Expert consensus on nucleic acid amplification test of respiratory pathogens in children / 中华实用儿科临床杂志

Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.

Study on the clinical epidemiological characteristics of human rhinovirus infection in children with community-acquired pneumonia / 中华实用儿科临床杂志

Objective:To analyze the dominant genotypes and epidemic characteristics of human rhinovirus (HRV) in pediatric community-acquired pneumonia (CAP) in China.Methods:Between June 2017 to December 2019, throat swabs or nasopharyngeal aspirates were collected from pediatric CAP patients hospitalized in 6 medical institutions in Southern and Northern China (bounded by Qinling and Huaihe River), respectively.A total of 16 species of common respiratory viruses were screened using respiratory pathogen detection kits.Samples with positive HRV were genotyped for further epidemiological analysis.Results:The total detection rate of HRV in pediatric CAP (2 913 cases) was 12.2%(356 cases) in this study, which was 10.3%(145/1 410 cases) and 14.0%(211/1 503 cases) in Northern and Southern China, respectively.The detection rate of HRV in the Southern region was significantly higher than that in the Northern region, the difference was statistically significant( χ2=9.562, P=0.002). Epidemiological analysis showed that the distribution of HRV-positive cases in the Northern region was similar in all age groups, while 90.5% of positive cases in the Southern region were infants under 3 years.Classified by seasonal distribution, HRV-positive cases in the Northern region were mainly distributed in summer and autumn, while those in the Southern region were mainly distributed in spring and autumn.The coinfection rate of HRV and other pathogens was 40.7%, which was significantly higher in the Southern region than that of Northern region (49.0% vs.28.0%), the difference was statistically significant( χ2=15.801, P<0.001). The most common pathogens mixed with HRV were respiratory syncytial virus (RSV), human boca virus (HBOV) and parainfluenza virus type Ⅲ (PIV3) in the Northern region, with the mixed infection rate of 5.0%, 5.0% and 4.0%, respectively, which were RSV, PIV3 and human metapneumovirus (HMPV) in the Southern region, with the mixed infection rate of 9.0%, 7.0% and 6.0%, respectively.The genotyping results showed that all three HRV genotypes were detected.HRV-A (118/220 cases) was the dominant genotype, followed by HRV-C(82/220 cases). Conclusions:The detection rate of HRV in pediatric CAP cases is 12.2% in this study.There are significant differences in age and seasonal distribution of HRV-positive cases in the Southern and Northern regions.Coinfection of HRV and other pathogens is detected.The coinfection rate is significantly higher in the Southern region than that in the Northern region.HRV-A is the dominant genotype, followed by HRV-C.

Progress in the treatment of childhood bronchial asthma exacerbations——comparison of guidelines for bronchical asthma in different countries / 中华实用儿科临床杂志

Bronchial asthma (also called asthma) is the most common chronic respiratory inflammatory disease in childhood.With the increased incidence of asthma in recent years,the guidelines for diagnosis and treatment of asthma have been also updated quickly at both domestic and overseas.Acute exacerbations of asthma will result in unscheduled medical attendances in emergency department or hospitalizations,and the severe one may be life-threatening,which brings a heavy burden to the families and society.Several guidelines,Meta analysis,and studies in treatment of childhood asthma exacerbations are reviewed in this article,so as to provide recommendations in the treatment of childhood asthma exacerbations for physicians.

Judgement, prevention and treatment of recurrent respiratory tract infections in children / 中华实用儿科临床杂志

Recurrent respiratory tract infections (RRIs) is a common clinical presentation in paediatrics and represent a huge burden of children health,family life and socioeconomic costs.Nowadays,the definition of pediatric RRIs has not been reached a consensus in the international field.Diagnosis and treatment of pediatric RRIs present a muddled picture clinically.This review introduces the definition and judgement,pathogeny and risk factors,classification,principle of management and prevention of pediatric RRIs in order to provide a reference for clinical practice of pediatrician.

Evaluation of clinical pathway introduced in children with bronchiolitis / 中华实用儿科临床杂志

Objective To investigate the efficacy of the clinical pathway introduced in children with bronchiolitis.Methods Based on a retrospective study,the duration of hospital stay,hospital expenses,antibiotics usage rates,curative rate and nosocomial infection rate were compared between 181 bronchiolitis patients (the clinical pathway group) managed according to clinical pathway and other 122 bronchiolitis patients (the control group).The variation of clinical pathway was analyzed in the clinical pathway group as well.Results The duration of hospital stay in clinical pathway group [4.96 (4.00,6.00) days] was significantly shorter than that in the control group [5.81 (4.82,7.00) days],and the difference was significant (Z =3.137,P ＜ 0.05).The hospital expenses [3 701.23 (3 124.50,4 396.19) yuan] in clinical pathway group were significantly lower than that in the control group [3 954.22 (3 325.07,4 679.66) yuan],and the difference was significant (Z =2.042,P ＜ 0.05).The antibiotics usage rate (20.44％)(37/181 cases) in clinical pathway group was significantly lower than that in the control group (40.16％) (49/122 cases),and the difference was significant (,x2 =13.945,P ＜ 0.05),and the curative rate (93.92％) (170/181 cases)in clinical pathway group was significantly higher than that in the control group (86.89 ％) (106/122 cases),and the difference was significant (x2 =4.447,P ＜ 0.05).The nosocomial infection rate (4.42％) (8/181 cases)was also lower than that in the control group (10.66％,13/122 cases),and the difference was significant (x2 =4.393,P ＜0.05).The variation rate of clinical pathway was 48.62％ (88/181 cases) in clinical pathway group.Conclusions The curative rate is improved and the duration of hospital can be shortened if the clinical pathway is introduced in bronchiolitis children,with less the hospital expense.Moreover,the antibiotics usage rates and the nosocomial infection rate are reduced in the implementation process of clinical pathway which is worthy to be put in use.However,there is a high variation rate in the clinical pathway.It should be interposed and administrated appropriately in dinical treatment for clinic.

Analysis of the significance of whole blood sample in the diagnosis of severe cases of hand, foot and mouth disease / 中国生化药物杂志

Objective To study the diagnostic significance of whole blood sample index in the severity of hand, foot and mouth disease, and to analyze its pathogenesis. Methods 194 cases of severe cases of hand, foot and mouth disease were selected as the case group,and 193 cases of mild hand, foot and mouth disease were selected as the control group. Blood samples were collected after admission to study the whole blood samples, including white blood cells, erythrocytes, platelets, medium cell ratio, lymphocyte ratio, mononuclear cell ratio, C-reactive protein test; The patient's immune system, the nervous system were also tested. Results Compared with patients with mild group, the white blood cell level of the patients in the severe group was higher and the albumin level was higher, the difference was statistically significant (P<0.05), the monocyte ratio, the T cell ratio was lower, the difference was statistically significant (P<0.05). Conclusion The white blood cell level and monocyte ratio of patients with severe hand, foot and mouth disease have changed. The whole blood sample has a certain sensitivity to the diagnosis of severe hand, foot and mouth disease.

Analysis of Clinical Features and Age Differences of Asthma Exacerbation in Children / 医学研究杂志

Objective To understand the clinical features and the differences of age on children with asthma exacerbation.Methods Totally 395 inpatients with asthma exacerbation of our hospital were enrolled from January 2013 to December 2015.All the inpatients were divided into 2 groups:＜ 5 years of age group and ≥5 years of age group.The general data,epidemiology,predisposing factors,respiratory tract infection and pathogenic spectrum of these children were compared and analyzed.Results Average age of all inpatients was 4.25 ±2.51 years old,the proportion of male and female was 2.06:1,and autumn was the epidemical season.367 inpatients(92.91％)were complicated with respiratory tract infection.113 inpatients (28.61％) had been diagnosed with asthma before hospitalization.31 inpatients(7.89％) were followed up with long term standardized treatment.Compared with ≥ 5 years of age group,inpatients of ＜ 5 years of age group were more easily to be complicated with respiratory tract infection (x2 =9.856,P =0.007),especially with pneumonia (x2 =9.846,P =0.002).The detection rate of respiratory syncytial virus in ＜ 5 years of age group were higher than ≥ 5 years of age group (x2 =10.870,P =0.001).But there were no significant difference between the two groups in the detection rate of mycoplasma.(x2 =3.090,P =0.079).The diagnostic rate of asthma before hospitalization and rate of long term standardized follow-up treatment in ＜ 5 years of age group were lower than ≥5 years of age group (x2 =16.742,P =0.000;x2 =12.948,P =0.000).Conclusion Respiratory tract infection,non-timely diagnosis and standard treatment were major predisposing factors for asthma exacerbation of children.＜ 5years of age group were easily to be complicated with respiratory tract infection,especially with pneumonia and respiratory syncytial virus infection.The diagnostic rate of asthma before hospitalization and rate of long term standardized follow-up treatment were lower.

Clinical characteristics and prognosis of neonatal VACTERL association in 33 cases / 中国新生儿科杂志

Objective To study the clinical characteristics,treatment and prognosis of neonatal VACTERL association.Method The clinical data of newborns diagnosed with VACTERL association from January 2010 to December 2015 were collected and retrospectively analyzed.Result A total of 33 patients diagnosed with VACTERL association were included,including 23 males and 10 females.Among them,17 cases were term infants,15 cases premature infants and 1 case of overdue birth,with an admission age of 1 to 24 days.The most common deformities were cardiac anomalies (C) in 27 cases (81.8％),followed by anal atresia/anorectal malformation (A) in 25 cases (75.8％),renal deformity (R) in 24 cases (72.7％),limb abnormalities (L) in 20 cases (60.6％),Tracheoesophageal fistula (TEF) in 8 cases (24.2％) and vertebral abnormalities (V) in 3 cases (9.1％).11 cases (33.3％) had other deformities.Among these 33 patients,24 cases had 3 types of malformations and 9 cases had 4 types of malformations.The most common combination was ACR (n =8).20 patients had no abnormalites on chromosome karyotype test including 2 patients had normal gene microarray results.16 patients received surgical treatment during neonatal period and 13 of them recovered and discharged.Among the other 17 cases received no surgery,only 1 patient improved and discharged.A telephone follow-up was proceeded in 14 discharged cases at 1 year old.Among them,13 cases had good prognosis,however,the remaining one was dead.Conclusion VACTERL association is a rare non-random combination of multiple malformations.The early discovery and appropriately treatment after diagnosis will improve the prognosis and prevent death.Doctors should reinforce the ability to detect various types of deformities and examine the chromosome and gene properly.

Clinical analysis of tracheobronchial foreign bodies combined with atelectasis in children / 中华全科医师杂志

Clinical data of 62 cases of tracheobronchial foreign bodies with pulmonary atelectasis admitted in Second Affiliated Hospital and Yuying Children′s Hospital during January 2007 to December 2016 were retrospectively analyzed .There were 40 boys and 22 girls aged 9 months to 10 years, and the symptom onset ranged from 6 hours to 4 months prior to medical intervention .The foreign bodies were vegetables in 55 (88.71%), pieces of meat in 3 (4.84%) and chemical product in 4 cases (6.45%). Sixty patients recovered after medical intervention , 1 died preoperatively and 1 died of severe reexpansion pulmonary edema ( RPE) .The foreign bodies were successfully removed with rigid bronchoscopy in a single attempt in 47 children (77.05%), 1 child (1.64%) required two attempts to completely remove the foreign bodies;10 children ( 16.39%) were treated with fiberoptic bronchoscopy;3 children ( 4.92%) received thoracotomy , in which 1 child ( 1.64%) received a lobectomy due to pulmonary atelectasis and lung consolidation during operation .Conclusion Foreign bodies combined with pulmonary atelectasis in children are likely to be misdiagnosed , which led to severe adverse events . RPE is a serious postoperative complication of children receiving rigid bronchoscopy as a treatment , especially those diagnosed with tracheobronchial foreign bodies combined with pulmonary atelectasis .

Association between HLAⅡgene polymorphism and genetic susceptibility to Mycoplasma pneumoniae pneumonia / 中华微生物学和免疫学杂志

Objective To investigate the correlations between HLAⅡgene polymorphism and the development of Mycoplasma pneumoniae pneumonia ( MPP ) in children and to identify the susceptibility genes and protective genes for MPP for further elucidating the pathogenesis of MPP and providing the guid-ance for researches on gene therapy for MPP. Methods Genotypes of HLAⅡgene ( HLA-DQA1 and HLA-DRB1) in 60 children with MPP and 30 healthy children were detected by using sequence specific primer polymerase chain reaction ( SSP-PCR) . The haplotype frequencies, linkage disequilibrium and correlations with MPP were analyzed by using Arlequin software and Chi-square test. Results The frequencies of HLA-DQA1*0201/*0301 in children with MPP (35. 83%/30. 00%) were higher than those in healthy children (16. 67%/8. 33%) (χ2=12. 139, P<0. 05, OR=5. 059;χ2=15. 142, P<0. 05, OR=7. 500). However, the frequency of HLA-DQA1*0401 in children with MPP decreased to 12. 50% as compared with 40. 00%in healthy children (χ2=24. 638, P<0. 05, OR=0. 083). The frequencies of HLA-DRB1*07/*15 in children with MPP increased to 38. 33%/30. 00% as compared with 20. 00%/16. 67% in healthy children (χ2=11. 735, P<0. 05, OR=4. 929; χ2=5. 692, P<0. 05, OR=3. 000). But the frequency of HLA-DRB1*11 dropped to 15. 00% as compared with 43. 33% in healthy children (χ2=19. 448, P<0. 05, OR=0. 087). Conclusion HLA-DQA1*0201, HLA-DQA1*0301, HLA-DRB1*07 and HLA-DRB1*15 might be the susceptibility genes for MPP in children, while HLA-DQA1*0401 and HLA-DRB1*11 were probably associated with the resistance to MPP. No extensive linkage disequilibrium was found between HLA-DQA1 and HLA-DRB1.

Clinical manifestations,imaging findings and pathological features of 15 cases with congenital cystic adenoma-toid malformation in the lung / 中华实用儿科临床杂志

Objective To explore the clinical manifestations,imaging findings,pathological classification and treatment of congenital cystic adenomatoid malformation (CCAM)of the lung.Methods The clinical features,imaging findings,pathology information,diagnosis,treatment method and its prognosis of children with CCAMconfirmed by ope-ration and pathology were retrospectively analyzed in Yuying Children′s Hospital Affiliated to Wenzhou Medical Univer-sity from August 2006 to August 201 4.Results Eleven patients were boys and 4 patients were girls.One case had a-symptomatic clinical features,1 2 cases had pulmonary infection,1 case had recurrent chest pain,and 1 case had de-pressed deformity in sternum inferior segment.Chest CT scanning indicated that 9 cases had multiple gas cysts at unila-teral side of lung,among which 1 case was of funnel chest and pulmonary sequestration,1 case of huge cyst containing air and fluid at inferior lobe of left lung,and 4 cases of high density lung shadow;CT examination indicated that 1 case had recurrent chest pain and eventration of diaphragm of the right side combined with pulmonary sequestration.All ca-ses were treated by surgical resection,of whom 1 case was given cystectomy and sequestrectomy,diaphragmatic plication respectively,1 case complicated with funnel chest disease underwent lesion pulmonary lobectomy,sequestrectomy and minimally invasive corrective surgery in pectus excavatum (Nuss surgery),and the remaining 1 2 cases received lesion pulmonary lobectomy.All of 1 5 cases recovered well without complications.Pathological classification type of CCAMin-cluded 1 1 cases of type Ⅰ,3 cases of type Ⅱ and 1 case of type Ⅲ,among which 2 cases had pulmonary sequestration. Conclusions CCAMis a rare disease which can be discovered along with pulmonary infection.Multiple gas cysts are the most common imaging findings and the preoperative diagnosis of CCAM is mostly based on chest CT examination. Type Ⅰ and type Ⅱ are the most common pathological classification.The surgical resection should be given early surgi-cal resection and the prognosis is usually good.

Pathogenic bacteria distribution and drug resistance in one hundred children of bacterial meningitis / 临床儿科杂志

Objective To investigate the pathogenic bacteria distribution, antibiotics resistance, and clinical features of childhood bacterial meningitis (BM). Methods Clinical data from BM children with positive cerebrospinal lfuid culture were retrospectively analyzed from March 2004 to March 2015. According to age, the BM children were divided into neonates group (0-28 days), infants group (—1 year), and children group (≥1 year). According to the onset time, the BM children were divided into the early group (March 2004 to March 2010) and the late group (April 2010 to March 2015). According to the clinical situation, the BM children were divided into the trauma and surgery secondary infection group and the control group. Results A total of 100 BM children were recruited. One hundred and two strains of pathogens were detected, 62 (60.8%) strains of Gram positive bacteria and 40 (39.2%) strains of Gram negative bacteria. The main pathogens were Streptococcus pneumoniae (33 strains), Escherichia coli (22 strains), and Streptococcus agalactiae (10 strains). The proportion of Streptococcus agalactiae was higher in the late group (18.8%(9 cases)) than that in the early group (1.9%(1 case)) (χ2=6.406, P=0.011). The proportion of coagulase-negative staphylococci was higher in the trauma and surgery secondary infection group than that in the control group (χ2=6.631, P=0.010). Drug sensitivity analysis found that 60.0%of Escherichia coli produced extended-spectrumβ-lactamases (ESBLs) in the control group, while the only one strain of Escherichia coli in the trauma and surgery secondary infection group was ESBLs negative. Streptococcus pneumoniae were sensitive to vancomycin and linezolid. Streptococcus agalactiae were all found in the control group, which were all sensitive to penicillin and linezolid. The sensitive rate to vancomycin was only 70%. The incidence of complications in neonates group, infants group, and children group was 55.0%(22/40), 78.6%(33/42), and 33.3%(6/18), respectively. The difference was statistically signiifcant (χ2=11.848, P<0.05). The most common complications in these three age groups were ventricular dilatation (40.9%), subdural effusion (45.5%), and hydrocephalus (40.0%), respectively. Thirty-ifve children were cured, 41 children were improved and discharged, 22 children were not cured and left the hospital, and 2 children died. Conclusions Streptococcus pneumoniae, Escherichia coli, and Streptococcus agalactiae were the predominant pathogens in childhood BM. The Streptococcus agalactiae infection is increased in the late group. The complications is varied in different age groups..

The imaging features of Mycoplasma pneumoniae pneumonia in children / 中华实用儿科临床杂志

Mycoplasma pneumoniae is a common pathogen of community acquired pneumonia in children.The imaging manifestations of Mycoplasma pneumoniae pneumonia in children varied,the understanding of the causes in clinical pediatrician is not sufficient.The common imaging appearances of chest X-ray,chest CT and chest magnetic resonance imaging (MRI) in children with Mycoplasma pneumoniae pneumonia attributed to age,course,clinical manifestations and severity of illness were summarized in this review.

Naringenin may block RSV-induced mucous hypersecretion in A549 cell via JNK/AP-1 signaling pathway / 中华儿科杂志

<p><b>OBJECTIVE</b>Naringenin has been reported to attenuate Mucin (MUC) 5AC secretion in many pathological models. Many stimuli activate MUC5AC expression through JNK/AP-1 signaling pathways. We hypothesized that naringenin may have inhibitory effects on mucous hypersecretion by modulating MUC5AC production and inhibiting JNK/AP-1 signaling pathways.</p><p><b>METHOD</b>The cell model of mucous hypersecretion was made by human lung adenocarcinoma epithelial (A549) cells stimulated by RSV. A549 cells were subcultured and then randomly divided into 7 groups, which were designated as group C (cell control group), groups R1-3 (cells were infected with RSV at the multiplication of infection (MOI) of 0. 5, 1. 0, 5. 0), groups N1-2 (cells infected with viruses in presence of Nar 30 - 100 mol/L), groups N3-4 (uninfected cells treated with Nar 30 - 100 µmol/L), group D (DMSO), group S (cells infected with viruses in presence of SP600125). After incubating for 24 hrs, the expression of MUC5AC at mRNA and protein level in the groups were determined by real-time quantitative PCR and enzyme-linked immunosorbent assay (ELISA). The protein expression changes of JNK, p-JNK and AP-1 were measured by Western blotting.</p><p><b>RESULT</b>The expressions of MUC5AC protein and mRNA in all RSV infected groups were significantly higher than that in group C in a dose-dependent manner (all P <0. 05). Nar of 30 and 100 µmol/L significantly and dose-dependently decreased RSV-induced secretion of MUC5AC protein in cell supernatant and expression of MUC5AC mRNA (P <0. 05). The relative content of p-JNK, AP-l in R2 groups were 3. 31 ± 0. 34 and 1. 94 ± 0. 05. Theyfrweremtgnificanty increased as compared with group C (both 1. 00 ± 0. 00) (all P <0. 05). The levels of p-JNK in N2 and S groups were 2. 10 ± 0. 20. 27 and 1.±97 ± 0. 16. The levels of AP-1 in N2 and S groups were 1. 40 ± 0. 03, 1. 36 ± 0. 05. Nar and SP600125 led to a largest decrease in levels of p-JNK and AP-1 when compared with group R2 (P <0. 05). The MUC5AC protein in group R2 was (48. 19 ± 0. 47) µg/L. The protein expression of MUC5AC in group R2 was significantly higher than that in group C [(36. 67 ± 1. 50) g/L] with a statistically significant difference (P <0. 05). The protein expression of MUC5AC in groups N2 and S were(43. 17 ± 1. 06) µg/L, (44.±02 ± 0. 99) µg/L, Nar and SP600125 remarkably inhibited RSV-induced secretion of MUC5AC in supernatant of A549 cells (P < 0. 05).</p><p><b>CONCLUSIONS</b>Naringenin might be able to block RSV-induced mucous</p>

Progress of treatment of infected pleural effusion in children / 国际儿科学杂志

Children′s infected pleural effusion refers to any of the pleural effusions caused by infection, the common pathogens include bacterium,mycoplasma and bacillus tuberculosis. The treatments of pleural effu-sion are general treatment,anti-infection drugs ( including antibiotics or antituberculosis drugs) ,thoracic puncture drainage,or combination of plasminogen-activator, electronic thoracoscopy ( video-assisted thoracic surgery, VATS) and thoracic surgery (pleural decortication,modified thoracoplasty surgery,pleural pneumonectomy). This article reviews recent progress in each method of treatments about the indications,effects and prognosis of the disease.

Analysis of 10-year-death cases in hospitalized children in Yuying Children's Hospital of Wenzhou Medical College / 中华实用儿科临床杂志

Objective To analyze the death cases of hospitalized children in Yuying Children's Hospital of Wenzhou Medical College from January 2004 to December 2013,and to detect the age distribution of deaths,the total cost and cost of different diseases,length of hospital stays,season distribution of deaths and mortality rates trends.Methods Five hundred and thirty-one death cases of 0-18 years old hospitalized children from 219 429 cases in Yuying Children's Hospital of Wenzhou Medical College during January 2004 to December 2013 were collected and analyzed.Results From January 2004 to December 2013,the total mortality rate of hospitalized children was 0.24％ (531/219 429 cases).The mortality rate of 0-28 d was highest (0.77％).The average economic cost of dead cases was 3.4 times compared with other hospitalized cases,three diseases with highest treatment expenses were congenital malformation,deformations and chromosomal abnormalities ; as well as the respiratory system diseases and tumor.Median hospital stay of the dead cases was 5.8 days.The top five causes of death were certain conditions originating in the perinatal period,such as congenital malformation,deformations and chromosomal abnormalities ; injury,poisoning and certain other consequences of external causes;certain infectious and parasitic diseases;diseases of the respiratory system.From January 2004 to December 2013,the mortality rate declined from 0.34％ to 0.12％ (x2 =67.138,P ＜ 0.001),and it was in a descending order.Conclusions Related departments of government should pay more attention to perinatal care,promote the congenital diseases screening,prevent respiratory infections,improve the level of emergency room,reduce poisoning and traffic accidents.And different measures should be taken according to the different characteristics of the death causes of different age groups.

Risk factors and management strategy of obstructive sleep apnea and hypopnea syndrom in children / 中华实用儿科临床杂志

Childhood obstructive sleep apnea and hypopnea syndrom (OSAHS) has complex causes,which can lead to cardiovascular diseases,neurological complications such as cognitive impairment,and metabolic syndrome.It has affected children's physical and mental health.Childhood OSAHS should emphasize the early identification of the risk factors,it's necessary to undergo polysomnography and intervene timely.The diagnosis and treatment of OSAHS should be combined with clinical characteristics,and should not only rely on undergo polysomnography report results.Tonsil and adenoidectomy is still the first line treatment,nasal inhaled hormone and leukotriene receptor antagonist are effective for mild OSAHS children.

Clinical analysis of 64 cases of non-traumatic pneumomediastinum in children / 临床儿科杂志

Objective To investigate the underlying causes, clinical characteristics, treatment and prognosis of non-traumatic pneumomediastinum (PM) in children. Methods A retrospective analysis of the clinical data of 64 children diagnosed with non-traumatic PM in Yuying Children’s Hospital Affiliated to Medical University from Jan 2003 to Dec 2013 was performed. Nineteen children with SPM and the other 45 with clear causes of non-traumatic PM were divided into two groups for comparison. According to age, 64 cases were divided into 0-6y group and 6-18y group for further comparison. Results A total of 64 patients with non-traumatic PM were collected. Nineteen of them aged 14.90±2.00 y had SPM with unknown etiology, and 84.2%were male. The other group of 45 patients aged 4.26±4.45y, and 55.6%of this group were male. The common causes were pneumonia or other lower respiratory tract infection, asthma and foreign body inspiration. The patients with SPM were always with chest pain. While the patients with clear causes of non-traumatic PM were more complained of dyspnea, coughing, subcutaneous emphysema. The treatment of patients with SPM was bed rest, oxygen uptaking, antitussive, anti-infection and other conservative therapy. All the patients with clear causes of non-traumatic PM had favorable prognosis with the treatment of actively curing primary disease and timely mediastinal air drainage, subcutaneous air drainage and thoracic close drainage. In 35 cases younger than 6 years old, the most common causes were pneumonia or other lower respiratory tract infection, none had SPM. In 29 cases older than 6 years, 19 of them had SPM. Conclusions Etiologies of pneumomediastinum varied with age in children,which should be vigilantly examined, especially for those younger than 6 years old. The key of the treatment to non-traumatic PM with clear etiologies was to treat its primary disease.

Anti-TLR2 antibody attenuates inflammatory response of Staphylococcus aureus pneumonia in mice / 中国免疫学杂志

Objective:To investigate the effects of the anti-TLR2 antibody blocking TLR2 signaling pathway on inflammatory response in Staphylococcus aureus pneumonia murine models.Methods: Sixty C57BL/6J mice were divided randomly into normal control,SA pneumonia,and anti-TLR2 antibody group,killed 3 and 8 days after inoculation respectively.Normal control mice inoculated sterile PBS intranasally ,SA pneumonia mice inoculated SA ,anti-TLR2 antibody group of mice injected with anti-TLR2 antibody by tail vein and then inoculated SA intranasally.At the predetermined point , the colony-forming units ( CFU ) of bacteria were higher , leukocytes and neutrophil percentage were counted in bronchoalveolar lavage fluid ( BALF ) , the concentrations of KC and IL-10 in BALF and serum were assayed by ELISA ,changes in pulmonary histopathology were observed with HE staining and TLR 2 expression was detected by immunohistochemical.Results:3 days after intranasal inoculation ,the concentrations of KC and IL-10 in BALF and serum was increased in SA pneumonia mice , pulmonary histopathology changes significantly in HE staining.Compared with SA pneumonia mice,the CFU of bacteria were higher,leukocytes count and neutrophil percentage ,the concentrations of KC in BALF and serum,as well as HE pathological scores were reduced significantly in anti-TLR2 antibody group mice ,while no significant difference in IL-10.8 days after intranasal inoculation , HE pathological scores of anti-TLR2 antibody group mice were significantly lower than SA pneumonia group mice ,the CFU of bacteria in BALF were not statistically different between those two groups.Conclusion:Anti-TLR2 antibody attenuates the production of inflammatory mediators and inflammatory cell infiltration in SA pneumonia mice .

Evaluations of the clinical pathway in children with Mycoplasma pneumoniae pneumonia / 临床儿科杂志

Objective To investigate the efficacy of the clinical pathway introduced in children with Mycoplasma pneu-moniae pneumonia (MMP). Methods Based on a retrospective study, the length of hospital stay, hospital expenses and curative rate were compared between 145 MMP patients managed according to clinical pathway and other 45 MMP patients. The causes of variation were analyzed in the clinical pathway group as well. Results The length of hospital stay in clinical pathway group [9 (6~10) days] was significantly shorter than that in the control group [10 (7-12.5) days] (P=0.003). The curative rate (93.8%) was significantly higher than that in the control group (84.4%) (P=0.043). The hospital expenses [4 696.5 (3 608.3-5 677.6) CNY] was significantly higher than that in the control group [3175.3 (2490.8-4585.0) CNY] (P<0.001). The variation rate of clinical pathway was 48.3%(70/145 cases) in clinical pathway group. Conclusions The curative rate is improved and the length of hospital stay is shortened after the clinical pathway is introduced in MMP children. However, there is a high variation rate in the clinical pathway. It is necessary to optimize the clinical pathway before it is adapted in clinic.