BackgroundPulmonary Epstein–Barr virus-associated smooth muscle tumor (EBV-SMT) is extremely rare in children with congenital immunodeficiency. This case report describes the clinical details of a pediatric pulmonary EBV-SMT case.Case presentationA 10-year-old boy presented with a three-year history of persistent cough and intermittent fever. Chest computed tomography (CT) revealed multiple nodules in both lungs. Histopathological examination of bronchoscopic excision specimens revealed spindle cell proliferation with a preliminary diagnosis of myofibromatosis, followed by immunohistochemical analysis showing positivity for smooth muscle actin (SMA), Ki-67 (5–8%), and calponin, while in situ hybridization showed diffuse positivity for Epstein–Barr virus-encoded RNA (EBER), confirming the diagnosis of EBV-SMT. Further immunological evaluation revealed suspected underlying immune dysfunction, characterized by persistently low CD4 + T-cell counts. The patient underwent multiple bronchoscopic interventions, including electrosnaring and forceps excision, as well as laser therapy, high-frequency electrocautery, and cryotherapy, to manage the largest pulmonary and intrabronchial lesions. He was also managed with regular intravenous immunoglobulin (IVIG) therapy and close clinical monitoring.ConclusionPulmonary EBV-SMT should be considered in pediatric patients with unexplained pulmonary nodules and underlying immunodeficiency. Early diagnosis is essential, and a combination of local tumor control with surgical or bronchoscopic interventions and immunomodulatory therapy may be necessary. However, these treatments may not prevent tumor recurrence and progression, highlighting the challenges in long-term management.

Background Kidney renal clear cell carcinoma (KIRC), the main histological subtype of renal cell carcinoma, has a high incidence globally. Cell-in-cell structures (CICs), as a cellular biological phenomenon, play pivotal roles in cell competition, immune evasion and tumor progression in the context of KIRC. Methods Data for this study were sourced from The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), and Gene Expression Omnibus (GEO) databases. Differentially expressed genes (DEGs) were identified using the limma package. Enrichment analyses were performed using the clusterProfiler package. Support vector machine-recursive feature elimination (SVM-RFE) and Least Absolute Shrinkage and Selection Operator (LASSO) regression, implemented via the caret and glmnet packages in R, were used to select biomarkers. The accuracy of these biomarkers was verified by using the receiver operating characteristic (ROC) curve as well as in vitro experiments (CCK-8 assay, wound healing assay, Transwell assay, and quantitative real-time PCR). The CIBERSORT algorithm was applied to explore the association between immune infiltration and the biomarkers. Further analysis explored the association between these biomarkers and clinicopathological characteristics of KIRC. For single-cell data, the Seurat package is used to read the sample data, and the SCTransform function is employed for normalization. Results This study identified 1,256 DEGs which enriched in T-cell immune system regulation processes. Five hub genes (CDKN2A, VIM, TGFB1, CTSS, and CDC20) were biomarkers with area under the curve (AUC) values > 0.8, indicating high predictive performance. In vitro validation experiments demonstrated that the expressions of all five biomarkers in KIRC cells were elevated, and the knockdown of CTSS could inhibit the migration and invasion of KIRC cells. Immune infiltration analysis showed higher proportions of T-cells and macrophages in tumor tissues. CDKN2A and CDC20 expressions correlated significantly with stage and grade, while TGFB1, CDKN2A, and CDC20 were highly expressed in proliferative tumor cells. Conclusion This study provides new biomarkers for KIRC, offering valuable insights into its developmental mechanisms for the research of CIC in this disease.

Clear cell renal cell carcinoma (ccRCC) is a highly heterogeneous cancer that poses great challenge to clinical treatment and prognostic prediction. Characterizing the cellular landscape of ccRCC in a single-cell dimension can help better understand the tumor heterogeneity and molecular mechanisms of ccRCC. This study analyzed single-cell profiles in ccRCC samples and para-tumor samples from Gene Expression Omnibus and identified a highly heterogeneous subcluster of renal tubule cells. Single-cell regulatory network inference and clustering analyses and cell communication analysis were performed to develop transcription factor-target gene regulatory networks and cell–cell interactions. Additionally, the distribution and prognostic risk of renal tubule cells from spatial transcriptome data (GSM6415706) and The Cancer Genome Atlas-Kidney Clear Cell Carcinoma data were analyzed. A total of 10 cell types were identified in ccRCC and para-tumor samples. The ccRCC renal tubule cells showed a high expression of the oncogene nicotinamide N-methyltransferase and a significantly high degree of tumor heterogeneity. We further identified 6 cell subclusters with specific expression of BEX2, PTHLH, SFRP2, KLRB1, ADGRL4, and HGF from the ccRCC renal tubule cells. ADGRL4+ renal tubule cells had highly metastatic and angiogenesis-inducing characteristics, with more ADGRL4+ renal tubule cells indicating a worse survival. ADGRL4+ renal tubule cells regulated the metastasis of other renal tubule cells through metastasis-related receptor-ligand communication. We also found that ADGRL4+ renal tubule cells clustered around the glomeruli but the rest of the renal tubule cell subclusters rarely localized in ccRCC tissues. ETS1 and ELK3 -dominant GRNs were remarkably activated in ADGRL4+ renal tubule cells, functionally, knockdown of ELK3 in A498 significantly disturbedaffected the cell migration and invasion. ADGRL4+ renal tubule cells, which were highly metastatic and invasive, might be an essential cell subcluster for ccRCC, and ADGRL4 could be used a novel therapeutic target.

To improve the quality of computed tomography (CT) images and provide help for benign and malignant diagnosis of renal parenchymal tumors, the independent component analysis (ICA) denoising algorithm was used. An improved ICA X-ray CT (X-CT) medical image denoising algorithm was proposed. ICA provided a higher signal-to-noise ratio for CT image denoising. Forty patients with renal tumor were selected as the observation group. The CT image performance of patients was evaluated by the denoising algorithm and compared with the wavelet transform algorithm, and the peak signal-to-noise ratio of the proposed algorithm was analyzed and compared. The results showed that among the 40 patients with renal tumors, 12 were renal clear cell carcinoma cases and 28 were cystic renal carcinoma cases. The accuracy of the enhanced CT image was 93.8%, and that of the CT image using the denoising algorithm was 96.3%; the difference between the two was significant (P < 0.05). The peak signal-to-noise ratio (PSNR) of the algorithm proposed was higher than the PSNR values of CT and noisy images. The PSNR of the proposed algorithm was significantly higher than that of mean filtering. The root mean square error (RMSE) algorithm of the proposed algorithm was significantly lower than that of the mean algorithm in image data processing (P < 0.05), which showed the superiority of the proposed algorithm. Enhanced CT can be staged significantly. In conclusion, the algorithm had a significant effect on the edge contour of detailed features, and the accuracy of CT images based on intelligent calculation was significantly higher than that of conventional CT images for benign and malignant renal parenchyma tumors, which was worth promoting in clinical diagnosis.

Background Along with the wide spread application and technical development of the flexible and rigid bronchoscopy, the airway foreign body removing method cme to the specific technique for different foreign bodies from the single foreign body forceps. Methods Selected 633 children who were diagnosed as airway foreign bodies by the Department of Respiratory Intervention, Children's Hospital affiliated to Shandong University from January 1st, 2018 to December 31st, 2021, and the airway foreign bodies were diagnosed using bronchoscopy. After comprehensive assessment of the foreign body nature in the airway, the foreign bodies were removed by freezing, laser, electrocoagulation, balloon and other techniques, the success rate of the foreign body removed from the airway was observed, the percentage of the foreign body removed using different techniques, the operation time, and the incidence of post-adverse reactions during operation. Results The success rate using flexible bronchoscope alone to remove foreign bodies in the airway was 99.2%. After flexible bronchoscopy, 19 cases of foreign bodies were removed by vacuum suction alone, 513 cases were removed by foreign body forceps alone, 62 cases were combined with cryotherapy, 2 cases were electrocoagulation, 6 cases were mesh baskets, 3 cases were balloons, 5 cases were laser, and various 18 cases of foreign bodies were invloved by technical combination. 5 cases of flexible bronchoscope combined with rigid bronchoscope combined to remove foreign bodies. The operation time was from 5 min to 1 h, with an average of 20 min. There were 17 cases of hypoxemia (2.7%) during operation, 36 cases (5.7%) of bleeding caused by airway mucosa injury after treatment, and 70 cases (11.2%) of laryngeal edema. The total incidence of adverse reactions was 19.6%, there were no deaths due to foreign bodies and treatment. Conclusions According to different properties of airway foreign bodies, it is safe and effective to select appropriate techniques to remove foreign bodies using the flexible bronchoscope, which can increase the removal rate of airway foreign bodies and reduce the occurrence of serious complications.

Objective:UPOINT clinical phenotype system was used to estimate the type III prostatitis patients. Put in the erectile dysfunction (ED) domain and analysis the ED domain's effect towards the UPOINT system.Methods:A total of 126 patients with type III prostatitis were prospectively collected and classified in each domain of the UPOINT system, including urinary, psychosocial, organ-specific, infection, neurological/systemic, and tenderness. Symptom severity was measured using the national institutes of health chronic prostatitis symptom index (NIH-CPSI) and the international prostate symptom score (IPSS). The erectile function was evaluated using the international index of erectile function (IIEF-5). Mental state was evaluated using the Symptom Checklist 90 (SCL-90). The quality of life of patients was assessed by the Quality of Life scale (QoL).Results:The percentage of patients positive for each domain was 60.32%, 43.65%, 53.17%, 11.11%, 42.06%, and 33.33% for the urinary, psychosocial, organ-specific, infection, neurological/systemic, and tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI (r = 0.630, P < 0.001) and IPSS (r = 0.429, P < 0.001). Symptom duration was associated with a number of positive domains (r = 0.194, P < 0.05). After adding an ED domain to establish a modified UPOINT system, the correlation between the number of positive domains and symptom severity was not improved (0.630 to 0.590, P < 0.001). The percentage of the patients who suffered psychosocial problems was 43.65%.Conclusions:In our cohort, the number of positive domains was correlated with symptom severity. Inclusion of the ED phenotype in the UPOINT phenotype classification system did not significantly enhance the association of positive presentation with symptom severity. Our findings presented do not support the utility of using ED as a stand-alone item in the UPOINT domain. Psychological problems should be considered when treating type III prostatitis patients.

Objective:To investigate the application of transbronchial needle aspiration (TBNA) in the diagnosis of tuberculosis with mediastinal lymphadenopathy in children.Methods:A retrospective study was conducted on clinical data in 8 children of tuberculosis with mediastinal lymphadenopathy treated in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University from March 2014 to July 2019.TBNA was performed after the mediastinal lymphadenopathy were diagnosed by chest enhanced CT and the final diagnosis was made.The diagnostic experience of TBNA was summarized.Results:Eight children with mediastinal lymphadenopathy included in this present study aged from 7 months to 8 years and 6 months (infants accounted for 75.0%), with a median age of 22.5 months.There were 3 males (37.5%) and 5 females (62.5%). The body mass was 8.5-39.0 kg, and the median body mass was 10.7 kg.The course of disease was 15-90 days, and the median number of days was 18.5 days.The clinical manifestations included cough in 8 cases, fever in 4 cases, wheezing in 1 case and laryngeal ringing in 1 case.Bronchoscopy and TBNA biopsy were performed.Cytology, etiology and pathology were examined after TBNA.A definite diagnosis could be made in 6 children, with a diagnosis rate of 75.0%.Among them, 4 cases were found with acid-fast bacilli in smear but pathological examination was negative; 1 case was pathologically conformed to the characteristics of tuberculosis infection but the smear was negative; the smear and pathology of 1 case were both suggestive of tuberculosis; 2 cases did not present etiological and histological evidence with TBNA.The diagnosis was made according to the positive acid-fast bacilli of alveolar lavage fluid smear.There were no complications during and after operation.Conclusions:TBNA is an important method to diagnose tuberculosis in children, which is effective, safe and has high clinical application value.

Objective:To investigate the diagnostic value of rapid on-site evaluation (ROSE) technique in the mucosal biopsy under respiratory endoscopy in children with active tuberculosis.Methods:Clinical data of 40 patients with active tuberculosis diagnosed in Department of Respiratory Intervention, Qilu Children′s Hospital, Shandong University from June 2017 to January 2020 were retrospectively analyzed.Results:(1) There were 33 cases of tracheobronchial tuberculosis and 7 cases of tuberculous pleurisy in the 40 cases, among them 9 cases were difficult to diagnose.(2)Among 33 cases of tracheobronchial tuberculosis, 24 cases (72.7%) of caseous necrosis breaking into the lumen, and 9 cases (27.3%) of mucosal swelling and external pressure.Cytological ROSE (C-ROSE) showed granuloma, epithelioid cells and lymphocytic infiltration with all bronchial mucosal biopsies.Different positives results of microbiological ROSE (M-ROSE) in different biopsy parts: positive results were found 6 times at caseous necrosis (13.6%, 6/44 times), 4 times at granulation hyperplasia (12.5%, 4/32 times), 2 times at hyperemia and edema (22.2%, 2/18 times), 0 time at yellow-white necrosis, and 54 times at the junction between lesions and normal mucosa (81.8%, 54/66 times). The mucosal pathology showed granuloma, exudation and necrosis, including 22 cases with tuberculous granuloma, 5 cases with characteristic tuberculous nodules, and 11 cases with positive acid-fast staining.(3)Seven cases of tuberculous pleurisy, serious pleural adhesion, pleural hyperemia and edema were observed under thoracoscopy.After clearing the adhesive tape, scattered caseous miliary nodules were found in pleura in 4 cases with a difficult clinical diagnosis.The C-ROSE of smear on thoracoscopic biopsy were characterized by necrotic and histopathic cell, with multinucleated giant cells, but granuloma was rare.M-ROSE in different parts: 8 times positive for millet nodules (80.0%), 0 time positive for adhesion band, 2 times positive for congestion oedema (14.3%); biopsy pathology showed granuloma and necrosis, with 3 cases characteristic tuberculosis nodules and 2 cases positive for anti-acid staining.(4)Pathogenic microorganisms were detected in 19 children using next generation sequencing (NGS) and Mycobacterium tuberculosis/Rifampicin resistance real-time nucleic acid amplification detection technology (Xpert MTB/RIF), including 7 positive for NGS (36.8%), 8 positive (42.1%) and 5 positive for both NGS and Xpert MTB/RIF (26.3%).Conclusions:Respiratory endoscopy combined with ROSE technique has important clinical significance in early diagnosis of active tuberculosis in children, and it is worth of promotion and applying.

Objective:To study the diagnostic value of non-enhanced lesions on enhanced CT in lung consolidation for necrotizing pneumonia in children.Methods:A total of 101 cases of necrotizing pneumonia with air sacs on CT scan who were hospitalized in the Department of Respiratory Intervention, Qilu Children′s Hospital of Shandong University from August 2016 to September 2018 were enrolled in this study(group with air lucency). Besides, another 75 cases of lobar pneumonia with non-enhanced lesions in lung consolidation but without air sacs on enhanced CT were also included from the same hospital over the same period(group without air lucency). Clinical data of these patients were retrospectively collected and statistically analyzed.Results:The white blood cell count was (12.5±5.5)×10 9/L in group with air sacs and (10.8±4.1)×10 9/L in group without air sacs, and the difference was statistically significant( t=-2.161, P=0.032). There was no statistical difference between the group with and without air sacs in age, gender distribution, the course prior to admission, duration of fever after admission, length of hospital stay, medical expense, the neutrophils percentage in peripheral blood, C-reactive protein, the erythrocyte sedimentation rate, serum procalcitonin, serum D-Dimer, serum lactate dehydrogenase, serum albumin, bronchoscopy times, the bronchial mucosal erosion ratio, the mucus plug score, the lavage purulent lavage ratio, and the ratio of luminal stricture or atresia in late bronchoscopy(all P>0.05). Conclusions:The clinical course of patients with non-enhanced lesions in lung consolidation but without air sacs is almost identical to that of patients with air sacs on CT scan.The presence of non-enhanced lesions in lung consolidation can be used as diagnostic basis of necrotizing pneumonia in children.

Objective:To study the early predictors of Mycoplasma pneumoniae necrotizing pneumonia in children.Methods:Clinical data of 291 children with lobar pneumonia caused by Mycoplasma pneumoniae who were hospitalized in Department of Respiratory Intervention, Qilu Children′s Hospital of Shandong University from August 2016 to September 2018, were retrospectively analyzed.The patients were divided into necrotizing pneumonia group (154 cases) and non-necrotizing pneumonia group (137 cases). After comparing clinical characteristics, laboratory tests, and bronchoscopy findings, multivariate logistic regression analysis was carried out on the indicators with statistical significance to obtain the independent predictive indicators of Mycoplasma pneumoniae necrotizing pneumonia, and then the cutoff value with the maximum diagnostic value of each indicator was found through receiver operating characteristic (ROC) curve analysis.Results:There were no significant differences in gender and age distribution, duration before admission, and platelet count between the 2 groups(all P>0.05). Necrotizing pneumonia group manifested with 11.0(8.3-14.4)×10 9/L of white blood cell count, 0.740±0.115 of neutrophil, 44.2(21.2-72.0) mg/L of C-reactive protein(CRP), 55(35-80) mm/1 h of erythrocyte sedimentation rate, 0.19(0.08-0.60) ng/L of procalcitonin, 2.63(1.62-3.79) mg/L of plasma D-dimer, 456(340-665) U/L of serum lactate dehydrogenase, (35.6±4.3) g/L of serum albumin, 121 cases(78.6%)of bronchoscopic mucosal erosion, 75 cases(48.7%)of purulent lavage, 119 cases(77.3%)of massive secretions embolism; non-necrotizing pneumonia group manifested with 8.7(6.9-11.6)×10 9/L of white blood cell count, 0.660±0.127 of neutrophil percentage, 15.9(7.5-34.3) mg/L of CRP, 45(30-60) mm/1 h of erythrocyte sedimentation rate, 0.10(0.06-0.20) ng/L of procalcitonin, 0.69(0.46-1.24) mg/L of plasma D-dimer, 314(250-419) U/L of serum lactate dehydrogenase, (38.9±3.7) g/L of serum albumin, 53 cases(38.7%)of bronchoscopic mucosal erosion, 20 cases(14.6%)of purulent lavage, and 76 cases(55.5%)of massive secretions embolism.All the above indicators had statistical differences between the 2 groups.Erythrocyte sedimentation rate, serum lactate dehydrogenase, D-dimer, and bronchoscopic mucosal erosion were independent predictors of Mycoplasma necrotizing pneumonia.The area under the ROC curve were 0.643, 0.749, 0.858 and 0.699, respectively, with the cut off point of 53 mm/1 h, 335 U/L, and 1.36 mg/L, respectively. Conclusions:Erythrocyte sedimentation rate≥53 mm/1 h, serum lactate dehydrogenase≥335 U/L, D-dimer≥1.36 mg/L, and bronchoscopic mucosal erosion are early independent predictors of Mycoplasma necrotizing pneumonia in children, among which D-dimer has the highest value.

RATIONALE:Broncholithiasis is a rare disease and is characterized by calcification in the tracheobronchial tree. This disease has a predilection in the adult and occurrence is rare in children. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnosis and treatment procedures.PATIENT CONCERNS:We report a 9-year- and 6-month-old girl who complained of chronic cough and recurrent wheeze for 2 months.DIAGNOSIS:Bronchialithiasis were found under bronchoscope. Pathologic examination revealed aspergillosis.INTERVENTIONS:The stone and surrounding granulation tissue were removed using a bronchoscope and the patient was treated with antifungal therapy.OUTCOMES:The patient was in good general health without any clinical symptoms during the follow-up period.LESSONS:Pulmonary Aspergillus infection can cause bronchiolithiasis. Stones were removed under bronchoscope, and anti-Aspergillus therapy was effective.

Objective To investigate the safety and efficacy of flexible and rigid ureteroscopy combined with holmium laser in the treatment of foreign body in the upper urinary tract.Methods The clinical data of 6 patients (4 male and 2 female) with iatrogenic foreign bodies in the upper urinary tract treated during Feb.2014 and June 2016 were retrospectively analyzed.All of the foreign bodies were caused by indwelling of double J stent,one of which was residual stones caused by residue of double J stent.All cases underwent flexible and rigid ureteroscopy combined with holmium laser.Results All foreign bodies were removed successfully.No calculi in the kidney calices or abnormalities were observed.No complications occurred.Conclusion Flexible and rigid ureteroscopy combined with holmium laser is safe,effective and minimal invasive in the treatment of foreign body in the upper urinary tract.

Previously, the main treatment options for tracheoesophageal fistula included surgery and conservative treatment. Herein, we report a child suffering from severe tracheoesophageal fistula due to button battery ingestion. The child relapsed soon after a repair surgery. Then, he was endotracheally implanted with a fully-covered metallic stent combined with a jejunal tube feeding. He recovered soon and the stent was removed five months later. The fistula was healed with no relapse during a 25-month follow-up. Therefore, endotracheal implantation of fully-covered metallic stent is an alternative treatment for tracheoesophageal fistula due to button battery ingestion, especially in cases with severe respiratory disorders.

喉喘鸣是儿科常见症状之一,最常见的病因是喉软骨软化症,此外还有喉部占位性病变、声带麻痹、气管支气管软化或狭窄等 [1].家长通常会带患儿就诊于儿科,而儿科医师对本病认识不足,常常诊断喉软骨软化症,而忽视其他病因的寻找.我院自开展儿童支气管镜技术以来,喉喘鸣的误诊率明显降低,但由于舌甲状舌管囊肿临床罕见,对本病认识不足导致误诊.现报道如下:

Objective: To investigate the genetic cause for a family with multiorgan dysplasia and "molar tooth sign" on MRI image. Method: The patient, a 3 months and 21 days old boy, was clinically examined and the medical history of his family was collected. Next generation sequencing was performed to analyze his clinical and genetic causes. Result: Clinical manifestation of the child displayed multiorgan dysplasia, such as six finger deformity, short limbs, coloboma of optic disc and choroid, situs inversus.Cranial MRI showed "molar tooth sign" . The gene sequencing confirmed that the child carried a de novo deletion of c. 2843_2844 delAA in OFD1 gene. Conclusion: The child has typical clinical features of Joubert syndrome, such as MRI "molar syndrome" , developmental abnormalities of ocular tissue and limb, visceral inversion, and so on.The OFD1 gene had a novel deletion mutation through gene detection. Combined clinical features with gene detection, it was clear that the child was a rare case of Joubert syndrome type 10 which was the first case of Joubert syndrome caused by OFD1 gene mutation in China.

加速康复外科(ERAS)是一种新的外科治疗理念,其核心是围手术期降低患者的应激反应,加速患者的康复.加速康复外科理念在各学科已取得了相当的成果,笔者所在医院泌尿外科根据ERAS的理念,围绕着减少应激反应采取了一系列有效的措施,包括积极采用微创技术、术前充分的宣教、围手术期合理的温度控制、术后积极镇痛、早期进食等,有效缓解了患者的焦虑情绪,减轻了患者的痛苦,加速其康复,缩短了住院时间.

Objective To discuss the effect of electronic bronchoscopy comprehensive therapy in the diagnosis and treatment of glottis and subglottic stenosis after intubation in children.Methods The records of 28 children diagnosed as glottis and subglottic stenosis after intubation by bronchoscopy in Qilu Children's Hospital of Shandong University from January 2012 to January 2015 were reviewed.They all had the neck and chest CT,bronchoscopic diagnostics,and received comprehensive treatment of laser,forceps,balloon angioplasty under electronic bronchoscopy,preoperative and postoperative evaluation was performed according to the improvement of respiratory status and endoscopic findings.All patients were followed up for 6-12 months.Results These 28 children were successfully extubated,and inspiratory dyspnea,hoarseness,and other symptoms were improved,endoscopic narrowest part was widened by 6-12 months of follow-up,including 17 cases reached clinical cure,about 6 times per patient;7 cases were successfully extubated and still in follow-up currently;2 cases of neonatal infants were extubated successfully,but they had vocal congestion,edema,glottis narrow fissure without special intervention,and were under clinical observation currently;2 cases gave up treatment because of the other problems.All patients had no serious bleeding,respiratory insufficiency or other complications.Conclusions Electronic bronchoscopic comprehensive treatment is an effective and safe method to treat glottis and subglottic stenosis after intubation in children.

Objective To describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children.Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary,Intervention Qilu Children's Hospital of Shandong University from no vember 2013 to June 2015.Pleural biopsy was performed under direct visual guidance to obtain tissues,and pleural adhesion and cellulose exudation had been cleaned out in 7 cases.Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy.Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion,thickened heart capsule was found in the operation,then continuous cardiac ultrasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure.The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti-infective therapy,the pleural adhesion was reduced.One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion.Medium bleeding was found in 1 case during the procedure.Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation.There were no severe complications in the other 7 patients.Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease,thoracoscopy is a safe and effective technique for pediatric patients.

Objective To discuss the diagnosis,curative effect evaluation of infantile subglottic hemangioma through bronchoscopy,and oral Propranolol curative effect.Methods Twenty-four cases of subglottic hemangioma were retrospectively analyzed from April 2012 to March 2015 in Shandong University Qilu Children's Hospital,all cases were diagnosised by neck enhanced CT or magnetic resonance,receiving oral Propranolol treatment.Starting dose was 0.5 mg/(kg · d),3 times per day,monitored in terms of blood pressure,blood sugar and heart rate,etc.with no bad reaction after 3 days of dosage,increased to 2.0 mg/(kg · d),6 days later to maintain the dose for at least 6 months,with bronchoscopy follow-up visit on a regular basis.All the children received 3 to 15 months of follow-up.Results Clear diagnosis of subglottic hemangioma was made in 24 cases who received oral Propranolol treatment,and after 5-7 days symptoms such as laryngeal stridor and dyspnea were relieved to different extent.Under the bronchoscope tumors could be observed to shrink.After 6 months of oral Propranolol,11 cases of tumors had completely faded,13 cases of tumors had significantly reduced,laryngeal stridor and breathing difficulties were relieved.One patient with parotid gland hemangioma was also improved,3 cases had mild bradycardia during hospital treatment,but during hospitalization and after discharge low blood pressure,hypoglycemia and other side effects were not observed.Conclusions Bronchoscopy in the diagnosis and treatment of infantile subglottic hemangioma plays an important role in the judgment of curative effect as it is both safe and reliable.Taking oral Propranolol can help to shrink tumors in a short period of time,improve the symptoms of respiratory tract obstruction,with distinct curative effect and little side effect.

Objective To investigate the efficacy and safety of integrated interventional treatment for children with endobronchial tuberculosis by electronic bronchoscopy.Methods From January of 2011 to August of 2014,45 cases(31 boys and14 girls)were enrolled,their age ranged from 4 months to 12 years old.On the basis of the conventional anti-tuberculosis treatment in all the patients,electrocoagulation under the bronchoscopy was performed,together with laser,refrigerant or balloon expansion.The tracking observation of curative effect and adverse reaction were observed.Based on the main symptoms of patients after treatment,and the conditions of chest imaging,bronchoscopy,the lesion repair,airway mucosa,lumen patency,therapy efficacy were evaluated.All patients underwent 6-12 months follow-ups.Results Among 45 cases of endobronchial tuberculosis in children,there were 9 cases suffering from ulcers and cheese necrotic changes (20.0％),granulation proliferative changes in 8 cases,accounting for 17.8％,stenosis scar changes in 7 cases(15.5％);44 mixed cases (97.8％) were observed under the microscope,of which 20 cases had tuberculosis lesions by bronchial biopsy,and of them acid-fast staining was positive in 12 cases (60.8％) confirmed by bronchoscopy combined with anti-tuberculosis treatment,and they received 8 to 13 times of treatment,32 cases were markedly effective,accounting for 71.1％,10 cases were effective,accounting for 22.2％;3 cases lost follow-up,and the total efficiency was 93.3％;all patients had no pneumothorax,pulmonary secondary infection,hemoptysis and other adverse reactions.Conclusions In addition to conventional anti-tuberculosis treatment,local comprehensive interventional treatment under the bronchoscopy can effectively remove cheese-like necrosis and reduce granulation hyperplasia and relieve the airway obstruction,promote the absorption of lesions and atelectasis recovery.The therapy is safe and reliable and worth of clinical application.