Early, rapid and accurate diagnosis of disease is of great significance for the prevention of disease progression and the best clinical rational treatment program. Respiratory tract infections are the common and frequently occurring diseases in infants and preschool children. About 90 percent of upper respiratory tract infections are caused by viruses, and followed by secondary bacterial infections. Bacterial pathogen often causes lower respiratory tract infections. This study describes the clinical features of typical pathogens of respiratory tract infections in children including respiratory syncytial virus, influenza virus, coronavirus and atypical pathogens-mycoplasma, chlamydia and legionella, and explains the clinical testing evaluation of widely used PCR method in the detection and diagnosis of respiratory tract infections in children. Finally, we analyzed the advantages and disadvantages of current used respiratory pathogen detection method-traditional culture method, based on pathogen antigen (antibody) assay and nucleic acids method.

Objective To investigate the effect of budesonide atomization on tracheal extubation in children.Methods A total of 85 patients with tracheal intubation in Tianjin Children's Hospital from May 2013 to September 2016 were selected in this study.Patients were randomly divided into budesonide group (n=44) and dexamethasone group (n=41).The budesonide group was given 1 mg of budesonide for inhalation 30 min before extubation,and 1 mg of budesonide inhalation immediately after extubation.Then every 8 hours for 0.5-1.0 mg budesonide inhalation for 4 days.The dexamethasone group was given dexamethasone 0.2-0.3 mg/kg intravenously 30 min before extubation,and dexamethasone 2.5-5.0 mg inhalation immediately after extubation.Then dexamethasone 2.5-5.0 mg inhalation was given every 8 hours for 4 days.The incidence of laryngeal edema (stridor,hoarseness),the time of extinction,the expression of hypoxia,reintubation rate within 24 hours and secondary infection rate after extubation were compared between the two groups.Results There were no significant differences in the mission success rate,the incidence of laryngeal edema,the time of extinction,the incidence of hypoxia and re-intubation rate between the two groups (P ＞ 0.05).Two patients were found secondary infection after extubation in dexamethasone group.Conclusion Both budesonide and dexamethasone show curative effects on the prevention and treatment of laryngeal edema after extubation.Budesonide atomization can replace systemic corticosteroids,thus reducing the adverse reactions of glucocorticoids.We recommend the use of budesonide in treating adverse events after extubation.

To compare the clinical effect of needling the Ashi point (4cm lateral to the lower border of the spinous process of cervical vertebra) plus Yaotongdian on the hand and point injection on the Ashi point with Triamoninde. The curative effect of acupuncture was better than that of point injection.

Objective To explore pathogenic composition of hand,foot and mouth disease(HFMD),and the molecular typing of enterovirus in Tianjin Children′s Hospital in 2016.Methods Single center study.A total of 327 samples of HFMD cases which collected from Tianjin Children′s Hospital from March to November in 2016 were tested for nucleotide acid of enterovirus(EV),human enterovirus 71(EV71),Coxsackievirus A 16(CA16)by real-time reverse transcription polymerase chain reaction(RT-PCR),among which 104 sample of other EV positive were selected to amplify and sequence the whole VP1 region by using RT-PCR.Homology was analyzed and phylogenetic tree were constructed by comparison of the sequence with all subgenotype of EV by Chromas1.62 and MEGA6.06.EV positive rate in different age groups were compared by SPSS20.0.Results Of all the 327 HFMD cases tested,there were 272 EV positive cases,the constituent ratio of EV71,CA16 and other EV were 55.1％(150/272),6.6％(18/272)and 38.2％(104/272)respectively.The EV positive rates of different age groups(69.0％-90.9％)were different significantly(x2=15.897,P=0.044),the 3 years-old-group had the highest EV positive rate than that of the other age groups(90.9％,40/44).Of all 104 samples of other EV tested,34 were CA10(12.5％)and 14 were CA6(5.1％).Phylogenetic analysis of 11 EV71 VP1 and 20 CA10 VP1 showed that the EV71 and CA10 strains belonged to genotype C4a and genotype G,respectively.ConclusionsEV71 was still the predominant pathogen in spite of the constituent ratio of other EVs increased markedly in 2016 in Tianjin.It is important to enhance etiological monitoring for control and prevention of HFMD.

Objective To investigate the curative effect of sodium nitroprusside in the treatment of EV71-related pneumoedema/pneumorrhagia and hypotension in this study. Methods This was a retrospective study of a total 10 children with EV71-related pneumoedema/pneumorrhagia treated with sodium nitroprusside using case-control methods. The clinical manifestations and outcomes of the 10 children (present cohort) were compared with those of 8 children (past cohort) who had EV71-related pneumoedema/pneumorrhagia without sodium nitroprusside. Results Among these 10 patients,all were at the appearance of pneumoedema/pneumorrhagia, cardiac arrhythmia and hypotension. Two patients showed severe cardiac arrhythmia, two patients showed cardiac arrest for many times. All 10 patients were treated with mechanical ventilation and other conventional treatments. At the first time of the manifest of hypotension,sodium nitroprusside were put into practice in all 10 patients. Ten patients were treated with intravenously sodium nitroprusside in the stage of hypotension by maxi30 min ～ 1 h,the patients showed an improvement in vultus,pulse and peripheral circulation and decrease of heart rate and elevation of blood pressure after 30 min ～2 h,but at least 2～6 h later,the blood pressure tended to stabilize at normal standard. Conclusion Hypotension is the intensive stage in EV71-related hand,foot and mouth disease ,and the shock syndrome caused by acute left ventricular disorder is related to sympathetic nerve activity. Sodium nitroprusside can effectively reduce the cardiac afterload,and correct shock and improve the prognosis.

Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis.In recent years, pertussis reappearance makes it become one of the important diseases affecting human health.Pertussis toxin is an important virulence factor produced by Bordetella pertussis.It is an important component of acellular pertussis vaccine, and is related to most clinical symptoms and fatal pertussis.This paper reviews the molecular structure and pathogenesis of pertussis toxin.

Asthma is one of the most common pulmonary chronic inflammatory diseases threatening public health.It is a heterogeneous disease driven by gene-environment interaction.The proposition of "hygiene hypothesis" and "microbial hypothesis" has gradually drawn attention to the close relationship between microorganisms and asthma.In recent years, studies on intestinal flora emerge endlessly.Studies have shown that intestinal flora is not only closely related to digestion, immunity, endocrine, circulation, neuropsychiatric system, but also to asthma.This paper reviews the possible relationship between intestinal flora and asthma in children from its physiological function, so as to explore the prevention and treatment strategy of asthma in the future.

Community-acquired pneumonia (CAP) is a leading cause of death in children under 5 years old.Bacterial pneumonia is still the primary cause of severe pneumonia.Prevalence of Staphylococcus aureus CAP and its clinical features remain incompletely understood, complicating the empirical selection of antibiotics. Staphylococcus aureus is the main bacterial pathogen of CAP besides Streptococcus pneumoniae.Due to the virulence its bacterial factors involved in nasal colonization and its relationship with the host immune response, staphylococcus aureus is easy to cause lung damage after the virus infection. Staphylococcus aureus also produces panton-valentine leukocidin, and other toxin factors, which lead to the death of host cells after infection, activate humoral immunity, produce a large number of inflammatory factors, further cause primary and secondary acute lung injury, and may cause systemic collapse infection.At pre-sent, there is little in-death research on the relationship between the toxicity of Staphylococcus aureus and the host immune response.The prevalence of methicillin resistant Staphylococcus aureus makes the anti-infection treatment increa-singly difficult.It is urgent to improve the comprehensive diagnosis and treatment measures, improve the treatment rate, reduce the disability rate, and develop therapies targeted at both pathogen virulence factors and host immunomodulation.

Objective To explore the correlation of total IgE and childhood atopic dermatitis (AD) in maternal serum and newborn cord blood, as well as its clinical significance of allergen testing. Methods Thirty-five cases diagnosed as AD (AD group) were selected, and other 35 children who were not diagnosed as AD (control group) were randomly selected from a birth cohort established in 2009—2011. The total IgE levels were detected by ELISA in maternal serum and newborn cord blood. The serum specific IgE antibody level was detected by quantitative immunoblotting method. Results The serum total IgE level was significantly higher in mother and newborn cord blood in AD group than that in control group (χ2=16.568 and 14.933, P<0.01). Compared to control group, there was a significantly higher positive rate of mother serum allergen includ?ing dust mites, house dust, ragweed pollen, song kind of pollen, poplar, surname and elm pollen, mould, shrimp, marine fish, in AD group (P<0.05). There was a significantly higher positive rate of artemisia pollen and fungi IgE in newborn cord blood in AD group (P<0.05). Conclusion The increased total IgE in maternal serum may play a predictive effect on infants suf?fering from AD. There is no obvious consistency in allergic state between mothers and infants.

Objective As a chronic inflammation of the airways under the influence of multiple factors, there are at least 300 million asthma patients worldwide, and the incidence of childhood wheezing diseases is increasing year by year.Scholars at home and abroad generally believe that respiratory infection is one of the important factors inducing children′s wheezing.To explore the respiratory infectious factors causing children′s wheezing, including pathogens and pathogenic mechanisms, has important clinical significance for the diagnosis and treatment of children′s wheezing diseases.This review summarizes the status of children′s lower respiratory tract infections, explores the characteristics of different pathogen infections, the pathogenesis of infection and the relationship with wheezing or asthma, briefly describes the current treatment and prevention methods, and deepens the understanding of the status quo of children with wheezing disease.