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06 June 2014, Volume 29 Issue 6 Previous Issue    Next Issue

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Epidemiology and development trend of wheezing in infants. ZHAO De-yu. 2014, 29(6): 401-404.  DOI: 10.7504/ek2014060601 Abstract ( )   PDF (1011KB) ( )   Abstract：Wheezing is common clinical symptoms in early childhood with respiratory diseases.In this paper,epidemidogy,risk factors and trend in development will be described.

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The etiology and phenotype of infant wheezing. YAN Yong-dong. 2014, 29(6): 404-407.  DOI: 10.7504/ek2014060602 Abstract ( )   PDF (1015KB) ( )   Abstract：Wheezing is common clinical symptoms in early childhood with respiratory diseases， which has a different etiology， pathological physiology change and prognosis， and it is a heterogeneous syndrome. The phenotype classification has not reached a consensus， but it helps to clarify wheezing pathogenesis， guide treatment and judge prognosis. In this paper， the current knowledge of etiology and phenotype of infant wheezing will be summarized.

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Diagnosis of wheezing in infants. ZOU Ying-xue. 2014, 29(6): 407-412.  DOI: 10.7504/ek2014060603 Abstract ( )   PDF (1043KB) ( )   Abstract：Wheezing in infants is common and the differential diagnosis is broad. For recurrent wheezing， especially colds and without other causes， a parental history of asthma， and physicians diagnosis of eczema or atopic dermatitis， and eosinophilia will increase the probability of a subsequent asthma diagnosis.Because objective measures of lung function are challenging to perform in infants， clinical signs and symptoms thus suggest the diagnosis of asthma.

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Combined therapy for infantile wheeze. BAO Yi-xiao,BAO Jun. 2014, 29(6): 411-417.  DOI: 10.7504/ek2014060604 Abstract ( )   PDF (1081KB) ( )   Abstract：Wheeze is a common symptom in infants and pre-school children characterized by chronic inflammation of the airway. The management of infantile wheeze focuses on anti-inflammatory agents including corticosteroids， bronchodilators， leukotriene receptor antagonists， antihistamine drugs and macrolides. Here we reviewed the current medications of infantile wheeze and propose a de-escalation combined therapy based on our long-term practice.

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Pulmonary fuction and exhaled nitric oxide in wheezing infants. CHEN De-hui. 2014, 29(6): 417-419.  DOI: 10.7504/ek2014060605 Abstract ( )   PDF (987KB) ( )   Abstract：The pathophysiology of wheezing in infants is yet to be fully understood, and approaches for a confirmatory diagnosis of this condition remain so far limited. Thus, a combination of medical history and laboratory investigations represents the most reliable source of clinical clues for diagnosis and differential diagnosis of infant wheezing.

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Application of exhaled nitric oxide in community children with asthma and its importance in asthma management. SHAO Ming-jun， LIU Chuan-he， SHA Li， LI Shuo， LUO Yan-qing， SONG Xin， LI Zhi-ying， CHEN Yu-zhi. 2014, 29(6): 429-433.  DOI: 10.7504/ek2014060608 Abstract ( )    Objective    To explore the change of exhaled nitric oxide （eNO） in children from community and its importance in asthma management. Methods    The study was conducted from October 2011 to December 2011. Totally 133 non-asthmatic children and 94 asthmatic children aged 7~12 years old from elementary schools in Beijing Xicheng District were included in the study. The eNO， skin prick test （SPT）， lung function and physical examination were carried out and information of medical history was collected in all children. The eNO level between non-asthmatic children and asthmatic children， and its association with atopy， rhinitis， lung function and asthma control were analyzed. Results    eNO levels of non-asthmatic children and asthmatic children were 11.63±1.88 ppb， and 19.68±2.31 ppb respectively and the difference between them was statistically significant （P<0.01）. In non-asthmatic children， the level of eNO in children with rhinitis was significantly higher than in children without rhinitis ［（17.49±2.02）×10-9 vs. （10.42±1.76）×10-9， P<0.01］ and eNO level in atopic children was higher than non-atopic children ［（23.06±2.18）×10-9 vs. （9.60±1.66）×10-9， P<0.01）. In asthmatic children， the difference in eNO level was not significant in children with rhinitis and without rhinitis ［（19.58±2.34）×10-9 vs. （20.09±2.25）×10-9］， but the eNO levels in atopic children （23.06±2.18）×10-9 was significantly higher than non-atopic children ［（8.75±1.86）×10-9， P<0.01］. The level of eNO of uncontrolled asthmatic children was significantly higher than controlled asthmatic children ［（25.09±2.31）×10-9 vs. （17.21±2.22）×10-9， P<0.05］. There was no significant difference in eNO level between children who used and those who did not use inhaled corticosteroid. The eNO level was not related to lung function parameters either in non-asthmatic or in asthmatic children. Conclusion    The eNO level increases significantly in children with asthma or rhinitis and  is associated with asthma control status. Atopy is an important factor on eNO level as well. Measuring eNO level would help improve the diagnosis of asthma and atopy and management of asthma and rhinitis in children from community.

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Bronchoalveolar lavage of flexible bronchoscopy in the diagnosis and treatment of children with Mycoplasma pneumoniae pneumonia. LIANG Lei*, YANG Ze-yu*, WANG Ya-ting. 2014, 29(6): 434-437.  DOI: 10.7504/ek2014060609 Abstract ( )   Objective    To investigate the application of bronchoalveolar lavage of flexible bronchoscopy in diagnosis and treatment of children with Mycoplasma pneumoniae pneumonia（MPP）. Methods    Clinical data of 155 pneumonia patients （57 cases of MPP and 98 cases of non-MPP），who had examination in flexible bronchoscopy, MP-DNA of bronchoalveolar larlavage fluid(BALF),and the traditional blood serological test of Mycoplasma pneumoniae，were retrospectively analyzed from Aug.2011 to Apr.2012 in Anhui Provincial Children’s Hospital. Results    Mycoplasma pneumoniae pneumonia often occur red in children over the age of 5 or with lobar pneumonia or atelectasis in the left lung. The accuracy of MP-DNA in BALF was higher than that of the blood serological test. After alveolar wash and administration of medicines, 95.7％ of the atelectasis cases were cured. Conclusions    Flexible bronchoscopy and bronchoalveolar lavage should be applied to MPP and atelectasis cases as soon as possible to promote lung recruitment and improve the outcome.

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Bacterial etiology analysis of alveolar lavage fluid in severe pneumonia of 2044 children. LIU Xia， MA Jing， ZHANG Zhong-xiao， ZHAO Feng-mei， NIU Tie-huan，YAN Xiu-li， KONG De-xiao， MENG Chen. 2014, 29(6): 438-441.  DOI: 10.7504/ek2014060610 Abstract ( )   Abstract： Objective To investigate the distribution and antibiotic resistance of bacteriosis in alveolar lavage fluid in children’s severe pneumonia. Methods The strains isolated from alveolar lavage fluid in 2044 cases of severe pneumonia in children from Jan.2009 to Dec.2011 were retrospectively analyzed. Results In 2044 samples， 247 strains were obtained. The dominant pathogenic bacteria were：49 strains of Klebsiella pneumoniae， 44 Escherichia coli， 23 Enterobacter cloacae， 17 Pseudomonas aeruginosa， 21 Streptococcus pneumoniae， 11 Staphylococcus aureus and 9 Staphylococcus haemolyticus. The obtained strains had severe drug resistance to some antibiotics，which were penicillin G， ampicillin， amoxicillin clavulanic acid， cefuroxime， erythrocin， and oxacillin， but not to cefoperazone and sulbactam sodium. Conclusion The germiculture of alveolar lavage fluid by bronchoscopes is a better way for detecting pathogenic bacteria in the lower respiratory tract. The main pathogenic bacteria of the pediatric severe pneumonia are Gram-negative bacilli， and it is important to early detect pathogenic bacteria and depress drug resistance improving curative effect and prognosis.

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Analysis of the diagnosis and treatment of 16 cases of childhood necrotizing pneumonia due to bacterial infection. MA Hong-ling，CHEN Jie-hua，YANG Fang-fang， SUN Jie， ZHENG Yue-jie， BAO Yan-min. 2014, 29(6): 442-446.  DOI: 10.7504/ek2014060611 Abstract ( )   Abstract： Objective To summarize the clinical characteristics of childhood necrotizing pneumonia due to bacterial infection. Methods Clinical features， radiographic manifestations， etiology， treatment and prognosis of 16 cases diagnosed as childhood necrotizing pneumonia according to radiographic manifestations were analyzed retrospectively. Results There were 9 boys and 7 girls in all 16 cases（average age 1.7±1.5 years）. The majority of the patients included in our study are previously healthy. All patients，whose average hospitalization time was 21.4±11.2 days， were suffering from cough， sputum and fever （heat peak 39.4±0.5 ℃， fever process 16.4±8.0 days and fever clearance time after treatment 9.1±5.1 days）. The average hospitalization time was 21.4±11.2 days. The white blood cell count （mean value 30.20±12.3×109/L， neutrophils ratio 0.73±0.12） were ＜5×109/L in 3 cases， （5～12） ×109/L in 3 cases， and ＞12×109/L in 10 cases. All cases showed a significant rise in C-reactive protein （mean value 115.1±73.3mg/L）. In the period of 11.4±4.0 days， cystic lesions in lung，which was more common on right lobe， could be found by chest X-ray or CT. In 7 cases， pleural fluid or blood culture was positive， respectively Streptococcus pneumoniae （2 cases）， Staphylococcus aureus （2 cases） and Pseudomonas aeruginosa （3 cases， one of which coinfection with Mycoplasma pneumoniae）. There were 13 cases which had Vancomycin and/or Imipenem treatment， and 5 cases were added Azithromycin or Erythromycin. Closed thoracic drainage was used in 9 cases， one of which had pleural abscess incision and drainage and fiberboard dissection. None of all cases had pulmonary lobectomy. The pulmonary lesions were mostly or practically absorbed in all cases with in 6 months in follow-up. Conclusion Long duration and fever process， high level of WBC and severe radiographic performance are usually shown in childhood necrotizing pneumonia. The common pathogen of childhood necrotizing pneumonia are Streptococcus pneumoniae and Staphylococcus aureus， but Pseudomonas aeruginosa is worth noticing as well. After timely anti-infective therapy， most childhood necrotizing pneumonia has favorable long-term prognosis.

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A preliminary study of screening for pediatric obstructive sleep apnea-hypopnea syndrome by ambulatory electrocardiography. WU Yun-xiao， XU Zhi-fei， ZHANG Li-bing， SHEN Kun-ling. 2014, 29(6): 447-452.  DOI: 10.7504/ek2014060612 Abstract ( )   Abstract： Objective To study the application of ambulatory electrocardiography to screen obstructive sleep apnea/hypopnea syndrome （OSAHS） in children was evaluated by time-domain and frequency-domain analysis of heart rate variability （HRV）. Methods Totally 100 individuals underwent polysomnography and 24-h ambulatory electrocardiography simultaneously. Identify appropriate boundary of HRV parameters to diagnose OSAHS by using ROC curve. Evaluate the feasibility of screening for OSAHS by time-domain and frequency-domain analysis of HRV. Results SDNNall day， SDANNall day， PNN50night， PNN50day-night and LF/HFnight were significantly different in OSAHS group as compared with non-OSAHS group. Thresholds were set at SDNNall day≤95.5 ms， SDANNall day≤80.5 ms， PNN50night≤24.6， LF/HFnight≥0.845 and absolute PNN50day-night≤24.55 by using the ROC curve. The area under ROC curve （AUC） could reach 0.695 by uniting 5 parameters. Conclusion Time-domain and frequency-domain analysis of HRV is a useful method for OSAHS screening.

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Clinical study of antitubercular agent-induced hepatotoxicity in 194 children. SUN Zhen-zhen， ZHU Chao-min. 2014, 29(6): 453-457.  DOI: 10.7504/ek2014060613 Abstract ( )   Abstract： Objective To study the influence factors， clinical features，and prognosis of antitubercular agent-induced hepatotoxicity in children. Methods The clinical data of 194 patients with hepatotoxicity caused by anti-tuberculosis agent，from 1691 patients with various types of tuberculosis as the research object， were analyzed retrospectively. Results The incidence of agent-induced hepatotoxicity was 8.8％. The patients aged ≤1 took the lead，with 61 cases （31.44%）；53.54% of agent-induce hepatotoxicity occurred in 6 ~ 10 days after medication.There were 63.31% patients with symptoms，and anorexia，nausea， vomiting，jaundice，bellyache，bloating and rash were the most frequently observed symptoms. Liver disfunction in patients with clinical manifestations was significantly more than those without clinical manifestations（P＜0.05）. There was no statistical difference in liver disfunction between patients with multi-system damage and single damage（P＞0.05）. As for those patients whose liver disfunction would be high，the difference in the use time of liver protectant was not statistically significant（P＞0.05）. Conclusion The incidence of antitubercular agent-induced hepatotoxicity is higher in the infancy. The non-specificity in clinical manifestations of antitubercular agent-induced hepatotoxicity in children，and the degree of hepatotoxicity are more serious in patients with clinical manifestation. The patients with the hematogenous disseminated tuberculosis may be easy to develop to hepatotoxicity. No correlation the use time of liver protectant and degree of hepatotoxicity.

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Analysis of clinical manifestations and gene mutations of Sjögren-Larsson syndrome. GAO Lei，JIANG Li-qiong，SHI Xiu-yu，ZHANG Li-ping，，MENG Yan，ZOU Li-ping. 2014, 29(6): 458-462.  DOI: 10.7504/ek2014060614 Abstract ( )   Abstract： Objective To analyze ALDH3A2 mutation in four Chinese patients with Sjögren-Larsson syndrome （SLS）. Methods Four patients were clinically diagnosed with SLS. Respectively take 3 ml of peripheral blood. All 11 exons and exon-intron boundaries of ALDH3A2 gene were amplified by polymerase chain reaction （PCR） and directly sequenced for genomic DNA. Results 1. All four patients had congenital ichthyosis， mental retardation，and spastic diplegia or tetraplegia. Patient 1 had a compound heterozygote：c.1157A＞G inherited from her father， IVS5-1del G inherited from her mother. Both her parents had normal phenotype. Patient 2 and Patient 3 were siblings， they were both homozygotes：a A-to-G transition at nucleotide 1157 in exon 8. The heterozygosity was demonstrated in their mother. Both her parents had normal phenotype. Conclusion Two different mutations were examined in these 4 Chinese patients， and the SLS cases were confirmed by ALDH3A2 mutation analysis.