Chronic cough in children is one of the most frequent reasons for consultation in clinic. The high cough sensitivity in most patients with chronic cough is difficult for treatment. Capsaicin,as the most com-monly used material for the test of cough sensitivity,is widely used in clinic. Capsaicin provocation test is more mature in foreign country,while in our country there is a few scholars applying it with the adult who suffered chronic cough,but few with children. This article reviews the process,chemical structure,nerve conduction,clini-cal operation,influence factors and safety of capsaicin provocation test.

Objective To explore the change of 8-iso-prostaglandin F2α(8-iso-PGF2α),serum ferritin (SF) and superoxide dismutase(SOD) in serum from children with mycoplasma pneumoniae pneumonia(MPP) and severe mycoplasma pneumoniae pneumonia(SMPP),and investigate the correlation between the severity of lung injury induced by oxidative stress(OS) and the severity in children with SMPP.Methods Sixty cases with MPP,30 cases with SMPP and 20 health children were selected in our study.The level of 8-iso-PGF2α,SOD and SF in serum were detected.Results (1) There were no significant difference regarding of 8-iso-PGF2α levels between the MPP group and the healthy control group ((6.01 (13.14)) ng/L vs.4.33 (2.42)) ng/L,P ＞ 0.05).The 8-iso-PGF2α level in patient of the SMPP group was 24.20 (24.05)) ng/L,significantly higher than that in the healthy control group (P ＜ 0.01) and MPP group (P ＜ 0.01).(2) There were no significant difference between the MPP group μg/L] and the healthy control group in terms of SF level((80.91 (54.57) μg/L vs.(82.48 (70.60)) μg/L,P ＞ 0.05).The SF level in the SMPP group was 139.69 (120.98)) μg/L,significantly higher than that in the healthy control group(P ＜ 0.01) and MPP group(P ＜ 0.O1).(3) The level of SOD in the MPP group was 138.60(25.20)) kU/L,significantly higher than that in the healthy control group ((123.10(11.28)) kU/L; P ＜ 0.01).The level of SOD in the SMPP group was 94.43 (63.58)) kU/L,significantly lower than that in the healthy control group (P ＜ 0.05).And level of SOD in the MPP group was significantly higher than that in the SMPP group(P ＜ 0.01).Conclusion The severity of lung injury induce by OS was related with the severity of the children with SMPP.OS may be a important factor in patients with SMPP exacerbation of lung injury.

Objective To investigate the effect of inhaled corticosteroid (ICS) on lung function and inflammatory mediators in cough variant asthma (CAV).Methods Fifty patients with CVA were randomly divided into group A (n =30) and group B (n =20),and 20 normal cases were recruited as healthy group (group C) in this study.All the cases were given a lung function test,bronchial dilation test(BDT) and serum levels of inflammatory mediators(interleukin(IL)-5,IL-8 and IL-10) assessment.The cases in group A were given longterm ICS intervention therapy of inhaled budesonide aerosol at dose of 200 μg/day with 6 months' follow-up period.The cases in group B and C were given salbutamol and symptomatic treatment if necessary.Assessment about lung function (forced vital capacity (FVC),1 s forced expiratory volume (FEV1),peak expiratory rate (PER) and maximum mid-expiratory flow rate(MMEF)),BDT,and inflammatory mediators in all groups were performed before and after treatment.Results (1) Lung function:before treatment,the level of FVC,FEV1 and PEF in three groups were not significantly different (P ＞ 0.05).MMEF in group A and B is significantly lower than that in group C (F =58.40,P ＜ 0.05).In group A,MMEF was significantly improved (P ＜ 0.05,P ＜ 0.01) after 3 and 6 months ICS treatment.In group B,MMEF was not statistical improvement compared with before treatment(P ＞0.05).The BDT positive rate in group C was significantly lower than that in group A and B.The BDT positive rate in group A decreased after ICS treatment for 3 and 6 months.Meanwhile,the BDT level decreased as the longer treatment.In group B,there was no statistical decrease in terms of BDT positive rate(P ＞0.05).(2)Inflammatory mediators:in group C,the serum levels of IL-5 and IL-8 were lower than those in group A and B,but the level of I L-10 was higher than it in the other two groups(P ＜0.05).After 3 and 6 months ICS treatment,the serum levels of IL-5 and IL-8 were significantly decreased and the level of I L-10 was increased.The longer course was given,the more obvious change they have.There was no statistical difference in group B after 3 to 6 months treatment.It was statistical difference between group A and group B after 3 to 6 months treatment (P ＜ 0.05).Conclusion ICS treatment can significantly improve lung function and inflammatory mediators in patients with cough variant asthma.The better improvement will get if the longer treatment is given.

Objective:To investigate the distribution and characteristics of serum allergen specific IgE (sIgE) in children in Tianjin from June 2015 to April 2019.Methods:The fluorescence enzyme linked immunosorbent assay results (obtained by UniCAP system) of serum allergen sIgE of 5 823 children aged 1-14 in Tianjin area were analyzed.The distribution of serum allergen sIgE and its correlation with the gender, disease type, age and season were discussed.Results:(1) Among the 5 823 cases, 3 602 cases (61.86%) were positive for serum allergen sIgE, including 1 556 cases (43.20%) positive for single airborne allergens, 779 cases (21.63%) positive for single food allergens, 1 267 cases (35.17%) positive for both food and airborne allergens.(2) The top 5 airborne allergens were moulds (33.02%), dermatophagoides farinae (27.21%), dermatophagoides pteronyssinus (24.28%), mugwort (21.64%) and ragweed (17.32%). (3) Food allergens were mainly egg white, milk and wheat, whose positive rates were 27.06%, 25.59% and 20.00%, respectively.(4) The positive rate of serum allergen sIgE in boys (64.02%) was significantly higher than that in girls (57.93%) ( χ2=20.94, P<0.05). (5) The positive rate of serum allergen sIgE in children with asthma (73.18%) was significantly higher than that in children with allergic rhinitis (59.82%)( χ2=64.51, P<0.05) and eczema (51.60%) ( χ2=40.04, P<0.05). The main airborne allergens in children with asthma included moulds, dermatophagoides farinae, dermatophagoides pteronyssinus, wheat and peanut.The main allergens in children with allergic rhinitis were moulds, egg white, wheat, mugwort and dermatophagoides farinae.The main allergens in children with eczema were egg white, milk, moulds, dermatophagoides farinae and dermatophagoides ptero-nyssinus.(6) With the increase of age, the positive rate of airborne allergens increased gradually.In food allergens, the positive rate of milk and egg white decreased gradually while that of wheat and peanut increased gradually with the increasing age.(7) In different seasons, the positive rate of allergen sIgE was varied.The overall positive rate was highest in summer(66.59%), followed by autumn(64.15%), spring(62.07%), and winter(54.63%) successively( χ2=49.38, P<0.05). Among the airborne allergens, the positive rates of dermatophagoides farinae and dermatophagoides pteronyssinus were the highest in summer and autumn[dermatophagoides farinae(32.25%, 30.17%); dermatophagoides pteronyssinus(30.40%, 27.54%)]. The positive rate of moulds was the highest in summer(45.41%), followed by autumn(36.19%). The positive rate of blattella germanica was the highest in summer(5.52%). The positive rates of cat dander, animal dander combination, artemisia argyi and weeds pollen combination were higher in autumn(33.33%, 13.94%, 24.84%, 19.88%). Conclusions:Moulds, dermatophagoides farinae, dermatophagoides pteronyssinus, egg white and milk are the most common allergens in children in Tianjin.The distribution of allergens is correlated with the gender, disease type, age and season.

A case of Mycoplasma pneumoniae (MP) pleural effusion in the Department of Pediatrics, the Second Hospital of Tianjin Medical University at May 2019 was analyzed retrospectively.The female child was 12 years old, with abdominal pain as the onset of symptoms, accompanied by fever." Gastrointestinal tract infection" symptomatic treatment did not relieve it.Before being admitted to the hospital for dyspnea, combined with physical examination, imaging studies revealed pleural effusion.Laboratory tests supported MP infection, and the course of the disease always lacked obvious manifestations of pulmonary infection.The combination of Azithromycin and Meloxicillin/Sulbactam anti-infective treatment was ineffective, and the temperature was stable after changing to oral Moxifloxacin, and the pleural effusion was rapidly absorbed after oral glucocorticosteroids, without recurrence after 6 months of follow-up. It is suggested that MP infection in children can lead to pleurisy and unilateral pleural effusion, which can have abdominal pain and fever as the main symptoms, and can be changed to quinolones according to individual condition when conventional macrolides are resistant.

Objective To discuss the effects of triangle limited fixation by Russian external fixator for proximal and distal tibiofibular fractures. Methods From December 2005 to December 2007, 54 patients with tibiofibular fractures were managed with close reduction and triangle limited fixation by Russian external fixator. They were 48 males and 6 females, aged from 18 to 54 years (average, 34 years). By AO classification, there were two cases of type 41-C3 (one complicated with type 43-B2 and one with type 43-A3), 17 cases of 42-A, 13 cases of 42-B, 12 cases of 42-C, 5 cases of 43-B, and 5 cases of 43-C.Twenty-six cases were open injury (by Gustilo classification, type Ⅱ in 13, type ⅢA in 10, type ⅢC in 3),and 28 closed injury (by Tscherne classification, grade Ⅰ in 8 and grade Ⅱ in 20). Results Follow-ups of 50 patients revealed that the fractures healed from 2 to 6 months (average, 3 months). Swelling subsided in just one week in the 28 patients with close injury. Of the 26 patients with open injury, 24 obtained primary healing of wounds, one obtained wound healing 4 weeks after changes of dressing, and one suffered amputation. No malfunctions were found in this group. One case had nonunion which was healed after change to single-ann external fixation. Conclusion Triangle limited fixation by Russian external fixator can be applied in the treatment of complex tibiofibular fractures.

Objective To investigate the potential role of respiratory syncytial virus (RSV) in wheezing episode in children, and to assess the association of the thromboxane A2 receptor gene (TBXA2R) T924C polymorphism with wheezing after RSV infection. Methods From may to december in 2008, one hundred and twenty-five asthmatic children who were suffering from acute episode were recruited as cases and 49 healthy children as controls in our Polymerase chain reactions-Restriction fragment length polymorphism (PCR-RELP) techniques were used to detect the TBXA2R SNP. RSV IgM and IgG were measured by ELISA. Results RSV specific antibody was positive in 57 asthmatic patients (45.6% ,57/125) and 8 controls (16.33% ,8/49) ,with significant difference between the two groups ( χ2 = 12. 890, P = 0. age asthmatic group and 76. 92% (30/39) in the <3 years of age asthmatic group, with significant difference between the two groups (χ2 = 22. 420, P = 0. 000 ). The genotypes distribution in the asthmatic patients was significantly different from that in the controls(χ2 = 5. 346, P = 0. 021). The frequency of TC and CC genotypes in the cases was significantly higher than that in the control group. The allele frequencies of T and C allele were similar in the two groups ( χ2 =2.660, P=0.103). Conclusions RSV infection was one of the factors that associated with asthma acute episode, especially in children younger than 3 years. The TC,CC genotypes increase the chance of wheezing in children infected by RSV.

Objective To evaluate the prognostic factors of predicting the outcome of Graves disease (GD) after treatment with antithyroid drugs.MethodsA retrospective audit was performed for 306 consecutive patients with newly diagnosed GD.They were divided into successful and failure groups (including recurrent and non-stop subgroups )according to the treatment outcomes.Different prognostic factors after treatment with antithyroid drugs were compared and the state of thyrotropin suppression was observed as the euthyroid state at Months 3,6 and 12 respectively.ResultsAmong them,141patients (46.1％ ) were cured and 165 patients (53.9％) had treatment failures.Age at the time of diagnosis was (46 ±10) years in the successful group and (36 ±9) years in the failure group(t =3.152,P =0.002).Free T3 ( FT3 ) was (25.2 ±8.9) and ( 18.7 ±9.4) pmol/L in the failure and successful groups respectively (t =3.326,P =0.001).The FT3 to FT4 ratio and thyrotrophin receptor antibody (TRAb) levels were higher in the failure group ( t =3.331,3.389,P =0.001).Logistic regression analysis showed that thyroid size,FT3 to FT4 ratio and TRAb at the time of diagnosis were associated with failure outcomes.The ratio of continuing thyrotropin suppression in the recurrent subgroup was more than that in the successful group ( X2 =77.515,114.441,136.232,all P ＜ 0.01).ConclusionsThe GD patients with a large thyroid size and high pre-mediation levels of TRAb and FT3 to FT4 ratio are more prone to respond unfavorably to antithyroid drug treatment.And those with a large thyroid size and post-medication ophthalmopathy and continuing thyrotropin suppression have a high rate of recurrence.

Both dysfunction of pancreatic β cells and β cells apoptosis were important factors contributing to type 2 diabetes. Abnormal glucose and lipid metabolism all existed in type 2 diabetes .With the study further progressing, more and more attention were paid to pancreatic β cells apoptosis accelerated by abnormal lipid metabolism. The literature about β cells injury by lipotoxicity, apoptosis induced factors accompanied by free fatty acids, and relevant mechanism was reviewed in this article.

Objective To investigate the influence to airway responsiveness by using low dose azithromycin in asthmatic children.Methods One hundred and four children with moderate persistent or severe persistent asthma were divided into Group A (include 56 cases) and Group B (include 48 cases) randomly.All of the patients were treated with seretide (50/100 μg/dose) 2 doses/d for4 weeks.Children with severe persistent asthma were added with montelukast 5 mg/d orally,children accompanied with allergic rhinitis were added with nasonex 100 ～200 μg/d intranasal.And four weeks later,all of the patients were given a 12-week observation.Group A kept on treating with seretide (the same dose as before),and azithromycin 7.5mg/ (kg·d) (the maximal dose was 250 mg/d) orally was administered intermittently twice a week.Group B kept on treating with seretide ( the same dose as before) only.At the end of the study,we assessed the number of days with asthmatic symptoms in two groups respectively.At the beginning and the end of the study,we measured the forced expiratory volume in one second (FEV1 ％ ),peak expiratory flow (PEF％),the PD20-FEV1 by histamine challenged at the 15 th day and at the end of the study in two groups.Twenty-four hours before the study and twenty-four hours after the study,we measured the 24-hour urinary 17-OHCS and 17-KS of the patients.Two weeks after the study,we measured the serumal ALT and AST of the patients.Results ( 1 ) The number of days with asthmatic symptoms was ( 2.13 ± 1.18 ) d and ( 2.25 + 1.19 ) d respectively in Group A and B,and there was no significant difference between two groups ( t =0.54,P=0.59).(2) The PEF％ before and after the study in Group A was (49.77 ± 15.02)％ and (82.73 ±7.81 ) ％ respectively ( t =16.59,P =0.000).The PEF％ before and after the study in Group B was (52.69±13.90)％ and (81.15±7.28)％ respectively (t=12.37,P=0.000).The FEV1％ before and after the study in Group A was (50.48 ± 15.08 ) ％ and ( 83.18 ± 6.61 ) ％ respectively ( t =16.25,P =0.000).The FEV1 ％ before and after the study in Group B was ( 53.29 ± 13.89 ) ％ and ( 82.73 ± 6.10 ) ％ respectively (t=12.83,P=0.000).(3) The PD20-FEV1 at the 15 th day and at the end of the study in Group A was (65.13 ±26.08) μg and (460.79 ±221.72) μg respectively (t =13.54,P =0.000).The PD20-FEVt at the 15th day and at the end of the study in Group B was ( 65.27 ± 25.75 ) μg and (65.66 ± 25.09 ) μg respectively (t =1.45,P =0.15).Compared the PD20-FEV1 between the two groups,there was significant difference at the end of the study (t =13.29,P =0.000).(4) The 24-hour urinary 17-OHCS was (14.27 ±3.41)nmol/L and (14.43 ±3.69) nmol/L respectively of Group A and was (14.31 ±3.66)nmol/L and ( 14.56 ± 3.37 ) nmol/L respectively of Group B before and after the study,and there was no significant difference between Group A and Group B.The 24-hour urinary 17-KS was ( 22.43 ± 5.69 ) nmol/L and (22.07±5.21 ) nmol/L respectively of Group A and was (22.40±5.04) nmol/L and (22.54 ±4.74)nmol/L respectively of Group B before and after the study,and there was no significant difference between Group A and Group B.(5) The serumal ALT of Group A and B measured 2 weeks after the study was (20.39± 9.12) U/L and ( 20.83 ± 7.83 ) U/L respectively ( t =0.26,P =0.79 ).The serumal AST of Group A and Group B measured 2 weeks after the study was (20.68 ±8.67) U/L and (21.44±8.60) U/L respectively (t =0.45,P =0.66 ).Conclusion It can significantly decrease the bronchial hyperreactivity of asthmatic children treated with low dose azithromycin orally for 12 weeks and seretide inhaled,but it can not decrease the number of days with asthmatic symptoms in the patients,can not improve the FEV1 and PEF significantly.There wasn't any influence on adrenal glands.function and liver function of the patients.