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Objective@#To evaluate the effectiveness of eradication therapy based on Helicobacter pylori (Hp) susceptibility and CYP2C19 genotype in children with refractory Hp infection.@*Methods@#In this prospective observational cohort study, 156 children with Hp refractory to amoxicillin+clarithromycin+omeprazole triple regimen in Baoding Children′s Hospital from December 2017 to May 2018 were enrolled. Ninety-two of them underwent Hp culture and CYP2C19 detection. Seventy-five cases with positive Hp culture were defined as culture successful group and were treated according to Hp susceptibility and CYP2C19 genotype. Seventeen cases with negative Hp culture were defined as culture failed group and were treated only based on the results of CYP2C19 genotype. Sixty-four children who did not have Hp culture and CYP2C19 gene testing were defined as the empirical eradication therapy group and were treated with quadruple regimen (amoxicillin+metronidazole+omeprazole+bismuth). Bacterial resistance, CYP2C19 polymorphism and therapeutic effectiveness between the three groups were compared using chi-square test.@*Results@#Among the 75 positive Hp culture results, 72 (96%) were resistant to clarithromycin, 3 (4%) were resistant to metronidazole, 5 (7%) were resistant to levofloxacin, 5 (7%) were resistant to rifampicin, 1 (1%) was resistant to tetracycline, and none was resistant to amoxicillin and furazolidone. The CYP2C19 polymorphism in 92 patients showed that 43 (47%) were extensive metabolizer (EM), 9 (10%) were poor metabolizer (PM), and 40 (43%) were intermediate metabolizer (IM). In terms of the effectiveness, eradication rate in the culture successful group,culture failed group and empirical eradication therapy group were 99% (74/75), 88% (15/17) and 72% (46/64), respectively (χ2=21.325, P<0.05). The eradication rate in the culture successful group was significantly higher than that in empirical eradication therapy group (χ2=21.005, P<0.05), while there was no difference between empirical eradication therapy group and culture failed group (χ2=1.154, P=0.283).@*Conclusion@#Eradication regimen based on bacterial susceptibility and CYP2C19 genotype should be considered in children with refractory Hp infection.
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Objective: To evaluate the effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection
Methods: A total of 120 patients with burn-induced invasive fungal infection were randomly divided into an early enteral nutrition [EN] group and a parenteral nutrition [PN] group [n=60]. The patients were given nutritional support intervention for 14 days, and the expression levels of serum transferrin, albumin, total protein, endotoxin, D-lactic acid and inflammatory cytokines were detected on the 1st, 7th and 14th days respectively
Results: As the treatment progressed, the levels of serum transferrin, albumin and total protein of the EN group were significantly higher than those of the PN group [P<0.05], while the levels of serum endotoxin and D-lactic acid of the form group were significantly lower [P<0.05]. After treatment, the expression levels of IL-6 and TNF-alpha were decreased in the EN group, which were significantly different from those of the PN group [P<0.05]. During treatment, the incidence rates of complications such as abdominal distension, diarrhea, sepsis, nausea, vomiting and gastric retention were similar. The mean healing time of wound surface was 9.34 +/- 0.78 days in the EN group and 12.46 +/- 2.19 days in the PN group, i.e. such time of the former was significantly shorter than that of the latter [P<0.05]
Conclusion: Treating patients having burn-induced invasive fungal infection by early enteral nutrition support with arginine can safely alleviate malnutrition and stress reaction, strengthen cellular immune function and promote wound healing, thereby facilitating the recovery of gastrointestinal motility and the function of intestinal mucosal barrier
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Objective To study the significance of level changes of serum hydrogen sulfide(H2 S) and interleukin-6(IL-6)in children with hand,foot and mouth disease(HFMD).Methods Nity-two cases with HFMD were enrolled and divided into severe HFMD group(48 cases)and common HFMD group(44 cases).Forty-six healthy children were enrolled as healthy control group.The serum H2 S and IL-6 were detected.Results Acute phase:compared to the healthy control group[H2 S(55.76 ±7.80)μmol /L,IL-6 (61.31 ±13.43)ng /L],the level of serum H2 S significantly reduced and the level of IL-6 significantly increased in severe HFMD group[H2 S(21.72 ±7.52)μmol /L;IL-6(131.33 ±17.82)ng /L]and common HFMD group[H2 S(31.86 ±8.41 )μmol /L;IL-6(95.48 ±15.07)ng /L](P ﹤0.01 ),and there was signifi-cantly difference between the severe HFMD group and common HFMD group(P ﹤0.01 ).Recovery phase:compared to the healthy control group,the serum H2 S level[(34.54 ±13.21 )μmol /L]was lower and IL-6 [(92.73 ±15.25)ng /L]was higher in severe HFMD group(P ﹤0.01 ).The serum H2 S level was negatively correlated with IL-6 in severe HFMD group and common HFMD group(r =-0.31 ,P ﹤0.01 ;r =-0.45, P ﹤0.01 ).Conclusion The serum H2 S and IL-6 participate in the pathological process of HFMD,and the level change can be used as one of indicators of early diagnosis.
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ObjectiveTo analyze the potential risk factors for relapse and development of epilepsy in patients with benign in-fantile convulsions associated with mild gastroenteritis (BICE).MethodsA total of 264 cases of BICE were recruited. Accord-ing to the frequency of convulsions, the patients were divided into single group (n=134, convulsion once), and multiple group (n=130, convulsions≥2 times). According to convulsion duration, the patients were divided into short-term group (n=186, con-vulsions duration <5 minutes) , and long-term group (n=78, convulsion duration≥5 minutes). The clinical data obtained during hospitalization and follow-up were analyzed.ResultsIn multiple group, 9.23% were relapsed and 6.15% developed epilepsy. In single group, 2.99% were relapsed and 0.75% developed epilepsy. There were signiifcantly different in the rate of relapses and development of epilepsy between two groups (P<0.05). In the long-term group, 12.82% were relapsed and 8.97% developed epi-lepsy. In the short-term group, 3.23% were relapsed and 1.08% developed epilepsy. There were signiifcantly different in the rate of relapses and development of epilepsy between the two groups (P<0.05).ConclusionsThere are the risks of relapse and development of epilepsy in BICE patients. Convulsions≥ 2 times and≥5 minutes may be the risk factors of relapse and devel-opment of epilepsy.
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Objective To explore the clinical characteristics and the prognosis of benin convulsions as-sociated with mild gastroenteritis( BICE) in children. Methods To study clinical features of 248 children with BCIE,they followed up for 12 months,and their prognosis were observe. Results Age between 3 months and 3 years,twice or more seizures were occurred on 124 patients. 64 patients suffered the seizures more than 30 mi-nutes. Cranial CT/MRI showed no abnormality. Laboratory examinations were normal, including plasma glu-cose,serum electrolytes and cerebrospinal fluid. Followed up for 12 months,14 patients (5. 6%) suffered from recurrence of BICE,12 patients (4. 8%) suffered from simple febrile seizures,and 8 patients (3. 2%) devel-oped epilepsy. Conclusion The prognosis is good in majority of cases,but some cases may transform febrile seizure or epilepsy. It is more likely to transform epilepsy,when the children suffer from febrile seizure.