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Objective:To investigate the pathogens and drug resistance of bacterial enteritis in children, analyze the clinical characteristics of bacterial enteritis in children, and provide basis for clinical diagnosis and treatment.Methods:The fecal culture strain and drug sensitivity of patients with bacterial enteritis admitted to our hospital from January 2016 to December 2020 were analyzed and summarized, and the clinical characteristics of patients who were infected by Salmonella and Escherichia coli were compared.Results:There were a total of 173 patients, aged from 21 days to 15 years, with a median age of 2.00(1.10, 3.54)years.Bacterial enteritis was most likely to occur in summer and autumn, and the incidence rate was 40.5% and 29.5%, respectively.One hundreds and seventy-three strains of bacteria were cultured in feces, including 148 strains of Salmonella(85.5%), 18 strains of Escherichia coli(10.4%), five strains of Staphylococcus aureus and two strains of Shigella.One hundreds and one of 141 patients who were infected with Salmonella were detected for leukocytes of in feces(71.6%), and four of 16 patients with Escherichia coli were detected for leukocytes(25.0%). The difference was significant( χ2=14.1, P<0.001). Eighty-eight of 113 patients(77.9%) who were infected by Salmonella with increased CRP(CRP>8 mg/L)and the proportion in Escherichia coli infection cases was 6/13(46.2%). There was significant difference( χ2=4.63, P=0.03). The drug sensitivity of Salmonella and Escherichia coli was summarized.There was no carbapenem resistant strain cultured; The sensitivity to piperacillin/tazobactam and cefoperazone/sulbactam was higher than 85%; The sensitivity to cefepime, ceftazidimeand ceftriaxone was higher than 75%; The sensitivity to ampicillin was lower than 30%, and the sensitivity to quinolones was between 20%-40%. Conclusion:Children aged 1-3 years are prone to bacterial enteritis in summer and autumn.The most common pathogens causing bacterial enteritis are Salmonella and Escherichia coli.White blood cells are more easily detected in feces of patients with Salmonella infection, and the increase rate of C-reactive protein in peripheral blood is higher.Patients with bacterial enteritis are recommended to use the third-generation cephalosporins and aforementioned antibiotics and piperacillin/tazobactam for empirical treatment.The sensitivity to quinolones is reduced, and may not be suitable for clinical application.
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Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.
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Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.
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Objective:To investigate the clinical efficacy of honeysuckle extraction liquid combined with nasal irrigation in the treatment of nasosinusitis after radiotherapy of nasopharyngeal carcinoma.Methods:Eighty-two patients with nasosinusitis post-radiotherapy who received treatment between February 2018 and February 2020 in the First Hospital of Jiaxing were included in this study. They were randomly assigned to receive either nasal irrigation with 0.9% sodium chloride injection (control group, n = 41) or atomization treatment with honeysuckle extract liquid plus nasal irrigation with 0.9% sodium chloride injection (observation group, n = 41), once daily for 4 successive weeks. Visual Analogue Scale (VAS) and nasal endoscopic Lund-Kennedy (LK) score, ciliary transport rate, clinical efficacy and adverse reactions were compared between the control and observation groups. Results:After treatment, the nasal congestion score [(0.82 ± 0.10) points], viscous or purulent nasal discharge score [(1.88 ± 0.25) points], olfactory dysfunction score [(1.12 ± 0.15) points], head and face pain score [(0.40 ± 0.06) points] and nasal endoscopic Lund-Kennedy score [(2.03 ± 0.26) points] in the observation group were significantly lower than those in the control group [(1.94 ± 0.26) points, (2.93 ± 0.37) points, (1.73 ± 0.25) points, (0.62 ± 0.09) points, (4.07 ± 0.47) points, respectively, t = 9.156, 15.056, 13.397, 13.023, 9.156, all P < 0.01]. The ciliary transport rate in the observation group [(4.71 ± 0.56) mm/min] was significantly higher than that in the control group [(3.94 ± 0.51) mm/min, t = 15.056, P < 0.01]. Total effective rate in the observation group was 97.56% (40/41), which was significantly higher than 80.49% (33/41) in the control group ( χ2 = 4.493, P < 0.05). In the control group, one patient had epistaxis, and no adverse reaction was observed in the observation group. Conclusion:Honeysuckle extraction liquid combined with nasal irrigation with 0.9% sodium chloride injection is effective in the treatment of nasosinusitis after radiotherapy for nasopharyngeal carcinoma, can greatly improve the symptoms and signs of patients, and is highly safe.
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Radiotherapy combined with chemotherapy is the main treatment for stage Ⅱ-Ⅳa nasopharyngeal carcinoma (NPC). In the era of intensity-modulated radiation therapy, the timing and implementation of chemotherapy are still controversial. In the past, the clinical guidelines for NPC generally described the specific radiotherapy technology, dose fractionation and the specific scheme of combined application of radiotherapy and chemotherapy, and may lack specific practical guidance. The joint international guidelines for NPC by CSCO and ASCO elaborates the mode and specific implementation recommendations of radical chemoradiotherapy for stage Ⅱ-Ⅳa NPC. This article aims to interpret the specific details of the guideline.
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Objective To explore the mechanism of HIF-1α promoting malignant development of nasopharyngeal carcinoma by upregulating PD-L1 expression under hypoxic conditions. Methods CNE2 cells were divided into normoxia (20%O2), hypoxia (1%O2), HIF-1α-siRNA+hypoxia and NC-siRNA+hypoxia groups. Cell proliferation, apoptosis, the mRNA levels of HIF-1α, STAT3 and PD-L1, the protein levels of HIF-1α, PD-L1, STAT3 and STAT3 phosphorylation were detected by MTT assay, flow cytometry, RT-PCR and Western blot, respectively. Results Cell proliferation of hypoxia group was significantly higher than that of normoxia group (P=0.000). The cell proliferation rate of HIF-1α-siRNA+hypoxia group was significantly lower than those in other groups (P=0.000). The apoptosis rate of HIF-1α-siRNA+hypoxia group was remarkably higher than those in other groups (P=0.001). RT-PCR detection showed that the mRNA levels of HIF-1α, PD-L1 and STAT3 in the HIF-1α-siRNA+hypoxia group were significantly lower than those in hypoxia group and NC-siRNA+hypoxia group. The protein expression of HIF-1α, PD-L1 and STAT3 showed similar tendency in Western blot assays compared with the mRNA levels. The pSTAT3 protein expression level in HIF-1α-siRNA+hypoxia group was significantly lower than those in hypoxia group and HIF-1α-siRNA+hypoxia group (P=0.001). Conclusion Under hypoxic microenvironment, HIF-1α may up-regulate the expression of PD-L1 through STAT3, thereby promoting the immune escape of cancer cells, leading to the malignant development of nasopharyngeal carcinoma.
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Objective:To explore the application value of FilmArray detection in children with acute lower respiratory tract infection and conduct economics analysis.Methods:From December 1, 2016 to November 30, 2017, 1 380 patients were enrolled in our study.Some children(FilmArray group) were tested for respiratory pathogens with FilmArray, while others (control group) were tested by 7-box antigen test of respiratory virus, gold colloid test of influenza and mycoplasma antibody.Those with underlying diseases were excluded.A total of 160 cases in the FilmArray group and 160 cases in the control group were obtained with tendency score matching method.The physical examination of pathogens, clinical indicators, usage of anti-infective drugs and hospitalization related costs were compared.Results:The positive rate of FilmArray test was significantly higher than that in control group (86.88% vs. 45.91%). The most common pathogens detected by FilmArray were adenovirus(39 cases), rhinovirus(34 cases), and parainfluenza virus(30 cases). In the FilmArray group, nine cases were positive for botulinum pertussis, accounting for 5.6% of the total.The hospitalization time of FilmArray group was shorter than that in control group [(8.89±6.23 days vs.(11.51±14.43)days]. In FilmArray group, the antibiotics were used for a shorter time, and 18 children did not use antibiotics during hospitalization.Compared with the control group, the hospitalization cost had no significant difference in the FilmArray group, but the antibiotic cost was less, as well as hospitalization time was shorter.The average hospitalization cost saved by using the FilmArray test was nearly 2 000 yuan per person. Conclusion:The application of FilmArray detection in children with acute lower respiratory tract infection can quickly and accurately identify a various infections of virus, bacteria and atypical pathogen, which guides using anti-infective drugs more reasonably.The application of FilmArray detection shortens the average hospitalization days of children, increases the utilization efficiency of medical resources, and reduces the medical cost and indirect economic loss of children’s families, which has certain economics significance.
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Objective To investigate the distribution and drug resistance to pathogenic bacterial pathogen in children with community acquired pneumonia (CAP),so as to provide recommendations for clinical rational use of anti-biotics. Methods A retrospective analysis was made on the distribution and drug resistance to bacteria in CAP chil-dren admitted to Department of Respiration,Shanghai Children′s Medical Center from January 2014 to December 2015. Results There were 463 patients with positive sputum culture,and a total of 496 strains of pathogens were found. There were 273 Galanz negative bacteria,195 Galanz positive bacteria and 28 other rare bacteria,accounted for 55. 04％,39. 31％ and 5. 65％ of the total bacteria,respectively. The main pathogens were Streptococcus pneumoniae, Staphylococcus aureus,Haemophilus influenzae,Klebsiella pneumoniae and Escherichia coli. The highest detection rate of bacteria in 1-12 months children with CAP was Staphylococcus aureus,Klebsiella pneumoniae and Escherichia coli;in > 12 months children with CAP,the highest detection rate of bacteria was Streptococcus pneumoniae,Haemophilus influenzae and Staphylococcus aureus. Both of Streptococcus pneumoniae and Staphylococcus aureus had a high resis-tance to Erythromycin,Clindamycin and Oxacillin. There were 11. 00％ Streptococcus pneumoniae and 94. 74％ taphy-lococcus aureus resistant to Penicillin,while they were not resistant to Vancomycin. Escherichia coli and Klebsiella pneumoniae both showed a high resistance to ampicillin,the second and third generation cephalosporins. Haemophilus influenzae were highly resistant to Compound sulfamethoxazole and Ampicillin. Galanz negative bacteria had the lowest resistance to Piperacillin/ Tazobactam and Amikacin. Conclusions The main pathogens of CAP in children were G -bacteria. There were some differences among the isolates at different ages of CAP. Their resistance to very common anti-biotics was very high in children.
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Objective To assess the efficacy of oral treatment and parenteral treatment in community acquired pneumonia( CAP) children by meta-analysis method. Methods Searches were made in MEDLINE、EMBASE and Cochrane Central Register of Controlled Trials ( CENTRAL ) from the establishment of the data base till September 2016. All randomized controlled trials about oral and parenteral treatment in community ac-quired pneumonia children were eligible. Review Manager 5. 3 was used to analyze the studies enroued in this meta-analysis. Results 4582 literatures were reviewed. Seven(n=5030)eligible trials were used for meta-a-nalysis. The treatment failure between community acquired pneumonia children treated with oral treatment and parenteral treatment was found no significant difference(OR =0. 82, 95% CI =0. 63-1. 08,P <0. 05). The treatment failure of oral treatment group was found to be significantly higher than parenteral treatment group in CAP children under 1 year of age(OR=2. 25,95%CI=1. 61-3. 14,P<0. 01). The treatment failure of children who had used antibiotics before included in the study was found to be significantly higher than those who had not used(OR=1. 94,95%CI=1. 50-2. 50,P<0. 01). The death rate of oral treatment group was found to be signif-icantly lower than the parenteral treatment group(OR=0. 31,95%CI=0. 11-0. 85,P=0. 02). There was no sig-nificant difference of relapse rate (OR=1. 28,95%CI=0. 34-4. 82) and loss to follow-up rate(OR=1. 08,95%CI=0. 77-1. 51) between the two group. Conclusion Oral treatment is as effective as parenteral treatment in CAP children. The death rate of oral treatment group is significantly lower than the parenteral treatment group.
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Objective To assess the efficacy of oral treatment and parenteral treatment in community acquired pneumonia( CAP) children by meta-analysis method. Methods Searches were made in MEDLINE、EMBASE and Cochrane Central Register of Controlled Trials ( CENTRAL ) from the establishment of the data base till September 2016. All randomized controlled trials about oral and parenteral treatment in community ac-quired pneumonia children were eligible. Review Manager 5. 3 was used to analyze the studies enroued in this meta-analysis. Results 4582 literatures were reviewed. Seven(n=5030)eligible trials were used for meta-a-nalysis. The treatment failure between community acquired pneumonia children treated with oral treatment and parenteral treatment was found no significant difference(OR =0. 82, 95% CI =0. 63-1. 08,P <0. 05). The treatment failure of oral treatment group was found to be significantly higher than parenteral treatment group in CAP children under 1 year of age(OR=2. 25,95%CI=1. 61-3. 14,P<0. 01). The treatment failure of children who had used antibiotics before included in the study was found to be significantly higher than those who had not used(OR=1. 94,95%CI=1. 50-2. 50,P<0. 01). The death rate of oral treatment group was found to be signif-icantly lower than the parenteral treatment group(OR=0. 31,95%CI=0. 11-0. 85,P=0. 02). There was no sig-nificant difference of relapse rate (OR=1. 28,95%CI=0. 34-4. 82) and loss to follow-up rate(OR=1. 08,95%CI=0. 77-1. 51) between the two group. Conclusion Oral treatment is as effective as parenteral treatment in CAP children. The death rate of oral treatment group is significantly lower than the parenteral treatment group.
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Kawasaki disease is far more frequent in children than in adults. The pathogenesis of Kawasaki disease is unknown, but it involves changes to the coronary artery and other diverse clinical manifestations. There are currently no specific laboratory diagnostic indexes, and especially since the disease is rare in adults, so it is extremely easy to misdiagnose or to overlook entirely. Our retrospective analysis of an diagnosis of and treatment for Kawasaki disease in an adult provides a guide to clinical doctors in terms of understanding Kawasaki disease, early diagnosis of it, and improved prognosis.
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Adulto , Humanos , Masculino , Aspirina , Usos Terapéuticos , Síndrome Mucocutáneo Linfonodular , Diagnóstico , Terapéutica , gammaglobulinas , Usos TerapéuticosRESUMEN
ObjectiveTo investigate the relationship between the change of circulating endothelial cell (CEC) level and coronary artery lesion (CAL) of Kawasaki disease (KD),and to further explore the method for early diagnosis of KD.MethodsThirty KD children were recruited for study,including 23 children with complete type of KD and seven children with incomplete KD.According to the results of echocardiography,the KD group was divided into CAL group (9 cases) and non-coronary artery lesion (NCAL)group (21 cases).Ten healthy children were enrolled as control group.Double-blind and controlled trial was conducted,and Hladovec method was applied for CEC counting.Results The CEC level was ( 1.09 ±0.60) × 107/L in KD group,which was higher than that of control group [ (0.38 ±0.14) × 107/L],and the difference was statistically significant ( t =2.85,P ＜ 0.01 ).The CEC level in the CAL group [ ( 1.84 ± 0.24) × 107/L] was higher than that of the NCAL group[ (2.01 ±0.38) × 107/L],and the difference was statistically significant ( t =2.24,P ＜ 0.05 ).The CEC level was ( 1.16 ± 0.63 ) × 107/L in the complete type of KD group and (0.83 ± 0.45 ) × 107/L in the incomplete KD group,which showed no significant difference between the two groups ( t =1.86,P ＞ 0.05 ).CondusionCEC level was elevated significantly in the acute phase of KD.The CEC level in CAL group was higher than that of NCAL group in acute phase.CEC level detection may be helpful for the early diagnosis of KD.