Expression and clinical significance of laboratory of genetics and physiology 2, retinoic acid inducible gene I and melanoma differentiation associated gene 5 in children with hand, foot and mouth disease / 中国小儿急救医学

Objective:To detect the expression levels of laboratory of genetics and physiology 2 (LGP2), retinoic acid inducible gene I (RIG-I) and melanoma differentiation associated gene 5 (MDA5) in children with hand, foot and mouth disease (HFMD), and to explore their possible clinical significance in HFMD.Methods:Fifty children with HFMD, who visited Second Affiliated Hospital of Xi′an Jiao Tong University, Xi ′an Children′s Hospital and Xi ′an Central Hospital from May 2020 to May 2021, were selected as the research subjects, and 20 children with physical examination at the same age during the same period were selected as the control group.Children with HFMD were divided into enterovirus 71 (EV-A71) type and coxsackievirus A6 (CV-A6) type according to the results of pathogen detection, and then divided into mild group and severe group according to the severity of the disease.The relative mRNA expression levels of LGP2, RIG-I and MDA5 in each group, and the correlation among the three proteins were compared and analyzed.Results:Among 50 cases of HFMD, 26 cases were EV-A71 type (16 cases were mild and 10 cases were severe) and 24 cases were CV-A6 type (17 cases were mild and 7 cases were severe). There was no significant difference in age and sex between HFMD group and control group ( P>0.05). The relative expression levels of LGP2 mRNA in EV-A71 and CV-A6 HFMD cases were 2.37(1.78, 3.25)% and 1.88 (1.35, 3.13)%, lower than that in control group [2.97(2.61, 3.55)%]. Only the difference between CV-A6 HFMD children and control group was statistically significant ( Z=-2.310, P=0.021). The relative expression levels of RIG-I mRNA in EV-A71 and CV-A6 HFMD cases were 9.95 (7.79, 14.62)% and 9.78(7.04, 15.83)%, lower than that in control group [18.47(13.00, 21.07)%]. The differences were all statistically significant ( P<0.05). The relative expression levels of MDA5 mRNA in EV-A71 and CV-A6 HFMD cases were 4.41(2.82, 5.99)% and 3.98 (2.18, 7.41)%, lower than that in control group [5.10(3.52, 7.71)%], but the differences were not statistically significant.There were no significant differences in the relative expression levels of the three indicators between the mild and severe groups of children with EV-A71 or CV-A6 HFMD.The expression levels of LGP2, RIG-I and MDA5 mRNA were highly correlated( P<0.001). Conclusion:The relative expression levels of LGP2, RIG-I and MDA5 mRNA in children with HFMD are decreased in different degrees than those in normal children.And there is a correlation among them.

Research progress on insulin like growth factor-1 and infectious diseases / 中国小儿急救医学

Insulin like growth factor-1(IGF-1) has been found to be a cell proliferation regulator that promotes cell differentiation and proliferation.In recent years, IGF-1 has been found to play an important role in infectious diseases, participating in the occurrence and development of a variety of infectious diseases.This review briefly summarized the research progress on IGF-1 in infectious diseases, providing new ideas for the application of IGF-1 in clinical diagnosis and treatment of infectious diseases.

Expression and clinical significance of vitamin D receptor in children with hand, foot and mouth disease / 中国小儿急救医学

Objective:To detect the expression level of vitamin D receptor(VDR) in children with hand, foot, and mouth disease(HFMD), and explore its potential value in the diagnosis and treatment of children with HFMD.Methods:A total of 82 children with HFMD hospitalized in the Second Affiliated Hospital of Xi′an Jiaotong University and Xi′an Children′s Hospital from May 2017 to May 2019 were selected as the case group.At the same time, 42 healthy children who underwent physical examination in the Child Health Department during the same period were randomly selected as the control group.Peripheral blood of two groups of children was extracted to detect and compare the expression levels of VDR mRNA in mononuclear cells, and the correlation between the expression level of VDR and HFMD and the correlation with various clinical characteristics were analyzed.Results:The relative expression of VDR in children with EV71 HFMD was 2.03%±0.38%, which was lower than that in children of control group(3.11%±1.29%), and the difference was statistically significant( t=-3.586, P=0.001). However, the relative expression of VDR in children with CA16 HFMD was 3.69%±1.79%, which was higher than that in children of control group, and the difference was not statistically significant( t=1.043, P=0.305). Among children with EV71 HFMD, the relative expression level of VDR was significantly different between the mild group and the severe group(2.18%±0.44% vs. 1.84%±0.17%, t=2.199, P= 0.041). There was no statistical difference regarding the relative expression level of VDR between mild and severe CA16 HFMD(4.16%±1.73% vs. 2.93%±1.73%, t=1.587, P=0.129). Conclusion:Compared with healthy children, the expression level of VDR is significantly lower in children with EV71 HFMD, and may be related to the severity of EV71 HFMD.

Association of single nucleotide polymorphisms in the vitamin D receptor gene with the clinical outcome of influenza in children / 中国小儿急救医学

Objective:To investigate the association of single nucleotide polymorphisms(SNPs)in the vitamin D receptor(VDR)gene with influenza susceptibility and severity of disease in children.Methods:Peripheral venous blood was collected from 172 children with influenza A (study group) and 88 healthy children (healthy control group) admitted to Xi ′an Children′s Hospital and Xi ′an Central Hospital from February 2019 to February 2021.Serum 25-hydroxyvitamin D(25-OH-D) level was detected by using 25-OH-D kit.The study group was divided into three groups according to clinical syndrome: mild group, severe group, and critical group.Four candidate loci in the VDR gene(ApaI, TaqI, FokI, and BSMI)were selected, and polymorphisms in the VDR gene of each group were determined by polymerase chain reaction restriction fragment length polymorphism and analyzed in relation to children with influenza.Results:Compared with the healthy control group[(109.65±4.35) nmol/L], the serum 25-OH-D levels in the study groups were lower[(73.55±2.46)nmol/L in the mild group, (45.59±4.62) nmol/L in the severe group, and (33.65±3.87) nmol/L in the critical group]( P<0.05); Genotypes AA, Aa and allele A of the ApaI locus(51.74%, 22.67%, and 63.08%, respectively)and genotypes FF, Ff and allele F of the FokI locus(41.86%, 34.88%, and 59.30%, respectively)accounted for a significantly higher proportion of cases in the study group than those in healthy control group(11.36%, 14.77%, 18.75%, 10.23%, 13.64%, and 17.05%, respectively)( P<0.05). The proportion of allele A at the ApaI locus and genotypes AA and Aa in severe group(63.70%, 43.84%, and 28.76%) were significantly higher than those in mild group(47.37%, 35.09%, and 24.56%)( P<0.05); The proportion of allele A and genotype AA and at the ApaI locus in critical group(92.86%, 88.10%, and 49.52%) were significantly higher than those in severe group( P<0.05). Serum 25-OH-D<50 nmol/L( OR=5.087, 95% CI 3.114-5.648), ApaI site genotypes AA ( OR=4.011, 95% CI 1.217-18.624)and Aa( OR=3.839, 95% CI 2.483-1.456), FokI site genotypes FF( OR=4.112, 95% CI 3.215-20.775)and Ff( OR=4.591, 95% CI 0.032-10.936)were risk factors for the onset of influenza in children. Conclusion:Serum 25-OH-D deficiency is associated with childhood influenza, and VDR gene genotype AA and Aa of ApaI locus, and FokI site genotype FF, Ff may increase the risk of childhood influenza susceptibility, and allele A of ApaI locus and genotypes AA and Aa are associated with the severity of influenza.

Utility of gamma-glutamyl transpeptidase and liver Young′s modulus for differential diagnosis of biliary atresia and infant intrahepatic cholestasis / 中国小儿急救医学

Objective:In this study, the clinical data of biliary atresia(BA) and infant intrahepatic cholestasis(IHC) was reviewed, and the utility of gamma-glutamyl transpeptidase(GGT) and liver Young′s modulus in the differential diagnosis of BA and IHC in infants was discussed.Methods:Based on the clinical data of 120 infants with cholestasis treated in the Children′s Hospital Affiliated to Xi′an Jiaotong University, from September 2017 to December 2019, the infants were divided into two groups according to the results of intraoperative cholangiography and follow-up: BA group( n=50); IHC group( n=70). The age, clinical manifestations, laboratory examination results, gallbladder contraction rate, hepatobiliary scintigraphy, liver Young′s modulus, and medical treatment effects were compared between the two groups.The utility of GGT and liver Young′s modulus in the differential diagnosis of BA and IHC was analyzed. Results:The age, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bile acid, fasting blood glucose, blood ammonia and splenomegaly between the two groups were compared and the results showed no statistical significance( P>0.05). In contrast, there were statistically significant differences( P<0.001) in stool color, liver size, total bilirubin(TB), direct bilirubin(DB), GGT, liver Young′s modulus, positive hepatobiliary scintigraphy, gallbladder contraction rate at 1 hour after meal, and medical treatment effect between the two groups.TB, DB, GGT, liver Young′s modulus and GGT combined with liver Young′s modulus were analyzed using ROC curves, and the area under the curve(AUC) were 0.820, 0.809, 0.906, 0.876 and 0.926, respectively.When GGT exceeded the cut-off value of 198.85 U/L, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 82.0%, 84.3%, 78.8%, 86.8% and 83.3%, respectively.When liver Young′s modulus exceeded the cut-off value of 8.6 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 88.0%, 80.0%, 75.9%, 90.3% and 83.3%, respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of GGT combined with liver Young′s modulus in diagnosing BA were 98.0%, 68.6%, 69.0%, 98.0% and 80.8%, respectively.Multivariate logistic regression analysis found that DB>115.55 μmol/L, GGT>198.85 U/L, and liver Young′s modulus>8.6 kPa were risk factors for BA( OR=9.510, P=0.001; OR=24.634, P<0.001; OR=21.469, P<0.001). Conclusion:GGT and liver Young′s modulus are useful in the differential diagnosis of BA and IHC.If GGT and liver Young′s modulu sexceed the threshold values of 198.85 U/L and 8.6 kPa respectively, it can effectively indicate that the child is BA.

Study on the relationship between high mobility group protein 1 and the severity of enterovirus 71 hand, foot and mouth disease / 中国小儿急救医学

Objective:To study the relationship between the level of high mobility group protein 1(HMGB1)and the severity of hand, foot and mouth disease (HFMD).Methods:A total of 150 children with enterovirus 71(EV71) HFMD admitted to Xi′an Children′s Hospital from April 2018 to December 2019 were selected as the study objects, including 100 mild cases(normal group) and 50 severe cases(severe group). Meanwhile, 50 healthy children during the same period were selected as control group.The level of HMGB1 in plasma was detected by ELISA.The clinical data and laboratory examination of the case group were collected.The factors that may affect the conversion of HFMD to severe were analyzed by single factor and multi-factor Logistic regression analysis.The risk factors of conversion of HFMD to severe and the correlation between the level of HMGB1 in plasma and the severity of HFMD were discussed.Results:The level of HMGB1 in EV71 HFMD children in the acute stage[(13 700±3 036)pg/mL] was significantly higher than that in the control group[(10 116±2 435) pg/mL]( t=5.913, P<0.05). After treatment, the level of HMGB1 decreased in the convalescence period[(10 658±2 349) pg/mL], and the difference was not statistically significant compared with the control group ( t=2.515, P>0.05). Blood glucose, white blood cell count and HMGB1 level in the severe group were all higher than those in the normal group (all P<0.05). Multivariate Logistic regression analysis found that the levels of blood glucose >8.3 mmol/L, peripheral blood leukocyte >15×10 9/L, and HMGB1≥ 13 110 pg/mL were the risk factors for severe aggravation of HFMD in children.The receiver operating characteristic curve analysis showed that when HMGB1 was 13 110 pg/mL, the Yoden index was the highest, with a sensitivity of 81.6% and a specificity of 72.0%. Conclusion:WBC>15×10 9/L, blood glucose>8.3 mmol/L and HMGB1≥13 110 pg/mL are the risk factors of HFMD.When HMGB1 is higher than, it suggests that HFMD may develop to severe.

Correlation between the levels of plasma brain natriuretic peptide and coxsackie virus A6 in hand, foot and mouth disease / 中国小儿急救医学

Objective:To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection.Methods:A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD.Results:Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×10 9/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD( OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001). Conclusion:BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.

Research progress of vitamin D and infectious diseases / 中国小儿急救医学

Vitamin D is a fat-soluble steroid hormone, which has a wide range of physiological effects in human body.It has been found that vitamin D not only plays an important role in diseases of skeletal system, cardiovascular system and immune system, but also participates in the occurrence and development of infectious diseases.In infectious diseases, vitamin D regulates innate and adaptive immune responses by regulating a variety of immune cells and cytokines, and also plays a bactericidal role by mediating the expression of antimicrobial peptides.This paper briefly introduced the relationship between vitamin D deficiency and infectious diseases in children.

Clinical characteristics of 7 children with Streptococcus pneumoniae cellulitis / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis. Methods:The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1 138 children diagnosed with invasive pneumococcal disease(IPD), 7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results:Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1 138 cases) of 1 138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old, and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis (LCH) was found in 1 case.Clinical manifestations: fever, local swelling and pain with infection.The focus of cellulitis: orbital cellulitis in 2 cases, buccal infection in 2 cases, upper extremity, head and buttock infection in 1 case, respectively.At the beginning of the disease: 2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media, 1 case was treated with acute periapical inflammation, 1 case was 10 months after chemotherapy.Type of infection: 6 cases were complicated with bloodstream infection, 2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results: 6 cases of Streptococcus pneumoniae were cultured in peripheral blood, 2 cases were positive in local pus culture.Drug sensitivity test: 6 cases were sensitive to Penicillin and Cephalosporin (Cefotaxime/Ceftriaxone), 1 case was resistant.Treatment: 3 patients were treated with Cephalosporins alone, 2 cases with Cephalosporins and Penicillins, 2 cases with Vancomycin and Meropenem for meningitis, 3 cases with local abscess by incision and drainage, 2 cases with meningitis in Intensive Care Unit, and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days). Discharge outcome: 6 cases improved and 1 case died. Conclusions:Cellulitis is a rare type of infection in children with IPD.It is mainly found in the head, face and around the orbit.It may be accompanied by bloodstream infection or bacterial meningitis.Most of them have a good prognosis.

Clinical features of 9 children with osteomyelitis caused by Streptococcus pneumonia / 中华实用儿科临床杂志

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia. Methods:The demographic characteristics, diagnosis, clinical manifestations, imaging features, treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed. Results:A total of 9 cases were enrolled, with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling, pain, limited mobility (9 cases) and fever (8 cases). Sites of infection included humerus (4 cases), femur (3 cases) and tibiofibula (2 cases), and 8 cases were complicated with septic arthritis; The laboratory tests showed increased white blood cells (8 cases, median 22.02×10 9/L), C-reactive protein (7 cases, median 55.44 mg/L) and erythrocyte sedimentation rate (6 cases, median 70 mm/1 h) of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins. Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity. All patients were treated with puncture, incision drainage or fenestrating decompression.Eight patients were cured and discharged finally. Conclusions:Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis, and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.

Association of Vitamin A and Vitamin D levels with severity of Coxsackie virus A6 induced hand, foot and mouth disease / 中华实用儿科临床杂志

Objective:To explore the relationship of Vitamin A and Vitamin D with the incidence and severity of hand, foot and mouth disease(HFMD) as well as with the anti-viral immune index interferon-α(INF-α), and to investigate the role of Vitamin A and Vitamin D in HFMD.Methods:A total of 305 children with Coxsackie virus A6(CA6) HFMD admitted at Xi′an Children′s Hospital from January 2017 to December 2018 were enrolled in the study.One hundred healthy children whose gender and age matched with those of children in the case group were selected as the healthy control group.Serum Vitamin A levels were detected by high performance liquid chromatography.Enzyme-linked immunosorbent assay was used to detect the levels of Vitamin D and IFN-α, and the correlation of the levels of Vitamin A and Vitamin D with the severity of HFMD was analyzed.Results:The levels of serum Vitamin A[(0.96±0.39) mg/mol] and Vitamin D [(42.14±15.13) μg/L] in patients with CA6 HFMD were lower than those of the healthy control group[(1.26±0.29) mg/mol, (49.63±8.86) μg/L], and the differences were statistically significant(all P<0.05). Logistic multivariate regression analysis showed that WBC>15×10 9/L, blood sugar>8.3 mmol/L, the deficiency of Vitamin A level and Vitamin D level were all risk factors for severe CA6 HFMD in children( OR=2.303, 4.622, 7.346, 5.211; all P<0.05). According to the receiver operating characteristic curve analysis, the Youden index was the largest at a Vitamin A level of 0.725 mg/mol, and the corresponding sensitivity and specificity were 82.0% and 64.8%, respectively.When Vitamin D level was 32.88 μg/L, the Youden index was the highest, and the sensitivity and specificity were 84.5% and 61.9%, respectively.The serum IFN-α concentration of patients with CA6 HFMD [(84.44±26.28) ng/L] was higher than that of the healthy control group [(36.58±14.39) ng/L], and the difference was statistically significant( P<0.05). In addition, the serum IFN-α concentration in severe HFMD children [(71.48±18.34) ng/L] was significantly lower than that in the common HFMD children [(91.25±27.27) ng/L], and the difference was statistically significant( P<0.05). The results of correlation analysis showed that serum IFN-α concentration is positively correlated with Vitamin A and Vitamin D levels ( r=0.783, 0.239; all P<0.001). Conclusions:The levels of serum Vitamin A and Vitamin D decreased in children with HFMD.WBC>15×10 9/L, blood sugar>8.3 mmol/L, the deficiency of Vitamin A level and Vitamin D level are related to severe HFMD.The se-rum IFN-α concentration is positively correlated with the levels of Vitamin A and Vitamin D. The deficiency of Vitamin A and Vitamin D is one of the early warning factors of severe HFMD.

Correlation between the levels of plasma brain natriuretic peptide and coxsackie virus A6 in hand, foot and mouth disease / 中国小儿急救医学

Objective@#To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection.@*Methods@#A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD.@*Results@#Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×109/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001).@*Conclusion@#BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.

[OAS1 gene polymorphism is associated with central nervous system involvement in children with enterovirus 71 infection].

OBJECTIVE: We investigated the association between OAS1 gene polymorphism and susceptibility to central nervous system (CNS) involvement of enterovirus (EV)71 infection. METHODS: This case-control study was conducted among 180 children with EV71 infection, including 72 with mild infections without any complications and 108 with severe infections and CNS involvement; 201 children undergoing routine physical examination served as the healthy controls. For all the participants, the single nucleotide polymorphisms (SNPs) at OAS1 rs2660 and rs1131454 were analyzed using SNPscan multiple SNP typing methods. RESULTS: No significant differences were found between the case and control groups in genotype or allele distributions of rs2660 and rs1131454. OAS1 rs2660 polymorphism was significantly different between the children with CNS involvement and those with mild EV71 infection, and the genotype AG frequency was higher and the genotype GG frequency was lower in children with CNS involvement. No significant difference was found in the distribution of genotypes or alleles of rs1131454 between the children with CNS involvement and those with mild EV71 infection. CONCLUSIONS: OAS1 gene rs2660 and rs1131454 SNPs are not associated with the susceptibility to or CNS involvement of EV71 infection, but OAS1 rs2660 SNPs are significantly correlated with the susceptibility to CNS involvement in EV71 infection. Children carrying OAS1 rs2660 AG genotype are more likely to have CNS involvement after EV71 infection.

Etiological and clinical characteristics of severe hand, foot and mouth disease in Xi′an in 2018 / 中华实用儿科临床杂志

Objective@#To understand the etiological and clinical characteristics of children with severe hand, foot and mouth disease (HFMD) in Xi′an in 2018, and to provide the evidence for clinical diagnosis and treatment.@*Methods@#The children with severe HFMD admitted at Xi′an Children′s Hospital from January to December 2018 were selected as the research objects.Clinical data were collected, and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR).@*Results@#Ninety-five cases of HFMD were treated in Xi′an Children′s Hospital in 2018, of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid, 30 cases were enterovirus 71(EV71)(31.6%), 39 cases were coxsackievirus A6(CA6) (41.0%), 3 cases were CA16(3.2%), 2 cases were CA10(2.1%) and 13 cases were other enteroviruses (13.7%). Among 95 patients, the ratio of male to female was 1.1∶1.0; the peak period of incidence of HFMD was from May to July, and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation, vomiting, irritability, lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash, and demethylation may occur in recovery period.The rash in EV71 cases was small, thick, hard and few.After active treatment, only one child with EV71 infection died because of severe cerebral dysfunction, frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.@*Conclusions@#In 2018, CA6 was the main pathogen of severe HFMD in Xi′an, with bullae was the main manifestation of skin rash, and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.

Epidemiological characteristics and etiology of herpangina cases in Xi’an, 2016 / 中华实验和临床病毒学杂志

Objective@#To analyze the epidemiological characteristics and etiologic agent of herpangina in Xi’an in 2016.@*Methods@#Herpangina epidemiological data and random stool samples were collected from two sentinel hospitals. The data were statistically analyzed with Excel and SPSS 18.0 and samples were detected and enteroviruses were genotyped using real-time PCR and RT-snPCR.@*Results@#Totally 421 cases were reported and the male-to-female ratio was 1.54∶1, age ranged from 3 month to 13 years, and 90.50% were under three years of age. Herpangina showed semiannual peaks in April to October, of which the highest was in June (23.75%, 100/421). Lab result showed that 71.05% were EV positive out of 152 samples, and further genotyping indicated 60 were non-typable, and other 48 comprised of eight serotypes of EV including EV-A71, CV-A4, CV-A5, CV-A6(6.48%), CV-A10(23.15%), CV-A12, CV-A16 and CV-B3.@*Conclusions@#Male children under 3 years of age were the main population and herpangina cases were most frequently reported in June in Xi’an in 2016. CV-A6 and CV-A10 were more frequently detected in the typable ones.

Distribution characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae in chil-dren from 2016 to 2017 / 中华微生物学和免疫学杂志

Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.

Etiological and clinical characteristics of severe hand,foot and mouth disease in Xi'an in 2018 / 中华实用儿科临床杂志

Objective To understand the etiological and clinical characteristics of children with severe hand,foot and mouth disease (HFMD) in Xi'an in 2018,and to provide the evidence for clinical diagnosis and treatment.Methods The children with severe HFMD admitted at Xi'an Children's Hospital from January to December 2018 were selected as the research objects.Clinical data were collected,and the anal swab were detected by adopting real time (RT)-polymerase chain reaction(PCR).Results Ninety-five cases of HFMD were treated in Xi'an Children's Hospital in 2018,of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid,30 cases were enterovirus 71 (EV71) (31.6％),39 cases were coxsackievirus A6 (CA6) (41.0％),3 cases were CA16 (3.2 ％),2 cases were CA 10 (2.1％) and 13 cases were other enteroviruses (13.7 ％).Among 95 patients,the ratio of male to female was 1.1 ∶ 1.0;the peak period of incidence of HFMD was from May to July,and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation,vomiting,irritability,lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash,and demethylation may occur in recovery period.The rash in EV71 cases was small,thick,hard and few.After active treatment,only one child with EV71 infection died because of severe cerebral dysfunction,frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.Conclusions In 2018,CA6 was the main pathogen of severe HFMD in Xi'an,with bullae was the main manifestation of skin rash,and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.

A multicentric clinical study on clinical characteristics and drug sensitivity of children with pneumococcal meningitis in China / 中华儿科杂志

Objective@#To understand clinical characteristics of children with pneumococcal meningitis (PM) in China and to analyze the drug sensitivity of Streptococcus pneumoniae isolates and associated impacts on death and sequelae.@*Methods@#The clinical data, follow-up results and antimicrobial sensitivity of isolated strains of 155 children (including 98 males and 57 females, age ranged from 2 months to 15 years) with PM in 10 tertiary-grade A class hospitals of Infectious Diseases Surveillance of Pediatrics (ISPED) from 2013 to 2017 were collected and analyzed retrospectively. Patients were divided into different groups according to the following standards: ≤1 year old group,>1-3 years old group and >3 years old group according to age; death group and non-death group according to the death within 30 days after PM diagnosis; complication group and non-complication group according to the abnormal cranial imaging diagnosis; sequelae group and no-sequelae group according to the follow-up results. Bonfereoni chi-square segmentation and Kruskal-Wallis H test were used for statistical analysis.@*Results@#There were 64 cases (41.3%) in the ≤1 year old group, 39 cases in the >1-3 years old group (25.2%), and 52 cases (33.5%) in the >3 years old group. The most common clinical manifestation was fever (151 cases, 97.4%). The mortality was 16.8% (26/155) during hospitalization. The neurological complication rate was 49.7% (77/155) during hospitalization, including the most common complication, subdural effusion and (or) empyema in 50 cases (32.3%) and hearing impairment in 6 cases. During follow-up after discharge, no death was found and focal neurological deficits were found in 47 cases (30.3%), including the frequent neurological sequelae: cognitive and mental retardation of different degree in 22 cases and hearing impairment in 14 cases (9.0%). The rate of cure and improvement on discharge was 74.8% (116/155) and the lost to follow-up rate was 8.4% (13/155). The proportions of died cases, neurological complications during hospitalization and proportions of peripheral white blood cell count <12 × 109/L before admission in ≤1 year old group were significantly higher than those in >3 years old group (25.0% (16/64) vs. 5.8% (3/52), 75.0% (48/64) vs. 25.0% (13/52), 48.4% (31/64) vs. 15.4% (8/52), χ2=7.747, 28.767, 14.044; P=0.005, 0.000, 0.000). The proportions of headache, vomiting, neck resistance and high risk factors of purulent meningitis in >3 years old group were significantly higher than those in ≤ 1 year old group (67.3%(35/52) vs. 1.6%(1/64), 80.8% (42/52) vs. 48.4% (31/64), 69.2% (36/52) vs. 37.5% (24/64), 55.8% (29/52) vs. 14.1%(9/64), χ2=57.940, 12.856, 11.568, 22.656; P=0.000, 0.000, 0.001, 0.000). Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 152/152), linezolid (100.0%, 126/126), moxifloxacin (100.0%, 93/93) and ofloxacin (100.0%,41/41); highly sensitive to levofloxacin (99.3%, 142/143) and ertapenem (84.6%, 66/78); moderately sensitive to ceftriaxone (48.4%, 45/93), cefotaxime (40.0%, 44/110) and meropenem (38.0%, 38/100); less sensitive to penicillin (19.6%, 27/138) and erythromycin (4.2%, 5/120). The proportions of non-sensitive strains of penicillin (21/21) and meropenem (17/18) in the death group were significantly higher than those (90/117, 45/82) in the survived group(χ2=4.648 and 9.808, P=0.031 and 0.002).@*Conclusions@#The children′s PM is mainly found in infants under 3 years old in China. Death and neurological complications are more common in PM children under 1 year old. The clinical manifestations and peripheral blood inflammatory markers of PM patients under 1 year old are not typical. Fever is the most common clinical manifestation and subdural effusion and (or) empyema is the most common complication. Long-term hearing impairment is common in PM and the follow-up time must be prolonged. The dead PM cases had high in sensitive rates to penicillin and meropenem.

Clinical characteristics of 84 children with invasive Haemophilus influenzae infection from 2014 to 2018 / 中华儿科杂志

Objective@#To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children.@*Methods@#The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children′s hospitals from 2014 to 2018 were analyzed retrospectively.@*Results@#Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced β-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively.@*Conclusions@#Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.

Analysis of clinical characteristics in 857 patients with pediatric pertussis in Xi'an / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics in children with pertussis,and to provide a scientific basis for treatment of pertussis.Methods Retrospective analysis of general data,symptoms,signs,auxiliary examinations,treatment and prognosis was performed on the patients with pediatric pertussis in Xi'an from January 2015 to December 2016;the epidemiological data were analyzed by using descriptive approach.Results In a total of 857 patients with pertussis,there were 469 males and 388 females (the gender ratio of 1.21 ∶ 1.00),183 cases (21.3％) from the urban areas and 674 cases (78.7％) from the rural areas.The cases were reported throughout the year,indicating 2 peak times of onset:355 cases (41.5％) from July to September and 218 cases (25.4％) from February to April.And 473 cases (55.2％) were younger than 6 months;479 cases (55.9％) were inoculated with diphtheria,tetanus and pertussis combined vaccine(DTP) vaccine;492 cases (57.4％) were exposed to their family members who coughed at that time.Cough was the main symptom,and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases (97.5 ％),facial suffusion in 806 cases (94.0％),peri-oral cyanosis in 308 cases (35.9％),asthma in 269 cases (31.4％),crow-like echo in 248 cases (28.9％),and apnea in 46 cases (5.4％);pulmonary moist rale was found by check-up in 761 cases (88.8％),and fever was observed in 159 cases (18.5％).The increased proportion of the peripheral blood lymphocytes was found in 702 cases (81.9％),the increased total count of leukocytes in 505 cases (58.9％),the increased procalcitonin(PCT) in 36 cases (4.2％) and the elevated level of high sensitivity C reactive protein(hsCRP) in 17 cases (2.0％);pneumonia was suggested by chest radiography in 673 cases (78.5％);in the blood-gas analysis,hypoxemia was suggested in 50 cases (5.8％) and respiratory failure in 9 cases (1.1％).In the 857 patients with pertussis,59 cases (6.9％) were with severe-type pertussis.At 1 week of the treatment,no spasmodic cough was reported in 515 cases (60.1％) and obviously relieved spasmodic cough in 198 cases (23.1％),and no deaths occurred.Conclusions The cases of pertussis occur throughout the year in Xi'an,predominately from July to September and February to April.A higher incidence is reported in the rural areas,compared with the urban areas,particularly in those younger than 6 months with incomplete DTP vaccination,who usually have severe conditions.In many cases,those with pediatric pertussis are infected by family members;most of them have spasmodic cough with good prognosis,without typical clinical signs.