New progress in diagnosis， prevention and epidemiology of Streptococcal pneumonia in Children / 上海预防医学

Streptococcus pneumoniae （Pneumococcus） is a kind of Gram-positive diplococcus with capsule， which is the main cause of morbidity and mortality of lower respiratory tract infection in the world. The death toll caused by Streptococcus pneumoniae is higher than that caused by Haemophilus influenzae type B， influenza virus and respiratory syncytial virus combined. In recent years， the infection rate and hospitalization rate of pneumococcal pneumonia have decreased with the vaccination of 7-valent pneumococcal conjugate vaccine （PCV 7） and 13-valent pneumococcal conjugate vaccine （PCV13）. This article will briefly review the new progress in hospitalization rate，diagnosis and treatment of pneumococcal pneumonia in children at home and abroad in the past decade.

Positive allergens in children with different allergic diseases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the major allergens in children with different allergic diseases, and to provide theoretical evidence for the clinical prevention, diagnosis, and treatment of allergic diseases in children.</p><p><b>METHODS</b>Skin prick test (SPT) was conducted to detect allergens in 1179 allergic children. According to clinical diagnoses, patients were categorized into six groups: atopic dermatitis (n=140), allergic gastroenteritis (n=37), allergic conjunctivitis (n=77), asthma (n=285), allergic rhinitis (n=301) and allergic co-morbidity (n=329) groups.</p><p><b>RESULTS</b>Of the 1179 patients, 82.0% had positive SPT results; the most prevalent inhalant allergens were Dermatophagoides farinae (68.1%) and Dermatophagoides pteronyssinus (53.5%), while the most common food allergens were milk (5.0%) and eggs (4.8%). The proportions were 84.3% and 83.8% for patients under or equal to 3 years of age in the atopic dermatitis and allergic gastroenteritis groups, respectively. Patients over 4 years of age accounted for the majority of the other four groups. Food as major allergens were found in both atopic dermatitis and allergic gastroenteritis groups; eggs and Dermatophagoides farinae were the most common allergens for the former group, while eggs and milk for the latter group. Inhalant allergens were the major allergens in the allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups, and the most prevalent allergens were Dermatophagoides farinae and Dermatophagoides pteronyssinus.</p><p><b>CONCLUSIONS</b>There are differences in the distribution of age and allergen types in children with different allergic diseases. Atopic dermatitis and allergic gastroenteritis are prevalent in infants and young children, and food allergens are more common. Patients in allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups are mostly children over 4 years of age, and inhalant allergens are more common.</p>

A novel point mutation in CD18 causing leukocyte adhesion deficiency in a Chinese patient / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Leukocyte adhesion deficiency type 1 (LAD-1) is a rare, autosomal recessive inherited immunodeficiency disease characterized by recurrent severe bacterial infection, impaired pus formation, poor wound healing, associated with the mutation in the CD18 gene responsible for the ability of the leucocytes to migrate from the blood stream towards the site of inflammation. Correct and early diagnosis of LAD-1 is vital to the success of treatment and prevention of aggressive infections. The purpose of this study was to collect the clinical findings of the disease and to identify the genetic entity.</p><p><b>METHODS</b>CD18 expression in the peripheral blood leukocytes from the patient, his parents and normal control was measured with flow cytometry. The entire coding regions of the CD18 gene were screened with direct sequencing genomic DNA.</p><p><b>RESULTS</b>CD18 expression level on this patient's leukocyte surface was significantly decreased, with normal level in control group, his father and mother. Gene analysis revealed that this patient had a homozygous c.899A > T missense mutation in exon 8 of CD18 gene, causing the substitution of Asp to Val at the 300 amino acid. His parents were both heterozygous carriers while no such mutation was found in 50 normal controls.</p><p><b>CONCLUSION</b>This study disclosed a novel point mutation Asp 300 Val located in a highly conserved region (HCR) of CD18 and confirmed the heterogeneity of the mutations causing LAD-1, indicating it was quite beneficial to establish correct and early diagnosis in children with severe LAD-1.</p>

Clinical features and follow-up of Chinese patients with symptomatic hypogammaglobulinemia in infancy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hypogammaglobulinemia is common in infant humoral immunodeficiencies and has complicated causes and outcomes. We aimed to determine the clinical manifestations, immunological changes and outcomes of Shanghai infants with hypogammaglobulinemia.</p><p><b>METHODS</b>Patients under 2 years old, having one or more warning signs of primary immunodeficiency disorders, serum immunoglobulin levels below the lower limit of reference range per age, and with normal numbers for lymphocyte subsets, were analyzed and followed up for 2 to 3 years.</p><p><b>RESULTS</b>A total of 91 children (male-to-female ratio: 2.25: 1) participated in the study. Initial clinical presentation was recurrent upper respiratory tract infection (46%), invasive infection (3%), atopic disease (32%). IgA reduction (77%) was prevalent; 34% patients had more than one isotype reduced. During follow-up, 51 of 62 patients (82.25%) had immunoglobulins normalized at the age between 12 - 48 months; these were diagnosed as transient hypogammaglobulinemia of infancy (THI). Long-term follow-up may reveal a diagnosis for the remaining 11 infants with persistent lower immunoglobulin levels, who did not have antibody titers measured. Earlier onset was correlated with higher rates of normalization. More patients were diagnosed with isolated hypogammaglobulinemia in 2006 compared with the previous 4 years (2002 - 2005).</p><p><b>CONCLUSIONS</b>The awareness of immunodeficiency among pediatricians has been greatly improved. Recurrent otitis media was not a major infection in our patients. THI is a relatively common condition associated with infant hypogammaglobulinemia. In the absence of specific antibody titers, the diagnosis of THI can be confirmed retrospectively with Ig levels normalized in follow-up visits. Therefore, long-term follow-up and frequent re-evaluation of these patients are necessary to distinguish them from true primary immunodeficiency.</p>

Etiology and airway management in children with tracheobronchomalacia / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate etiology and airway management in children with tracheobronchomalacia.</p><p><b>METHOD</b>Bronchoscopic examinations were performed in 671 children. The cases with tracheomalacia and bronchomalacia were analyzed in etiopathogenesis and summarized their therapy simultaneously.</p><p><b>RESULT</b>Bronchoscopic examination indicated tracheomalacia and bronchomalacia in 148 cases, tracheomalacia in 77 cases and bronchomalacia in 71 cases. Among the cases with tracheomalacia, compression by vascular rings was found in 46 cases, incorporated congenital esophageal atresia with tracheoesophageal fistula was found in 5 cases, tracheomalacia was associated with tracheostoma and mechanical ventilation in 6 cases, with congenital airway malformation in 11 cases and isolated tracheomalacia was found in 4 cases. Among the cases with bronchomalacia, incorporated congenital cardiovascular malformation was found in 64 cases, congenital airway malformation in 6 cases and isolated bronchomalacia in 1 case. Ten children with anomalous innominate artery underwent aortopexy, twelve children with dextro-aorta arch with concomitant aberrant left subclavian artery and double aorta underwent arches vascular ring lysis, six children with pulmonary sling underwent plasty. Severe malacia segments were resected directly in four children during operation. Mechanical ventilation was performed in 38 children. Tracheostoma was performed in 4 children to treat tracheomalacia and bronchomalacia, it could relieve symptom to a certain extent. In 2 children metal stents were inserted into the bronchus for the treatment of bronchomalacia, one was successful and the other needed re-insertion of stent again, these two patients underwent balloon-dilatation in distal part of stent afterwards.</p><p><b>CONCLUSION</b>The congenital cardiovascular malformation was the main reason to develop tracheobronchomalacia in children. The symptom of majority of the cases with cardiovascular malformation would be improved within 6 months after surgical intervention. In severe cases, treatments included mechanical ventilation and tracheostoma. Stenting could be applied in refractory cases, but it had certain limitations.</p>

Overview of clinical occurrence of primary immunodeficiency disorders in children / 中华儿科杂志

<p><b>OBJECTIVE</b>More than one hundred primary immunodeficiency disorders have been discovered so far. But the incidence of these disorders in our country is still not clear, so we analyzed the clinical data of 93 children with primary immunodeficiency disorders seen in our hospital in recent 30 years to understand the occurrence of primary immunodeficiency disorders in children, to promote the clinicians to become familiar with these disorders, to improve the nationwide registry system and to establish the basis for the treatment and prevention in future.</p><p><b>METHODS</b>To analyze the constituent ratio of the 93 children with primary immunodeficiency disorders seen in our hospital from 1974 to 2003, diagnostic and classification criteria were set by taking the proposal by International Union of Immunological Societies (IUIS) PID classification committee in 2003 into account. All the data were analyzed retrospectively.</p><p><b>RESULTS</b>In the 93 children with primary immunodeficiency disorders, antibody deficiencies were the most frequent (39.8%) finding, followed by combined immunodeficiency, combined T- and B-cell disorders (22.6%), and T lymphocytic deficiencies alone (14.0%). Immunodeficiency with other major defects accounted for 12.9%, phagocytic disorders 9.7%, and complement deficiencies 1.1%. Thus, there seemed to be a tendency that the incidence increased with time. The incidence of these disorders has increased significantly as shown by 50 diagnosed cases in children with these disorders since 1996. Sixteen children died, with the highest mortality occurred with combined immunodeficiency. Seven children developed bronchiectasis. Two children suffered from persistent diarrhea while one of the two was complicated with persistent intestinal fistula. One child developed juvenile rheumatoid arthritis, another one with granulocytopenia and iridocyclitis, and the other with allergic purpura. The boys: girls ratio for all disorders was 3:1. The age of onset ranged from 10 days to 37 years of age.</p><p><b>CONCLUSIONS</b>There are vast variety of primary immunodeficiency disorders in our area and antibody deficiency is the most common abnormality. Combined immunodeficiency has early onset age and high mortality rate. With the great improvement of the diagnostic techniques, these disorders have become a group of important disorders and all the clinicians should pay great attention to these disorders.</p>

Comparison of surface marker of monocyte-derived dendritic cells between cord blood and adult peripheral blood / 上海第二医科大学学报

0.05).The percentage of CD40 positive cells in CBMC-derived DC was lower than that in PBMC-derived DC[(34.80?7.77)% vs(54.37?9.57)%,P

Mechanism of inhibitory effect of intravenous immunoglobulin on neonatal umbilical cord blood lymphocytes / 中华儿科杂志

<p><b>OBJECTIVE</b>The expression of CD25, CD45RA, CD45RO on umbilical cord blood mononuclear cells (CBMCs) and CD3(+) T lymphocytes was investigated to explore the mechanism of immunosuppressive effects of intravenous immunoglobulin on neonatal immune function.</p><p><b>METHODS</b>Umbilical cord blood mononuclear cells and CD3(+) T lymphocytes isolated from 8 neonates were studied. The expression of CD25, CD45RA, CD45RO on umbilical cord blood mononuclear cells (CBMCs) and CD3(+) T lymphocytes induced with various stimuli of different combinations of IVIG and phytohemagglutinin (PHA) including (1) control group, (2) PHA activation group, (3) IVIG pre-inhibition group, (4) PHA pre-activation group, (5) PHA+IVIG group was measured with four-color immunofluorescence antibodies staining-flow cytometric technique. The results were also compared with peripheral blood mononuclear cells of 8 adults (PBMCs).</p><p><b>RESULTS</b>IVIG inhibited the PHA-induced proliferation of CBMCs as reflected by the decreased expression of CD25 and CD45RO. The amounts of CD25(+) and CD4(+)CD45RO(+) CBMCs reached 77.52% +/- 2.31% and 64.29% +/- 3.09% after PHA use. But a decreased response in CD25(+) (7.66% +/- 1.20% and 7.78% +/- 1.46%) and CD4(+)CD45RO(+) CBMC (3.18% +/- 1.90% and 3.11% +/- 0.08%) was observed when IVIG was added in both IVIG pre-inhibition group and PHA+IVIG group. As compared with PBMCs, IVIG failed to induce the increase of the expression of CD45RA in CBMCs whereas CD45RA(+) PBMCs increased from 54.93% +/- 3.63% to 72.77% +/- 0.39% in IVIG pre-inhibition group. Moreover, IVIG inhibited the expression of CD25 and CD45RO on cord blood CD3(+) T lymphocytes no matter whether they were activated with PHA or not. The amounts of CD25(+) and CD4(+)CD45RO(+) CD3(+) T lymphocytes reached 97.92% +/- 2.19% and 80.41% +/- 5.57% after PHA use. But a decreased response in CD25(+) CBMCs (77.29% +/- 0.63%, 51.48% +/- 1.85% and 62.73% +/- 1.24%) and CD4(+)CD45RO(+) CD3(+) T lymphocytes (35.47% +/- 2.55%, 40.14% +/- 1.16% and 36.41% +/- 2.96%) was observed when IVIG was added in IVIG pre-inhibition group, PHA pre-activation group and PHA+IVIG group, and the degree of inhibition of IVIG on cord blood CD3(+) T lymphocytes was much lower than that of CBMCs.</p><p><b>CONCLUSIONS</b>Cord blood T lymphocytes activation was inhibited by IVIG through the inhibition of CD25(+) CBMCs expression and the prevention of transformation from CD4(+)CD45RA(+) cells into CD4(+)CD45RO(+) cells. This IVIG-mediated suppression of activation in cord blood T cells may be derived from the indirect effect of other immune cells or molecules other than the direct effects on T cells. IVIG failed to induce the increase of expression of CD45RA in CBMCs, which may be related to the fact that majority of CBMCs were CD45RA(+) cells, but this may not rule out that the immunosuppressive effect of IVIG could be accomplished by the increase of CD45RA(+) cells in adult peripheral blood mononuclear cells. The suppressive effect of IVIG on CD4(+)CD45RO(+) T lymphocytes may account for its inhibitory effect on immunoglobulin production of neonates' B cells. Considering that naïve CD45RA(+) cells dominate in neonates and IVIG can inhibit transformation from CD4(+)CD45RA(+) cells into CD4(+)CD45RO(+) cells, it is recommended that IVIG should be used properly in neonates, otherwise it may deteriorate their poor immune function especially when it is used for prophylaxis or as a treatment of neonatal non-infectious diseases, and its immunosuppressive action will increase the susceptibility of neonates to infection.</p>

Clinical Significance of Changes of Interleukin-15 Levels in Children with Kawasaki Disease / 实用儿科临床杂志

Objective To explore the role of interleukin-15(Il-15)in pathogenesis of Kawasaki disease(KD)and its potential cli-nical value.Methods Thirty patients with KD were selected in Xinhua hospital from Oct.2004 to Jan.2006.The serum concentration of IL-15 was measured by enzyme linked immunosorbent assay(ELISA)in acute stage and convalescent stage of KD,and 30 children with low respiratory inflection and 20 healthy children were studied as controls.Results Serum IL-15 level in acute KD was significantly higher than that in normal control,and the two sides were remarkably different in statistics(q=25.64 P

Reactivity and antigenic cross-reactivity of latex in children with allergic disorders / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the relationship between latex allergen and clinical presentation as well as allergenic cross-reactivity between latex and other allergens, to know the incidence of latex allergy in Chinese children and elucidate the allergenic cross-reactivity of latex with other allergens.</p><p><b>METHODS</b>Totally 265 children with allergic disorders were assayed with 13 international standard allergen agents by means of SPT.</p><p><b>RESULTS</b>In 79 children with latex allergenic SPT position, 53 were boys and 26 were girls with an average age of 5.6 years, and 14 cases had episodes occurred in winter, 14 cases in spring, 24 cases in summer, and 27 cases in autumn. Of them, 66 cases presented as asthma, 5 cases atopic skin disorders, 1 case anaphylactoid purpura, 1 case hives and 6 cases only had mild cough. Statistical analysis showed that the positive percentage of the latex SPT had no obvious relation with sex and age, but was higher in summers and autumns than in winters and springs (P < 0.01). Children with allergic symptoms had higher positive rate in latex allergenic SPT than those without them, that is, the positive percentage of the latex SPT significantly increased among children presenting with some allergic symptoms, such as asthma, hives and atopic skin disorders (P < 0.01). All the children with latex allergenic SPT position had cross-reactivity with acarid allergen, 62.0% approximately 43.0% with animal protein allergens including milk, cats, shrimp, dogs, eggs in the order of decreasing cross-reaction rate, and 10.1% - 3.8% with mold and plant farina allergens. But the cross-reactivity between latex and mold or tree farina I were not statistically significant.</p><p><b>CONCLUSION</b>Thirty percent of the children with allergic disorders were latex allergenic SPT positive. Latex allergenic SPT positive results were significantly correlative to allergic clinical presentation and season, while were not relative to sex and age. The cross-reactivity of latex with acarid was most common, followed by animal protein allergens, while the cross-reactivity with mold and plant farina allergen was rare.</p>

Reactivity and Antigenic Cross - Reactivity of Cat Fur or Dog Fur in Children with Allergic Disorders / 实用儿科临床杂志

Objective To explore the relationship between cat fur or dog fur allergens and clinical presentation, as well as allergenic cross-reactivity between cat fur or dog fur allergens and other allergens. Methods Totally 548 children with allergic disorders were assayed with 13 international standard allergen agents by means of SPT. The results were denominated according to the size of skin areola or welt, reference histamine as positive, isotonic Na chloride as negative. Results In 143 children with cat fur allergenic SPT position, 98 cases were boys and 45 cases were girls with an average age of 5. 84 years. In 96 children with dog fur allergenic SPT positive,60 cases were boys and 36 cases were girls with an average age of 6.06 years. The most had occurred in summer. Of them,a large number of cases presented asthma,secondly presented mild cough. Besides, the cross- reactivity of cat fur and dog fur allergenic SPT positive in 64 cases with acarid was most common, followed by latex, which exceeded animal protein, while the cross - reactivity of mold, plant farina and chomophyte allergens were rare. Conclusions About 20% children with allergic disorders are cat fur or dog fur allergenic SPT positive. Cat fur or dog fur allergenic SPT positive results are significantly correlative to age and season, however they are not relative.to sex. Cat fur or dog fur allergens exist correlations with other allergens.

Non-myeloperoxidase-mediated system activity of neutrophil in newborn infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the variety of non-myeloperoxidase-mediated system activity of neutrophils in newborns during bacterial infection and the effect of cord plasma on the activation of non-myeloperoxidase-mediated system.</p><p><b>METHODS</b>An infection model with Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) and a non-infection model with phorbol-12-myristate-13-acetate (PMA) were established to investigate the activation of non-myeloperoxidase-mediated system in neutrophils. According to the intensity of fluorescence, the activation of non-myeloperoxidase-mediated system of neutrophils was detected by flow cytometry (FCM). The blood cells and plasma were separated from cord blood and adult blood and cross-mixed in order to investigate the opsonic activity.</p><p><b>RESULTS</b>In the non-infection model, the activation of non-myeloperoxidase-mediated system with PMA stimulation in cord blood was lower compared with that in adult blood, the statistical difference was significant (t = 3.378, P < 0.01). In the infection model, the activations of non-myeloperoxidase-mediated system in cord blood were also lower compared with those in adult blood, while the statistical difference could only be found in the model with E. coli stimulation (t = 12.150, P < 0.001). Furthermore the experiments demonstrated that cord plasma could deeply depress the non-myeloperoxidase-mediated system activity with E. coli stimulation. On the contrary, adult plasma could successfully recruit the potential of non-myeloperoxidase-mediated system activity of neutrophils in newborns.</p><p><b>CONCLUSION</b>The function of neonatal neutrophils might not developed very well. As a stimulant, E. coli failed to induce the non-myeloperoxidase-mediated system activity in neonates, which might be related to the lower level of immunoglobulins in cord blood. This result indicated that immunoglobulins played a more important modulating role in bacterial killing during gram-negative bacterial infections.</p>

Significance of Interleukin-10 and Transforming Growth Factor-beta 1 Detection in Children with Mycoplasma Pneumoniae Pneumonia / 实用儿科临床杂志

Objective To explore the changes of interleukin-10(IL-10) and transforming growth factor-beta 1(TGF-?1)in 26 children with mycoplasma pneumoniae pneumonia(MPP).Methods Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of IL-10 and TGF-?1 in the serum of 12 healthy children as normal controls and 26 patients of acute stage as acute stage MPP group,9 of acute stage MPP group in recovery stage as recovery stage MPP group.The levels of IL-10 and TGF-?1 were compared between the three groups.Results IL-10 level in acute stage MPP group was significantly lower than that in normal controls(P