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.

目的 分析基于MRI成像的孤立局灶性皮质发育不良(Focal cortical dysplasia,FCD)患儿术后癫痫未完全缓解的原因.方法 回顾性分析2014年7月-2018年1月经病理证实且术后癫痫未完全缓解的21例孤立性FCD患儿的MRI及临床资料,分析其病理学类型及MRI征象,及不同MRI征象在每种病理类型FCD中出现的频次.分析手术失败的可能性因素.结果 21例患儿中男15例、女6例,平均年龄(5.7±0.3)岁,平均病程(3.4±0.5)年,此部分患儿的MRI征象主要以局灶性灰白质分界模糊、皮质结构异常改变(增厚和/或变薄)、transmantle征(自皮层下白质向脑室方向延伸锥形异常信号)及灰白质异常信号为主要表现,与其他FCD患儿MRI征象类似.17例(80.9％)患儿术后2周～6个月脑电监测术区出现癫痫样放电,其中FCD Ⅰ型与Ⅱ型分别占35.3％、64.7％.术中脑电监测,6例transmantle征区域未见癫痫样放电,只切除周围异常放电皮层区域,2例行transmantle征及周围异常放电区域全部切除,此两种切除方式,术后均有不同程度的癫痫发作.结论 术后癫痫未完全缓解孤立性FCD的MRI征象无特异性,行致痫灶全部切除后仍有不同程度的癫痫发作,原因可能与潜在致痫因素有关.

目的:探讨胸部CT鉴别小儿支原体肺炎与小儿支原体肺炎合并链球菌肺炎间的临床差异.方法:调研2016年6月—2017年5月我院小儿科收诊的58例小儿支原体肺炎患儿,视为对照组;同时调研同期的58例合并链球菌肺炎的患儿,视为观察组.全部患儿均由同一组医师给予胸部CT检查,观察两组患儿CT检查结果间的差异.结果:经胸部CT检查发现,对照组患儿的CT磨玻璃影发生率、扇形薄片影发生率、网状影、支气管壁增厚发生率、支气管血管束增厚发生率、无规律肺内实变影发生率等数据统计与观察组比较存在明显差异,P＜0.05.结论:通过观察胸部CT的检查结果,观察磨玻璃影、扇形薄片影、网状影、支气管壁增厚、支气管血管束增厚、胸腔积液的厚度等临床表现,可有效的甄别支原体肺炎与合并链球菌肺炎.

Objective To discuss the imaging appearance of congenital lingual root cyst. Methods 34 cases of congenital lingual root cyst were studied retrospectively. The imaging results were compared with pathology and laryngoscope. Results All 34 cases were correctly diagnosed according to the typical imaging appearance,and were confirmed by pathology. Twenty-two ca-ses underwent MRI examination,thirteen underwent CT and thirteen with US examination, showing a cystic lesion at the root of tongue,lingual surface of epiglottis,junctional zone of root and body of the tongue,or the epiglottis clearance,six cases with nar-rowing of the cavum pharyngis. The lesions were shown homogeneous hypo-intence on T1-weighted image and hyper-intence on T2-weighted image,and homogeneous hypo-density on CT image. Only one case demonstrated slight enhancement sign of local cystic wall on contrast enhancement MRI. On ultrasonographic,the lesions were shown as cystic fluid dark space with posterior shado-wing. The laryngoscope displayed the epiglottis was oppressed and softened by lingual root cyst, which caused poor ventilation. Conclusion Imaging appearance can display the features, positions, relationship with surrounding tissue of congenital lingual root cyst. Ultrasonography is the feasible and first choice,while MRI should be the best methods.

目的:分析小儿肺炎支原体肺炎应用X线和CT检查的临床表现.方法:选择我院2016年5月—2018年3月收治的85例小儿肺炎支原体肺炎患儿,均行X线检查和CT检查,将X线检查结果设为对照组,CT检查结果设为研究组,比较两组诊断结果.结果:研究组诊断符合率90.59％,显著优于对照组,比较差异具有统计学意义(P<0.05);研究组满意度94.12％,显著高于对照组,比较差异具有统计学意义(P<0.05).结论:相比于X线检查,小儿肺炎支原体肺炎实施CT检查的效果显著,可有效提高诊断符合率,且患者满意度高.

Objective To determine the value of T1 weighted inversion recovery (T1WIR) in revealing child's Myelination Within 0~8 months by comparing with T1 weighted spin echo (T1WSE).Methods 63 children aged 0~8 months underwent magnetic resonance imaging ,including both T1WSE and T1W-IR.Then we analyzed each anatomical site of myelination compara-tively, thus determined which sequence was more clear , and a more complete display anatomical structure , and the correlation in terms of image artifacts .Results The TIWIR sequence could display the anatomical structure adged 0~8 months more clearly than T1 WSE sequence , and the difference was statistically significant ( P <0.005 ) .Meanwhile , the T1 WIR resolved the effect of truncation artifact and venous indwelling needle , thus displaying the anatomical Structure between the brain cortex and cortex and cerebrospinal fluid better .Conclusion The T1 WIR sequence could display children's myelination degree aged 0~8 months more accuratelly , resolve the effect of artifact .The combination of both could evaluate children's myelination degree aged 0~8 months more accurately .

目的：分析肠道病毒71型（简称EV71型）危重症手足口病患儿的临床特点，为该病的诊断及治疗提供依据。方法回顾性分析187例EV71型危重症手足口病患儿的临床资料，分析临床表现、实验室检查、影像学检查、治疗方法等资料。结果187例患儿早期临床症状表现为持续高热、精神萎靡、肢体抖动、眼球震颤等，均伴有神经系统症状。脑脊液压力增大者占50．80％。145例行颅脑MRI 检查，示脑干损伤者占31．72％、脑水肿者占43．45％、大脑白质脱髓鞘病变者占7．59％。入院后给予退热、镇静、大剂量维生素C、磷酸肌酸、胃黏膜保护剂等对症治疗，针对病情危重程度给予限制入量、降低颅内压、应用糖皮质激素、静脉注射丙种免疫球蛋白、拮抗交感神经兴奋性等治疗。187例患儿治疗10～57 d、平均13．5 d。其中死亡12例，转康复科康复治疗9例，其余均临床治愈出院。结论 EV71型危重症手足口病患儿易出现神经系统受累，颅脑MRI检查有助于诊断及病情判断，早期诊断和及时干预是有效手段。

Objective To explore the diagnostic value of CT in children 's congenital cystic adenomatoid malformation ( CCAM) type Ⅲ.Methods CT manifestations of CCAM type Ⅲin 5 children's confirmed by surgery and pathological examina-tion were analyzed retrospectively , chest CT scan was performed before surgery and CT enhanced scan .Results 5 cases of con-genital cystic adenomatoid malformation of the lung CT showed cystic-substance type in 3 cases, the substance of type in 2 cases were single.There were lung involvement in 4 cases, 1 case of left lung involvement , with pathology of dysplasia lumen or adeno-matous structure .Conclusion CT examination can clearly show the lesion , scope and type of CCAM type Ⅲ surrounding rela-tionship , the clinical treatment and diagnosis play a positive role , which is an important means of diagnosis CCAM typeⅢ .

病例资料患儿,男,16 d.右侧小腿肿胀3 d伴触痛.体检发现右胫骨中段肿胀,触痛明显,心肺正常,肝脾无异常发现.

患儿男,9d,足月顺产.生后9d未排便,6d时在当地医院就诊,做过治疗性灌肠,未见粪便排出,有食欲,奶后约30min呕吐.查体:一般情况差,腹胀如鼓,无肠型及蠕动波,未触及包块,肠鸣音活跃.直肠指诊见少许黄便.临床诊断:腹胀待查;排除肠道先天性疾患.