Plastic bronchitis (PB) is a rare respiratory condition which can result in severe respiratory complications such as respiratory failure and death. Mycoplasma pneumoniae infection is a main etiology cause of plastic bronchitis. However, the pathogenesis of plastic bronchitis complicated by Mycoplasma pneumoniae pneumonia (MPP) has not yet been fully elucidated. Our article aims to explore biomarkers for early prediction of MPP cases complicated with plastic bronchitis. We utilized a protein chip to screen for significantly different proteins among the groups of healthy, general Mycoplasma pneumoniae pneumonia (GMPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP) patients, where layilin exhibited a potent change across biology information technology. Next, we demonstrated the high expression of MUC5AC, MUC5B, and layilin in bronchoalveolar lavage fluid (BALF) of MPP cases complicated with plastic bronchitis. Further study suggested that the level of layilin had a positive correlation with both MUC5AC and MUC5B. A receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of MUC5AC, MUC5B, and layilin in MPP cases with PB. Data show that the three indicators have similar diagnostic ability for MPP children with plastic bronchitis. Then, we used different concentrations of community-acquired respiratory distress syndrome (CARDS) toxin or lipid-associated membrane proteins (LAMPs) to simulate an in vitro experiment. The in vitro assay revealed that CARDS toxin or LAMPs induced A549 cells to secrete MUC5AC, MUC5B, layilin, and proinflammatory factors. These findings suggest that MUC5AC, MUC5B, and layilin are correlated with MPP. The high expression of MUC5AC, MUC5B, and layilin play an essential role in prediction in the development of plastic bronchitis caused by MPP. The high expression of MUC5AC, MUC5B, and layilin may be relevant to the severity of illness.

Early distinction between refractory M. pneumoniae pneumonia (RMPP) and non-RMPP (NRMPP) is still difficult. The community-acquired respiratory distress syndrome (CARDS) toxin can induce inflammatory and histopathological phenotypes associated with M. pneumoniae infection. This study aimed to investigate the clinical significance of CARDS toxin and pro-inflammatory cytokines in children with RMPP and to explore whether CARDS toxin can induce TNF-α expression. Levels of CARDS toxin and cytokines in BALF from control and children with MPP were determined by real-time PCR and ELISA, respectively. A receiver-operating characteristic (ROC) analysis was performed to assess the diagnostic values of CARDS toxin, TNF-α, and IL-6 in RMPP. The recombinant CARDS toxin was constructed and prepared at different concentrations for stimulation of RAW264.7 cells. After co-culture with CARDS toxin, cytokines were detected by ELISA and the mRNA levels were measured by real-time PCR. Effects of CARDS toxin and TNF-α on inflammatory cell infiltration and mucus secretion in mouse lungs were also evaluated. Levels of CARDS toxin, TNF-α and IL-6 in bronchoalveolar lavage fluid (BALF) were significantly higher in RMPP cases compared with NRMPP cases. Furthermore, TNF-α had better diagnostic ability for differentiation of RMPP with AUC of 0.824 and Youden index of 0.692 compared with CARDS toxin and IL-6. Moreover, CARDS toxin was positively correlated with TNF-α level in MPP cases. In vitro assay revealed that CARDS toxin induced RAW264.7 macrophages to secrete TNF-α. Further in vivo assay showed that TNF-α deletion partially abrogated the CARDS toxin-mediated induction of inflammatory cell infiltration and mucus secretion in mouse lungs. The high co-expression of TNF-α and CARDS toxin in BALF is a good diagnostic biomarker for differentiating children with RMPP and NRMPP.

Objective To explore the clinical characteristics of bronchial pneumonia complicated with gas-tric volvulus in infants. Methods A total of 132 infants with bronchial pneumonia and gastric volvulus hospitalized in the Children Hospital of Soochow University from January 2009 to November 2012 were enrolled in the study. Gas-tric volvulus was diagnosed by barium upper gastrointestinal series (GI). 48 cases with the diagnosis of bronchial pneumonia at the same period were selected as controls. The clinical,laboratory data and radiographic findings of the two groups were analyzed. Results Bronchial pneumonia complicated with gastric volvulus mostly occurred in infants aged 2.64 ± 1.70 months. Compared to the controls, they had a longer clinical course before hospitalization (10 days,5.5 days,respectively,P<0.001) and a longer hospital stay(8.11 ± 3.10 days,7.63 ± 2.46 days,respec-tively,P=0.042). They presented diverse respiratory manifestations,such as digestive tract symptoms complicated with vomiting (50.4%) and cough after feeding(23.3%). All patients were organoaxial gastric vovulus. Gastrice-sophageal reflux was the trigger of cough and it could be relieved by the right position in patients with unsatisfactory effect of antibiotics treatment. No operation was carried out in the study. Conclusion Gastric volvulus plays an im-portant role in infants with recurrent bronchial pneumonia with diverse respiratory manifestations and could be relieved by position.

Objective To summarize the epidemiology and evaluate possible age-related differences in the presenting clinical features in three year-old children with Mycoplasma pneumoniae pneumonia(MPP)during 2009 to 2014.Methods The medical records of 17855 children with community-acquired pneumonia enrolled by Children′s Hospital of Soochow University during 2009 to 2014.Totally 1145 younger than three year-old children with MPP were enrolled,and they were classified into three groups of 1 month to 1 year-old group (n=512),1 to 2 year-old group (n=393) and 2 to 3 year-old group (n=240).The epidemiology and possible age-related differences in the presenting clinical features,main laboratory and imaging results in three year-old children with MPP were summarized.Results (1) The highest infection rate of different reasons in Suzhou was in autumn(10.46%),and the lowest was in spring(6.95%),The highest infection rate of different ages was 2 to 3 year-old group(11.61%),and the difference was statistically significant (P<0.05).(2) Compared with 1 month to 1 year-old group(n=512,4.31%) and 1 to 2 year-old group (n=39,10.09%),2 to 3 year-old group (n=240,11.61%) had higher infection rate,more patients with fever(53.9% vs. 77.1% vs. 85.4%) and high fever(16.8% vs. 30.5% vs. 41.4%),longer time to normalization of temperature(3d vs. 5d vs. 6d),but less patients with wheezing(61.3% vs. 52.4% vs. 42.9%) and dyspnea(7.6% vs. 4.6% vs. 3.8%).(3) The differences were statistically significant in the percentage of neutrophils,lymphocytes,CRP and platelet count between different ages(P<0.001).(4) The incidences of large area of lesions in chest X-ray examination among different ages had significant differences(P<0.001).Conclusions MP is one of the important pathogens of respiratory tract infection in younger than 3 year-old children.It can occur in every season,and the highest infection rate of MP is in autumn and spring.In younger than 3 year-old,older patients are more vulnerable to infection of MP,the number of fever and high fever are more,fever duration is longer,but younger patients are more vulnerable to virus infection and prone to dyspnea.Chest X-ray examination shows small patchy shadow in most cases,the younger children are more easily to have large area of lesions and pleural effusion.

We aimed to find the relationship between the clinical characteristics and mucus plug formation and developed models to predict mucus plug formation in refractory Mycoplasma pneumoniae pneumonia (RMPP) infection. Methods: RMPP patients treated with bronchoscopy were retrospectively enrolled in the study between November 2011 and November 2015. Multivariate logistic regression was performed to identify independent predictors of mucus plug formation. Results: Of the 173 RMPP patients enrolled, the mucus plug group accounted for 82 (47.4%) cases. Multivariate logistic regression analysis identified age, fever duration, C-reactive protein (CRP) and lactic dehydrogenase (LDH) as independent risk factors for mucus plug. We assigned one point for age, length of fever and CRP and two points for LDH. Using this predicted score, we identified patients with mucus plug with 71.8% sensitivity and 78.9% specificity. Conclusions: Our predictive models based on demographic and laboratory variables accurately predicted mucus plug formation in initial treatment of patients with RMPP.

The present study evaluated the association between different Mycoplasma pneumoniae (M. pneumonia) genotypes and clinical features of pediatric patients. Subjects were children diagnosed with community-acquired pneumonia at the Children's Hospital of Soochow University (Suzhou, China) from January 2012 to December 2013. Clinical and laboratory tests were conducted and clinical samples positive for M. pneumoniae were genotyped by nested-multiplex polymerase chain reaction. Three type I strains and three type II strains were also randomly selected for sequencing. A total of 335 clinical samples positive for M. pneumoniae were obtained. The average age of M. pneumonia-infected pediatric patients was 4.8±3.3 (years). Genotyping results identified 304 positive samples as group I strains and 30 samples as group II strains, in which 1 sample was type II variant 2a. It was also observed that point mutations were more likely to occur in type I strains compared with type II strains. Although clinical pulmonary infection scores between patients with type I and type II strains did not significantly differ, patients with type I strains had a higher risk of developing severe M. pneumoniae pneumonia (SMPP) and extrapulmonary complications, and had significantly higher percentages of peripheral blood neutrophils than patients with type II strains (P<0.05). Collectively, these data indicate that the predominant strains of M. pneumoniae in Suzhou between 2012 and 2013 were type I, and that pediatric pneumonia patients with type I strains of M. pneumoniae were more likely to progress to SMPP.

OBJECTIVETo analyze the clinical characteristics of protracted bacterial bronchitis (PBB) in children.METHODThe clinical data of patients seen from October, 2010 to March, 2014 in Department of Respiratory Diseases of our hospital were retrospectively analyzed. Inclusion criteria were over 4 weeks cough, receiving fiberoptic bronchoscopy, positive bacterial culture and (or) the increased percentage of neutral granulocytes in bronchoalveolar lavage fluid (BALF).RESULTTwenty eight patients were involved, 26 were male (93%) and two were female (7%). The median age of patients was 8.5 months. The median duration of cough was four weeks. The average length of hospital stay was (8.3 ± 3.9)days. The main clinical feature was wet cough in 28 cases, wet cough with wheezing was seen in 21 cases. The wet cough phase distribution was irregular in 21 cases. The crackles with wheeze (in 21 cases) was main signs of PBB. The percentage of CD3⁻ CD16⁺ 56⁺ cells increased in peripheral blood. The fiberoptic bronchoscopic manifestations of PBB were luminal mucosal edema. Eleven patients also had airway malacia. The neutrophil median in BALF was 0.2. The positive rate of bacterial culture of BALF was 36%. The main bacteria were Streptococcus pneumoniae (50%) and Haemophilus influenzae (30%). The main treatment for PBB patients included amoxycillin/clavulanate potassium and second-generation cephalosporins. The average duration of treatment was (17.3 ± 3.2)days, the prognosis was good.CONCLUSIONPBB is common in male infants. Persistent wet cough with wheezing was the main characteristic of PBB. PBB is commonly accompanied by immune dysfunction and airway malacia, and the pathogens were Streptococcus pneumoniae and Haemophilus influenzae.

ObjectiveTo analyze the genotype and variation ofMycoplasma pneumonia (MP) strains isolated from chil-dren with MP infection in Soochow area.MethodsThe nasopharyngeal secretions from hospitalized children with MP infection were collected during January 2012 and December 2013. The nested-multiplex PCR based on MPP1 gene was performed to detect the subtype ofMP gene.ResultsIn 313 samples, 304 (97.12 %) samples were classiifed as P1-I type and 8 (2.56%) sam-ples were classiifed as P1-II type and one (0.32%) was V2 variant. Gene sequencing results were consistent with nested-multiple PCR results.ConclusionsNested-multiplex PCR is a reliable method for genotyping of MPP1 gene. During the study period, P1-I type was the common genotype and only one case of V2 variant was found.

目的：分析儿童肺炎支原体肺炎(MPP)合并支气管黏液栓临床特点,提高对该疾病的认识,为早期临床诊断提供依据。方法回顾性总结2011年11月至2014年1月苏州大学附属儿童医院通过支气管镜检查明确合并支气管黏液栓53例 MPP 患儿临床资料。结果96.23%患儿体温为高热或超高热,平均热程9.3 d。外周血中性粒细胞比例均升高。肺部影像学表现为肺不张/肺实变和(或)大灶性、节段性肺炎,49.06%炎症累及两叶以上,60.38%合并胸腔积液。支气管镜下53例均可见一个及以上部位支气管黏液栓阻塞(其中黏液栓塑型19例),黏膜充血水肿、滤泡增生、糜烂坏死及管腔开口炎性狭窄。黏液栓病理示假膜样炎性坏死组织,见大量中性粒细胞及淋巴细胞浸润。经1～5次灌洗后支气管黏液栓消失,64.15%肺泡灌洗后1周胸片病灶明显吸收,50.94%第一次肺泡灌洗后1～3 d体温恢复正常,堵塞严重者需借助毛刷或异物钳清理黏液栓。结论 MPP 合并支气管黏液栓临床多出现持续高热或超高热,影像学表现肺不张/肺实变和(或)大灶性、节段性肺炎,多合并胸腔积液,在予抗感染同时及早进行支气管镜灌洗治疗可明确诊断,及时清除黏液栓,促进疾病恢复,减少后遗症发生。

OBJECTIVE:To explore the dynamic changes of airway hyperresponsiveness (AHR) in children with cough variant asthma (CVA).METHODS:A prospective observational study was conducted at the Children's Hospital of Soochow University from April 2012 to March 2013. A total of 36 patients were diagnosed as CVA. According to the integral dose of histamine resulting in a 20% (PD20) fall in forced expiratory volume in 1 s (FEV1), the severity of CVA was graded. Corresponding treatment was administered and the dynamic changes of airway hyperresponsiveness were followed for 0, 1 and 6 months.RESULTS:Among them, 14 patients suffered from CVA only while another 22 cases had CVA plus upper airway cough syndrome (UACS). PD20 of CVA and CVA+UACS groups were (0.46 ± 0.26) and (0.58 ± 0.34) mg respectively. No statistically significance existed between two groups (t = -0.880, P > 0.05). According to the value of PD20, AHR in CVA patients was classified into four degrees of severe, moderate, mild and very mild. Initially there were moderate (n = 8), mild (n = 21) and very mild (n = 5). At 1 month follow-up, moderate (n = 1), mild (n = 28) and borderline (n = 7); At 6 month, moderate (n = 2), mild (n = 20) and very mild (n = 7). And 4 cases turned negative and another 3 cases became lost. Cough symptom score and PD20 showed no significant correlation (r = -0.086, P > 0.05).CONCLUSIONS:AHR in CVA patients is predominantly mild and very mild. And it decreases rapidly mostly during initial treatment phase. The proportion of conversion from CVA into negative and typical bronchial asthma is relatively low.

2007年1月至2011年12月,对持续喘息≥6周或反复喘息≥3次,经支气管扩张剂及糖皮质激素治疗2周,喘息仍未缓解的214例住院患儿行电子支气管镜检查.结果显示,214例患儿中,存在明确器质性疾病的共189例,病因的总诊断率为88.3％;共有38例(17.8％)在术中和术后24 h出现一过性、轻微并发症.电子支气管镜是一鉴别诊断儿童持续或反复喘息的重要而又安全的工具.

Objective To explore the clinical characteristics of mycoplasma pneumonia with pulmonary atelectasis and lavage interventional effect through fiberoptic bronchoscopy in children.Methods During Jun 2012 to Apr 2013,fifty-three children diagnosed of mycoplasma pneumonia with pulmonary atelectasis who received fiberoptic bronchoscopy were enrolled as the experimental group.Thirty-five children diagnosed of mycoplasma pneumonia without pulmonary atelectasis were chosen as control group.According to the lavage interventional time of fiberoptic bronchoscopy,we divided the patients in the experimental group into two groups,the early group and late group.Clinical data and laboratory finds were collected and analyzed.Results The duration of fever,hospital stay and C-reactive protein (CRP) of the experimental group were significantly higher than those of the control group (P ＜ 0.05).The location of pulmonary atelectasis in the experimental group were usually in the right middle lobe (18 cases,33.9％).Under fiberoptic bronchoscope,all patients had obviously bronchial mucosa congestive edema.Some of them had follicular hyperplasia (9 cases,17.0％),mucosal erosion (3 cases,5.7％),mucus plug formation (7 cases,13.2％) and poor ventilation of segmental bronchi (4 cases,7.5 ％).Neutrophils (43 cases,81.1％) increased and phagocytic cells (31 cases,58.5％) dereased obviously in bronchoalevolar lavage fluid.After treatment in the experimental group,52 children (98.1％) got complete recruitment of atelectasis.The average duration of fever and hospital stay of the early group were significantly shoter than those of late group (P ＜ 0.05).Conclusion Children diagnosed of mycoplasma pneumonia with pulmonary atelectasis had longer fever duration and higher CRP level.Bronchoscopic interventional therapy promoted the recovery of pulmonary atelectasis.Using bronchoscop early in shorten the duration of fever and hospitalization in children diagnosed of mycoplasm pneumonia with pulmonary atelectasis.

Objective To explore the clinical features of positive MP-DNA gene in bronchoalveolar lavage fluid( BALF) of children with mycoplasma pneumonia pneumonia( MPP). Methods 94 children with MPP from January 2010 to June 2011 were given flexible bronchoscopy and bronchoalveolar lavage examination,and then were divided into the experiment group with 61 cases( BALF MP-DNA positive) and the control group with 33 cases( BALF MP-DNA negative). The clinical features were compared between the two groups.Results School-age children were significantly more in the experiment group than in the control group( P < 0. 05). Hyperthermia,CRP,Chest X-ray and / or CT atelectasis and pleural effusion were more serious in the experiment group than in the control group( P < 0. 05).There was no significant difference on bronchoscopic findings and BALF cytological classification between the two groups. Conclusion The clinical features of children with MPP are school-aged,hyperthermia,high expression of CRP,atelectasis,and pleural effusion. The positive MP-DNA can be easily detected in BALF,which may be associated with strong immune response. Appropriate extension of macrolide antibiotics therapy and immunization therapy should be useful.

目的 总结儿童电子支气管镜术并发症发生的原因及处理经验.方法 2008年2月至2011年6月,收集苏州大学附属儿童医院进行电子支气管镜术诊治的585例患儿的临床资料,回顾分析其术中、术后并发症,观察并发症原因并总结应对措施.结果 585例患儿中,共有220例发生并发症,≤1岁组为95例,＞1～3岁组为67例,＞3～7岁组为51例,＞7～14岁组为7例.＞7～14岁组并发症最低,为10.8％,其余3组并发症发生率均约为40％.并发症中以出血发生率最高,但以喉痉挛最为严重.≤1岁组缺氧发生率最高,其余3组以出血的发生率最高.结论 儿童电子支气管镜术并发症经适当处理后均能缓解.对患儿病情及身体素质的全面了解、周到的术前处理、术中对可能并发症发生的防范措施和熟练正确的操作可减少并发症的发生.

【Objective】 To understand the morbidity and onset of asthma in children age,inductive factors,treatment status,in order to provide better scientific basis for management of childhood asthma.【Methods】 A sample survey methods,had two steps:the first step suspected children with asthma were screened to get information,the second step:screening children with suspected had made clinical diagnosis of asthma,and the inductive factors and the treatment situation were understood in asthma children.【Results】 By 10 805 screening questionnaires 622 cases were related to wheezing,540 cases of children were clinically diagnosed with asthma,5 cases cough variant asthma and 77 cases of suspected asthma in children.Cumulative prevalence of asthma was 5%,of which male and female prevalence rates were 6.22%,3.51% respectively.1 130 cases of allergic rhinitis,the prevalence rate was 10.46%,male and female prevalence rates were 12.37%,8.13% respectively.884 cases of eczema,prevalence was 8.18%,male and female prevalence rates were 8.85%,7.35% respectively.77.17% asthma age of onset was at 3 years of age.98.23% children with asthma had application of antibiotics in acute exacerbation of asthma,59.97%with inhalation therapy in acute exacerbation of asthma inhaled therapy to maintain remission of only 8.89%.【Conclusions】 1)2010,Suzhou cumulative prevalence of asthma in children aged 0~14 is more than ten years ago.2)Onset of asthma in children over the age of 3 years of age.therefore,prevent asthma in the early.3)The majority of asthma treatment is not standardized,new knowledge,new drug must education in correct treatment for asthms.

Objectives To investigate the Clara cell secretory protein(CC16)expression in the blood and lung tissue of asthmatic mice and the effect of budesonide on CC16 expression,and to analyze its role in pathogenesis of asthma.Methods Total 72 healthy mice were divided randomly into three groups:allergic asthma group,budesonide group and normal control group.The asthma model of mouse was established by sensitized and challenged with ovalbumin.RT-PCR was performed for CC16mRNA in the lung tissue and expression of CC16mRNA among the three groups was compared.Results The expression of CC16mRNA is significantly decreased in the lung of asthmatic mice,compared with the normal control group(P 0.05);it is significantly increased with the treatment of budesonide,compared with the allergic asthma group(P 0.05).Conclusions It is suggested that CC16 may be an important endogenous anti-inflammatory factor and involved in asthma develpment.Glucocorticoids may play anti-inflammatory role in treatment of asthma by increasing CC16 in serum.

目的探讨电子支气管镜在喉-气管-支气管软化症诊断中的应用价值。方法回顾性分析105例因反复呼吸道感染或喘息且临床治疗效果不佳而行电子支气管镜检查的患儿的临床资料。结果喉-气管-支气管软化是反复喘息、反复呼吸道感染且临床治疗效果不明显最为常见的原因之一。喉-气管-支气管软化症有25例,占23.8%(25/105)。其中喉软化9例,气管软化2例,支气管软化5例,喉软化+气管软化1例,喉软化+支气管软化2例,气管软化+支气管软化6例。混合性软化症占所有软化的36%(9/25)。1岁以内喉-气管-支气管软化占41.5%(17/41),1~3岁组为15.8%(6/38),3岁以上组仅为7.7%(2/26)。年龄越小,喉-气管-支气管软化发病率越高,各年龄组间比较差异有统计学意义(P<0.05),但喉-气管-支气管软化发病率与性别无关(P>0.05)。结论喉-气管-支气管软化好发于小年龄儿童,尤其是小婴儿。支气管镜检查是诊断喉-气管-支气管软化的金标准,有利于疾病的早期诊断、早期治疗。

Objectives To explore the diagnosis value of electronic bronchoscopy in dyspnea in children. Methods All pediatric patients with dyspnea that could not be relieved by medicine were performed by electronic bronchoscopy. The clinical data were analyzed retrospectively. Results Among 53 cases, 22 cases was laryngo-tracheo-bronchomalacia, fol- lowed by 15 cases of tracheobronchial anomalies, 4 cases of foreign body, 4 cases of tumor or vegetation, one case of pulmonary tuberculosis, and one case of pneumorrhagia. There were no abnormality in 6 cases and they were mostly likely to be caused by inflammation. Total diagnosis rate was 88.6% (except inflammation). Conclusions Electronic bronchoscopy has dual applications in diagnosis and therapy of respiratory system diseases in children. It should be recommended and more widely used in clinic.

Objective To explore the value of electronic bronchoscopy for children with atelectasis and emphysema. Methods 31 cases with atelectasis and 35 with emphysema were examined and treated by electronic bronchoscopy and bronchoalveolar lavage. Results In 31 cases with atelectasis, 24 cases were caused by inflammation (77.4%), which was the most common cause, followed by tracheobronchomalacia and bronch deformity n=5;(16.2%). 1 case had granuloma and 1 had tumour. In 35 cases with emphysema, 22 cases were caused by inflammation (62.9%), which was the most common cause, followed by foreign body n=7;(20%), tracheobronchomalacia n=5;(14.3%). Foreign body was most commonly seen in children during 1～3 years. 1 case had tumour. 19 of 24 cases had infection-associated atelectasis, showing re-expansion and were treated by bronchoalveolar lavage. Conclusion Inflammation is the most common cause of atelectasis and emphysema in children, followed by foreign body, tracheobronchomalacia and bronch deformity. Electronic bronchoscopy is effective in the diagnosis and treatment of atelectasis and emphysema in children.

目的 探讨儿童气道异常在电子支气管镜下的表现和临床特征.方法 对2007年1月至12月在我院住院的108例反复呼吸道感染、持续喘息、呼吸困难、肺不张等经常规治疗效果不佳的患儿行电子支气管镜检查,并总结分析其镜下病变特征、临床表现等.结果 108例患儿中气道异常38例,占35%,其中先天性气道异常29例,后天性气道异常9例.先天性气道异常以气道软化最多见,\u003c1岁婴儿气道异常检出率为65.5%,与其他各年龄组相比,差异有显著性(P\u003c0.05).结论 气道异常是儿童反复呼吸道感染、持续喘息、呼吸困难的常见原因之一,年龄越小,气道异常比例越高.支气管镜检查可提高其诊断率,明确异常类型,对治疗有指导意义。