Protein-losing enteropathy in children / 中国实用儿科杂志

Protein-losing enteropathy,or protein-losing gastroenteropathy,refers to a group of diseases in which serum proteins are excessively lost from the gastrointestinal tract due to various causes. The pathogenesis mainly includes mucosal erosion and exudation,increased permeability and intestinal lymphatic obstruction. Clinical manifestations vary greatly with underlying diseases,and the common manifestations are diarrhea,edema and malnutrition. The main characteristics of laboratory examination are the decrease of serum albumin and globulin. Increase in 24-hour alpha-1 antitryptase clearance rate or lymphonuclide intestinal protein tracing image can be used as an evidence of intestinal protein loss. Treatment includes dietary therapy and treatment for underlying diseases.

Characterization of erythromycin-resistant Streptococcus pneumoniae isolates causing invasive diseases in Chinese children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Erythromycin-resistant Streptococcus pneumoniae isolates that causing invasive pneumococcal diseases (IPD) in Chinese children remain uncharacterized. This study aims to identify the resistance genes associated with erythromycin resistance and to determine the genetic relationships of IPD isolates in Chinese children.</p><p><b>METHODS</b>A total of 171 S. pneumoniae strains were isolated from 11 medical centers in China from 2006 to 2008. All the isolates were characterized via serotyping and antibiotic susceptibility determination. The erythromycin-resistant isolates were further characterized via ermB and mefA gene detection, multi-locus sequence typing analysis, and pulsed-field gel electrophoresis.</p><p><b>RESULTS</b>A total of 164 (95.9%) isolates showed resistance to erythromycin, of which 162 strains with high high-level resistance (MIC ≥ 256 µg/ml). A total of 104 (63.4%) isolates carry the ermB gene alone, whereas 59 (36.0%) harbor both ermB and mefA genes. Of the 59 strains, 54 were of serotypes 19A and 19F and were identified as highly clonal and related to the Taiwan(19F)-14 clone.</p><p><b>CONCLUSIONS</b>The erythromycin resistance rate in IPD isolates is significantly high and is predominantly mediated by the ermB gene. Isolates that carry both ermB and mefA genes are predominantly of serotypes 19A and 19F.</p>

Detection and drug resistance analysis of extended-spectrum beta-lactamases-producing Shigella in pediatric patients / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the occurrence and drug resistance of extended-spectrum beta-lactamases (ESBLs)-producing strains of Shigella in pediatric patients, so as to provide information for clinical treatment.</p><p><b>METHOD</b>A total of 59 strains of Shigella were isolated from stool specimens of hospitalized children with shigellosis from January 2004 to December 2008. The broth dilution test recommended by Clinical and Laboratory Standards Institute (CLSI) was performed to detect the ESBLs producers. Susceptibility test was carried out by agar dilution method. Escherichia coli ATCC25922 and Klebsiella pneumonia ATCC700603 were used as quality control strains.</p><p><b>RESULT</b>Of the 59 isolates, 21 (35.6%) strains were identified as ESBLs producers. All of the 21 strains were detected by cefotaxime and cefotaxime/clavulanic acid, only 5 (23.8%) were detected by ceftazidime and ceftazidime/clavulanic acid. Both ESBLs and non-ESBLs producers showed high resistance to penicillins. The resistance of ESBLs-producing strains to third and fourth-generation cephalosporins, aztreonam was significantly higher than that of non-ESBLs-producing strains, as well as sulphonamides and quinolones. The drugs sensitive to ESBLs producers were imipenem, meropenem, piperacillin/tazobactam, cefoperazone/sulbactam and cefoxitin, with resistance rate of 0.0%, 0.0%, 14.3%, 9.5%, 14.3%, respectively.</p><p><b>CONCLUSION</b>The prevalence of ESBLs-producing Shigella in pediatric patients is at a high level in this area, and the enzyme-producing strains are multidrug resistant. It is recommended that the detection of ESBLs in Shigella should be carried out by microbiological laboratories. Any of the above 5 antibiotics of low resistance should be used according to the patient's condition.</p>

Frequency of ABO type IgM antibody in 276 infants younger than six months / 中国实验血液学杂志

The aim of study was to explore the frequency of ABO type IgM antibody in infants younger than six months. 309 hospitalized infants younger than six months were selected at first and their EDTA K(3) anticoagulant blood samples were taken. All the infants were divided into five groups: neonates within 1 week as group I; neonates aged 8 to 14 days as group II; neonates aged 15 days to 1 month as group III; infants aged two to 3 months as group IV and infants aged 4 to 6 months as group V. The monocolonal anti-A, anti-B serums, A cells, B cells and O cells were utilized to carried out the blood typing with tube test. The results indicated that from 309 samples tested 33 AB type sample were excluded. Out of the remains of 276 samples, 29 of 46 samples in group I were positive and with the ABO type consistent rate 63% (29/46); 41 of 64 samples in group II were positive and with the ABO type consistent rate 64% (41/64); 47 of 74 samples in group III were positive and with the ABO type consistent rate 63% (47/74); 28 of 45 samples in group IV were positive and with the ABO type consistent rate 62% (28/45); 40 of 47 samples in group V were positive and with the ABO type consistent rate 85%. It is concluded that the ABO type IgM antibody appear in most infants younger than six months and these IgM antibodies may be regarded as the important evidence for ABO typing in infants.

Study on the distribution and correlation of trace elements in whole blood of children in Beijing / 中华流行病学杂志

Objective To study the distribution and correlation of trace elements in peripheral blood of children in Beijing so as to offer scientific evidence for the supplementation of trace elements and to prevent lead intoxication. Methods Contents of trace elements in whole blood of 13 929 children in Beijing region were detected by Atomic Absorption Spectrometer. According to developmental condition, children were divided into young infancy group, infancy group, toddler's age group, preschool age group, school age group and adolescence group. Every group was divided into males and females. Distribution and correlation of trace elements in different age groups and in different sex sets were then analyzed and compared. Results The level of copper, calcium and magnesium were stable in different age groups and in different sex sets.There were no obvious significant differences in age groups and sex sets and there were no deficiency of copper, calcium and magnesium discovered. The level of zinc increased gradually following the growth of age and the level of zinc was (81.71±15.91)μmol/L. There were significant differences in different age groups noticed as well in sex sets of infancy group, toddler's age group and preschool age group. The rate of deficiency of zinc decreased gradually following the growth of age. The rate of zinc deficiency was 13.7% and there were obvious differences noticed in sex sets of toddler, preschool and school age groups. The level of iron increased gradually following the growth of age with the level of iron as (8.28±0.78)mmol/L.There were significant differences noticed in different age groups, after infancy stage. There was significant difference noticed also in sex sets after school age group. The rate of iron deficiency decreased obviously following the growth of age. The iron deficiency rate was 12.9%, and significantly different in sex sets of young infancy, school age and adolescence groups. The level of lead increased gradually following the growth of age, with the overall level as (59.97±26.52)μg/L; There was an obvious significant differences noticed in different age groups with significant differences noticed in sex sets after toddler's age group. The rate of lead intoxication increased gradually following the growth of age. The rate of lead intoxication was 8.2%. There were significant differences noticed in sex sets after toddler's age group.However, there were negative correlations noticed among the levels of lead and copper, zinc, calcium,magnesium and iron. There were no correlations between the level of calcium and iron found but showed positive correlation among other trace elements. Conclusion The deficiency of calcium was basically corrected but the deficiency of zinc and iron were still obvious. There was a high level of lead noticed in these children. It is important to advocate on healthy feeding program, on culture good hygienic habit and on away from the lead pollution sites.

Characterization of multidrug-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the present study, we characterized multidrug-resistant Pseudomonas aeruginosa (MDRP) clinical isolates from a paediatric facility and investigated the types and features of the metallo-beta-lactamases (MBLs) produced by carbapenem-resistant strains.</p><p><b>METHODS</b>Four hundred and ninety-eight strains of Pseudomonas aeruginosa were isolated from patients at Beijing Children's Hospital between January 2005 and December 2006. The minimal inhibition concentrations (MICs) of the strains for 13 antibiotics were measured. A combination of the E test and PCR amplification/DNA sequencing was used to define the carbapenem-resistant strains.</p><p><b>RESULTS</b>We found that 24.1% (120/498) of the isolates were MDRP. The frequencies of resistance to imipenem and meropenem were 34.2% and 35.8%, respectively, and the MIC50 and MIC90 values for the two antibiotics were identical at 4 microg/ml and 32 microg/ml, respectively. The detection rate for carbapenem resistance was 49.2% (59/120). Among the 59 carbapenem-resistant Pseudomonas aeruginosa strains, 39 (66.1%) were positive for the MBL genotype; 35 (89.7%) strains carried the bla(IMP) gene and 4 (10.3%) strains carried the bla(VIM) gene. Neither bla(SPM) nor bla(GIM) was amplified from any of the 59 isolates. DNA sequencing revealed that IMP-1 was present in 35 IMP-producing isolates and VIM-2 was detected in four VIM-producing isolates.</p><p><b>CONCLUSIONS</b>These MDRP isolates exhibited high frequencies of resistance to carbapenems among clinical isolates from a paediatric facility in Beijing, China. The production of MBL appears to be an important mechanism for carbapenem resistance in Pseudomonas aeruginosa.</p>

Establishment of method collecting peripheral blood hematopoietic stem/progenitor cells from infants / 中国实验血液学杂志

The aim of this study was to explore a safe method collecting peripheral blood stem/progenitor cell (PBSPC) from the infants of body weight less than 20 kg by using the COBE Spectra Blood Cell Separator through Auto-PBSC procedure. After washing tube by normal saline, one unit of irradiated RBC was infused into the apheresis set. When the collection terminated, only the concentrated RBC in the apheresis set was returned to the infant. The peripheral mononuclear cells (PBMNCs) and CD34+ cells were counted, the cell viability was determined. The results showed that 13 PBSPC collections were carried out successfully from 7 infants of body weight<20 kg. The average count of MNCs was 4.44x10(8)/kg [(3.46-6.45)x10(8)/kg], the CD34+ count was 2.20x10(6)/kg [(1.34-3.79)x10(6)/kg] and the cell viability was 98.45% (97%-100%) respectively. The vital signs of all the infants went smoothly during collection of PBSPCs. In conclusion, with the aid of COBE Spectra blood cell separator and other measures, the collection of PBSPCs from infants of body weight<20 kg is safe and effective, the PBMNCs containing enough PBSPC can be harvested for transplantation.

Hemangioma of Small Intestine in Children Causing Recurrent Gastrointestinal Hemorrhage:3 Cases Report and Literature Review / 实用儿科临床杂志

Objective To summarize the clinical characteristics and diagnosis and treatment of hemangioma of small intestine in children.Methods Location,pathology,clinical manifestation,diagnosis and treatment of 3 cases from our hospital and 44 cases reported in our courtry with hemangioma of the small bowel were analyzed from 1994 to 2004.Results These tumors locating in jejunum,ileum,duodenum as well as parts small intestine were 31.9%,42.6%,4.2% and 21.3%,respectively.Solitary and multiple tumors were 29.8% and 70.2% separately.The histopatholical report of 10 cases revealed that capillary,cavernous,mixed type hemangioma and hematolymphangioma were 2,6,1 and 1 cases,respectively.Thirty nine children presented with recurrent black stool.Five patients manifest in the form of intussusception.One child passed a bloody stool so massive as to cause shock.Small-bowel obstruction occurred in 5 cases.The hemoglobin of 38 patients were lower than 90 g/L.The incidence of preoperative diagnosis was only 10.6%.All of patients were performed operation.Conclusions The frequent locations of hemangioma of small intestine are in ileum and jejunum,and multiple tumors are common.The diseases are characterized as recurrent hematochezia with painlessness.Preoperative diagnosis of a small bowel hemangioma can be very difficult.The segments of small bowel with hemangioma resection are the most method of the treatment.

Analysis of Acquired Immunodeficiency Syndrome with Manifestation of Chronic Diarrhea in 7 Children / 实用儿科临床杂志

Objective To explore the clinical manifestation and laboratory examination of chronic diarrhea in children with acquired immunodeficiency syndrome(AIDS) and analyze the reasons that causes the chronic diarrhea in children.Methods Clinical data of 7 patients (male 4 cases,famale 3 cases)with AIDS with manifestation of chronic diarrhea among the 17 cases were diagnosed as AIDS in Beijing children′s hospital from Jan.1999 to Dec.2006.The time of diarrhea,degree of dinrrhea,characteristic of stool,accompaniment symptom,laboratory examination were retrospectively analyzed.Results The average onset age was 6 years old(from 2-9 years old).The average time of diarrhea was 6 months(from 1-16 months).Four cases main complained with chronic diarrhea,3 cases came to the hospital because of fever,cough and wasting;6 cases with diarrhea,7 cases with malnutrition and anemia,5 cases accompanied hypokalemia and metabolic acidosis,6 cases had delay in growth and development,2 cases with abnormal stool routine exam,1 case with positive stool culture of fungi.All patients were with lower CD4,5 cases with lower CD4/CD8.Conclusions Chronic diarrhea is a common symptom in children with AIDS,and usually accompanied by obvious delay in growth and development,malnutrition and anemia,the reasons that causes the chronic diarrhea are consi-dered to be related with both the opportunistic infection and HIV infection.

Analysis of genotype of metallo-?-lactamases produced by carbapenem-resistant Pseudomonas aeruginosa in pediatric patients / 中华检验医学杂志

Objective To investigate the genotype of metallo-?-lactamases (MBL) produced by carbapenem resistant Pseudomonas aeruginosa in pediatric patients.Methods 59 strains of resistance to imipenem or meropenem were collected from December 2003 to November 2005 in Beijing children's hospital.Isolates were further evaluated for MBL production by two screening methods.MBL Etest strips were used to screen the phenotype of MBL production.Molecular screening for blaVIM,blaIMP,blaSPM and blaGIM was carried out using primers targeting the conserved regions of the MBL genes.The PCR fragments obtained with integron primers were sequenced on both strands.The nucleotide sequences were compared with sequences available over the Internet.Results Of the 59 carbapenem resistant Pseudomonas aeruginosa included in this study,29 (49.2%)were MBL positive using Etest methods,and 39 (66.1%) of these tested positive for MBL genes by PCR.35 (89.7%) were positive for blaIMP genes and 4 (10.3%) were positive for blaVIM genes.All isolates were negative for SPM and GIM DNA sequencing revealed that the IMP-1 was detected in 35 IMP-producing isolates,and VIM-2 was detected in 4 VIM-producing isolates.Conclusions This study has demonstrated that MBL-producing strains in pediatric are more common than in adult.IMP-1-producing strains are the main in pediatric,and VIM-2-producing strains concurred.The production of MBL is one of the important reasons of carbapenem resistant Pseudomonas aeruginosa in pediatric.It is very important to monitor the production of MBL.

Study on clinical and pathology of children with gastrointestinal bleeding / 实用儿科临床杂志

Objective To evaluate the etiologies of children with gastrointestinal bleeding(GIB), and the relationship between the pathological findings and clinical.Methods Gastroscopy or proctoscope was performed in 153 children with GIB. Pathological studies and tests as for helicobactor pylori (Hp) were undertaken.Results Among 153 children,140 cases(91.5 %) had definite diagnosis,including 74 children with upper gastrointestinal bleeding(UGIB) and 66 cases with lower gastrointestinal bleeding(LGIB). Gastric pathologic study was conducted in 56 cases. All patients had chronic superficial gastritis(CSFG). Hp test was positive in 33 patients. There was significant difference in the positive rate of Hp test between patients with gastritis or duodenitis and those with ulcers (P