Bronchial asthma is one of the most popular chronic disease in childhood.In resent ten years,the morbidity rate of the asthma during childhood in our country was going up,and the children's health was seriously affected.Children in different age have different respiratory apparatus constitution,physiological functions and immunization,which means different diagnosis and treatment were needed.The objective of this article is to introduce the diagnosis and treatment of the disease.

Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than three years.The species of foreign body aspiration are many and varied.Immediately after inhalation the child starts to cough,wheeze,or have laboured breathing.The clinical manifestation will be different when foreign body stays in different part of bronchial tree.It's extremely easy to cause misdiagnosis.No matter whether aspiration or not,bronchoscopy should be taken.The bronchoscopy is not only the means of diagnosis,and removes the foreign body at the same time which helps to treat timely.

Objective To explore the clinical diagnosis and treatment of pediatric bridging bronchus deformity and brid-ging bronchus with pulmonary artery sling. Methods The clinical data of the 21 cases of diagnosed bronchial bridge deformity and bronchial bridge with pulmonary artery sling, the imaging findings of all the echocardiography, MSCT chest scan, enhanced CT and reconstructive image were retrospectively analyzed. Results In 21 cases, 10 were diagnosed as bronchial bridge only, among which three cases had other types of congenital heart disease;11 cases were diagnosed of pulmonary artery sling with pulmonary artery sling, among which 8 cases had other types of congenital heart disease;their average age of the 8 cases were all younger than 2 years old, except one case;most of them had the symptoms of recurrent respiratory tract infections and parox-ysmal dyspnea. According to Wells, bronchial bridge was divided into type I and typeⅡ;15 cases were type I, 6 cases were typeⅡ, 10 patients with bronchial bridge only were all type I, 5 cases of typeⅡwere associated with pulmonary artery sling. All of the 6 cases were diagnosed as typeⅡassociated with pulmonary artery sling. Conclusions Infants and young children with clini-cal recurrent respiratory tract infections should be considered the possibility of bronchus bridge deformity, and should be paid more attention to the possibility of pulmonary artery sling. MSCT plain chest scan, enhanced CT and airway reconstructive im-age are the important ways to diagnose the disease.

Humans ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; diagnosis

Diabetes patients in China is large in number, low level of health literacy, and their self management mainly relies on community doctor's health propaganda and education, as a result, it is very important to train community healthcare professionals to improve their communication skills with patients.Guided by the Social Cognitive Theory (SCT), the researchers developed a literacy-addressing training model specifically through: 1) low literacy healthcare education materials written in plain language, simple text, maximal white space, and behavior-oriented images or pictograms;2) a standardized health communication curriculum to promote simple communication with decreased jargon usage, teach teach back, and enhance shared goal-setting;3) use of standardized patients to enhance doctor-patient communication training;and 4) MOOC and a series of videos demonstrating doctor-patient communication scenarios.The novel training model can be used in continuing medical education through traditional on-site classes or by E-learning platform.It is expected to improve the communication skills of community doctors and patients, improve the satisfaction of both doctors and patients, and the effect of patients' self-management.

Objective: To observe the decompressive effect of laminectomy on the spinal cord compressed anteriorly in the cervical spine. Methods : The compression of the cervical spinal cord-meningeal complex was simulated using a small transducer pushed into the spinal canal in 7 whole cadaver spines. The depth of canal occlusion was controlled depending on 20%, 30% and 40% of the saggital diameter of the canal. The distribution and the change of the stress on the spinal cord-meningeal complex and the displacement of dural sac were recorded before and after laminectomy. Results: When the anterior transducer was pushed into the spinal canal with 40% occlusion, the force was 3.86 kPa on the anterior wall and 0.38 kPa on the posterior wall of the spinal cord-meningeal complex respectively. After extensive laminectomy, the anterior compressive force decreased 6.06% - 14.38% and the displacement of the posterior dura wall was 0.44 mm. Conclusions: The anterior compressive force was mainly absorbed by the anterior part of the spinal cord-meningeal complex. Extensive laminectomy had no significant decompressive effect on the spinal cord compressed anteriorly inthecervical spine.

Objective To study the causes, technique, selection and results of revision surgery in the patients with cervical spondylosis after anterior decompression. Methods Twenty nine patients with cervical spondylosis were treated with revision surgery after anterior decompression. Among them, there were 19 patients with cervical myelopathy, 8 with combination of myelopathy and radiculopathy, and 2 with radiculopathy only. The procedures included removal of the residual compressive elements, migrated bone grafts and implants, and refusion with bone graft and internal fixation. Depending on the clinical symptoms and findings of physical examination, X ray films and MRI were used to analyze the causes and the results of the revision surgery. Results There were 11 patients with incomplete initial decompression, 4 patients with the migration of the bone graft, 4 patients with new neural compression after cages interbody fusion, 2 patients with loose and migration of the plates and 8 patients with the degenerative changes in adjacent segments. Solid fusion in 23 cases and delayed fusion in 6 cases were observed during follow up. The neural recovering rate after the revision surgery was 52.4% in the patients with cervical myelopathy and 46.7% in the patients with combination of myelopathy and radiculopathy. Conclusion The main causes for the reoperation after anterior decompression were residual or newly formed neural compression. The complete decompression and segmental stabilization in the cervical revision surgery was essential for obtaining the good results.

Objective To analyze the clinical characteristics of Mycoplasma pneumoniae pneumonia in children under 2 years old. Methods The clinical features and treatment outcomes were analyzed in 57 children under 2 years old and compared with 153 children more than 2 years old. Results Compared with children more than 2 years old, in children under 2 years old, the number of cases with fever was fewer, the fever peak was lower and the lasting time was shorter. However, in children under 2 years old, the severe pulmonary signs were more common, the incidence of wheeze was higher, meanwhile, the count of white blood cells (WBCs) was signiifcantly increased, more small pieces of lfuff shadow was showed on chest X-ray, and the pulmo-nary complications were fewer, less corticosteroid was needed for treatment. After one-week therapy, the chest X-ray shadows were disappeared in most of children. Complications out of lungs, such as rash, liver function damage and cardiac damage can be found in both groups and no signiifcant difference (P>0.05). Conclusions Mycoplasma pneumoniae pneumonia in children under 2 years old had the characteristics of mild symptoms, severe pulmonary signs, few pulmonary complications, light systemic inlfammations and mild radiological changes.

Objective To investigate the correlation with lung function and clinical significance of lung function and exhaled nitric oxide (FeNO) changes in various disease stages for children with asthma.Methods Seventy-nine asthma outpatient children aged 6-14 years old were selected from Nanjing Children's Hospital Affiliated to Nanjing Medical University,25 cases of whom were at acute exacerbation stage,28 cases at chronic persistent stage and 26 cases at remission stage.Twenty-five healthy children were randomly selected as the healthy control group, for whom FeNO and lung functions were measured respectively.FeNO and lung functions were analyzed on whether there were statistical differences between the subjects in these groups and whether their FeNO and lung functions were correlated.Results Comparison of FeNO and the percentages of the expected value(FEV1 ％) of forced expiratory volume in one second between acute exacerbation group [(58.79 ± 12.25) ppb and (52.25 ± 7.89) ％], chronic persistent group [(42.13 ± 11.38) ppb and (66.14 ± 5.29) ％], remission group [(25.41 ± 7.15) ppb and (86.22 ± 15.21) ％] and the healthy control group [(12.84 ± 6.22) ppb and (93.62 ± 12.13)％], showed that FeNO in asthma acute exacerbation group, chronic persistent group and remission group was higher than that in the healthy control group, with statistically significant difference(all P ＜0.05).Except for remission group,in which FEV1 was not statistically significant different from the healthy control group (P ＞ 0.05) ,the differences in other groups were all statistically significant(all P ＜ 0.05).FeNO and FEV1％ were negatively correlated at acute exacerbation (r =-0.779, P =0.000) , but they were not correlated at chronic persistent and remission state.Conclusions FeNO values increased in asthma children.FeNO as a sensitive indicator to reflect airway inflammation can be used to evaluate the control and severity of airway inflammation.FeNO and FEV1％ of lung functions were negatively correlated in asthma children at acute stage.

Objective To investigate the clinical data of Mycoplasma pneumoniae pneumonia(MPP)compli-cated with embolism in children,and to improve the understanding of the clinical features,diagnosis and treatment of the disease.Methods Six cases of MPP complicated with embolization,who were treated at Nanjing Children′s Hospital Affiliated to Nanjing Medical University from January 201 0 to June 201 5,were analyzed retrospectively.Results The ages of 6 cases ranged from 3 years and 3 months old to 1 3 years and 1 0 months old,and 3 cases were boys,3 cases were girls.All of 6 patients had high fever,positive anti -Mycoplasma IgM antibody (≥1 160)and sputum fluores-cence quantitative -Mycoplasma pneumonia (FQ -MP DNA),and all the chest imaging was consistent with pneumonia. Among 6 patients,4 cases complicated with liver function damage,4 cases had D -dimer rise,5 cases of erythrocyte sedi-mentation rate increased at different degree,while pleural effusion or pleuritis was found in 5 cases.The region of embo-lism in the cases included left renal artery in 1 case,the left popliteal artery in 1 case,the right middle cerebral artery em-bolism combined with cerebral infarction in 1 case,the right subclavian vein embolism combined with right upper extremi-ty embolism in 1 case,the basilar artery and bilateral posterior cerebral artery embolism combined with cerebral infarction in 1 case,and the other case involved the right pulmonary embolism.One case received thrombus dislodgment operation, and all of 6 cases were given the treatment including anti -infection,anticoagulation and low dose of glucocorticoid the-rapy,among whom 1 case died of cerebral hernia,and the other 5 cases improved.Conclusions MPP is often complicated with hypercoagulative state and potentialized to thrombosis,and thrombus may occur in vessels of whole body organs,and cerebral infarction had poor prognosis.Consequently,doctors should be aware of the potential risk factors for thrombosis. Early diagnosis and prompt anticoagulation and thrombolytic therapy could reduce mortality and disability rate.