Bronchoalveolar lavage is a lung interventional technique,it has a good prospect in the diagnosis and treatment of childhood respiratory diseases,especially in severe and difficult cases.This article focused on the role of bronchoalveolar lavage in the diagnosis and treatment of respiratory diseases in children,described the impact of pulmonary surfactant.

Objective To investigate the pharyngeal bacterial pathogens of children's community acquired pneumonia(CAP)in hospital,and provide evidences to clinical empirical therapy.Methods Three hundred and fifty-nine patients with CAP were selected.Before the treatment,pharyngeal swabs was taken for culture to find bacteria,then to be done drug sensitivity quantitative test and examed the extended spectrum β lactamages(ESBLs).Results The positive rate was 21.7%(78/359)and bacteria was 82 strains.It was mainly consisted with gram negative bacteria(73.2%,60/82),and klebsiella pneumonia (30.5%,25/82).Streptococcus pneumonia(18.3%,15/82)was the most common in gram positive bacteria.Klebsiella pneumonia was resistant to amoxicillin.Drug resistance of ESBLs producing strains was increased.Streptococcus pneumonia was highly resistant to erythromycin,clindamycin,and tetracycline.The ratio of bacteria infection in infancy age(34.6%.47/136)was higher than others.Conclusions Gram negative bacteria is significant pharyngeal bacterial pathogens in CAP of children.The most common ono is klebsiella pneumonia,and the corresponding one in gram positive bacteria is streptococcus pneumonia.Clinical doctors should avoid using high antibiotic-resistance drugs.

Objective To investigate the viral pathogens of children with community acquired pneumonia(CAP) in dalian city during the last year in hospital,and provide evidences to clinical empirical therapy.Methods Some patients of department of respiratory.in Dalian children's hospital were devided into four groups from May 2007 to 2008.Serum virus antibodies were detected after 1 week of natural course of disease.Results In 280 cases who were detected for viral IgM antibodies,the positive rate was 28.2%.It was mainly consist with respiratory syncytial virus,adenovirus,and parainfluenza virus.The ratio of virus infection in school age group(54.0%) was higher than that in other groups.The second is in toddler age.Conclusion Virus are significant pathogens in CAP of children.The most common viral agent is respiratory syncytial virus(RSV),and the next one is adenovirus(ADV).The ratio of virus infection in school age group is the highest.We should give anti-virus and propotional supportive treatment to these children promptly.

Objective To investigate the viral pathogens of children with community acquired pneumonia (CAP) in dalian city dur-ing the last year in hospital ,and provide evidences to clinical empirical therapy. Methods Some patients of department of respiratory, in Dalian children' s hospital were derided into four groups from May 2007 to 2008. Serum virus antibodies were detected after 1 week of nat-ural course of disease. Results In 280 cases who were detected for viral lgM antibodies, the positive rate was 28.2%. It was mainly con-sist with respiratory syncytial virus, adenovirus, and parainfluenza virus. The ratio of virus infection in school age group (54.0%) was higher than that in other groups. The second is in toddler age. Conclusion Virus are significant pathogens in CAP of children. The most common viral agent is respiratory syncytial virus (RSV), and the next one is adenovirus (ADV). The ratio of virus infection in school age group is the highest. We should give anti - virus and propotional supportive treatment to these children promptly.

Objective:To investigate the changes of thymic lymphocyte procyanidin(TSLP)and interleukin-4(IL-4),interleukin-10(IL-10)and interleukin-13(IL-13)in the lung tissue of young rats infected with respiratory syncytial virus,and to investigate the changes of TSLP and Th2 Correlation.Methods:18 Wistar rats were randomly divided into RSV infection group and normal group,9 rats in each group.Application of RSV virus droplets nasal modeling,saline diarrhea as a control.The lung tissue of rats was taken for pathological observation;the load of syncytial virus at different time points and the expression of TSLP in lung tissue were detected by Real-time quantitative polymerase chain reaction(q-PCR);at the same time,the expression of TSLP at the protein level was detected by Western blot.The levels of cytokines IL-4,IL-10 and IL-13 in serum were measured by enzyme-linked immunosorbent assay(ELISA).And the relationship between TSLP and IL-4,IL-10 and IL-13 was analyzed by Spearman correlation.Results:Compared with the normal control group,the rats in the model group showed symptoms such as poor mental state,rough hair,decreased activity and shortness of breath after intranasal infection,and the symptoms were aggravated.Pathological observation showed that the alveolar wall was thickened in the model group,and a large number of lymphocytes,plasma cells,eosinophil infiltration.q-PCR was used to detect the syncytial virus load in model group,and reached the peak at about 5 days,then decreased gradually.RSV infection increased the secretion of TSLP in rat respiratory tract.q-PCR and Western blot showed that TSLP concentration in model group was higher than that in control group(P<0.05).The levels of IL-4,IL-10 and IL-13 in the serum of the model group were higher than those in the control group(P<0.05).Spearman correlation analysis showed that TSLP was positively correlated with IL-4 and IL-10 expression in RSV model group,and there was no correlation between TSLP and IL-13 expression.Conclusion:RSV infection in rat lung tissue can induce increased expression of TSLP,while promoting the occurrence of Th2 type of inflammatory response and the expression of related cytokines,in order to further study of RSV infection caused by bronchiolitis and asthma and other respiratory diseases,the mechanism of action and clinical treatment laid the foundation.

This study was aimed to observe the method of "Xuan-Jiang-Qing" of Ding-Chuan (DC) decoction on the expression of T-bet and GATA3 of lung tissues,IFN-γ and IL-4 in serum of young rats infected with respiratory syncytial virus (RSV),in order to further explore the mechanism of Th1/Th2 immune balance.A total of 54 ealthy young Wistar rats were randomly divided into 6 groups,which were the normal group,RSV model group,DC decoction group,ascending (Xuan) therapy group,descending (Jiang) therapy group,pyretic clearing (Qing) therapy group,with 9 rats in each group.Except the normal group,rats in other groups were with RSV (Long bead) virus to establish the animal model.Two hours after intranasal medication,intragastric administration of corresponding medication was given to each intervention group.And equal volume of normal saline was given to the normal group and the RSV model group.Levels of T-bet and GATA3 protein in lung tissues were detected by Western blotting.Levels of INF-γand IL-4 cytokines in serum were detected by ELISA.The results showed that DC decoction and each decomposing agent group can adjust the general condition of RSV infection and reduce the lung index after RSV infection (P ＜ 0.05).Compared with the normal group,the expression of T-bet protein in lung tissues was decreased and the expression of GATA3 protein was significantly higher in the RSV model group and each intervention group with significant difference (P ＜ 0.05).The expression of T-bet protein was up-regulated and the expression of GATA3 protein was down-regulated in DC decoction and ascending (Xuan) therapy group compared to the RSV model group with significant difference (P ＜ 0.05).Compared with the normal group,the content of INF-γin serum of RSV model group was significantly decreased,and the content of IL-4 was increased with significant difference (P ＜ 0.05).Compared with the model group,DC decoction group can increase the content of INF-γ,and each intervention group can reduce the IL-4 content with statistical significance (P ＜0.05).It was concluded that the method of "Xuan-Jiang-Qing" of DC decoction can obviously increase T-bet and INF-γ cytokines,and inhibit GATA3 and IL-4 cytokines among RSV infected young rats.It can regulate Th1/Th2 cell immune balance.It is one of the important effectiveness mechanisms to prevent and treat RSV infection.

Objective To study the expressions of thymic stromal lymphopoietin (TSLP),GATA-3 transcription factor and serum interleukin (IL)-4 and IL-13 in lung tissue of young rats infected with respiratory syncytial virus (RSV) at different time points,and to analyze the expression level of TSLP and its downstream related factors.Methods Sixty healthy Wistar rats were randomly divided into normal group and model group.Under the ether anesthesia,RSV Long virus solution was inoculated into the nasal cavity of the model group for 3 days,once a day,and the virus infection model was established.The normal conditions of the 2 groups were observed and recorded on the 3rd,5th and 7th day after the model was established.The expression levels of RSV mRNA,TSLP and its downstream factors were analyzed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay.Results (1)Compared with the normal group,the model group was in poor condition and progressively increased.(2) After the RSV infection,the virus load in the model group reached the peak on the 5th day,which was 4.58 ±0.21.(3)The expression levels of TSLP at the corresponding time points were 0.94 ± 0.26,1.27 ± 0.10 and 1.27 ± 0.01,respectively,which were significantly higher than those in the normal group on the 5th,7th day (t =-11.409,-57.482,all P ＜0.05).(4) The expression of GATA3 at the each time point in the model group were 1.16 ± 0.07,2.61 ± 0.41 and 0.64 ± 0.06,raspectively,which were higher than those in the normal group,and the expression level of GATA3 was statistically significant (t =-26.899,-10.637,-15.187,all P ＜ 0.05).(5) Compared with the normal group,the expressions of IL-4 and IL-13 in the model group were higher than those in the normal group,and the expressions level of IL-4 and IL-13 in the model group showed an increasing trend.Conclusion RSV infected rats can up-regulate the dynamic response of Th2 cells by increasing the expression of TSLP,GATA3 transcription factor and IL-4 and IL-13.

OBJECTIVETo observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage, for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.

METHODFrom July 2011 to March 2012, 30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen. They were 3 to 12 years old, the average age was 5.3 years, including 17 boys and 13 girls, the ratio of boys and girls is 1.3: 1. Continuous sampling the electrocardiogram before and during the process including anesthesia, entering into glottis, lavage, aspiration, and revive, and recording the heart rate, rhythm amplitude and width of P wave, the PR interval, the form and width of QRS complex were also measured. The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.

RESULTThe incidence of heart rate increase was 100.0%, 26 (86.7%) patients began to emerge after anesthesia, the rest of the patients also developed heart rate increase after the start of bronchoscopic operation. All patients had sinus tachycardia, and were most obvious in the progress of lavage and revive. In the process of entering into glottis, lavage, aspiration, 13 (43.3%) patients had arrhythmia episodes. Types of arrhythmia included sinus bradycardia, atrioventricular block and premature beat. Incidences of intraoperative arrhythmia compared with the pre- and post-operation were all statistically significantly different (P = 0.00). The most common arrhythmia were premature beat, in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction. Two patients had III° atrioventricular block accompanied by serious sinus bradycardia. All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended. Five patients (16.7%) had PR interval prolongation. Five patients (16.7%) had incomplete right bundle branch block (IRBBB) . Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05]. Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05], but showed the most notable effect on heart rate.

CONCLUSIONBronchoalveolar lavage can influence the heart rhythm and conduction, but most of the influence with pathological significance are transient. Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low, the bronchoalveolar lavage technique is safe. The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage. During the procedure, the patient's ECG changes should be closely monitored to reduce the incidence of adverse reactions.

Arrhythmias, Cardiac ; etiology ; physiopathology ; Bronchoalveolar Lavage ; adverse effects ; methods ; Bronchoscopy ; adverse effects ; methods ; Cardiac Complexes, Premature ; etiology ; physiopathology ; Cardiac Electrophysiology ; Child ; Child, Preschool ; Electrocardiography ; Female ; Heart Block ; etiology ; physiopathology ; Heart Rate ; physiology ; Humans ; Hypoxia ; etiology ; physiopathology ; Male ; Pneumonia ; pathology ; therapy

Objective:mariPOC ? multianalyte assays and direct immunofluorescence assays (DFA) were used to detect respiratory viruses in children with pneumonia and evaluate the performance of mariPOC ? method by comparing the results. Methods:Nasopharyngeal swab samples were tested by both mariPOC ? and DFA for influenza A and B, respiratory syncytial viruse, adenoviruse, and parainfluenza 1, 2, and 3 viruses. Real-time PCR was also used to detect the DNA of FluA、FluB、RSV、PIV 1、2、3 and ADV as reference method, in order to verify the inconsistent result of the above two method. Results:Four hundred children with pneumonia were enrolled. The total positive rates of mariPOC ? and DFA were 40.25% and 38.25% respectively. According to the results, the positive consistency between mariPOC ? and DFA was 92.16% and the negative consistency was 91.90%, the overall agreement rate was 92.00%. There were 32 samples where mariPOC ? and DFA gave contradicting results. In real-time PCR confirmation, the result of 20 samples were consistent with mariPOC ? test and 12 agreed with DFA. Compared with real-time PCR, the sensitivity of mariPOC ? was 93.06%, the specificity was 100.00%, and the total coincidence rate was 97.00%. Conclusions:mariPOC ? multianalyte assays had good correlation with DFA for detection of respiratory viruses in children with pneumonia. Compared with the reference method real-time PCR, it has better sensitivity, specificity and total coincidence rate. mariPOC ? multianalyte assay has the obvious advantages of high sensitivity, fast detection and intelligence, which can be effectively applied to clinical examinations.

This study was aimed to evaluate the clinical effect and safety of Qing-Fei Tong-Luo (QFTL) ointment for treating children with pneumonia.Randomized controlled trial (RCT) was conducted among 460 cases of children with pneumonia.The observation group was given QFTL ointment combined with basic treatment.And the control group was only treated by basic treatment.Evaluation was given on the total clinical efficacy,disappeared time of fever,cough,expectoration,shortness of breath,and medication safety.The incidence of respiratory diseases was followed up on the 30th days after drug withdrawal.The results showed that in the aspect of clinical efficacy between two groups,the cure rate of the observation group was 98.26％,and that of the control group was 93.89％,with statistic significance (P ＜ 0.05).The cure rate of the observation group was better than that of the control group.There was statistical difference on expectoration disappeared time (P ＜ 0.05).There was no statistical difference on disappeared time of fever,cough and shortness of breath (P ＞ 0.05).There was statistical difference on the incidence of respiratory diseases on the 30th days followed-up after drug withdrawal (P ＜ 0.05).There was no statistical difference on the incidence of upper respiratory tract infection,pneumonia and asthma (P ＞ 0.05).No adverse reactions occurred in the observation group.It was concluded that QFTL ointment combined with basic therapy on the treatment of pneumonia in children was significantly better than the control group in the aspect of clinical efficacy,expectoration disappeared time and the incidence of bronchitis.It is safe and effective.The prognosis is good and worthy of promotion in the clinical practice.