The clinical value of applying portal vein resection and reconstruction in left trisectionectomy for treating advanced hilar cholangiocarcinoma is approved, while it is still a big challenge for clinicians. One female patient suffering from abdominal pain and jaundice received treatment in the General Hospital of PLA in July, 2009. She was prelimiarily diagnosed with Bismuth type Ⅲ a hilar cholangiocarcinoma. A tube was inserted in the left lateral inferior bile duct to carry out percutaneous transhepatic biliary drainage (PTBD). After the anatomic variation of the left bile duct was found, the diagnosis was revised as Bismuth type Ⅳ. A left trisectionectomy was proposed, and another PTBD tube was inserted in the right posterior bile duct.Combined portal vein resection and reconstruction and left trisectionectomy was successfully performed. The postoperation course was uneventful, except for the transient liver dysfunction and biliary-enteric anastomotic leakage.

Objectives To explore the effects of nasopharyngeal bacterial colonization in children with acute bronchiolitis due to respiratory syncytial virus (RSV).Methods Hospitalized children of acute bronchiolitis were enrolled to detect pathogen and bacterial colonization.Their clinical data and laboratory results were collected and analyzed.Cases of elective surgery were also obtained as control group.Results Fifty-five percent of all children with bronchiolitis had a lower positive rate of nasopharyngeal bacterial culture (55.0％ vs.74.1％,P ＜0.01).Children with nasopharyngeal bacterial colonization had a higher rate of severe bronchiolitis (13.8％ vs.4.2％,P =0.018),presented dyspnea more frequently (19.8％ vs.9.5％,P =0.037) and had a longer hospital duration (8.2 vs.7.5 days,P =0.036) as compared with those without bacterial colonization.In terms of laboratory results,a higher proportion of C-reactive protein was found in children with bacterial colonization than those with non-bacterial colonizations (17.2％ vs.4.2％,P =0.003).Conclusion Bacterial colonization may be a predictor for severe bronchiolitis.

Objectives To investigate the significance of electronic bronchoscopy and bronchoalveolar lavage in diagno-sis and treatment in children with pulmonary mass lesion. Methods A total of 74 hospitalized children from January 2011 to June 2012 whose imaging examinations showed massive patchy shadow were examined and treated by electronic bronchoscopy and bronchoalveolar lavage. Their clinical data were retrospectively analyzed. Results The major cause for the massive shadow was infection according to electronic bronchoscopy examination (68/74, 91.89%), 65 cases of them were lobar pneumonia, 3 cas-es were pulmonary tuberculosis followed by 5 cases of foreign body (6.76%) and one case of pneumorrhagia (1.35%).The lower left lung was the most frequently seen site of infection, followed by lower right lung. The agreement between infection sites and imaging examination was 97.30%. Bronchoalveolar lavage fluid showed that the primary pathogen of lobar pneumonia infection is Mycoplasma pneumoniae (MP) (42/65, 64.62%). The highest detection rate of MP was found in preschool group and the detec-tion rate between different age groups indicated statistically significant difference (P<0.01). The imaging examination showed pulmonary lesions in 61.54%children with lobar pneumonia improved significantly in one week. The improvement rate of pul-monary lesions was higher in infected children with short duration (1-2 weeks, 90.91%) between disease onset and electronic bronchoscopy inspection than those with longer duration (2-3 weeks, 51.72% and >3 weeks, 35.71%) (P<0.05). Conclusions Electronic bronchoscopy and bronchoalveolar lavage play dual roles in etiological diagnosis and therapy in children with pulmo-nary mass lesion.

Aim To evaluate the mucosal-protective effects of carboxymethylpachyman( CMP) on Fluorou-racil(5-Fu)-induced mice intestinal mucositis and ex-plore its mechanisms. Methods ICR mice were as-signed randomly to four groups:normal group( n=8;re-ceiving pure water orally for 14 d) ,CMP group( n=8;200 mg·kg-1 CMP for 14 d orally),5-Fu group(n=8;25 mg·kg-1 5-Fu for 7 d,intraperitoneally( i. p. ) , and CMP+5-Fu group( n=8;200 mg·kg-1 CMP for 14 d orally and 25 mg·kg-1 5-Fu for 7 d,i. p. ). At day 14the mice were sacrificed. The intestinal propel-ling rate and the colon length were measured. ROS, GSH and IL-1βcontents,and CAT,GSH-Px activities in homogenate supernatant of PPs were measured by kits for observing the effects of CMP on mice lipid peroxida-tion and intestinal mucosal inflammatory induced by 5-Fu. Colon tissues were used for hematoxylin and eosin ( HE ) staining for the determination of the effect of CMP on mice colon histopathology, immunohistochem-istry for the protein levels of NF-κB and p-p38 . Results CMP significantly extended colon lengths,accelerate the intestinal propelling rates, reduced colonic mucosa epithelium goblet cell loss, inflammatory cells infiltra-tion,and crypt depth shallow induced by 5-Fu. CMP obviously reduced ROS and IL-1β contents, and pre-vented reductions in homogenate supernatant of PPs GSH content, CATand GSH-Px activities by 5-Fu ad-ministration,and also reduced the expression of NF-κB and p-p38 in colon tissues. However, CMP alone had no effect on the colon of normal mice. Conclusion The current study demonstrates that CMP may have sig-nificant protective effects against 5-Fu-induced intesti-nal mucositis. Its mechanism may be related to enhan-cing the antioxidant activity,anti-inflammatory and an-ti-apoptotic effects.

Objective To study the characteristics of etiology of lobar pneumonia in hospitalized children.Methods Medical history and sputum specimens were collected from 1 179 hospitalized children with lobar pneumonia from January 2006 to December 2015.Multiple pathogenic joint detection combined with the history data were used for analysis.Seven kinds of common respiratory virus were detected by direct immunofluorescence.Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP) and human Bocavirus (hBoV) were detected by fluorescence quantitative polymerase chain reaction (PCR).Human Rhinovirus (HRV) and human Metapneumovirus (hMPV) were detected by reverse transcription PCR.Aspirates were cultured for bacteria.MP specific antibody IgG and IgM were tested by enzyme-linked immunosorbent assay (ELISA).Positive rates of each group were compared by χ2 test or Fisher exact test.Results Total etiology detection rate of lobar pneumonia in hospitalized children was 83.9% (989/1 179).The etiology detection rate of MP, virus, bacteria and streptococcus pneumoniae (SP) were 74.0%, 14.2%, 18.3% and 12.2%, respectively.The virus detection rate in 1-3 years old group was the highest, and that in ≥6 years old group was lower than other group (χ2=70.095, P<0.01).The MP detection rate increased with age (χ2=119.777, P<0.01).The bacteria detection rate in ≥6 years old group was significantly lower than those of <1 years old group, 1-3 years old group and 3-6 years old group (χ2=8.939, 14.319, 45.738, all P<0.01).The detection rates of total virus, MP, bacteria and mixed infection had no statistical difference in the four seasons (all P>0.05).The MP detection rate was above 70% in every season.The detection rates of SP and hBoV were basically the same in every season.The detection rate of HI was higher in spring, Pinf 3 and SA were higher in summer, HRV was higher in autumn, and respiratory syncytial virus (RSV) and moraxella catarrhalis (MC) were higher in winter.Conclusions Lobar pneumonia occurs more common in elder children.MP is the major pathogen of lobar pneumonia, and SP is the second.The MP detection rate increases with age.The pathogen detection rate varies with age, but the effect of seasonal factor is not obvious on pathogen detection in lobar pneumonia.

Objective To explore the level of expression, clinical signiifcance of sB 7-H 3 in the bronchoalveolar lavage lfuid (BALF) of refractory Mycoplasma pneumoniae (MP) pneumonia (RMPP) in children and the relationship between sB7-H3 and various cytokines. Methods The BALF of forty-three hospitalized children with RMPP (RMPP group) were collected for the diagnosis and treatment. Thirteen cases were lavaged only once and the other thirty cases had collected the BALF twice. The BALF of iffteen hospitalized children with bronchial foreign body were collected as control group. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF were detected by enzyme-linked immunosorbent assay. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF at the acute phase were compared with control group and the group after treatment. Analyzed the correlation between the level of sB 7-H 3 and IL-1β, IL-2 , IL-36 in the BALF of RMPP children at acute stage. Results The levels of sB 7-H 3 , IL-1β and IL-36 in the BALF of the ifrst lavage group were higher than those of single lavage group and control group (all P<0 . 05 ). The levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF of single lavage group were higher than those of control group (all P<0 . 05 ). The levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF of the second lavage group were lower than those of the ifrst lavage group (all P<0 . 05 ).The levels of sB 7-H 3 , IL-2 in the BALF of the second lavage group were higher than those in the control group (both P<0 . 05 ), but the levels of IL-1β, IL-36 in the BALF showed no difference between the second lavage group and the control group (both P>0 . 05 ). The levels of sB 7-H 3 had positive correlation with the levels of IL-1β, IL-2 and IL-36 (all P<0 . 001 ). Conclusions sB 7-H 3 may control the secretion of IL-1β, IL-2 and IL-36 , and participate in immune response and lung injury after MP infection, which may lead to occurrence and development of RMPP.

Objectives To compare the clinical features between rhinovirus and respiratory syncytial virus infection in lower respiratory tract in children. Methods From December 2012 to May 2013, direct immunofluorescence assay was per-formed to test RSV in 1 037 nasal aspirate specimens with LRTIs. RT-PCR method was used to test HRV RNA. The medical re-cords of patients with a positive test of HRV or RSV were reviewed and compared. Results The isolating rate for HRV and RSV was 8.78%(91/1 037) and 17.16%(178/1 037) respectively. The frequency of co-infection of HRV with other virus was 18.68%, higher than that of RSV (7.30%,χ2=7.867, P=0.005). The age distribution had significant difference between children infected with HRV and RSV (Z=5.40, P<0.001). 78.38% patients with HRV infection were younger than 3 years old, and 83.03%patients with RSV infection were younger than 1 year old. Dyspnea, hyoxemia and wheezing were more common in pa-tients with RSV infection. Admission occurred much later in the course of the HRV infection (P<0.01). Leukocytosis, eosinophi-lia, and an elevated total serum IgE were more common in patients with HRV infection (P<0.05). Conclusions HRV is one of the important causes of LRTIs in Suzhou. The susceptible population, clinical presentation and laboratory results of HRV infec-tions are different from that of RSV infections.

Objective To analyze the correlation between response to hepatitis B virus (HBV) vaccine and cellular immunity and clinical characteristics in children with respiratory infection.Methods Nine hundred and sixty children in Department of Respiratory in Children's Hospital of of Soochow University,who were over 7 months old and had full course of HBV vaccination between January and December 2015 were enrolled in this study.Peripheral blood (1-2 mL) was collected,and antigen-antibody of HBV was detected by using enzyme-linked immunosorbent assay and PCR included HBV surface antigen,hepatitis B antibody,HBV e antigen,HBV e antibody,HBV core antibody,and HBV nucleic acid.According to the results,these children were divided into 4 groups:non response group,low response group,normal response group and high response group according to their responses to HBV vaccine.Cellular immunity was detected by using flow cytometry and patients' clinical data was collected.Results There was no statistical differences of CD3 + CD4 +,which were (3.43 ± 0.28) ％,(3.42 ± 0.30) ％,(3.43 ± 0.36) ％ and (3.52 ± 0.29) ％,among the four groups (F =0.520,P =0.669).CD3 + CD8 + in non response group was (3.18 ±0.28)％,which was significantly higher than that in low response group,normal response group and high response group [(3.08 ± 0.36)％,(3.05 ±0.34)％,(2.93 ±0.30)％],the differences were significant (all P＜0.05);CD4/CD8 in non response group (0.26 ± 0.43) were significantly lower than that in normal response group (0.40 ± 0.50),the differences were significant (P =0.001).There was no significant difference of CD3 +,CD3 + CD8 + and CD4/CD8 among low response group,normal response group and high response group (all P ＞ 0.05).CD3-CD19 + and CD19 + CD23 + level were lowest in non response group [(3.00 ± 0.57) ％,(2.25 ± 0.67) ％] and highest in high response group [(3.33 ± 0.45) ％,(2.57 ± 0.38) ％],the differences were significant (all P ＜ 0.05).Among the 4 groups,children in normal response group had the shortest average hospitalization days [(1.88 ±-0.31) d],which was significantly shorter than that in non response group,low response group and high response group [(1.96 ± 0.39) d,(1.95 ± 0.38) d,(1.96 ±0.15) d],the differences were significant (all P ＜0.05),there was no significantly difference of average hospitalization days among other 3 groups (all P ＞ 0.05).Proportion of severe pneumonia was significantly higher in non response group [6.1％ (22/363cases)] and high response group [13.3％ (2/15 cases)] compared to those in normal response group [2.6％ (7/274cases)],the differences were statistically significant (x2 =4.417,P =0.036;x2 =5.476,P =0.019).The total white blood cell number was lowest in non response group (F =4.695,P =0.003).Platelet number was increased with higher degree of response to HBV (F =6.598,P ＜ 0.001).Conclusions Cellular immunity is lower in respiratory infection children with non response or low response to HBV vaccine.After they have respiratory infection,children with non response to HBV vaccine may have a longer course of disease and worse condition.

Objective To explore the influence of coinfection with other pathogens on human metapneumovirus (hMPV) infection in children.Methods A total of 11 299 children admitted to the Department of Respiratory Disease,Children's Hospital of Soochow University between June 2010 and May 2015 were enrolled in this study.Sputum specimens were collected and multiple pathogenic joint detection was done,including peripheral blood,and blood routine,C reactive protein (CRP),hepatic function and cellular immunity.Patients' clinical data were collected.Results Among 11 299 hospitalized children,hMPV was positive found in 222 children (1.96％).One hundred and fourteen children (51.4％) had hMPV simple infection and 108 cases of them (48.6％) were coinfected with other pathogens.The hMPV coinfected with bacteria (63 cases,28.4％)was most common.The average age of multiple coinfected children was older than that of simple hMPV infection in children [(2.43 ± 2.47) years old vs.(1.27 ± 1.30) years old],and the difference was significant (Z =-2.360,P ＜ 0.05).Fever seemed to be more common in children coinfected with bacteria or multiple coinfection (63.5％ and 70.0％) compared with those with simple hMPV infection (43.0％),and the differences were significant (x2 =6.827,4.986,all P ＜ 0.05).There was no significant difference in other clinical features among 5 groups (all P ＞ 0.05).Multiple coinfection children had a higher percentage of neutrophils (0.50 ± 0.18) than that in simple hMPV infection children (0.37 ± 0.19),children coinfected with bacteria (0.39 ±0.19) or other virus (0.35 ±0.19),and the differences were significant (all P ＜0.05).CRP was elevated in 30.2％ (19/63 cases) of children coinfected with bacteria,which was significantly higher than that of simple hPMV infection children (16.7 ％,19/114 cases),and the difference was significant (x2 =4.381,P ＜ 0.05).CD3 + CD4 + was significantly lower in multiple coinfection children (0.31 ± 0.07),but there were no significant difference compared with other groups (all P ＞ 0.05).CD19 + CD23 + was significantly higher in children coinfected with other virus com pared with that of simple hMPV infection group,hMPV coinfected with bacteria,hMPV coinfected with Mycoplasma pneumonia and multiple coinfect group (0.37 ± 0.10 vs.0.30 ± 0.09,0.30 ± 0.08,0.29 ± 0.07,0.29 ± 0.09),and the differences were significant (all P ＜ 0.05).Conclusions It is suggested that hMPV seems easily coinfected with other pathogens,especially with bacteria.It should be on high alert that bacteria coinfection is accompanied with high percentage of neutrophils and high level of CRP.Coinfection does not significantly exacerbate the clinical symptoms of hMPV infection,but may exacerbate the cellular immune disorders to a certain extent.

Objective To analyze the epidemiological characteristics of Mycoplasma pneumoniae (MP) infection in children with respiratory tract diseases ,and to provide scientific basis for clinical diagnosis and treatment and to formulate control measurements for the administrative department of public health .Methods Sputum specimens of 20 021 cases of hospitalized children with respiratory tract diseases from October 2005 to December 2014 in Suzhou were collected .MP DNA was detected by fluorescence quantitative polymerase chain reaction .At the same time ,venous blood was collected within 24 h after admission and 7-10 d of treatment .Specified MP antibodies IgG and IgM were tested by enzyme-linked immunosorbent assay to analyze the detection rate of MP . The positive rates between groups were compared using chi-square test or Fisher exact test .Measurement data were compared using Wilcoxon test .Results The MP infection rate was 36 .08% (7 224/20 021 cases) in 20 021 children .The MP infection rate of girls was 40 .81% (3 057/7 490) ,which was significantly higher than that of boys (33 .25% [4 167/12 531] ,χ2=116 .20 ,P<0 .01) .The MP infection rates of children at the age of less than six months ,6 months to 1 year old ,1-3 years old ,3-7 years old and older than 7 years old were 18 .35% ,29 .39% ,43 .93% ,54 .10% and 64 .48% ,respectively ,which increased with age (χ2 =1 949 .65 , P<0 .01) .The MP infection rates in spring ,summer ,autumn and winter were 31 .97% ,41 .57% , 40 .88% and 29 .90% , respectively . The MP infection rate of children in summer and autumn was significantly higher than that in spring and winter (χ2 =234 .61 , P<0 .01) .The MP infection rate was highest in the autumn of year 2008 (55 .07% ) and lowest in the spring of year 2010 (18 .48% ) for the decade .The MP infection rate showed fluctuations with different degrees in four seasons except in 2007 . In the past ten years ,the MP infection rate in Suzhou area was at a higher level in 2008 ,2009 ,2012 and 2013 ,which were 46 .03% ,46 .60% ,39 .28% and 47 .40% ,respectively .The MP infection rate was the lowest (25 .24% ) in 2011 in the decade ,and maintained around 30% in the rest years .Conclusions The MP infection rate in children with respiratory tract diseases is at a high level in Suzhou area .The MP infection rate of girls is higher than that of boys .MP infection could occur among all age groups ,and the MP infection rate increases with age .MP infection rate peaks in summer and autumn .MP infection has a small prevalence every two or three years ,which could sustain about two years .