Protracted bacterial bronchitis (PBB) is one of the common causes of chronic cough in children.The common pathogenic bacteria of PBB include haemophilus influenzae, streptococcus pneumoniae and moraxella catabilis.Viruses are also involved in the development of PBB.In addition, the microbiome of PBB is different from that of normal children, with lower respiratory tract flora disorder.This paper summarized the recent progress in the microbiology of PBB.

Objective To evaluate the efficacy and safety of phacoemulsification combined with trabeculectomy and phacoemulsification after trabeculectomy in patients with angle-closure glaucoma and cataract with high intraocular pressure.Methods We divided 32 eyes of 32 patients with angle-closure glaucoma and cataract with high intraocular pressure into 2 groups.Phacoemulsification combined with trabeculectomy were performed in group 1,and phacoemulsification after trabeculectomy were performed in group 2.The intraocular pressure,visual acuity,and complications were determined.Results In these 2 groups,the intraocular pressure decreased and the visual acuity increased 1 week after the surgery,without statistical significance.No serious complication was found in these 2 groups.Conclusion It is effective and safe to perform phacoemulsification combined with trabeculectomy in patients with angle-closure glaucoma and cataract with high intraocular pressure.

Objective To observe the effects of high sucrose,high saturated fatty acid and high unsaturated fatty acid(diets) on insulin resistance and endothelium-dependent vasodilation function.Methods Adult Wistar rats were divided into normal control(NC) group,high sucrose(HS) group and high saturated fatty acid(HSF) group,high unsaturated fatty acid(HUF) groups.Insulin sensitivity was tested by hyperinsulinemic-euglucemic clamp after 24 weeks.Acetylcholine-induced(or sodium nitroprussideinduced) relaxation of preconstricted isolated renal arteries was measured by Mulvany myograph.Results GIR was obviously lower in experimental groups than that in NC group.GIR was negatively correlated with triglyceride (TG),free fatty acid(FFA).Acetylcholine-induced relaxation was markedly decreased in all experimental groups compared with that in NC group and the maximal response was decreased 37.4% in HSF group,32.7% in HUF group,27.7% in HS group.Acetylcholine-induced relaxation was enhanced by incubation with L-Arg and decreased incubated with L-NNA,MB in all experimental groups.Vasodilation response was negatively correlated with TG,INS and well positively correlated with NO,GIR.There was significantly negative correlation between FFA andNO.Conclusions: The rats fed high sucrose,high saturated fatty acid and high unsaturated fatty acid diets developed insulin resistance with reduced endothelium-dependent vasodilation function.

Objective To evaluate the clinical efficacy of Achillon,a novel guide for Achilles tendon suture produced by Newdeal Ltd in France,in the mini-invasive surgical treatment of acute Achilles tendon rupture. Methods Between December 2010 and March 2011,7 patients(7 feet) with acute Achilles tendon rupture were treated in our department.They were 5 males (5 feet) and 2 females (2 feet),with an average age of 34.2 years (range,21 to 53 years).The interval between injury and operation ranged from 1 to 11 days(3.8 days on average).A longitudinal incision approximately 2.0-3.5 cm in length was made around the ruptured Achilles tendon for minimally invasive repair after insertion of the Achillon.Postoperative rehabilitation was carried out. Results All the wounds healed at the first stage.All patients were followed up for 5 to 11 months, with an average of 7.2 months. All patients regained normal weight-bearing walking 3 months after operation without any re-rupture. According to the ankle-hindfoot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS),they scored 93.2 points.By the visual analogue scale(VAS),they scored 1.2 points at the operation site. Conclusion The surgical treatment of acute Achilles tendon rupture with Achillon has advantages of mini-invasion,a low rate of incision problems and quick function recovery.

Background and purpose:Gestational trophoblastic neoplasm (GTN) is a spectrum of disease arising from trophoblastic cells, and the majority of patients with GTN have favorable outcome because of the sensi-tivity to chemotherapy. While the cure rate for high-risk patients is still 70% to 80% as a result of drug resistance and disease recurrence. This study aimed to evaluate the clinical characteristics and outcome of patients with high-risk GTN.Methods:The clinical records of patients with high-risk GTN treated in Obstetrics and Gynecology Hospital of Fudan University from Jan. 2003 to Jan. 2013 were analyzed and reviewed retrospectively from the aspect of different treatment.Results:Fifty-one patients with high-risk GTN were admitted to this hospital. Among 51 high-risk GTN patients, 46 patients were evaluated retrospectively and 5 patients were excluded for incomplete treatments. Of the 46 patients with high-risk GTN, 27 patients were treated by chemotherapy alone, 19 patients received chemotherapy and adjuvant surgical therapy. Forty-four patients received EMA-CO (VP-16+Act-D+MTX/VCR+CTX) as a ifrst-line chemotherapy, 81.82% (36/44) had complete remission and 8 patients developed resistance to EMA-CO. EMA-EP (VP-16+Act-D+MTX/VP-16+cisplatin) was used as second-line chemotherapy for the 8 patients resistant to EMA-CO, 6 patients (2 underwent adjuvant surgical therapy) achieved remission and 2 patients died as a result of drug-resistance and disease progression. For the remaining 2 patients, one was treated by 5-FU+KSM and pulmonary resection, and the other was treated by MTX for misdiagnosis as ectopic pregnancy and then converted to EMA-CO for the pathological diagnosis of choriocarcinoma after surgery. Both of them achieved complete remission. Ultimately, 95.65% (44/46)patients achieved complete remission. Among the 19 patients who underwent adjuvant surgical therapy, 94.70% (18/19) patients achieved complete remission after chemotherapy and adjuvant surgery, and the remaining one patient died of disease progression.Conclusion:Standard combination chemotherapy is crucial in the treatment of high-risk GTN. The role of adjuvant surgery in the management of high-risk GTN should not be underestimated.

Objective To analyse the clinical practicability and significance of fertility-sparing surgery for women with recurrent borderline ovarian tumors ( BOT).Methods The clinical and pathological recordings of 12 patients suffered from recurrent BOT in the Obstetrics and Gynecology Hospital of Fudan University from Jan.2002 to Dec.2012 were analyzed retrospectively.The menstruation situation , fertility function , recurrence rate and survival after second conservative surgery were collected and analyzed .Results The average onset age of these 12 patients was 26 years, and none of them had procreation before the second operation.The pathological diagnosis were still BOT and the recurrent sites of 10 patients were still restricted to the ovaries.Of the 12 cases, 8 cases of them had normal menstruation functions and 4 cases had less menstrual volumes or longer menstrual periods.Among 6 cases desired for pregnancy after the second operation,4 cases of them were successful.The spontaneous pregnancy rate was 4/6.The mean duration of follow-up was 53 months(range:23-97 months).All recurrent BOT, three cases developed recurrence once more,two cases of them were just be hinted by B ultrasounds and only one cases was approved to be BOT again by a once more surgical pathology.But no disease related deaths occurred.Conclusions The second fertility-sparing surgery may be feasible for women with recurrent BOT who are young and strongly desired for preservation of fertility.The spontaneous pregnancy rate is satisfactory.However, carefully follow-up is still needed.

Objective To investigate the radiographic body posture selection and improvement and it's application value.Methods We selected the uncommon postures optimal for radiographic diagnosis according to different body parts of compound injury patients,and offered the filming process and cautions of some improved postures in radiographic practice.Results Appropriate body posture,improved filming position and processes,optimized parameters of exposure,and the application of digital imaging devices could ensure the image quality of diagnosis.Conclusion Effective filming processes,improved body postures and variable digital devices should be selected in compound injury patients according to practical condition.

Objective:To explore the clinical characteristics and risk factors of severe and critical influenza in children.Methods:The clinical data of 214 inpatient children with severe and critical influenza hospitalized in the Second Affiliated Hospital & Yuying Children′s Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2019 were retrospectively collected. The clinical characteristics including age, gender, symptoms, signs, underlying diseases, C-reactive protein (CRP), treatment and outcome of children with severe and critical influenza were compared. Chi-Square test was used for statistical analysis. A binary logistic regression model was constructed to analyze the risk factors for critically ill influenza.Results:Of the 214 children, 153 were male (71.5%), 177(82.7%) were under 5 years old. There were 52 children with underlying diseases. Fever occurred in 207 cases. Among the 54 cases that had convulsion during the course of the disease, three developed acute necrotizing encephalopathy. The influenza subtype was mainly type A, accounting for 190(88.79%). A total of 42(19.6%) children were critically ill. The incidence of critical influenza in children with underlying diseases (61.9%, 26/42) was higher than that in severe influenza children (15.1%, 26/172), and the difference was statistically significant ( χ2=40.175, P<0.01). The incidence of critical influenza in children with CRP≥40 mg/L was higher than that of severe influenza in children with CRP ≥40 mg/L (33.3%(14/42) vs 9.3%(16/172)), and the difference was statistically significant ( χ2=16.173, P<0.01). Multivariate logistic regression showed that underlying diseases (odds ratio ( OR)=8.794, 95% confidence interval ( CI) 3.845-20.111) and CRP ≥40 mg/L ( OR=5.050, 95% CI 1.966-12.970) were risk factors for critical influenza. All severe cases were improved and discharged.Among the 42 critically ill children, seven children died. Conclusions:Among the severe and critical influenza in children, the majority of children are under five years old.Underlying diseases and CRP ≥40 mg/L are risk factors for critical influenza.

Objective To investigate the eftect of radiation dose of dual-source computed tomography (CT) dual energy single-phase enhanced scan in patients with esophageal cancer.Methods The prospective study was conducted.The clinicopathological data of 56 patients with esophageal cancer who were admitted to the Lishui Hospital of Zhejiang University between January 2015 and December 2016 were collected.All the patients were divided into the experimental group (undergoing dual-source CT dual energy single-phase enhanced scan) and control group (undergoing dual-phase CT enhanced scan) bv randomised block method.TNM classification of esophageal cancer (Seventh Edition) published by American Joint Committee on Cancer (AJCC) was used as a standard TNM staging.Two observers independently read films.All the patients underwent radical resection of esophageal cancer or palliative surgery,and then received adjuvant radiochemotherapy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to March 2017.Observation indicators:(1) consistencies of T staging,N staging and M staging;(2) accuracies of T staging,N staging and M staging (pathological results as a gold standard);(3) radiation dose of CT scan;(4) treatment and follow-up situations.The Kappa test was used for evaluating the consistency,κ≥0.75 as a good consistency,0.40≤κ＜0.75 as a normal consistency and κ＜0.40 as a poor consistency.Comparisons of count data and ratio were done by the chi-square test.Comparisons of measurement data were analyzed by the t test.Results A total of 50 patients were enrolled in the study,including 25 in the experimental group and 25 in the control group.(1) Consistencies of T staging,N staging and M staging:all the 50 patients finished successfully CT scans.Two observers considered that consistencies of T staging,N staging and M staging in the 2 groups were normal (κ =0.452,0.618,0.729,P＜0.05).Consistencies of N staging and M staging were superior to T staging.(2) The pathological results were used as a gold standard.Accuracies of T staging,N staging and M staging in the experimental and control groups were 72％,76％ and 88％,84％ and 92％,88％,respectively,with no statistically significant difference between the 2 groups (x2 =0.10,0.37,0.50,P＞0.05).(3) Radiation dose of CT scan:volume CT dose index (CTDIvol),dose length production (DLP) and effective radiation dose (E) were (10.35±2.01) mGy,(400.63± 34.13) mGy · cm,(5.61 ± 0.47) mSv in the experimental group and (3.55 ± 0.60)mGy,(140.66± 10.89) mGy · cm,(1.98±0.17) mSv in the control group,respectively.There were statistically significant differences in CTDIvol and E between the 2 groups (t =16.23,36.30,P＜0.05).(4) Treatment and follow-up situations:of 50 patients,43 patients received treatments,including 32 undergoing radical resection (11 receiving postoperative adjuvant chemotherapy),6 undergoing palliative surgery,3 receiving single radiotherapy and 2 receiving single chemotherapy.Thirty-six of 43 patients were followed up for 3-18 months,with a median time of 6 months.During follow-up,1-year survival rate was 61.1％.Conclusion Dual-source CT dual energy single-phase enhanced scan in patients with esophageal cancer cannot reduce accuracy of TNM staging,but decreased effectively radiation dose.

Objective To evaluate the effect of Da Vinci surgical system for the treatment of hepatopancreatobiliary diseases.Methods The clinical data of 29 patients with hepatopancreatobiliary diseases who had undergone operations with Da Vinci surgical system from March to November 2009 at the General Hospital of PLA were retrospectively analyzed.Results The operations were successfully done on 28 patients,except 1 patient was converted to open pancreaticoenterostomy.The total operation time was(339±149)minutes,and the time for operations done with Da Vinci surgical system was(285±117)minutes.The postoperative bowl movement recovery time was(33±21)hours,and the length of postoperative hospital stay was(8±6)days.No blood transfusion was needed.Three patients had postoperative complications and were cured by conservative treatment.Conclusion Laparoscopic operations for hepatopancreatobiliary diseases can be applied with the help of the threedimensional imaging system and flexible surgical instruments of the Da Vinci surgical system,and its superiority is more obvious when applied for intractable hepatopancreatobiliary diseases.