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.

Objectives To analyze the clinical manifestation of pulmonary injury in children with systemic lupus erythematosus (SLE).Methods The clinical data of 8 SLE children with onset of respiratory symptoms as the first sign were retrospectively analyzed from January 2011 to December 2015.Results In these 8 children (4 females and 4 males) aged 6-15 years old.All of them presented cough,and 7 cases had fever,5 cases had anhelation,3 cases had hemoptysis,3 cases had stethalgia,3 cases had dyspnea and 3 cases had cyanosis.The types of pulmonary injury were pleural efthsion in 5 cases (62.5％),acute lupus pneurnonitis in 4 cases (50.0％),chronic interstitial pneumonia in 2 cases (25.0％),and pneumorrhagia in 2 cases (25.0％).In 7 children who performed chest high resolution CT examination,it showed that 5 cases had ground-glass shadow,5 cases had pleural effusion,5 cases had enlargement of mediastinum or lymph nodes,and 4 cases had segmental pulmonary consolidation.After treatment of the primary disease,the respiratory symptoms and pulmonary images were improved rapidly in 7 cases,and one case died of pneumorrhagia.Conclusion The clinical ministrations in SLE children with onset of respiratory symptoms as the first sign were not specific,and it was usually confused with respiratory infection.However,it usually had other organs involved and the chest imaging was more commonly showed groundglass shadow,segmental pulmonary consolidation,and pleural effusion.

Objective To explore the value of procalcitonin,C-reactive protein and neutrophil percentage in early diagnosis of bacterial bloodstream infection in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 413 cases with tumor fever who were performed PCT,CRP,blood test and blood culture in the same day in our hospital from January to December in 2015.According to blood culture results,they were divided into observation group(211 cases) and control group(202 cases).The observation group was divided into Gram-negative(G-) group and Gram-positive(G+) group.The diagnostic efficacy of PCT,CRP and NEUT％ on bacterial bloodstream infection was evaluated by receiver operating characteristic curve (ROC).Results The specificity of PCT in the observation group was the highest and the sensitivity of CRP was the highest.The levels of PCT,CRP and NEUT％ in the observation group were significantly higher than those in the control group(P＜0.05).PCT level in the G-group were apparently higher than that of G+ group(P＜0.05),while CRP and NEUT％ levels had no statistical significance between the two groups(P＞0.05).According to ROC curve,In the observation group,The AUC of PCT,CRP and NEUT％ were 0.848,0.796 and 0.718,respectively.In G-and G+ group,the AUC of PCT were 0.877 and 0.767,respectively.Conclusion PCT,CRP and NEUT％ were significantly increased in the malignant patient with bloodstream infection,PCT has showed better diagnostic efficiency compared to CRP or NEUT％ and better clinical value in distinguish between G-and G+ bacterial infection type.Combined detection of PCT,CRP,NEUT％ can help for early diagnosing malignant tumor with bacterial bloodstream infection.

Objective To explore the factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia. Methods The general information, the biochemical test results, and plasma concentration of vancomycin were collected from 93 pediatric patients with severe gram-positive cocci pneumonia. The relative factors influencing trough concentration of vancomycin were analyzed retrospectively. Results With the dosage of 40-60 mg/(kg·d), serum trough concentration of vancomycin were between 10-20 mg/L in 26 patients, <10 mg/L in 54 cases, ≥20 mg/L in 13 cases. The ALT, AST, GFR, and γ-GT were significantly different among three groups (P<0.05); the 10-20 mg/L group had the highest levels of AST and γ-GT, the ≥20 mg/L group had the highest level of ALT and the lowest level of GFR. Multiple linear regression analysis showed that GFR was negatively linearly correlated with the serum trough concentration of vancomycin (R2=0.039, P<0.05). The median serum trough concentration of vancomycin in pediatric patients with GFR≥90, 60–90, 30–60 mL/(min·1.73m2) were 8.66, 18.21, 8.45 mg/L respectively, and the difference is statistically significant (P<0.05). Conclusions The serum trough concentration of vancomycin is negatively linearly correlated with GFR in pediatric patients with severe gram-positive cocci pneumonia. The patients with impaired renal function are easier to reach the target serum trough concentration of vancomycin. Clinical use of vancomycin should follow the low doses in the range the guideline recommended, and the serum trough concentration should be closely monitored.

Objective To analyze the clinical feature and common etiology of diffuse alveolar hemorrhage (DAH) in children. Methods Clinical data from 138 children with initially diagnosed DAH were retrospectively analyzed. The etiology, diagnosis, treatment, and prognosis had been summarized. Results Among 138 children, 76 were male and 62 were female. The clinical features are pallor ( 130 cases, 94 . 2%), cough ( 86 cases, 62 . 3%), fever ( 74 cases, 53 . 6%), anhelation ( 67 cases, 48 . 6%), hemoptysis ( 59 cases, 42 . 8%) and dyspnea ( 43 cases, 31 . 2%). Chest imaging changes were mainly patch shadow and ground glass shadow. Moreover, the detection rate of hemosiderin cells in sputum, gastric juice and bronchoalveolar lavage lfuid was 90 . 8%( 79/87 ). The common underlying diseases that caused DAH were idiopathic pulmonary hemosiderosis ( 65 cases), hematological system disease ( 22 cases), vascular inlfammatory diseases ( 15 cases), infectious diseases ( 14 cases) and cardiovascular disease ( 5 cases). The mortality rate in acute phase of DHA was 23 . 2%( 32/138 ). Conclusions DHA is a life-threatening clinical emergency disease, its cause was complex and diverse, and the acute mortality rate is high. Glucocorticoid is the ifrst choice of treatment for majority of patients.

Objective To analyze the characteristics of serum vancomycin concentrations and its clinical therapeutic effects. Methods Serum vancomycin concentrations of 59 children diagnosed with severe Gram positive cocci pneumonia and treated with vancomycin were retrospectively analyzed. Vancomycin concentrations, biochemical values and disease status of patients were analyzed. Results The serum vancomycin concentrations of severe Gram positive cocci pneumonia children accompanied by acyanotic congenital heart disease was significantly higher than those without congenital heart disease, ( 12 . 12 mg/L vs 7 . 76 mg/L, P=0 . 008 ). The therapeutic effect of 40-60 mg/(kg·d) dosage group was signiifcantly higher than that of?60 mg/(kg·d) dosage group. Acute liver function damage and moderate/severe anemia may be risk factors for poor therapeutic effects to severe Gram positive cocci pneumonia children (P?

Objective To explore the clinical characteristics and prognosis of congenital pulmonary artery sling (PAS) in children. MethodsThe clinical data of 38 children diagnosed with PAS during June 2009 and February 2015 were retrospectively analyzed. ResultsIn 38 PAS children, 35 cases (89.47%) were hospitalized for varying degrees of respiratory manifestations with recurrent cough (89.47%) and wheezing (84.21%) being the most common. The remaining 3 cases were found abnormal in routine preoperative examination and the diagnosis was confirmed after further examination. All 38 children were performed computer tomography angiography (CTA). Thirty-seven cases were diagnosed of PAS and diagnostic rate was 97.37%. One case was suspected of pulmonary dysplasia and diagnosed of PAS after operation. Twenty-six children received surgical treatment, of whom 25 children had pulmonary artery reconstruction (LPA). Seven children died during/after operation and 18 survived. The remaining 12 children received non-surgical treatment, of whom 9 died and 3 survived.ConclusionCardiac uhrasonography may reveal PAS in the early stage, while CTA is the best method for conifrmed diagnosis. LPA reconstruction is an important means of relieving left pulmonary artery oppression.

Objective To evaluate the influence of atopy on exhaled nitric oxide in chronic persistent asthmatic children. Methods A total of 52 chronic persistent asthmatic children who completed FeNO measurements and skin prick testing were enrolled. Patients were divided into non-atopic group and atopic group by skin prick testing results, and subdivided into non-allergic rhinitis and rhinitis group according to whether combined with allergic rhinitis. At the same time 78 healthy children were chosen as control group. Moreover, 32 chronic persistent asthmatic children who completed FeNO measurements twice interval of three months were enrolled. Results The FeNO level was signiifcantly different among the atopic group (n=40), the non-atopic group (n=12) and the control group (H=33.29, P=0.000);The FeNO level was signiifcantly higher in the atopic group than that in the non-atopic group (P<0.05). And the FeNO level were signiifcantly different among the rhinitis group (n=41), the non-rhinitis group (n=11) and the control group (H=30.63, P=0.000). The FeNO level was signiifcantly higher in the rhinitis group than that in the control group (P<0.05), however there were no difference between the rhinitis group and the non-rhinitis group(P>0.05).There were no correlations between FeNO levels of chronic persistent asthmatic children and the wheal diameter of house dust mites or dust mites (r=2.05, P=0.135;r=1.58, P=0.312). Moreover, the FeNO level was signiifcantly lower after 3 months ICS treatment (z=-2.05, P=0.041). Conclusions Atopy had major inlfuence on the FeNO level of chronic persistent asthmatic children, and the FeNO level declined with the theatment of ICS.

Objective To assess the effects of inhaled corticosteroids on growth velocity in children with asthma .Methods We searched the Cochrane Airways Group Specialised Register of trials (CAGR) ,which was derived from systematic searches of bibliographic databases including CENTRAL ,MEDLINE ,EMBASE ,CINAHL ,AMED and PsycINFO .We also searched Wan Fang Chinese periodical Database and VIP Chinese periodical Database from the establishment of the database to October 2014 .Articles which were parallel‐group randomised controlled trials comparing daily used of ICS ,delivered by any type of inhalation device ,ver‐sus placebo or non‐steroidal drugs in children up to 18 years of age with persistent asthma are selected .The data analysis was used by RevMan 5 .2 software .Results A total of 18 randomized control trials were included .Meta analysis showed that inhaled cortico‐steroids for 6-8 months ,1 year significantly slowing down growth velocity in children with asthma (MD= -0 .77 ,-0 .55 ,respec‐tively ,P<0 .01) .Inhaled corticosteroids for 2 years had no significant inhibition on growth velocity in children with asthma (MD=-0 .30 ,P>0 .05) .Conclusion This systematic review showed that ICS therapy had temporarily inhibition on growth velocity in children with asthma ,the peak inhibition happen within half a year ,its inhibitory effect decrease with time .