Particular difficulties were presented when diagnosis of asthma in children under 5 was made. Diagnosis of asthma in early childhood is a big challenge and has been based largely on clinical justification and assessment of symptoms and physical signs. The PRACTALL consensus report focus exclusively on pediatric asthma, such as natural history and pathophysiology of pediatric asthma, different patterns of recurrent wheeze in pediatric patients, different phenotypes of asthma in children, and provides recommendations for diagnosis, practical management and monitoring. More factors should be considered for diagnosis of asthma in children under 5, including the patterns of recurrent wheeze, history of atopy, risk factor of asthma, long-term follow-up, extensive differential diagnoses, response to bronchodilator and/or anti-inflammatory treatment and so on.

Mycoplasma pneumoniae (MP) is an important etiological agent in childhood community acquired pneumonia. Pediatricians are concerned about the clinical problems of MP infection. In this review,MP infection-related clinical issues, such as epidemiology, pathogenesis, clinical features, imaging, and relationship of bronchial asthma, laboratory diagnosis and treatment, were discussed to improve pediatricians' awareness and knowledge of clinical diagnosis and treatment of MP infection.

Objective To observe clinical symptoms and the length of hospital stay of patients with bronchiolitis under different treatment,and the curative effect of inhalation of hypertonic saline combined with epinephrine in the treatment of bronchiolitis.Methods A total of 158 patients with bronchiolitis under 2 years old between August 2012 and May 2013 in Shengjing Hospital of China Medical University were enrolled.According to the admission dyspnea score (respiratory distress assessment instrument,RDAI),all cases were divided into two major groups,moderate group and severe group.Two major groups were randomly divided into three groups (treatment group 1,2,3)according to the different treatments respectively.Patients in the treatment group 1 were inhaled pulmicort combined with combivent,treatment group 2 were inhaled hypertonic saline,and treatment group 3 were inhaled hypertonic saline combined with epinephrine.The symptoms and signs disappeared days,respiratory assessment change score,length of hospital stay and the curative effect in every group were observed before and after the treatment.Results In the moderate group,there were no significant differences in the length of time of cough,wheeze,lung rales disappears as well as the average length of hospital stay between before and after treatment in three treatment groups respectively (P ＞0.05,respectively).In the severe group,there were significant differences in the respiratory assessment change score and length of hospital stay of treatment group 2 and treatment group 3 than that of treatment group 1 respectively(P ＜ 0.05,respectively).There were no significant differences in the length of hospital stay and length of time of cough,wheeze,lung rales disappears between treatment group 2 and treatment group 3 respectively(P ＞ 0.05,respectively).Conclusion There were no significant differences in the curative effect between each treatment group for the moderate bronchiolitis patients.For the severe bronchiolitis patients,hypertonic saline combined with epinephrine inhalation had better curative effect,less adverse reactions.

Objective To invstigate the effect of Lactobacillus salivarius on asthma Balb/c mouse in IgE,IL-4 and IFN-γ of serum and lung tissue homogenates.Methods Thirty female Balb/c mice weighing 16-18 g (4 weeks old), SPF grade, were randomly divided into three groups: normal control group (N), asthma group(A), asthma combined Lactobacillus salivarius group (AH).Acute asthma model was established by ovalbumin challenge method, mice were observed in behavioral changes, non-invasive method for the determination of airway responsiveness in mice, the changes in airway inflammation and the number changes of tracheal cilia were observed by pathological HE staining and the electron microscope.Respectively, the levels of IgE and IL-4/IFN-γin the serum and lung tissue homogenate were measured by ELISA.Results five ～ ten min after 4％ OVA saline solution atomization excitation mice in A group appeared obvious restlessness, head and facial itching, scratching, shortness of breath, perioral cyanosis with abdominal breathing, sneezing, stooping, forelimbs shrinkage, urine and feces incontinence and other asthma acute phase performances, The above reaction alleviated in AH group compared to A group;Pathology of HE staining in asthma group showed the thickening bronchial wall, narrow lumen, peribronchial and perivascular infiltration with a large number of eosinophil-based inflammatory cells,lumen with many inflannatory secretions,Pathological changes in lung tissue of mice in AH group significantly alleviated compared with asthma group;Under the electron microscope, the number of cilia in A group significantly decreased compared with N group, while AH group significantly increased compared with A group;Expression level of IgE,IL-4 in the serum and lung homogenate of A group was significantly higher than that of N group (P ＜ 0.05), the level of IFN-γexpression was significantly lower than N group (P ＜ 0.05), however the expression level of IgE, IL-4 in AH group significantly decreased compared with A group (P ＜ 0.05), and IFN-γexpression level elevated compared with A group(P ＜ 0.05).Conclusion Lavage with Lactobacillus salivarius before sensitization could alleviate clinical symptoms of asthmatic mice, partially correct Th1/Th2 imbalance as well as reduce airway infammafion.

In order to improve rational useage of inerferon in clinic,this article elaborate the background of this Specialists consensus on pediatric clinical application of recombinant human interferon-α1 b,the differences of various subtypes of interferon,the envidence and method of interferon-α1b clinical application,the satety and the adverse reaction monitoring issues in this article.

Objective To explore the influence of Lactobacillus salivarius on IgE,eosinophil cationic protein(ECP)and transforming growth factor(TGF)-βof serum and lung tissue homogenates of asthmic Balb/c mouse.Methods Thirty female Balb/c mice weighing 16-18 g(4 weeks old),SPF grade,were ran-domly divided into three groups:normal control group(group A),asthma group(group B),asthma combined Lactobacillus salivarius group(group C).Acute asthma model was established applying ovalbumin,behavioral changes were observed in mice,the changes in airway inflammation and the number changes of tracheal cilia were observed by pathological HE staining and the electron microscope respectively.The levels of IgE,ECP and TGF-βin the serum and lung tissue homogenate were measured by ELISA method.Results (1 )The mice in group B presented obvious restlessness,head and facial itching,scratching,shortness of breath,peri-oral cyanosis with abdominal breathing,sneezing,stooping,forelimbs shrinkage,urine and feces incontinence and other asthma acute phase performances in 5-1 0 minuts after 4% ovalbumin saline solution atomization excitation,the above reaction alleviated in group C compared to group B.(2)Pathology of HE staining in group B showed the thickening bronchial wall,narrow lumen,peribronchial and perivascular infiltration with a large number of eosinophil-based inflammatory cells,lumen with many inflammatory secretions,pathological changes in lung tissue of mice in group C significantly alleviated compared with group B.Under the electron microscope,the number of cilia in group B significantly decreased compared with group A,while group C significantly increased compared with group B.(3)Expression levels of serum IgE and ECP in group C were sig-nificantly lower than those in group B[(0.86 ±0.14)μg/ml vs.(1.30 ±0.12)μg/ml;(2.30 ±0.15)ng/ml vs.(3.41 ±0.15)ng/ml,P <0.05,respectively].The contents of lung tissue homogenate IgE[(0.97 ± 0.06)μg/ml]and ECP[(5.88 ±0.13)ng/ml]in group C significantly decreased,respectively,compared with the IgE[(1.13 ±0.05)μg/ml]and ECP[(8.08 ±0.15)ng/ml]in group B(P<0.05).The levels of serum TGF-β[(0.17 ±0.01 )μg/ml]and lung tissue homogenates TGF-β[(0.18 ±0.01 )μg/ml]in group C were higher than the serum TGF-β[(0.13 ±0.01 )μg/ml]and lung tissue homogenates TGF-β[(0.15 ±0.01 )μg/ml]in group B,respectively,the differences were statistically significant(P<0.05 ). Conclusion Lavage with Lactobacillus salivarius before sensitization could alleviate clinical symptoms of asthmatic mice,as well as reduce airway inflammation in some degree,TGF-βmay be involved in the mecha-nism of Lactobacillus salivarius playing a protective role.

Objective To investigate the effects of vasoactive intestinal peptide on transforming growth factor-β1(TGF-β1)expression in lung tis-sue of asthmatic mice with airway remodeling. Methods A total of 30 SPF grade female Balb/c mice were randomly divided into three groups:con-trol(group A),asthmatic(group B),and vasoactive intestinal peptide treatment(group C). Aerosolized ovalbumin was used to establish the asth-matic mice model. Pathological changes of bronchial and lung tissues were observed by HE,the perimeter of basement membrane(Pbm),internal wall area(WAi)and smooth muscle area(WAm)in bronchial lung tissue were analyzed using the pathological image. The expression levels of TGF-β1 mRNA and protein in lung tissue were detected by real-time PCR and Western blot. Results Pathologic changes including collagen deposition,in-filtration of inflammatory cells and smooth muscle layer thickness were found in group B. In addition,the WAi/Pbm and WAm/Pbm were significant-ly higher in group B than those of the group A(P<0.05),and lower in group C than in group B(P<0.05). The expression levels of TGF-β1mRNA and protein in group B were higher than both group A(P<0.05)and group C(P<0.05). Conclusion Vasoactive intestinal peptide may inhibit airway remodeling,which may be associated with reduced expression of TGF-β1.

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.

Necrotizing pneumonia is a severe complication of community-acquired pneumonia in children, with no clear deif-nition currently, characterized by parenchymal injury, necrosis and cavity formation. Streptococcus pneumonia is the most common pathogen;however a positive microbiology is not always obtainable. The clinical manifestation of necrotizing pneumonia is more seri-ous than ordinary pneumonia, and complications are common. Chest CT scan is helpful to early detection and diagnosis. Antibio-tics remain the mainstay of treatment, and the prognosis is relatively well.

Objective To investigate the effect of budesonide on NK-1 receptor expression in airway smooth muscle cell (ASMC). Methods According to the random method,45 wistar rats were divided into three groups: asthmatic group, budesonide treatment group and control group. Aerosolize ovalbumin was used to make asthmatic rat model. Budesonide treatment group were given budesonide after inhaled ovalbumin. On day 21 .primary rat ASMC culture was conducted. The fourth cell passage and purified ASMC was collected for RT-PCR. The content of NK-1R was determined by real-time quantitative PCR. Data were expressed as mean±standard error (SE). The ANOVE Tukey test was carried out by using SPSS17.0 software and P＜0. 05 was considered significant. Results As compared with that of asthmatic group(1.1687±0.1356),NK-1R mRNA in therapy group( 1.0820 ±0. 1146) decreased significantly (P ＜0.05) ,but remained still higher than that of control group(1.034 7±0.2503) (P＜0. 05). Conclusion NK-1R may be involved in the pathogenesis of asthma. Budesonide may down-regulate the expression of the NK-1R mRNA in the airway smooth muscle cell, which may inhibit inflammation in asthmatic attacks.