BackgroundPulmonary thromboembolism is rare in children, but can be life-threatening. Timely diagnosis and treatment of pulmonary thromboembolism are crucial for reducing mortality associated with pulmonary thromboembolism in children. While guidelines for pulmonary thromboembolism in adults are available, guidelines for standardized diagnosis and management of pulmonary thromboembolism in children are not. This expert consensus aims to provide recommendations for the management of pulmonary thromboembolism in children based on the current best available evidence.Data sourcesFollowing the World Health Organization Handbook for Guideline Development, the expert panel consisted of 30 members from different clinical areas. The panel identified clinical questions through systematic reviews and expert discussions, systematically reviewed evidence on pulmonary thromboembolism in children, and evaluated the quality of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Using the GRADE Evidence to Decision Framework, the panel made recommendations, considering the effects of interventions, resource use, values and preferences, equity, acceptability, and feasibility.ResultsThe epidemiology, classification, and pathophysiology characteristics are summarized. The expert panel developed 33 recommendations addressing 20 questions related to diagnosis steps, treatment approaches such as anticoagulant therapy, thrombolysis therapy, catheter-based interventional therapy, surgical embolectomy, multidisciplinary team, and treatment of patients with comorbidities, prognosis, education, as well as follow-up. Among these, 18 are weak recommendations based on very low quality evidence, and 15 are good practice statements.ConclusionsThe expert panel provided recommendations for pulmonary thromboembolism in children based on available evidence, which was generally low in quality and volume. The panel urges further research on early identification and diagnosis strategies, preventive and therapeutic regimens, and long-term management for pulmonary thromboembolism.

This study aimed to investigate and evaluate the epidemiological characteristics, transmission chains, and effectiveness of control measures for two clusters of Severe Fever with Thrombocytopenia Syndrome (SFTS) infections in Jinan City, China, to inform and strengthen future SFTS prevention and control strategies. Field epidemiological investigations were conducted, encompassing all identified cases, which included confirmed cases (n = 4) and a clinically diagnosed case (n = 1), along with their close contacts (n = 11). The response strategy involved serological testing of close contacts and monitoring the SFTSV carriage rate in host animals and vector ticks. Two clusters of SFTS infection occurred in rural areas of Jinan in June 2025, involving four laboratory-confirmed and one clinically diagnosed case (two males and three females; case fatality rate: 20.0

Background: The study was to systematically evaluate the correlation between childhood asthma and obstructive sleep apnea (OSA). Methods: Several medical literature data bases were searched for studies published up to March 2025, by using the keywords "asthma" and "obstructive sleep apnea" and "child*." We included observational studies, children with OSA diagnosed via polysomnography, clinical criteria, or validated tools; and asthma confirmed by physician diagnosis, medication use, or validated questionnaires and international code. Results: Eleven studies were included that covered populations in the United States, Europe, and Asia. The pooled odds ratio (OR) for the association between childhood asthma and OSA was 1.66 (95% confidence interval [CI], 1.21-2.26; p < 0.001). Subgroup analysis by study design showed significant associations in cohort (OR 2.00 [95% CI, 1.35-2.96]) and cross-sectional (OR 1.55 [95% CI, 0.69-3.44]) but not in case-control studies (OR 0.85 [95% CI, 0.32-2.28]). Geographically, the association was strongest in America (OR 1.99 [95% CI, 1.35-2.96]) and Asia (OR 1.64 [95% CI, 1.19-2.25]), with a nonsignificant trend in Europe (OR 0.91 [95% CI, 0.34-2.42]). Sensitivity analyses directionally consistent with the results, and Egger's test (p = .587) indicated no significant publication bias. Conclusion: Childhood asthma is significantly associated with an increased risk of OSA, with sleep disorders likely exacerbating this relationship. Integrated screening and management strategies are warranted, particularly in high-risk regions such as America and Asia.

BACKGROUND:Cough variant asthma (CVA) in children frequently precedes typical asthma (TA), yet accurate prediction of this progression remains challenging. METHODS:A prospective cohort of 289 children diagnosed with CVA between June 2023 and June 2024 was followed for 12 months until June 2025. Patients were randomly divided into a training set (n = 203) and a validation set (n = 86) in a 7:3 ratio. Predictors were screened by univariate logistic regression and LASSO regression. A nomogram was constructed using the rms package in R and evaluated by ROC curves, 1000-iteration Bootstrap calibration, decision curve analysis (DCA), and Hosmer-Lemeshow tests. RESULTS:During the 12-month follow-up, 42 children (14.5%) progressed to TA. Ten independent predictors were finally selected by LASSO regression and incorporated into the nomogram: personal history of allergy (OR = 3.62, 95% CI:1.78-7.36), family history of asthma (OR = 3.18, 95% CI:1.37-7.39), poor treatment compliance (OR = 2.94, 95% CI:1.32-6.55), history of pet keeping (OR = 2.41, 95% CI: 1.11-5.24), FeNO (OR = 1.09, 95% CI:1.05-1.14), CaNO (OR = 1.16, 95% CI: 1.06-1.27), X5%pred (OR = 1.04, 95% CI:1.02-1.07), R5%pred (OR = 1.03, 95% CI:1.01-1.06), FEF25%pred (OR = 0.96, 95% CI:0.94-0.98), and MMEF%pred (OR = 0.97, 95% CI: 0.95-0.99). The nomogram showed good discrimination with AUCs of 0.863 (95% CI: 0.782-0.944) in the training set and 0.838 (95% CI:0.742-0.933) in the validation set. Hosmer-Lemeshow tests indicated good fit (training:χ2=6.7277, P = 0.5663; validation:χ2=7.7376, P = 0.4595). DCA demonstrated favourable clinical net benefit across a wide range of threshold probabilities. CONCLUSIONS:This novel nomogram integrating ten key risk factors provides a preliminary and visually intuitive tool for risk stratification of CVA progression to TA in children.

Background:Pediatric pulmonary embolism (PE) exhibits distinct risk factors, with respiratory infections playing a predominant yet understudied role in children. Methods:This multicenter, retrospective study analyzed pediatric patients with PE from 8 Chinese tertiary hospitals between 2003 and 2023. Patients were stratified into infection-associated PE (I-PE) and non-infection-associated PE (NI-PE) groups based on systemic infection status for comparative analysis. Results:Among 196 pediatric patients diagnosed with PE, I-PE was predominant at 75.5%, vs. 24.5% for NI-PE. The vast majority of I-PE group (77.0%) were associated with respiratory infections, among which 20.3% were attributable to Mycoplasma pneumoniae. Clinically, the I-PE group had higher inflammatory markers (CRP: 45.1 mg/L, ESR: 41 mm/h; P < 0.05) and more frequent chest pain (31.8% vs. 16.7%) and hemoptysis (19.6% vs. 0%; P < 0.05 for both). Low-risk stratification predominated in both groups (91.2% vs. 89.6%). Anticoagulation safety profiles were comparable (bleeding events: 5.4% vs. 4.2%), while the I-PE group without comorbidities demonstrated faster resolution of emboli (44 vs. 345 days). The PE-related mortality rate was 2.6% (below expected), with 10 (5.1%) cases developing late cardiopulmonary dysfunction. Conclusions:This study revealed a predominance of school-age children within the identified PE cohort, whose actual prevalence exceeding prior estimates. The association between infection, particularly acute respiratory infection, and PE in this cohort supports consideration of PE in children with respiratory infection and concerning features. I-PE presents with marked inflammation, a higher proportion of markedly elevated D-dimer (≥5 μg/mL), and typical symptoms (chest pain/hemoptysis), yet demonstrates better short-term outcomes. NI-PE correlates with underlying diseases and warrants long-term complication monitoring. Recognizing these differences is vital for enhancing outcomes in children with respiratory diseases. PE should be considered in children with severe pneumonia who present with disproportionate inflammation or chest pain.

Background: Cystic fibrosis (CF) is common genetic disorder in Europe and North America but rarer in Asian populations. Objective: To explore the clinical manifestations and gene mutations of cystic fibrosis. Methods: This case series study enrolled children with CF diagnosed in the pediatric respiratory department of Shandong Provincial Hospital affiliated to Shandong First Medical University between June 2016 and August 2022. Results: Seven children, including 6 girls and 1 boy, were enrolled. All 7 patients had recurrent wet cough and (chronic) pneumonia. Six patients suffered from chronic sinusitis, 4 patients had recurrent wheezing; 2 patients had chronic diarrhea, malnutrition and growth lag; 2 patients were complicated by allergic bronchopulmonary aspergillosis; and 1 patient had pancreatic insufficiency. Bronchiectasis, thickening of bronchial wall and mucous impaction, were seen in the chest CT of 7 children. Six patients showed a large amount of viscous sputum adhered to the bronchial wall by bronchoscopy. Infection ofPseudomonas aeruginosa was found in 6 cases, Staphylococcus aureus in 2 cases, and Aspergillus fumigatus in 2 cases by bronchoalveolar lavage fluid or sputum culture. Sweat sodium chloride test was performed in 3 cases, and the result showed that Cl-> 60 mmol/L. CFTR gene mutations were found in 7 cases, which were rare mutations of Caucasians, including 2 cases with new mutation sites (c.325T>G and 326A>G). Conclusions: The major clinical presentations of CF could be chronic and recurrent upper and lower respiratory tract infections, malnutrition, and digestive tract diseases. The rare and even new mutations of Caucasians on CFTR gene may occur in Chinese children.

BACKGROUND:Chronic cough (CC) is a common respiratory symptom in children, often linked to allergic conditions, environmental exposures, and potentially indicative of underlying asthma. OBJECTIVE:To investigate the relationships of CC in children with allergic predispositions, environmental exposures, and airway inflammatory markers. METHODS:A case-control study was conducted at a tertiary hospital. Data on cough duration, personal and family allergic histories, and environmental exposures were collected. Airway inflammation was assessed using fractional exhaled nitric oxide (FeNO50), and lung function was evaluated via spirometry. RESULTS:Children with CC showed a higher prevalence of allergic conditions, including rhinitis (74.77% vs. 24.13%, OR = 9.312, p < 0.0001), food allergy (59.81% vs. 27.59%, OR = 3.907, p = 0.0017), eczema (55.14% vs. 31.03%, OR = 2.731, p = 0.0213), and family history of allergies (71.96% vs. 27.59%, OR = 6.738, p < 0.001). Environmental exposures, such as household smoking (55.14% vs. 20.69%, OR = 4.712, p = 0.001) and mold exposure (28.68% vs. 7.35%, OR = 3.442, p = 0.0251), were more common in the CC group. CC children exhibited elevated FeNO50 (median: 18 vs. 14 ppb, p = 0.0153) and impaired small airway function (FEF75%pred: 53.84 ± 20.21 vs. 65.07 ± 28.52, p = 0.0170). CONCLUSIONS:Pediatric CC is strongly associated with allergic predispositions, environmental exposures, and eosinophilic airway inflammation, potentially reflecting an asthma-related phenotype.

OBJECTIVE:To systematically evaluate the association between asthma and the risk of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT). DATA SOURCES:PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published up to May 2025. STUDY SELECTION:Observational studies (cohort, case-control, and cross-sectional) reporting the association between asthma and VTE, PE, or DVT with available odds ratios (ORs) or hazard ratios and 95% confidence intervals (or data to calculate them) were included. RESULTS:The meta-analysis revealed a significant association between asthma and increased risk of VTE. Patients with asthma had a 2.41-fold higher odds of PE (OR = 2.41, 95% CI: 1.77-3.27), 1.56-fold higher odds of DVT (OR = 1.56, 95% CI: 1.49-1.63), and 1.61-fold higher odds of overall VTE (OR = 1.61, 95%: CI 1.45-1.77). Cohort studies showed the strongest association (OR = 4.21, 95% CI 2.56-6.92). Subgroup analysis by region indicated the highest risk in Asia (OR =3.19, 95% CI: 2.06-4.96), followed by America (OR = 2.24, 95% CI: 1.55-3.24) and Europe (OR = 1.64, 95% CI: 1.49-1.81). CONCLUSION:Asthma is significantly associated with an elevated risk of PE, DVT, and VTE, with particularly strong associations observed in cohort studies and Asian populations. These findings highlight the need for further research into underlying mechanisms and whether optimized asthma management can reduce thrombotic risk.

INTRODUCTION:The epidemic pattern of the Respiratory syncytial virus (RSV) has changed during the COVID-19 pandemic. To analyze the epidemic pattern of RSV infection and explore the fluctuations of immunity. METHODOLOGY:Pediatric inpatients diagnosed with RSV infection or RSV pneumonia from January 2019 to August 2023 in a tertiary hospital were retrospectively included. The children were divided into three groups: before the implementation of non-pharmaceutical interventions (NPIs) group, during the implementation of NPIs group, and after the lifted NPIs group. RESULTS:A total of 462 children were included in this study. During the implementation of NPIs, there were almost no RSV hospitalizations from February to October 2020. In May 2023, the number of children infected with RSV increased dramatically. The RSV infected children in after the lifted NPIs group was mainly ≥ 3 years old. RSV mixed infections (56.93%) were slightly more common than RSV single infection (43.07%). The levels of IgG, IgA, IgM, and CD3+%, CD8+% during the implementation of NPIs and after the lifted NPIs groups were lower than those in the other group of infants 0-6 months old, and the levels of CD3+ % and CD3 + CD4+ % in children 7-12 months old were found to be similar. CONCLUSIONS:After the lifted NPIs, the RSV epidemic season was delayed to spring and summer. Humoral immunity and part of the cellular immunity in infants varies before and after NPIs. We pay close attention to the surveillance data of RSV to prevent RSV infection.

BACKGROUND:The incidence of pediatric pulmonary embolism is increasing, with varying clinical characteristics, severity, and prognosis. Compared with data from adults, data and knowledge regarding the prognosis of pediatric pulmonary embolism are scarce. This study aims to study the overall prognosis of pediatric pulmonary embolism and explore its influencing factors. METHODS:The study included patients diagnosed with pulmonary embolism aged 1-18 years across eight tertiary referral hospitals from January 1, 2003, to December 31, 2023. Pulmonary embolism was diagnosed on the basis of clinical presentation with imaging evidence. The overall prognosis of children with pulmonary embolism was reported, and its influencing factors were analyzed. RESULTS:A total of 196 children were enrolled, with a median age of 11.8 (7.9, 15.4) years, 113 males (58%) and 186 Han (95%). The overall mortality rates were 2.2% at 30 days, 3.4% at 90 days, and 5.1% during the entire follow-up period. The pulmonary embolism-related mortality rates were 1.6% (30 days), 2.7% (90 days), and 2.6% (entire follow-up period). Deep vein thrombosis at other sites occurred in 2.7% (30 days), 4.1% (90 days), and 7.6% (entire follow-up period) of the children. Among the 148 children who underwent repeat imaging examinations, 119 (81%) achieved complete remission; 24 (16%) achieved partial remission; and 4 (3%) experienced recurrence or progression during the follow-up period. Multivariable logistic regression analysis revealed that tachypnea, co-infection, and underlying disease of the tumor were independent risk factors for compound adverse events (death, pulmonary embolism progression/recurrence, and at other sites) within 90 days. CONCLUSIONS:The short-term mortality of children with pulmonary embolism was relatively low. Children with pulmonary embolism who had tachypnea, co-infection, or underlying disease of the tumor were at increased risk of compound adverse events within 90 days.

OBJECTIVES:To investigate the control status of bronchial asthma (referred to as "asthma") in school-age children with normal pulmonary ventilation function and the occurrence of acute attacks within 1 year of follow-up.METHODS:A retrospective analysis was conducted on clinical data of 327 children aged 6-14 years with bronchial asthma and normal pulmonary ventilation function from April to September 2021. Based on the measured value of one second rate (FEV1/FVC), the children were divided into the ≥80% group (267 cases) and the <80% group (60 cases). The pulmonary ventilation function, asthma control level, and occurrence of acute attacks within 1 year were compared between the two groups.RESULTS:The baseline pulmonary ventilation function in the <80% group was lower than that in the ≥80% group, and the proportion of small airway dysfunction was higher than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the small airway function indices in the <80% group improved but remained lower than those in the ≥80% group (P<0.05). The rate of incomplete asthma control at baseline was 34.6% (113/327), and the asthma control level in the <80% group was lower than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the asthma control level in the <80% group remained lower than that in the ≥80% group, and the proportion of acute asthma attacks was higher than that in the ≥80% group (P<0.05).CONCLUSIONS:Approximately one-third of school-age children with asthma still have incomplete asthma control when their pulmonary ventilation function is normal. Among them, children with measured FEV1/FVC<80% have an increased risk of acute asthma attacks and require close follow-up and strengthened asthma management.

RATIONALE:Endobronchial neurofibroma is an extremely rare neoplastic disease. The majority of endobronchial neurofibroma are symptomatic, but nonspecific. The treatment of endobronchial neurofibroma is controversial that surgery is previously considered to be the main option. With the development of bronchoscopic intervention, most endobronchial neurofibroma can be treated with transbronchial endoscopic resection with few complications. Here we reported a case of diagnosed endobronchial neurofibroma that was successfully resected with transbronchial electrical snaring and laser coagulation. Moreover, the relevant literature was reviewed to raise awareness of this disease. PATIENT CONCERNS:A 57-year-old man presented to our hospital with cough, sputum, and shortness of breath for 2 days. Physical examination was normal. Laboratory tests revealed moderately increased C-reactive protein. Chest computed tomography showed a 10 × 8 mm round, polypoid-shaped nodule located in the left main bronchus, which was heterogeneous after contrast enhancement. It demonstrated a smooth, round, hypervascularized neoplasma obstructing most of the lumen of the upper left main bronchus under bronchoscopy. INTERVENTIONS AND OUTCOMES:The tumor was removed with electrical snaring and laser coagulation completely instead of surgical resection, without any complications. Pathologically, it was confirmed of endobronchial neurofibroma. Repeated bronchoscopy showed no recurrence of the tumor, and the procedure site healed with a little of fibrotic scar formation. LESSONS:Endobronchial neurofibroma is rare. Although the standard treatment for endobronchial neurofibroma is surgery, transbronchial endoscopic resection (electrical snaring and laser coagulation) is an applicable option, especially for those lesions strictly in the lumen.

To understand the changes in humoral immunity and lymphocyte subsets levels among hospitalized children with Mycoplasma pneumoniae (MP) infection from 2019 to 2023. This study retrospectively analyzed inpatients aged 0–14 years who were diagnosed with MP infection or MP pneumonia in a tertiary hospital from January 2019 to December 2023. The children were divided into three groups: before the implementation of nonpharmaceutical interventions (NPIs), during the implementation of NPIs, and after the NPIs being lifted. A total of 4103 patients were enrolled in this study, of whom 2125 were diagnosed with MP infection and 1978 were diagnosed with MP pneumonia. The number of MP infection cases dramatically decreased early during the implementation of NPIs, and the previous epidemic trend resumed after the NPIs were lifted, with the number of cases during the period 2019–2023 peaked in November 2023. In children aged < 5 years, the levels of IgA and IgM and the percentages of total T cells and cytotoxic T cells in the “before the implementation of NPIs” group were greater than those in the other groups, and the percentage of total B cells was lower than that in the other groups. In children aged ≥ 5 years, the IgM level in the “before the implementation of NPIs” group was greater than that in the other groups. The number of MP-infected hospitalized children decreased significantly after NPI implementation and reached its highest peak during 2019–2023 in November 2023. After the NPIs were lifted, the level of humoral immunity was decreased and balance lymphocyte subsets were disrupted, especially in children aged < 5 years. We should pay close attention to and prevent MP infection in a timely manner after epidemics caused by large respiratory pathogens.

Objective: To analyze the clinical manifestations, imaging features, and treatment of Mycoplasma pneumoniae pneumonia with pulmonary venous thrombosis (PVT) in children and to improve the understanding of PVT among clinicians. Methods: We retrospectively analyzed a case of refractory mycoplasma pneumoniae pneumonia (RMPP) with PVT and reviewed the related literature. We also summarized the clinical features of the disease and our experience in diagnosing and treating the patient. Results: Our case is a 5-year-old female who was admitted to the hospital for fever and cough that was persistent for ten days before admission. Chest CT of the child showed pneumonia, atelectasis, pleural effusion, and pericardial effusion. After treatment with anti-infection, anti-inflammatory, and immunomodulatory medications, the symptoms of the child improved. Since the chest CT of the child showed atelectasis of the lung, we performed bronchoscopy. Bloody sputum was observed in the trachea, right main bronchus, and the lower bronchioles. Local hemostatic and systemic hemostatic agents were given for five days; however, bloody sputum was still observed during bronchoscopy. Finally, pulmonary vein and left atrium thrombosis were confirmed through chest CTA examination. Thrombi disappeared after anticoagulant therapy with low molecular weight heparin (LMWH) and warfarin, and there was no discomfort in the follow-up for two years. Conclusion: PTV may occur after mycoplasma pneumoniae infection. Early diagnosis and treatment are very important for patient prognosis.

Background: This study aimed to explore the risk factors for chronic cough in children and provide a reference for prevention and healthcare measures. Methods: PubMed, Web of Science, Cochrane, and EMBASE were searched for observational studies published up to April 2024. Outcome included risk factors associated with chronic cough in children. Two investigators independently searched and screened the literature, evaluated the qualities and extracted baseline datas. Results were analyzed using random-effects models with odds ratios and their 95 % confidence intervals to address heterogeneity. Subgroup analyses, sensitivity analyses and assessment of publication bias were performed. Stata17 and GRADEwas used for the meta-analysis. Results: 18 studies including 97,462 children were reviewed. Asthma(OR = 4.06, 95%CI: 2.37-6.96, P<0.01), NO2(OR = 1.19, 95%CI: 1.01-1.39, P = 0.031), Home remodeling history (OR = 1.82,95% CI: 1.61-2.05, P< 0.01), Environment Tobacco Smoke(OR = 1.41, 95% CI: 1.15-1.73, P = 0.001), Pet exposure (OR = 1.56, 95% CI: 1.25-1.95, P<0.01), Mould (OR = 1.64,95%CI: 1.45-1.85, P<0.01), Age<1 year(OR = 3.19, 95 % CI: 1.8-5.63, P<0.01) were reported as risk factors for chronic cough in children, these results were discussed qualitatively in the study. Conclusion: Asthma, NO2, Home remodeling history, Environment Tobacco Smoke(ETS), Pet exposure, Mould, and Age<1 year are risk factors for chronic coughing in children. Due to the few studies and insufficient evidence, other potential risk factors need to be robustly confirmed by subsequent large-sample and multicenter trials.

Background: Asthma is the most prevalent chronic respiratory disease in children, and gastroesophageal reflux disease (GERD) is one of its extraesophageal complications of asthma. Both conditions are commonly observed in pediatric outpatient clinics, but the causality between them in children is still debated. Therefore, we conducted a systematic review and meta-analysis to evaluate the bidirectional association between asthma and GERD in children. Methods: We systematically reviewed original studies published from January 2000 to February 2024 by searching the data bases. We also performed manual retrieval and screening to identify studies that met the inclusion criteria. The quality of the final included studies was evaluated by using the Newcastle-Ottawa Scale, and outcome measures were extracted. Results: We identified nine eligible studies, which included 304,399 children of different ages from seven countries. Overall, the risk of developing GERD in children with asthma (odds ratio [OR] 2.16 [95% confidence interval [CI], 1.6-2.91) was higher than the risk of developing asthma in children with GERD (OR 1.55 [95% CI, 1.32-1.82]). Conclusion: Based on the available studies, it can be concluded that asthma and GERD are mutually aggravating factors in children, presenting a bidirectional association. However, the risk of developing GERD in children with asthma is higher to some extent. More large-scale and high-quality prospective cohort studies are needed in the future to provide richer evidence and more research opportunities.

BACKGROUND:Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children. METHODS:We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for "macrolide-resistant", "Mycoplasma pneumoniae", "MP", "M. pneumoniae", "pneumonia", "MRMP", "lower respiratory tract infection", "Mycoplasma pneumoniae infection", "children", and "pediatric". RESULTS:Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics. CONCLUSIONS:This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

目的 明确山东省儿童慢性咳嗽患病率及相关影响因素.方法 采用自行设计的问卷,对山东省各地市0～14岁人群进行横断面调查,由参与调查者在手机或电脑终端完成问卷调查并提交.结果 研究人群10186名,男童5 480名,女童4 706名,由家长完成问卷调查.其中829例儿童既往有慢性咳嗽病史,占8.1％,咳嗽持续时间4～8周者697例(84.1％).家长认为慢性咳嗽的自身因素中儿童存在过敏性疾病占主导地位(83.4％),相关的呼吸道疾病因素包括上呼吸道感染(90.8％)、气管-支气管炎(87.5％)、支气管肺炎(70.5％)、支气管哮喘(62.9％).周围环境因素中气候变化影响最为明显(91.6％).608例(73.3％)患儿在咳嗽1周内就诊.就诊过程中分别有89.1％和56.3％的患儿曾行血常规及胸片检查.对于治疗方式的选择,家长对中药的接受度普遍较高,接受中医或中西医结合治疗的有647例(78.0％),以西药为主的仅173例(20.9％).治疗药物选择抗生素及激素大多遵从医嘱,分别为661例和622例,743例(89.6％)家长可接受激素治疗.慢性咳嗽对患儿及家长造成严重心理影响的分别占22.2％及67.3％.结论 山东省慢性咳嗽患病率较高,影响因素多样,辅助检查仍有待进一步普及.慢性咳嗽对患儿及家长均造成不同程度心理影响.

BackgroundAcute lung injury (ALI) is a severe and fatal respiratory disease. SIRT6 exerts pivotal activities in the process of lung diseases, but whether SIRT6 impacts ALI has not been covered. MethodsLentivirus recombinant expressing vector SIRT6 gene (Lent-SIRT6) was constructed in mice, and there were control, lipopolysaccharide (LPS), LPS + Vehicle, and LPS + Lent SIRT6 groups. RT-qPCR and western blot detected SIRT6 expression in lung tissues. HE staining observed pathological alternations in lung tissues. Wet-to-dry ratio of the lungs was then measured. The cell count of bronchoalveolar lavage fluid (BALF) was evaluated. Serum inflammation was examined with enzyme-linked immunosorbent assay, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and western blot were to measure apoptosis. Western blot tested the expression of ACE2/STAT3/PIM1 signaling-associated factors. At the cellular level, LPS was used to induce lung epithelial cells BEAS-2B to establish cell injury models. SIRT6 was overexpressed and ACE2 expression was inhibited by cell transfection, and the mechanism of SIRT6 in LPS-induced lung injury model was further explored by Cell Counting Kit-8 (CCK-8), western blot, quantitative reverse-transcription polymerase chain reaction, TUNEL, and other techniques. ResultsThe results of animal experiments showed that SIRT6 overexpression could reduce LPS-induced lung pathological injury, pulmonary edema, and BALF cell ratio and attenuate LPS-induced inflammatory response and cell apoptosis. In the above process, ACE2, STAT3, p-STAT3, and PIM1 expression were affected. In cell experiments, SIRT6 expression was reduced in LPS-induced BEAS-2B cells. Inhibition of ACE2 expression could reverse the inhibitory effect of SIRT6 overexpression on ACE2/STAT3/PIM1 pathway, and cellular inflammatory response and apoptosis. ConclusionSIRT6 eased LPS-evoked inflammation and apoptosis of lung epithelial cells in ALI through ACE2/STAT3/PIM1 signaling.

目的 总结儿童肺结核、结核性胸膜炎及淋巴结结核的临床特点.方法 回顾性分析47例肺结核、结核性胸膜炎及淋巴结结核儿童的病历资料,分析其一般临床特征以及实验室检查、影像学检查、支气管镜检查特征.结果 47例患儿中,男30例、女17例,年龄4个月～13岁;居住地:城市17例,农村或乡镇30例;结核类型:单纯肺结核20例,其中粟粒性肺结核2例,肺结核合并结核性胸膜炎15例,单纯结核性胸膜炎6例,淋巴结结核6例;有卡介苗接种史46例,有结核接触史17例;临床表现:发热47例,咳嗽41例,胸痛/胸闷18例,盗汗10例,消瘦8例,呼吸困难4例,乏力2例,浅表淋巴结肿大6例.接受PPD试验32例,阳性22例;接受γ-干扰素释放试验35例,阳性30例;痰/胃液、气道分泌物、淋巴结细针穿刺物抗酸杆菌涂片阳性7例,其中4例同时行病理活检发现结核性肉芽肿及干酪性坏死,支气管肺泡灌洗液高通量测序技术发现结核杆菌序列3例.胸部影像学表现为肺实变或斑片状阴影23例、树芽征10例、球形病灶1例、空洞1例、腋窝淋巴结肿大/钙化2例;21例单纯或合并结核性胸膜炎患儿均为单侧胸腔积液表现;6例淋巴结结核患儿均予彩色多普勒超声检查,发现淋巴结钙化4例、液化坏死2例.7例胸部影像学表现为大叶性肺炎/肺不张、球形病灶患儿行支气管镜检查,镜下主要表现为支气管黏膜糜烂、病变部位痰液壅塞或干酪样物附着并堵塞管腔.结论 儿童结核病临床表现不典型,以发热、咳嗽为主;肺结核影像学表现以肺部实变及斑片状阴影多见,支气管镜检查可提高其确诊率;结核性胸膜炎表现为单侧胸腔积液,若单核细胞占比>90%,结核性胸膜炎可能性较大;淋巴结钙化在淋巴结结核中较为常见.