2011年 · 第49卷第02期

For a long time, diffuse parenchymal lung disease/interstitial lung disease in children in China (pediatric diffuse parenchymal lung disease/pediatric interstitial lung disease, pDPLD/pILD) Most of the diagnoses are only based on clinical manifestations and chest X-ray signs, with a single diagnostic name, lack of unified classification, and messy treatment plans, which makes it difficult to reach a consensus. In recent years, the Children's Diffuse Lung Disease/Interstitial Lung Disease Collaborative Group (referred to as Children's pDPLD/pILD Collaborative Group) of the Respiratory Group of the Pediatrics Branch of Chinese Medical Association has made progresses in stages by taking the international diagnostic model as a model. The related articles published in this journal explained the ideas and classifications of clinical-radiation-pathological diagnosis of such diseases in children with abundant case data, and handed over the first report and summary to pediatric colleagues, indicating that China's pediatric respiratory professional team has taken a solid first step in standardizing the diagnosis of interstitial lung disease in children.

Initiated by the Editorial Committee of Chinese Journal of Pediatrics and jointly formulated by the Respiratory Group of Pediatrics Branch of Chinese Medical Association, the Emergency Group and the Immunology Group, the Safety of Management of Acquired Pneumonia in Children's Hospital (hereinafter referred to as the Guide) has been published in this journal. Comprehensive guidelines for the management of community-acquired pneumonia in children developed in 2007^[1,2]China's pediatrics have systematic and complete guiding principles for the diagnosis, treatment and prevention of clinical pneumonia.

· Foreword

The prevalence of allergic rhinitis (AR) in children is about 10% in China^[1,2]And continued to increase. As allergic rhinitis in children has an important impact on the occurrence, development, severity and clinical outcome of lower respiratory tract inflammatory diseases (such as bronchial asthma), the formulation of this diagnosis and treatment guideline is of great significance to standardize clinical diagnosis and treatment and asthma prevention and control. This guideline is applicable to pediatric patients between 2 and 14 years of age.

The training of health personnel and team building is the fundamental guarantee to improve the quality and level of health service and protect people's health. It is imperative to establish a specialist physician system with Chinese characteristics. The Ministry of Health organized experts to conduct special research on the training mode, training standards, funding mechanism, assessment and evaluation, and admission legislation of residents. With reference to the training experience of specialists abroad and Hong Kong, Taiwan and other regions in China, the Ministry of Health formulated the training rules and training base standards for 18 general specialties and 16 sub-specialties^[1,2]。 As a secondary discipline, pediatrics is listed as a general specialty, and the "Detailed Rules for the Training of Pediatric Specialists" and "Standards for the Training Base of Pediatric Specialists" have been formulated^[3,4]。 Through the review, a number of resident training bases have been recognized nationwide. As the first batch of pilot areas for the Ministry of Health to carry out specialist training, Beijing has accumulated some experience in the practice of promoting residents to enter accredited bases for standardized training. Guangdong, Sichuan and other provinces have successively piloted them, and Shanghai has taken the lead in exploring the socialized training mode.

In recent times, "superbug" events have been occurring all over the world. On August 11, 2010, the authoritative medical journal "The Lancet" reported a class of "superbacteria" carrying the superdrug resistance gene NDM-1 (expressing the β-lactam ring structure of NDM-1 enzyme), which can resist almost all commonly used clinical antibiotics. Its infection cases have been found in South Asia, Britain, the United States, Sweden, the Netherlands, Australia, Canada, Japan, Hong Kong, China and other places, and many deaths have been found all over the world. On September 6, Japan reported that 53 patients were infected with multidrug-resistant Acinetobacter, which was resistant to almost all antibiotics, and caused death while hospitalized in the Affiliated Hospital of Teikyo University School of Medicine. On October 20th, Brazilian officials announced that another "superbug"-carbapenemase Klebsiella pneumoniae (Klebsiella pneumoniae carrying carbapenemase gene, referred to as KPC) was discovered in 16 public and private medical institutions in Brazil. It is resistant to extended-spectrum carbapenems and all beta-lactam antibiotics, and the mortality rate is as high as 30% ~60%. In just a few months, "superbug" incidents occurred one after another all over the world, once again warning mankind that the abuse of antibiotics is the "culprit" of "promoting" superbugs. If the use of antibiotics cannot be strictly regulated, the appearance of more drug-resistant strains will be inevitable!

acute lung injury (ALI) /acute respiratory distress syndrome (ARDS) refers to acute hypoxic respiratory insufficiency or respiratory failure caused by diffuse pulmonary interstitial and alveolar edema caused by damage to pulmonary capillary endothelial cells and alveolar epithelial cells during non-cardiogenic diseases such as severe infection, shock, trauma and burns. It is one of the common critical diseases in pediatric critical care medicine with high mortality rate^[1,2]。 Low tidal volume and appropriate positive end-respiratory pressure (PEEP) ventilation strategies are the only well-established treatments that can reduce the mortality of patients with ALI/ARDS^[3,4]。 There are still many problems in other treatment measures that have not been solved. Liquid therapy is the basic treatment method for critically ill children, but many problems such as the timing, types and quantity of liquid therapy for different critically ill children are controversial. The issue of ALI/ARDS fluid management is now discussed.

Epilepsystatus epilepticus (SE) is a neurological critical disease, especially in infants and young children. According to different clinical manifestations, it can be divided into convulsive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE)^[1]。 People have a deep understanding of the former, which is more harmful to children; However, the latter is often missed or misdiagnosed as viral encephalitis, psychosis, hysteria, etc. because of the absence of convulsive seizures and complex and diverse clinical manifestations, and the delay of treatment leads to irreversible brain injury. Critically ill children are more likely to develop NCSE due to multiple organ dysfunction and internal environment disorder. In recent years, long-range EEG monitoring at bedside has been able to effectively detect the onset of NCSE in critically ill children^[2]These children already have neurological damage, and SE attacks can lead to secondary brain damage, which should be highly valued.

Cystic fibrosis (CF) is an autosomal recessive hereditary disease, which is the main cause of bronchiectasis in Caucasian children. non-cystic fibrosis bronchiectasis, however, is common in developing countries. Previously, it was thought to be mainly seen in chronic suppurative inflammation, which is manifested by irreversible dilatation of the bronchus with thickening and destruction of the tube wall. With the development of high-resolution CT (HRCT) technology, combined with a large number of research results in recent years, the diagnosis rate of non-cystic fibrotic bronchiectasis in developed countries is also increasing. And new evidence in recent years suggests that early childhood bronchiectasis is reversible. Its pathogenesis is mainly bronchial obstruction, secretion retention and infection. Most children can be clinically cured when diagnosed and treated early in the disease^[1]； Irreversible bronchiectasis in traditional concepts needs to be re-recognized. Therefore, the summary is as follows.

Children's dilated cardiomyopathy (DCM) is not a disease, but a group of diseases caused by infection, poisoning, metabolism, genetics and other factors or unknown etiology. Clinically, it is characterized by left ventricle, right ventricle or biventricular enlargement and systolic dysfunction^[1]。 It is the most common type of pediatric cardiomyopathy. Clinical diagnosis can be made by clinical symptoms and signs, laboratory tests (including echocardiography, etc.). DCM leads to decreased left ventricular function, progressive heart failure (HF), myocardial remodeling and heart enlargement, ventricular and supraventricular arrhythmias, conduction system abnormalities, thromboembolism and sudden death, and poor prognosis, which is one of the common important causes of HF and death. In the past ten years, basic and clinical research has focused on blocking myocardial remodeling and controlling heart failure. Drugs and comprehensive measures have made great progress in the treatment of DCM, and its prognosis has also been greatly improved.

The 12th National Pediatric Respiratory Conference, sponsored by the Respiratory Group of Pediatrics Branch of Chinese Medical Association and the Editorial Board of Chinese Journal of Pediatrics, was successfully held in Tianjin on October 20-25, 2010. More than 600 representatives from all over the country attended the meeting. The conference arranged academic exchange forms such as expert answers, special lectures, conference speeches, group speeches, posters and written exchanges, and invited six internationally renowned overseas experts, one from Hong Kong and Taiwan Province, and nine domestic experts to give special lectures. The conference received 297 manuscripts, of which 12 and 24 delegates gave conference and group speeches respectively, and 24 outstanding manuscripts were posted on the wall. The conference evaluated the papers and posters selected as speakers, and awarded 1 special prize, 2 first prizes, 5 second prizes and 12 third prizes, and awarded certificates and bonuses.