Progress in the diagnosis and treatment of severe pediatric Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

In recent years, the number of severe and drug-resistant Mycoplasma pneumoniae pneumonia (MPP) in school-aged children in East Asian countries is on the rise, especially in China.Pediatric MPP is a heterogeneous disease.Some MPP children have a self-limited progression after infection, while some suffer an aggravated and prolonged course of disease.The sequelae of airway occlusion leads to the declines of lung function and quality of life.Although a series of nationally epidemiological data on pediatric MPP in China are scant, pediatric MPP should be regarded as the highly concerned main respiratory disease of school-aged children due to the large population of children in China and the long-term effects of MPP-induced airway occlusion.This article briefly reviews the correlation between Mycoplasma pneumoniae resistance and severe MPP, as well as the classification and treatment of MPP.

Tidal breathing nasal nitric oxide in preschool children aged 3 to 5 years / 中华实用儿科临床杂志

Objective:To explore the threshold of tidal breathing nasal nitric oxide (TB-nNO) in diagnosing primary ciliary dyskinesia (PCD) in children aged 3 to 5 years.Methods:Retrospective study.The TB-nNO values were examined of 165 healthy children aged 3-5 in a kindergarten in Xicheng District, Beijing, from March 27 to March 29, 2018, which were also measured in children aged 3-5 years who were diagnosed as PCD, cystic fibrosis, bronchiolitis obliterans, bronchiectasis caused by other diseases and asthma in the Second Department of Pediatric Pneumology, Beijing Children′s Hospital, Capital Medical University from January 2018 to December 2021.Relevant factors associated with TB-nNO in normal children were screened by a multiple linear regression model.The cut-off value of TB-nNO in diagnosing PCD in preschool children aged 3-5 years was determined by calculating the maximum area under the receiver operating characteristic (ROC) curve.Results:TB-nNO value in healthy children aged 3, 4 and 5 years were (94.8±36.4) nL/min, (103.3±50.7) nL/min and (106.9±61.5) nL/min, respectively.The mean TB-nNO value in 9 children with PCD was (18.9±10.8) nL/min.TB-nNO values in 49 children with asthma, 19 children with bronchiolitis obliterans, 17 children with bronchiectasis and 6 children with cystic fibrosis were (97.7±51.1) nL/min, (93.2±49.2) nL/min, (93.7±75.3) nL/min and (45.4±18.2) nL/min, respectively.Using 30 nL/min of TB-nNO as the cut-off point, the sensitivity and specificity of TB-nNO in diagnosing PCD were 88.9% (8/9) and 96.9%, respectively.The area under the ROC curve was 98.3% (95% CI: 95.3%-100.0%). Conclusions:TB-nNO value of 30 nL/min can be used as the cut-off point in the diagnosis screening of PCD in children aged 3-5 years.Its diagnostic value in this age group should be further evaluated.

The role of Huaiqihuang Granules in the long-term management of bronchial asthma in young children: a multicenter real-world study / 中华实用儿科临床杂志

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Investigation of knowledge, attitude and practice of sarcopenia among nurses and its influencing factors / 中国实用护理杂志

Objective:To investigate the nurse′s knowledge, attitude and practice of sarcopenia and to analyze the related factors.Methods:From November 10th to 22nd in 2020, self-designed questionnaires were used to survey the knowledge, attitude and practice of 1 056 nurses from 139 hospitals in 19 provinces, autonomous regions of China. Multiple stepwise linear regression was used to analyze the main influencing factors of knowledge, attitude and behavior of nurses with sarcopenia.Results:The average knowledge score was (24.25 ± 7.38) points, the attitude score was 63(55, 65) points, the behavioral score was (31.25 ± 13.28) points. Multiple stepwise linear regression results showed that the educational background and professional title of nurses were the maininfluence factors of knowledge score ( t=4.97, 3.35, P<0.05). The nurse′s knowledge score and whether they were teaching nurses or not were the main factors influencing attitude score ( t=9.12, -3.10, P<0.05). Attitude score, working years, and whether a nurse specialist were the main factors influencing behavior score ( t=9.82, 0.77, -5.29, all P<0.05). Conclusions:The nurse′s attitude toward preventing sarcopenia was positive, but their knowledge level was poor, the behavior intervention was insufficient. Nursing managers should carry out training of sarcopenia actively, to improve the screening, evaluation and early intervention ability of nurses for sarcopenia.

Proteomics study of Mycoplasma pneumoniae pneumonia reveals the Fc fragment of the IgG-binding protein as a serum biomarker and implicates potential therapeutic targets / 医学前沿

Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.

Value of sweat conductivity testing in the diagnosis of cystic fibrosis in children / 中华儿科杂志

Objective@#To assess the diagnostic value of sweat conductivity testing in Chinese children with cystic fibrosis (CF).@*Methods@#This is a retrospective study. Sweat conductivity tests were conducted in 45 CF children (CF group) and 200 non-CF children (non-CF group) diagnosed with other chronic pulmonary diseases at the No. 2 Department of Respiratory Medicine, Beijing Children′s Hospital from May 2014 to June 2018. Pearson′s chi-square test was used to assess the differences between CF and non-CF groups. A receiver operating characteristic curve was constructed to calculate the best cut-off value to diagnose or rule out CF. The pulmonary function parameters (forced expiratory volume in the first second, forced vital capacity,forced expiratory flows at 75% of exhaled vital capacity) of CF children over 6 years old were analyzed. The relationship between sweat conductivity and pulmonary function was compared between the two groups (80-120mmol/L vs.>120mmol/L).@*Results@#The age of CF group was 9 (7,12) years old, 19 males (42%) and 26 females(58%); the age of non-CF group was 8 (5,11) years old, 106 males (53%) and 94 females(47%). The results of sweat conductivity test showed that sweat conductivity in CF group 108(99, 122) mmol/L was significantly higher than that in non-CF group 43(36, 52) mmol/L (χ2=207, P<0.01). A cut-off value of 80 mmol/L for CF diagnosis showed a sensitivity of 93.3% and a specificity of 98.5%. The receiver operating characteristic curve analysis suggested the best conductivity cut-off value for the diagnosis of CF was at 83.5 mmol/L,with a sensitivity of 93.3% and a specificity of 100%,and an area under the curve of 0.993 (95% confidence interval 0.985-1.000). The best conductivity cut-off value to rule out CF diagnosis was at 63.5 mmol/L,with a sensitivity of 97.8% and a specificity of 90.5%. There was no correlation between the level of sweat conductivity and the extent of pulmonary function decline.@*Conclusions@#Sweat conductivity testing can be used for the screening of CF in Chinese children. A diagnosis of CF should be considered if the value is greater than 80 mmol/L.

Clinical analysis of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation / 中华儿科杂志

Objective@#To improve the awareness of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation.@*Methods@#A retrospective analysis of the clinical manifestations, radiological features, laboratory tests, genetic variations, treatments and prognoses was conducted in six children presented with diffuse lung disease and finally diagnosed with methylmalonic acidemia and hyperhomocysteinemia in Ward 2 of Department of Respiratory Diseases, Beijing Children′s Hospital, from August 2017 to November 2018.@*Results@#Six children were included in this study. Two children were male and four were female. The average age of onset was 28 months. The mean age at diagnosis was 34 months. The average interval from onset to diagnosis was 6 months. Four children who underwent genetic tests were found to have variants of gene MMACHC and diagnosed with CblC type. All children had respiratory symptoms and signs as initial or main presentation, which were tachypnea (5 cases), exercise intolerance (5 cases), cough (4 cases), cyanosis (4 cases), clubbing (4 cases), dyspnea (3 cases) and retractions (3 cases). Pulmonary arterial hypertension was found in all six children. Pericardial effusion (4 cases), kidney involvement (3 cases), nervous system involvement (3 cases), gastrointestinal system involvement (3 cases) and anemia (2 cases) also coexisted. The high resolution computed tomography (HRCT) features included dilated pulmonary artery (6 cases), ground-glass opacities (4 cases), diffuse poorly defined ground-glass centrilobular nodules (3 cases), pleural effusion (3 cases), thickening of interlobular septum (2 cases), etc. All children had an elevated concentration of methylmalonic acid in urine and homocysteine in plasma. Genetic tests were performed in four patients, and MMACHC genetic mutations were found in all of them. Clinical manifestations, HRCT features and pulmonary arterial hypertension turned better in five children after treatment. One patient who was not regularly followed-up died.@*Conclusions@#Pulmonary involvement including diffuse lung disease and pulmonary arterial hypertension could coexist with methylmalonic acidemia and hyperhomocysteinemia, which may have respiratory symptoms and signs as the initial or main presentation. Characteristic HRCT features were found in some patients. Plasma homocysteine test is a quick method for screening the disease in children with diffuse lung disease and (or) pulmonary arterial hypertension. Both diffuse lung disease and pulmonary arterial hypertension may turn better after treatment.

Early identification and management of severe post-infectious bronchiolitis obliterans / 中国小儿急救医学

Post-infectious bronchiolitis obliterans is a severe form of chronic obstructive lung disease in children that follows an insult to the lower respiratory tract infection. It′s associated with viruses,bacteria and mycoplasma pneumoniae infection. Persist wheezing,recurrent exacerbation and exercise intolerance are the main manifestations. Mosaic attenuation and air trapping can be seen in HRCT. Lung function test shows obstructive dysfunction. Its prognosis is bad. Early identification and management of severe post-infectious bronchiolitis obliterans can improve prognosis greatly.

Exploratory research on diagnostic essentials of pediatric tuberculous pleurisy / 中华儿科杂志

Objective@#To summarize the clinical diagnostic essentials of pediatric tuberculous pleurisy so as to reduce the misdiagnosis rate.@*Method@#A retrospective study was conducted on 113 cases of tuberculous pleurisy who were seen from August 2006 to September 2014 in the second Department of Respiratory Medicine, Beijing Children′s Hospital Affiliated to Capital Medical University. Meanwhile, another 113 cases of children over 5 years of age with mycoplasma pneumoniae pneumonia complicated with pleural effusion were randomly selected as control group. The following five items were analyzed in relation to the diagnosis: fever, cough, lung lesions, pleural effusion(unilateral or bilateral), adenosine deaminase (ADA) level in pleural effusion, tuberculin skin test(PPD). The sensitivity and specificity of single item and combined items in diagnosis were studied.@*Result@#(1) Among two groups, the proportion of patients with persisting fever was 92.0% (104 cases) and 98.2% (111 cases), while the proportion of patients with cough was 47.8% (54 cases) and 99.1% (112 cases) (χ2=76.3, P<0.01), respectively. There were 25(22.1%) cases and 113(100.0%) cases with lung lesions (except for atelectasis) in two groups (χ2=144.1, P<0.01), respectively. The proportion of patients with unilateral pleural effusion was 94.7%(107 cases) and 71.7%(81 cases)(χ2=21.4, P<0.01) while the patients with positive PPD results was 93.8%(106 cases) and 3.5%(4 cases)(χ2=184.3, P<0.01). The level of ADA in pleural effusion in both groups are comparable[46.4(22.0-70.9)U/L]and[39.5(26.3-78.5)U/L]. (2)The sensitivity of the lack of cough, lack of lung lesions, unilateral pleural effusion and PPD test positive in diagnosis of tuberculous pleurisy were 52.2%, 77.9%, 94.7%, 93.8%, while the specificity was 99.1%, 100.0%, 28.3%, 96.5%, respectively. Among the four items, the specificity of unilateral pleural effusion was only 28.3%, so it needed to be added with other indicators to improve the specificity. The sensitivity of unilateral pleural effusion combined with positive PPD, lack of cough, lack of lung lesions were 88.5%, 50.4% and 73.5%, while the specificity was 96.5%, 99.1%, and 100.0%, respectively, which significantly improved the specificity so as to reduce misdiagnosis.@*Conclusion@#In children aged over 5 years who present with persistent fever and pleural effusion, tuberculous pleurisy should be considered even in the absence of cough or lung lesions(except for atelectasis), or with positive PPD result, any of the three features is specific for the diagnosis. Unilateral pleural effusion is more meaningful for the diagnosis when it is combined with any of the above three features.

Clinical characteristics of Mycoplasma pneumoniae pneumonia with different imaging changes in children / 中华实用儿科临床杂志

Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) with different imaging changes in children.Methods Hospitalized patients with MPP during September 2012 to August 2013 in Beijing New Century Children's Hospital were retrospectively reviewed.The data including clinical features,laboratory tests,treatment and prognosis were collected.The patients were divided into 3 groups according to the radiological findings,including interstitial infiltration (group 1),intralobular infiltration (group 2) and segmental or larger infiltration (group 3).The clinical data were compared among the 3 groups.Results The percentages of patients in the 3 groups were 18.8％ (36/191 cases) in group 1,39.8％ (76/19 cases) in group 2 and 41.4％ (79/191 cases) in group 3,respectively.In 144 cases of MPP patients older than 3 years old,48.6％ (70/144 cases) were segmental or larger infiltration.The incidence of higher fever,hypoxemia and elevated C-reaction protein and lactate dehydrogenase in group 3 [50.6％ (40/79 cases),87.3％ (69/79 cases),78.5％ (62/79 cases),29.1％ (23/79 cases)] were higher than those in group 1 [5.6％ (2/36 cases),61.1％ (22/36 cases),19.4％ (7/36 cases),0] and group 2 [10.5％ (8/76 cases),67.1％ (51/76 cases),14.5％ (11/76 cases),3.9％ (3/76 cases)],and the differences were significant(all P ＜ 0.01).Patients in group 3 had higher risk of cardiac and/or liver impairment,refractory MPP,and treated by glucocorticoids and bronchoalveolar lavage [41.8 ％ (33/79 cases),29.1％ (23/79 cases),94.9 ％ (75/79 cases),50.6％ (40/79 cases)].The hospital stay was (9.48 ±3.26) d in group 1,(9.24 ±2.97) d in group 2,and (12.09 ±3.01) d in group 3,respectively,and the difference was significant among 3 groups (F =19.348,P =0.005),the hospital stay in group 3 was longer than that in the other 2 groups (t =4.210,5.931,all P =0.000),while there was no difference between group 1 and group 2 (P ＞ 0.05).Patients in group 1 with wheeze were more co-mmon,and were treated by Azithromycin earlier than that in group 3 [(5.08 ± 3.43) d vs.(4.16 ± 2.20) d],the difference was significant(t =2.498,P =0.014),while the incidence of hypoxemia was common than that in group 2 (x2 =3.176,P =0.012).Conclusions MPP patients with segmental or larger infiltration are older than patients in the other groups,and present with severe complications,higher inflammatory factors,longer hospital stay,and higher risk for refractory MPP.Glucocorticoids and bronchoalveolar lavage are usually used in these patients.Patients with interstitial infiltration are prone to manifest with wheeze and hypoxemia,and its diagnosis and treatment by Azithromycin are usually delayed.Therefore,pediatrician should pay more attention to MPP patients with different imaging changes,in order to diagnose and treat the patients timely.

Clinical analysis of 11 children with pancreatic cystic fibrosis / 中华儿科杂志

Objective@#To increase the recognition of pancreatic cystic fibrosis (PCF) in children and facilitate diagnosing and treatment of this rare entity.@*Method@#This is a retrospective analysis of children who presented to Beijing Children′s Hospital affiliated to Capital Medical University from January 2010 to December 2015. We describe their clinical features, laboratory testing and management.@*Result@#Eleven children were diagnosed with PCF by genetic testing or sweat chloride test during these 5 years, including 4 boys and 7 girls. Their age ranged from 0.5-14.3 (mean 9.0±3.9) years. Family history was positive in 3 children. Significant clinical findings on presentation were: malnutrition 6, including 2 cases of mild, moderate and severe malnutrition each; diarrhea 4 (yellow mushy or watery stool with frequency ranging from 2-5 times a day), including 1 case of acute diarrhea and 3 of chronic diarrhea, 3 of them had steatorrhea; abdominal pain 3. All of them had pancreatic lesions shown by abdominal ultrasound. Blood tests showed 6 cases had elevated serum amylase and lipase. The main treatment was pancreatic replacement therapy and nutritional support.@*Conclusion@#PCF is rare in children. Malnutrition, diarrhea and abdominal pain are the main clinical manifestations. Treatment is mostly pancreatic enzymes replacement and supportive care.

Clinical features of pediatric tuberculous pleurisy / 中华实用儿科临床杂志

Objective To sum up the clinical manifestations and laboratory features for the diagnosis of pediatric tuberculous pleurisy,and to improve the recognition of this disease in early stage.Methods A retrospective study of 113 children diagnosed as tuberculous pleurisy from August 2006 to September 2014 in the Second Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University was conducted.Meanwhile,another 113 cases of children with mycoplasma pneumoniae pneumonia complicated with pleurisy were selected as control group.The general information,clinical symptoms,pleural effusion and imaging features between 2 groups were analyzed and compared by using SPSS 16.0 statistical software.Results The proportion of patients with cough in tuberculous pleurisy group and control group was 47.79％ (54/113 cases) and 99.12％ (112/113 cases) (x2 =76.33,P ＜ 0.01) respectively,and the proportion with severe cough was 3.70％ (2/54 cases) and 97.32％ (109/112 cases) (x2 =144.10,P ＜0.01),while the disease duration was 15.00 (10.00,30.00) days and 10.00 (8.00,14.50) days (W =8 668.00,P ＜ 0.01),respectively,and all the differences between 2 groups were significant.The proportion of patients with low fever,moderate fever,high fever and hyper fever was 8.65％ (9/104 cases),47.12％ (49/104 cases),44.23 ％ (46/104 cases) and 0,respectively in tuberculous pleurisy group,while the proportion was 0.90％ (1/111 cases),18.92％ (21/111 cases),79.28％ (88/111 cases) and0.90％ (1/111 cases) respectively in control group,and the difference between 2 groups was significant(W =9 064.00,P ＜ 0.01).The unilateral effusion ratio in tuberculous pleurisy group and the control group was 94.69％ (107/113 cases) and 71.68％ (81/113 cases),respectively (x2 =21.39,P ＜ 0.01).The monocyte ratio was higher in tuberculous pleurisy group [0.89 (0.76,0.93)] than that in the controlgroup [0.60 (0.30,0.78)] (W =888.50,P ＜ 0.01) and the level of protein in 2 groups was [51.00 (47.35,54.20) g/L] and [42.10 (37.85,46.15) g/L],respectively (W =842.50,P ＜ 0.01).The level of lactate dehydrogenase (LDH) in tuberculous pleurisy group[553.50 (358.00,749.25) U/L] was lower than that in the control group[1 189.10 (670.95,1 820.00) U/L] (W =2 186.00,P ＜ 0.01),and the differences were significant between 2 groups.In addition to pleural effusion,the high density was the main feature of imaging examination in 2 groups.The proportion of patients with atelectasis was 77.88％ (88/113 cases) and 4.42％ (5/113 cases) (x2 =125.90,P ＜ 0.01),while the proportion of patients with consolidation was 4.42％ (5/113 cases) and 72.57 ％ (82/113 cases),respectively (x2=110.80,P ＜ 0.01).All the differences between 2 groups were significant.The sputum culture-positive rate of mycobacterium tuberculosis was only 1.77％ (2/113 cases) and the other pathogen examinations were negative in tuberculous pleurisy group.Conclusions For patients with unilateral pleural effusion,when the onset only has fever (moderate-high fever),and respiratory symptoms are not clear or symptoms are not proportional to radiographic severity,or when high monocytes proportion (＞ 0.70) in pleural effusion and radiographic evidence of compression atelectasis are observed,tuberculous pleurisy should be considered and further questioning of the predisposing factors,purified protein derivative test should be taken so as to diagnose the tuberculous pleurisy at early stage.

Clinical significance of adenosine deaminase in tuberculosis pleuritis in children / 国际儿科学杂志

Objective To explore the clinical significance of adenosine deaminase ( ADA) in pleural ef-fusion for diagnosis of tuberculosis pleuritis in children. Methods The level of ADA in pleural effusion was ret-rospectively analyzed in 28 cases with purulent pleuritis,thirty-four cases with mycoplasma pneumoniae pleuri-tis,forty-five cases with tuberculosis pleuritis from July 2011 to January 2014 in Beijing Children′s Hospital Af-filiated to Capital Medical University. Results The level of ADA in three groups was expressed by median (range interquartile). ADA in the purulent pleuritis group [126. 35 (76. 80,178. 13)U/L]was higher than the group of mycoplasma pneumoniae pleuritis [ 55. 55 ( 42. 80, 79. 03 ) U/L ] and tuberculosis pleuritis [ 26. 50 (22. 05,50. 95)U/L]. The difference was statistically significant (P< 0. 01). The cut-off value of pleural effu-sion ADA for diagnosis of tuberculosis pleuritis is not available by application of ROC curve. Conclusion Higher ADA value is not only the characteristic of tuberculosis pleuritis,but also purulent pleuritis and mycoplas-ma pneumoniae pleuritis. ADA has no clinical value in diagnosis of tuberculosis pleuritis in children.

Diagnostic value of transbronchial lung biopsy in pediatric interstitial lung diseases / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in pediatric interstitial lung diseases.Methods Retrospective data evaluation the efficacy and application of 10 undiagnosed pediatric interstitial lung diseases patients by No-X-ray guided TBLB between December 2013 and December 2014 were investigated.Results Specimens from all cases were successfully obtained,6 patients were confirmed by pathological diagnoses,and4 patients were confirmed by pathology and clinical manifestations.Among 10 patients,3 of them had allergic alveolitis,2 cases had bronchiolitis obliterans organizing pneumonia (BOOP),1 had pulmonary vasculitis,2 cases had nonspecific interstitial pneumonia,and the other 2 had bronchiolitis obliterans.The complications include 2 pneumothorax,1 case was cured with thoracic cavity closed drainage,and the other case case did not receive special treatment and alleviated himself.No bleeding and other complications occurred.Conclusion The results suggest that TBLB is a safe and effective minimally invasive modality for the diagnosis of pediatric diffuse lung disease.

Allergic bronchopulmonary aspergillosis: a report of four cases with literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA) so as to diagnose and treat the disease earlier.</p><p><b>METHOD</b>A retrospective study was conducted on ABPA patients diagnosed in the Second Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University from April 2010 to March 2014. The literature of children's ABPA retrieved from the databases at home and abroad in recent 10 years were analyzed.</p><p><b>RESULT</b>(1) Among the 4 cases of ABPA, cystic fibrosis (CF) and asthma were diagnosed in 2 and 1 cases, respectively. Cough was present in 3 patients, recurrent wheezing in 2 and chest tightness in 1 case. CT scans showed central bronchiectasis in all 4 cases, while 1 patient had migratory shadows. All cases had elevated serum total IgE, immediate cutaneous reaction to aspergillus fumigatus; A. fumigatus-specific IgE and IgG were positive in 4 cases. The diagnosis of the 4 cases was confirmed according to the history, radiologic investigations and laboratory findings. All of them were improved after the treatment with glucocorticosteroid and antifungal agents (voriconazole or itraconazole). (2) We retrieved articles on the ABPA in the databases at home and abroad published in the recent 10 years, there were 22 foreign reports and only one case in domestic report. Among the 22 foreign cases, 16 patients were CF, 3 were asthmatics. ABPA was diagnosed as the initial presentation in only one case with CF.</p><p><b>CONCLUSION</b>In asthmatics or the patients with allergic disease, if there are highly elevated serum total IgE, central bronchiectasis or recurrent atelectasis in chest imaging, the patients should be further investigated for ABPA. The diagnosed cases of ABPA should be screened for CF routinely.</p>

Clinical features and treatment of refractory Mycoplasma pneumoniae pneumonia unresponded to conventional dose methylprednisolone in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical manifestations of refractory Mycoplasma pneumoniae pneumonia (RMPP) which unresponded to methylprednisolone in the dosage of 2 mg/(kg·d) for 3 days.</p><p><b>METHOD</b>Retrospective analysis was performed on the clinical data of 110 children (64 boys and 46 girls) with RMPP. The patients were divided into "effective group" and "ineffective group" according to initial effect of 2 mg/(kg·d) methylprednisolone. The clinical manifestations, laboratory examination, radiological features and bronchofibroscopic findings of the children were compared. In order to seek the reference indexes which indicate nonresponsive to 2 mg/(kg·d) methylprednisolone, an ROC curve was made, of which the diagnostic cut-off was five independent correlation factors while grouping was made according to patients' different response to glucocorticosteroid.</p><p><b>RESULT</b>The effective group had 86 (86/110, 78.2%) children while ineffective group had 24 (24/110, 21.8%). The ineffective group children had the following performance: 16 children (16/24, 66.7%) in ineffective group had ultrahyperpyrexia (T ≥ 40 °C), which was significantly more severe compared to those in effective group (32/86, 37.3%, P < 0.01); the levels of white blood cell (WBC) count, percentage of neutrophils count (N), C-reactive protein (CRP), serum ferritin (SF), alanine transaminase (ALT), lactic dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) and fibrinogen (Fib) in ineffective group were significantly higher than those in effective group(P < 0.01); while percentage of lymphocyte count (L) was lower than that in effective group(P < 0.01). Proportion of mixed infection in ineffective group was higher than that in effective group (33.3% vs. 4.7%). Radiological manifestations: It was more frequently seen in ineffective group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis (41.7% vs. 0%). Abundant secretions blockage (45.0% vs. 16.9%) and mucosal necrosis (37.5% vs. 8.1%) on bronchofibroscopy were more frequently seen in ineffective group. The critical values of the five independent correlation factors were CRP 110 mg/L, SF 328 mg/L, LDH 478 IU/L, N 0.78, L 0.13.</p><p><b>CONCLUSION</b>Treatment with 2 mg/(kg·d) methylprednisolone can improve clinical symptoms and radiological manifestations of most children with RMPP quickly, but it may be ineffective in some situations such as lasting high fever or ultrahyperpyrexia for more than 7 days, CRP ≥ 110 mg/L, N ≥ 0.78, L ≤ 0.13, serum LDH ≥ 478 IU/L, SF ≥ 328 µg/L, chest CT scan indicating high density consolidation in more than a whole pulmonary lobe involved and moderate-abundant pleural effusion.</p>

Clinical characteristics of children with Langerhans cell histiocytosis with pulmonary involvement / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the recognition of the clinical presentation and radiologic manifestation of children with Langerhans cell histiocytosis (LCH) with pulmonary involvement.</p><p><b>METHOD</b>A retrospective analysis was conducted on children who presented with respiratory symptoms or abnormal lung radiologic findings, and finally diagnosed with LCH in Ward 2 of Divison of Respiratory Diseases, Beijing Children's Hospital during the last 4 years.</p><p><b>RESULT</b>Fourteen children (10 boys and 4 girls) were included in this study. Male to female ratio was 2.5: 1. The median age was 1.3 years. Pulmonary involvements were coexisted with other involved organs in all the patients, such as skin (10 cases, 71%), liver (8 cases, 57%), and bone involvement (7 cases, 50%). The most common symptoms were cough and fever (7 cases, 50%). Respiratory symptoms were nonspecific, and 3 children had no respiratory symptom but abnormal findings on lung high-resolution CT (HRCT). The most common HRCT finding was the coexistence of nodules and cysts (6 cases, 43%). Other findings include cysts only (5 cases, 36%), nodules only (1 case), and with neither nodule nor cyst (2 cases, 14%). Pneumothorax was found in 7% of children.</p><p><b>CONCLUSION</b>Pulmonary involvement in children with LCH is easily misdiagnosed, and often coexisted with other involved tissues/organs such as skin and liver. Rash, which is easily missed in physical examination is very important for the diagnosis of LCH. The characteristic findings of lung HRCT (nodules and/or cysts) are helpful for diagnosis.</p>

Exploration and research of community management model for asthmatic children / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the efficacy of community management model of bronchial asthma in children.</p><p><b>METHOD</b>Through community outreach and clinic, 120 cases of children with asthma were enrolled from the 11 000 children aged 0 to 14 in Zhanlanlu area, and a community management model of asthma was established according to the Global Initiative for Asthma requirements combined with the actual situation of the community, both physicians and patients participated in case identification, file creation, and long-term standardized management. Through repeated medical education, the telephone hotline and interactive network of asthma among physicians, children and parents, a physician-patient relationship was established. The data of standardized medication, scheduled re-visit to the hospital, frequency of asthma attacks, antibiotic use, medical expenses, the loss of parents work hours etc. before and after the implementation of community management model were analyzed and compared.</p><p><b>RESULT</b>After implementation of community management model, the use of systemic corticosteroids (19.4%), oral medication (31.6%) was significantly lower than those before implementation (68.3% and 90.0%) (χ(2) = 51.9, 41.1, P < 0.01), use of inhaled corticosteroids (76.5%) and oral leukotriene receptor antagonist (79.6%) was significantly higher compared with control and before management level (10.0%), χ(2) = 106.0, P < 0.01. The days of attacks of asthma (4.6 ± 2.3), the use of antibiotics (16.2 ± 6.1), (5.7 ± 2.9) and the cost of treatment significantly decreased. In 16 cases (13.3%) two-way referral was applied. In this study, the dropout rate was 18.3%, by telephone and network supervision of lost cases, re-education, made some children return to management, eventually the dropout rate was 9.2%.</p><p><b>CONCLUSION</b>Enrollment of children with bronchial asthma into community management model made the children adhere to the management regularly and a standardized management was achieved.</p>

Clinical analysis of 2 cases with chylothorax due to primary lymphatic dysplasia and review of literature / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and diagnosis of 2 cases with chylothorax due to primary lymphatic dysplasia and to elevate pediatrician's recognition level for this disease.</p><p><b>METHOD</b>Clinical manifestations of the children were retrospectively analyzed. Primary lymphatic dysplasia was diagnosed by lymphoscintigraphy.</p><p><b>RESULT</b>The first patient was a male aged 2-year-7-month who presented with a history of tachypnea for 43 days, fever and sore throat for 5 days at the early stage of the illness. He had a history of external injury before his illness. Physical examination showed his left chest bulging and left side diminished breath sound. His pleural effusion showed dark red (It was divided into two layers after standing, the upper layer turned into milky white, and the lower turned into hemorrhagic liquid) . White blood cell (WBC) count was 9 000×10(6)/L, mononuclear cell was 0.9, polykaryocytes was 0.1, triglyceride was 12.37 mmol/L in the pleural effusion. Contrast-enhanced lung CT (revascularization) showed pericardial effusion and a massive left sided pleural effusion. The second patient was a male aged 9 years and 6 months, who presented with a history of cough for 24 days, intermittent fever, vomiting, abdominal pain for 19 days, and edema of lower limbs for 4 days. Physical examination showed edema in both eyelids, lower extremities and scrotum. The level of albumin was 14 g/L and the titer of Mycoplasma pneumoniae IgM was 1: 320 in the serum. His hydrothorax pleural effusion showed milk white. White blood cell (WBC) count was 74×10(6)/L, mononuclear cell was 0.78, polykaryocytes was 0.22, triglyceride was 1.01 mmol/L in the pleural effusion. Chyle test showed positive in his pleural effusion and seroperitoneum. High-resolution CT of the lung revealed bilateral interstitial and parenchymal infiltration and both sided pleural effusion. Abdominal ultrasound showed giant hypertrophy of the gastric mucosa and massive ascites. Gastroscopy showed giant hypertrophy of the gastric mucosa. Lymphoscintigraphy revealed primary lymphatic dysplasia in both children.</p><p><b>CONCLUSION</b>Primary lymphatic dysplasia might occur in children and result in dropsy of serous cavity (chylothorax, chylopericardium, chylous ascites). Dropsy of serous cavity showed bloody or milk white. WBC count might elevate with lymphocyte increasing mostly, triglyceride was often higher than 1.0 mmol/L in dropsy of serous cavity. Primary lymphatic dysplasia can be diagnosed by lymphoscintigraphy.</p>

Mechanisms of refractory Mycoplasma pneumoniae pneumonia in children / 临床儿科杂志

Most of Mycoplasma pneumoniae pneumonia (MPP) will be controlled after being treated with macrolide antibiotics. But in recent years refractory Mycoplasma pneumoniae pneumonia (RMPP), including severe mycoplasma pneumoniae pneumonia, are increased. RMPP often causes many severe complications and sequelae such as necrotizing pneumonia, bronchiolitis obliterans, bronchitis obliterans, atelectasis and bronchiectasis. Two main mechanisms of MPP are proposed: damages to airway directly by mycoplasma pneumonia (MP), and inflammatory reaction caused by mycoplasma pneumoniae (MP). RMPP is also associated with many other factors such as MP genotype and load, macrolide-resistant MP, airway mucus hypersecretion, hypercoagulability, combined infection with bacteria or viruses, and community acquired respiratory distress syndrome toxin (CARDS Tx). The exploration of mechanisms of RMPP helps us acquire effective treatment and prevent sequelae.