With the wide applications of flexible bronchoscopy in pediatric clinical affairs,the rate of adverse reactions and complications have been increased synchronously.In order to safely make correct diagnosis and improve the therapeutic effects,lower the incidence of complications,it is very important to be familiar with various complications and the ways of management about them as well as indications,contraindications and operating procedures.It's also necessary to negotiate with children's parents on health and fortune including anaesthesia so as to decrease the risks of unexpected affairs and adverse effects.

Objective To determine risk factors and treatments of capillary leak syndrome (CLS) in infants with congenital heart disease(CHD)after extracorporeal bypass (GBP) . Method A retrospective study of 38 infants with CIS and another 150 cases without CLS of a random choice who underwent extracoiporeal bypass from June 2003 to July 2007 was carried out.Several risk factors with statistical significance were screened out with uni-varite logistic regression analysis, and the independent rask factors of CLS were determined with inultivariate step-wise logistic regression analysis. The outcome of CIS infants was compared with infants of control group. Results Logistic analysis showed the risk factors of CLS were the duration of GBP ( OR = 10. 353) , type of CHD ( OR = 6. 912), age ( OR = 6. 254) and temperature of CBP ( OR = 4. 151) . Of the CLS infants cohort, 10 cases underwent peritoneal dialysis and 4 cases died. Conclusions The risk factors of CLS in infants after CBP are the length of time consumed during CBP, type of CHD, age and temperature of CBP.

Objective Gastrointestinal dysfunction is closely correlated with the impairment of intestinal barrier caused by serious infection.We focused on the role of platelet activating factor(PAF)in the intestinal impairment caused by endotoxemia by studying on the morphology of intestinal epithelial ceils and diamine oxidase (DAO)levels with the application of Ginkgolide B(PAF receptor antagonist).Method Eighteen-day-old Wistar rats were randomized into lipopolysaccharide(LPS)(5 mg/kg),PAF receptor antagonist(pretreatment and treatment)and normal saline(Control)groups(n=8 at each time point).Ginkgolide B(PAF receptor antagonist BN52021)5 mg/kg was administered 30 minutes before(in pretreatment group)and after LPS injection(in treatment group).The ileum specimens(n=8)were harvested at 1.5,3,6,24,48 and 72 hours after LPS or NS injection.The ultrastructures of intestinal epithelial cells were studied by transmission electron microscopy (TEM)and with hematoxylin and erosin staining.The contents of DAO in ileum tissue and plasma were measured respectively with spectrophotometer.According to data Normality and Variance equality,ANOVA analysis and LSD (least significant difference)-t test were used for multiple group difference.The whole test Was performed in the animal laboratory,pathological laboratory,biochemical laboratory of our hospital and electron microscopy laboratory of Liao-ning University of Traditionary Chinese Medicine.Results Histologic examination of intestinal injury in LPS group showed the edema of intestinal villi,the capillary congestion in lamina propria,the dilation of interstitial lymphatic vessel.and the polymorphonuclear infiltration in enteric cavity in LPS group at 1.5,3,6,24 hours.The edema of the intestinal villi were shown in antagonist group.Ultrastructural study showed microvilli and tight junctions were intact in the control group.The tight junctions enlarged and the microvilli were thin,rare or disrupted in the experimental group.The pathological changes in PAF antagonist group were slightly lighter than that in the LPS group.The DAO content in the ileum tissue was obviously decreased in the LPS group compared with that in the control group.It reached to a nadir at 6 hrs[from(0.172±0.004)U/mg to(0.096±0.010)U/mg,F=13.372,P＜0.01).The DAO content in plasma was obviously higher in the LPS group than that in the control group.The patterns of DAO changes in the PAF antagonist group were as the same as that in the LPS group at each time point.Conclusions PAF may play a certain role in the injury of intestinal barrier in endotoxemia.Preventive and remedial administration of Ginkgolide B may relieve intestinal injury.The activity changes of DAO in plasma synchronized with that in ileum tissue.It may be deduced that the alterations of DAO in plasma may indicate the destruction of intestinal mucosa in the early stage sensitively.

Objective To investigate the correlation between exhaled nitric oxide and lung function (FEV1)in asthmatic children.Methods Fifty three stable asthmatic children aged 5 to 14 years old were recruited from ShengJing Hospital of China Medical University.According to whether the patients were treated with inhaled corticosteroid(ICS)therapy regularly,they were divided into two groups:steroid group and non-steroid group,then fraction of exhaled nitric oxide(FeNO)and lung function were measured.Results In non-steroid group,the levels of FeNO(mean 40.450±25.428 part by billion)were significantly higher than those in the steroid group(mean 19.879±13.845 part by billion),and they were statistically significant.(P = 0.003).The mean FEVI in non-steroid group was(95.152±8.993)%,and the mean FEVI in non-steroid group was(91.350±11.690)%,and there were no significant differences between two groups (P =0.189).Significantly negative correlation was found between FeNO and FEV1 in steroid group(r =-0.465,P = 0.039),but there was no significant correlation between them in steroid group(r = 0.058,P =0.747).Conclusion The levels of FeNO were higher in non-steroid group than those of the steroid group in the stable asthmatic children.FeNO is a good biomarker to evaluate the airway inflammation of asthmatic children.

Objective To study the temporal changes of alveolar epithelial type Ⅱ cells and surfactant pro-tein A in young rats with acute lung injury induced by lipopolysaecharide. Method Totally 110 SD young rats (male:53, female : 57) were randomly divided into ALI and normal control groups (six subgroups in each group).LPS(4 mg/kg) was given intraperitoneally in ALI group. The same amount of normal saline was given in the con-trol groups. Eight rats in each subgroup were sacrificed at 6, 12, 24, 36, 48 and 72 hours after the injection.Lung samples were taken for transmission electron microscope examination. RT-PCR was epmloyed for the mea-surement of SP-A mRNA. Western blot was used for the detection of SP-A in the lung tissue. ANOVA and homo-geneity of variance test were performed by SPSS 12.0. Results The microvilli disappeared at 24 hours after the injection of LPS. The number of lamellar body (LBs) was provisionality increased at 24 hours and 48 hours. The ring-like an'angement of LBs around nucleus and the giant LB with vacuole-like deformity were found as the main characteristics of AEC- Ⅱ in ALI at 48 hours. The number of LBs reduced and broken and residual LB remained at 72 hours. SP-A elevated greatly from 24 to 48 hours (P < 0.01), reached peak at 36 hours (6.94 ± 0.80, P <0.01),reached the lowest level(3.87 ±0.50, P <0.01)at 72 hours. Conclusions The pathological changes of AEC-Ⅱ and SP-A in lung tissue wiht ALI are time-dependent. The typical alterations of AEC- Ⅱ occurs at 48 hours accompanied by the compensatory increase of SP-A. AEC- Ⅱ is seriously injuried with the typical changes of LBs and the diminishing of SP-A in lung tissue.

Objective To investigate the changes and clinical significance of the levels of matrix metallopro-teinase -9(MMP -9)in the serum and bronchoalveolar lavage fluid (BALF)in children with asthma whose had differ-ent levels of 25 -hydroxyl -vitamin D3 [25 (OH)D3 ]in the serum.Methods Fifty children with asthma between January 201 3 and January 201 5 were enrolled as the asthma group,based on the disease severity,and the patients were divided into the moderate to severe group (37 cases)and the mild group (1 3 cases),while 20 children with abnormal airway or tracheal foreign body were as a control group.The levels of 25 (OH)D3 and MMP -9 in the serum,levels of MMP -9 in BALF were measured and compared by using enzyme linked immunosorbent assay (ELISA)me-thod.Re-sults The level of serum 25 (OH)D3 in the asthma group[(1 9.5 ±6.4)μg/L]was lower than that in the control group[(39.3 ±7.1 )μg/L ],and there was a statistical difference between 2 groups(P <0.05).The level of serum 25(OH)D3 in moderate to severe group[(1 6.6 ±4.1 )μg/L]was lower than that in the mild group[(27.9 ±4.5)μg/L],there were statistically significant difference between 2 groups(P <0.05).There was no significant difference in the total number of cells and the percentage of macrophages among different serum 25(OH)D3 levels of children with asthma and the control group(P >0.05).The percentages of neutrophils,eosinophils and epithelial cells in BALF were significantly higher in different serum 25(OH)D3 levels of children with asthma than those of the control group(all P <0.05).There were significant difference levels of MMP -9 in the serum and BALF among different serum 25(OH)D3 levels of children with asthma and the control group(all P <0.05).In children with asthma,the levels of 25(OH)D3 in serum were significantly negatively correlated with the percentages of neutrophils,eosinophils and epithelial cells in BALF (r =-0.683,-0.795,-0.670,all P <0.05 ),exiting a significantly negatively correlation also seen between the serum levels of 25(OH)D3 and MMP -9 (r =-0.796,P <0.05).Conclusions Children with asthma often have low levels of serum 25 -(OH)D3 ,25(OH)D3 and MMP -9 may be involved in airway inflammation and airway remo-deling in children with asthma,and they may involve in the occurrence and development of asthma.

Objective·To investigate and analyze periodontal health knowledge and behaviors in medical students and the relationship of these knowledge and behaviors with periodontal health status, and to determine the periodontal health level of this population. Methods·A total of 602 medical students were included in this cross-sectional epidemiological study. The questionnaire covered sociodemographic information, periodontal health-related behaviors and knowledge, experience about themselves, and periodontal health of parents, etc. Meanwhile, periodontal health indices of index teeth were examined, including probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP), etc. Results·Of 570 subjects aged 16-26 who completed the survey, 79.82% never used dental floss, and 78.25% never underwent periodontal debridement. 50.25% of the index teeth had BOP, and only 0.70% of the subjects had no BOP. 81.05% of the subjects had some degree of periodontal attachment loss. Male students were more susceptible to periodontitis (P=0.027) and gingivitis (P=0.012) than female students. Conclusion·No new risk factors affecting the periodontal health are identified. Regular periodontal cleaning and protection are important for young people to prevent periodontitis.

Objective Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are common and life-threatening disease in children with mortality as high as 40%-70%. Alveolar type Ⅱ cells (ATII cells),characterized by the presence of lamellar bodies (LBs),synthesize and secret surfactant proteins (SPs),which contribute significantly to surfactant homeostasis and pulmonary immunity.The functions of ATⅡ cells including pulmonary surfactant production are autocratically dominated by the structural integrity of ATII cells.Our study is focused on the ultrastructural alterations of AT Ⅱ cells in rats with lipopolysaccharide(LPS)-induced ALI.Methods Rat ALI models were established by intraperitoneal injection of LPS (4 mg/kg).0.9 % NS with same amount was given in the normal control group.The rats were randomly chosen and sacrificed at 24, 48 and 72 hrs after LPS injection (8 rats at each time point).Lung samples (1 mm3 of the size) were obtained from the lower parts of left lungs and fixed with 2.5% glutaraldehyde for the transmission electron microscope examination.Results The microvilli around ATII cells disappeared and the number of LBs increased at 24 hrs after LPS administration.LBs rearranged like a ring around the nuclei.It was commonly seen that two nuclei were present in one AT Ⅱ cell.Vacuole-like deformity prominently occurred in cytoplasm at 48 hrs.Giant LBs presented at the same time.The shapes of nuclei were irregular and some of the borders were unclear at 48 and 72 hrs.The remnant of ruptured LBs scattered in cytoplasm at 72 hrs.The number of LBs reduced obviously.Karyolysis occurred in some of the nuclei.Conclusions The ALI-related alterations of ATII cells characterized by the changes of LBs,nuclei,and nucleoli were time-dependent. ATII cell injury was serious at 48 and 72 hrs.This may lead to the insufficiency of pulmonary surfactant synthesis and unstability of pulmonary homeostasis,which contributed to to the pathogenesis of acute lung injury.

Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products (sRAGE) in infants and young children undergoing cardiopulmonary bypass ( CPB),and to investigate whether they could protective the occurrence of noninfectious pulmonary complication (NPC) after cardiac surgery.Methods This was a case-control study.The subjects included all children aged ＜3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st 2011.The patient who showed pulmonary inflammation or had abnormal liver or renal function before surgery was excluded.The remain patients were divided into 2 groups according to whether they had developed NPC postoperatively.Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax,pneumomediastinum,or phrenic nerve palsy.Forty patients were categorized into the no-NPC group.Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline,before CPB,immediately after CPB,1 h,12 h and 24 h after operation.Differences concentrations between two groups were analyzed with t test.A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC.A P value ＜0.05 was considered statistically significant.Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB ( P ＜ 0.01 ).The levels of sRAGE dropped to lower than baseline level (P ＜0.05),while S100A12 was still at high level 24h after operation (P ＜0.01 ).Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group (P ＜ 0.05).Twenty-four hours after operation,levels of S100A12 were still higher in NPC group than no-NPC (P ＜ 0.01 ),while levels of sRAGE were similar in the two groups ( P ＞ 0.05 ).In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC (OR =1.042,95％ CI:1.010 ～ 1.076,P =0.011 ).Levels of S100A12 immediately after CPB were positively associated with mechanical ventilation time ( r =0.47,P ＜ 0.01 ),duration of surgical Intensive Care Unit ( r =0.407,P =0.002) and hospital stay ( r =0.421,P =0.01 ).Conclusions Plasma levels of S100A12 and sRAGE were significantly increased immediately after CPB and the elevated plasma S100A12 immediately after CPB served as an early reliable biomarker of the occurrence and the prognosis of NPC after CPB in infants and young children.