Clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia / 中国当代儿科杂志

OBJECTIVES@#To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents.@*METHODS@#A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups.@*RESULTS@#The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria.@*CONCLUSIONS@#For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.

Consistency between nasopharyngeal aspirates and bronchoalveolar lavage fluid in pathogen detection in children with pneumonia: an analysis of 533 cases / 中国当代儿科杂志

OBJECTIVES@#To study the consistency between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in pathogen detection in children with pneumonia@*METHODS@#A retrospective analysis was performed on the data of pathogens detected in 533 children with pneumonia from February 2017 to March 2020. The paired McNemar's test was used to compare the difference in pathogen detection between NPA and BALF groups. The @*RESULTS@#NPA had a sensitivity of 28%, a specificity of 74%, a positive predictive value of 14%, and a negative predictive value of 91% in detecting bacteria, and a @*CONCLUSIONS@#There is poor consistency between NPA and BALF in the detection of bacteria and viruses, and clinicians should be cautious in diagnosing lower respiratory tract infection based on bacteria or viruses detected in NPA. There is moderate consistency between NPA and BALF in the detection of

Influencing factors for the clinical effect of bronchoalveolar lavage in children with Mycoplasma pneumoniae pneumonia and atelectasis / 中国当代儿科杂志

OBJECTIVE@#To study the influencing factors for the clinical effect of bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and atelectasis.@*METHODS@#A total of 75 children with MPP and atelectasis were divided into a good response group with 51 children and a poor response group with 24 children according to the clinical effect of BAL treatment. LASSO logistic regression analysis was used to investigate the factors influencing the clinical effect of BAL treatment. The receiver operating characteristic (ROC) curve and restricted cubic spline model analysis were used to evaluate the value of the course of the disease at the time of BAL treatment in predicting the clinical effect of BAL treatment.@*RESULTS@#Compared with the good response group, the poor response group had a significantly lower percentage of lymphocytes in bronchoalveolar lavage fluid, a significantly higher proportion of children with atelectasis of two or more lung lobes or stenosis of the bronchial cavity or opening caused by inflammation, and a significantly longer course of the disease at the time of BAL treatment and azithromycin treatment (P<0.05). The LASSO logistic regression analysis showed that a prolonged course of the disease at the time of BAL treatment (OR=1.23), atelectasis of two or more lung lobes (OR=11.99), and stenosis of the bronchial cavity or opening caused by inflammation (OR=5.31) were independent risk factors for poor clinical effect of BAL treatment (P<0.05). The ROC curve analysis showed that the course of disease of ≥11.5 days at the time of BAL treatment suggested a poor clinical effect of BAL treatment, with a sensitivity of 91.7% and a specificity of 54.9%. The restricted cubic spline model analysis showed that there was a non-linear dose-response relationship between the course of disease at the time of BAL treatment and the clinical effect of BAL treatment (P<0.05).@*CONCLUSIONS@#Early BAL treatment may have a good clinical effect in children with MPP and atelectasis. Atelectasis of two or more lung lobes and inflammation-induced stenosis of the bronchial cavity or opening shown under bronchoscope may indicate a poor clinical effect of BAL treatment.

Value of lactate dehydrogenase in predicting refractory Mycoplasma pneumoniae pneumonia in children: an evaluation based on decision curve analysis and dose-response analysis / 中国当代儿科杂志

OBJECTIVE@#To study the value of lactate dehydrogenase (LDH) in predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children.@*METHODS@#Propensity score matching was used to select 73 children with RMPP (refractory group) and 146 children with non-refractory Mycoplasma pneumoniae pneumonia (common group). The logistic regression analysis, restricted cubic spline model, and decision curve analysis were used to analyze the clinical value of LDH in predicting RMPP.@*RESULTS@#There were significant differences in the incidence of high fever, white blood cell count, platelet count, percentage of neutrophils, and serum levels of C-reactive protein, procalcitonin, hemoglobin, albumin, glutamic-pyruvic transaminase, aspartate aminotransferase and LDH (P<0.05). There were also significant differences between the two groups in the Mycoplasma pneumoniae-DNA load in nasopharyngeal aspirates and the incidences of pleural effusion, pulmonary consolidation, atelectasis, shortness of breath and skin lesions (P<0.05). The multivariate logistic regression analysis showed that high fever, hemoglobin level, LDH level, and pulmonary consolidation were independent predictive factors for RMPP (OR=10.097, 0.956, 1.006, and 3.756; P<0.05). The results of the restricted cubic spline analysis showed a non-linear dose-response relationship between the continuous changes of LDH and the development of RMPP (P<0.01). The decision curve analysis showed that LDH had an important clinical value in predicting RMPP.@*CONCLUSIONS@#LDH is an independent predictive factor for the development of RMPP and its intensity of association with the development of RMPP exhibits a non-linear dose-response relationship.

Clinical features of children with bronchial asthma complicated by pulmonary fungal infection and risk factors for pulmonary fungal infection / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with bronchial asthma complicated by pulmonary fungal infection and the risk factors for pulmonary fungal infection.@*METHODS@#A retrospective analysis was performed for the clinical data of 150 children with bronchial asthma who were admitted from January 2015 to June 2018. Among these children, 75 had pulmonary fungal infection (fungal infection group) and 75 did not have such infection (control group). The distribution of pathogenic fungi, clinical symptoms/signs and treatment outcome were recorded for the fungal infection group. The multivariate logistic regression analysis was used to investigate the risk factors for pulmonary fungal infection.@*RESULTS@#A total of 69 pathogenic fungi were detected in 75 children in the fungal infection group, among which Candida albicans had the highest detection rate of 61%. Major clinical symptoms were cough (93%), persistent high fever (56%), wheezing (49%) and dyspnea (48%). Major signs were dry and moist rales (43%) and moist rales (29%). Parts of children had hepatosplenomegaly. Among the 75 children in the fungal infection group, 39 were markedly improved, 26 were improved, 7 had no response, and 3 experienced aggravation and then died. Age 3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation and prolonged hospital stay were independent risk factors for pulmonary fungal infection in children with asthma (OR=4.865, 3.241, 2.255, 3.725, 3.568, 1.549, 3.808; P3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation or prolonged hospital stay have a higher risk for secondary pulmonary fungal infection.

Clinical effect of fluticasone propionate, montelukast sodium and ketotifen in treatment of cough variant asthma in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA).@*METHODS@#A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence.@*RESULTS@#After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P0.0024).@*CONCLUSIONS@#For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.

Comparison of establishment of bronchiolitis obliterans murine model by oropharyngeal aspiration and intratracheal instillation of diacetyl / 西安交通大学学报(医学版)

Objective To compare the different methods of administration of diacetyl (DA)-established bronchiolitis obliterans (BO)murine model so as to establish a simple,easy-to-operate and stable BO murine model. Methods SPF grade C57BL/6 male mice (6 to 8 weeks)were randomly divided into four groups with 10 mice in each group:oropharyngeal aspiration group (OPR),intratracheal instillation group (ITI),and control groups (OPR-CON and ITI-CON).OPR group was treated with DA (400 mg/kg,327 mg/kg)by oropharyngeal aspiration;ITI group received DA (400 mg/kg,327 mg/mL)through intratracheal instillation;OPR-CON group and ITI-CON group were treated with sterilized distilled water instead of DA,while the other experimental conditions were the same as those in OPR and ITI groups.The mice were kept in SPF-class animal center for 7 d to collect specimens. Collected bronchoalveolar lavage fluid (BALF)and the left lung were examined pathologically.Results Male C57 BL/6 mice were treated with a single dose of DA (400 mg/kg,327 mg/kg)by OPR or ITI,which could establish BO model.The successful model was evaluated by pulmonary function,BALF counts and pathological examination. Airway hyperresponsiveness occurred with the two-method resulted BO.And two methods of instilling DA resulted in airway injury,lumen occlusion,infiltration of inflammatory cells in the airway and around the vessels.The mortality rate of mice was up to 60% and the success of model construction was only 20% in BO model by oropharyngeal aspiration of DA,while that in ITI group mortality was only 30%,the success of model construction was up to 60%.There was no death in control groups.Conclusion BO murine model could be successfully established by OPR or ITI of DA (400 mg/kg,327 mg/mL).However,the BO model was established well by ITI of DA with lower mortality rate.Therefore,ITI of DA-established BO murine model is recommended for use.

Diagnostic values of bronchoscopy and multi-slice spiral CT for congenital dysplasia of the respiratory system in infants: a comparative study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate and compare the diagnostic values of bronchoscopy and multi-slice spiral computed tomography (CT) for congenital dysplasia of the respiratory system in infants.</p><p><b>METHODS</b>Analysis was performed on the clinical data, bronchoscopic findings and multi-slice spiral CT findings of 319 infants (≤1 years old) who underwent bronchoscopy and/or multi-slice spiral CT and were diagnosed with congenital dysplasia of the respiratory system.</p><p><b>RESULTS</b>A total of 476 cases of congenital dysplasia of the respiratory system were found in the 319 infants, including primary dysplasia of the respiratory system (392 cases) and compressive dysplasia of the respiratory system (84 cases). Of the 392 cases of primary dysplasia of the respiratory system, 225 (57.4%) were diagnosed by bronchoscopy versus 167 (42.6%) by multi-slice spiral CT. There were significant differences in etiological diagnosis between bronchoscopy and multi-slice spiral CT in infants with congenital dysplasia of the respiratory system (P<0.05). All 76 cases of primary dysplasia of the respiratory system caused by tracheobronchomalacia were diagnosed by bronchoscopy and all 17 cases of primary dysplasia of the respiratory system caused by lung tissue dysplasia were diagnosed by multi-slice spiral CT. Of the 84 cases of compressive dysplasia of the respiratory system, 74 cases were diagnosed by multi-slice spiral CT and only 10 cases were diagnosed by bronchoscopy.</p><p><b>CONCLUSIONS</b>Compared with multi-slice spiral CT, bronchoscopy can detect primary dysplasia of the respiratory system more directly. Bronchoscopy is valuable in the confirmed diagnosis of tracheobronchomalacia. Multi-slice spiral CT has a higher diagnostic value for lung tissue dysplasia than bronchoscopy.</p>

Effect of clinical pathway management on pediatric pneumonia / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate effect of clinical pathway management on pediatric pneumonia.</p><p><b>METHOD</b>Data were colleted from children hospitalizated with bronchial pneumonia, bronchiolitis, mycoplasma pneumonia in Center of Respiratory Disorders in Children's Hospital of Chongqing Medical University from January 2011 to December 2012. According to implement of clinical pathway management, all patients were divided into pathway management group (n = 405) and non-pathway management group (n = 503). Length of stay, costs of hospitalization, clinical effect and use of antibiotics were compared in these two groups.</p><p><b>RESULT</b>In pathway management group, average length of stay of children with bronchial pneumonia and bronchiolitis was (6.1 ± 1.6) d and (6.2 ± 1.5) d respectively. While in non-pathway management group, length of stay was (7.2 ± 1.9) d and (7.3 ± 1.5) d (P = 0.000). There was no significant difference in length of stay between these two groups of children with mycoplasma pneumonia [ (6.9 ± 1.8) d vs.(7.7 ± 2.5) d] (P = 0.198). Costs of auxiliary tests in pathway management group was slightly higher than that in non-pathway management group. While other costs in pathway management group were significantly lower than those in non-pathway management group. Total costs of hospitalization of patients with these three diseases in pathway management group and non-pathway management group were ¥(4609 ± 1225) vs ¥ (5629 ± 1813) , ¥ (5006 ± 1250) vs. ¥ (5686 ± 1337), ¥ (4946 ± 1259) vs. ¥ (6488 ± 3032) respectively. There was a significant difference (P < 0.05). Percentages of antibiotics use in two groups were 70.9% vs.99.4%, 45.7% vs.93.4% and 96.2% vs.100.0%. Antibiotics related indicators such as mean number of day of use, ratio of combination and grade of antibiotics were significantly higher in pathway management group compared to non-pathway management group (P < 0.01). There was no significant difference in other indicators like clinical effect and unscheduled readmission in 30 days between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Clinical pathway management can regulate medical behaviors through reduction of medical costs, avoidance of excessive laboratory tests and therapy, and regulation of antibiotic use.</p>

Clinical analysis of 12 cases of childhood atypical endobronchial tuberculosis / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of atypical endobronchial tuberculosis(EBTB) in children and explore the value of bronchoscopy examination in diagnosis and treatment of this disease.Methods The records of 12 children diagnosed as atypical EBTB in Children's Hospital of Chongqing Medical University from Jan.2008 to Dec.2011 were reviewed,and their medical history,clinical manifestation,imaging and laboratory findings were analyzed.They all had fiberoptic bronchoscopy and bronchoalveolar lavage.Four patients had bronchial lining pathologic biopsy.Bronchoscope findings of the 12 children were analyzed.Results The clinical manifestations of childhood atypical EBTB were various.The major were cough(11 cases,91.7％) and fever(7 cases,58.3％),other manifestations included wheeze (3 cases,25.0％),shortness of breath following exercise (2 cases,16.7％),and so on.Only 1 case had hemoptysis (8.3％).The major imaging findings were lymph node enlargement of hilar and(or) mediastinum (10 cases,83.3％).Five cases were with obstructive pulmonary emphysema and atelectasis (41.7％).It was more common than other type of pulmonary tuberculosis.It mainly expressed granulation tissue and neoplasm (7 cases,58.3％),caseoussubstance (4 cases,33.3％),extrinsic compression (4 cases,33.3％) and narrowed orifice of the lobe bronchus (2 cases,16.7％) under fiber bronchoscopy.The detection rate of mycobacterium tuberculosis was 50.0％ (6 cases) through bronchoalveolar lavage fluid.Four children were diagnosed by transbronchial biopsy and 2 children were diagnosed by gastrointestinal fluid smear after fiberoptic bronchoscopy.Conclusions The clinical manifestations of childhood atypical EBTB are various.Bronchoscopy examination,bronchoalveolar lavage and transbronchial biopsy play very important role in diagnosis and pathological classification of childhood atypical EBTB.

Causes of stopping subcutaneous specific immunotherapy in asthmatic children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To improve the compliance with subcutaneous specific immunotherapy (SCIT) by analyzing the causes of stopping SCIT in asthmatic children.</p><p><b>METHODS</b>A telephone follow-up was conducted in the asthmatic children who received SCIT but did not finished the 3-year course of treatment from June 2005 to October 2010, so as to analyze the causes of stopping SCIT.</p><p><b>RESULTS</b>A total of 616 asthmatic children received SCIT, and 322 (52.2%) of them stopped SCIT.A total of 127 cases (39.4%) of the 322 children received telephone follow-up. In the 127 children, 53 (41.8%) stopped the SCIT for the reason of bad effecacy, 29 (22.8%) for remission of asthma,12 (9.4%) for expensive fees, 10 (7.9%) for complex process of treatment, 10 (7.9%) for adverse reaction, 9 (7.1%) for long distance from the hospital, and 4 (3.1%) for having no time for treatment. And 69 (54.3%) of them stopped SCIT in the first year, 28 (22.1%) in the second year, and 30 (23.6%) in the third year. Currently, 85 cases (66.9%) of the 127 asthmatic children were up to the control level, and the other 42 cases were not. There was significant difference in the control level of asthma berween the group receiving treatment with regular inhaled corticosteroids (ICS) and the group receiving treatment with irregular ICS (P<0.01).</p><p><b>CONCLUSIONS</b>Bad efficacy, remission of asthma, expensive fees, complex process of treatment, and adverse reaction are the main reasons contributing to the stop of SCIT in asthmatic children. To improve the compliance with SCIT, It is important to make the patients and their parents understand the long treatment course and slow effect of SCIT, encourage them to use objective indices for evaluating the state of asthma, and effectively prevent and treat the adverse reactions.</p>

Research Progress on CD4~+CD_(25)~+Regulatory T Cells in Bronchial Asthma / 实用儿科临床杂志

Bronchial asthma is the most common chronic diseases in children.Asthma can not be fully explained by imbalance of Thl/Th2.With the research progress of CD4+ CD25+ Treg cell,it has been found that CD4+ CD25+ Treg cell related factors such as forkhead/winged helix transcription factor,heine oxygenase-1,transforming growth factor-?,cytotoxic T lymphocyte-associated antigen-4 are closely linked to asthmatic mechanisms.

Diagnosis and Management of Chronic Cough in Children,American College of Chest Physicians Evidence-Based Clinical Practice Guideline / 实用儿科临床杂志

Cough is one of common respiratory symptoms in pediatric pulmonology.But there′s no practical pediatric guideline for diagnosis and management in particular an evidence-based one.This article introduces American College of Chest Physicians(ACCP) evidence-based clinical practice guidelines for evaluation chronic cough in pediatrics from which can be borrowed ideas.The introduction of ACCP guidelines for evaluation chronic cough in pediatric provided modified naming to previous diseases,discussed etiology of cough caused by different diseases and drew detailed flow charts for chronic cough diagnosis and management.