Primary ciliary dyskinesia (PCD) is a rare disorder characterized by dysfunction of motile cilia and chronic progressive respiratory disease, mianly inherited in an autosomal recessive manner. Biallelic variants in dynein axonemal heavy chain 11 (DNAH11) have been reported in association with PCD and are typically associated with normal ciliary ultrastructure. In addition, exon-level copy number variants (CNVs) in DNAH11, particularly duplications, remain poorly characterized and are prone to being overlooked by conventional sequencing workflows. We report a 9-year-old Chinese girl with recurrent lower respiratory tract infections, chronic pansinusitis, and bronchiectasis. Pulmonary function testing showed isolated small-airway dysfunction with preserved FEV1, with nasal nitric oxide (nNO) severely reduced (5.4 nL/min). Trio whole-exome sequencing integrated with read-depth CNV analysis detected novel compound heterozygous DNAH11 variants: a paternal inherited missense variant (c.6556A>C, p.Thr2186Pro) and a previously unreported maternally derived intragenic duplication encompassing exons 30–54. The missense variant was confirmed by Sanger sequencing, and the exon-level dosage gain was confirmed by qPCR. This case expands the spectrum of DNAH11 variants and highlights the importance of incorporating CNV detection into exome-based diagnostic process for children with a highly suggestive PCD phenotype.

BACKGROUND:Sleep disordered breathing (SDB) is prevalent in individuals with Prader-Willi syndrome (PWS). However, its clinical characteristics, risk factors, and impact on sleep architecture remain incompletely understood. This retrospective case-control study aims to characterize respiratory events in PWS; asses body mass index (BMI)-SDB severity association; and quantify sleep architectural changes to inform PWS screening and management. METHODS:Children with PWS who underwent PSG in the Department of Respiratory Medicine, Children's Hospital of Soochow University from December 2020 to January 2025 were enrolled in this study. Age- and gender-matched control subjects of children diagnosed with obstructive sleep apnea-hypopnea syndrome (OSAS) without underlying comorbidities, evaluated using identical PSG equipment. SPSS30.0 was used to perform 1:2 matching according to age and gender. The clinical characteristics and PSG results were compared between groups. Correlations between BMI, adenoid/tonsil hypertrophy and the severity of SDB were analyzed. RESULTS:19 children with PWS underwent sleep monitoring, of whom 16 completed PSG. The PWS cohort (n = 16) included 9 males (56.3 %) and 7 females (43.8 %), ranging in age from 3.4 to 14.7 years (mean age: 8.4 ± 3.5 years), with a median BMI of 24.5 kg/m2 (IQR: 21.6-35.1). All 16 PWS children were diagnosed with OSAS, 75 % presenting moderate-to-severe OSAS (P < 0.001). Compared with the OSAS control group, the PWS group exhibited significantly higher BMI values (P < 0.001),fewer awakenings (P = 0.007) and a reduced proportion of NREM3 sleep (P = 0.040). While OSA predominates in the SDB spectrum of PWS, central sleep apnea (CSA), mixed apnea, and hypoventilation events were also observed, with all respiratory event indices significantly higher in PWS than controls (all P < 0.05). PWS children demonstrated significantly lower mean oxygen saturation and lowest oxygen saturation (LSaO2) (all P < 0.001), as well as higher oxygen desaturation index (ODI) and obstructive apnea-hypopnea index (OAHI) (all P < 0.005). BMI was positively correlated with obstructive apnea-hypopnea index (OAHI) (r = 0.558, P = 0.025) and Hypopnea index (HI) (r = 0.639, P = 0.008), and negatively correlated with LSaO2 (r = -0.551, P = 0.027). CONCLUSION:PWS children exhibit a diverse spectrum of SDB, with OSA as the dominant respiratory event type with abnormal arousal responses to respiratory events. The severity of SDB in PWS is strongly related to BMI. These findings highlight the critical role of obesity in exacerbating respiratory compromise and emphasize the necessity of routine PSG screening and targeted BMI management in PWS care.

Mycoplasma pneumoniae (MP) is a major cause of pediatric respiratory infections, characterized by cyclical epidemics and age- and season-specific patterns. However, long-term epidemiological data spanning multiple epidemic cycles are limited. We conducted a 20-year retrospective study of children (< 18 years) hospitalized with respiratory tract infections and undergoing MP testing at Children's hospital of Soochow University from October 2005 to December 2025. MP infection was defined by positive PCR and/or serological evidence. Positivity was analyzed by age, sex, season, calendar period, and COVID-19 pandemic phase. Among 51,399 specimens, 16,086 were MP-positive (31.30

BACKGROUND:Airway epithelial barrier dysfunction is a central feature of asthma pathogenesis, yet the molecular mechanisms by which post-translational modifications regulate epithelial integrity remain incompletely understood. Fucosylation has emerged as a potential regulator of epithelial homeostasis across mucosal tissues. OBJECTIVE:We sought to investigate whether epithelial fucosylation contributes to allergen-induced barrier dysfunction and airway inflammation and to define their underlying mechanisms. METHODS:Fucosylation levels were assessed in saliva from children with asthma using mass spectrometry. Air-liquid interface epithelial cultures were used to assess barrier function by transepithelial electrical resistance, tight junction protein expression and cytokine release. Transcriptomic analyses were performed to identify dysregulated fucosylation pathways. Fut1 was selectively inhibited in vivo and in vitro using intratracheally delivered AAV6-encoded shRNA. Downstream targets were also evaluated by RNA sequencing. RESULTS:Fucosylation was significantly increased in saliva from children with asthma and in allergen-exposed mouse airways. Pharmacologic inhibition of fucosylation preserved epithelial barrier integrity, maintained junctional organization and reduced allergen-induced epithelial cytokine release. Transcriptomic profiling identified fucosylation as a major upregulated pathway, with increased expression of Fut1, Fut2, Fut7 and Fut9. Epithelial-specific Fut1 knockdown attenuated Th2-driven inflammation, preserved epithelial junctional architecture and suppressed alarmin release. Integrated analyses revealed 56 Fut1-dependent genes enriched in cell-adhesion pathways, including Cdh12, App, Ank3 and Cd9. Fut1-CDH12 protein interaction was confirmed by immunoprecipitation, and FUT1-dependent induction of CDH12 disrupted epithelial junctional organization and barrier function. CONCLUSION:These findings identify the FUT1-CDH12 axis as a previously unrecognized epithelial mechanism promoting barrier dysfunction and allergic airway inflammation in asthma.

ObjectiveTo analyze the characteristic changes in the gut microbiome in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to investigate the relationship between the gut microbiome and polysomnography (PSG) results.MethodsChildren diagnosed with primary snoring and OSAHS by PSG were enrolled in the study group. Nonsnoring children undergoing elective surgery were selected as the control group. Stool, sleep monitoring data, and medical history data were collected. The clinical history data were analyzed by SPSS 25.0 software. 16S rRNA high-throughput sequencing technology was used to analyze the gut microbiome, and relevant biostatistical methods were used to analyze and describe the characteristics of the gut microbiome.ResultsA total of 62 OSAHS patients (42 mild OSAHS and 20 moderate to severe OSAHS), 16 primary snoring patients and 46 controls were enrolled in this study. There were significant differences in the partial alpha diversity index (observed otus index, Chao1 index) and beta diversity under the Jaccard and unweighted UniFrac distance methods between the mild OSAHS group and the moderate to severe OSAHS group. There were differences in some gut microbiome at different levels of phylum, class, order, family, genus and species between the control group and OSAHS group. There was a significant difference in the abundance ratio between Firmicutes and Bacteroidetes (F/B), and the ratio gradually increased among the three groups. The predictive model for OSAHS diagnosis established by the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of Firmicutes and the F/B were more than 50%. At the genus level, Akkermansia was positively correlated with sleep efficiency (SE), Dialister was positively correlated with mean oxygen saturation (SaO2mean) and lowest oxygen saturation (LSaO2), Escherichia-Shigella was negatively correlated with total sleep time (TST), and Faecalibacterium was negatively correlated with the obstructive apnea index (OAI).ConclusionThe gut microbiome of children with OSAHS is slightly different at the phylum, class, order, family, genus and species levels. The F/B and Firmicutes abundance detection have limited predictive capability for the diagnosis of OSAHS. At the genus level, some gut microbiota were correlated with PSG indicators.

BACKGROUND:Obstructive sleep apnea (OSA) may induce chronic systemic inflammation, which may serve as a potential mechanism contributing to multiple complications. The timely identification of high inflammatory status (HIS) in pediatric OSA is crucial for effective clinical diagnosis and management. This study aimed to evaluate influencing factors in hsCRP levels, and further investigated the risk factors associated with HIS in pediatric OSA patients. METHODS:Children aged 3 to 15 years who presented with snoring symptoms and underwent polysomnography (PSG) at the sleep center were included in this study. All participants completed a comprehensive questionnaire, a physical examination, nasopharyngeal X-ray imaging and a blood test. The physical examination included measurements of height, weight, and visual evaluation of tonsillar hypertrophy. RESULTS:A total of 1,171 children were enrolled, with 562 cases diagnosed with OSA. Utilizing threshold for hsCRP generated via ROC curve, 299 and 872 children exhibited HIS and Low Inflammatory Status, respectively. Compared to the control group, the hsCRP levels in the OSA group were significantly elevated. Pediatric OSA with HIS had higher BMI and a greater proportion of both overweight and obese. Logistic regression analysis demonstrated that HIS was independently positively correlated with BMI and mean time of obstructive apnea, and negatively associated with minimum SpO2. CONCLUSIONS:HsCRP in pediatric OSA patients were notably elevated, whilst identifying BMI, mean time of obstructive apnea, and minimum SpO2 as independent factors leading to HIS. HsCRP may function as an effective blood index capable of identifying individuals exhibiting HIS linked to OSA.

BACKGROUND:Limited data are available on the relationship between seasonal factors and obstructive sleep apnea-hypopnea syndrome (OSAHS) in China. The aim of this study was to investigate the effects of seasonal factors on the severity of OSAHS in children. METHODS:Children 2.0 to 16 years old presenting with snoring and/or mouth breathing, suspected of having OSAHS, and admitted to the Department of Respiratory Medicine of Children's Hospital of Soochow University from December 2016 to February 2022 were enrolled in this study. The severity of OSAHS was determined by full-night polysomnography (PSG) in the sleep laboratory. The correlation between seasonal factors and PSG monitoring results was analyzed. RESULTS:Of the 589 included patients, 301 cases (51.1%) were diagnosed with OSAHS. In the OSAHS group, 77 cases (25.6%) were detected in spring, 74 cases (24.6%) were detected in summer, 59 cases (19.6%) were detected in autumn, and 91 cases (30.2%) were detected in winter. There were 238 cases (79.1%) of tonsillitis hypertrophy, 276 cases (91.7%) of adenoid hypertrophy, 215 cases (71.4%) of rhinitis/sinusitis, and 36 cases (12.0%) of asthma. The proportion of rhinitis/sinusitis and tonsillar hypertrophy in spring was higher than that in summer (P = .015 and P = .036, respectively), and the proportion of adenoid hypertrophy in winter was higher than that in summer (P = .024). The diagnostic rate of severe OSAHS in winter was higher than that in summer (χ2 = 7.053, P = .008). The respiratory arousal index in winter was higher than that in summer (H = -39.297, P = .018), and the spontaneous arousal index in spring was higher than that in autumn (H = 44.059, P = .020). It was found that the rapid eye movement (REM)-apnea index (AI) in spring and winter was higher than that in summer (H = 52.292, -52.554; all P < .05). The comparison of PSG results of children with OSAHS ≤6 years old in different seasons showed that REM-AI in winter was higher than that in summer (H = 8.570, P < .05). CONCLUSION:Severe OSAHS is more common in winter. Respiratory events are increased in spring and winter, mainly in children ≤6 years old. Seasonal factors may have a certain impact on OSAHS.

Objective:To investigate the value of pulse oxygen saturation (SpO 2) monitoring in predicting children with moderate-to-severe obstructive sleep apnea (OSA). Methods:It was a retrospective study involving 341 children with snoring during nighttime sleep who had visited the Children′s Hospital of Soochow University from June 2017 to November 2020 and monitored for polysomnography (PSG) and SpO 2.The SpO 2 parameters mainly included oxygen desaturation index (ODI), oxygen desaturation index ≥3% (ODI3), oxygen desaturation index ≥4% (ODI4), mean pulse blood oxygen saturation (MSpO 2), lowest pulse blood oxygen saturation (LSpO 2), cumulative time spent with blood oxygen saturation below 95%, 92% and 90%(T95, T92 and T90). According to obstructive sleep apnea hypopnea index (OAHI), patients were divided into the snoring and mild OSA group (OAHI≤5 times/h) and moderate-to-severe OSA group (OAHI>5 times/h). Differences in SpO 2 parameters were compared between groups using the Chi- square test and Mann- Whitney U test. Spearman correlation analysis was used to analyze the correlation between SpO 2 parameters and OAHI in all children.The SpO 2 parameters were included in the Logistic regression model.Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of SpO 2 parameters on moderate-to-severe OSA. Results:A total of 341 patients were recruited, including 206 male and 135 female patients with the mean age, body mass index (BMI) and OAHI of 6.0 (4.0, 7.5) years, 16.2 (15.1, 18.0) kg/m 2 and 0.6 (0.1, 3.0) times /h, respectively.There were 283(83.0%) and 58 (17.0%) patients in the snoring and mild OSA group and moderate-to-severe OSA group.The ODI3[0.7 (0.3, 1.4) times/h vs.7.7 (4.4, 12.8) times/h], ODI4[0.4 (0.1, 0.8) times/h vs.5.3 (2.7, 9.1) times/h], T95[1.4 (0.3, 5.3) min vs.13.7 (7.0, 33.5) min], T92[0.1 (0, 0.5) min vs.1.8 (0.9, 6.0) min] and T90[0 (0, 0.1) min vs.0.6 (0.2, 2.2) min] were significantly lower in the snoring and mild OSA group than those of moderate-to-severe group, while LSpO 2[91.0 (89.0, 93.0)% vs.86.5 (82.0, 88.0)%] and MSpO 2[ 97.0 (97.0, 98.0)% vs.96.0 (96.0, 97.0)%] were significantly higher(all P<0.001). All SpO 2 parameters were significantly correlated with OAHI (all P<0.001), and the correlation coefficient between ODI3 and OAHI was 0.660.ODI3 was an independent predictor of moderate-to-severe OSA ( OR=3.117, 95% CI: 1.635-5.945, P=0.001). The area under the ROC curve of ODI3 in predicting the moderate-to-severe OSA was 0.957, and the cut-off value of 3.45 times/h and specificity of 95.4%.MSpO 2 was an independent predictor of moderate-to-severe OSA ( OR=2.917, 95% CI: 1.589-5.354, P=0.001). Conclusions:ODI3 can be used to predict the moderate-to-severe OSA in children.

Abstract Objective To investigate the etiological characteristics of plastic bronchitis (PB) caused by pulmonary infections in children and to identify any differences in the clinical features of PB cases caused by different pathogens. Method We collected data on children diagnosed with PB and admitted to the Respiratory Department at Soochow University Children’s Hospital between July 2021 and March 2023 utilizing electronic bronchoscopy. We analyzed clinical characteristics and the species of pathogens causing the illness in these children. Result A total of 45 children were enrolled. The main clinical symptoms observed were cough (100%), fever (80%), shortness of breath (28.9%), and wheezing (20.0%). Pathogens were identified in 38 (84.4%) patients. Mycoplasma pneumoniae (MP) had the highest detection rate at 53.3%, followed by the Boca virus at 26.7%. MP-induced PB typically occurs in older children with an average age of 7.46 ± 2.36 years, with the main symptoms including high fever (85.7%) and local hyporespiration (42.9%). In contrast, Boca virus-induced PB tends to occur in younger children, with the main symptoms of moderate fever (54.5%), and wheezing (54.5%). The MP group exhibited a higher incidence of both internal and external pulmonary complications, including pleural effusion (42.9%), elevated aspartate aminotransferase (52.4%), lactic dehydrogenase (76.2%), and D-D dimer (90.5%). Conversely, the Boca virus group primarily showed pulmonary imaging of atelectasis (81.8%), with no pleural effusion. The average number of bronchoscopic interventions in the MP group was 2.24 ± 0.62, which was significantly higher than that required in the Boca virus group (1.55 ± 0.52). During the second bronchoscopy, 57.1% of children in the MP group still had visible mucus plugs, while none were observed in the Boca virus group. Conclusion MP and Boca virus are the primary pathogens responsible for PB among children. The clinical manifestations of PB typically vary significantly based on the pathogen causing the condition.

Purpose: To explore the screening value of the adenoidectomy / nasopharyngeal (A/N) ratio from nasopharyngeal lateral radiography in children with obstructive sleep apnoea hypopnea syndrome (OSAHS). Methods: Children who had visited the respiratory department due to snoring and/or mouth breathing’ were enrolled. Nasopharyngeal lateral radiography and polysomnography (PSG) were performed. PSG monitoring is the gold standard for OSAHS. The differences in PSG monitoring results among different A/N groups were compared, and the correlation between the A/N ratio and PSG monitoring results was analysed. The receiver operating characteristic curve (ROC) was plotted to evaluate the screening value of OSAHS in children with the A/N ratio from nasopharyngeal lateral radiography to determine the diagnostic critical point. Results: A total of 425 children were enrolled. A total of 183 patients (43.1%) were diagnosed with OSAHS, including 113 cases (26.6%) of mild OSAHS and 70 cases (16.5%) of moderate to severe OSAHS. A total of 52 patients (12.2%) had an A/N ratio ≤ 0.60, 77 patients (18.1%) had an A/N ratio from 0.61~0.70, 142 patients (33.4%) had an A/N ratio from 0.71~0.80, and 154 patients (36.2%) had an A/N ratio ≥0.80 The patients with moderate-severe OSAHS had a higher A/N ratio than those with mild OSAHS and non-OSAHS. The OAHI, ODI, and the diagnostic rate of OSAHS were higher and the LSaO 2 was lower in the A/N≥0.80 group than in the other three groups. Spearman’s rank correlation showed that the A/N ratio was correlated with OAHI, ODI, and LSaO 2 (r=0.275, 0.227, -0.225, respectively). The area under the ROC curve for the diagnosis of OSAHS by the A/N ratio was 0.659, the critical value was 0.825, and the sensitivity and specificity were 45.1% and 80.9%, respectively. An A/N ratio ≥0.825 was identified as the main influencing factor of OSAHS by logistic multivariable regression analysis. Conclusion: There is a correlation between the degree of adenoid hypertrophy and OSAHS, and an A/N ratio ≥0.825 has good suggestive value for the diagnosis of OSAHS but is not a substitute for PSG.

This study aimed to explore the effects of forkhead box P2 gene (Foxp2) on T-helper 9 (Th9) differentiation in asthmatic mice. An in vivo asthmatic mouse model was induced with ovalbumin (OVA). An in vitro model was established by culturing CD4+ T cells with TGF-β, IL-4, and anti-IFN-γ. ELISA, flow cytometry, qRT-PCR and Western blot were performed to examine IL-9 secretion, Th9 cell number, and Th9 cell transcription factor expression, respectively. Pathological changes in lung tissues and airway mucus secretion were assessed with HE and PAS glycogen staining. Anti-IL-9 mAb reversed the elevation in Th9 cells and IL-9 expression in lung tissues and bronchoalveolar lavage fluid (BALF) of asthmatic mice. Foxp2 was downregulated in BALF and lung tissue of asthmatic mice and Th9 cells. Overexpression of Foxp2 inhibited Th9 cell differentiation in vitro and improved airway inflammation in vivo. Our study suggests that overexpression of Foxp2 attenuates allergic asthma by inhibiting Th9 cell differentiation.

目的 通过分析不同季节阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿临床及多导睡眠监测(PSG)资料,探讨季节因素对苏州地区儿童OSAHS的影响.方法 选取自2017年3月-2019年2月因"打鼾、张口呼吸"等症状就诊于苏州大学附属儿童医院呼吸科,行PSG检查的患儿为研究对象.根据年龄分为两组(≤6岁;＞6岁),比较两组OSAHS患儿在不同季节的诊断情况、睡眠结构、阻塞性呼吸暂停低通气指数(OAHI)、氧减指数(ODI)、最低血氧饱和度(LSaO2)等指标在不同季节的差异.结果 1)227例OSAHS患儿夏季诊断率最低(x2 =8.964,P=0.03).2)轻、中、重度OSAHS患儿季节诊断率比较,差异无统计学意义(P＞0.05).3)春季OSAHS患儿非快动眼睡眠2期(NREM2)比例低于夏季、冬季(P＜0.05),春季快动眼睡眠期(REM)比例高于夏季、冬季(P＜0.05),而非快动眼睡眠3期(NREM3)比例夏季低于春季、冬季(P＜0.05).4)春季LSaO2低于夏季(P=0.011),快动眼睡眠期呼吸暂停指数(REM AI)高于秋冬季(P＜0.05).5)≤6岁OSAHS患儿春季NREM2期比例低于夏季(P＜0.001);夏季NREM3期比例低于春冬季(P＜0.05);春季REM期比例高于冬季(P=0.048),LSaO2(％)低于夏季(P=0.004),REM-AI高于冬季(P＜0.01).结论 季节因素对于儿童OSAHS严重程度无明显影响,不同季节OSAHS睡眠结构及呼吸事件有所不同,主要见于≤6岁患儿.

Abstract Background MicroRNAs play an important role in T cell responses. However, how microRNAs regulate Th cells in asthma remains poorly defined. Objective In this study, we investigated the mechanism and pathways of miR‐29b regulating Th cells in asthma, in order to find new targets for asthma. Methods We detected miR‐29b, B7‐H3 and STAT3 in the peripheral blood of children with asthma, explored the relationship between these molecules and their effects on T cells through in vitro cell culture, and verified it by animal model. Results MiR‐29b levels were decreased in the peripheral blood mononuclear cells from children with asthma. Vitro studies found that the expression of miR‐29b in macrophages was decreased and the expression of B7‐H3 and STAT3 was increased after house dust mite (HDM) stimulation. After down‐regulation of miR‐29b in macrophages, the expressions of B7‐H3 and STAT3 in macrophages were increased and T cells differentiate into Th2 cells. After the addition of B7‐H3 or STAT3 antibodies, the differentiation of naive T cells into Th2 cells was reduced. In OVA induced mice asthmatic model, after the up‐regulation of miR‐29b in lung, the expression of B7‐H3 and STAT3 decreased in the lung tissues of mice, and the expression of Th2 cells and type II cytokine decreased simultaneously. The pathological changes of lung tissues were also alleviated. Conclusion The expression of miR‐29b is decreased in asthmatic children. MiR‐29b can inhibit Th2 cell differentiation by inhibiting B7‐H3 and STAT3 pathways at the same time, and reduce asthmatic immune inflammation.

目的 分析学龄前期及学龄期阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床及睡眠结构特点.方法 纳入2016年12月-2019年11月于苏州大学附属儿童医院呼吸科就诊,经多导睡眠监测诊断为OSAHS的123例患儿为研究对象,选择同期诊断为鼾症(PS)的313例患儿为对照组,根据年龄将两组患儿分为学龄前期组及学龄期组,收集临床资料及多导睡眠监测(PSG)结果.结果 学龄前期及学龄期OSAHS患儿夜间及日间症状均较对照组显著(P＜0.05).学龄前OSAHS患儿快动眼睡眠期(REM)比例高于对照组(Z=2.467,P＜0.05);学龄期OSAHS患儿总睡眠时间(TST)及睡眠效率低于学龄前OSHAS患儿(t=2.518,Z=1.527),NREM2期比例升高(t=4.080),NREM3期比例下降(Z= 1.832),氧减指数(ODI)升高(Z=1.653,P＜0.05).呼吸暂停低通气指数(AHI)与学龄前期患儿NREM 1期睡眠比例呈正相关(r=0.217),与REM期比例呈负相关(r=-0.220),体重指数(BMI)与学龄期OSAHS患儿NREM 3期比例呈负相关(r=-0.429,PP＜0.05).结论 OSAHS患儿临床表现与鼾症患儿不同,且不同年龄症状有所差异;学龄期OSAHS患儿睡眠结构改变较学龄前期患儿明显;学龄前期、学龄期OSAHS患儿睡眠结构改变分别与AHI、BMI有关.

We aim to analyze the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Polysomnography (PSG) and nasopharynx lateral film were performed, and clinical data were collected in 469 children who came to the outpatient department due to "snoring during sleep with mouth opening breathing, hard breathing or suffocation". Among the enrolled children, 123 (22.6%) were diagnosed with OSAHS, with 70 were mild and 53 were moderate-severe. Percentage of adenoid hypertrophy was higher in OSAHS patients ( p <0.01), instead of tonsil enlargement. The OSAHS children were agged 5 (4, 7). Compared with PS, the percentage of snoring, apnea, dyspnea, increased nocturia, and daytime sleepness were significsntly higher in moderate-severe patients ( p <0.01). In OSAHS groups, AHI, ODI, Longest time of apnea were increased, while minimum SpO2 and mean SpO2 during sleep were decreased significantly ( p <0.01) than PS. Time ratio of NREM1 was elevated in moderate-severe OSAHS patients ( p <0.01). Time ratio of REM was elevated in mild patients( p <0.01). Compared with the preschoolers, the percentage of leg movement and sleepness were significsntly higher in school-agers ( p <0.05). The youngers had higher time ratio of NREM3 and better sleep efficieny (p<0.01). However, AHI(p<0.05) and ODI(p<0.01) were higher in elder OSAHS significantly. Snoring (OR =5.745, p < 0.01), adenoid hypertrophy (OR =4.381, p < 0.01), apnea (OR =2.670, p < 0.001), dyspnea (OR =1.975, p < 0.01), and CRP (OR =1.172, p < 0.001) were independent risk factors for OSAHS. Conclusion AHI, ODI, Longest time of apnea, minimum SpO2 and mean SpO2 should be considered and analyzed simultaneously in diagnosis. The school-age OSAHS patients seems to more serious than the preschoolers. Snoring, apnea, dyspnea, adenoid hypertrophy, and CRP are risk factors for OSAHS.

OBJECTIVE:To compare and analyze the clinical manifestations and sleep structure of children with obstructive sleep apnea-hypopneasyndrome (OSAHS) with different body mass index (BMI). METHODS:452 children who were diagnosed with OSAHS between December 2016 and February 2021 by the Department of Respiratory Medicine, Children's Hospital of Soochow University were included in the study. All of them did polysomnography (PSG). They were divided, according to their BMI, into the normal BMI group, the overweight group, and the obesity group. Their clinical data and PSG results were collected. RESULTS:287 boys (63.5%) and 165 girls (36.5%) were enrolled, with their age ranging between 3 and 15, and the median age being 5.5 (4.5, 7.0). Their BMI ranged between 12.09 kg/m 2 and 38.48 kg/m 2, with the median being 16.29 kg/m 2. 275 cases (60.8%) had normal BMI, 76 cases (16.8%) were overweight, and 101 cases (22.3%) were obese. There was no significant difference in the distribution of clinical manifestations and severity of OSAHS among the three groups. The duration and proportion of rapid eye movement (REM) stage sleep in the obese group was lower than that of the overweight and the normal BMI groups ( P<0.05). The lowest oxyhemoglobin saturation (LSaO 2) of children in the overweight group was lower than that of the normal BMI group ( P=0.050). The oxygen desaturation index (ODI) of the obese group was higher than that of the normal BMI and the overweight groups ( P<0.05). CONCLUSION:Obesity worsens the degree of hypoxia in children with OSAHS and affects their sleep structure.

Background The aim of the study was to identify the pathogens, in addition to bordetella pertussis ( B. pertussis ), which cause pertussis-like syndrome in children and to compare clinical presentation between those with B. pertussis and pertussis-like syndrome. Methods A cross-sectional analysis was conducted from March 2016 to September 2018. In total, 281 children with suspected pertussis infections were enrolled in this study. Multi-pathogen detection was performed. Results In total, 281 children were enrolled including 139 males and 142 females. Among them, 149 (53.0%) were B. pertussis positive, and 72 (15.6%) children tested positive for other pathogens. Mycoplasma pneumoniae (MP, 27 cases) was the most common causative pathogen in pertussis-like syndrome, followed by human rhinovirus (HRV, 23 cases), Streptococcus pneumoniae (SP, 13 cases), Haemophilus influenzae (HI, 12 cases) and parainfluenza virus 3 (Pinf-3, 9 cases). Children in the B. pertussis group had a higher rate of vaccination and longer hospital stay ( P < 0.05). B. pertussis was more likely to be detected in winter than other pathogens, but this difference was not significant ( P = 0.074). The number of white blood cells, neutrophils and blood platelets was significantly higher in children in the B. pertussis than in the pertussis-like group ( P < 0.05). In addition, the percentage of CD3-CD19+ cells was significantly higher in the B. pertussis group ( P = 0.018). Conclusion About half of the children with pertussis-like syndrome were B. pertussis positive. MP was the second most common causative pathogen followed by HRV, SP, HI and Pinf-3. Children infected with B. pertussis had longer hospital stay and higher numbers of white blood cells, neutrophil and blood platelets compared with other pathogens.

目的:分析苏州地区儿童难治性肺炎支原体肺炎(RMPP)流行病学特征,为临床合理诊疗提供参考.方法:收集2011年1月至2015年12月苏州地区11 064例肺炎住院患儿的痰标本,采用荧光定量PCR法检测MP-DNA;同时在入院24 h内及治疗7 ～10 d采集静脉血,ELISA法检测血清特异性MP抗体IgG、IgM,结合临床表现分析RMPP流行状况.结果:RMPP在MPP中的总发生率为14.30％,其中男性发生率为13.12％,女性发生率为15.90％,女性患儿RMPP发生率明显高于男性患儿(x2=5.918,P＜0.05).＜4岁患儿RMPP发生率为6.83％,4～7岁为20.86％,≥7岁为40.84％,RMPP发生率随着年龄的增大逐渐升高(x2=365.233,P＜0.01).春季RMPP发生率为14.39％,夏季为16.93％,秋季为12.56％,冬季为12.88％,夏季RMPP发生率最高(x2=10.426,P＜0.05).2011-2015年住院患儿RMPP在MPP中的发生率逐年升高(x2=52.709,P＜0.01).结论:苏州地区2011-2015年RMPP在MPP中的发生率为14.30％,女性患儿RMPP发生率高于男性,随着年龄的增大RMPP发生率逐渐升高,夏季为RMPP高发季节,RMPP有逐年升高的趋势.

目的 探讨Prader-Willi综合征(PWS)儿童睡眠呼吸暂停综合征的特征.方法 回顾分析1例重度肥胖学龄期PWS患儿无创呼吸机治疗前后的临床及多导睡眠监测资料,并通过关键词"PWS、阻塞性睡眠呼吸暂停综合征(OSAS)、肥胖低通气综合征(OHS)、儿童"分别检索PubMed、万方、知网等数据库,收集1980-2018年有关PWS患者合并OSAS、OHS的资料,分析其睡眠呼吸障碍的特征及影响因素.结果 10岁男性患儿,体质量60 kg,身高124 cm,BMI 39.02(>P97),因咳嗽、口唇发绀入院.入院时神志清,呼吸40次/min,两肺呼吸音粗,可及干、湿啰音,四肢肌张力弱.血氧饱和度82％,清醒状态下动脉血PCO 2115 mmHg.予气管插管、机械通气,联合抗感染治疗等控制病情后拔管撤机,清醒时指脉氧在85％～92％,有频繁呼吸暂停、脉氧下降;整夜多导睡眠监测示呼吸暂停低通气指数31.7次/h,最低脉氧46％,提示重度睡眠呼吸暂停综合征、重度低氧血症.结论 PWS患儿的睡眠呼吸障碍是一个复杂的并发症,可合并重度睡眠呼吸暂停综合征、肥胖低通气综合征.多导睡眠监测对其诊断及鉴别中具有重要作用.无创呼吸机治疗有效.

To investigate the impact of viral and bacterial co-infection in hospitalised children with Mycoplasma pneumoniae pneumonia (RMPP). Retrospective analysis of 396 children with RMPP in our hospital admitted between 1 January 2011 and 31 December 2016 was performed. Nasal aspirate samples were collected for pathogen detection and clinical data were collected. We analysed clinical characteristics, lung imaging characteristics and pathogenic species among these children. Of the 396 RMPP cases, 107 (27.02%) had co-infection with other pathogen, with Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus being the most common bacteria of infection and human bocavirus (HBoV), human rhinovirus, respiratory syncytial virus being the most common viruses of infection. Children with co-infection were younger than that with single infection (P = 0.010). Children with both virus and bacteria co-infection had been the youngest (P = 0.040). Children with co-infection had a longer fever process, higher leukocyte count, higher C-reactive protein compared with single infection (P < 0.05). Children with co-infection had a higher percentage of pnemothorax and diffuse large area of inflammation in chest X-ray manifestation compared with children with single infection (P < 0.05). S. pneumonia and HBoV was the leading cause of co-infection in RMPP. Co-infections led to more disease severity in children with RMPP compared with single infections.