Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019 / 中华儿科杂志

Objective: To explore the clinical characteristics, common pathogens in children with vulvovaginitis. Methods: This was a retrospective cases study. A total of 3 268 children with vulvovaginitis were enrolled, who visited the Department of Pediatric and Adolescent Gynecology, Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2019. Patients were divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Patients were also divided in to 4 groups according to the season of first visit. The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups. Their clinical data were collected and then analyzed by χ2 test. Results: The were 3 268 girls aged (6.2±2.5) years. There were 1 728 cases (52.9%) aged <7 years, 875 cases (26.8%) aged 7-<10 years, and 665 cases (20.3%) aged 10-18 years. Of these cases, 2 253 cases (68.9%) were bacterial vulvovaginitis, 715 cases (21.9%) were fungal vulvovaginitis and 300 cases (9.2%) were vulvovaginitis infected with other pathogens. Bacterial culture of vaginal secretions was performed in 2 287 cases, and 2 287 strains (70.0%) of pathogens were detected, of which the top 5 pathogens were Streptococcus pyogenes (745 strains, 32.6%), Haemophilus influenzae (717 strains, 31.4%), Escherichia coli (292 strains, 12.8%), Staphylococcus aureus (222 strains, 9.7%) and Klebsiella pneumoniae (67 strains, 2.9%). Regarding different age groups, H.influenzae was the most common in children under 7 years of age (40.3%, 509/1 263), S.pyogenes (41.9%, 356/849) was predominantly in children aged 7 to 10 years, and E.coli was predominant in children aged 10 to 18 years (26.3%, 46/175). Susceptibility results showed that S.pyogenes was susceptible to penicillin G (610/610, 100.0%), ceftriaxone (525/525, 100.0%), and vancomycin (610/610, 100.0%); the resistance rates to erythromycin and clindamycin were 91.9% (501/545)and 90.7% (495/546), respectively. For H.influenzae, 32.5% (161/496) produced β-elactamase, and all strains were sensitive to meropenem (489/489, 100.0%) and levofloxacin (388/388, 100.0%), while 40.5% (202/499) were resistant to ampicillin. Among E.coli, all strains were sensitive to imipenem(100%, 175/175). The resistance rates of E.coli to levofloxacin and ceftriaxone were 29.1% (43/148) and 35.1% (59/168), respectively. A total of 48 strains of methicillin-resistant Staphylococcus aureus (MRSA) were isolated with a proportion of 28.3% (45/159) in 3 268 patients. The results of drug susceptibility test showed that all MRSA strains were sensitive to linezolid 100.0% (40/40), vancomycin (45/45, 100.0%), and tigecycline (36/36, 100.0%); the resistance rates of MRSA to penicillin G, erythromycin and clindamycin were 100% (45/45), 95.6% (43/45) and 88.9% (40/45), respectively. All methicillin-sensitive Staphylococcus aureus (MSSA) strains were sensitive to oxacillin (114/114, 100.0%), linezolid (94/94, 100.0%), vancomycin (114/114, 100.0%), and tigecycline (84/84, 100.0%); it's resistance rates to penicillin G, erythromycin and clindamycin were 78.1% (89/114), 59.7% (68/114) and 46.5% (53/114), respectively. The drug resistance rate of MSSA to penicillin G, erythromycin and clindamycin were lower than those of MRSA (χ²=11.71,19.74,23.95, respectively, all P<0.001). Conclusions: The age of consultation for pediatric infectious vulvovaginitis is mainly around 6 years. The most common pathogens are S.pyogenes, H.influenzae and Escherichia coli. Third generation cephalosporins can be used as the first choice of empirical anti-infection drugs. However, the results of drug susceptibility should be considered for targeted treatment.

Clinical application of the modified pediatric nutritional risk screening tool / 中国当代儿科杂志

OBJECTIVE@#To study the clinical application of the modified nutritional risk screening tool and nutrition assessment in pediatric patients in China, and to provide a theoretical basis for establishing a standardized nutritional management process for pediatric patients.@*METHODS@#A retrospective analysis was performed for the nutritional risk screening and nutrition assessment data of 16 249 hospitalized children. According to the degree of nutritional risk, the children were divided into a high nutritional risk group with 588 children, a moderate nutritional risk group with 4 330 children, and a non-nutritional risk group with 11 331 children. Nutrition assessment results were compared between groups. The composition of nutritional risk screening scores and the impact of nutritional risk screening on the rate of nutrition support therapy were analyzed.@*RESULTS@#The incidence rate of nutritional risk was 30.27% (4 918/16 249), and the incidence rates of malnutrition and overnutrition were 27.37% (4 448/16 249) and 11.29% (1 834/16 249), respectively. Nutrition assessment results were significantly correlated with nutritional risk (≥ 5 years old:@*CONCLUSIONS@#There is a high incidence rate of nutritional risk in hospitalized children. The use of the modified pediatric nutritional risk screening tool can promote the implementation of standardized nutritional management.

An analysis on biovars and antimicrobial susceptibility of 78 Ureaplasma strains isolated from respiratory tract of hospitalized infants / 预防医学

Objective To learn the biovars,antimicmbial susceptibility in Ureaplasma species isolated from respiratory tracts of infants hospitalized in tertiary children's hospital,and to provide evidences and clinical basis for the prevention and treatment of Ureaplasma infection in infants.Methods Ureaplasma species cultivation,identification and antibiotic susceptibility testing were performed using Mycoplasma IST2.The primers according to the conservative MB-Ag gene were designed to identify Ureaplasma biovars.Erythmmcin resistant genes (ermA,ermB and ermC) and active effiux transporter genes (mefA/E,msrA/B and mreA) were amplified using PCRs.Results A total of 78 Ureaplasma positive cases,of them,48 Ureaplasma strains were isolated from premature neonates.Biovar 1 was present in 51 (65.38％) strains,and biovar 2 was present in 27 (34.62％) strains.There were no significant differences among sex,premature infant,age,gestational age,birth weight,length of stay (P ＞ 0.05).The drug resistance rates to ciprofloxacin and ofloxacin were 80.77％,and to tetracycline was 1.28％.All strains were sensitive to doxycycline,josamycin and pristinomycin.The drug resistance rates to the macrolide antibiotics (erythromycin,azithromycinand and clarithromycin) were ＜ 12％.There was no statistically significant difference among the drug resistance rates of different biovars and these antibiotics (P ＞ 0.05).Only the methylated enzyme gene (ermB) and the active efilux pump gene (msrA/B) were detected,and the detection rate was 39.74％ and 12.82％ respectively.The ermB gene mainly exists in biovar 2,and the detection rate is 55.56％ (P ＜ 0.05).The msrA/B was balanced distributed between biovar 1 and 2 (P ＞ 0.05).A total of 78 Ureaplasma strains were isolated from 24 cases of neonatal septicemia,30 cases of congenital infection pneumonia,9 cases of retinopathy of prematurity,9 cases of neonatal intracranial hemorrhage,and 15 cases of bronchopulmonmT dysplasia.Conclusion Biovar 1 is more prevalent in Ureaplasma species isolated from infant respiratory tract,and higher detection rate of Ureaplasma is found in the preterm infants.All Ureaplasma strains have high drug resistance to both ciprofloxacin and ofloxacin,but low drug resistance to the macrolide antibiotics (erythromycin,azithromycin and clarithromyc),that could be used as a first choice for the treatment of Ureaplasma infection.Erythromycin resistance gene ermB,mainly exists in biovar 2.

Nerve regeneration factor promotes nerve regeneration after sciatic nerve injury in rats / 第二军医大学学报

Objective: To investigate the promoting effect of nerve regeneration factor (NRF) on nerve regeneration after sciatic nerve injury in rats. Methods: Thirty Sprague-Dawely rats, including 15 females and 15 males, were equally randomized into 3 groups: low dose NRF group, high dose NRF group and control group. Rats' sciatic nerves were injured by crushing and sciatic function index (SFI) was determined by walking tract analysis at days 10, 15 and 20 after crushing. Then sciatic nerves on both sides were dissociated for electrophysiology study and the recovery rate of nerve conduction velocity (NCV) was calculated. Then, 2 rats were randomly selected from each group and the ultrastructure of regenerated sciatic nerves was observed by electron microscope. Meanwhile, the spinal cord segments (L4-L6), the distal site of injured sciatic nerve and the injured gastrocnemius muscle in other rats were observed by light microscope. The count of motor neurons of anterior horn, the number of myelinated fibers, the transverse section area of gastrocnemius muscle cells and other parameters were determined. Results: At day 10 after crushing, SFI scores had no significant difference between 3 groups; at day 15 after crushing, SFI score of high dose NRF group was significantly higher than that of the control group (P<0.01); at day 20 after crushing, SFI scores of 2 NRF groups were significantly higher than those of the control group (P<0.01, P<0.05). At day 20 after crushing, the recovery rates of NCV in the high dose group, the low dose group and the control group were (57±26)%, (44±15)% and (31±9)%, respectively, with significant difference between the high dose group and the control group (P<0.05). Compared with the control group, the high dose group had more mature myelinated nerve fibers and less degenerated nerve fibers. In the high dose group, the layout of regenerated nerve fibers was dense and well-arranged, the gastrocnemius muscle cells was well alive and neatly arranged, and the bilateral motor neurons of anterior horn was more close to each other. The numbers of motor neurons of anterior horn and myelinated nerve fibers in high dose group were significantly higher than those in control group (P<0.05,P<0.01); the transverse section areas of gastrocnemius muscle cells in both NRF groups were significantly higher than those in the control group (P<0.01,P<0.05). Conclusion: NRF can promote the regeneration of peripheral nerves and improve the recovery of their function.