Diagnosis of tuberculosis in children is challenging. Traditional and molecular microbiologic methods lack sensitivity,particularly in children. With the development of science and technology,more and more testing me﹣thods are applied in clinical practice,so that tuberculosis(TB)can be diagnosed in time and treated at the right time. TB is still one of the most difficult infectious diseases to treat,and the second most frequent cause of death due to infec﹣tious disease throughout the World. The number of cases of multidrug － resistant TB( MDR － TB)and extensively drug－resistant TB(ⅩDR－TB),Which are characterized by high mortality rates,is increasing. Therefore,appropriate drug selection is particularly critical in the treatment of drug－resistant tuberculosis.

Objective:To investigate the clinical significance of cytokine levels and routine cytology in bronchoalveolar lavage fluid (BALF) in children with severe Mycoplasma pneumoniae pneumonia (SMPP).Methods:A total of 207 children with Mycoplasma pneumoniae pneumonia who underwent parallel bronchoalveolar lavage in the Department of Respiratory, Shanghai Children′s Hospital, Shanghai Jiaotong University from July 2018 to February 2019 were enrolled in this study.There were 121 patients in the SMPP group and 86 patients in the non-SMPP group.Flow cytometry was used to determine the level of cytokines in BALF.Meanwhile, the cells in BALF were stained and cytokines levels and routine cytology were compared between the 2 groups.Receive operating characteristic(ROC) curves were used to analyze the predictive value of cytokine levels and routine cytology for SMPP.Results:The levels of interleukin(IL)-8, IL-1βand IL-6 and white blood cell count in BALF of SMPP group were significantly higher than those of non-SMPP group [1 717.77 (784.31, 3 304.03) ng/L vs.1 013.03 (469.27, 2 040.52) ng/L, 373.18 (70.08, 941.56) ng/L vs.107.50 (0.10, 489.88) ng/L, 200.74 (41.09, 570.61) ng/L vs.95.47 (0.10, 337.68) ng/L, 1 890.00 (955.00, 3 600.00)×10 6/L vs.1 430.00 (467.50, 2 724.00)×10 6/L]( Z=3.27, 3.45, 2.47, 2.57, all P<0.05). The percentage of macrophages in the non-SMPP group was significantly higher than that in the SMPP group [0.04 (0, 0.12) vs. 0 (0, 0.06)] ( Z=-2.67, P=0.01). The optimal critical value and the area under curve (AUC) of IL-8 were 722.69 ng/L and 0.63 (95% CI: 0.56-0.71, P<0.01), respectively. The optimal critical value and AUC of IL-1β were 166.33 ng/L and 0.64, respectively (95% CI: 0.56-0.72, P<0.01). The optimal critical value and AUC of IL-6 were 142.95 ng/L and 0.60, respectively (95% CI: 0.52-0.68, P<0.05). The optimal critical value and AUC of the total white blood cells were 970×10 6/L and 0.61, respectively (95% CI: 0.53-0.69, P<0.05). The optimal critical value and AUC of the percentage of macrophages were 0.19 and 0.60, respectively (95% CI: 0.32-0.48, P<0.05). Conclusions:Children with SMPP have higher levels of cytokines IL-8, IL-1β and IL-6, a higher white blood cell count, and a lower percentage of macrophages in BALF than children with no SMPP. However, cytokine levels and cytology are inadequate to predict SMPP since they are not effective in the clinical diagnosis of SMPP.

Objective To explore the clinical characteristics of bronchial foreign bodies in children. Method The clinical data of 147 children with exogenous bronchial foreign body admitted between 2014 and 2016 were retrospectively analyzed, and the applications of rigid bronchoscopy and flexible bronchoscopy for foreign body extraction were compared. Results All 147 cases were diagnosed with bronchial foreign bodies by chest CT, chest X-ray or respiratory endoscopy. In these cases (104 boys and 43 girls) , 87.8％ of whom were aged 1-3 years, the most common types of bronchial foreign body were nuts. The common complications were bronchial mucosal granulation tissue hyperplasia (88 cases, 59.86％) , pneumonia (56 cases, 38.1％) , atelectasis (15 cases, 10.2％) , respiratory failure (14 cases, 9.52％) and bronchiectasis (4 cases, 2.72％) respectively. The foreign bodies were removed by soft bronchoscopy in 106 cases which were successfully removed at one time in 100 cases. Respiratory endoscopy was undergone in 141 cases to remove foreign bodies, and flexible bronchoscope was applied in 106 (72.11％) cases and foreign bodies were successfully removed in first attempt in 100 cases (94.34％) . Rigid bronchoscope was used in 35 cases (23.81％) and foreign bodies were successfully removed in first attempt in 28 cases (80.0％) . Conclusion The majority of children with bronchial foreign body are male. Both flexible and rigid bronchoscopes can remove exogenous foreign bodies in the lower respiratory tract.