Pathogen and clinical characteristics of bacterial enteritis in a third class children′s hospital in Shanghai city from 2016 to 2020 / 中国小儿急救医学

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.

Rapid detection of pneumocystis carinii infection in immunocompromised patients by loop mediated isothermal amplification technique / 中国小儿急救医学

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.

Rapid detection of pneumocystis carinii infection in immunocompromised patients by loop mediated isothermal amplification technique / 中国小儿急救医学

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.

Clinical value of FilmArray meningitis/encephalitis Panel in detecting the etiology of infection in central nervous system / 中国小儿急救医学

Objective:To explore the value of FilmArray meningitis/encephalitis(ME)Panel in etiological diagnosis of infection in central nervous system(CNS) in Chinese children.Methods:Cerebrospinal fluid(CSF)obtained through lumbar puncture was collected from 145 patients with suspected CNS infection at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from March 2019 to November 2019.All specimens were cultured simultaneously, which were detected by FilmArray ME Panel, and the results of cerebrospinal fluid culture and FilmArray ME Panel were compared.Results:Among 145 patients with suspected CNS infection, three samples were found to be positive after cerebrospinal fluid culture, and the positive rate was 2.1%(3/145). For the FilmArray ME Panel, 30 specimens were found to be positive, with a positive rate of 20.7%(30/145), and the difference of positive rate between the two methods was statistically significant( χ2=24.927, P<0.05). Among the samples FilmArray ME Panel tested positive with pathogen, 26 specimens were positive with virus making up 17.9%(26/145)and enterovirus(15.2%)was the primary pathogen.In addition, of the 142 specimens cerebrospinal fluid culture negative, 28 samples were tested positive by the FilmArray ME Panel, accounting for 19.7%(28/142). Conclusion:FilmArray ME Panel has the characteristics with high positive rate and could be time-saving.Meanwhile, FilmArray ME Panel has significant advantage in the detection of virus and improves the positive detection rate of virus.

Enlightenment of Taiwan occupational therapy postgraduate education on higher education in mainland China / 中华医学教育探索杂志

Occupational therapy, as one of the important subdisciplines of rehabilitation therapy, takes occupational activities as the medium or purpose of treatment and life participation as the goal of treatment to meet the growing demand for rehabilitation. According to the Minimum Standards for the Education of Occupational Therapists developed by the World Federation of Occupational Therapists, many countries and regions have formulated educational standards that meet their own national or regional characteristics. Comparatively, the number of occupational therapists is seriously insufficient, the talents cultivation is relatively lagging behind, and the education level is uneven in mainland China; while in Hongkong and Taiwan, occupational therapy has an independent education system and a relatively mature talent training model. This study summarized the practical experience and reviewed the relevant literature. Based on the summary and review, we made a comparative analysis of postgraduate education in mainland China and Taiwan from the aspects of educational system and accreditation, enrollment objects, curriculum setting and teaching methods, which would provide a reference for the improvement of occupational therapy personnel training system in mainland China.

The application value of FilmArray detection in children with acute lower respiratory tract infection / 中国小儿急救医学

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.

Exploration of clinical characteristics of influenza A virus infection in children / 中国小儿急救医学

Objective:To explore the clinical characteristics of influenza A virus infection in children, and provide evidence for early identification of severe patients.Methods:A total of 114 patients with influenza like symptoms admitted to Shanghai Children′s Medical Center from October 2017 to May 2019 were enrolled in our study.All the patients were confirmed influenza A infection by Xpert-Xpress influenza/respiratory syncytial virus detection platform.The patients were divided into mild influenza A group (47 cases) and severe influenza A group (67 cases with pneumonia). The clinical data of these patients were analyzed and compared.Results:The male to female ratio of 114 cases was 1.28∶1.The age of included patients ranged from 1 month 12 days to 12 years old, and the median age was 3.00 (4.27) years old.The most common clinical manifestations were fever, cough and wheezing, accounting for 79.82%, 68.42%, and 43.00%, respectively.The rate of mixed infection was 24.56%, and adenovirus(5.26%), respiratory syncytial virus(4.39%) as well as mycoplasma(3.51%) accounted for the top three, and the rate of mixed bacterial infection was 12.28%.The median age of the patients in the severe influenza A group was 1.00 (3.58) years, and that in the mild influenza A group was 4.00 (5.00) years, with statistical difference ( Z=-3.81, P<0.001). The mixed infection rate was 38.80% (26/67) in severe influenza A group and 4.26% (2/47) in mild influenza A group, with statistical difference ( χ2= 17.8, P<0.001). The neutrophil/lymphocyte ratio in peripheral blood was 2.64 (3.37) in severe influenza A group and 1.17 (2.02) in mild influenza A group, with statistical difference ( χ2=-2.46, P=0.01). Conclusion:Children with smaller age, mixed infection and higher neutrophil/lymphocyte ratio are easy to develop into severe cases.The detection system of Xpert-Xpress influenza / respiratory syncytial virus is a simple, rapid and accurate method for influenza detection, which provides a good basis for diagnosis and treatment.

A novel decision tree-based algorithm for differentiation of incompleted Kawasaki disease from infectious diseases / 中国小儿急救医学

Objective:To establish a novel decision tree-based algorithm in complete Kawasaki disease(cKD)and evaluate its diagnostic value in incomplete Kawasaki disease(iKD)and pediatric infectious disease(IF)with common clinical characteristics, which facilitates early and accurate diagnosis of iKD.Methods:Based on inclusion criteria of KD and IF, clinical and laboratory data of patients with cKD, iKD and IF from Shanghai Children′s Medical Center between December 2018 and December 2019 were collected.The training data set included cKD and random half number of IF patients, and validation data was constituted with iKD and the rest of IF patients.The decision tree algorithm analysis was performed in training data set to generate a clinical diagnostic panel for cKD.Finally, the decision tree-based algorithm was verified and evaluated among the iKD patients.Results:A single statistical analysis was performed on 26 examination indexes of constructing decision tree-based algorithm.It was found that 16 examination indexes were obviously different between cKD and IF patients, and 17 examination indexes were significantly different between iKD and IF patients.According to date set of cKD and IF patients, the decision tree-based algorithm was established.The erythrocyte sedimentation rate>35mm/h, N-terminal atrial brain natriuretic peptide precursor≥315 pg/ml, CD3 -/CD19 + %≥21%, and the amount of neutrophil≥8.5×10 9/L were constructed as key elements.The algorithm had a sensitivity of 0.947 and a specificity of 0.963, and correctly classified subjects with iKD who were difficult to be distinguished from patients with IF. Conclusion:A decision tree-based algorithm based on the examination indexes of cKD is one of the effective methods to identify iKD and IF, which provides strong support for the early clinical diagnosis of iKD.

Clinical features analysis of cryptococcus neoformans infection in children / 中国小儿急救医学

Objective:To analyze the clinical characteristics, diagnosis and treatment strategies of cryptococcus neoformans infection in children, and to explore the application value of PCR and high-throughput gene analysis in the diagnosis and treatment of cryptococcus neoformans infection.Methods:The clinical data of children with cryptococcus neoformans infection were retrospectively analyzed, who were hospitalized in Shanghai Children′s Medical Center from July 1998 to December 2018, including epidemiological characteristics (age, gender, underlying disease, and contact history, etc.), clinical manifestations, laboratory tests, imaging studies, pathogen detection methods, and treatment and prognosis.Results:A total of ten children were enrolled in the survey, including five males and five females, and the median age was 6.28(4.08, 12.02) years; four cases had a history of poultry/soil/corrosion exposure; seven cases were diagnosed as cryptococcus neoformans meningitis, three cases were diagnosed as disseminated cryptococcal disease; five cases had underlying disease, including two cases of which were found to have primary immunodeficiency through high-throughput genetic analysis; headache with fever was the most common clinical symptom of cryptococcus neoformans meningitis.All three cases of disseminated cryptococcosis had primary or secondary immunodeficiency.All children were treated with 5-fluorocytosine + amphotericin B/amphotericin B liposome in induction therapy, and fluconazole in consolidation therapy.Notably, two cases showed hypokalemia during induction therapy, and one case showed mild renal dysfunction during consolidation treatment; five cases were cured, three cases were abandoned, one case was relapsed, and one case died.Conclusion:Children with cryptococcosis neoformans infection who are considered to have normal immune function may have primary immunodeficiency caused by gene mutation.PCR can improve the detection rate of cryptococcus neoformans and shorten the detection time.A significant increase in eosinophils may indicate the spread of infection.Hydration and regular potassium supplementation may reduce the toxicity of amphotericin B. Control of intracranial hypertension is the key to improve the success rate of treatment.

The analysis of microflora distribution and drug resistance of urinary tract infection in children / 中国小儿急救医学

Objective:To investigate the distribution and drug resistance of pathogens in urinary tract infection in children.Methods:The clinical data of 108 cases of urinary tract infections with positive urinary culture from January 2018 to December 2018 in our hospital were analyzed retrospectively.The patients were divided into simple urinary tract infection group( n=29) and complex urinary tract infection group( n=79). Antibiotic resistance in each group was compared. Results:Gram-negative bacilli were found in 90 cases(77.59%, 90/116). Gram-positive cocci were found in 26 cases(22.41%, 26/116). Escherichia coli, Klebsiella pneumoniae and Enterococcus faecium were the main pathogens.Gram-negative bacilli had the lowest resistance rate to amikacin, imipenem and piperacillin/tazobactam(about 10%). The resistance rate of Gram-negative bacilli to furantoin and quinolones was about 20%, while 30% to 40% to the third and fourth generation cephalosporins and their enzymatic preparations.No Gram-positive cocci was found to be resistant to vancomycin and linezolid.The resistance rate of Gram-positive bacteria to streptomycin and furantoin was 0-20%.There was no significant difference in resistance rate of Gram-negative bacteria to common antibiotics between simple urinary tract infection group and complex urinary tract infection group( P>0.05). Conclusion:Gram-negative bacteria are the main pathogens of urinary tract infections.With the change of drug resistance of pathogens, it may be necessary to change the empirical treatment of urinary tract infection.Furantor can be used as a recommendation for the empirical treatment of mild infection.In the past, there may be underestimate of drug resistance of simple urinary tract infection, and further research is needed.

Clinical characteristics and prevalence of adenovirus with respiratory tract infections in children / 中国小儿急救医学

Objective:To explore the clinical characteristics prevalence of respiratory adenovirus infections in children, and to provide reference for diagnosis, monitoring and timely treatment.Methods:A total of 775 clinical specimens were collected from Shanghai Children′s Medical Center during November 2016 to November 2017, and 84 cases of adenovirus infections were detected by FilmArray.Results:Among 775 samples, 84 samples(10.8%) were adenovirus positive.The epidemic peak of adenovirus infection was winter, spring and summer, especially in winter(20.8%), and the highest detection rate was in January(32.2%). The age ranged from 6 months to 2 years(47.7%). The common clinical manifestations are fever(91.7%), cough(96.4%), wheezing(48.8%), and shortness of breath(14.2%). A total of 15 cases(17.9%) had underlying diseases, the most of them were congenital heart diseases(9 cases, 10.7%). A total of 53 cases(63.1%) were mixed infection, and 21 cases(25.0%) were complicated with human rhinovirus/enterovirus.There were 5 cases of upper respiratory tract infection, 3 cases of bronchitis and 76 cases of pneumonia, including 55 cases of mild pneumonia and 21 cases of severe pneumonia.The average length of hospital stay was 8.3 days.The length of hospital stay, cases of wheezing and severe cases in the mixed infection group were significantly higher than those in the single infection group( P<0.05). Hospitalization days, wheezing symptoms, extrapulmonary symptoms, basic diseases and mixed infections in severe group were significantly higher than those in mild group( P<0.05). Conclusion:Adenovirus infection occurs in children aged 6 months to 2 years, with a high incidence in winter, spring and summer.The peak month is January.The main clinical manifestations are high fever, cough and wheezing.Children with underlying diseases, wheezing symptoms, extrapulmonary symptoms and mixed infections are more likely to develop severe diseases.FilmArray detection system can quickly and accurately detect pathogens, provide a good basis for early diagnosis, monitoring and treatment of clinicians.

Clinical characteristics and prevalence of adenovirus with respiratory tract infections in children / 中国小儿急救医学

Objective@#To explore the clinical characteristics prevalence of respiratory adenovirus infections in children, and to provide reference for diagnosis, monitoring and timely treatment.@*Methods@#A total of 775 clinical specimens were collected from Shanghai Children′s Medical Center during November 2016 to November 2017, and 84 cases of adenovirus infections were detected by FilmArray.@*Results@#Among 775 samples, 84 samples(10.8%) were adenovirus positive.The epidemic peak of adenovirus infection was winter, spring and summer, especially in winter(20.8%), and the highest detection rate was in January(32.2%). The age ranged from 6 months to 2 years(47.7%). The common clinical manifestations are fever(91.7%), cough(96.4%), wheezing(48.8%), and shortness of breath(14.2%). A total of 15 cases(17.9%) had underlying diseases, the most of them were congenital heart diseases(9 cases, 10.7%). A total of 53 cases(63.1%) were mixed infection, and 21 cases(25.0%) were complicated with human rhinovirus/enterovirus.There were 5 cases of upper respiratory tract infection, 3 cases of bronchitis and 76 cases of pneumonia, including 55 cases of mild pneumonia and 21 cases of severe pneumonia.The average length of hospital stay was 8.3 days.The length of hospital stay, cases of wheezing and severe cases in the mixed infection group were significantly higher than those in the single infection group(P<0.05). Hospitalization days, wheezing symptoms, extrapulmonary symptoms, basic diseases and mixed infections in severe group were significantly higher than those in mild group(P<0.05).@*Conclusion@#Adenovirus infection occurs in children aged 6 months to 2 years, with a high incidence in winter, spring and summer.The peak month is January.The main clinical manifestations are high fever, cough and wheezing.Children with underlying diseases, wheezing symptoms, extrapulmonary symptoms and mixed infections are more likely to develop severe diseases.FilmArray detection system can quickly and accurately detect pathogens, provide a good basis for early diagnosis, monitoring and treatment of clinicians.

Clinical analysis of 82 cases of children with post-influenza acute lower respiratory tract infection / 中国小儿急救医学

Objective To explore the clinical characteristics of acute lower respiratory tract infection in children after influenza,and to provide evidence-based basis for timely diagnosis and accurate treatment of acute lower respiratory tract infection in children after influenza. Methods Eighty- two patients with acute lower respiratory tract infection admitted to Shanghai Children′ s Medical Center from October 2016 to November 2017 were enrolled in our study. The clinical data of these patients were analyzed and influenza A or influenza B were confirmed by Filmarray platform. The clinical characteristics of patients with influenza A and influenza B,severe pneumonia and non-severe pneumonia,mechanical ventilation and non-mechanical ventilation were compared. Results The age distribution of the children ranged from 0. 13 to 15 years old, with 73 cases (89. 0％ ) being younger than 5 years old. There were 47 cases of influenza A (57. 3％ ) and 35 cases of influenza B (42. 7％ ). The proportions of cases in spring,summer,autumn and winter were 35. 3％ ,15. 9％ ,15. 9％ and 32. 9％ ,respectively. Congenital heart disease was the most common underlying disease (28 cases,34. 1％ ). Twenty-five(30. 5％ ) patients were diagnosed as severe pneumonia. Oseltamivir was added on the first to eighth days of the course with median time ( IQR) 2. 0 (3. 0) days. Thirteen (15. 9％ ) patients needed ventilator-assisted ventilation. There were significant differences in the incidence of influenza A and influenza B in summer (12 / 47 vs. 1 / 35,χ2 = 7. 7,P < 0. 01). Compared to non-severe pneu-monia,severe pneumonia was positively correlated with underlying diseases(17 / 25 vs. 18 / 57,χ2 = 9. 4,P <0. 01),digestive tract symptoms(10 / 25 vs. 6 / 57,χ2 = 9. 6,P < 0. 01) and high PCT level(8 / 23 vs. 8 / 56,χ2 = 3. 1,P < 0. 01),but negatively correlated with oseltamivir application[M(IQR)] [5. 0(2. 5) d vs. 2. 0 (1. 5)d,Z = - 6. 1,P < 0. 01]. There was significant difference in the proportion of influenza A/ B between ventilator group and non-ventilator group (11 / 2 vs. 36 / 33,χ2 = 4. 7,P < 0. 01). Conclusion Filmarray re-spiratory tract detection system can detect influenza virus infection quickly and accurately,providing a good basis for early diagnosis and treatment. Children under 5 years old are susceptible to influenza. Influenza in children mainly occurs in winter and spring. Influenza A mainly occurs in summer. Patients with influenza A infection,underlying diseases,digestive tract symptoms during the course of illness and elevated PCT are more likely to progress to severe illness or even use ventilator treatment. Early use of oseltamivir can improve the prognosis of the disease.

Analysis of clinical prognosis and mutant gene phenotype in children with hemophagocytic lymphohisti-ocytosis / 中国小儿急救医学

Objective To investigate the clinical manifestations,prognosis and gene mutation pheno-types of hemophagocytic lymphohistiocytosis(HLH)in children of our hospital. Methods The clinical data of 42 patients with HLH from April 2013 to December 2018,and the genetic data of 8 patients with familial HLH(FHL)were collected retrospectively. The age,clinical manifestation,laboratory examination,prognosis and the characteristics of gene mutation phenotype of patients with HLH and FHL were analyzed emphatical-ly. Furthermore,the clinical manifestations and prognosis of patients with HLH were analyzed according to whether EB virus was infected. Results Among these 42 patients with HLH,the onset age was ranged from 1 month to 13 years old and most of them were younger than 5 years old. The main clinical manifestations in-cluded cytopenia,prolonged fever,enlargement of liver and spleen and lymph nodes enlargement and serosal effusion. Laboratory examination showed that lactate dehydrogenas,ferritin,erythrocyte sedimentation rate and triglyceride increased significantly. The survival rate of the group in ferritin exceeding 4 500 μg/L and non- chemotherapy was lower than that of the group of ferritin less than 4 500 μg/L and chemotherapy in clinical prognosis(P<0. 05). Ten patients of them survived after chemotherapy,and 2 patients survived for 5 to 6 months after hematopoietic stem cell transplantation in FHL. Patients with EB virus infection were older than those without EB virus infection. They had longer fever duration and higher proportion of lymph nodes enlargement and ferritin more than 4 500 μg/L(P values were 0. 01,0. 04,0. 03,0. 03 respectively). Howev-er,there was no significant difference in survival time between the two groups. Eight patients had mutations in UNC13D(50. 00%), PRF1 ( 25. 00%), PRKDC ( 12. 50%) and IL2RG ( 12. 50%) genes respectively, and most of the mutations were complex heterozygous mutations(62. 50%). All the mutations were originated from their parents. Conclusion HLH is characterized by cytopenia,prolonged fever,enlargement of liver and spleen. HLH is more common in children under 5 years old. The clinical manifestations of HLH with EB virus infection are more severe while the prognosis is not statistically significant. The incidence of FHL is higher. There are more UNC13D gene mutations and complex heterozygous mutations. Children with HLH should be detected and treated with standardized therapy as soon as possible. Hematopoietic stem cell transplantation is a good treatment for HLH,especially for FHL patients.

Analysis of clinical prognosis and mutant gene phenotype in children with hemophagocytic lymphohistiocytosis / 中国小儿急救医学

Objective@#To investigate the clinical manifestations, prognosis and gene mutation phenotypes of hemophagocytic lymphohistiocytosis(HLH)in children of our hospital.@*Methods@#The clinical data of 42 patients with HLH from April 2013 to December 2018, and the genetic data of 8 patients with familial HLH(FHL)were collected retrospectively.The age, clinical manifestation, laboratory examination, prognosis and the characteristics of gene mutation phenotype of patients with HLH and FHL were analyzed emphatically.Furthermore, the clinical manifestations and prognosis of patients with HLH were analyzed according to whether EB virus was infected.@*Results@#Among these 42 patients with HLH, the onset age was ranged from 1 month to 13 years old and most of them were younger than 5 years old.The main clinical manifestations included cytopenia, prolonged fever, enlargement of liver and spleen and lymph nodes enlargement and serosal effusion.Laboratory examination showed that lactate dehydrogenas, ferritin, erythrocyte sedimentation rate and triglyceride increased significantly.The survival rate of the group in ferritin exceeding 4 500 μg/L and non-chemotherapy was lower than that of the group of ferritin less than 4 500 μg/L and chemotherapy in clinical prognosis(P<0.05). Ten patients of them survived after chemotherapy, and 2 patients survived for 5 to 6 months after hematopoietic stem cell transplantation in FHL.Patients with EB virus infection were older than those without EB virus infection.They had longer fever duration and higher proportion of lymph nodes enlargement and ferritin more than 4 500 μg/L(P values were 0.01, 0.04, 0.03, 0.03 respectively). However, there was no significant difference in survival time between the two groups.Eight patients had mutations in UNC13D(50.00%), PRF1(25.00%), PRKDC(12.50%)and IL2RG(12.50%)genes respectively, and most of the mutations were complex heterozygous mutations(62.50%). All the mutations were originated from their parents.@*Conclusion@#HLH is characterized by cytopenia, prolonged fever, enlargement of liver and spleen.HLH is more common in children under 5 years old.The clinical manifestations of HLH with EB virus infection are more severe while the prognosis is not statistically significant.The incidence of FHL is higher.There are more UNC13D gene mutations and complex heterozygous mutations.Children with HLH should be detected and treated with standardized therapy as soon as possible.Hematopoietic stem cell transplantation is a good treatment for HLH, especially for FHL patients.

Prevalence and molecular characteristics of Listeria monocytogenes in cooked products and its comparison with isolates from listeriosis cases / 医学前沿

This study aimed to investigate the prevalence and molecular characteristics of Listeria monocytogenes in cooked products in Zigong City, China. The overall occurrence of the L. monocytogenes in the ready-to-eat (RTE) shops and mutton restaurants surveyed was 16.2% (141/873). An occurrence of 13.5% was observed in RTE pork, 6.5% in RTE vegetables, and more than 24.0% in either cooked mutton or cooked haggis. Serotype 1/2b (45.4%), 1/2a (33.3%), and 1/2c (14.2%) were the predominant types. By comparing the clonal complexes (CCs) based on multilocus sequence typing (MLST) of the L. monocytogenes from cooked foods in Zigong City and 33 listeriosis cases from different districts of China, CC87, CC9, CC8, and CC3 were showed to be prevalent in cooked products and CC87 and CC3 were the first two frequent types in the 33 clinic-source strains. All CC87 stains harbored the newly reported Listeria pathogenicity island 4 (LIPI-4) gene fragment ptsA, and all CC3 strains possessed the Listeria pathogenicity island 3 (LIPI-3) gene fragment llsX. These may increase the occurrence of the strains belonging to CC87 and CC3 in listeriosis cases in China and also underline the risk of infection owing to the consumption of the cooked products from Zigong. ST619 (serotype 1/2b) harbored both llsX and ptsA, indicating a potential hypervirulent sequence type in Zigong.

Application of meticulous management in safety construction of intravenous infusion / 中华医学教育探索杂志

For the safety problems of internal medicine intravenous infusion,we carry out meticulous management,establish quality control system of intravenous infusion safety management,and formulate quality control plan.We collect and analyse the potential unsafety factors in the various departments of internal medicine.We have revised the intravenous infusion system and procedures,formulated standards for safety inspection of intravenous fluids,and standardized the admission system for nurses.We carry out training on intravenous infusion related knowledge for nursing staff,carry out meticulous management of venous transfusion links,and actively carry out learning and communication.All these measures have greatly enhanced the safety awareness of the nursing staff.The safety index of intravenous infusion for liver diseases was preliminarily summarized.The use rate of the safe indwelling needle was increased from 30.60％ to 92.30％,the rate of appropriate rate of drop speed increased from 68.45％ to 93.20％,the three sign standard rate rose from 75.20％ to 95.10％,and the patient's satisfaction with infusion increased from 85.60％ to 96.82％.Meticulous management can improve the safety of the internal medicine intravenous infusion as a whole.

A robot exoskeleton can improve hand function early after stroke / 中华物理医学与康复杂志

Objective To explore the effectiveness of a myoelectricity-driven hand robot on the recovery of hand motor function early after a stroke.Methods Thirty stroke survivors were randomly assigned to either a control group (n=15) or an experimental group (n =15).Both groups received routine rehabilitation exercises,while the experimental group additionally received hand training using a robotic hand exoskeleton.Before and after 4 weeks of treatment,the motor function of the wrist and fingers in both groups were measured using the Fugl-Meyer assessment.Spasticity in the index,middle,ring and little fingers was quantified using the modified Ashworth scale.The muscle force of the fourth finger,thumb and all of the fingers during maximum voluntary extension and flexion were recorded using the robot's surface electromyography system.Results Significant increases in the average Fugl-Meyer scores in both groups were observed after 4 weeks of treatment,but the experimental group's average score was by then significantly higher than that of the control group.The experimental group's average Ashworth score and the average sEMG amplitudes were also significantly better than those of the control group.Conclusion Supplementing routine rehabilitation exercises with a hand robot can improve hand motor function and muscle force significantly,as well as relieving hand spasticity early after a stroke.

Clinical analysis of 38 cases with histiocytic necrotizing lymphadenitis in children / 中国小儿急救医学

Objective To study the clinical and pathological features of histiocytic necmtizing lym-phadenitis( HNL) in children. Methods The clinical data and histological findings of 38 cases of HNL admitted in our hospital from June 2000 to May 2015 were reviewed. Results Most of the patients were school-age children with male-femal ratio of 1. 4: 1. The main clinical features were lymphadenopathy (100%),fever(68. 24%),leucocytopenia(52. 63%),rising of lymphocytes percentage(84. 21%). All of the lymph node excisional biopsy met the criterion of HNL. Some cases spontaneously relieved and some cases were treated with NSAID,glucocorticoid or immunoglobulin and benefited significantly. There was no recurrence. Conclusion The clinical situation is not specific. The diagnosis is established by lymph node ex-cisional biopsy. HNL is benign and self-limited disease. The effect of management using glucocorticoid, NSAID and immunoglobulin is remarkable. Long term follow-up is necessary.

Effects of high frequency repetitive transcranial magnetic stimulation on executive function in patients after stroke / 中华神经科杂志

Objective To observe the effect of high frequency repetitive transcranial magnetic stimulation ( rTMS) on executive function in patients after stroke .Methods Thirty-six stroke patients with executive dysfunction in the Second Affiliated Hospital of Guangzhou Medical University from March 2016 to April 2017 were randomly divided into experimental group ( n=18 ) and control group ( n=18 ) .The experimental group received 10 Hz rTMS of the left dorsolateral prefrontal cortex ( DLPFC ) and cognitive functional training , while the control group received sham rTMS and cognitive functional training , for four weeks.Mini-Mental State Examination(MMSE), Wisconsin Card Classification Test(WCST), Digit Symbol Test( DST) and Digital Span ( DS) were used for cognitive assessment at baseline and therapy completed . Results After a four weeks therapy , the total number of responses showed no significant difference in WCST between two groups.But the control group after treatment showed that MMSE score (17.44 ±4.73) and DST score (4.50 (2.75, 8.25)) were improved compared with that before treatment (MMSE score 15.28 ±4.61, t=-8.371, P=0.000;DST score 4.00 (2.75, 7.25), Z=-2.122, P=0.049), and the DS score and the numbers of correction , classification and continuous errors of WCST showed no significant difference compared with that before treatment .The experimental group after treatment showed that MMSE score (20.67 ±4.59), DST score (7.50(4.75, 12.50)), DS score (recite in order 7.00 (7.00, 8.00), recite in reverse order 3.00 (2.00, 4.00)), the numbers of correction of WCST (24.61 ± 8.30), the numbers of continuous errors (12.17 ±5.08), the numbers of classification (2.00 (2.00, 3.00) were improved compared with that before treatment ( MMSE score 15.50 ±5.24, t=-21.013, P=0.000;DST score 3.00(1.00, 7.00), Z=-3.757, P=0.000; DS score recited in order 6.00(5.00, 6.00), Z=-3.703, P=0.000;DS score recited in reverse order 2.00(1.00, 3.00), Z=-3.494, P=0.000;The numbers of correction of WCST (16.50 ±9.34), t=-6.544, P=0.000); The numbers of continuous errors (18.06 ±5.63, t=9.744, P=0.000); The numbers of classification (1.00 (1.00, 2.00), Z=-3.900, P=0.000 ).And the curative effect was better than that of control group . Conclusion High frequency rTMS combined with cognitive function training can improve the executive dysfunction of stroke patients , and the improvement is better than cognitive functional training alone .