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06 March 2018, Volume 33 Issue 3 Previous Issue    Next Issue

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Expert consensus on clinical application of antihistamine H1 receptor drugs for common allergic diseases in children 2018, 33(3): 161-170.  DOI: 10.19538/j.ek2018030601 Abstract ( )

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Recognition and reasonable therapy of airway mucus hypersecretion in children BAO Yi-xiao*，ZHANG Ping-bo 2018, 33(3): 171-174.  DOI: 10.19538/j.ek2018030602 Abstract ( )   Airway mucus is an important part of the respiratory defense barrier，and the important component is mucin. Mucus hypersecretion is a clinical feature of severe respiratory diseases such as asthma，bronchiolitis and pneumonia. In this state，the expression of mucin-5AC（MUC5AC） is remarkably increased by the action of inflammatory mediators and cytokines，which leads to the retention of mucus or the formation of mucus plug and makes the disease worse. Mucoactive medications include expectorants，mucoregulators，mucolytics and mucokinetics，so we should choose these drugs rationally. Meanwhile it is worth exploring to inhibit mucus secretion from the source. Airway-clearance techniques，such as deep breath，artificial tapping，Changing the position，mechanical expectoration and others，depend on the technical innovation and operation skills. Chinese medicine can be used in different diseases，but we should pay attention to its side effects.

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Mechanism of airway mucus hypersecretion and airway clearance in children LU Yan-ming， ZHOU Wen-jing 2018, 33(3): 175-179.  DOI: 10.19538/j.ek2018030603 Abstract ( )   The pathophysiological changes related to airway mucus hypersecretion include submucosal glands hyperplasia，increased mucus volume，excessive mucins secretion of MUC5AC and MUV5B，and goblet cell hyperplasia. The mucus hypersecretion is regulated by various factors and signaling pathways. The mechanisms of airway clearance include cough reflex，mucociliary clearance system（MCC），the aerodynamics and cellular immune responses. MCC is the most important barrier，so MCC dysfunction leads to the failure of airway clearance in common pediatric respiratory diseases such as primary ciliary dyskinesia，lower respiratory tract infection，asthma and cystic fibrosis.

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Mechanism of virus-induced airway mucus hypersecretion ZHANG Hui-qin，SUN Xin 2018, 33(3): 179-183.  DOI: 10.19538/j.ek2018030604 Abstract ( )   Airway mucus hypersecretion is an important feature of chronic respiratory diseases. Viral infection is a common factor inducing airway mucus hypersecretion. Understanding the relationship between the viral infection and airway mucus hypersecretion and mechanism is very important to preventing and reducing airway mucus hypersecretion，decreasing the mortality of chronic respiratory diseases. The increase of MUC5AC expression is the major pathological basis of airway mucus hypersecretion，so it is necessary to discuss the signal transduction pathway of MUC5AC secretion caused by common respiratory virus infection.

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Diseases associated with airway mucus hypersecretion in children ZHANG Hai-lin，Lü Fang-fang 2018, 33(3): 184-188.  DOI: 10.19538/j.ek2018030605 Abstract ( )   Excessive mucus produced by airway glands and goblet cells can cause airway mucus hypersecretion，long term of mucus secretions can blocking the airway and cause severe airflow limitation and ventilation dysfunction. Meanwhile，excessive mucus can reduce mucociliary clearance and local defense function，and foreign bodies and pathogens may remain in the lungs and airway，leading to recurrent respiratory infections. Airway mucus hypersecretion is closely related to bronchial asthma，bronchiectasis，low respiratory tract infection and other diseases. Airway mucus hypersecretion is an important factor influencing the occurrence，development and prognosis of bronchial asthma，bronchiectasis，lower respiratory tract infection and other diseases，so pediatricians should pay high attention to them.

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Advantages and disadvantages of non-drug expectoration measures ZHANG Ya-jie，PAN Jia-hua 2018, 33(3): 188-191.  DOI: 10.19538/j.ek2018030606 Abstract ( )   With the influence of environment，inheritance，premature delivery and other risk factors，the prevalence of respiratory diseases in children is getting higher and higher，meanwhile，the treatment of sputum in the respiratory tract is very importance. The incomplete development of the airway and the weakness of cough reflex in infants，especially in premature infants，therefore，and sputum is more difficult to expel. Drug-expectoration has certain limitations，therefore，non-drug expectoration such as atomization，mechanical vibration，lung physiotherapy，negative pressure attraction and other techniques has some advantages of excreting sputum quickly and have slight side effects. The article summarizes the pros and cons of non-drug expectoration to provide reference for clinicians.

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Modified Chinese version of the Test for Respiratory and Asthma Control in Kids（TRACK） and its clinical value HONG Jian-guo 2018, 33(3): 192-195.  DOI: 10.19538/j.ek2018030607 Abstract ( )   null

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Clinical situation of therapeutic drug monitoring in Chinese children WANG Guang-fei，LI Jing，LU Jin-miao，et al 2018, 33(3): 196-201.  DOI: 10.19538/j.ek2018030608 Abstract ( )   In the paper，authors first briefly reviewed the development of therapeutic drug monitoring（TDM） in China. Then， we focused on the role of TDM in pediatric clinical care，discussing the characteristics，optimization of sampling time and hot spots of TDM in children. On the basis of drug monitoring reports，limitations of TDM came into the public’s mind which resulted from the physiological factors，pathological factors，gene polymorphism，toxic metabolites and drug-drug interactions. By fully recognzing the limitations of TDM， we can do a better job in the TDM field to improve the safety and effectiveness of clinical drug use.

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Clinical distribution and resistance analysis of Klebsiella pneumoniae in children HU Hai-yun*，WANG Chun，YAO Jian-jie，et al 2018, 33(3): 202-208.  DOI: 10.19538/j.ek2018030609 Abstract ( )   Objective　To investigate the clinical distribution characteristics and the resistance of Klebsiella pneumoniae  isolates during the period from Jan. 2011 to Dec. 2015 in Children’s Hospital Affiliated to Shanghai Jiao Tong University and to provide references for clinical control and therapy of infection. Methods　A total of 1566 Klebsiella pneumoniae strains were collected in our hospital from 2011 to 2015. The bacteria were identified by vitek 2 compact instrument and antibiotic susceptibility was determined by K-B disk diffusion method. The data were analyzed by SPSS 19.0. Results　A total of 1566 Klebsiella pneumoniae strains were isolated from Jan. 2011 to Dec. 2015. In five years，the Klebsiella pneumoniae-positive specimens were mostly derived from sputum（60.22%-73.63%），urine（7.53%-12.81%） and blood（3.66%-5.45%）；the rate of the ESBL-producing strains of Klebsiella pneumoniae  was 69.18%-76.02%（P＞0.05）；the rate of  carbapenem-resistant  Klebsiella pneumoniae isolated was 5.82%-31.50%（P＜0.01）；both the bacteria of the ESBL-producing strains and  carbapenem-resistant  Klebsiella pneumoniae were mainly  distributed in neonate ward units and secondly comprehensive ward and intensive care unit. The drug resistance of the ESBL-producing strains of Klebsiella pneumoniae were significantly higher than the non- ESBL-producing strains（P＜0.05）. The resistance rate of carbapenem-resistant  Klebsiella pneumoniae has been high，and gradually increased from 2011 to 2015（P＜0.05）. The isolated strains were resistant to all antimicrobial drugs except trimethoprim- sulfanilamide and amikacin. The 5-year resistance rate statistics were significantly increased（P＜0.05）. Conclusion　Drug resistance of Klebsiella pneumoniae in pediatrics is becoming more and more serious. Multidrug resistant strains are becoming more and more common in Neonatal ward and ICU. The pressure of antibiotics used in the treatment of Klebsiella pneumoniae is increasing in clinical. The infection should be controlled effectively and the resistant strains should be reduced.

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Clinical study of combined de-escalation therapy in the treatment of infant wheezing LIU Hai-pei*，BAO Yi-xiao，TIAN Ye，et al 2018, 33(3): 209-213.  DOI: 10.19538/j.ek2018030610 Abstract ( )   Objective　To evaluate the efficacy and safety of combined de-escalation therapy in the treatment of infant wheezing. Methods　Stratified random，open，parallel control method was adopted. A total of 206 cases of infant wheezing（mild-to-moderate at acute exacerbation） were recruited from 4 clinical research centers from Feb. 2013 to Jan. 2015，and were divided into the experiment group（n＝106） and the control group（n＝100）. ①The experiment group was given the combined de-escalation therapy：prednisone acetate tablets 0.5 mg/（kg·d），QD for 3 d；azithromycin suspension 10 mg/（kg·d），QD for 3 d；tulobuterol tape 0.5 mg/d，QD for 7 d；loratadine syrup 3 mg/d，QD for 14 d；montelukast sodium 4 mg/d，QD for 28 d. The drugs were taken orally or used externally. ②The control group was given the conventional therapy：methylprednisolone 1 mg/（kg·d），QD for 3 d；cephalosporin（medication dosage referring to the drug instructions） for 3 d；ambrocol oral solution，2.5-7.5 mL each time，Q12 h（taken as prescribed but not more than 7 d）. Both methylprednisolone and cephalosporin were administered by intravenous drip. Before and after treatment，observe the symptom and sign improvement，the treatment effect and the repeatedness of wheezing. Results　After 7 d of treatment，the mean decreased value of symptom score was 5.89 in experiment group and 4.84 in control group；the total effective rate was 98.11% in experiment group and 92.00% in control group（P＜0.05）. After 28 d of treatment，the experiment group has lower rate of recurrent wheezing incidence（12.26%） than the control group（24.00%）（P＜0.05）. Conclusion　The efficacy of combined de-escalation therapy for infant wheezing（mild-to-moderate at acute exacerbation） is superior to conventional therapy with good clinical safety. The combined de-escalation therapy may achieve good social and economic benefits by reducing the risk of recurrent wheezing.

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Clinical analysis of 5 cases of drug-resistant tuberculosis LIU Hui，LIU Jin-rong，YANG Hai-ming，et al 2018, 33(3): 214-218.  DOI: 10.19538/j.ek2018030611 Abstract ( )   Objective　To summarize the clinical characteristics of drug-resistant tuberculosis in children and improve the level of diagnosis and treatment of the disease. Methods　The clinical data of 5 children with drug-resistant tuberculosis treated in Beijing Children’s Hospital from March 2013 to March 2017 were retrospectively analyzed. Clinical data included general information，tuberculosis exposure history，clinical and imaging performance，etiological examination，drug sensitivity test，treatment protocol and outcome. All five patients（4 male and 1 female） had pulmonary tuberculosis；two had tuberculous meningitis；four had bronchial tuberculosis. Results　All had laboratory-confirmed drug-resistant tuberculosis；two were with rifampicin-resistant tuberculosis（RR-TB） confirmed by Xpert MTB/RIF；one had confirmed by multidrug-resistant tuberculosis（MDR-TB） cervical lymph node puncture fluid culture；one had by pre-extensive drug- resistant tuberculosis（Pre-XDR） sputum culture and the other case was MDR-TB confirmed by the positive culture of his father’s sputum. All patients received regimens recommended by WHO，containing second-line anti-tuberculosis drugs，after diagnosis of drug-resistant tuberculosis. Two children were cured；two children were improved，but still receiving anti-tuberculosis treatment. Treatment failed in one child. All children had no severe adverse events. Conclusion　The drug-resistant tuberculosis in children can be diagnosed by molecular technique Xpert MTB/RIF and mycobacterium tuberculosis culture. The molecular technique is of great value in early and rapid diagnosis of drug-resistant tuberculosis. Most children with drug-resistant tuberculosis have a favourable prognosis after timely and effective treatment. The incidence of serious adverse effects of second-line anti-tuberculosis drugs is low in children.

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Clinical value of fiberoptic bronchoscopy in diagnosis of active pulmonary tuberculosis ZHAI Jia，ZOU Ying-xue，GUO Yong-sheng，et al 2018, 33(3): 219-223.  DOI: 10.19538/j.ek2018030612 Abstract ( )   Objective　To evaluate the clinical value of fiberoptic bronchoscopy in diagnosis of active pulmonary tuberculosis. Methods　Clinical data of 5 children with tuberculosis confirmed by fiberoptic bronchoscopy was collected，who were treated in Tianjin Children’s Hospital from Oct. 2013 to Apr. 2016. The clinical features and treatment procedure of the 5 cases were analyzed. Results　The age of the 5 cases（3 male and 2 female） ranged from 1 to 13 years old with the disease course of 12-35 days. The immune function of the 5 cases were normal. All of the cases were with abrupt onset. 3 cases had fever，2 cases had recurrent cough. Three cases misdiognosed as pneumonia and infant wheezing. One case was misdiagnosed as pulmonary abscess. One case was misdiagnosed as pneumonia. All of the 5 cases denied having tuberculosis contact history and all the patients received regular BCG vaccination. Lesion invased the lung and pleural with 3 cases diagnosed as lung tuberculosis（1 case with secondary left main bronchial stenosis） and 2 cases as tuberculosis of bronchus. All of the cases received regular anti-tuberculosis treatment and were discharged with the hospitalization of 11 days. The outcome was good. Conclusion　The clinical symptom， sign and bronchoscopic features were not typical in children with tuberculosis. For children with the symptom of persisting cough who don’t respond to conventional anti infection treatment，fiberoptic bronchoscopy examination is recommended to help make clinical diagnosis.

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Correlation between fraction of exhaled nitric oxide and airway reversibility in asthmatic children aged 5 to 14 LIU Xin，SHANG Yun-xiao，FENG Yong，et al 2018, 33(3): 224-228.  DOI: 10.19538/j.ek2018030613 Abstract ( )   Objective　To explore the correlation between FeNO levels and airway reversibility and its clinical significance in assessment of children with asthma. Methods　A total of 161 children at 5 to14 years old with asthma admitted to pediatric respiratory outpatient of Shengjing Hospital Affiliated to China Medical University from November 2014 to November 2015 were divided into allergic group and non-allergic group according to the allergic condition. FeNO and bronchial dilatation tests were made in the two groups. The correlation between FeNO levels and improvement rate after bronchodilator in two groups was analyzed. Results　（1）FeNO level in allergy group was obviously higher than that in non-allergic group（P＝0.002）. （2） FeNO level of children in allergic group was positively correlated with improvent of bronchial improvement（P＜0.05），and negatively correlated with FEV1%， FEV1/FVC%， FEF50%， FEF25% and FEF75/25% of basic lung function（P＜0.05），but was irrelevant  to FVC%， PEF% and FEF75% of basic lung function（P＞0.05）.（3）FeNO level of children in non-allergic group was irrelevant to improvement rates of bronchial dilation and basic lung function（P＞0.05）. Conclusion　For asthmatic children with allergic constitution，FeNO level is positively correlated with airway reversibility. It may be a good noninvasive predictor for evaluating asthma and airway reversibility in children with asthma. While for children without allergic constitution，FeNO level cannot indicate the airway reversibility effectively.

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Clinical value of the test of tidal breathing lung function and exhaled nitric oxide in asthmatic children aged 2 to 5 ZHANG Hui-qin，ZHANG Jing-jing，TAO Xiao-juan，et al 2018, 33(3): 229-232.  DOI: 10.19538/j.ek2018030614 Abstract ( )   Objective　To study the clinical value of the test of tidal breathing lung function and exhaled nitric oxide in asthmatic children aged 2 to 5. Methods　216 children with asthma treated from January 2012 to June 2015 in the Pediatric Department of Xijing Hospital of Fourth Military Medical University were listed in asthma group，and 128 normal children in the same period were selected as control group. Tidal breathing lung function and exhaled nitric oxide at the acute and remission stages of asthma were tested respectively，and compared with control group. Tidal breathing lung function were compared before and after bronchial dilation test. Correlation between exhaled nitric oxide level and tidal breath lung function parameters was analyzed. Results　The ratio of time to peak tidal expiratory flow to total expiratory time（TPEF/TE） and ratio of volume to peak expiratory flow to total expiratory volume（VPEF/VE） in acute stage of asthma group were significantly lower than those of the asthma group in the remission stage and the control group（P＜0.05）. TPEF/TE and VPEF/VE had significantly improved in asthma group in remission stage，but were still significantly lower than those of the control group（P＜0.05）. TPEF/TE and VPEF/VE had significantly improved after bronchial dilation test in the acute stage of asthma group（P＜0.05）. Taking an improvement rate of ≥15% either for TPEF/TE or for VPEF/VE as an indicator of positive bronchial dilation test，thus the positive rate was 69.90%. The levels of FeNO in acute and remission stages of asthma group［（35.50±14.13）×10-9，（28.16±5.52）×10-9］ were significantly higher than those of the control group［（12.77±7.00）×10-9（P＜0.05）］，and the levels of FeNO in acute stage of asthma group were significantly higher than those of asthma group in remission stage（P＜0.05）. FeNO levels were not correlated with TPTEF/TE and VPEF/VE in acute or in remission stages of asthma group. Conclusion　Tidal breathing lung function，exhaled nitric oxide test and bronchial dilation test are complementary；combined applications can effectively improve the diagnosis and treatment in early childhood asthma.

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Clinical diagnosis and treatment of hemoptysis in 25 children ZHAO Meng-jiao，MA Jing，LIU Xia，et al 2018, 33(3): 233-236.  DOI: 10.19538/j.ek2018030615 Abstract ( )   Objective　To investigate the diagnosis and clinical curative effect of hemoptysis in children. Methods　A retrospective analysis was performed in 25 cases of hemoptysis who were admitted to Jinan Children’s Hospital from January 2013 to June 2016. The clinical information including clinical manifestations，laboratory tests，image data，bronchoscopy data and digital subtraction angiography（DSA） data were collected，and the clinical features，etiology，treatment and prognosis were retrospectively analyzed. Results　A total of 25 patients（16 males and 9 females） were included. The age was from 7 months to 16 years. Among them 17 patients had mild hemoptysis；moderate and massive hemoptysis were found in 7 and 1 patient. Abnormal bronchial pulmonary vascular development（16，64%） was the most common etiology of hemoptysis，and other causes included respiratory tract infections（6，24%），bronchiectasis（3，12%），bronchial foreign bodies（2，8%），and chest trauma（1，4%）. About 84% were treated with antibiolics and 84% were given hemostatic agents，16% of whom received bronchial arterial embolization therapy，two received bronchoscopic removal of foreign bodies and 1 child received lobectomy. The treatment was effective，and nobody suffered from recurrent hemoptysis. Conclusion　The etiology of hemoptysis is complex，the most common cause is abnormal bronchial pulmonary vascular. The bronchial artery embolization therapy effect is good.

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Dihydropteridine reductase deficiency：A report of 1 case LI Feng-xia，LIU Hong-li，ZHANG Jing，et al 2018, 33(3): 237-238.  DOI: 10.19538/j.ek2018030617 Abstract ( )

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Temple-Baraitser syndrome：A report of 1 case ZHENG Jiang-zhen，SUN Ping，HU Xiao-yun，et al 2018, 33(3): 239-240.  DOI: 10.19538/j.ek2018030618 Abstract ( )