In order to solve the young doctor's practical problem,several measures were taken including strengthening the construction of medical ethics and humanity quality,enhancing operation ski-lls,paying attention to medical data accumulation,cultivating research innovative thinking,etc. Mean-while,training and education mode was changed,technical skill training and comprehensive quality cul-tivation were enhanced and long-term effective assessment mechanism was built. Clinical practical experi-ence and the general patient satisfaction result showed that satisfactory effect was achieved.

Objective To explore the change of 8-iso-prostaglandin F2α(8-iso-PGF2α),serum ferritin (SF) and superoxide dismutase(SOD) in serum from children with mycoplasma pneumoniae pneumonia(MPP) and severe mycoplasma pneumoniae pneumonia(SMPP),and investigate the correlation between the severity of lung injury induced by oxidative stress(OS) and the severity in children with SMPP.Methods Sixty cases with MPP,30 cases with SMPP and 20 health children were selected in our study.The level of 8-iso-PGF2α,SOD and SF in serum were detected.Results (1) There were no significant difference regarding of 8-iso-PGF2α levels between the MPP group and the healthy control group ((6.01 (13.14)) ng/L vs.4.33 (2.42)) ng/L,P ＞ 0.05).The 8-iso-PGF2α level in patient of the SMPP group was 24.20 (24.05)) ng/L,significantly higher than that in the healthy control group (P ＜ 0.01) and MPP group (P ＜ 0.01).(2) There were no significant difference between the MPP group μg/L] and the healthy control group in terms of SF level((80.91 (54.57) μg/L vs.(82.48 (70.60)) μg/L,P ＞ 0.05).The SF level in the SMPP group was 139.69 (120.98)) μg/L,significantly higher than that in the healthy control group(P ＜ 0.01) and MPP group(P ＜ 0.O1).(3) The level of SOD in the MPP group was 138.60(25.20)) kU/L,significantly higher than that in the healthy control group ((123.10(11.28)) kU/L; P ＜ 0.01).The level of SOD in the SMPP group was 94.43 (63.58)) kU/L,significantly lower than that in the healthy control group (P ＜ 0.05).And level of SOD in the MPP group was significantly higher than that in the SMPP group(P ＜ 0.01).Conclusion The severity of lung injury induce by OS was related with the severity of the children with SMPP.OS may be a important factor in patients with SMPP exacerbation of lung injury.

Chronic cough in children is one of the most frequent reasons for consultation in clinic. The high cough sensitivity in most patients with chronic cough is difficult for treatment. Capsaicin,as the most com-monly used material for the test of cough sensitivity,is widely used in clinic. Capsaicin provocation test is more mature in foreign country,while in our country there is a few scholars applying it with the adult who suffered chronic cough,but few with children. This article reviews the process,chemical structure,nerve conduction,clini-cal operation,influence factors and safety of capsaicin provocation test.

Objective To investigate the effect of inhaled corticosteroid (ICS) on lung function and inflammatory mediators in cough variant asthma (CAV).Methods Fifty patients with CVA were randomly divided into group A (n =30) and group B (n =20),and 20 normal cases were recruited as healthy group (group C) in this study.All the cases were given a lung function test,bronchial dilation test(BDT) and serum levels of inflammatory mediators(interleukin(IL)-5,IL-8 and IL-10) assessment.The cases in group A were given longterm ICS intervention therapy of inhaled budesonide aerosol at dose of 200 μg/day with 6 months' follow-up period.The cases in group B and C were given salbutamol and symptomatic treatment if necessary.Assessment about lung function (forced vital capacity (FVC),1 s forced expiratory volume (FEV1),peak expiratory rate (PER) and maximum mid-expiratory flow rate(MMEF)),BDT,and inflammatory mediators in all groups were performed before and after treatment.Results (1) Lung function:before treatment,the level of FVC,FEV1 and PEF in three groups were not significantly different (P ＞ 0.05).MMEF in group A and B is significantly lower than that in group C (F =58.40,P ＜ 0.05).In group A,MMEF was significantly improved (P ＜ 0.05,P ＜ 0.01) after 3 and 6 months ICS treatment.In group B,MMEF was not statistical improvement compared with before treatment(P ＞0.05).The BDT positive rate in group C was significantly lower than that in group A and B.The BDT positive rate in group A decreased after ICS treatment for 3 and 6 months.Meanwhile,the BDT level decreased as the longer treatment.In group B,there was no statistical decrease in terms of BDT positive rate(P ＞0.05).(2)Inflammatory mediators:in group C,the serum levels of IL-5 and IL-8 were lower than those in group A and B,but the level of I L-10 was higher than it in the other two groups(P ＜0.05).After 3 and 6 months ICS treatment,the serum levels of IL-5 and IL-8 were significantly decreased and the level of I L-10 was increased.The longer course was given,the more obvious change they have.There was no statistical difference in group B after 3 to 6 months treatment.It was statistical difference between group A and group B after 3 to 6 months treatment (P ＜ 0.05).Conclusion ICS treatment can significantly improve lung function and inflammatory mediators in patients with cough variant asthma.The better improvement will get if the longer treatment is given.

Objective:To investigate the distribution and characteristics of serum allergen specific IgE (sIgE) in children in Tianjin from June 2015 to April 2019.Methods:The fluorescence enzyme linked immunosorbent assay results (obtained by UniCAP system) of serum allergen sIgE of 5 823 children aged 1-14 in Tianjin area were analyzed.The distribution of serum allergen sIgE and its correlation with the gender, disease type, age and season were discussed.Results:(1) Among the 5 823 cases, 3 602 cases (61.86%) were positive for serum allergen sIgE, including 1 556 cases (43.20%) positive for single airborne allergens, 779 cases (21.63%) positive for single food allergens, 1 267 cases (35.17%) positive for both food and airborne allergens.(2) The top 5 airborne allergens were moulds (33.02%), dermatophagoides farinae (27.21%), dermatophagoides pteronyssinus (24.28%), mugwort (21.64%) and ragweed (17.32%). (3) Food allergens were mainly egg white, milk and wheat, whose positive rates were 27.06%, 25.59% and 20.00%, respectively.(4) The positive rate of serum allergen sIgE in boys (64.02%) was significantly higher than that in girls (57.93%) ( χ2=20.94, P<0.05). (5) The positive rate of serum allergen sIgE in children with asthma (73.18%) was significantly higher than that in children with allergic rhinitis (59.82%)( χ2=64.51, P<0.05) and eczema (51.60%) ( χ2=40.04, P<0.05). The main airborne allergens in children with asthma included moulds, dermatophagoides farinae, dermatophagoides pteronyssinus, wheat and peanut.The main allergens in children with allergic rhinitis were moulds, egg white, wheat, mugwort and dermatophagoides farinae.The main allergens in children with eczema were egg white, milk, moulds, dermatophagoides farinae and dermatophagoides ptero-nyssinus.(6) With the increase of age, the positive rate of airborne allergens increased gradually.In food allergens, the positive rate of milk and egg white decreased gradually while that of wheat and peanut increased gradually with the increasing age.(7) In different seasons, the positive rate of allergen sIgE was varied.The overall positive rate was highest in summer(66.59%), followed by autumn(64.15%), spring(62.07%), and winter(54.63%) successively( χ2=49.38, P<0.05). Among the airborne allergens, the positive rates of dermatophagoides farinae and dermatophagoides pteronyssinus were the highest in summer and autumn[dermatophagoides farinae(32.25%, 30.17%); dermatophagoides pteronyssinus(30.40%, 27.54%)]. The positive rate of moulds was the highest in summer(45.41%), followed by autumn(36.19%). The positive rate of blattella germanica was the highest in summer(5.52%). The positive rates of cat dander, animal dander combination, artemisia argyi and weeds pollen combination were higher in autumn(33.33%, 13.94%, 24.84%, 19.88%). Conclusions:Moulds, dermatophagoides farinae, dermatophagoides pteronyssinus, egg white and milk are the most common allergens in children in Tianjin.The distribution of allergens is correlated with the gender, disease type, age and season.

A case of Mycoplasma pneumoniae (MP) pleural effusion in the Department of Pediatrics, the Second Hospital of Tianjin Medical University at May 2019 was analyzed retrospectively.The female child was 12 years old, with abdominal pain as the onset of symptoms, accompanied by fever." Gastrointestinal tract infection" symptomatic treatment did not relieve it.Before being admitted to the hospital for dyspnea, combined with physical examination, imaging studies revealed pleural effusion.Laboratory tests supported MP infection, and the course of the disease always lacked obvious manifestations of pulmonary infection.The combination of Azithromycin and Meloxicillin/Sulbactam anti-infective treatment was ineffective, and the temperature was stable after changing to oral Moxifloxacin, and the pleural effusion was rapidly absorbed after oral glucocorticosteroids, without recurrence after 6 months of follow-up. It is suggested that MP infection in children can lead to pleurisy and unilateral pleural effusion, which can have abdominal pain and fever as the main symptoms, and can be changed to quinolones according to individual condition when conventional macrolides are resistant.

BACKGROUND: Nickel-chromium ceramic alloy with well anti-causticity has been widely used in clinic; however, it should be paid much attention to the toxic and side effects of the released nickel and glucinium ions. Therefore, studies about modifying alloy component, enhancing physical and chemical performance, and improving biocompatibility are hot topics recently. OBJECTIVE: To measure the in vitro cytotoxicity of self-made nickel-chromium ceramic alloy comparing with nickel-chromium alloy and pure titanium metal. DESIGN, TIME AND SETTING: A contrast observational experiment was performed at Central Laboratory of China Medical University from May to December 2006. MATERIALS: L-929 cells at logarithmic phase were used in this study. Self-made nickel-chromium ceramic alloy was provided by Metal Institute of Chinese Academy of Science, pure titanium was provided by Matsukaze Japan Co., Ltd., and nickel-chromium alloy was provided by Heraeus Kulzer Dental Co., Ltd. METHODS: L-929 cells were assigned into nickel-chromium ceramic alloy, pure titanium, nickel-chromium alloy, positive control, and negative control groups. The cells were cultured in 96-well culture plate. Every five wells were randomly selected from each group, and 12 wells were used for the duplication. Cell suspension (100 μL) at concentration of 1.0×108/L was added in each well. Leaching liquor (100 μL) was added in self-made nickel-chromium ceramic alloy, pure titanium alloy, and nickel-chromium alloy groups, respectively, lead leaching liquor (100 μL) was added in positive control group to make the final concentration at 50%, and RPMI 1640 culture solution (100 μL) was added in the negative control group. MAIN OUTCOME MEASURES: Absorbance was measured at day 1, 2, 3, 4 and 5 using MTT colorimetric assay to calculate relative growth rate. RESULTS: There were no significant differences in absorbance between three metal groups and negative control group (P > 0.05), but there were significant differences in absorbance between three metal groups and positive control group (P < 0.05 or P < 0.01). Cell growth rate was > 100% and cytotoxicity was grade 0 in the pure titanium group; while, cell growth rate ranged from 86.36% to 99.49% and cytotoxicity was grade 1 in both self-made nickel-chromium ceramic alloy and nickel-chromium alloy groups. At day 3 after culture, cytotoxicity was grade 2 in the positive control group. CONCLUSION: Self-made nickel-chromium ceramic alloy has a little cytotoxicity and requires for the clinical application.

Objective To investigate the blocking effects of Pyrin domain protein on mouse allergic airway inflammation induced by ovalbumin and its mechanism.Methods Forty male BALB/c mice were randomly divided into 4 groups with 10 mice in each group.Control group:mice were treated with saline;OVA group:mice were sensitized and challenged with OVA; Pyrin domain protein 3 d group:mice were sensitized and challenged as asthmatic group and treated with 100 μg/kg triptolide before challenged; Pyrin domain protein 7 d group:mice were sensitized and challenged as asthmatic group and treated with 100 μg/kg triptolide before challenged.All mice were killed 24 h after final OVA challenge.The left lung was isolated for pathological examination.Lung sections were stained with hematoxylin and eosin(HE),Masson's trichrome.The thickness of bronchial airway,bronchial smooth muscle thickness,and the collagen deposition area were measured by image analysig system.The concentrations of IL-4,IL-5,TNF-α and IFN-γ in BALF were measured by ELISA,the RT-PCR and Western blot was performed to detect the mRNA expression of connective tissue growth factor (CTGF),TGF-β 1 mRNA and NF -kB from the right lung tissues.Results In OVA group,the number of inflammatory cells and the concentrations of IL-4,IL-5,TNF-a in BALF and Bronchial airway thickness,bronchial smooth muscle thickness,the collagen deposition area,CTGF,TGF-β1 mRNA and NF-kB in lung tissue were significantly higher than those in control group(P＜0.05).IFN-γ were lower than those in control group( P＜0.05 ).While in Pyrin domain protein 3 d group and Pyrin domain protein 7 d group,the number of inflammatory cells,the concentrations of IL-4,IL-5,TNF-α in BALF and bronchial airway thickness,bronchial smooth muscle thickness,the collagen deposition area and NF-kB in lung tissue were significantly lower than those in OVA group,IFN-γwere higher than those in OVA group( P ＜0.05).In Pyrin domain protein 7 d group CTGF and TGF-β1 mRNA in lung tissue were significantly lower than those in OVA group.Conclusion Pyrin domain protein might inhibits airway inflammation and development of airway remodeling in asthmatic mouse,the possible mechanism might in part by associated with reducing the expression of NF-kB and further inhibiting CTGF,TGF-β1.

Objective To investigate the potential role of respiratory syncytial virus (RSV) in wheezing episode in children, and to assess the association of the thromboxane A2 receptor gene (TBXA2R) T924C polymorphism with wheezing after RSV infection. Methods From may to december in 2008, one hundred and twenty-five asthmatic children who were suffering from acute episode were recruited as cases and 49 healthy children as controls in our Polymerase chain reactions-Restriction fragment length polymorphism (PCR-RELP) techniques were used to detect the TBXA2R SNP. RSV IgM and IgG were measured by ELISA. Results RSV specific antibody was positive in 57 asthmatic patients (45.6% ,57/125) and 8 controls (16.33% ,8/49) ,with significant difference between the two groups ( χ2 = 12. 890, P = 0. age asthmatic group and 76. 92% (30/39) in the <3 years of age asthmatic group, with significant difference between the two groups (χ2 = 22. 420, P = 0. 000 ). The genotypes distribution in the asthmatic patients was significantly different from that in the controls(χ2 = 5. 346, P = 0. 021). The frequency of TC and CC genotypes in the cases was significantly higher than that in the control group. The allele frequencies of T and C allele were similar in the two groups ( χ2 =2.660, P=0.103). Conclusions RSV infection was one of the factors that associated with asthma acute episode, especially in children younger than 3 years. The TC,CC genotypes increase the chance of wheezing in children infected by RSV.

Objective To discuss the effects of triangle limited fixation by Russian external fixator for proximal and distal tibiofibular fractures. Methods From December 2005 to December 2007, 54 patients with tibiofibular fractures were managed with close reduction and triangle limited fixation by Russian external fixator. They were 48 males and 6 females, aged from 18 to 54 years (average, 34 years). By AO classification, there were two cases of type 41-C3 (one complicated with type 43-B2 and one with type 43-A3), 17 cases of 42-A, 13 cases of 42-B, 12 cases of 42-C, 5 cases of 43-B, and 5 cases of 43-C.Twenty-six cases were open injury (by Gustilo classification, type Ⅱ in 13, type ⅢA in 10, type ⅢC in 3),and 28 closed injury (by Tscherne classification, grade Ⅰ in 8 and grade Ⅱ in 20). Results Follow-ups of 50 patients revealed that the fractures healed from 2 to 6 months (average, 3 months). Swelling subsided in just one week in the 28 patients with close injury. Of the 26 patients with open injury, 24 obtained primary healing of wounds, one obtained wound healing 4 weeks after changes of dressing, and one suffered amputation. No malfunctions were found in this group. One case had nonunion which was healed after change to single-ann external fixation. Conclusion Triangle limited fixation by Russian external fixator can be applied in the treatment of complex tibiofibular fractures.