Pediatric laryngopharyngeal reflux (P-LPR) has drawn a lot of attention in recent years.However, its epidemiological characteristics are still unclear.Challenges laid on the lack of unified diagnostic criteria, difficulty in distinguishing physiological and pathological reflux in infants and young children, and misdiagnosis and mistreatment due to overlapping symptoms of P-LPR with common pediatric diseases (such as respiratory tract infection and allergic rhinitis). This article reviews the epidemiological characteristics and research bottlenecks of P-LPR, in hope to provide guidance for the establishment of an evidence-based P-LPR diagnostic algorithm, optimization of clinical management and improvement of prognosis.

Laryngopharyngeal reflux (LPR) refers to the reflux of gastroduodenal contents into the upper aerodigestive tract above the upper esophageal sphincter, including the nasopharynx, oropharynx, hypopharynx, and larynx, etc.It can lead to morphological changes in the upper aerodigestive tract as well as a series of symptoms and signs.The mechanism of LPR in children remains incompletely understood.Anatomical and physiological factors provide predisposing conditions for LPR in children, making them more vulnerable to refluxate injury.The direct damage to the laryngopharyngeal mucosa by the refluxate, inflammatory responses, and indirect injury triggered by neuroreflex mechanisms collectively contribute to the onset and progression of LPR.In this article, recent advances in research on the mechanism underlying pediatric LPR are reviewed, aiming to provide a theoretical basis for clinical practice.

Pediatric laryngopharyngeal reflux (P-LPR) has drawn a lot of attention in recent years.However, its epidemiological characteristics are still unclear.Challenges laid on the lack of unified diagnostic criteria, difficulty in distinguishing physiological and pathological reflux in infants and young children, and misdiagnosis and mistreatment due to overlapping symptoms of P-LPR with common pediatric diseases (such as respiratory tract infection and allergic rhinitis). This article reviews the epidemiological characteristics and research bottlenecks of P-LPR, in hope to provide guidance for the establishment of an evidence-based P-LPR diagnostic algorithm, optimization of clinical management and improvement of prognosis.

Laryngopharyngeal reflux (LPR) refers to the reflux of gastroduodenal contents into the upper aerodigestive tract above the upper esophageal sphincter, including the nasopharynx, oropharynx, hypopharynx, and larynx, etc.It can lead to morphological changes in the upper aerodigestive tract as well as a series of symptoms and signs.The mechanism of LPR in children remains incompletely understood.Anatomical and physiological factors provide predisposing conditions for LPR in children, making them more vulnerable to refluxate injury.The direct damage to the laryngopharyngeal mucosa by the refluxate, inflammatory responses, and indirect injury triggered by neuroreflex mechanisms collectively contribute to the onset and progression of LPR.In this article, recent advances in research on the mechanism underlying pediatric LPR are reviewed, aiming to provide a theoretical basis for clinical practice.

[Objective]To analyze the clinical characteristics and imaging features of effectively treated pediatric Mycoplasma pneumoniae pneumonia(MPP)with pulmonary consolidation,follow up the volume changes of pulmonary consolidation on lung CT scans of the affected children,and investigate the resolution patterns of pulmonary consolidation,and predict the time required for complete resolution.[Methods]We enrolled children with MPP and pulmonary consolidation hospitalized in the Department of General Pediatrics at Children's Hospital of Chongqing Medical University between January 2018 and May 2024.Data collected included demographics,clinical symptoms,laboratory indicators,treatment status,imaging data during hospitalization,as well as follow-up lung CT data and reexamination intervals after discharge.Consolidation volumes were measured before and after the treatment to calculate the resolution rate and resolution velocity.Descriptive statistical analysis was performed on clinical characteristics,imaging features and consolidation resolution.[Results]Among 238 children with MPP and lung consolidation,females slightly outnumbered males(the male to female ratio is 109 vs.129),with a mean age of approximately 5 years.At admission,the median cough and fever durations were 7(5-9)days and 6(4-7)days,respectively.No significant increase was found in white blood cells count or lactate dehydrogenase(LDH),and hypersensitive high-sensitivity C-reactive protein(CRP)slightly increased.Azithromycin was the first line of treatment in most cases,though second-line drugs increased in the recent two years due to the rising resistance.Bronchoalveolar lavage was performed in 66.8%(159/238)of children,and 33.2%(79/238)did not receive lavage.Consolidation was predominantly unilateral(206 unilateral vs.32 bilateral)and right-sided(117 right-sided vs.89 left-sided).The ratio of consolidation volume to total lung volume was 4.48(2.61-7.35)%,the consolidation resolution rate at follow-up was 96.08(88.02-98.95)%,the reexamination interval was 17(15-21)days,the resolution velocity was 2.15(1.23-4.01)cm3/d,and the time to complete resolution was 18.96(16.14-23.33)days.[Conclusions]Pulmonary consolidation in pediatric MPP achieves substantial resolution on CT within 2-3 weeks after effective clinical treatment.Initial consolidation volume and resolution velocity can predict the time required for complete resolution,thereby clinically guiding optimal CT follow-up scheduling.

Human metapneumovirus（hMPV）is an important cause of acute respiratory infections in children，especially in children with immunocompromised，which can cause severe infection and even life-threatening.The clinical manifestations of hMPV infection are difficult to distinguish from other respiratory viral infections，and the etiological testing is essential for diagnosis and treatment of hMPV infection.Timely identification of severe hMPV infection is important to improve the prognosis.No specific antiviral drugs and vaccines are available for hMPV. Routine use of antiviral drugs is not recommended. Further research is needed to provide more reliable evidence for the prevention and treatment of hMPV infection.

Objective:To explore the effect of exercise rehabilitation on pulmonary function, aerobic capacity and quality of life in children with bronchial asthma.Methods:According to the PICOS principle, China National Knowledge Infrastructure (CNKI) , VIP, Wanfang Database, SinoMed, Web of Science, Cochrane Library, PubMed, Embase and CINAHL were used to search for all Chinese and English randomized controlled trials on the effect of exercise rehabilitation on children with bronchial asthma from January 1, 2000 to December 23, 2021. The Cochrane manual was used to systematically review the literature. Meta-analysis was performed using RevMan 5.3.Results:Finally, 15 articles were included, with a total of 936 subjects. Meta-analysis results showed that exercise rehabilitation could improve percentage of forced vital capacity in the predicted value (FVC%) [mean difference ( MD) =2.75, 95% confidence interval ( CI) (1.22-4.28) , P=0.000 4] , percentage of forced expiratory volume in one second in predicted value (FEV 1%) [standardized mean difference ( SMD) =0.22, 95% CI (0.07-0.36) , P=0.003] , percentage of peak expiratory flow in the predicted value (PEF%) [ MD=7.15, 95% CI (3.30-11.00) , P=0.000 3] , maximum oxygen uptake (VO 2max) [ MD=5.86, 95% CI (2.53-9.19) , P=0.000 6] and quality of life [ MD=0.67, 95% CI (0.43-0.91) , P<0.000 01] , but there was no statistically significant difference in improving the ratio of FEV 1% to FVC% (FEV 1/FVC%) [ MD=-0.97, 95% CI (-3.55-1.61) , P=0.46] . Conclusions:Exercise rehabilitation can improve partial pulmonary function, aerobic capacity and quality of life in children with asthma. However, it still needs to continue to be promoted in the clinical practice, in order to verify its effectiveness with more high-quality research.

Objective:To investigate the effects of Streptococcuspneumoniae (Spn) colonization and the change of upper airway microbiome on the clinical manifestations in children with respiratory syncytial virus (RSV) infection. Methods:A retrospective cohort included 508 RSV-infected children with pneumonia and hospitalized in Respiratory Department of Children′s Hospital of Chongqing Medical University from July 2009 to July 2018. A total of 508 cases of RSV-infected children (RSV non-sequencing group) were divided into 2 groups: children with Spn airway colonization (RSV+Spn group) and children without with Spn airway colonization (RSV group) according to the detection for virus and bacteria in nasopharyngeal aspirate, and these 2 groups were compared in terms of clinical manifestations by chi-square test in different age groups. In addition, in RSV pandemic season from November 2018 to February 2020, nasopharyngeal aspirates were collected from 20 children hospitalized in Respiratory Department of Children′s Hospital of Chongqing Medical University and infected with RSV but without any positive detection of bacteria (RSV 16 S-sequencing group) and from children undergoing surgery without any sign of respiratory infection (control group). The difference of microbiome detected by 16 S RNA sequencing was compared using rank sum test between RSV 16 S-sequencing group and control group, and also between children with severe and mild pneumonia in RSV 16 S-sequencing group.Results:A total of 508 RSV non-sequencing group included 346 males and 162 females, and the visiting age was 6 (2, 12) ?months. RSV group included 443 cases and RSV+Spn group included 65 cases. In the study 244 cases were aged <6 months and 264 cases were aged ≥6 months. In children aged ≥6 months of RSV non-sequencing group, the proportion of cases presenting fever over 38 ℃ and cases with severe pneumonia in RSV+Spn group were higher than those in RSV group (53.2% (25/47) vs. 34.6% (72/217), 38.3% (18/47) vs. 21.2% (46/217), χ2=5.70,6.15, both P<0.05). RSV 16 S-sequencing group included 16 males and 4 females and the visiting age was 3.0 (1.9, 8.0) months. Airway microbiome diversity in RSV 16 S-sequencing group was lower than that in control group (alpha index: 0.93 (0.42, 2.51) vs. 3.05 (2.88, 3.61), U=60.00, P=0.001). Conclusions:RSV infection is associated with the changes of the upper airway microbiome. When the balance of airway microbiome is broken and the presence of the dominant colonization of Spn follows, it may aggravate the severity of RSV infection in children aged ≥6 months.

Plastic Bronchitis (PB) is a condition characterized by formation of plugs or casts in the tracheobronchial tree, which can induce partial or complete airway obstruction and ventilatory dysfunction.The clinical manifestations are nonspecific, usually including cough, progressive dyspnea and refractory hypoxemia.However, dyspnea and hypoxemia can be quickly improved by removing branching casts with bronchoscopy.Now, the the clinical features and differential diagnosis of PB are described in this article, in order to improve the diagnosis of the disease.

Objective:To investigate the clinical characteristics of children with invasive pneumococcal di-sease (IPD) and the sensitivity of Streptococcus pneumoniae (SP) isolates to antibacterial drugs, so as to provide the reference for diagnosis and treatment of IPD. Methods:The clinical data of IPD patients in the Children′s Hospital of Chongqing Medical University from January 2014 to December 2018 as well as the drug sensitivity results of SP isolates were retrospectively analyzed.Results:The male to female ratio of 139 patients enrolled was 1.5∶1.0.One hundred and sixteen (83.5%) patients were under 5 years old.Of the 31 patients (22.3%) with underlying diseases, 7 patients (5.1%) had hematological malignancy, 6 patients (4.3%) had congenital heart diseases, and 18 patients (12.9%) were immunosuppressed.The common sources of infection were the respiratory system (59.0%, 82/139 cases) and the central nervous system (28.8%, 40/139 cases). The in-hospital mortality rate among them was 15.8% (22/139 cases). More than 90.0% of the SP isolates were insusceptible to Erythromycin, Tetracycline and Clindamycin, and 74.8% (104/139 cases) of the isolates were insusceptible to Meropenem.The susceptibility rate of SP isolates to Amoxicillin was 69.1% (96/139 cases). The SP isolates were completely susceptible to Vancomycin, Linezolid, Moxifloxacin and Ofloxacin.Meningitis isolates had lower susceptibility rates to Penicillin (10.0% vs. 54.5%, P<0.001) and Cefotaxime (32.5% vs. 74.7%, P<0.001) than those in nonmeningitis isolates. Conclusions:Children under 5 years old with underlying diseases are susceptible to IPD and have a high mortality rate.The SP isolates in children with IPD are highly insusceptible to Erythromycin, Tetracycline, Clindamycin and Meropenem, and completely susceptible to Vancomycin, Linezolid, Moxifloxacin and Ofloxacin.Meningitis isolates are less susceptible to Penicillin and Cefotaxime than non-meningitis isolates.