Objective To investigate the status of nasopharyngeal carriage rate, serotype distribution and antibiotic resistance pattern of Streptococcus pneumoniae isolates collected from children with respiratory tract infections inpatiented in Youyang county.Methods The nasopharyngeal swab was collected from children with respiratory tract infections inpatiented in People′s Hospital of Chongqing Youyang County from January to December in 2015. The serotype was determined by Quellung reaction, and the antibiotic susceptibility was tested by E-test method and disc diffusion.Results The nasopharyngeal carriage rate of Streptococcus pneumoniae was 25.3% (267/1054), major in winter and spring among children younger than 5 years old. Serotype 19F(47, 17.6%), 6A(35, 13.1%), 14(31, 11.6%), 19A(28, 10.5%), 23F(28, 10.5%) and 6B(25, 9.4%) were the common serotypes, and the coverage rate of 13-pneumococcal conjugate vaccine (PCV13) was 73.8%(197/267). All of the isolates were sensitive to ceftriaxone, vancomycin and levofloxacin. The sensitive rates to linezolid, imipenem and telithromycin were 96.3%, 87.5% and 84.5%, respectively. All of the isolates were sensitive to penicillin using the parenteral breakpoints, but the sensitive rate was just 16.9% according to the oral breakpoints. 99.3% (135/136) of the isolates were resistant to erythromycin and azithromycin. The non-suscepibility rates to oral penicillin, cefepime, cefuroxime and imipenem were higher in PCV13 isolates than non-PCV13 isolates (P<0.01). Isolates of serotype 19A were more resistant than the other serotype isolates.Conclusion The nasopharyngeal carriage rate of Streptococcus pneumoniae was 25.3%, the common serotypes were 19F, 6A, 14, 19A, 23F and 6B. PCV13 coverage rate was high, and the non-suscepibility rates to oral penicillin, cefepime, cefuroxime and imipenem were higher in PCV13 isolates than non-PCV13 isolates.
Objective To explore the predictive value of lactate level on the mortality in children with moderate to severe traumatic brain injury (TBI) within 3 hours after admission.Methods The retrospective study was conducted in Critical Care Medicine, Children′s Hospital of Chongqing Medical University from May 2011 to May 2014 including patients with moderate to severe TBI ［admission Glasgow Coma Scale (GCS) ≤13］. The included patients were divided into death group and survival group. The clinical data regarding age, gender, body weight and laboratory index within 3 h after admission (serum lactic acid, potassium, sodium, PLT count, D-Dimer) were collected to perform univariate and multivariate analysis between death and survival groups. The receiver operating characteristic curve of serum lactic acid was used to dertermine the optimal cut-off value, and the corresponding sensitivity and specificity were calculated.Results A total of 109 patients were enrolled, including 92 survivals and 17 deaths. The median lactate level,combined other organ injury ratio,the incidence of admission GCS≤8 and hypotension on admission of death group were higher than those of the survival group (4.9 vs 0.8 mmol·L-1,76.5% vs 42.4%,94.1% vs 45.7%,76.5% vs 7.6%; all P≤0.01). The plasma potassium level of death group was lower than that of survival group ［(3.4±0.5) vs (3.7±0.6) mmol·L-1, P＝0.047)］.The ROC curve showed that lactate level could predict the mortality of pediatric patients with moderate to severe TBI (AUC=0.949,95%CI: 0.889 to 0.982, P< 0.001). The corresponding sensitivity and specificity of lactic acid cut-off value of 2.5 mmol·L-1 were 88.2% and 90.2%, respectively. Multivariate logistic regression analysis showed that lactic acid level (OR = 1.579,95%CI:1.129 to 2.209)and hypotension within 3 hours after admission (OR=21.658; 95%CI: 2.673 to 175.480)were the independent risk factors of death in moderate to severe TBI. However, GCS≤8 on admission, other organ injury and plasma potassium level on admission were not the independent risk factors for death in this study.Conclusion The level of admission lactate can predict the death of children with moderate to severe TBI. The elevated admission lactate is also an independent risk factor for the mortality of children with moderate to severe TBI.
Objective The aim of this study was to develop a composite index indicators of Neonatal Intensive Care Unit（NICU） quality and thus to promote the continuing improvement of NICU overall quality, improve the success rate of treatment and quality of life in the critical newborns.Methods Based on Donabedian′s model which provided the framework, the study was established premilinarily and defined as composite index indicator of NICU quality through combining with the relevant policies，laws of national hospital management, construction and management standards of NICU. Meanwhile, pediatric, adult and intensive care quality indicators were well referenced. Two rounds of questionnaires were delivered. The expert panel members exchanged their opinions anonymously through letters of inquiry and then provided recommendations for delete, add, split, revise and merge. After the two rounds, Analytic Hierarchy Process was adopted to calculate weights of nursing quality indicators through erecting the judgment matrix. Results Forty-eight NICU experts in 12 tertiary maternal and child health hospital or children′s hospital spread across 9 provinces in China participated in two rounds of Delphi panels and all panel members responded. Sixty-seven indicators including 19 structure indicators, 18 process indicators and 30 outcome indicators were established based on the Donabedian′s model. In the first round, 8 were deleted, 1 was splited, 4 were added, 4 were revised and 2 were merged while only 5 were deleted without other changes in the second round. The Analytic Hierarchy Process was used to determine the weight of the ultimate composite indicator of NICU quality(16 structure indicators, 18 process indicators and 24 outcome indicators). Statistical data showed that the mean importance scores of 3 first-level indicators, 14 second-level indicators and 58 third-level indicators were 4.6-4.9、4.1-4.9, 3.7-5.0,0.310 8, 0.493 4, 0.195 8, and the full mark rate was 60.4%-88.6%、25.6%-90.7%, 6.3%-97.9% respectively, which had shown a wider tendency of the range. The three levels indicators were well consistency with the consistency ration (CR) less than 0.1.Conclusion Based on the Donabedian′s model, 58 NICU nursing quality indicators which reached a reliable consensus within the panel members were identified. The study offered the instructive probe for further researches.
Objective To review the efficacy of early intratracheal administration of budesonide for preventing bronchopulmonary dysplasia (BPD) in preterm neonates using meta-analysis methods.Methods Related literatures were retrieved in PubMed, EMBASE, the Cohrane Library, CNKI and Wanfang Database from establishment to June 2016. Two reviewers independently screened literatures, extracted data, and assessed the quality of included studies. The meta-analysis was performed by RevMan 5.3 software. A subgroup analysis about delivery method was made between inhalation (subgroup A) and using surfactant as a vehicle (subgroup B). Results Six randomized controlled trials (1 347 infants) with low risk of bias were included in meta-analysis. The analysis showed that the incidence of BPD was decreased in experimental groups, the RR and 95%CI was 0.67(0.57,0.78), and similar trends were found in subgroup A and B, the corresponding RR and 95%CI was 0.74(0.61,0.90) and 0.53(0.40,0.70), respectively. There was no significant difference in mortality between experimental and control groups, the corresponding RR and 95% CI was 0.94(0.60,1.47). However, the incidence of BPD or death was lower in experimental groups, the RR and 95%CI was 0.74(0.60,0.91), and the incidence of BPD or death was lower in subgroup B than that in subgroup A, the corresponding RR and 95%CI was 0.60(0.49,0.74) and 0.87(0.76,1.00), respectively. There was no significant difference in the incidence of infection (sepsis) or retinopathy of prematurity between experimental and control groups.Conclusion The incidence of BPD can be decreased by early intratracheal administration of budesonide, and the delivery method of using surfactant as a vehicle may be better than inhalation.
Objective To investigate the treatment effect of steroid for intravenous immunoglobulin (IVIG) unresponsive Kawasaki disease (KD).Methods Data of children with initial IVIG unresponsive KD in Children′s Hospital of Chongqing Medical University were retrospectively collected. Total cases were divided into 3 groups: IVIG only, steroid only and IVIG plus steroid according to re-treatment methods. Those who used steroid including steroid group and IVIG plus steroid group were divided into intravenous sequentially oral steroid group(intravenous-oral steroid group) and oral steroid group. The whole fever time,duration of fever after re-treatment, laboratory examination results before and after re-treatment were focused and the difference ratio△(the ratio of the difference value before and after re-treatment to the value before re-treatment) was calculated. Coronary artery lesions (CALs) outcomes were observed in acute stage and CALs and thrombus 6,12 and 24 months after hospital discharge were followed-up.Results A total of 143 children with initial IVIG unresponsive KD were analyzed. There were 107 cases in IVIG group, 12 cases in steroid group and 24 cases in IVIG plus steroid group. There was no significant difference in gender, age and weight among three groups. Compared with IVIG group, WBC and PLT after re-treatment and △CRP were higher in IVIG plus steroid group, and the whole fever time of this group was longer. However the △WBC and △PLT were lower in IVIG plus steroid group. The incidence of coronary artery aneurysm in acute stage and coronary artery dilatation 6 months after hospital discharge was higher in IVIG plus steroid group than that of IVIG group. Compared with IVIG group, △WBC was lower and the whole fever time was longer in steroid group. There were 18 cases in intravenous-oral steroid group and oral steroid group respectively. No statistically significant difference in gender, age and weight was found between those two groups. In oral steroid group, △CRP was lower and △PLT was higher than those of intravenous-oral steroid group. There was no significant difference in long-term progression of coronary artery between the two groups. In the follow-up cases, 2 cases with thrombosis were found in the intravenous-oral steroid group, but the thrombus disappeared after anti-coagulation therapy.Conclusion This study suggested that direct application of steroid treatment is effective and relatively safe in acute stage for initial IVIG unresponsive KD patients, and the incidence of CALs does not increase in long-term follow-up. Taking ordinary dose steroid orally or intravenous-oral way showed no significant difference on the effect of the treatment in acute period and long-term prognosis for initial IVIG unresponsive KD patients. But intravenous-oral way has an increased thrombotic risk.
Objective To study the retinal function of preterm infants with the history of spontaneously regressed retinopathy of prematurity (ROP) after the final screening by flash electroretinogram (F-ERG).Methods A case-control study was conducted among the preterm infants with the history of spontaneously regressed ROP and they were defined as case group, and those without ROP as control group. The case group was further divided into three subgroups (A, B, C) based on the screening interval periods. According to the guidelines for ROP screening in China, the retinal function was assessed in both groups by F-ERG at the final screening point.Results 119 preterm infants in case group and 160 in control group met the inclusion criteria in neonatology department of Children's Hospital of Fudan University from January 2015 to January 2016. According to the exclusion criteria, 39(78 eyes) of the case group and 37 (74 eyes) of the control group were analyzed in this study. Compared with the control group, the average response amplitude of b-wave of the rod, a-wave and b-wave of the largest mixed reaction, oscillatory potentials (OPs), b-wave of the cone of case group were statistically reduced, and the average latency of responses was significantly prolonged in all of the case groups. There was no statistical difference of the average amplitude and the average latency of all responses between group A and group B; Compared to group A, the average amplitude of b-wave of the rod, OPs and b-wave of the cone of group C was significantly reduced , and the average latency of all the other responses of group C was significantly prolonged except a-wave of the largest mixed reaction and a-wave of the cone. There was no statistical difference of the average amplitude and the average latency of all responses between group B and group C.Conclusion Compared to no-ROP preterm infants, the retinal development of preterm with the history of spontaneously regressed ROP was delayed at the final screening point. There was a close correlation between the stage and position of ROP and the retinal development.
Objective To evaluate the clinical characteristics, diagnosis and prognosis of congenital vascular ring(CVR) in children.Methods The CVR parting ,clinical data,imaging examinations and treatment of 99 cases with CVR in Children′s Hospital of Chongqing Medical University from January 2006 to December 2015 were retrospectively analyzed.According to the prognosis, patients were divided into survival group and death or giving up the treatment groups, the risk factors of poor prognosis were analyzed. Results A total of 99 cases diagnosed as CVR were enrolled,including 55 males and 44 females, with median age of 7.2 months.The diagnosis included pulmonary artery sling in 51 cases,double aorta arch in 32 cases,right aortic arch with left ductus arteriosus in 15 cases,left aoaic arch with vagus right subclavian artery in 1 case. Only 51 cases (51.5%) had respiratory system performance, 8 cases (8.1%) had cardiovascular system performance, 2 cases (2.0%) had digestive system performance, 3 cases (33.3%) had breathing combined cardiovascular system performance 3, 5 patients without clinical symptoms. Merge heart malformations were found in 64 cases (64.6%), of them 31 cases with ASD, 2 cases with VSD, 9 cases with ASD + VSD and 22 cases with complex cardiac anomalies. Tracheobronchial stenosis was found in 69 cases, esophageal stenosis in 14 cases, 10 cases with laryngeal cartilage dysplasia, 9 cases with congenital bronchial pulmonary hypoplasia.The diagnosis accuracy of echocardiographic was 57.4% and that of computed tomography angiography was 91.6%,26 cases checked with the fiber bronchoscope were found airway stenosis; 14/17 (82.3%) accepting line barium esophageal imaging examination were found esophageal pressure distortion and narrow. Fifty-seven cases were treated with surgical operation, of them 4 cases died, six cases with difficult postoperative offline gave up treatment. 42 cases with non-surgical treatment, 1 case died and 10 cases with difficult offline gave up treatment. Age and proportion of the pulmonary artery sling with pulmonary dysplasia of dead or abandoned children group was significantly higher than those of survival group.Conclusion Eehocardiography combined with CTA is the best way to diagnose CVR.Type of CVR,age and the combining pulmonary hypoplasia are related to prognosis.
Objective To investigate the relationship between clinical characteristics and pediatric critical illness score in children with severe Mycoplasma pneumoniae pneumonia (MPP).Methods Retrospective analysis was utilized for the clinical data (age, sex, duration of fever, laboratory examination, outcome of ECG，chest X-ray and CT within 48 h after admission) of the children who were hospitalized at PICU of Fujian Maternity and Children Health Hospital due to severe MPP from January 2014 to December 2015. According to the pediatric critical illness score (PCIS) criteria, patients were divided into extremely critical group (PCIS<70), critical group (80>PCIS>70) and non-critical group (PCIS>80). The clinical characteristics were screened by univariate analysis, and then statistically significant clinical markers were analyzed by multivariate logistic regression analysis. These comparison and analysis were conducted with regard to the relationship between their clinical characteristics and PCIS.Results A total of 114 children hospitalized with severe MPP were enrolled, including 61 males and 53 females. Cardiovascular system damage was found in 29 cases, 23 cases were with digestive system damage, 18 cases with nervous system damage, 27 cases with hematological system damage. They were divided into 3 groups in accordance with PCIS: 77 were in non-critical group, 30 were in critical group, 7 were in extremely critical group. Among three groups, there were no significantly differences in age and sex. There were statistical significances in the proportions of abnormal electrocardiographic pattern, extrapulmonary complications of 2 or more organ damages, co-infection of 2 or more noxaes and course of disease more than 12 days. Prealbumin level decreased and D-Dimer level increased among three groups, both with statistical significance. Multivariate logistic regression analysis showed there was positive correlation between the proportions of co-infection of 2 or more noxaes (OR=7.147,95%CI: 1.435 to 35.59), D-Dimer level (OR=1.507,95%CI：1.054 to 2.156) and PCIS, there was negative correlation between prealbumin level (OR=0.914,95%CI:0.845 to 0.990) and PCIS in children.Conclusion Co-infection of 2 or more noxaes, D-Dimer, prealbumin may be related to the severity of severe MPP.
Objective To summarize the clinical characteristics and genetic diagnosis of infantile inflammatory bowel disease (IBD) within four months after birth to make clinicians pay more attentions to this kind of disease.Methods Seven infants with IBD admitted to our hospital from 2007 to 2015 were recruited and their clinical data were reviewed and analyzed. Five of them were taken gene sequencing including IL10RA, IL10RB, IL6, NOD2, IRGM, ABCB1, ATG16L1, IL23R and IRF5.Results The onset time of our patients ranged from four days to four months after birth. Diarrhea and bloody stools were the first signs. Malnutrition, fever, oral ulcer and perianal lesions were common concomitant symptoms. 5 of them had a family history. Most of the patients had elevated WBC, PLT, CRP and ESR and some of them had positive autoimmune antibodies. Colonoscopy showed multiple ulcers affecting the colon. 5 infants who received gene sequencing were found IL10RA mutation. All the patients received treatments including antibiotics, switching formula feeding and 5-aminosalicylic acid. Some of them were treated by steroid, immunosuppressant or thalidomide. 5 patients got better and 2 died.Conclusion Infants with diarrhea and bloody stools without any causes might cause IBD. Early diagnosis and treatment could enhance the prognosis. The gene of IL10RA mutation might be found in the infants with IBD.
Abstract ObjectiveThe numbers, subsets and function of natural killer (NK) cells altered in chronic hepatitis C virus (HCV) infected patients which indicating its association with chronic HCV infection, but the exact mechanisms remain unclear. To explore the functional effect of HCV infection on NK cells in vitro and the possible mechanism behind it.Methods Human hepatoma Huh7.5 cells were transfected with genomic RNA from cell culture adapted JC1 genotype 2a HCV strain (Huh7.5-HCVcc) and co-cultured with NK cells isolated from whole peripheral blood of concentrated healthy donors. The functional effect of HCV infection on NK cells was assessed by testing cytokine-secreting and cytotoxicity before and after co-culture.Results When co-cultrued with Huh7.5-HCV of MOI 4.8, the levels of IFN-γ, TNF-α and IL-10 secreted by NK cells were inhibited. The inhibition of secreting IFN-γ was specially significant at 6(P<0.001), 9(P<0.001) and 12(P=0.001) hours co-cultured with Huh7.5-HCV. The inhibition of secreting TNF-α was specially significant 6 h(P<0.001), 9 h(P<0.001) and 12 h(P=0.001) after co-cultured with Huh7.5-HCVcc. And the significant inhibition of secreting IL-10 appeared at 6 h(P<0.001) and 9 h(P=0.006) after co-cultured with Huh7.5-HCVcc. The strongest cytokine-secreting inhibition appeared 6 h after co-cultured with Huh7.5-HCVcc, the inhibition rate was 24.1%, 20.7% and 24.3%, respectively. The cytotoxicity decreased significantly 6 h after co-cultured with Huh7.5-HCVcc(P=0.023), and the average inhibition rate was 16.6%.Conclusion When in vitro cocultrued with Huh7.5-HCVcc of MOI 4.8, the NK cells functions of IFN-γ, TNF-α and IL-10 cytokine-secreting and cytotoxicity were inhibited. The degree of inhibition was different at different time points, which indicated that NK cells may act differently during HCV infection.
Abstract Among the common adverse drug reactions (ADR) induced by antituberculosis drugs, antituberculosis drug-induced hepatotoxicity (ATDH) is the most serious ADR. Three common first-line antituberculosis drugs, isoniazid (INH), rifampicin (RMP), and pyrazinamide (PZA), may induce ATDH. Investigations on susceptibility to ATDH have so far focused on gene polymorphisms of drug metabolism enzymes (DMEs) and drug transporters, such as phase I metabolizing enzymes (such as the Cytochrome P450 superfamily), phase II metabolizing enzymes (such as N-acetyl transferase 2 and Glutathione S-transferase), and drug transporters (such as Solute carrier and Adenosine triphosphate binding cassette). Recently the role of antioxidant response (such as Manganese superoxide dismutase) and immune response (such as human leukocyte antigen) in the progression of ATDH has also attracted more and more attention. In addition, non-genetic factors, such as age, gender, nutritional status, alcoholism, pre-existing liver disease and other factors, may have an impact on the risk of ATDH. To improve the understanding of ATDH and explore the direction of future research, this review focuses on the relevance between the related gene polymorphisms of DME, drug transporters, antioxidant response, immune response and the risk of ATDH, as well as non-genetic factors influencing the occurrence of ATDH.
