With the development of modern science,the updates of endoscopic technology,respiratory endoscopy has become essential means in the clinical diagnosis and treatment of respiratory disease in children.Due to the particularity of its complex structure and material,to strengthen the cleaning,disinfection and sterilization of respiratory endoscopy and attachment can ensure medical safety,prolong the service life of the endoscopic.It also was the primary guarantee to ensure that the treatment of respiratory endoscopy proceed smoothly and securely.

Objective To study the physiological indexes of children receiving cardiopulmonary exercise testing (CPET) in order to provide some data for establishing the normal CPET reference value in Chinese children.Methods One hundred and twenty-eight healthy children underwent the CPET with the standard scheme.All children were divided into 3 groups according to ages:3-6 years old, ＞6-10 years old and ＞ 10-14 years old.The physiological indexes of CPET were collected, including maximal oxygen uptake (VO2max/kg) , oxygen uptake at anaerobic threshold (VO2/kg@AT), maximal tolerance power (Pmax), maximal heart rate (HRmax), peak respiratory minute volume to CO2 (peak VE/VCO2), slope of respiratory minute volume to CO2 (VE/VCO2 slope), maximal tidal volume (VTmax) and the maximal minute ventilation (VEmax).The range in normal values for physiological CPET variables was recorded.Results The VO2max/kg was (31.71 ± 7.31) mL/(min · kg), (31.05 ± 5.96) mL/(min · kg), and (34.10 ±8.72) mL/(min · kg) in the 3-6 years old group, ＞6-10 years old group and ＞ 10-14 years old group of boys.The VO2/kg@AT was (28.32 ± 10.20) mL/ (min · kg), (23.13 ± 9.56) mL/(min · kg), and (22.18 ± 7.72) mL/(min · kg)in the 3-6 years old group, ＞6-10 years old group and ＞ 10-14 years old group of boys.The VO2 max/kg was (29.27 ± 4.19) mL/(min · kg), (30.67 ± 5.59) mL/ (min · kg) (29.18 ± 6.56) mL/ (min · kg) in the 3-6 years old group, ＞ 6-10 years old group and ＞ 10-14 years old group of girls.The VO2@AT was (26.64 ±9.49) mL/(min · kg) ,(20.53 ±7.66) mL/(min · kg) ,(17.83 ±6.49) mL/(min · kg)in the 3-6 years old group, ＞6-10 years old group and ＞ 10-14 years old group of girls.VO2max/kg and VO2/kg@AT did not change with age,there was no gender difference in VO2max/kg(P ＞0.05).VO2/kg@AT of boys was higher than girls in the 3-6 years old group(t =2.351 ,P =0.023).The Pmax,VEmax and VTmax increased with the growth of age(boy: F =49.436,24.290,28.958, all P ＜ 0.001;girl : F =58.287,42.990,28.802, all P ＜ 0.001), but not significant in different gender group(P ＞ 0.05).In boys peak VE/VCO2, VE/VCO2 slope and HRmax were significantly different (F =4.758,P =0.012;F =8.050, P =0.001;F =3.869, P =0.026), however these indexes were not significantly different in girls(all P ＞ 0.05).Conclusions This study provides a set of data for the most important CPET variables in Chinese children.VO2max/kg does not change with age,so it can be used as a valuable parameter in exercise ability evaluation.

The children with pulmonary hypermastigote infection,has not been reported at home and abroad.In recent years,we have carried out the children's electronic bronchoscopy,bronchoalveolar lavage fluid routine smear examination,found a lively movement round or oval body-hypermastigote.Metronidazole treatment is effective in controlling the disease.After discovery,understanding,rediscovery,reunderstanding,now have a preliminary understanding of the disease,first reported as follows.

Objective To study the value of serum albumin ( ALB ) level for the prognosis of late-preterm infants infection. Methods Late-preterm infants admitted to the neonatal intensive care unit ( NICU) from July 2012 to July 2013 were recruited and their clinical data retrospectively reviewed, including the laboratory examination results, neonatal critical illness scores ( NCIS ) , perinatal complications and prognosis. The infants were assigned into three groups based on ALB levels (＞30 g/L, 25-30 g/L, ＜25 g/L). Results A total of 257 cases were recruited and 122 cases (47. 4％) had ALB levels ＜25 g/L. 32 had neonatal sepsis ( sepsis group) , 190 neonatal infection ( infection group) and 35 without infection ( no-infection group ) . The incidences of hypoalbuminemia among these groups were 84. 4％, 50. 0％ and 28. 6％, with the mortality rate 15. 6％, 0. 5％ and 0％. The incidence of hypoalbuminemia and mortality rate in sepsis group were significantly higher than the other groups ( P＜0. 05 ) , and no statistically significant differences between infection group and no-infection group ( P＜0. 05). The ALB level in survived infants [(29. 6±7. 5)g/L] was statistically higher than the deceased ones [(20. 4±6. 9)g/L](P＜0. 05). The incidence of critically ill newborns was 65. 5％ in ALB ＜25 g/L group, significantly higher than the other groups (P＜0. 05). 26. 2％ in ALB ＜25 g/L group had more than 4 organs injuries, significantly higher than ALB ＞30 g/L group ( P＜0. 05 ) . Conclusions Hypoalbuminemia is common among neonates with sepsis. The ALB level had predictive value for the prognosis of neonatal infection.

Objective To summarize the clinical features,diagnostic and treatment experience of severe hand,foot and mouth disease(HFMD) cases receiving mechanical ventilation from Jan 1 to Sep 6,2009 in our hospital and provide reference for reducing the occurrence of neurogenic pulmonary edema(NPE) and mortality. Methods 147 severe HFMD who received mechanical ventilation were analyzed by a retrospective investigation. Results 85.0% children were less than 3 years old and 100% patients had a fever. The mechanical ventilation occurred within 1 to 4 days after fever (3.06 ± 1. 02) d. Neurological complications presented as bad spirit,easy surprised, involuntary movement of the extremities and lethargy. Respiratory system complication presented as polypnea, hypepnea and irregular rhythm. Circulatory system complication presented as heart rate increase or decrease, hypertension or hypotension, piebald skin and low limb temperature.Some of the children had high white blood cell counting,glucose and lactic acid of the blood. The EV71-PCR positive rate was 34. 7% for throat swabs,and 42. 2% for anal swabs. Chest X-ray presented as increased broncho vascular shadows, exudation or nonapparent abnormality. Only three children were dead, fatality rate was 2. 0%. Conclusion The HFMD cases in this outbreak are relatively more serious,and change rapidly. It's difficult to treat as soon as NPE appeared,and it has high fatality rate. Early recognition of critical patients,timely giving mechanical ventilation,and the comprehensive treatment can reduce NPE incidence and the mortality.

Objective To explore the effects of early intervention on brain injury in premature infants with neonate respiratory failure (NRF). Methods 151 premature infants in neonatal intensive care unit (NICU) who were diagnosed as NRF within 24 hours after birth in our hospital were studied. All of them accepted endotracheal intubation and mechanical ventilation, and were complicated with brain injury. According to their admission date and their parents' desire, these premature infants were divided into routine group (n=71) and intervention group (n=80). Both 2 groups received similar routine care, and the intervention group accepted touching, passive exercise and stimulation of hearing, vision and touch in addition. Active motor training and family intervention were also given to the intervention group after dis-charge. They were assessed with Neonatal Behavioral Neurological Assessment (NBNA) at the corrected age of 40 weeks, Infant Neurologi-cal International Battery (Infanib) at the corrected age of 3 and 6 months, mental development index (MDI) and psychomotor development index (PDI) at the corrected age of 6, 12 and 18 months, Gesell Development Schedules at the corrected age of 18 months. Results There was no significant difference in NBNA score between 2 groups at 40 weeks of gestational age (P>0.05). The percentage of normal ones with Infanib was higher in the intervention group than in the routine group at the age of 3 and 6 months (P<0.05). The MDI and PDI were signifi-cantly higher in the intervention group than in the routine group at the age of 6, 12 and 18 months (P<0.001). The scores of gross motor, fine motor, adaptation, language and social skills were significantly higher in the intervention group than in the routine group at the age of 18 months (P<0.001). The incidence of sequelae was lower in the intervention group (12.5%) than in the routine group (25.4%) (P<0.05). Con-clusion Early intervention can promote the intelligence and motor development, and improve the outcome of brain injury in the premature infants with NRF.

Objective To evaluate the clinical value of bedside echocardiography in full term infants in NICU.Methods The bedside echocardiography was performed for 313 full term infants,and then they were ana-lyzed.Results The main clinical characteristics of totally 313 cases of neonates were tachypnea,heart murmur and cyanosis.Patent foramen ovale and patent ductus arteriosus were common in the no cyanotic blood shunt,no cyanotic congenital heart disease(CHD)was mainly made of atrial septum defect(31 cases),followed by ventricular septal defect (20 cases).Cyanotic CHD was made of pulmonary atresia(6 cases),complete transposition of great artery (5 cases),tetralogy of fallot(5 cases),total anomalous pulmonary venous drainage(5 cases).Tricuspid regurgitation was common in abnormal blood flow,moderate to severe pulmonary hypertension was common for full term infants. Conclusion There were many abnormal echocardiography examination results,and atypical noise was common in neonatal CHD,routine examination of bedside echocardiography for full term infants in NICU was important for early detection of CHD and may help treatment timely to improve the prognosis.

BACKGROUND:The umbilical cord blood is rich in hematopoietic stem/progenitor cel s that have strong proliferation and differentiation ability as wel as ability to form colonies, and exert important roles in stimulating bone marrow function, improving blood cel viability and quantity, promoting immune cel maturation, and maintaining immune balance.
OBJECTIVE:To evaluate the clinical effects of autologous umbilical cord blood mononuclear cel transplantation on the immunologic function and prognosis for premature infants.
METHODS:Sixty-two preterm infants who entered into NICU immediately after birth, weighing ≤ 1 500 g, were divided into treatment group and control group according to parent’s wil ingness. In the treatment group, the umbilical cord blood was extracted from the umbilical vein and re-infused into the preterm infants after density gradient centrifugation within 4 hours. The cel ular immunity levels, humoral immunity levels and clinical parameters were monitored before and after treatment.
RESULTS AND CONCLUSION:After 1 week of treatment, the CD4, CD4/CD8 levels were significantly increased compared with the control group (P=0.01, 0.03), but CD8 level had no changes. At 1 week after treatment, IgM levels were both increased in the two groups, especial y in the control group (P=0.00);IgA levels had no changes;IgG levels were decreased, especial y in the control group (P=0.02). The incidence of severe infection during hospitalization was 13%in the treatment group, which was lower than the control group (16%), but there was no difference between the two groups. The proportion of infants undergoing mechanical ventilation and average length of stay had significant differences between the two groups (P<0.05). After 12 months, the incidence of recurrent respiratory tract infections was zero in the treatment group and one case in the control group, and there was a significant difference between the two groups. These findings indicate that autologous umbilical cord blood mononuclear cel transplantation can improve the immunologic function, slower the reduction of IgG levels, reduce the usage of breathing machine, shorten the length of stay, and reduce the incidence of recurrent respiratory tract infections in preterm infants.

Objective To observe the diagnostic value of high-sensitivity C-reactive protein/albumin ratio (hs-CRP/ALB) in early-onset infection in premature and its clinical significance. Methods Clinical data of premature patients with high risk factors of intrauterine infection admitted to neonatal intensive care unit (NICU) of Liaocheng People's Hospital in Shandong Province from July 2013 to July 2015 were analyzed retrospectively. They were divided into infection and non-infection groups, as well as survival and death groups according to the outcome of the premature babies. The pre-albumin (PA), ALB, white blood cell count (WBC), platelet count (PLT), and hs-CRP at the moment of NICU admission (0 hour) and 24, 48 and 72 hours after NICU admission were compared. The receiver operating characteristic (ROC) curve was plotted for evaluation of the predictive value of serum hs-CRP/ALB ratio for the babies during hospitalization. Results A total of 214 cases of premature infants were enrolled, with 102 cases in infection group, and 112 in non-infection group. In infection neonates, 97 of them survived, and 5 died. ① The level of hs-CRP after NICU admission was increased in infection and non-infection groups, and it was significantly higher at 48 hours in infection group than that of the non-infection group [mg/L: 22.0 (7.6, 40.4) vs. 18.3 (12.9, 23.4),Z = 5.257, P = 0.038]. Then hs-CRP was decreased in non-infection, but it was persistently increased in infection group, and it was significantly higher at 72 hours in infection group than that of the non-infection group [mg/L: 25.5 (9.8, 43.5) vs. 12.2 (1.9, 22.1), Z = 5.879, P = 0.042]. The levels of ALB and WBC in infection group was significantly lower than those of the non-infection group [ALB (g/L): 27.9±2.7 vs. 29.1±2.9, t = 5.178, P = 0.026; WBC (×109/L): 13.7±7.1 vs. 16.1±7.9, t = 4.368, P = 0.037], and at 48 hours hs-CRP/ALB in infection group was significantly higher than that of non-infection group [0.16 (0.08, 0.57) vs. 0.07 (0.00, 0.23), Z = 3.436, P = 0.042]. There was no significant difference in PA and PLT between infection and non-infection groups. ② In premature patients with infection, ALB in non-survival group was decreased (g/L: 20.4±6.9 vs. 29.6±7.5, t = 7.859, P = 0.003), and 48-hour hs-CRP and hs-CRP/ALB ratio was significantly increased when compared with that of survival group [hs-CRP (mg/L): 25.8 (15.6, 54.8) vs. 18.2 (12.9, 36.2), Z = 4.067, P = 0.043; hs-CRP/ALB: 0.31 (0.28, 0.76) vs. 0.06 (0.00, 0.21), Z = 6.102, P = 0.011].③ It was shown by ROC curve analysis that the area under ROC curve (AUC) of 48-hour hs-CRP/ALB ratio for evaluating infection was 0.765, when the cut-off of 48-hour hs-CRP/ALB ratio was 0.08, the sensitivity was 84.2%, and the specificity was 76.3%. Conclusions The values of hs-CRP and ALB can be used as effective indexes in early diagnosis of intrauterine bacterial infection, and increase in 48-hour hs-CRP/ALB can improve the sensitivity of the diagnosis. Hs-CRP/ALB can be combined to guide rational use of antibiotics.

Objective To investigate the correlations between the clinical manifestations based on pathologic grades and renal pathological features of Henoch - Schonlein purpura nephritis(HSPN)in children. Methods The clinical data of 77 patients with HSPN in the Department of Nephrology,Anhui Provincial Children's Hospital from Ja-nuary 2004 to March 2014 were retrospectively analyzed. The relationship between clinical manifestation and pathologi-cal features was analyzed. Results Among the 77 patients,21 cases(27. 3% )had both abdominal symptoms,and ar-thritis was reported in 15 cases(19. 5% ),28 cases(36. 4% )had abdominal symptoms and arthritis,and 13 cases (16. 9% )had no such symptoms. Hematuria and proteinuria were the most common clinical types[48. 1%(37 / 77 ca-ses)],followed by simple hematuria or proteinuria[27. 3%(21 / 77 cases)],nephrotic syndrome[23. 4%(18 / 77 ca-ses)],and chronic nephritis[1. 3%(1 / 77 cases)]. The major of pathological changes in HSPN were grade Ⅱ[46. 8%(36 / 77 cases)]and grade Ⅲ[45. 5%(35 / 77 cases)],the minority of them were grade Ⅰ[6. 5%(5 / 77 cases)]and grade Ⅳ[1. 3%(1 / 77 cases)]. The severity of urine protein was positively associated with pathologic classification (r s = 0. 472,P = 0. 000). According to the glomerular deposition of immune complex,there were 6 types. The percen-tage of deposition of IgA + IgM was 62. 3%(48 / 77 cases),IgA + IgG + IgM was 19. 5%(15 / 77 cases),IgA 14. 3%(11 / 77 cases),that of IgA + IgG 1. 3%(1 / 77 cases),and the IgM 1. 3%(1 / 77 cases),no Ig 1. 3%(1 / 77 cases). In these cases,76. 6%(59 / 77 cases)had complements C3 deposition;pathologic stage characterized by Ⅲ level and a-bove were common[54. 2%(32 / 59 cases)],Ⅱ level 42. 2%(25 / 29 cases),Ⅰ level 3. 4%(2 / 59 cases). Among the different types of immune complex depositions,there was no statistically significant difference in pathological types of distribution,while the clinical type and complements C3 deposition were significantly associated with pathologic classifi-cation(rs = 0. 361,P = 0. 001). Sixty - two cases were rated as level 1(80. 5% ),and 15 cases was level 2(19. 5% );in different clinical group,rating in glomeruli was statistically different(χ2 = 17. 2,P = 0. 004). Renal tubular interstitial rating of all the patients were level 1(100% ). Conclusions The severity of urine protein,complements C3 deposition is associated with pathologic classification. Pathologic classification can basically reflect the renal damage in HSPN.