Objective To explore the therapeutic value of bronchoscopy in pediatric status asthmaticus.Methods A total of 16 children with status asthmaticus received standard medical therapies (therapy group) from January 2008 to August 2010 in pediatric intensive care unit (PICU) at First Hospital,Xiamen University.However,l0 of them underwent fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) (bronchoscopy group) along with standard medical therapies from September 2010 to July 2012.The values of oxygenation index (PaO2/FiO2),arterial partial pressure of carbon dioxide (PaCO2),blood oxygen saturation (SaO2),heart rate (HR),respiratory rate (RR) within 1 hour before bronchoscopy procedure,within 6 hour post procedure and within 24 hour post procedure were observed.The extinction time of wheezing sound,PICU length of stay and admission length of stay were observed between therapy and bronchoscopy groups.Results Bronchoscopies revealed a lot of thick mucus plugs and secretions.Large airways were lavaged for clearance of obstructive secretions with normal saline.Within BAL fluid counts of the bronchoscopy group,there were neutrophilia (n =8),eosinophilia (n =4) and neutrophilia/ eosinophilia (n =3).Within BAL fluid cultivation of the bronchoscopy group,4 patients had positive results for Streptococcus pneumoniae (n =2),Pseudomonas aeruginosa (n =1) and Staphylococcus aureus (n =1).In bronchoscopy group,the values of PaO/FiO2,PaCO2,SaO2,HR and RR were 319 ± 19,(40 ±4) mm Hg(1 mm Hg =0.133 kPa),(92.6 ± 1.5) ％,(128 ± 12) rates/min and (35 ± 4) breaths/min within 6 hour post procedure versus 255 ± 24,(54 ± 5) mm Hg,(89.2 ± 2.6) ％,(148 ± 10) rates/min and(50 ± 6)breaths/min within I hour before procedure (P ＜ 0.01).At 24 hour post procedure,the values of PaO2/FiO2,PaCO2,SaO2,HR,RR for bronchoscopy group were 354 ± 21,(40 ± 3) mm Hg,(93.4 ±1.1)％,(125±9)rates/min and(34 ±3)breaths/min versus 317 ±21,(46 ±4)mm Hg,(90.1±2.5) ％,(138 ± 8) rates/min and (43 ± 3) breaths/min respectively for therapy group (P ＜ 0.01).The extinction time of wheezing sound was (67 ± 22) hours for bronchoscopy group vs.(98 ± 23) hours for therapy group(P ＜ 0.01).The mean PICU length of stay was (1.6 ± 0.7) days for bronchoscopy group vs.(2.6 ± 0.7) days for therapy group (P ＜ 0.01).The mean admission length of stay was (5.0 ± 0.7) days for bronchoscopy group vs.(6.6 ± 1.2) days for therapy group(P ＜ 0.01).All patients for bronchoscopy group tolerated the procedure without any complications.Conclusion As a safe adjunctive therapy in pediatric status asthmaticus,flexible bronchoscopy with bronchial lavage may reduce the admission and PICU length of stay and alleviate clinical symptoms.

Objective To determine the lumbar anatomical structure parameters of the lumbar spine posterior column and its sample data of three-dimensional conformation,and based on these data to design the lumber laminar screw dynamic fixation system.Methods 20 human L3 ～ S1 bone specimens,the thickness of the lumber laminar region were measured to obtain the normal anatomical parameters of the lumbar laminar.And 20 healthy lumbar vertebrae L3-S1 for three-dimensional reconstruction were detected by CT scan,which could obtain the structure data of the normal lumbar posterior three-dimensional conformation,and to obtain conformational sample data of three-dimensional space of the posterior structure.Results Lumbar lamina medial 1/3 could serve as a spine laminar screw setting area by anatomical observations and measurements.Lamina thickness of L3-4 on average (6.6 ±0.9) mm,L5 ～ S1average (6.0 ± 0.6) mm.Lumber laminar screw length 6.5 ～ 8.0mm could meet the requirements of bilateral cortical fixation.Conclusion Lower lumbar spinal lamina area can serve as the region to fix the bilateral cortical bone screw,and the optimal length of the laminar screw is 6.5 ～ 8.0rmm.

Aim To investigate the drug-containing serum of Rhizoma drynariae on osteogenesis differentiation of bone marrow mesenchymal stem, and discuss the possible mechanism.Methods BMSCs were cultured in media with different concentrations of medicine containing serum.BMSCs proliferation ability was detected in 3,5,7,9 days by CCK-8.ALP activity was detected after 7,10,14 days′ induction.After 3 weeks culturing, alizarin red staining was performed to observe the formation of calcium nodules.The expression of β-catenin,LRP5,RUNX-2 and Osteriex mRNA were detected using RT-PCR.The protein expression of β-catenin,LRP5 was detected using Elisa method.Results Rhizoma drynariae drug-containing serum could obviously promote the proliferation of BMSCs and calci-fied nodule formation.Besides, the ALP activity was improved in a certain period of time.The expression of β-catenin,LRP5,GSK-3β,RUNX-2 and Osteriex mRNA were significantly up-regulated,and the protein expression of β-catenin,LRP5 was up-regulated too.The expression of GSK-3β was down-trgulated.Conclusions Rhizoma drynariae drug-containing serum promotes mineralization and osteogenic differentiationof BMSCs, and the mechanism is closely related with activating WNT/beta-catenin signaling pathway, raising the beta-catenin, LRP5, RUNX-2, and Osteriex mRNA expression, beta-catenin, LRP5 protein expression,and down-regulation of GSK-3β mRNA expression.

Objective:To explore the feasibility and safety of long-term home mechanical ventilation(HMV) in children with chronic respiratory failure.Methods:Clinical data of 11 children with chronic respiratory failure, who underwent HMV with the care of the First Affiliated Hospital of Xiamen University from January 2013 to December 2019, were retrospectively reviewed. The clinical manifestation, growth and development, quality of life, adverse events and prognosis of HMV children were analyzed.Results:There were 8 boys and 3 girls with the onset age of 26 days to 13 years old; and the age at starting HMV was 3 months to 13 years old. Eight children were diagnosed as neuromuscular diseases, and 3 children were diagnosed as respiratory diseases. The duration of institutional mechanical ventilation was 2 weeks to 8 months. Six patients underwent invasive HMV via a tracheostomy, and 5 received non-invasive ventilation via nasal and face masks. Bi-level positive airway pressure ventilation mode was applied in all the patients. The duration of HMV was 3 months to 27 months. During follow-up, no HMV related adverse events were observed. Both the quality of life and nutritional status were improved in all cases. One patient lost follow-up 9 months later and 1 patient died of severe adenovirus pneumonia during hospitalization for examination, the remaining 9 cases survived. Liberation from HMV was obtained in 4 patients. The frequency of readmission was 1 to 2 times.Conclusion:It is suggested that long-term HMV is safe and feasible for children with chronic respiratory failure.

Objective To evaluate the association between iodine intake and treatment outcomes of radioiodine remnant ablation in patients with papillary thyroid cancer (PTC),and to investigate the determinants related to the ablation efficacy.Methods A total of 95 PTC patients (28 males,67 females;average age 39.8 years) without distant metastases from January 2013 to May 2014 were enrolled in this retrospective study.All patients underwent total thyroidectomy and 2-4 weeks of low iodine diet (LID) before initial 131I therapy.Patients were divided into 3 groups according to urinary iodine excretion (UIE):moderate-severe iodine deficiency group (0＜UIE＜50 μg/L,n =30),mild iodine deficiency group (50 μg/L≤UIE＜100 μg/L,n =26),adequate iodine group (100 μg/L ≤ UIE ＜ 300 μg/L,n =39).Patients were followed up for 3-6 months after radioiodine ablation,successful ablation was defined as no visible uptake in the thyroid bed on diagnostic 131I whole body scan and Tg level ＜2 μg/L (with negative TgAb),or no visible uptake in thyroid bed on posttreatment 131I whole body scan.x2 test,two-sample t test,Mann-Whitney u test and logistic regression analysis were performed.Results In all,84.2％ (80/95)of patients were successfully ablated.The successful rates in the three iodine intake groups were 96.7％ (29/30),84.6％ (22/26) and 74.4％ (29/39),respectively,with significant difference (x2=7.374,P＜0.05).Univariate analysis revealed that UIE,pre-treatment TSH,pre-treatment Tg and the amount of remnant thyroid tissue at ablation affected ablation efficacy (x2 =7.374,t =2.037,z =-2.966,x2 =4.144,all P＜0.05).Logistic regression showed that the level of pre-treatment Tg (P ＜ 0.05) and iodine intake (P ＜ 0.05) were independent factors of ablation efficacy.Conclusion Iodine intake before 131I remnant ablation is one of the important factors affecting treatment outcomes.Thyroid remnant could be more successfully ablated if reasonable LID protocols be adopted according to the iodine nutritional status before treatment.

Objective: To obtain monoclonal antibodies against programmed cell death 10(PDCD10) for further study of the structure and function of PDCD10 protein.Methods: Balb/c mice were immunized with recombinant PDCD10,hybridoma cell lines secreting monoclonal antibodies against PDCD10 were screened by regular cell fusion and subcloning approach.The specificities of these monoclonal antibodies were determined by ELISA,Western blotting and Immunofluorescecence assay.Results: Three hybridoma cell lines(5G1,4F7 and 3H5) stable in secreting specific monoclonal antibodies were successfully obtained.Subclass of IgG belonged to IgG1(4F7 and 5G1)and IgG2b(3H5),respectively.The ascite titers of these monoclonal antibodies reached 1∶10~7.They could specifically bind to recombinant PDCD10 and endogenous and overexpressed PDCD10 proteins proved by ELISA and Western blotting.They failed to react with E.coli lysates and glutathione S-transferase(GST).In addition,these three monoclonal antibodies could recognize different epitopes of PDCD10 proteins assessed by immune fluorescence competitive binding assay.Both endogenous and overexpressed PDCD10 protein mainly located in the nucleus.Conclusion: Monoclonal antibodies against PDCD10 with high titers and specificity have been successfully prepared,which has laid the foundation for further study of PDCD10 protein.

Objective: To review children′s primary ciliary dyskinesia (PCD) in the pathogenesis, clinical manifestation, diagnosis and treatment. Method: To summarize and analyze the clinical data of a patient who was admitted to the first affiliated hospital of Xiamen University with primary ciliary dyskinesia in April 2014 while referring to related literature. Result: An 11 years old boy, weighting about 22 kg, had a course of more than 10 years with repeated cough, stuffy and runny nose shortly after the birth. Examinations after admission to hospital showed that he presented with visible clubbing, bilateral paranasal sinus area tenderness, pharynx posterior wall with visible yellow pussy stuff drip and bilateral lung had scattered wet rales. Auxiliary examination revealed bilateral maxillary sinus, ethmoid sinus inflammation and bronchitis with left lower lung bronchiectasis. Fiberoptic bronchoscopy discovered congestion and a lot of sputum; ciliary biopsy pathology displayed that cilia were sparse and partial cilia 9+ 2 microtubules structural abnormalities. Full sequence of exon gene sequencing revealed two mutations located at chromosome 16 chr16: 71061369 (non-coding regions) and chr16: 70993591 (coding). Two novel mutations m. 3362A>G(E20) and c. 6101G>A(E39) in exon 16 of the HYDIN gene were identified. With the" ciliary motility disorder, gene" as keywords , the CNKI, Wanfang digital knowledge service platform and PubMed were searched for relevant articles from the establishment to July 2016. The studies retrieved included 9 cases and these cases were summarized. Comprehensive analysis showed that HYDIN gene mutations related PCD patients had the typical PCD performance such as repeatedly wet cough, sinusitis, bronchiectasis, and otitis media. The majority of patients have a history of acute respiratory distress syndrome in infancy and no visceral dislocation was not found. Most of the patients had no obvious structural abnormalities in cilia electron microscopic examination. Conclusion The PCD patients with HYDIN genes mutations have clinical manifestations such as sinusitis, otitis media, bronchiectasis but without transposition of viscera. Cilia structure can be normal under the electron microscopic examination in some of patients.

Objective:To compare the clinical characteristics of Mycoplasma pneumoniae pneumonia and adenoviral pneumonia in children. Methods:Clinical data of 151 children with pneumonia admitted to our hospital from January 2019 to June 2019 were retrospectively analyzed, including 106 cases of Mycoplasma pneumoniae pneumonia (MP group) and 45 cases of adenoviral pneumonia (ADV group). The general conditions, clinical manifestations, laboratory results, pulmonary imaging, proportion of severe cases, respiratory support style and length of hospital stay were compared between two groups. Results:The MP group had shorter fever time compared to the ADV group ( t=15.910, P<0.01); and the maximum temperature in the MP group was lower than the ADV group ( Z=3.561, P<0.01). In the comparison of shortness of breath, wet rales in the lungs, tri-concave sign, hypoxemia, the differences were all significant between two groups (χ 2=11.203, 6.807, 36.746, 21.177, all P<0.01). The WBC in the MP group was lower than that in the ADV group ( t=33.960, P<0.01); the PCT, IL-6, LDH and 25-(OH) D 3 levels in the MP group were lower than those in the ADV group ( Z=5.986, 3.146, 4.203, 2.094, all P<0.05); while there was no significant difference in CRP levels between two groups ( Z=1.360, P>0.05). Pulmonary imaging in the MP group mainly involved unilateral lung, and the ADV group mainly involved bilateral lungs (χ 2=27.055, P<0.01). There was no significant difference in pulmonary patchy exudation between two groups(χ 2=0.298, P>0.05). There were 30 patients (28.3%) with severe pneumonia in MP group and 33 patients (73.3%) in the ADV group ( t=26.345, P<0.01). Twelve patients (11.3%) in the MP group were given non-invasive respiratory support, 1 patient (0.9%) was given invasive respiratory support; while 31 patients (68.9%) were given non-invasive respiratory support in the ADV group, and 5 patients (11.1%) were given invasive respiratory support (χ 2=66.439, P<0.01). The MP group had shorter hospital stays than ADV group ( t=31.014, P<0.01). Conclusion:The conditions of disease are more severe, and length of hospital stay is longer in children with adenoviral pneumonia than those with Mycoplasma pneumoniae pneumonia.

OBJECTIVETo analyze the clinical manifestations of refractory Mycoplasma pneumoniae pneumonia (RMPP) which unresponded to methylprednisolone in the dosage of 2 mg/(kg·d) for 3 days.

METHODRetrospective analysis was performed on the clinical data of 110 children (64 boys and 46 girls) with RMPP. The patients were divided into "effective group" and "ineffective group" according to initial effect of 2 mg/(kg·d) methylprednisolone. The clinical manifestations, laboratory examination, radiological features and bronchofibroscopic findings of the children were compared. In order to seek the reference indexes which indicate nonresponsive to 2 mg/(kg·d) methylprednisolone, an ROC curve was made, of which the diagnostic cut-off was five independent correlation factors while grouping was made according to patients' different response to glucocorticosteroid.

RESULTThe effective group had 86 (86/110, 78.2%) children while ineffective group had 24 (24/110, 21.8%). The ineffective group children had the following performance: 16 children (16/24, 66.7%) in ineffective group had ultrahyperpyrexia (T ≥ 40 °C), which was significantly more severe compared to those in effective group (32/86, 37.3%, P < 0.01); the levels of white blood cell (WBC) count, percentage of neutrophils count (N), C-reactive protein (CRP), serum ferritin (SF), alanine transaminase (ALT), lactic dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) and fibrinogen (Fib) in ineffective group were significantly higher than those in effective group(P < 0.01); while percentage of lymphocyte count (L) was lower than that in effective group(P < 0.01). Proportion of mixed infection in ineffective group was higher than that in effective group (33.3% vs. 4.7%). Radiological manifestations: It was more frequently seen in ineffective group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis (41.7% vs. 0%). Abundant secretions blockage (45.0% vs. 16.9%) and mucosal necrosis (37.5% vs. 8.1%) on bronchofibroscopy were more frequently seen in ineffective group. The critical values of the five independent correlation factors were CRP 110 mg/L, SF 328 mg/L, LDH 478 IU/L, N 0.78, L 0.13.

CONCLUSIONTreatment with 2 mg/(kg·d) methylprednisolone can improve clinical symptoms and radiological manifestations of most children with RMPP quickly, but it may be ineffective in some situations such as lasting high fever or ultrahyperpyrexia for more than 7 days, CRP ≥ 110 mg/L, N ≥ 0.78, L ≤ 0.13, serum LDH ≥ 478 IU/L, SF ≥ 328 µg/L, chest CT scan indicating high density consolidation in more than a whole pulmonary lobe involved and moderate-abundant pleural effusion.

Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Bacterial Infections ; drug therapy ; epidemiology ; C-Reactive Protein ; analysis ; Child ; Child, Preschool ; Coinfection ; Female ; Ferritins ; blood ; Fever ; diagnosis ; drug therapy ; Humans ; Infusions, Intravenous ; Leukocyte Count ; Lung ; diagnostic imaging ; pathology ; Male ; Methylprednisolone ; administration & dosage ; therapeutic use ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; blood ; diagnosis ; drug therapy ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo test the efficiency of transfecting (99)Tc(m)-labeled anti-miR208b oligonucleotide into early hypertrophic cardiac myocytes in vitro.

METHODSThe anti-oligonucleotide targeting miR208b (AMO) was synthesized and modified with LNA followed by conjugation with N-hydroxysuccinimidyl S-acetyl-meraptoacetyl triglycine (NHS-MAG3) and radiolabeling with (99)Tc(m). NHS-MAG3-LNA-AMO and labeled AMO were purified with Sep-Pak C18 column chromatography, and the former was examined for UV absorption at the 260 nm using Gene Quant DNA/RNA calculator. The labeling efficiency, radiochemical purity, stability and molecular hybridization activity were analyzed. An angiotensin II-induced cell model of hypertrophic cardiac myocytes was transfected with (99)Tc(m)-NHS-MAG3-LNA-AMO via liposome, and the relative expression of miRNA208b and retention ratio of the labeled AMO in early hypertrophic cells were determined.

RESULTSThe labeling efficiency and radiochemical purity of the labeled AMO after purification exceeded 84% and 86%, respectively. The radio- chemical purities of the labeled AMO incubated in serum and normal saline for 12 h were both higher than 80%, and the labeled AMO showed a capacity to hybridize with the target gene. In the hypertrophic model of cardiac myocytes, the retention ratio of labeled AMO at 6 h was higher than 20%.

CONCLUSIONThe (99)Tc(m)-labeled antisense probe can be efficiently transfected into hypertrophic cardiac myocytes in vitro, which provides an experimental basis for subsequent radionuclide imaging studies.

Humans ; Isotope Labeling ; Liposomes ; MicroRNAs ; genetics ; Myocytes, Cardiac ; Oligonucleotides ; Oligonucleotides, Antisense ; Oligopeptides ; Radiopharmaceuticals ; Silicon Dioxide ; Succinimides ; Transfection