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06 December 2016, Volume 31 Issue 12 Previous Issue    Next Issue

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Further standardization of nebulization therapy in children HONG Jian-guo 2016, 31(12): 881-883.  DOI: 10.7504/ek2016120601 Abstract ( )   Inhalation therapy is an effective therapeutic strategy for respiratory diseases. With the continuous improvement of drug preparation and inhalation devices，inhalation therapy in clinical use has been increasingly widespread. With the advantages of the effective drug output and good distribution of drug aerosol in lungs and no specific needs for cooperation during the process of inhalation，nebulization is more suitable for use in clinical pediatric. However，it should be noted that in clinical practice there is still something that is unreasonable，or even not standardized. Combining with some of the phenomena in clinical practice，the standardization points of nebulization therapy in childhren are proposed.

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Pharmacological characteristics of drugs used in nebulized therapy CHENG Neng-neng 2016, 31(12): 884-887.  DOI: 10.7504/ek2016120602 Abstract ( )   Nebulized therapy is an efficient way to deliver drugs directly into the respiratory tract by inhalation，improving the efficacy of the drugs for respiratory diseases while minimizing systemic drug exposure and reducing side effects. The drugs commonly used in nebulized therapy include ICS，SABA，SAMA and expectorants. An attempt is made to optimize the clinical use of the nebulized drugs by addressing the comparison of pharmacological characteristics between the nebulized drugs with similar therapeutic action and deepening the understanding of their mechanisms of action.

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Key points of clinical application of aerosol inhalation of hormones CHEN Zhi-min，LIU Jin-ling 2016, 31(12): 887-890.  DOI: 10.7504/ek2016120603 Abstract ( )   Inhaled corticosteroids（ICS） are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy，fewer side-effects and convenience. Here，we focused on some points which should be paid attention to，including how to choose appropriate patients，how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.

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Proper use of nebulized bronchodilator ZHOU Xiao-jian 2016, 31(12): 890-894.  DOI: 10.7504/ek2016120604 Abstract ( )   Nebulized bronchodilator can relieve the airway to improve the ventilation. In order to standardize the use of nebulized bronchodilators in children. In this paper we focus on drugs currently used as nebulization bronchodilators in children，evaluate the requirement for nebulized bronchodilator in children and the effect of nebulized bronchodilator therapy on the patients with different respiratory disease.

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Characteristics and main points of clinical application of different atomizing inhalation devicesv ZHAO De-yu 2016, 31(12): 895-898.  DOI: 10.7504/ek2016120605 Abstract ( )   Inhalation therapy is the first choice for the treatment of bronchial asthma in children. There are a lot of atomizing inhalation devices in clinical treatment，the different atomizing inhalation device has different principle and influence factors. Therefore，it is very important to select the appropriate atomizing inhalation device. According to the age of the patient, the severity of the disease and the different treatment environment，the appropriate drugs and devices are selected for atomization treatment.

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Standardized management of aerosol treatment room WU Xing-dong，CHEN Hong-bing，XU Shui-xiang 2016, 31(12): 898-901.  DOI: 10.7504/ek2016120606 Abstract ( )   As an effective treatment for childhood asthma， aerosol inhalation is widely used in medical institutions at all levels in China. Standardized management of atomization therapeutic room can ensure the quality and safety of atomization treatment. The important contents of standardized management of atomization therapeutic room mainly include atomization treatment environment，management of atomization equipment，aerosol drug administration，aerosol personnel management（including personnel qualification and training，compliance education of children and their families），atomization process management，atomization system，quality management and continuous improvement and information management.

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Points for attention in family nebulization inhalation treatment YIN Yong 2016, 31(12): 901-903.  DOI: 10.7504/ek2016120607 Abstract ( )   Family nebulization therapy is getting more and more attention with the increasing number of  patients who need long-term nebulization of inhaled corticosteroids. Scientific management of family nebulization ICS, which is one of the most important treatment for children with chronic respiratory diseases, will enhance the compliance of long-term treatment and improve prognosis. More attention needs to be paid to the details of family nebulization, and improve the overall efficacy of treatment.

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Study on clinical features and TACI genes of common variable immunodeficiency disease YANG Zhen，CHEN Tong-xin 2016, 31(12): 904-909.  DOI: 10.7504/ek2016120608 Abstract ( )   Objective    To study the clinical characteristics of common variable immunodeficiency（CVID） and CVID-related genes in order to guide the clinical diagnosis and treatment. Methods    The data of 53 children with CVID were analyzed retrospectively，including demographic and clinical manifestations，immunologic findings，treatment and prognosis. TACI gene sequencing was done in 22 cases. Results    The median onset age was 5.34（1-16） years old，the median delay time from onset to diagnosis was 5.05（0-17.9） years. The main performance was recurrent respiratory tract infections （79.2%）; 77.4% of the patients were accompanied by other symptoms，including hepatomegaly，splenomegaly，autoimmune diseases，et al. About 56.6% CVID patients did not receive IVIG after the diagnosis. The case number of repeated respiratory tract infections in IVIG group was smaller than that of non-IVIG group（P＜0.05）. Six patients died. The levels of serum IgG，IgA and IgM were decreased in most of the patients；the median levels of serum IgG，IgA and IgM were 1.39（0.33-1.93） g/L，0.22（0.04-0.87） g/L and 1.36（0.04-1.44） g/L，respectively . The tests for subtypes of lymphocytes showed that CD8+T cells increased obviously，with an inversion ratio of CD4/CD8 in 52.8% patients. Two new mutations were detected in TACI gene sequencing：Cys100Tyr and Ser165Asn. Conclusion    Most patients with CVID have not been fully valued by pediatricians in Chinese Mainland. The prognosis can be significantly changed by early diagnosis and intravenous IVIG replacement.  Further studies on genetic basis will be needed to illuminate the many causes of this disease and possibly therapeutic targets.

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Distribution characteristics of hepatitis B virus serological patterns in 29290 0-7-year-old children CHENG Jing*， XU Hong-mei 2016, 31(12): 910-914.  DOI: 10.7504/ek2016120609 Abstract ( )   Objective    To investigate the serological patterns of hepatitis B virus and the distribution characteristics among 0-7-year-old children. Methods    The detection results of hepatitis B virus serological markers （HBVM） in 0-7-year-old children and the family history of ‘HBsAg（+）’ children from Children's Hospital of Chongqing Medical University in 2013 were analyzed retrospectively. Results    Seventeen serological patterns of hepatitis B virus were found，and the detection rate of each pattern in different age groups was different. The positive rate of HBsAg was 0.32%，and there were no significant differences in HBsAg positive rate in different age groups. The detection rates of ‘anti-HBs（+） anti-HBc（+）’，‘anti-HBs（+） HBeAg（+） anti-HBc（+）’，‘anti-HBs（+） anti-HBe（+） anti-HBc（+）’，‘anti-HBc（+）’ and ‘anti-HBe（+） anti-HBc（+）’ in 0 to 28 day age group and 1 month to 1-year age group were significantly higher than other age groups （P＜0.05）. PreS1-Ag was detected in five serological patterns，the highest frequency pattern was ‘HBsAg（+） HBeAg（+）’ （100%）， followed by ‘HBsAg（+） HBeAg（+） anti-HBc（+）’. The detection rate of PreS1-Ag in the HBeAg （+） group was 80.77%，which was significantly higher than the HBeAg （-） group （χ2＝14.083，P＝0.000）. Conclusion    There is no significant change in positive rate of HBsAg with the increase of age among 0-7-year-old children in Chongqing，but the distribution of serological patterns is associated with age. There is correlation between PreS1-Ag and HBeAg，and the combined test of the two serological markers can better reflect the HBV replication，which has important clinical value.

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Analysis on antibiotic resistance patterns and epidemiological features of 546 Haemophilus influenzae strains isolated from children during 2007-2014 in Children’s Hospital，Zhejiang University School of Medicine GONG Song-di*，HUA Chun-zhen，LI Jian-ping，CHEN Xue-jun，Shang Shi-qiang，CHEN Zhi-min 2016, 31(12): 915-919.  DOI: 10.7504/ek2016120610 Abstract ( )   Objective    To investigate the antibiotic resistance patterns and epidemiological features of Haemophilus influenzae（HI） strains，and to provide reference for choosing antibiotics in clinical treatment. Methods    A total of 546 strains were identified from 2007 to 2014  in Children’s Hospital，Zhejiang University School of Medicine and 98.7% were isolated from respiratory tract specimens. Three hundred and forty-eight isolates（63.7%） were from boys and the male-female ratio was 1.76∶1. The age of the infected children ranged from 7 days to 13 years. Haemophilus influenza strains were cultured in Haemophilus selective medium. All strains were identified with Ⅴ factor and Ⅹ factor requirement test and the drug-sensitivities tests were performed with disk diffusion method. Cefinase was used to detect β-lactamase. Results    Most of the strains（331 isolates，60.6%） were isolated in spring，while only 23（4.2%） were isolated in autumn. The β-lactamase positive strains increased annually and the total rate was 26.7%（146）， and 28.0%（153  strains） were resistant to ampicillin. The multi-resistance strains were 60（11.0%） and the major multi-resistance type was those resistant to ampicillin，trimethoprim-sulfamethoxazole and clarithromycin at the same time，and the multi-resistance rate in β-lactamase-positive strains were significantly higher than that in β- lactamase- negative strains（χ2＝145.1，P＜0.005）. Conclusion    Most of the Haemophilus influenzae strains are isolated from respiratory samples in children younger than 1 year old in our hospital，and the peak months were February，March，April and May. The resistance rate to ampicillin of HI strains has increased annually，whereas to the second generation of cephalosporin，HI strains are still sensitive and they can be used in clinical treatment as the first choice.

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Relationship between the clinical characteristics and lymphocyte subsets ratio in children under 2 years old with bronchiolitis DONG He-ting，JI Wei，GU Wen-jing，ZHANG Xin-xing，YAN Yong-dong，CHEN Zheng-rong，WANG Mei-juan 2016, 31(12): 920-924.  DOI: 10.7504/ek2016120611 Abstract ( )   Objective    To determine the relationship between clinical features of bronchiolitis in children under 2 years old and  lymphocyte subsets ratio. Methods    Two hundred and sixty-eight hospitalized children in Children Hospital of Soochow University from January 2014 to September 2015 were enrolled in this study. Peripheral blood was collected and cellular immunity was detected by flow cytometry. Pathogens were tested and patients’ clinical data was collected. Results    Bronchiolitis infants were identified in 11.84% of 2264 patients in corresponding period. Prevalence rate of pathogen was 57.84%，whose sequence was（from high to low） respiratory syncytial virus（RSV，21.27%），mycoplasma pneumoniae（MP，16.42%），Haemophilus influenzae（10.07%），Streptococcus pneumoniae（8.96%）. CD3+，CD3+CD8+ ratio of the children with bronchiolitis and without wheezing patients was lower than healthy control group. The CD4+/CD8+ ratio was the highest in bronchiolitis group，which was the lowest in healthy control group. The CD3- CD19+ ratio was higher in bronchiolitis and no-wheezing group than in healthy control group（P＜0.05）. Conclusion    Lymphocyte subsets disorder in brochiolitis children was samilar to that in asthma patients. Children between 6 months and 1 year old were more likely to develop bronchiolitis than the other two groups. Bronchiolitis infants may have high expression tendency of B lymphocyte，especially those with allergic symptoms. RSV is still the most common pathogen in bronchiolitis.

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Correlation between pulmonary ventilation function and chest CT changes in children with refractory Mycoplasma pneumoniae pneumonia ZHOU Cai-li*，LIU Zong-wei，ZHAO Hua-feng，ZHOU Qing-xia，DUAN Quan-ji 2016, 31(12): 925-928.  DOI: 10.7504/ek2016120612 Abstract ( )   Objective    To study the correlation between pulmonary ventilation function and chest CT changes in children with refractory Mycoplasma pneumoniae pneumonia（RMPP）. Methods    The clinical data of children with refractory Mycoplasma pneumoniae pneumonia who were diagnosed and treated in our hospital from October 2014 to January 2016 were retrospectively analyzed. A total of 116 cases were divided into three groups according to the chest CT signs of children：grinding glass sample change group， consolidation change group and patch shadow change group. Lung function parameters were compared among the groups. Results    Comparison among the three groups showed that PEF of three groups was lower than 80%；in the grinding glass sample change group and consolidation change group，FEV1 and MMEF 25-75 were both below the normal，and in patch sample change group，FVC，FEV1 and MMEF 25-75 were all in the normal range，the differences being statistically significant（P＜0.05）. Conclusion    The children whose chest CT shows grinding glass sample change have pulmonary ventilation dysfunction，and the more the lung lobe with inflammation，the worse the lung ventilation function. The children whose chest CT shows consolidation change have airway obstructive ventilation dysfunction，with moderate obstruction as the main one. The children whose chest CT shows patch shadow change have mild obstructive ventilation dysfunction，and the more lung lobe with inflammation，the lower the lung capacity，but the lung capacity is still in the normal range.

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Eosinophilic cystitis in the pediatric population：An analysis of four cases WANG Xiu-li，WU Yu-bin，YANG Yi，DU Yue， ZHAO Cheng-guang 2016, 31(12): 929-932.  DOI: 10.7504/ek2016120613 Abstract ( )   Objective　To investigate the clinical features，diagnosis，treatment and prognosis of eosinophilic cystitis in pediatric population. Methods　The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results　All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition，odynuria，dysuria，suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms，peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years，two cases had are recurrence and one case had two recurrences. Conclusion　Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.

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Application of regional sodium citrate anticoagulation in continuous blood purification for children with high risk of bleeding LI Jun，ZHANG Su-fang，LIN Xia，BI Si-ming，DANG Wei 2016, 31(12): 933-936.  DOI: 10.7504/ek2016120614 Abstract ( )   Objective    To investigate the safety and efficacy of application of regional sodium citrate anticoagulation in children with high risk of bleeding in the continuous blood purification（CBP）. Methods    A total of 11 patients with severe hepatic dysfunction and severe bleeding due to different diseases were treated with regional sodium citrate anticoagulation during CBP from March 2015 to May 2016. The changes of ACT，serum calcium and arterial blood gas before and after treatment of CBP were monitored，and the clinical bleeding performance and the operation status of the filter were observed. Results　After the application，the ACT value after the filter during the treatment with regional citrate was significantly longer than the ACT value before the filter；before the filter，the ACT values before treatment and after treatment had no significant changes. During the treatment，the value of calcium ions after the filter was significantly lower than the value before the filter，and the value of 2 cases after the filter was once lower than 0.2 mmol/L，then was corrected by slowing down the citrate solution dripping. Before the filter，the values of calcium level in 8 cases had no significant changes before the treatment and during treatment. All cases completed CBP treatment successfully withould severe bleeding or aggrevation of bleeding. Conclusion    The clinical effect of regional sodium citrate anticoagulation in pediatric critical ill patients with CBP is effective. It has the advantages of less influence on the systemic coagulation and higher safety. It is suitable for the children with hepatic dysfunction，severe bleeding or who are not suitable for heparin anticoagulation. It is an effective and feasible，safe anticoagulation method in critical ill children with CBP.

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Trend of change in the positive rate of common inhaled allergens among children with allergic rhinitis in Children’s Hospital of Chongqing Medical University YUAN Long*，LI Ke-qiong，CHEN Yi，WANG Hong，BAI Yan，YUAN Ke，LI Jing，CHEN Di-long 2016, 31(12): 937-940.  DOI: 10.7504/ek2016120615 Abstract ( )   Objective    To understand the trend of inhaled allergen positive rate among 0-12-year-old children from 2006 to 2013 in Chongqing Children’s Hospital，and to provide evidence for preventing allergic rhinitis in children. Methods　All cases were collected from Otorhinolaryngological Department of the Children’s Hospital of Chongqing Medical University from 1st January，2006 to 29th October，2013. Totally 10983 children with allergic rhinitis aged 0-12 years old in Chongqing urban districts were enrolled. All the patients underwent skin prick test（SPT） with 13 standardized common inhalant allergens. Then the children were divided into the infants group（aged＜3 years），preschool children（3 years≤aged＜7 years） and school-age children（7 years≤aged＜12 years） according to age. The trend of inhaled allergen positive rate over 8 years was observed. Results    From 2006 to 2013，the SPT positive rate increased sharply，then tended to be stable，and then decreased slowly（Curve Estimation：R 2＝0.836，adjustment R 2＝0.770. ANOVA test：F＝12.727，P＝0.011）. It may be related to meteorological factors. With the growth of age，the positive rates of Dermatophagoides pteronyssinus，Dermatophagus farinae，Blomia tropicalis，Cockroaches，cat fur，dog fur and mugwort increased，which were 121.200，123.060，103.237，104.784，17.042，8.515 and 11.256，respectively，　P was 0.000，0.000，0.000，0.000，0.000，0.014 and 0.004，respectively）. Conclusion 　Meteorological factors and age may have effects on allergic rhinitis（AR） in children；with the growth of age，the positive rates of inhaled allergens have tendency variation.

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Association between persistent wheezing and bacterial infection of the lower respiratory tract in infants and young children and analysis of the curative effect of antibiotics DING Feng-xia，LIU Bo，XIE Xiao-hong，FU Zhou，LUO Jian 2016, 31(12): 941-945.  DOI: 10.7504/ek2016120616 Abstract ( )   Objective　To investigate the relevance of bacteria infection of the lower respiratory tract with persistent wheezing of infants and young children，and further evaluate the effect of antibiotic therapy on them. Methods　We collected the medical records of the infants and young children hospitalized for persistent wheezing in Children’s Hospital of Chongqing Medical University from January 1， 2005 to January 1， 2016， and analyzed the pathogen in BALF culture，including bacteria culture， the seven kinds of viral antigen of nasopharyngeal aspirate， MP-PCR and CP-PCR. Further，we divided the cases with positive bacterial isolates into two groups based on whether they were administered with antibiotics. The population proportion of symptom improvement and the mean days of hospital stay were recorded. Results　Among the 136 children who underwent BALF，there were 67（49.3%） children with positive bacterial isolates，and the most common bacteria were Pneumococcal pneumonia，Klebsiella pneumoniae pneumonia subspecies，and Haemophilus parainfluenzae. The population proportion of symptom improvement of antibiotic group was higher than control group（P＜0.05），and the mean days of hospitalization was shorter in antibiotic group compared with control group （P＜0.05）. For Streptococcus pneumoniae，a high prevalence of resistant strains was found to Meropenem（81.82%），Macrolide erythrocin（63.64%） and Cefoxitin resistence（54.55%）. Conclusion    Bacterial infection of the lower respiratory tract maybe relevant in some infants and young children with persistent wheezing，and antibiotic treatment may improve the rate of  symptom improvement in these children and shorten the mean days of hospitalization. Therefore，some of infants and young children with persistent wheezing can be improved after antibiotic treatment.

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Analysis of the screening results of inherited metabolic diseases in neonates in Guizhou from 2010 to 2015 WU Ying-yu，ZHANG Yu-qiong，ZHANG Ai-hua，et al 2016, 31(12): 946-948.  DOI: 10.7504/ek2016120617 Abstract ( )

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Progress in the application of pulmonary function in testing small airway function in children FENG Yong，SHANG Yun-xiao 2016, 31(12): 949-953.  DOI: 10.7504/ek2016120618 Abstract ( )

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Primary ciliary dyskinesia caused by HYDIN gene mutation：A report of 1 case CHEN Li-li，YANG Yun-gang，WU Jin-zhun，et al 2016, 31(12): 954-955.  DOI: 10.7504/ek2016120619 Abstract ( )

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Infectious mononucleosis complicated by Kawasaki-like syndrome：A report of 1 case LI Shen-tang，YANG Zuo-cheng 2016, 31(12): 956-957.  DOI: 10.7504/ek2016120620 Abstract ( )

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Type 1 diabetes mellitus complicated with pulmonary mucormycosis in children：A report of 1 case LIU Dan，ZHONG LI-li，CHEN Min 2016, 31(12): 958-960.  DOI: 10.7504/ek2016120621 Abstract ( )