RESUMEN
As a biomarker of airway inflammation, alveolar exhaled nitric oxide(CaNO), which represents small airway inflammation, is increasingly used in respiratory diseases.CaNO not only can be applied to children bronchial asthma severity evaluation, the selection of treatment and treatment effect of the dynamic monitoring, can also be applied to the early diagnosis of interstitial lung disease and assessment of the severity of lung damage for other diseases such as tuberculosis, pulmonary hypertension diagnosis.This paper reviews the diagnostic and therapeutic value of CaNO in pediatric respiratory diseases, and discusses the role of CaNO in the diagnosis and therapeutic evaluation in pediatric lung diseases.
RESUMEN
Clara cell secretory protein 16(CC16)is one of the most important secreted proteins of Clara cells in respiratory epithelium, which mainly exists in the lining fluid of lung epithelial cells.When the bronchoalveolus-capillary membrane barrier is damaged, a large amount of CC16 will enter the blood.It′s eventually excreted in the urine.In recent years, more and more studies have found that CC16 not only has anti-inflammatory, immune-modulating, anti-oxidation and anti-fibrosis effects, but also is a sensitive indicator of the integrity of the airway epithelium, which can predict the occurrence and development of many children′s pulmonary diseases.This article mainly summarizes the biological characteristics and functions of CC16, and summarizes the research progress of CC16 in the diagnosis and treatment of pediatric pulmonary diseases.
RESUMEN
Human adenovirus pneumonia(adenovirus pneumonia for short)is one of the important types of community-acquired pneumonia in children.Severe pneumonia can easily occur in infants or patients with impaired immune function, which can lead to acute lung injury and pulmonary sequelae.In severe infection, the significant imbalance between inflammatory cells and cytokines leads to tissue damage.In this paper, the classification, structure, infection receptor of human adenovirus and the immunological pathogenesis of adenovirus pneumonia are described.
RESUMEN
Mycoplasma pneumoniae pneumonia (MPP) is usually self-limited.However, refractory MPP affects some patients even after the treatment of macrolide antibiotics, leading to clinical or imaging deterioration.In recent years, novel insights in the clinical manifestations of MPP have been largely obtained, especially in the unique epidemiological characteristics of mycoplasma pneumoniae (MP) in 3 to 5 years interval, and the relationship between refractory and severe MP infection, outbreak and epidemic.The rapid laboratory diagnosis of MP and the selection of optimal therapeutic strategy for severe MPP cases are the huge challenges in clinical practice.Therefore, many studies have been performed to explore the early warning role of serum biomarkers in severe cases, as well as their diagnostic and therapeutic potentials.However, the understanding of the exact application value of these inflammatory markers is still limited.The ideal blood biomarkers of MPP should be reliable, rapid, and widely used, which can assist the diagnosis of severe cases, determination of complications, understanding of the pathogenesis and predictions of clinical outcomes or treatment effect.
RESUMEN
Objective@#To summarize the diagnosis, clinical manifestations, treatment and prognosis of congenital cystic lung lesions.@*Methods@#A retrospective study described the clinical course of 96 patients (46 female and 50 male) diagnosed with congenital cystic lung lesions treated at the Tianjin Children′s Hospital from January 2010 to March 2019. The clinical findings, imaging examinations, pathological findings, treatment and follow-up were analyzed.@*Results@#Totally 96 patients (aged from 4 days to 13 years) with congenital cystic lung lesions were included in this study. Eighty-six patients (90%) were diagnosed when they had cough and fever symptoms. Forty (42%) patients exhibited congenital cystic adenomatoid malformation, 30 underwent surgical excision, two were at emergency operations and one dead. There were 12 (13%) patients with pulmonary sequestration and four were surgical treated. Twelve (13%) patients with bronchogenic cyst were included and 4 were surgically treated. There were 3 (3%) patients with congenital lobar emphysema and one was surgically treated. Another patient with pneumothorax was operated in other hospital 2 months after discharge. Twenty-nine (30%) patients with unclassified congenital cystic lung lesions could not be definitively diagnosed by CT. Some of them were difficult to be distinguished from necrotizing pneumonia. Finally, 2 patients were diagnosed as necrotizing pneumonia after 6, 10 months follow-up. After operation 37 out of 39 patients recovered well.@*Conclusions@#The diagnosis of congenital pulmonary cystic disease depend on imaging and pathological examination. Most patients are diagnosed when they have respiratory tract infection. The main clinical manifestations are cough and fever. The prognosis of operative management is good.
RESUMEN
Community-acquired pneumonia (CAP) is a leading cause of death in children under 5 years old.Bacterial pneumonia is still the primary cause of severe pneumonia.Prevalence of Staphylococcus aureus CAP and its clinical features remain incompletely understood, complicating the empirical selection of antibiotics. Staphylococcus aureus is the main bacterial pathogen of CAP besides Streptococcus pneumoniae.Due to the virulence its bacterial factors involved in nasal colonization and its relationship with the host immune response, staphylococcus aureus is easy to cause lung damage after the virus infection. Staphylococcus aureus also produces panton-valentine leukocidin, and other toxin factors, which lead to the death of host cells after infection, activate humoral immunity, produce a large number of inflammatory factors, further cause primary and secondary acute lung injury, and may cause systemic collapse infection.At pre-sent, there is little in-death research on the relationship between the toxicity of Staphylococcus aureus and the host immune response.The prevalence of methicillin resistant Staphylococcus aureus makes the anti-infection treatment increa-singly difficult.It is urgent to improve the comprehensive diagnosis and treatment measures, improve the treatment rate, reduce the disability rate, and develop therapies targeted at both pathogen virulence factors and host immunomodulation.
RESUMEN
Asthma is one of the most common pulmonary chronic inflammatory diseases threatening public health.It is a heterogeneous disease driven by gene-environment interaction.The proposition of "hygiene hypothesis" and "microbial hypothesis" has gradually drawn attention to the close relationship between microorganisms and asthma.In recent years, studies on intestinal flora emerge endlessly.Studies have shown that intestinal flora is not only closely related to digestion, immunity, endocrine, circulation, neuropsychiatric system, but also to asthma.This paper reviews the possible relationship between intestinal flora and asthma in children from its physiological function, so as to explore the prevention and treatment strategy of asthma in the future.
RESUMEN
Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis.In recent years, pertussis reappearance makes it become one of the important diseases affecting human health.Pertussis toxin is an important virulence factor produced by Bordetella pertussis.It is an important component of acellular pertussis vaccine, and is related to most clinical symptoms and fatal pertussis.This paper reviews the molecular structure and pathogenesis of pertussis toxin.
RESUMEN
Objective@#As a chronic inflammation of the airways under the influence of multiple factors, there are at least 300 million asthma patients worldwide, and the incidence of childhood wheezing diseases is increasing year by year.Scholars at home and abroad generally believe that respiratory infection is one of the important factors inducing children′s wheezing.To explore the respiratory infectious factors causing children′s wheezing, including pathogens and pathogenic mechanisms, has important clinical significance for the diagnosis and treatment of children′s wheezing diseases.This review summarizes the status of children′s lower respiratory tract infections, explores the characteristics of different pathogen infections, the pathogenesis of infection and the relationship with wheezing or asthma, briefly describes the current treatment and prevention methods, and deepens the understanding of the status quo of children with wheezing disease.
RESUMEN
The school-age boy was admitted to Tianjin Children's Hospital for "fever and cough for 6 days".After detail examinations,the diagnosis of severe Mycoplasma pneumoniae pneumonia was proved.Treatments:anti-infection with Azithromycin and Meropenem;the obstruction of air way was relieved;assisted with symptomatic and supportive treatment.During the treatment,disorder of consciousness and hemiplegia of right limbs occurred,cerebral infarction was proved later by magnetic resonance angiography(MRA).Severe Mycoplasma pneumoniae pneumonia complicated with cerebral infarction is clinically rare with a high morbidity and mortality.Attention should be paid to body examination and Laboratory test.Multi-disciplinary cooperation is helpful.
RESUMEN
Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.
RESUMEN
Objective To explore pathogenic composition of hand,foot and mouth disease(HFMD),and the molecular typing of enterovirus in Tianjin Children′s Hospital in 2016.Methods Single center study.A total of 327 samples of HFMD cases which collected from Tianjin Children′s Hospital from March to November in 2016 were tested for nucleotide acid of enterovirus(EV),human enterovirus 71(EV71),Coxsackievirus A 16(CA16)by real-time reverse transcription polymerase chain reaction(RT-PCR),among which 104 sample of other EV positive were selected to amplify and sequence the whole VP1 region by using RT-PCR.Homology was analyzed and phylogenetic tree were constructed by comparison of the sequence with all subgenotype of EV by Chromas1.62 and MEGA6.06.EV positive rate in different age groups were compared by SPSS20.0.Results Of all the 327 HFMD cases tested,there were 272 EV positive cases,the constituent ratio of EV71,CA16 and other EV were 55.1％(150/272),6.6％(18/272)and 38.2％(104/272)respectively.The EV positive rates of different age groups(69.0％-90.9％)were different significantly(x2=15.897,P=0.044),the 3 years-old-group had the highest EV positive rate than that of the other age groups(90.9％,40/44).Of all 104 samples of other EV tested,34 were CA10(12.5％)and 14 were CA6(5.1％).Phylogenetic analysis of 11 EV71 VP1 and 20 CA10 VP1 showed that the EV71 and CA10 strains belonged to genotype C4a and genotype G,respectively.ConclusionsEV71 was still the predominant pathogen in spite of the constituent ratio of other EVs increased markedly in 2016 in Tianjin.It is important to enhance etiological monitoring for control and prevention of HFMD.
RESUMEN
Objective To investigate the effect of budesonide atomization on tracheal extubation in children.Methods A total of 85 patients with tracheal intubation in Tianjin Children's Hospital from May 2013 to September 2016 were selected in this study.Patients were randomly divided into budesonide group (n=44) and dexamethasone group (n=41).The budesonide group was given 1 mg of budesonide for inhalation 30 min before extubation,and 1 mg of budesonide inhalation immediately after extubation.Then every 8 hours for 0.5-1.0 mg budesonide inhalation for 4 days.The dexamethasone group was given dexamethasone 0.2-0.3 mg/kg intravenously 30 min before extubation,and dexamethasone 2.5-5.0 mg inhalation immediately after extubation.Then dexamethasone 2.5-5.0 mg inhalation was given every 8 hours for 4 days.The incidence of laryngeal edema (stridor,hoarseness),the time of extinction,the expression of hypoxia,reintubation rate within 24 hours and secondary infection rate after extubation were compared between the two groups.Results There were no significant differences in the mission success rate,the incidence of laryngeal edema,the time of extinction,the incidence of hypoxia and re-intubation rate between the two groups (P ＞ 0.05).Two patients were found secondary infection after extubation in dexamethasone group.Conclusion Both budesonide and dexamethasone show curative effects on the prevention and treatment of laryngeal edema after extubation.Budesonide atomization can replace systemic corticosteroids,thus reducing the adverse reactions of glucocorticoids.We recommend the use of budesonide in treating adverse events after extubation.
RESUMEN
Early, rapid and accurate diagnosis of disease is of great significance for the prevention of disease progression and the best clinical rational treatment program. Respiratory tract infections are the common and frequently occurring diseases in infants and preschool children. About 90 percent of upper respiratory tract infections are caused by viruses, and followed by secondary bacterial infections. Bacterial pathogen often causes lower respiratory tract infections. This study describes the clinical features of typical pathogens of respiratory tract infections in children including respiratory syncytial virus, influenza virus, coronavirus and atypical pathogens-mycoplasma, chlamydia and legionella, and explains the clinical testing evaluation of widely used PCR method in the detection and diagnosis of respiratory tract infections in children. Finally, we analyzed the advantages and disadvantages of current used respiratory pathogen detection method-traditional culture method, based on pathogen antigen (antibody) assay and nucleic acids method.
RESUMEN
Objective To explore the correlation of total IgE and childhood atopic dermatitis (AD) in maternal serum and newborn cord blood, as well as its clinical significance of allergen testing. Methods Thirty-five cases diagnosed as AD (AD group) were selected, and other 35 children who were not diagnosed as AD (control group) were randomly selected from a birth cohort established in 2009—2011. The total IgE levels were detected by ELISA in maternal serum and newborn cord blood. The serum specific IgE antibody level was detected by quantitative immunoblotting method. Results The serum total IgE level was significantly higher in mother and newborn cord blood in AD group than that in control group (χ2=16.568 and 14.933, P<0.01). Compared to control group, there was a significantly higher positive rate of mother serum allergen includ?ing dust mites, house dust, ragweed pollen, song kind of pollen, poplar, surname and elm pollen, mould, shrimp, marine fish, in AD group (P<0.05). There was a significantly higher positive rate of artemisia pollen and fungi IgE in newborn cord blood in AD group (P<0.05). Conclusion The increased total IgE in maternal serum may play a predictive effect on infants suf?fering from AD. There is no obvious consistency in allergic state between mothers and infants.
RESUMEN
Objective To investigate the curative effect of sodium nitroprusside in the treatment of EV71-related pneumoedema/pneumorrhagia and hypotension in this study. Methods This was a retrospective study of a total 10 children with EV71-related pneumoedema/pneumorrhagia treated with sodium nitroprusside using case-control methods. The clinical manifestations and outcomes of the 10 children (present cohort) were compared with those of 8 children (past cohort) who had EV71-related pneumoedema/pneumorrhagia without sodium nitroprusside. Results Among these 10 patients,all were at the appearance of pneumoedema/pneumorrhagia, cardiac arrhythmia and hypotension. Two patients showed severe cardiac arrhythmia, two patients showed cardiac arrest for many times. All 10 patients were treated with mechanical ventilation and other conventional treatments. At the first time of the manifest of hypotension,sodium nitroprusside were put into practice in all 10 patients. Ten patients were treated with intravenously sodium nitroprusside in the stage of hypotension by maxi30 min ～ 1 h,the patients showed an improvement in vultus,pulse and peripheral circulation and decrease of heart rate and elevation of blood pressure after 30 min ～2 h,but at least 2～6 h later,the blood pressure tended to stabilize at normal standard. Conclusion Hypotension is the intensive stage in EV71-related hand,foot and mouth disease ,and the shock syndrome caused by acute left ventricular disorder is related to sympathetic nerve activity. Sodium nitroprusside can effectively reduce the cardiac afterload,and correct shock and improve the prognosis.