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    06 March 2016, Volume 31 Issue 3 Previous Issue    Next Issue

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    Paying attention to problems in etiological diagnosis and treatment of childhood cough
    HONG Jian-guo
    2016, 31(3): 161.  DOI: 10.7504/ek2016030601
    Abstract ( )  

    Cough is a common clinical symptom in children. Acute cough in children is frequently associated with viral respiratory tract infection. It is usually self-limited. The causes of chronic cough in children differ from those in the adults. Although Chinese cooperative multicenter study of chronic cough has shown that the leading causes for chronic cough in children are cough variant asthma,post-infection cough and the upper airway cough syndrome in China,there are obvious regional differences. Due to reason of lack of detection means,there may be the possibility of underdiagnosis of protracted bacterial bronchitis and other diseases,so pediatricians should pay enough attention to the issue. Generally no special medications are needed for acute cough in children. As for chronic cough,possible etiology should be studied to make a confirmed diagnosis,and then therapy should be based on the etiology. It appears that there is overuse of cough medicines in pediatric practice. Special attention should be paid to avoid combined use of cough medicines that contain the same ingredients.

    Ongoing research in cough pathogenesis
    NONG Guang-min
    2016, 31(3): 165.  DOI: 10.7504/ek2016030602
    Abstract ( )  

    Cough is an important protective reflex. However, the recurrent and severe cough may disturb the rest and life and may even lead to the complications,such as pneumothorax, rupture of bronchi,mediastinal emphesema and so on. Exploration of the cough pathogenesis helps the management of cough. The accurate cough pathogenesis is unclear at present. The progress of the cough pathogenesis is necessary to be summarized.

    Differential diagnosis of chronic cough
    CHEN De-hui
    2016, 31(3): 168.  DOI: 10.7504/ek2016030603
    Abstract ( )  

    The cause of chronic cough in children is complicated,which is related to respiratory system and multisystem,and also involves many causes. For lack of characteristic clinical manifestations,pediatricians should set up correct clinical pathway in diagnosis and differential diagnosis during the first visit or follow-up. Pediatricians should pay attention to distinguishing between the specific cough and non-specific cough. Then,a careful clinical history should provide the important signals in the diagnostic clues. The infectious and non-infectious chronic cough could be distinguished by the sputum features. The clinical significances in non-invasive airway information tests should be analyzed systematically. When the new features are found,we should correct the diagnosis of chronic cough in time.

    Diagnosis and treatment of cough variant asthma in children
    BAO Yi-xiao, CHEN Yi
    2016, 31(3): 173.  DOI: 10.7504/ek2016030604
    Abstract ( )  

    Cough variant asthma is a special type of asthma, especially in children. Clinically,chronic persistent cough,as the sole or main clinical symptoms,with presence of airway hyperresponsiveness,is a characteristic manifestation of cough variant asthma. The etiology of CVA has not been determined. Now it is considered as similar as bronchial asthma. The essences are mainly chronic airway inflammation and airway hyperreactivity. The etidogy is closely related with season. And the frequency of disease development is seasonal. Good treatment response of the bronchodilator is the most reliable basis for diagnosis. Early intervention with anti-inflammation agent is benefitial to preventing the occurrence of typical asthma.

    Persistent bacterial bronchitis
    YU Xiu-hua,CHENG Huan-ji
    2016, 31(3): 176.  DOI: 10.7504/ek2016030605
    Abstract ( )  

    Children often visit their general practitioner for treatment of chronic cough. Recently, pediatricians have paid more attention to protracted bacterial bronchitis(PBB) as it is one of the most common causes of chronic wet cough in children. PBB is associated with persistent or protracted bacterial infection of the conducting airways. Clinical diagnosis is very important. Haemophilus influenzae, especially non-typable H. influenza strains, streptococcus pneumoniae and moraxella catarrhalis are the three most commonly identified bacteria. The occurrence of PBB is related to bacterial biofilm formation in the airway,impaired mucociliary clearance,systemic immune function defects,and airway anomalies. The common symptoms of PBB include wet cough,wheezing,and stridor. Pulmonary signs are moist rales and/or wheezing. The current international clinical guidelines recommend antibiotic treatment as appropriate management for PBB. A two-week amoxicillin/clavulanate regimen will achieve cough relief in a significant number of children with PBB.

    Upper airway cough syndrome in children
    JIAO Lu-yan,CAO Ling
    2016, 31(3): 179.  DOI: 10.7504/ek2016030606
    Abstract ( )  

    Cough is one of the most common symptoms in clinics. Upper airway cough syndrome is one of the major causes of chronic cough. In recent years,research on the mechanism of chronic cough caused by UACS has been made progress. The pathogenic mechanisms,pathogenesis,clinical manifestation and treatments of UACS should be summarized to aid pediatricians in expanding their knowledge of the syndrome.

    Choice of medicine for cough in children
    ZHAO De-yu,YANG Qian-yuan
    2016, 31(3): 183.  DOI: 10.7504/ek2016030607
    Abstract ( )  

    Cough is one of the most common symptoms of respiratory system in children. Because of its complicated etiology, cough has been a more intractable problem for pediatricians. For the treatment of children cough, the clear diagnosis of the disease should be made first. According to different etiology, the choice of treatment drugs is various. The empirical therapy can be accepted when the diagnosis is not clear. Once the diagnosis is clear, appropriate treatment drugs can be
    given.

    Effect of inhaled budesonide suspension on the activation of basophils in children with asthma
    ZHAO Li-xia*,YIN Yong,ZHANG Hao,ZHONG Wen-wei,ZHANG Lei,ZHANG Jing,WANG Wei,DONG Wen-fang
    2016, 31(3): 186.  DOI: 10.7504/ek2016030608
    Abstract ( )  

    Objective    To explore the effect of inhaled budesonide suspension on the activation of peripheral blood basophils in children with asthma. Methods    Forty-eight children with asthma admitted between January 2013 and March 2014 in Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine were adopted in asthma group. Fifty-three children with pneumonia in the same period and 49 children performed physical
    examination in Department of Child Care were adopted in pneumonia group and normal control group,respectively. Flow cytometry combined with dust mite stimulation was used to measure the expression of CD63 in blood basophils of the three groups, and the results were compared. The asthmatic children were detected the expression of CD63 in blood basophil again after 6 months of therapy with budesonide suspension, and the results were compared before and after treatment. Results    Compared with the pneumonia group and normal control group, the  basophils fluorescence intensity of CD63 was increased significantly in asthma group before and after dust mite stimulation (P<0.01). The asthmatic children receieved 6 months of treatment with  inhaled budesonide suspension. The  basophils fluorescence intensity of CD63 did not change before dust mite stimulation (P>0.05),but decreased significantly after dust mite stimulation(P<0.05). Conclusion    The detection of basophil activation can be used to monitor the status of 
    asthma control.The basophil is one of the important targets for inhaled corticosteroid which affects children asthma.

    Study on the influencing factors and the clinical efficacy of dust mite specific immunotherapy for children  with  asthma  and allergic rhinitis
    LIU Xiao-ying*,WANG Jing,WANG Qun,HUANG Hui-jie,LI Zhen,REN Yi-xin,WANG Yan,LIU Yong-ge,XIANG Li
    2016, 31(3): 190.  DOI: 10.7504/ek2016030609
    Abstract ( )  

    Objective    To understand the dynamic changes of early clinical curative effect in children with asthma and allergic rhinitis who received the dust mite specific immunotherapy,and to discuss the influencing factors of the efficacy. Methods    A total of 70 cases with mild or moderate persistent asthma combined with allergic rhinitis who received the dust mite specific immunotherapy combined with drug therapy between February 2012 and November 2012 in Beijing Children’s Hospital were adopted in the case-self-control study. Results    Totally 54 cases completed treatment of 12 months. The clinical response rates to SIT (effective cases) at 3,6,9 and 12 months after SIT were 72.2%(39),75.9%(41),81.5%(44) and 87.0%(47), respectively. After one year of treatment,the average daily SMS and VAS score were all decreased (5.28±2.28 vs. 2.87±1.96,5.59±3.35 vs. 4.04±3.68, P<0.05). PEF% pred was improved[(95.41±15.18) vs. (99.24±16.24),P<0.05]. Conclusion    The effective rate of SIT increases gradually with prolonged treatment. When children with asthma and allergic rhinitis received immunotherapy combined with drug therapy,the patients with higher baseline SMS,shorter asthma history and lower PEF%pred respond more effectively to SIT.

    Wheezing children in Suzhou Children’s Hospital from 2011 to 2014:A pathogenic analysis of 3596 cases
    GU Wen-jing*, JI Wei, ZHANG Xin-xing, CHEN Zheng-rong,YAN Yong-dong,WANG Mei-juan,HUANG Li, JIANG Wu-jun, SHAO Xue-jun
    2016, 31(3): 195.  DOI: 10.7504/ek2016030610
    Abstract ( )  

    Objective    To study the characteristics of etiology and the distribution of age and season of wheezing children in Children’s Hospital Affiliated to Soochow University. Methods    A total of 3596 cases of children hospitalized because of wheezing were collected from January 2011 to December 2014,including their medical history and sputum specimen. Multiple pathogenic joint detection was used to detect pathogens and analyze the data by combining with their medical history. Seven kinds of common respiratory virus (respiratory syncytial virus,adenovirus,influenza virus A, influenza virus B, parainfluenza 1, parainfluenza 2, parainfluenza 3) were detected by the direct immunofluorescence. MP, CP and HBoV were detected by fluorescence quantitative PCR. HRV and HMPV were detected by RT-PCR. Sputum was cultured for bacteria. Results    Wheezing occured mainly in children under three years old,especially in those under one year old. The incidence of wheezing was the highest in winter, followed by spring and autumn. Summer was the lowest. Total etiology detection rate of 3596 wheezing children was 63.0%(2264/3596). Virus was detected positive in 1458 cases(40.5%). MP was detected positive in 342 cases(9.5%). Bacteria were detected positive in 1052 cases(29.3%). The virus detection rate of wheezing children gradually declined with age(P<0.001). The MP detection rate of wheezing children increased with age(P<0.001),but the bacteria detection rate had no obvious difference (P>0.05). Conclusion    Wheezing occurs mainly in children under the age of three years old,and the incidence of wheezing is the highest in winter. The pathogen detection of wheezing children has obvious seasonal and age characteristics. Virus is the major pathogen in the younger group. Bacteria and MP are common in the elder group.

    Analysis of features of streptococcus pneumoniae isolated from the cultured bacteria sample in pediatric patients
    DONG Fang*,ZHEN Jing-hui,WANG Yan,XU Bao-ping,WANG Quan,LIU Gang,YAO Kai-hu,SONG Wen-qi,SHEN Kun-ling
    2016, 31(3): 201.  DOI: 10.7504/ek2016030611
    Abstract ( )  

    Objective    To investigate the clinical distribution, serotypes and patterns of antibiotic resistance of Streptococcus pneumonia isolated in pediatric in-patients. Methods    The clinical specimen from children hospitalized in Beijing
    Children’s Hospital,Capital Medical University from March 2013 to February 2014 were cultured. Serotyping of streptococcus pneumoniae was carried out by capsule swelling test. Identification and antimicrobial susceptibility was determined by Phoenix 100 microbiological system. Results were analyzed according to the guidelines of Clinical and Laboratory Standard Institute (2013). WHONET 5.6 software was used to analyse the data. Results    66.1% were isolated from children under 3 years old from 195 strains of streptococcus pneumoniae. Twenty serotypes of 195 strains of streptococcus pneumoniae were identified. The main serotypes were 19F and 19A,32.3% and 20.5% respectively. The non-susceptibility rate of streptococcus pneumoniae to erythromycin and clindamycin was very high. The non-susceptibility rate of streptococcus pneumoniae to penicillin was 46.7%. The non-susceptibility rates to cefotaxime, cefepime, meropenem and trimethoprim-sulfamethoxazol in penicillin-non susceptible streptococcus pneumoniae(PNSP) were markedly higher than penicillin-susceptible streptococcus pneumoniae(PSSP),and the difference had no statistical significance(P<0.05). Conclusion    In Department of Pediatrics,the detection of streptococcus pneumoniae,the determination of serotypes and drug risistance can not be ignored. Vaccination and proper antibiotics should be given in anti-infection treatment.

    Epidemiological characteristics of viral spectrum detected by throat swab: A consecutive study on children with acute respiratory infections from 2007 to 2013 in Nanxiang Hospital in Shanghai
    YAN Hua-jie*,SHENG Jun,DONG Wei,PU Yan-yan,LIU Jia,YAO Fu-jia,SHAO Jie
    2016, 31(3): 206.  DOI: 10.7504/ek2016030612
    Abstract ( )  

    Objective    To analyze the seasonal variation of viral spectrum detected by throat swab in children with respiratory infections. Methods    Totally 4389 throat swab samples were collected weekly at the Pediatric Outpatient Department between 2007 and 2013 in Shanghai Jiading Nanxiang Hospital. Totally 325 cases of influenza A and 128 cases of influenza B viruses(FLU-A,B),67 human metapneumoviruses(HMPV),320 respiratory syncytial viruses(RSV),274 parainfluenza viruses(PIV) 1-4,105 human enteroviruses(EV),72 human rhinoviruses(HRV),105 coronaviruses(Cov),118 human Boca virus(HBOV) and 146 human adenoviruses(ADV) were identified by RT-PCR. Results    Viruses were detected in 1526(34.8%) throat swab samples. FLU-A was detected mostly, in 7.4%(325/4389) samples,followed by RSV 7.3%(320/4389), ADV 3.3%(146/4389),and PIV-1 2.9%(128/4389). Between 2007 and 2012,the rate of FLU-A detection peaked between August and February-March,and PIV-1 was the most frequently detected PIV,peaking in summer. Conclusion    In Shanghai winter is the peak season for viruses such as RSV,FLU-B and HBOV. FLU-A is frequently detected between late summer and winter,peaking in summer. Epidemics of PIV-1 also peak in summer. RSV incidence increases in autumn and peaks in winter,presenting an epidemic phenomena of peaking every other year.

    Clinical retrospective analysis of 53 cases of children with plastic bronchitis
    ZHAI Jia,ZOU Ying-xue,ZHANG Wen-shuang,GUO Yong-sheng,LI Jiao
    2016, 31(3): 211.  DOI: 10.7504/ek2016030613
    Abstract ( )  

    Objective    To investigate the clinical features of plastic bronchitis (PB), to improve the understanding of PB in children. Methods    The clinical manifestations,laboratory,imaging,bronchoscopy,aspirate pathology, treatment and prognosis of PB in 53 neonates treated in Tianjin Children’s Hospital from October 2012 to January 2014 were analyzed retrospectively.   Results    Fifty-three children were finally diagnosed with PB by the pahtology examination of bronchoscopy or plastic like material of the bronchus. All the included 53 cases had the symptom of fever and cough with the higest temperature of >39℃. Of the included 53 cases, more than 80% of them had the fever period less than 1 week with the shortest fever period of less than half a day. All the cases was firstly diagnozed with the X-ray or CT presention of lung consolidation. And about 63% of children had the presention of pleural effusion. The best efficacy treatment procedure for PB was directively removing the plastic like materials combined with position drainage, physiotherapy and glucocorticoid. The mean hosptial stay was 12.6 days with cure or improvement. After 3 months’ follow-up,no recurrence case was found. Conclusion    Plastic bronchitis is severe acute disease in Department of Pediatrics. The clincial characteristics of PB are rapid development with high fever, cough, dyspnea, lung consolidation and pleural effusion. Clinial laboratory exmination usually demonstrats significant elevated serum CRP, PCT and ESR, which indicats non usefull for regular antibiotic treatment. When PB is diagnosed, the best treatment procedure is bronchoalveolar lavage therapy.

    Distribution of positive strains in blood culture in children of different age with fever and antibiotic resistance analysis
    ZHANG Jiao-sheng*,DONG Yi-mei,ZHENG Yue-jie,ZHAO Rui-zhen,DENG Ji-kui
    2016, 31(3): 215.  DOI: 10.7504/ek2016030614
    Abstract ( )  

    Objective    To investigate the distribution of positive strains in blood culture in children of different age with fever and drug resistance of the main bacterium. Methods    A total of 856 cases of fever children with positive strains from Shenzhen Children’s Hospital cultured from Jan.1,2011 to Dec.31,2013 were divided into five groups according to age: newborn, infants,younger children,preschool children (>3~ 7 years old) and school-age to adolescence children (over 7 years). Bacterial types of positive strains in different ages were analyzed,and drug sensitivity test results of common bacterial were summarized retrospectively. Results    The patients with positive blood culture were 856 cases(6.1%),and the total number of blood culture was 14,102 cases over the same period. Gram-positive bacteria were found in 643 cases, Gram-negative in 190,fungi and bacteria that could not be characterized in 23. The No.1 bacteria in different age groups were: coagulase-negative staphylococci (129,57.6%)in newborns group,coagulase-negative staphylococci (151,49.3%)in infant group,coagulase-negative staphylococci (89,47.1%)in younger child group,coagulase-negative staphylococci (45,48.9%)in preschool group,coagulase-negative staphylococci (20,88.9%) in school-age to adolescence children. Antibiotic susceptibility test results:methicillin resistant strains in staphylococcus spp(MRSA and MRCNS) accounted for 20.7% and 87.8%. Conclusion    The distribution of pathogens are different in different ages;antibiotics should be choosed based on pathogen distribution when there is no positive results of bacterial culture.

    Value of quantitative assay of urinary gonadotropins in assessing sexual development in girls
    CHEN Ye*,WANG Jun-qi,NI Ji-hong,LU Wen-li,SUN Wen-xin
    2016, 31(3): 219.  DOI: 10.7504/ek2016030615
    Abstract ( )  

    Objective    To investigate the value of quantitative assay of urinary gonadotropins (UGn),including ULH and UFSH,in sexual development in girls. Methods    A total of 109 girls with sexual development underwent both GnRH stimulation and UGn assay admitted from October 2013 to February 2015 in Rui Jin Hospital Shanghai Jiao Tong University School of Medicine were analyzed. Two successive morning urine was collected for detection of UGn. On the second day girls underwent conventional GnRH stimulation test while serial blood samples and the total 4-hour urinary sample after GnRH administration was collected for detection of UGn. Results    ①There were no significant differences in UGn concentrations between two consecutive days but UGn was significantly correlated with basic serum Gn. ②Total 4 h UGn  concentrations were significantly correlated with peak value of serum Gn. The ratio of ULH/UFSH was also correlated with ratio of serum LH/FSH. ③The value of assessment for breast development in Tanner stage Ⅱ and Ⅲ was similar by quantitative assays of UGn or serum Gn. ④Determination of basic morning ULH level and total 4 h ULH and the ratio of ULH/UFSH after GnRH stimulation were all helpful for clinical discrimination of PT and CPP. Conclusion    UGn detection is considered as a significant criteria for assessment of activity of HPG axis in children with sexual development,and can be used as a non-invasive and sensitive diagnostic method.

    Comparative analysis of the effect of budesonide and dexamethasone in the treatment of children with acute laryngitis and its influence on immune function
    ZHAO Hui
    2016, 31(3): 224.  DOI: 10.7504/ek2016030616
    Abstract ( )  
    Advance in the diagnosis and treatment of osteoporosis in children
    ZHENG Rong-fei, XIONG Feng
    2016, 31(3): 227.  DOI: 10.7504/ek2016030617
    Abstract ( )  
    Onychomadesis caused by hand-foot-mouth disease: a clinical analysis of 83 cases
    HU Feng-e, MENG Xian-ping, YUAN Li-ying, et al
    2016, 31(3): 233.  DOI: 10.7504/ek2016030618
    Abstract ( )  
    One case report of hospital-acquired methicillin-resistant Staphylococcus aureus sepsis complicated by cellulitis
    WEI Xue-mei, HE Yan-xia, DENG Ji-kui
    2016, 31(3): 235.  DOI: 10.7504/ek2016030619
    Abstract ( )  
    One case report of idiopathic CD4+ T lymphocytopenia and fugal pneumonia
    AN Shu-hua, WANG Ya-kun, LI Jin-ying,et al
    2016, 31(3): 238.  DOI: 10.7504/ek2016030620
    Abstract ( )