BACKGROUND:This study aims to investigate the radiological outcomes in children with bronchiectasis under current treatment strategies through a real-world prospective observational study, and to conduct a preliminary analysis of potential influencing factors. METHODS:A total of 492 pediatric patients with bronchiectasis who underwent chest HRCT were enrolled from the Children's Hospital of Chongqing Medical University between January 2018 and December 2022, with follow-up extending until June 2024. Reversible imaging changes in bronchiectasis were determined by comparing changes in chest HRCT and modified Reiff scores (MRS). Univariable logistic regression models were used to preliminarily screen for factors related to imaging prognosis; variables with a significance level of P < 0.05 were subsequently included in multivariable logistic regression models for further analysis. RESULTS:Ultimately, 273 eligible pediatric patients were included in the final analysis, after excluding those lost to follow-up, those without follow-up chest HRCT, and those who underwent lobectomy. Reversible imaging changes were observed in 125 patients (45.8%), comprising 72 cases (26.4%) of complete radiological remission and 53 cases (19.4%) of improvement. Conversely, 148 patients (54.2%) exhibited stable or progressive disease. Multivariable logistic regression analysis revealed that localized radiological changes were significantly associated with radiological reversibility (OR = 1.82, 95% CI 1.11-3.00; P = 0.018). Bronchiectasis associated with a genetic condition and any acute exacerbation of respiratory symptoms during follow-up showed a significant negative association with radiological reversibility (OR = 0.48, 95% CI 0.25-0.91; P = 0.028 and OR = 0.58, 95% CI 0.35-0.97; P = 0.038, respectively). CONCLUSION:Pediatric bronchiectasis is partially reversible with appropriate treatment within a reasonable follow-up period. Patients with localized radiological changes are most likely to exhibit reversible imaging changes, whereas those with comorbid genetic diseases and recurrent infections are the least likely to do so.

ObjectivePlastic bronchitis (PB) in children is a critical condition requiring prompt intervention. Early identification of high-risk patients is crucial for timely bronchoscopic management. This study aimed to develop and validate a novel nomogram model for the early prediction of PB risk in pediatric patients.MethodsWe conducted a retrospective analysis of clinical data from children with respiratory conditions. The cohort was divided into a training set (n = 326) and an independent validation set (n = 136). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for PB by comparing demographics, clinical symptoms, laboratory findings, and imaging features between groups. A predictive nomogram was subsequently constructed based on the results of the multivariate analysis.ResultsMultivariate analysis identified seven independent predictors of PB: elder age, longer cough duration, mycoplasma pneumoniae infection, atelectasis, lung consolidation, pleural effusion, and pleurisy. The nomogram demonstrated excellent discriminative ability, with an area under the receiver operating characteristic curve (AUC) of 0.920 in the training set and 0.929 in the validation set. Good calibration was confirmed by the Hosmer–Lemeshow test (p = 0.545).ConclusionWe successfully developed and validated a practical nomogram incorporating seven readily available clinical parameters. This model serves as a reliable and non-invasive tool for the early assessment of PB risk in children, potentially facilitating timely clinical decision-making and intervention.

BackgroundPrior studies of protracted bacterial bronchitis (PBB) in children were mainly conducted in high-income areas, and no data from low- and middle-income countries have been published. In this study, we aimed to clarify the outcomes of PBB in a larger cohort in southwest China, focusing on the pathogen distribution and risk factors with an extended course of antibiotics.MethodsChildren with PBB who underwent flexible bronchoscopy were included. Clinical review, cytologic examination, and semiquantitative bacterial culture of bronchoalveolar lavage fluid (BALF) were performed as clinically indicated. Multiple linear regression and decision tree analyses were used to determine factors with an extended course of antibiotics.ResultsThe study included 138 children. Two pathogens were detected in 23 BALF samples. Streptococcus pneumoniae (Sp) and Haemophilus influenzae (Hi) were cultured in 67 and 59 BALF samples, respectively. Sp infection in BALF was an independent factor influencing the duration of the course of antibiotics (β = 11.988, t = 2.529, P = 0.013) according to multiple linear regression. One rule was used to predict an extended course of antibiotics (>4 weeks) with accuracy of 87.54% by decision tree analysis, namely, Sp infection in BALF, percentage of neutrophils in BALF >91%, and use of inhaled corticosteroids (ICS) before admission.ConclusionThe most prevalent pathogen in children with PBB in southwest China was S. pneumoniae, which necessitated a longer course of antibiotics, particularly when paired with a percentage of neutrophils in BALF >91% and administration of ICS prior to admission. Further research of children with PBB in low- and middle-income countries is urgently required.

This study aims to delineate the etiological spectrum of pediatric bronchiectasis in western China and compare the clinical characteristics among different etiologies. We conducted a retrospective cohort study of children newly diagnosed with bronchiectasis by high-resolution chest computed tomography at a tertiary pediatric hospital in western China (2018–2022). We collected clinical data on demographics, symptoms, airway comorbidities, imaging, pulmonary function, microbiological data, and bronchoalveolar lavage cellular data. The data underwent both descriptive and etiology-based inter-group analyses. This study included 484 children newly diagnosed with bronchiectasis between 2018 and 2022. An etiology was identified in 99

Vitamin D plays a vital role in immunity and is related to susceptibility and the severity of pneumonia. The home confinement caused by the novel coronavirus disease (COVID-19) decreased sunlight exposure derived from outdoor activities in children, thereby possibly exerting an influence on 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study is to quantify vitamin D level changes and trends among infants and toddlers with community-acquired pneumonia (CAP) during and post the home confinement period. This study included children who were hospitalized in the respiratory department of the Children's Hospital of Chongqing Medical University with CAP between February 1 and July 31 from 2020 to 2022 (N = 397). We used propensity score matching to control the confounding bias. The levels and trends of the children's serum 25(OH)D concentrations overall and by age groups were compared between the different periods. The serum 25(OH)D concentration during the home confinement period was lower (p < 0.05) but was still at the vitamin D sufficiency level. There was a gradual decrease in the 25(OH)D concentrations in the subsequent several months after the beginning of home confinement, and the recovery time was delayed. When analyzed by age group, the serum 25(OH)D concentration of the toddler group changed more significantly than that of the infant group between the different periods. The insufficiency of sunlight exposure caused by home confinement resulted in a slight and gradual decrease in vitamin D levels among children with CAP. In addition, the impact was more significant for toddlers.

我国临床研究生的培养模式几经转变.在当前培养模式下,临床研究生的教育更注重临床思维的培养,而科研思维的培养在一定程度上被弱化,在临床教学和科研教学之间甚至存在脱节.因此加强临床研究生科研思维的锻炼,深化临床教学和科研教学的结合,才能培养出临床本领过硬、科研能力拔尖的高素质医学人才.提升临床研究生的科研素养,首先要正确认识临床研究生培养过程中存在的问题,如过于注重临床培养、科研时间难以保证、缺乏足够的科研培训、研究生教材更新慢等.针对上述问题,文章提出一系列改善科研思维的培养模式,以期提高临床研究生的科研质量.

1 病例资料 女,7 月龄,因"外院先天性心脏病修补术后Ⅲ度房室传导阻滞 3 周"收住重庆医科大学附属儿童医院(我院)心血管科. 患儿于 3 周前因诊断"室间隔缺损、房间隔缺损、动脉导管未闭、肺动脉高压(重度)"于外院在全麻下行室间隔缺损修补术＋房间隔缺损修补术＋动脉导管未闭缝闭术＋房间隔缺损补片造瘘术,术后心电图提示Ⅲ度房室传导阻滞(图1A),术后予以临时起搏器植入并观察3 周未恢复窦性心律而携带临时起搏器转入我院,入院时烦躁、多汗、食欲差、尿少.

BACKGROUND:Tracheobronchomalacia (TBM) is often manifested as wheezing. Reassessing the role of TBM in persistent wheezing in children is essential.METHODS:We selected children who were diagnosed with TBM by bronchoscopy and who underwent bronchoscopic reexamination for persistent wheezing or chronic cough between January 2009 and July 2019. The clinical and bronchoscopy data were collected and retrospectively reviewed. For statistical analysis, we used the Kaplan-Meier method, Kruskal-Wallis test, and Fisher exact test.RESULTS:A total of 79 patients (57 males and 22 females) were included. The median age of the first TBM diagnosis was 7 (interquartile [IQR] 4-11) months. The median age of the first wheezing episode was 4 (IQR 3-7) months. During the time interval between the two bronchoscopies, malacia lesions resolved in 50 patients (63.3%), improvement was seen in 14 patients (17.7%), no change was observed in 11 patients (13.9%), and the condition was aggravated in 4 patients (5.1%). The malacia lesions in 37 patients resolved before 2 years of age. Among the 50 resolved patients, 22 patients (44.0%) reported wheezing three times or more between bronchoscopy evaluations, and 13 of these 22 patients (59.1%) with atopy or family history of allergic diseases were ultimately diagnosed with bronchial asthma.CONCLUSIONS:In children with persistent wheezing, the role of TBM should be reassessed, especially in those with atopy or family history of allergic diseases, and bronchial asthma should be considered early.

Objective: This study aimed to explore the association between the variability in electrolytes and the in-hospital mortality in critically ill children admitted into intensive care units (ICUs).Design: This is a retrospective case–control study.Setting and Participants: Total of 11,245 children have been admitted to ICUs of Children's Hospital of Zhejiang University from 2010 to 2018.Methods: The coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) were calculated as variability indices. High variability was defined as having values in the highest quartile for each parameter. Age, sex, diagnoses of disease, and surgical treatment were adjusted in the multivariable-adjusted logistic regression model.Results: A total of 11,245 children were included, and 660 patients died in the hospital. The median (P25, P75) potassium, sodium, and chloride of all patients were 3.8 (3.58, 4.09), 136.83 (135.11, 138.60), and 108.67 (105.71, 111.17), respectively. U-shaped relationships between the mean, lowest, and highest levels of potassium, sodium, and chloride and the in-hospital mortality were observed. The lowest mortality was noted when serum potassium, sodium, and chloride were between ~3.5 and 5.0, 135 and 145, and 105 and 115 mmol/l, respectively. The areas under the curve (AUCs) of three indices of variability in electrolytes were larger than those of the mean and lowest levels of electrolytes in predicting the in-hospital mortality. In the multivariable-adjusted model, the odds ratios and 95% confidence interval (CI) of the in-hospital mortality were 3.14 (2.44–4.04) for one parameter, 5.85 (4.54–7.53) for two parameters, and 10.32 (7.81–13.64) for three parameters compared with subjects having no parameters of high variability measured as the CV. The results were consistent when the variability was determined using the SD and VIM (all P for trend <0.001). Consistent results were noted in various subgroup analyses.Conclusions: This study showed that individuals with higher variability of each parameter were related with higher risk of in-hospital mortality. There was a linear association between the number of high variability parameters and the in-hospital mortality. The variability of electrolytes might be a good predictor for in-hospital mortality of children in ICUs.

Objective To investigate the risk factors for pneumonia in children with Epstein-Barr virus (EBV) infectious mononucleosis(IM).Methods The clinical data of children with EBV-IM from March 2015 to February 2018 in Children's Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into a pneumonia group and a non-pneumonia group.The difference between 2 groups was analyzed,including gender,age,duration of fever,the maximum temperature in disease duration,the size of liver,the size of spleen,tonsillopharyngitis,cervical lymphadenopathy,edema of the eyelids,white blood cell (WBC),lymphocyte,atypical-lymphocytes,C-reactive protein (CRP),procalcitonin (PCT),alanine transaminase (ALT),glutamic oxalacetic transaminas (AST),lactic dehydrogenase (LDH),cytomegalovirus (CMV) antibody,the titer of mycoplasma (MP) antibody,EBV DNA,length of stay,and hospitalization expenses.The single factor analysis was performed to analyze the above data between 2 groups,and the data with statistical significance were analyzed by the multifactor Logistic regression.The receiver operator characteristic (ROC) curve was drawn to evaluate the predicting ability of the indicators for IM combined with pneumonia.Results Among 923 cases,133 cases(14.4％) EBV-IM patients were complicated with pneumonia.The findings of single factor analysis indicated that the risk factors were the duration of fever,the size of liver,the size of spleen,and the titer of MP antibody (all P ＜ 0.05).The multifactor Logistic regression showed that the duration of fever,the size of liver,the titer of MP antibody were the risk factors for EBV-IM children with pneumonia (P =0.013,0.028,0.014).The area under curve (AUC) of the duration of fever was 0.624,and the critical value was 7.5 d (P =0.000);the AUC of the size of liver was 0.590,and the critical value was 2.65 cm (P =0.003).Conclusions The incidence rate of EBV-IM children combined with pneumonia was high.With the presence of the titer of MP antibody ≥ 1:160,the duration of fever ≥7.5 days,and the size of liver ＞ 2.65 cm,it may be independent risk factors for pneumonia in IM children with EBV infection,which requires special attention clinically and earlier chest imageological examination are needed.

Objective To investigate the efficacy and safety of montelukast sodium combined with fluticasone propionate in treatment of children with cough variant asthma.Methods Two hundred and forty children diagnosed as cough variant asthma in our hospital during February 2013 to January 2015 were randomized into three groups.Children in group Mon + Flu were given montelukast sodium combined with inhaled fluticasone propionate,children in group Flu was given inhaled corticosteroids alone and children in group Mon was given montelukast sodium alone.Cough,lung function and adverse reactions were observed after 8 and 12 weeks of treatment and the recurrences of cough symptoms were followed up within 24 weeks.Results After 8 weeks of treatment,the score of cough in group Mon + Flu (1.1 ± 0.7) was lower than those in groups Flu (1.7 ±0.8) and Mon (1.6 ±0.8) (t =4.973,4.353,P ＜0.05),while there was no significant difference between group Flu and group Mon(t =0.560,P ＞ 0.05).Meantime,the percentage of predicted in FEV1 in group Mon+ Flu (93.4 ± 15.8) was significantly higher than those in group Flu (87.4 ± 11.0) and group Mon (86.5 ± 9.8) (t =2.804,3.315,P ＜ 0.05).The percentage of predicted in PEF in group Mon + Flu(89.8 ± 15.4)was significantly higher than those in group Flu(84.9 ± 13.4)and group Mon(85.1 ± 12.3) (t =2.126,2.124,P ＜ 0.05),and there was no significant difference between latter two groups (t =0.525,0.082,P ＞ 0.05).After 12 weeks of treatment,there was no significant difference in scores of cough and percentage of predicted in FEV1 and PEF among three groups (P ＞ 0.05).There was no significant difference in incidence of adverse reactions among three groups (x2 =1.026,P ＞ 0.05).The recurrence rate of group Mon + Flu (3.85％) and group Flu(5.26％) were significantly lower than that of group Mon (17.33％) (x2 =7.428,5.505,P ＜ 0.05),while there was no difference between groups Mon + Flu and Flu (P ＞ 0.05).Conclusions For children with cough variant asthma montelukast sodium combined with fluticasone propionate has better efficacy than monotherapy in 8 weeks of treatment,but there was no difference in 12 weeks of treatment.The recurrence rate in group Mon + Flu and group Flu is lower than that in group Mon.

Objective To estimate the effect of nebulized magnesium sulfate on treating children with acute asthma. Methods Electronic literature search was performed up to July 2014 at the Cochrane Library,PubMed,EMBASE,CBM,CNKI,VIP and Wanfang database. The randomized controlled trails( RCTs)of nebulised magnesium sulphate for treating acute asthma in children were obtained,including the use of nebulized MgSO4 combined with bronchodilators and compared with the use of bronchodilators. The pulmonary function and adverse drug reaction were selected as primary and secondary outcomes. Data were pooled using random effects meta-analysis of the standardized mean difference( SMD)in pulmonary function by RevMan software. The subgroup analysis was performed for each pulmonary function parameter and magnesium sulfate nebulized with and without other bronchodilators. Results A total of 8 RCTs involving 1 161 patients were included. ①Nebulized MgSO4 had no significant effect upon respiratory function(10 min:SMD= _0. 32,95%CI:_0. 67 to 0. 04,P=0. 08;20 min:SMD= _0. 11,95%CI:_0. 40 to 0. 17,P=0. 43)in children. ②Subgroup analysis:MgSO4 was significantly inferior to salbutamol upon pulmonary function when compared with salbutamol(10 min:SMD= _0. 75,95%CI:_1. 29 to _0. 22,P=0. 005;20 min:SMD= _0. 46,95%CI _0. 72 to _0. 20,P=0. 006);MgSO4 didnˊt show significant effect upon respiratory function( FEV1 %predicted,PEF %predicted)to saline when used in combination with bronchodilators(FEV1% predicted after 10 min:SMD= _0. 03,95%CI:_0. 52 to _0. 46,&nbsp;P=0. 89;PEF% predicted after 10 min:SMD= _0. 02,95%CI:_0. 23 to 0. 19,P =0. 83;FEV1% predicted after 20 min:SMD=0. 04,95%CI:_0. 29 to 0. 37,P=0. 81;PEF% predicted after 20 min:SMD=0. 05,95%CI:_0. 31 to 0. 42,P=0. 78 ). ③Common adverse drug reaction of MgSO4 ,such as arrhythmia,decrement of myotasis reflex were not reported in included 8 studies. There was no difference in incidence of adverse drug reaction between MgSO4 and control groups. Conclusion The use of nebulized MgSO4 in the treatment of acute asthma appears to be less benefit upon improving pulmonary function in children when compared with salbutamol,and to be without significant effect upon improving pulmonary function compared with salbutamol.