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06 September 2019, Volume 34 Issue 9 Previous Issue    Next Issue

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Expert consensus on the clinical application of antihistamines in the treatment of infants with allergic rhinitis Special Committee of Pediatric Otorhinolaryngology of Pediatric Branch of Chinese Medical Association 2019, 34(9): 721-728.  DOI: 10.19538/j.ek2019090601 Abstract ( )

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Etiology and clinical epidemiological characteristics of bronchiolitis LIU Jun*， XIE Zheng-de 2019, 34(9): 729-732.  DOI: 10.19538/j.ek2019090602 Abstract ( )   Bronchiolitis is an acute lower respiratory tract infection in early childhood. Respiratory syncytial virus（RSV） is the most common etiology of bronchiolitis. Infections with Mycoplasma pneumoniae，Chlamydia pneumonia and Chlamydia trachomatis can also cause bronchiolitis. Bronchiolitis mainly occurs in infants under 2 years of age，with a peak age of 2 to 6 months. Bronchiolitis is the most common reason for hospitalization in infants，and infants under 6 months of age have the highest hospitalization rate. Since bronchiolitis is mainly caused by RSV infection，its seasonal characteristics are similar to those of local RSV infection. Bronchiolitis is a disease with a high incidence but a low mortality rate. Being less than 3 months，prematurity，congenital heart disease and so on are risk factors of severe bronchiolitis.

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Heterogeneity of viral bronchiolitis DONG Lin，GU Xiao-mei 2019, 34(9): 733-737.  DOI: 10.19538/j.ek2019090603 Abstract ( )   Bronchiolitis is the most common lower respiratory tract infection and the leading cause of hospitalization in infants. It has become one of the public health problems worldwide. The pathogenesis is unclear and there are currently no targeted therapies that have been proven to be effective in bronchiolitis. There exists a poor understanding of the mechanisms underlying the variable disease severity and the inconsistent manifestation of long-term respiratory morbidity. Nor can these outcomes be reliably predicted in patients on initial presentation. Bronchiolitis is generally considered a single disease，however，more and more researches have shown that it is a heterogeneous disease that needs individualized and specific treatment，with differences in etiology，clinical charicteristics，immunology，microecology and long-term respiratory outcomes. The study on heterogeneity of viral bronchiolitis will contribute to individualized and targeted therapy and may reduce the development of recurrent wheezing and asthma.

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Relationship between bronchiolitis and asthma YANG Nan，SHANG Yun-xiao 2019, 34(9): 737-742.  DOI: 10.19538/j.ek2019090604 Abstract ( )   Bronchiolitis is the leading cause of wheezing in infants under 2 years old，mostly caused by viral infection. Respiratory syncytial virus（RSV） and rhinovirus（RV） are the most common pathogens. Recent studies have demonstrated a relationship between infants with bronchiolitis induced by virus infection（RSV or RV）in the early stage of life and the subsequent development of asthma later during childhood. This review summarized the relationship between bronchiolitis induced by RSV and RV infection and recurrent attacks of wheezing or asthma，the long-term impact on lung function，the pathogenesis， risk factors and prevention strategies of asthma after virus infection.

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Treatment for severe bronchiolitis LUO Jian 2019, 34(9): 742-745.  DOI: 10.19538/j.ek2019090605 Abstract ( )   Bronchiolitis mainly occurs in infants under 2 years old. The infection is mainly caused by respiratory syncytial virus. Bronchiolitis  is self-limited in clinic. The treatment is mainly symptomatic and supportive treatment，including monitoring the change of disease，oxygen supply and maintaining the stability of water and electrolyte environment. Other measures should be taken to treat children with severe infection when routine oxygen inhalation，sputum aspiration and atomization are not effective. Including giving epinephrine，glucocorticoid，hypertonic saline atomization inhalation and active anti-infection treatment. More and more attention has been paid to the application of noninvasive ventilation in children with severe bronchiolitis，and early use of continuous positive airway pressure ventilation can reduce the rate of invasive tracheal intubation，effectively improve respiratory distress，reduce respiratory work and shorten hospitalization time. For children with risk factors，the changes of children’s condition should be closely monitored，and the aggravation and deterioration of the disease should be dealt with in time.

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Factors affecting prognosis of bronchiolitis in children and management after hospitalization YU Xing-mei，HAO Chuang-li 2019, 34(9): 745-749.  DOI: 10.19538/j.ek2019090606 Abstract ( )   Bronchiolitis is a common lower respiratory tract infection in infants. Its incidence is high in young children，which seriously affects children’s health. A variety of factors can affect the prognosis of bronchiolitis. Giving preventive and therapeutic measures can affect its prognosis，and reduce the occurrence of wheezing in some children.

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A new view of treatment for bronchiolitis SHI Rui-ming，DIAO Min，LI Cheng-yao 2019, 34(9): 749-752.  DOI: 10.19538/j.ek2019090607 Abstract ( )   Bronchiolitis is a common lower respiratory tract infection in infants and young children, mostly caused by respiratory syncytial virus. At present, the treatment mainly includes oxygen therapy, control of wheezing, maintenance of internal environment stability and so on. Most cases of bronchiolitis still lack specific antimicrobial agents. To explore a new treatment method for bronchiolitis is helpful to improve the symptoms, shorten hospitalization days，and improve the prognosis of children with moderate to severe bronchiolitis, especially those younger than 6 months with high risk factors.

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Retrospect and prospect of lung ultrasound in Chinese children LIU Jing 2019, 34(9): 753-756.  DOI: 10.19538/j.ek2019090608 Abstract ( )

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A multicenter clinical study on the cause constituent ratio of chronic wet cough in children 2019, 34(9): 757-762.  DOI: 10.19538/j.ek2019090609 Abstract ( )   Objective　To identify the causes of chronic wet cough in children in China and the constituent ratio of each cause so as to explore the most appropriate diagnosis procedure and treatment plan for children with chronic wet cough. Methods　A prospective study was conducted between June 2015 and May 2018 in twenty-six hospitals in seventeen provinces，municipalities and autonomous regions；children with chronic wet cough were enrolled to identify the specific cause based on a questionnaire survey and then followed up in the next three months；all the data were collected and statistically analyzed to identify the constituent ratio of each cause. Results　A total of 1505 cases were enrolled，of whom 1470 cases were qualified，the qualified rate being at 97.67%. The leading 4 causes were upper airway cough syndrome（UACS） with 584 cases（39.73%），asthma combined with UACS 241 cases（16.39%），asthma combined with infection 164 cases（11.16%），and PBB 151 cases（10.27%）. In children aged＜12 months，PBB ranked first（40.00%）. There were 483 effective cases of chronic wet cough with multiple etiologies，accounting for 33.74% of the total cases；the main etiology among them was asthma combined with UACS，accounting for 16.39%. UACS is the primary cause of chronic wet cough in children in East China，North China and South China. Among other causes of chronic wet cough in children，the consituent ratio of each cause was different according to different ages and different regions，and even the same cause had different constituent ratio due to seasonal changes in the same region. Conclusion　The main causes of chronic wet cough in Chinese children are UACS，asthma with UACS，asthma with infection and PBB. Children at different ages have different cause constituent ratio. For children aged＜12 months，PBB ranks first. The constituent ratio of each cause is different in different ages，regions and seasons.

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Clinical observation on uterine and breast development in girls with Turner syndrome with the estrogen hormone replacement therapy GUO Song，LI Yan-hong，ZHANG Jun，et al 2019, 34(9): 763-767.  DOI: 10.19538/j.ek2019090610 Abstract ( )   Objective　To research an appropriate estrogen therapy for in the pubertal development in Turner syndrome （TS） achieved by estradiol valerate. Methods　In 57 TS girls of no spontaneous puberty or puberty arrest，we retrospectively studied pubertal stage and uterine dimension during the estrogen replacement therapy. Data from patient records was collected，described the pubertal developing procedure，and compared in groups which grouped by estrogen dosage to detect an appropriate dosage and that can lead a better breast and uterine development. Results　The median age at start of puberty induction was 15.00 years，with a range of 11.5-21.0 years. （1） Breast development：Breast development to Tanner stage B2 was achieved in 0.29（0.25-0.33） years，stage B3 in 0.75（0.46，1.08） years，stage B4 in 2.20（0.92，3.08） years and B5 in 3.67（1.71，4.44） years. （2）Uterine development：The uterine volume and length in TS girls before treatment was 0.51（0.14，0.86）ml and 1.89（1.23，2.18） cm. We grouped the patients of Tanner stage B2 in groups of estrogen dosage ≤0.5 mg/d and＞0.5 mg/d and the uterine dimension and weight showed no difference. When the patients were grouped as groups of dosage＜1.0 mg/d and group of dosage≥1.0 mg/d in stage B3，the uterine indexes in lower dosage group were less than group with larger dosage. When they were grouped as groups of dosage＜1.5 mg/d and ≥1.5 mg/d，the uterine volume 6.96（3.15-11.00） ml in lower dosage group was smaller than that in group with larger dosage. Conclusion　During estrogen treatment in TS girls，normal breast development can be achieved. In a clinical setting，the uterine volume and length under pubertal induction developed properly with the breast stages progressing. when the breast developed to stage B2，the uterine development was more dependable on estrogen. We recommend a low daily beginning estrogen dosage until stage B2，which can be increased gradually after B2 to speed up the uterine development.

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Clinical characteristics and etiological analysis of premature pubarche：A report of 55 cases LIN Juan，MA Hua-mei，LI Yan-hong，et al 2019, 34(9): 768-774.  DOI: 10.19538/j.ek2019090611 Abstract ( )   Objective　To analyse the clinical characteristics，aetiology distribution，and metabolic risk parameters of patients with with premature pubarche（PP）. Methods　A retrospective study was performed in 55 patients affected by PP，who received ACTH stimulation test，and the data were evaluated. Among them 17 cases were detected CYP21A2 gene，and indicators of lipid metabolism of idiopathic premature adrenarche（IPA，15 cases） and idiopathic premature pubarche（IPP，14 cases） were analyzed. Results　The sample included 55 patients with PP（53 female and 2 male），with a mean pubarche age of （7.2±0.9） years for girls and （7±0.8） years for boys. There was an accelerated bone age（BA/CA ratio＞1）（1.20 ± 1.5） in girls. A total of 9 patients were classified as non-classic congenital adrenal hyperplasia（NCCAH， 16.4%）， 15 as IPA（27.3%）， 14 as IPP（25.4%）， 16 as HPGA function launch（29.1%） and 1 with exaggerated adrenarche（EA，1.8%）. There was no significant difference in the diagnostic rate of NCCAH between ACTH stimulation test and CYP21A2 gene detection（P＝0.596）. The sex hormone binding protein（SHBP） of IPA was reduced（P＝0.007）. Conclusion　The etiology of premature pubarche-non-classic congenital adrenal hyperplasia（16.4%） is not uncommon. The ACTH stimulation test is useful for the diagnosis of NCCAH，but the sensitivity is not 100%.

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Clinical analysis of the recombinant human growth hormone combined with letrozole in the treatment of short pubertal boys ZHANG Ying，CHEN Rui-min，YANG Xiao-hong，et al 2019, 34(9): 775-779.  DOI: 10.19538/j.ek2019090612 Abstract ( )   Objective　To explore the therapeutic effects and adverse reactions of a combination treatment of recombinant human growth hormone（rhGH） with letrozole，compared with rhGH alone，in short pubertal boys. Methods　Fifty-five short pubertal boys were divided into two groups，one group was treated with rhGH（rhGH group，n＝24），and the other group was treated with the combination of rhGH and letrozole（combination group，n＝31）. All boys had completed the over one year of treatment. The advancement of bone age（BA），height standard deviation score by bone age（Ht SDSBA），body mass index standard deviation（BMI SDS），glucose and lipid metabolism，and the changes of the external genitalia and adverse reactions were evaluated. Results　The age of two groups was（12.72±0.99） years and（12.90±1.36） years，respectively（P＞0.05）.The treatment periods were（1.71±0.55） years and（1.58±0.46） years，respectively（P＞0.05）.Their BA increased（0.96±0.27） years/year and（0.50±0.20） years/year during treatment，respectively（P＜0.01）. Their Ht SDSBA increased（0.89±0.50） and（1.22±0.42）（P＜0.01） and testicular size ??increased（7.47±3.41） mL and（9.50±3.12） mL（P＞0.05） respectively during treatment. There were no statistically significant difference in BMI SDS，glucose or lipid metabolism between the two groups. Three boys in combination group suffered from fractures during the treatment. Ultrasound bone density scan showed serious shortage of bone mineral density；after supplemental calcium and calcitriol，bone density increased within 3 to 6 months，and there was no recurrence of fracture. Conclusion　Combination of rhGH and letrozole in short pubertal boys could inhibit BA progression and ameliorate HtSDSBA，without affecting the normal sexual development，but bone density may be affected，and long-term follow-up is needed.

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Pulmonary artery denervation to treat idiopathic pulmonary arterial hypertension in children：A case report and literature review LUO Gang，LIU Ai，JI Zhi-xian，et al 2019, 34(9): 780-784.  DOI: 10.19538/j.ek2019090613 Abstract ( )   Objective　To explore the safety and feasibility of pulmonary artery denervation（PADN） in children with idiopathic pulmonary hypertension（IPAH）. Methods　On July 11，2019，PADN was performed in Qingdao Women and Children’s Hospital on the bifurcation of main pulmonary artery and the opening of left and right pulmonary artery in a child with IPAH. The pressure and resistance of pulmonary artery were monitored after operation. Results　The pressure and resistance of pulmonary artery decreased significantly immediately after PADN. No serious complications occurred. Conclusion　PADN may be safe and feasible for children with IPAH. Further follow-up and multi-center registry study is necessary to confirm the efficacy and feasibility of PADN.

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Clinical characteristics of tracheobronchial foreign body in children：A report of 228 cases CHEN Li-li，WU Jin-zhun，CHEN Xian-rui， et al 2019, 34(9): 785-788.  DOI: 10.19538/j.ek2019090614 Abstract ( )   Objective　To explore the clinical characteristics，diagnosis and treatment of tracheobronchial foreign body in children and analyze the risk factors for granuloma formation. Methods　A retrospective analysis of 228 children diagnosed with tracheobronchial foreign body was carried out，who were treated between January 2011 and December 2017，and the binary Logistic regression on risk factors of secondary airway intimal granulation after tracheobronchial foreign body was done.Results　The high incidence age of tracheobronchial foreign body in children was 1～3 years old（76.3%），and the ratio of male to female was 2.3∶1. The plant foreign bodies were the main proportion（82.9%），and the foreign bodies in left lung（52.6%） was slightly higher than in the right lung（39.5%）. Endotracheal granulation（74.4%），pneumonia（76.3%） and emphysema（51.3%） were the most common complications of tracheobronchial foreign body. The type and the remaining time of foreign body were the independent risk factor for the formation of endotracheal granulation（P＜0.01）. The longer the disease duration，the greater the risk of granulation formation（P＜0.01）. The ROC curve showed that the remaining time of foreign bodies could be used as a reliable indicator of endotracheal granulation，critical values of the independent correlation factor was the course of disease more than 7.5 d. All the foreign bodies in 228 cases（100%） were successfully removed by fiberoptic bronchoscopy under local anesthesia，226 cases of 1-time take-out（success rate 99.1%），and no obvious complications occurred during and after surgery. Conclusion　Children aged from 1 to 3 years old are the high incidence of respiratory foreign body，and plants are more common. Plant foreign body residue is prone to endotracheal granulation，and the longer the course，the higher risk the granulation. Avoiding feeding infants nuts，early identification and correct diagnosis，and choosing the suitable operation method is the key to preventing and treating foreign body inhalation.

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Research progress in the drug resistance mechanism of Mycobacterium tuberculosis and the antibiotic treatment for multidrug resistant tuberculosis JIANG Tian，XU Hong-mei 2019, 34(9): 789-792.  DOI: 10.19538/j.ek2019090615 Abstract ( )

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Research progress in the assessment model of liver failure in children XUE Qin，ZHAO Shao-dong 2019, 34(9): 793-796.  DOI: 10.19538/j.ek2019090616 Abstract ( )

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Thyroid storm combined with pancytopenia caused by antithyroid drugs：A report of 1 case LIU Lu-qiong，XU Jing，HUANG Yong-kun，et al 2019, 34(9): 797-799.  DOI: 10.19538/j.ek2019090617 Abstract ( )