Clinical data of 28 cases of childhood bronchiolitis obliterans treated from September 2008 to November 2010 were retrospectively analysis.Pulmonary high-resolution CT (HRCT) showed that bronchial wall thicken was seen in all 28 patients,the mosaic pattern in 26 cases,patchy shadows in 18 cases,bronchiectasis with typical signet ring sign in 2 cases,atelectasis in 2 cases without pleural effusion.Pulmonary function tests and flexible bronchofiberscopy were performed in 6 cases,which showed the inflammation in bronchial tunica intima and obstruction of small airway.Blood routine,blood sedimentation,c-reaction protein,TORCH,hepatic function,renal function and immune function were normal.Patients received comprehensive treatment with methylprednisolone,clarithromycin and montelukast.The clinical conditions of 28 cases were improved with varying degrees after treatment and no significant side effects were observed.

Objective To discuss adhesion blocking experiment of vascular endotelial cells with platelets.Methods The expression,regulation and adhesion of CD226 on vascular endothelial cells incubated by sera from 10 PIH patients and 10 normal pregnant women repectively was detected by flow cytometry,then incubated with interacted platelets by PTA1/Ig protein.Results The positive rate of CD226 in PIH group was significantly higher than that in normal pregnant woman group(P

Purpose To evaluate features of the left ventricular twist in patients with atrial septal defect (ASD) using speckle tracking imaging (STI) in order to guide clinical application.Materials and Methods Fifty-eight patients with ASD confirmed by ardiac ultrasound in Shanghai Children's Medical Center from October 2015 to January 2016 were enrolled in this study as case group,which were further divided into group ASD-A with 30 cases and group ASD-B with 28 cases according to the volume of right ventricular.The volume of right ventricular was significantly increased in the group ASD-A,but the volume of right ventricular was not significantly increased in the group ASD-B.At the same time,30 normal children with matched age and sex were chosen as control group.The parameters of left ventricular twist motion in each group were measured and compared by using STI.Results In group ASD-A,The basal and apical part of 6 children rotated counterclockwise.Compared with those in the control group,the basal rotation angle and apical rotation angle of left ventricular in group ASD-A were significantly higher (P＜0.01),and the peak twist and torison of left ventricular in group ASD-A were also higher (P＜0.05).Compared with those in the control group,only the apical rotation angle in group ASD-B was higher (P＜0.05),but the rest parameters of the left ventricular twist motion in group ASD-B were not statistically significantly higher (P＞0.05).Conclusion The significant increase in the volume of right heart load in ASD impacts on the basal and apical rotation of left ventricular.

Objective To investigate the detection of IMP andVIM metallo-β-lactamases (MβLs)genes in clinically iso-lated gram-negative bacteria as well as bacterial resistance toβ-lactam antimicrobial agents.Methods 113 clinically isolated bacteria were performed antimicrobial susceptibility testing by Kirby-Bauer method ,drug-resistant genes IMP and VIM were detected by polymerase chain reaction (PCR),PCR products were sequenced and aligned with BLAST software. Results VIM gene was detected in 1 Pseudomonas fluorescens strain ,IMP gene was detected in 15 strains ,they were Klebsiella pneumoniae (n=6),Acinetobacter baumannii (n=3),Escherichia coli (n=2),Ralstonia picket-tii (n=1),Pseudomonas aeruginosa (n=1 ),Citrobacter amalonaticua (n=1 ),and Enterobacter cloacae (n=1 ). BLAST results showed that VIM gene was VIM-2 subtype,similarity with gene bank was 99%;all IMP genes were IMP-1 subtype,which were highly homologous ,similarity was 98%-99%.Resistant rates of IMP positive strains to ceftriaxone,cefotaxime,cefoxitin,aztreonam and imipenem were all significantly higher than negative strains (all P <0.05).Conclusion IMP genes of different strains are highly homologous,all are IMP-1 type,indi-cating that IMP genes are highly transmissible and can spread among different species of bacteria.IMP genes are related with resistance ofβ-lactam antimicrobial agents.

Kawasaki disease (KD) is an acute systemic small and medium vasculitis syndrome,which is most commonly found in children under the age of 5 years.The most severe complications of KD are coronary artery lesions (CAL),which will lead to coronary artery dilatation,myocardial infarction and sudden death.In the acute stage,severe clinical manifestations are associated with shock,and all organs could be involved,which is called severe Kawasaki disease (SKD),sometimes requiring treatment in the pediatric intensive care unit (PICU) have been reported.Although the clinical symptoms of children with SKD are severe,most patients can survive without any sequelae as long as they can be diagnosed accurately and treated rapidly.In recent years,scholars at home and abroad have paid more and more attention to SKD.Based on these,we take SKD as the research object,try to explain the progress of clinical diagnosis and treatment,which is beneficial to pediatric clinicians to accurately judge and treat related diseases.

Objective To summarize the clinical characteristics, diagnosis and surgical management experiences of 51 cases of pulmonary fungal infections. Methods The clinical data of 51pulmonary fungal infection patients hospitalized in department of thoracic surgery of PLA General Hospital from 1981 to 2008 were retrospectively analyzed. Results The recruited cases included three cases of Candida albicans, 22 of Aspergillus, and 26 of Cryptococcus. The clinical symptoms included cough, hemoptysis, fever, chest tightness, chest pain and asthma. Twenty cases were identified through routine healthy examination. Of chest X-ray and computed tomograply scan, 29 cases presented with solid nodules in the lung, some of which had burrs and spikes; 13 presented with pulmonary cavity with even wall thickness and smooth inner wall including 7 with aspergillar glomera.Forty-eight cases underwent standard thoracotomy operations and 3 cases underwent thoracoscope or thoracoscopy-assisted minithoracotomy. Seventeen underwent pulmonary lobectomies, and 34 wedge resections. There was no operative mortality in the 51 patients. All diagnoses were confirmed by postoperative pathology. There was no relapse during 3- 10 years of follow-up. Conclusions Primary pulmonary fungal infections lack characteristic presentations in clinical manifestations and imaging examinations. Pathology is the evidence for definite diagnosis. Surgical intervention is an effective tool for diagnose and treatment of this disease.

ObjectiveTo evaluate the feasibility and accuracy of velocity vector imaging (VVI) in assessing ventricular function in children with single ventricle after cavopulmonary connection.Methods Thirty children with single ventricle after cavopulmonary connection were enrolled in this study,30 agematched normal children were served as control group.The systolic peak velocity,displacement,strain and strain rate in this two groups measured in 6 segments by VVI were compared.dp/dt of single ventricle was estimated by atrioventricular regurgitation using simplified Bernoulli equation.Results Strain and strain rate were significantly lower in all 6 segments in children with single ventricle after cavopulmonary connection compared with values in normal children( P ＜0.05,respectively),strain rate of the basal segment at the rudimentary chamber correlated best with dp/dt (r =0.72,P ＜0.01).Conclusions Segmental ventricular dysfunction was observed in children with single ventricle after cavopulmonary connection,and could be assessed accurately using velocity vector imaging.

Objective To investigate the short axis systolic function of children with single-left ventricle(LV),and to appraise the clinical value of velocity vector imaging(VVI) on assessing it.Methods The study group consisted of 14 patients with single-LV.The control group consisited of 14 age-matched normal children.VVI was used to analyse the circumferential and radial strain and strain rate of regional single-LV at the level of papillary muscle.Results Compared with values in control group,single-LV circumferential strain values were significantly lower in anterior septum,posterior septum,anterior wall,lateral wall and inferior wall(all P ＜0.05).Single-LV circumferential strain rate values were significantly lower in anterior septum,posterior septum,anterior wall,lateral wall and posterior wall compared with controls(all P ＜0.05). In control group,circumferential strain and strain rate were higher in inferior septum and anterior septum compared with other segments( P ＜0.05).Single-LV radial strain values were significantly lower in all segments compared with values in control (P ＜ 0.05).In control group,radial strain and strain rate of papillary muscle level showed no significantly difference( P ＞0.05).Conclusions Circumferential and radial systolic ventricular function are impaired in children with single-LV.VVI can beused as a quantitative tool in evaluating the short axis systolic function of single-LV.

Objective To investigate the early risk factors of the formation of pancreatic pseudocysts after severe acute pancreatitis. Methods One hundred patients with severe acute pancreatitis admitted from Jul. 2005 to Mar. 2007 were included. Clinical and laboratory data within 24 hours of admission and radiological tests of chest, abdominal dynamic contrast-enhanced computed tomography and abdominal ultrasound within 3 days after admission were analyzed and multiple stepwise logistic regression analysis was performed. Results 30 patients developed pancreatic pseudocysts and the incidence of pancreatic pseudocysts in the clinical course of severe acute pancreatitis was 30%. There were significant difference between group A (pancreatic pseudocyst group) and group B (non-pancreatic pseudocyst group) in serum albumin[(33.23±4.810g/L vs (36.07±4.92)g/L], CT severity index (CTSI) (3~6 vs 2~4 points) ,length of hospital stay[(26.83±19.760) day vs (14.51±7.71) days, (P<0.05)]. Meanwhile, there were no significant differences between the two groups in age, gender proportion, body temperature, heart rate, breath rate and mean arterial pressure in admission,urine volume within 24 hours, early defaecation within 24 hours after admission, blood routine, liver function, kidney function, electrolytes, blood cholesterol and triglycerol, PT, APTr, arterial blood gas analysis, blood amylase, C-reaction protein, APACHE Ⅱ, RANSON scoring, early ascites and pleural effusion. But multiple stepwise logistic regression analysis showed that the serum albumin and CTSI were associated with the formation of pancreatic pseudocysts after severe acute pancreatids. Conclusions The serum albumin and CTSI were the independent risk factors of the formation of pancreatic pseudocysts after severe acute pancreatitis.

Objective To analyze the clinical characteristics,diagnosis and the surgical treatment experience of the pulmonary sequestration.Methods The clinical data from 26 patients with pulmonary sequestration undergoing surgical operation were reviewed and analyzed retrospectively.Results Pulmonary sequestration was diagnosed in 16 out of 26 patients before the operation with the diagnosis rate of 61.5%(16/26).Pre-operation chest X-ray and plain CT-scan were performed in 26 cases.Enhancement CT scanning and CTA imaging were performed in 8 cases, magnetic resonance imaging were performed in 5 cases.21 patients with intralobar sequestration underwent lobectomy and 8 patients with extralobar sequestration underwent local lesion resection.Abnormal supply arteries were intraoprat-ibely found in 21 cases originating from the thoracic main artery,3 cases from the celiac artery,2 cases from the dia-phragm artery.Smooth recovery was achieved in all patients.No peri-operative death occurred.Symptoms disappeared were followed-up for 6 months.Conclusion Enhancement CT scanning,CTA imaging and magnetic resonance ima-ging ( MRI) may improve the diagnosis of pulmonary sequestration.Operation is a safe and effective method for the treatment of pulmonary sequestration.But intraoperative abnormal blood supply arteries should be paid attention to the treatment and prevention of intraoperative and postoperative bleeding.