Objective To evaluate efficacy and safety of transcatheter patent ductus arteriosus(PDA) closure compared with mini-incision transthoracic occlusion in children.Methods The safety and complications of 175 patients who underwent transcatheter closure(transcatheter group) hospitalized in Department of Pediatrics,Linyi People's Hospital were analyzed,the ages ranging from 3 months to 14 years,and the material used was Chinese homemade occluder except for the spring coil.Compared with the 157 patients who underwent mini-incision transthoracic occlusion (mini-incision group) hospitalized in Department of Heart Surgery,Linyi People's Hospital from Jan.2009 to Nov.2013,the ages ranging from 5 months to 14 years,the material used was same as the transcatheter group.Acquired data was processed through statistics.Results One hundred and seventy-one of the 175 patients achieved success in the transcatheter group,technically success rate was 97.71％,there were 8 patients with complications,but no death,the occurrence rate of complications was 4.57％ ;however,137 of 157 patients achieved success in the mini-incision group,technically success rate was 87.26％,there were 21 patients with complications and 1 death,the occurrence rate of complications was 13.38％.Success rate of the transcatheter group was much higher than the mini-incision group(x2 =8.05,P ＜ 0.01),while complications of the transcatheter group was significantly less than the mini-incision group(x2 =13.48,P ＜ 0.01),and also the transcatheter group had less hemorrhage during operation,shorter operation time,shorter hospital stay and less hospital expenses compared with the mini-incision group [(0.021 ± 0.007) L vs (0.088 ± 0.027) L,(36.81± 7.19) minvs (88.65 ±27.92) min,(4.16±0.45) dvs (10.68 ±2.38) d,(27 943.6± 2754.1) RMBvs(35037.4±8659.2) RMB;t=29.23,22.19,33.44,18.47,allP＜0.01].Conclusions Transcatheter PDA closure in children is better than mini-incision transthoracic occlusion because of its higher efficacy and lower risk,so it is the first choice of treatment to the children with PDA.

Objective To explore the application of the automatic bone age assessment of BoneXpert software in Children and adolescent of China (Shanghai).Methods Left hand and wrist radiographs of 434 cases of children from trauma (264 boys and 170 girls) were obtained from Jan.2010 to Dec.2013.Bone age was assessed by BoneXpert software and 40 radiographs were randomly chosen and re-evaluated after a week.Results Seven images were rejected by BoneXpert,so the efficiency of the software was 98.4％ and it takes only 14.5 s for every image.Sample assessments by two times are exactly the same.As to BoneXpert software,there were statistical differences between bone age and chronological age in 8 groups:7,8,9,11 years old boys and 2,3,9,11 years old girls(P ＜ 0.05) out of 26 groups,and the average difference was about 1 s.The following modifications suggested that 0.57,0.79,0.93,-0.38 and-0.22,0.30,0.37,0.59 years could be added respectively for the groups of boys aged 7,8,9,11 and girls aged 2,3,9,11 years old according to their average differences between the bone age and the chronological age.Conclusions The BoneXpert method for automated determination of skeletal maturity which evaluates bone age objectively and quickly can be applied clinically after slight adjustment in some age groups.BoneXpert software is 100 percent automatic and could eliminate the subjective evaluation inaccuracy.

Objective To observe the effect of nasal continuous positive airway pressure (nCPAP) and Biphase positive airway pressure (BIPAP) on the oxygen exchange indexes in newborns with mild to moderate neonatal respiratory distress syndrome (NRDS).Methods After infusion of pulmonary suffactant into lung bilaterally,116 cases with mild to moderate NRDS were treated with nCPAP(nCPAP group,n =75) and BIPAP(BIPAP group,n =41) respectively.Oxygen exchange indexes including arterial partial pressure of oxygen [pa (O2)],modified oxygenation index (P/F),alveolar-arterial oxygen tension difference (A-aDO2),respiratory index (RI),artery/alveolar oxygen partial pressure ratio[pa (O2)/pA (O2)] and pulmonary shunt fraction (Qs/Qt) were measured or calculated at 0 (before treatment),2,8 and 24 h after being treated with nCPAP or BIPAP.Results Six different oxygen exchange indexes of Pa (O2),P/F,A-aDO2,RI,pa (O2)/pA(O2) and Qs/Qt in both groups didn't show statistical significance at 0 hour:pa(O2) (kPa) (6.1 ±0.6 vs 6.1 ±0.6,t =0.11,P ＞0.05),P/F(kPa) (15.59 ± 1.45 vs 15.71 ± 1.45,t =1.59,P ＞ 0.05),A-aDO2(kPa)(6.04 ±0.64 vs 6.24 ±0.69,t =1.59,P ＞0.05),RI(6.0 ± 1.0 vs 6.2 ± 1.1,t =1.35,P ＞ 0.05),p,(O2)/pA(O2) (0.24 ±0.02 vs 0.25 ±0.03,t =1.63,P ＞0.05)and Qs/Qt(％)(11.9±1.6 vs 11.6 ± 1.6,t =1.10,P ＞ 0.05).A-aDO2,RI,pa (O2)/pA (O2) and Qs/Qt of BIPAP group had more improvement than those of nCPAP at 2 and 24 h,and oxygen exchange indexes at 2 h of BIPAP group and those of nCPAP group were:A-aDO2 (kPa) (3.83 ±0.49 vs 4.24 ± 0.67,t =18.26,P ＜ 0.05),RI(2.7 ± 0.5 vs 3.3 ±0.7,t =20.59,P ＜ 0.05),p,(O2)/pA(O2) (0.35 ±0.03 vs 0.32 ±0.04,t =15.35,P ＜0.05) and Qs/Qt(％) (8.8 ± 1.6 vs 9.8 ±2.0,t =7.68,P ＜ 0.05) ; 24 h indexes in BIPAP group and the indexes of nCPAP group were:A-aDO2 (kPa) (2.29 ± 1.19 vs 3.07 ± 1.67,t=18.43,P ＜0.05),RI(1.4 ±1.4 vs 2.3 ± 1.6,t=25.02,P ＜0.05),pa(O2)/pA(O2) (0.49 ±0.10 vs 0.42 ±0.11,t =14.96,P ＜0.05) and Qs/Qt(％) (6.5 ±3.0 vs 8.5 ±4.4,t =9.59,P ＜0.05).pa(O2) and P/F of both groups didn't show statistical difference significantly [Pa (O2)(kPa) (12.6 ± 1.0 vs 12.7 ± 1.0,t =3.76,P ＞ 0.05),P/F(28.49 ± 3.17 vs 31.85 ± 2.85,t =3.76.P ＞ 0.05)].Nineteen cases in nCPAP group needed invasive mechanical ventilation,and only 3 cases in BIPAP group underwent the procedure;there was a significant difference (x2 =4.01,P ＜ 0.05).Oxygen exchange indexes in both groups were gradually improved from 2 h,8 h to 24 h,but 22 deteriorated cases showed no improvement,who underwent invasive ventilation.Positive end-expiratory pressure (PEEP) positive airway pressure (EPAP) was (0.42 ± 0.19) kPa in BIPAP group,and (0.56 ± 0.23) kPa in nCPAP group (t =3.45,P ＜ 0.01).Conclusions 1.BIPAP and nCPAP can improve the ability of oxygen exchange in newborns with mild to moderate NRDS,but BIPAP is more effective than nCPAP,which can shorten the possibility of invasive ventilation and reduce the PEEP level.2.p,(O2),P/F,pa (O2)/pA (O2) and RI may be more suitable for evaluating oxygen exchange for neonatal NRDS.

Objective To establish a standardized scoring system after tetralogy of Fallot (TOF) correction and explore its clinical application values.Methods During the period of Jan.2006 and Apr.2014 at the Third Affiliated Hospital,Zhengzhou University and Henan Provincial People's Hospital,a total of 624 infants undergoing stage Ⅰ anatomic correction were selected and their common clinical parameters such as liver size,systolic blood pressure,urinary volume,oxygenation index and occurrences of complications were recorded and scored.The cases were divided into low-risk,medium-risk and high-risk groups according to scores.The relevant endpoint parameters,including mortality or survival,on-pump time,intensive care unit(ICU) duration,hospitalization and medical expenses were recorded to analyze their relationship with postoperative scores.Results The data indicated that the short-term mortality after repair of tetralogy of Fallot was 5 ％.Moreover,there was no statistical difference (P =0.309) in the mortality between the lowrisk group (total score ＜ 3 and mortality of 0) and medium-risk group,and the mortality of the medium-risk group was statistically different(P ＜ 0.001) from that of the high-risk group (total score ＞ 7 and mortality of ＞ 80％).The postoperative standby time,ICU stay,total hospital stays and cost increased with the rise of the score(P ＜ 0.001),and there were no statistical differences in hospital stays(P =0.469) and cost(P =0.365) between the medium-risk group and the high-risk group.Conclusions Based upon common clinical parameters,a standardized scoring system has been successfully established for patients after TOF correction,which plays an important role in gauging the disease progression and predicating the immediate postoperative outcomes of TOF.

The American College of Rheumatology (ACR) published treatment recommendations for juvenile idiopathic arthritis (JIA) in 2011.The recommendations meant as a guide to health care providers caring for JIA children with dividing JIA into 5 distinct subtypes.The ACR updated the 2011 recommendations in 2013 and focused on the treatment of systemic-onset juvenile idiopathic arthritis (SOJIA).According to the clinical feature of the SOJIA,the subtybe is developed to 3 phenotypes.And the conception was firstly addressed that systemic JIA with features concerning for macrophage activation syndrome(MAS).Different treatment options was applied for clinical manifestations score,and these recommendations offered guidance for providers caring for children with the most common phenotypes associated with systemic JIA,rather than exceptional cases with unusual disease manifestations or refractory disease.

Pertussis is an severe infectious respiratory disease that continues to be a serious public health problem,which is caused by Bordetella Pertussis.Because it's highly infectivity,it is still an important etiological factor associated with persistent cough in adults and adolescents.With the introduction of mass vaccination in 1974,there has been a dramatic decrease in the morbidity and mortality.However,in recent years,increasing numbers of pertussis are reported in adolescents and adults in many countries where with high vaccination coverage.The thesis summarize and discuss the progress of pertussis cpidemiology and clinical characteristics.

Childhood tuberculosis remains a serious public health threat which draws more and more attention.The unspecific symptoms or signs and the paucibacillary nature of childhood tuberculosis make it hard to diagnose which delays appropriate treatment and increases disease burden and mortality.Molecular methods such as polymerase chain reaction (PCR),real-time PCR,and DNA line probe based on mycobacterium tuberculosis specific nucleotide sequence will make a quick and reliable diagnosis of childhood tuberculosis.

Neonatal intrahepatic cholestasis caused by Citrin deficiency(NICCD) is one of phenotypes of Citrin deficiency.It's an autosomal recessive disorder which was mainly seen in East Asia,including China.Case of NICCD was reported firstly by Japanese in 2001.In south area of China,the morbidity of NICCD is higher than that in north area of China.Most of the patients with NICCD has benign prognosis.Symptoms resolve within the first year of life,thus making a diagnosis difficult after this time.But few of patients will develop liver failure,even be fatal to life.Early diagnosis,regular follow-up and proper management may improve the prognosis.

Functional chronic abdominal pain is very common in pediatrics,but the understanding of the diagnosis and treatment in clinics are to be strengthened.The diagnosis,differential diagnosis and treatment progress of 4 kinds of main functional chronic abdominal pain in children are reviewed such as functional dyspepsia,irritable bowel syndrome,functional abdominal pain and functional abdominal pain syndrome,abdominal migraine according to Rome Ⅲ diagnostic criteria of functional gastrointestinal diseases in children.

Enteric nervous system abnormalities are the main cause of severe chronic constipation in children.These abnormalities are collectively known as intestinal dysganglionosis,including Hirschsprung's disease (HD),and Hirschsprung's disease allied disorders(HAD) such as immature ganglion,hypoganglionosis(HG) and intestinal neuronal dysplasia(IND).HD and HAD have similar clinical manifestations,and accurate diagnosis is challenging.In this paper,difficulties in diagnosis and treatment of HAD are introduced.