antifungal therapy is the main treatment for CF with ABPA, but there are individual differences in the efficacy.The level of serum total IgE is not always consistent with lung function and chest images.The overall prognosis is poor, and it is infeasible to evaluate the prognosis by single factor.