Objective To study the risk factors of preschool recurrent wheezing in Anhui area. Methods The clinical data from 816 children were collected through a questionnaire. The risk factors of preschool recurrent wheezing were investigated by logistic regression analysis. Results Preschool recurrent wheezing was associated with premature delivery, caesarean section, early weight gain(0 ~ 3 m), food allergy, allergic rhinitis, eczema, asthma or allergic rhinitis history of parents, passive smoking, viral infection and mycoplasma infection. The logis-tic regression analysis showed that premature delivery, early weight gain(0 - 3m), eczema, asthma or allergic rhi-nitis history of parents, passive smoking, viral infection and mycoplasma infection were the risk factors of preschool recurrent wheezing(P < 0. 05). Conclusion Premature delivery, early weight gain(0 - 3m), eczema, asthma or allergic rhinitis history of parents, passive smoking, viral infection and mycoplasma infection are the risk factors of preschool recurrent wheezing.

Bronchopulmonary dysplasia remains the most common severe complication of preterm in-fants,affecting the quality of life in preterm children seriously. There is no specific or effective treatment availa-ble to date for BPD. Since the aetiopathogenesis of BPD is multifactorial,involving diverse molecular signaling pathways,a variety of biomarkers detected in biological fluids have been proposed for early identification of in-fants predisposed to BPD.

Objective To determine the range of total serum bilirubin(TSB) of healthy term newborns during the first post natal week in Huainan region of Anhui province and provide the theoretical basis for the neonatal jaundice intervention in this region.Methods The bilirubin analyzer for capillary blood was used to measure TSB level of 1257 healthy term newborns during the first post natal week,P25,P50,P75 and P95 were recorded at every time point,the peak serum bilirubin(PSB) and the time it appeared was observed.50 blood samples were randomly selected and the TSB level was measured by the routine laboratory method,at the same time,the serum bilirubin level was measured by bilirubin analyzer for capillary blood.Then,the linear correlation coefficient of capillary blood bilirubin level and TSB level was calculated and statistically analyzed,and at last got the linear regression model.The newborns'skin xanthochromia coverage scales and TSB levels were recorded in order to get the corresponding TSB level in terms of xanthochromia coverage.Results In this study,the serum bilirubin P25,P50,P75 and P95 of 1 257healthy term newborns were 58.64μmol/L,72.51μmol/L L,102.44μmol/L,120.35 μmol/L,respectively in the first day,2nd day 105.41μmol/L,119.72μmol/L,150.18μmol/L,185.30μmol/L,3rd day 128.85μmol/L,157.951μmol/L,191.22μmol/L,227.61μmol/L,4th day 160.24μmol/L,191.40μmol/L,216.65μmol/L,277.49μmol/L,5th day 164.26μmol/L,179.51 μmol/L,209.88μmol/L,263.74μmol/L,6th day 131.87mol/L,172.73μmol/L,195.57μmol./L,231.26μmol/L,and the 7th day 118.94μmol/L,157.57μmol/L,204.83μmol/L,223.84μmol/L,with PSB 294.46μmoL/L appeared at the fourth day.The correlafionship was existed between the capillary blood bilirubin measurement and the routine laboratory method (r =0.948,t =21.067).The TSB level was (1 12.3 ± 6.2) μmol/Lwhen the xanthochromiawas on thehead,(165.1 ± 2 6.7) μmol/Lon the chest,(214.0 ±30.8) μmol/L on the belly,(268.5 ± 28.2) μmol/L on the knee or elbow,and ＞ 271.7μ mol/L on the palm or sole of the foot.Conclusion The TSB variation rang is 120.35 ～ 223.84μmol/L within 7 days after their birth in Huainan region of Anhui province,capillary blood bilirubin is reliable in measuring serum bilirubin level of newborns ; visual assessment of xanthochromia coverage is also an easy and feasible way of estimating serum bilirubin level initially.

Objective To analyze the risk factors for CAL secondary to Kawasaki disease children.Methods The clinical data of 60 patients with Kawasaki disease were retrospectively analyzed.Results There were 27 CAL secondary to Kawasaki disease in 60 Kawasaki disease patients.9 patients were age ≤ 1 year.16 CAL secondary to Kawasaki disease were male.11 CAL secondary to Kawasaki disease were female.6 CAL secondary to Kawasaki disease were WBC＞20 × 109/L、21 CAL secondary to Kawasaki disease were WBC ≤20 × 109/L;17 CAL secondary to Kawasaki disease were PLT＞300 x 109/L、10 CAL secondary to Kawasaki disease were PLT≤300 x 109/L;9 CAL secondary to Kawasaki disease were ESR＞100mm/1h、15 CAL secondary to Kawasaki disease were ESR ≤ 100mm/1 h;5 CAL secondary to Kawasaki disease were fever duration＞10d using IVIG、22 CAL secondary to Kawasaki disease were fever duration ≤ 10d using IVIG.There were no significant differences(P＞0.05),9 CAL secondary to Kawasaki disease were CRP＞100mg/L、18 CAL secondary to Kawasaki disease were CRP≤ 100mg/L,showed significant difference(P＜0.01).Conclusion Kawasaki disease patients had CAL secondary to Kawasaki disease has no difference between male and female.The high risk factors for CAL secondary to Kawasaki disease are age ≤ 1 year,CRP＞100mg/L.

Streptococcus pneumoniae( SP) is the leading pathogenic bacteria of invasive bacterial infec-tions in children. It can cause some life-threatening diseases such as pneumonia,meningitis and sepsis. Strepto-coccus pneumoniae frequently colonizes the upper respiratory tract. It is essential to know the host immune re-sponse during the infection. This paper reviews antigenic structure of SP,pneumococcal conjugate vaccine and pneumococcal virulence factors,especially focuses on the immune response including the effect of innate immu-nity,macrophage,neutrophil and T-cell.

Objective To sum up the clinical characteristics of children with severe pneumonia,and in order to improve the dingnosis treatment and prognosis.Methods Restrospective analysis was carried out on the clinical manifestations signs basic diseases etiology check imaging of children with severe pneumonia who had been in the hos-pital for ten years,and with the same period,120 children with common pneumonia in hospital were compared with and analyzed.Results Among 193 case,boys was 127 cases,girls was 63 cases,with males to females rate of 21.115 cases(60.0%)were aged 0 year to 3 years old.The onset of 125 cases(65.0%)were winter and spring.All patients had fever 98 cases(50.8%)with high temperature of 39 -41℃,all patients suffered from respiratory symp-toms,including 183 cases(94.8%)with cough,113 cases(58.5%)with breathing.All patients suffered from diffi-cult breathing,shortness of breath on cyanosis(=cyanopathy),105 cases(54.3%)with wet lung rate,152 cases (78.7%)with respiratory insufficiency on respiratory failure,12 cases(6.2%)with acute respiratory distress syn-drome,163 cases (84.5%)with heart failure,67 cases (34.7%)with abdominal distension,23 cases needed mechanical ventication.91 cases(47.2%)with antibodies positime for mycoplasma pneumoniae infection when testing servm virns antibody and respiratory virus antigen.20 cases(10.4%)were found to have positive antibody,conduc-ting fluid culture,cultivate a positive strains of 31 cases(16.1%),including 7 cases(3.6%)of psendomonas aerngi-nosa,6 cases(3.1%)of eschericria coli,6 cases(3.1%)of klebsiella pneumoniae,5 cases(2.6%)of enterobacter cloacae,3 cases(1.6%)of streptococlus pneumoniae,2 cases(1.0%)of viridans streptococci,1 case(0.5%)of hemolytic staphylococci,1 case(0.5%)of radiation agrobacterium,2 cases(1.0%)of candida mycoderma bacteria which was fungi.The imaging indicated.106 cases(54.9%)presented as lobi pulmonis or segmental large patches of dense increased shadom or pulmonary parenchymal inflammatory lesions the performance of lung interstitial inflammatory lesionsl(such as increased lung markings,fuzzy and with flocculant shadow etc)were 87 cases(33.2%).30 cases (15.5%)suffered from pleural effusion,18 cases(9.3%)suffered a telectasis with in the chest,16 cases(8.3%) suffered from empyema.Conclusion Children with severe pneumonia had prone to heart failure respiratory failure, complication.The clinical manifestations of severe pneumonia is severe.Clinically suspected severe.Pneumonia should complete etiological and chest radiographic examination for early diagnosis and treatment.

Objective To investigate the similarities and differences of incomplete Kawasaki disease and typical Kawasaki disease,in order to provide basis for early diagnosis and treatment.Methods The clinical and laboratory data of 60 children with Kawasaki disease were retrospectively analyzed.Results The incidence rate of symptoms in clinical diagnostic criteria was lower in incomplete Kawasaki disease than that in typical Kawasaki disease(x2 =16.46,10.10,11.71,34.43,all P ＜ 0.01).No statistical differences of leukocytes,platelet,erythrocyte sedim-entation rate and C-reactive protein were found in the incomplete Kawasaki disease and typical Kawasaki disease(x2 =0.04,0.12,0.04,0.26,all P ＞ 0.05).The incidence rate of coronary artery lesions had significant difference between incomplete Kawasaki disease and typical Kawasaki disease (x2 =31.43,P ＜ 0.01).Conclusion The early diagnosis of Kawasaki disease could be confirmed by representative clinical characteristics,laboratory examination and ultrasound cardiogram.

Objective To evaluate the efficacy of the flexible ureteroscopy and Holmium and FREDDY laser lithotripsy for renal calculi at various locations.Methods From May 2002 to May 2007,338 cases of renal calculi(sized less than 20 mm in diameter)were treated by flexible ureteroscopy and laser lithotripsy in our hospital.The data of the patients were analyzed retrospectively.Among the cases,the calculi were located at the upper or middle calyx or the renal pelvis in 288 patients,at the lower calyx in 37,and in multiple calyxes in 13.All the patients received KUB and IVU before the procedures.With the TerumoTM settled in place,a F8/9.8 Wolf rigid ureteroscope was inserted to observe and dilate the ureteral lumen.Then,an Olympus P3 6.9F flexible ureteroscope was used.When the insertion of the rigid ureteroscope was difficult,a re-ureteroscopy would be tried 2 weeks later with a pig-tail stent in place.The WOM U-100 FREDDY laser and the Lumenis Holmium laser were used to perform the procedure and a pig-tail stent would be set at the end of the procedure.The urethral catheter was removed in the first postoperative day and an intravenous antibiotic prophylaxis was administrated during the first 2 days postoperatively.A follow-up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the result of the endoscopic nephrolithotripsy.Any residual calculi larger than 4 mm in diameter was taken significant.Results In 28 patients the rigid ureteroscope or the ureteral sheath couldn't be inserted in the first time,and the success rate of the ureteroscopic insertion was 91.7%(310/338).The re-ureteroscopy was successful in the patients after 2 weeks.The calculi were detected in 97.3%(329/338)of the patients,and the procedures succeeded in 306 of them(306/329,93.0%).The success rate of laser nephrolithotomy was 78.0%(32/41)for the lower calyx calculi,which was significantly lower than that for the middle,upper calyxes or renal pelvic calculi 95.1%(274/288),?2=13.601,P=0.000].After 4 weeks,the total evacuation rate of the calculi was 87.6%(296/338).For the calculi in the upper or middle pole or in the renal pelvis,the complete evacuation rate was 90.1%(264/293),which was significantly higher than that for the lower pole 71.1%(32/45),?2=12.929,P=0.000].No patient had ureteric perforation or active bleeding after the surgery.The mean operation time was 35 min(12-55 min).After the operation,11 cases developed nephritic colic.None of them had septicemia or acute renal failure.Gross hematuria disappeared in 1-2 days postperation.Conclusions The flexible ureteroscopy and Holmium and FREDDY laser lithotripsy are safe and effective for renal calculi sized less than 20 mm in diameter,especially for those in the upper,middle poles and renal pelvis.A re-ureteroscopy with the pig-tail stent in place is suggested in two weeks after the failure of the first procedure.

Objective To discuss the management of renal vein trauma in the percutaneous ne-phrostomy (PCN) procedure.Methods Three cases with renal vein trauma by PCN or malposition of nephrostomic catheter were reviewed.Case 1 was a patient with staghorn calculi.There was mas-sive hemorrhage after the puncture and the dilatation during PCN.Then the nephrostomy catheter was clamped.The post-operative CT scan showed the nephrostomy catheter passed the inferior vena cava to the right external jugular vein.Case 2 was a patient with a 3 cm calculus in the inferior calice of the right kidney.A massive haemorrage occurred after the dilatation by the 16 F sheath guided by ultra-sound during PCN.The nephrostomic catheter was found in the renal vein by X-ray film.Case 3 was a patient with bilateral hydronephrosis complicating chronic renal failure,which caused by the meta-static of the gastric carcinoma.After the puncture,the massive hemorrage appeared and a nephros-tomic catheter was placed and then clamped.The catheter was seen in the renal vein confirmed by the X-ray.For all 3 patients,the catheter was withdrawn carefully monitored by the X-ray until the place of the renal vein perforation during the first 24-48h.Then it was withdrawn 3 to 4 cm each time un-til reach the pelvic.Results The hemorrhage was well controlled and nobody needed the surgical in-tervention.There was no renal function aggravation in these 3 patients.Conclusions The renal vein trauma during the echo-guide PCN procedure can be treated by clamping the nephrostomy catheter and withdrawing it gradually.Thus,the surgical intervention can be avoided and this method will not im-pair the renal function.

Objective This study aimed to assess the adherence to guideline-recommended therapies according to risk stratification in the management of acute coronary syndrome(ACS). Methods We analyzed 1,001 consecutive patients admitted with ACS. Patients were stratified using the GRACE risk score into low- and high-predicted risk of mortality at 6 months. We evaluated the use of hospital angiography,revascularization,and guideline-recommended medications between high and low-risk patients. Results High-risk compared to low-risk patients were less likely to underwent coronary angiography and/or revascularization during the hospitalization. The use of hospital-initiated pharmacotherapies was also lower in high-risk patients(P<0.05). Advanced age, increased creatinine level and higher GRACE score were independent predictors for failure to administer evidence-based therapies. Conclusion Patients with ACS at high risk of mortality were paradoxically less likely to undergo revascularization or receive medications according to guidelines. Better adherence to evidence-based therapies in high-risk patients may improve clinical outcome and quality of health care.