Objective To explore the processing Methods of big data of hospital information systems(HIS) and analyze the characteristics and trends of outpatient visits and medical services in a tertiary pediatric hospital in Shanghai during the past 10 years.Methods Data were extracted from the database of outpatient registry in HIS from 2009 to 2018. Data cleaning (diagnosis, address, replication, outliers, and missing data), data assembly (linkage of database), data reduction, data anonymization and data audit were conducted according to the procedure of big data. We analyzed the characteristics and trends of outpatient visits and medical services.Results The total outpatient visits from 2009 to 2018 were 20,775,899 and 18,242,822 visits were included in this study. Males were 4,656,843 accounting for 57.42%. Patients under 1 year old, from 1 to 3 years old, from 3 to 7 years old and from 7 to 18 years accounted for 9.57%,40.94%, 24.82% and 24.67% respectively. The missing data rate of diagnosis, address, and name of doctors was 5.92%, 45.31% and 28.61%,respectively. There were no significant differences in the percentage of sex and age in different years among the population with missing data. The average increasing rate of outpatient visits was 5.22% in the past 10 years. The increasing rate of 2012 and 2014 were 11.22% and 10.93% respectively, compared with the same period of last year. The increasing rate slowed down to 2.90% after 2015. The distribution of outpatient address showed the trends of expansion from the east of China to the South-west, North-west, South, Middle and North-east. The average workload of a doctor was 51 visits in a day. According to professional titles, there were 63, 54, and 45 visits per day for junior, intermediate, and senior doctors, respectively. The number of specialty clinics increased from 46 in 2009 to 180 in 2018 and serviced the 68.12% of outpatient visits. The number of specific disease clinics increased from 16 in 2009 to 142 in 2018.Conclusion The big data of outpatient visits in a tertiary pediatric hospital(National Children's Medical Center) in China showed that there was a sustainable upward trend in outpatient visits; the origin of patients expanded from Shanghai to the whole of China; the average visits for a single physician were lower than that of the country. Specialized clinics in specialties or diseases are an important trends for the development of children's hospitals.
Objective To question the prediction model of intravenous gamma globulin (IVIG) resistance in children with Kawasaki disease (KD).Methods Medical records of KD patients, who were first diagnosed and treated in Children's Hospital of Fudan University, were retrospectively collected. All eligible KD patients were randomly assigned to the establishment group and the validation group at the ratio of 7∶3. A prediction model of IVIG resistance was constructed in the establishment group through univariate and multivariate logistic regression analysis, and then validated in the validation group. In addition, KD children were stratified by gender, age of onset, fever days before initial IVIG, KD type, etc. A new prediction model was constructed and validated separately in each layer. Finally, the published prediction models of IVIG resistance, which were established based on clinical manifestations and laboratory indicators, were applied to the whole sample population to evaluate the predictive value.Results A total of 1,360 KD children were enrolled, including 875 males (64.3%). The median age of onset was 1.8 (0.9, 3.2) years. There were 171 patients in the IVIG resistant group, 1,189 in the IVIG sensitive group, 952 in the establishment group and 408 in the validation group, respectively. Demographic characteristics, main clinical symptoms, laboratory indicators, and the rate of IVIG resistance and coronary artery lesions were not significantly different between the establishment group and the validation group (P >0.05). In the establishment group, the constructed prediction model included 1 score each for male, age of onset ≥2 years, N%≥0.75, Hb≥110 g·L-1 and 2 scores each for fever days before initial IVIG ≥5 days, ALB≥34 g·L-1, Na+≥133 mmol·L-1. The AUC was 0.818 (95% CI: 0.774-0.861). With a cutoff point of ≥5 scores, the sensitivity and specificity were 0.767 and 0.726, respectively. In the validation group, the AUC was 0.777 (95% CI: 0.712-0.842) with the sensitivity and specificity of 0.627 and 0.776, respectively. When 11 published prediction models of IVIG resistance were applied to the whole sample population, the sensitivity and specificity were 0.272-0.799 and 0.412-0.926, respectively. Of the prediction models established in our and other studies, none had both sensitivity and specificity ≥75%.Conclusion Demographic characteristics, clinical symptoms, and laboratory indicators of KD children were insufficient to establish a clinically useful prediction model of IVIG resistance.
Objective To study the species distribution of pathogenic bacteria in children with bacterial diarrhea in Chongqing in the past 27 years, and to provide scientific basis in prevention and treatment of children's bacterial diarrhea in Chongqing.Methods A retrospective study was conducted on the bacterial culture-positive strains of fecal specimens from hospitalized children with diarrhea from January 1, 1991 to December 31, 2017.During the same hospitalization period of the same child, if fecal specimens were sent for multiple times and the same strain was isolated, only the first record was included for analysis.The gender, age, living environment of the children, and the type and time of detection of positive pathogenic bacteria in fecal specimens were selected.Results 2,409 strains of pathogenic bacteria were isolated from 33,957 fecal specimens of children with diarrhea during the past 27 years, with the total detection rate being 7.09%, including Shigella spp.(78.83%, 1,899/2,409),mainly Shigella flexneri (87.36%,1,659/1,899), of which S.flexneri Type Two was more common (97.17%,1,612/1,659);Salmonella spp.(13.24%,319/2,409), mainly Salmonella typhimurium(69.28%,221/319); Diarrheal escherichia coli(5.06%,122/2,409),mainly pathogenic E.coli(77.05%,94/122).In terms of the detection period, the detection rate was the highest in 1995, which was 27.67%(249/900). Before 2000 (except 1992), the detection rate was >10%, and after 2000, it fell to below 5%;The number and detection rate of pathogenic bacteria were the highest in August, September and October. From the year 1991 to 1999 (n=1,860), the year 2000 to 2008 (n=348), and the year 2009 to 2017 (n=201), the proportion of S.flexneri Type Two was decreased from 80.48% to 0,and the proportion of Salmonella typhimurium increased from 4.35% to 58.71%. The proportion of Salmonella typhimurium in infants was the highest (29.58%), and the proportion of S.flexneri Type Two was the highest in other age groups.Conclusion The dominant pathogenic bacteria species causing bacterial diarrhea in children was S.flexneri Type Two in the early time period (from the year 1991 to 1999), while Salmonella typhimurium was more predominant in late time period (from the year 2009 to 2017).
Objective To establish the reference ranges of peripheral blood lymphocyte subpopulations values in Gansu children of preschool age.Methods Gansu Han children who received a preoperative, postoperative or routine physical examination aged from 0 to 7 years old were enrolled into the study. The children, who have cardio-cerebral vascular disease, abnormal blood routine, liver and kidney dysfunction, infection within 3 weeks of lymphocyte subpopulation detection, primary immunodeficiency disease, were excluded. Included children were divided into neonatal group (0 to 28 d), infant group (28 d to 12 months), toddler age group (1 to 3 years) and preschool age group (3 to 7 years). Peripheral blood was collected, and relative counts of lymphocyte subpopulations were detected by flow four, color cytometric analysis within 24 h. The (P2.5, P97.5) was used as the normal reference range of each index.Results ①A total of 792 children were enrolled into the analysis of this article, including 472 boys, 320 girls, 174 newborns, 216 infants, 170 toddlers, and 232 preschoolers. ②The interior group comparison between males and females showed there was a statistically significant difference between males and females in CD4+T、CD8+T、B、NK lymphocyte percentages and CD4+/CD8+ value in the neonatal group; in CD4+T、CD8+T、B lymphocyte percentages and CD4+/CD8+ value in the infant group; in T、CD4+T、B、NK lymphocyte percentages in the preschool age group. ③The percentages of lymphocyte subpopulations were statistically significant in the distribution of girls and boys in all age groups. The T and CD4+T lymphocyte percentages declined with age, and the trend in decreasing degree was similar between boys and girls. The CD8+T lymphocyte percentage increased with age, and the trend of girls in increasing degree was more obvious. B lymphocyte percentage showed a marked rise in children within 1 year old (from neonatal group to infant group), followed by a gradual decline, and the trend of girls was more moderate. NK lymphocyte percentage, on the other hand, displayed a pattern of change almost opposite that for B lymphocyte,which decreased within 1 year and then increased, and the trend of boys was more obvious.Conclusion The distribution of lymphocyte subpopulations percentages in healthy children is related to region, age and gender.
Objective To analyze the clinical characteristics, risk factors and distribution of bloodstream infection pathogens in febrile neutropenic children with acute lymphoma leukemia in Children's Hospital of Shanghai Jiaotong University from Jan.2007 to Dec.2016.Methods Clinical and pathogen data of febrile neutropenic children with acute lymphoma leukemia were retrospectively reviewed and analyzed.Results In total, 312 children with ALL were enrolled into the study, including 1,548 FN cases and 1,700 blood cultures. The occurrence rate of bloodstream infection was 8.2% (127/1,548). Bloodstream infection mortality rate was 9.4% (12/127). Among 127 strains of isolated bloodstream pathogens,Gram-positive bacteria accounted for 51.1% (65/127), Gram-negative bacteria 47.2% (60/127) and fungi 1.5% (2/127). Compared with Gram-positive bacterial bloodstream infection, Gram-negative bacterial bloodstream infection had higher incidence of ANC <0.1×109·L-1 (P=0.041) and septic shock (P=0.002). Gram-negative bacilli Pseudomonas aeruginosa had an increasing trend of infection. There was no significant increase in drug-resistant gram-negative bacilli.Conclusion Gram-positive bacteria were still the main pathogens of FN bloodstream infection. Coagulasenegative Staphylococcus was the most common pathogen of Gram-positive bacteria, and Escherichia coli was the main pathogen of Gram-negative bacteria. Gram-negative bacterial bloodstream infection is more serious than Gram-positive bacterial bloodstream infection complications, which mostly occurs in the stage of severe granulocyte deficiency. Bloodstream infection combined with septic shock is an independent risk factor for FN death.
Objective To explore the characteristics of aspiration pneumonia in children with congenital upper airway dis-eases.Methods A retrospective review was performed on hospitalized children with a documented diagnosis of congenital upper airway disease and aspiration pneumonia at a tertiary children's hospital from December 2014 to June 2018. Differences were evaluated between cases with and without neurologic impairment.Results A total of 72 cases were reviewed, including 47 males and 25 females, with median age of 4 months. Laryngomalacia was the most common upper airway lesion with a high rate of compound lower airway lesions and other comorbidities. Main clinical manifestations were coughing, choking and wheezing. The vast majority (80.6%) of children had onset of symptoms before 3 months of age. Fifty-four out of 69 cases showed positive aspiration findings in radionuclide salivagram. Twenty out of 35 cases showed positive aspiration findings in upper gastrointestinal series. Flexible laryngoscopy identified 61 cases with upper airway lesion among 64 children. Flexible bronchoscopy identified 13 cases with upper airway lesion and 7 cases with lower airway lesion among 27 children. Fifty cases showed positive pathogen findings. Fifty-four cases received nasogastric tube feeding. Fifteen received ICU treatment and 3 cases died finally. Those with neurologic impairment were more likely to have recurrent pneumonia and had higher cost for hospitalization.Conclusion Children with aspiration pneumonia and congenital upper airway diseases usually present with symptoms before 3 months of age. They have a high prevalence of synchronous airway lesions and other comorbidities. Patients with neurologic impairment combined are more likely to have recurrent pneumonia and higher financial burden. Endoscopy and radionuclide salivagram are useful tools for diagnosis.
Objective To summarize the clinical characteristics of a boy with Stimulator of interferon genes(STING)-associated vasculopathy with onset in infancy(SAVI).Methods The clinical characteristics of a child with SAVI from Qilu Children's Hospital of Shandong University were collected.A literature search (search terms including'STING-associated vasculopathy with onset in infancy'、'STING'、'SAVI'、'autoinflammatory diseases'、and'interferonopathy')was conducted using CNKI、WanFang Data、VIP and EMBASE、PubMed to include recently published SAVI studies (from January 2010 to April 2018).Results A 11-year-old boy, often suffering from recurrent respiratory tract infection(RRTI), presented with coughing, decreased activity endurance and clubbed fingers. His erythrocyte sedimentation rate(ESR) was abnormally elevated. ANA and anticardiolipin antibody were positive, and the High-resolution computed tomography(HRCT) revealed interstitial lung diseases. Genetic mutation of TMEM173(c.463G>A,p.V155M)was confirmed by Sanger sequencing.It was effectively treated with toltinib 5 mg twice a day. At present, 30 cases of SAVI have been reported at home and abroad, including 1 in Chinese and 13 in English. SAVI is more common in males, mainly in infants and young children. The first symptoms were rash (58.0%), shortness of breath (41.9%) and limited activity (48.3%). Laboratory tests were often accompanied by elevated inflammatory markers and positive anti-nuclear antibodies. 70.9% of the pulmonary imaging showed interstitial pneumonia. SLE is easily misdiagnosed in clinic and can be diagnosed by gene examination. JAK inhibitors are effective.Conclusion SAVI is a rare autoinflammatory disease, which is a TMEM173 gene mutation. It is clinically characterized by decreased activity tolerance, growth restriction and interstitial lung disease. Janus kinase inhibitor(JAK) is effective in treating this disease.
Objective To understand the pathogenic evolution of throat swab specimens of kindergarten children suffering from acute upper respiratory tract infections (AURTIs) for the first time.Methods Kindergarten was taken as the place of a cohort study and the subjects were pre-school children who were enrolled in a kindergarten for the first time. The kindergarten life was taken as the exposure factor. During the physical examination before the enrollment and the first onset of AURTIs after 48 hours of enrollment and at the end of the first semester (pre-school children without AURTIs), nasopharyngeal secretions were collected by throat swabs, and bacteria culture was done and tests were carried out for respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus A (Iva), influenza virus B(Ivb), parainfluenza virus Ⅰ (PIV Ⅰ), parainfluenza virus Ⅱ (PIV Ⅱ), parainfluenza virus Ⅲ (PIV Ⅲ), Mycoplasma pneumoniae and Chlamydia.Results Nine kinds of bacteria were found in 114 of 115 cases with an average age of 3.4 years. One case had (3.3±0.8) kinds of bacteria on average and there was one mycoplasma-positive (1.1%) case. During the semester 91 cases (79.1%) had AURTIs, for the first time the second to sixth onset of AURTIs were 63, 29, 16, 6, and 2 cases respectively and twelve cases developed to lower respiratory tract infection and 1 case to sepsis. Twelve kinds of virus were found after the culture of throat swab specimens of 115 preschool children collected at the time of enrollment. Compared with the time of enrollment, at the first onset of AURTIs there was an increase in the number of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Escherichia coli and Streptococcus pyogenes which were identified ≥3+ increased. There were 25 cases of (27.5%) mycoplasma and virus including 14 cases of mycoplasma, 5 cases of Iva, 2 cases of PIV Ⅰ, Ivb and ADV. AURTIs did not occur in 24 preschool children during the semester. A total of 9 kinds of bacteria were cultured at the time of enrollment, with an average of 3.5±0.7 in each case. At the end of the semester, 9 kinds of bacteria were cultured, with an average of 3.6±0.5 in each case. Compared with the time of enrollment, there was one more case of Streptococcus pyogenes which were identified ≥3+. No mycoplasma, chlamydia and virus were detected. For 115 cases of healthy pre-school children at the time of enrollment and 24 cases without AURTIs during the semester, bacteria colonization included Neisseria, Streptococcus viridans, Micrococcus, Gram-positive bacilli, Coagulase-negative Staphylococcus, Streptococcus pneumoniae, Influenza Haemophilus, Staphylococcus aureus, Enterobacter cloacae and Streptococcus pyogenes.Conclusion Senventy-nine percent of healthy pre-school children have AURTIs after enrollment, mostly infected by bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Escherichia coli and Streptococcus pyogenes), Mycoplasma and viruses (Iva, PIV Ⅰ , Ivb, ADV) .
Objective To introduce the Bayesian meta-analysis of the diagnostic test using the SAC software PROC MCMC program.Methods Meta-analysis code based on SAS PROC MCMC program prepared by Menke J was used and the study on the accuracy of high-resolution ultrasound diagnosis of anterior disc displacement of temporomandibular joint published by Dong Xiaoyu et al. was selected as an example data. Bayesian meta-analysis implementation method for diagnostic test was introduced.Results Based on the example data, the Results of Bayesian fixed effect model and random effect model meta-analysis were given. The Results of random effects analysis showed that the combined sensitivity, specificity, diagnostic Odds Ratio (DOR)of high-resolution ultrasound diagnosis for anterior disc displacement with reduction (ADDWR) were 0.852 (95%CI: 0.766-0.924), 0.865 (95%CI: 0.760-0.944), 53.413 (95%CI: 11.855-170.4) respectively.Conclusion SAS PROC MCMC was an excellent method for achieving bivariate random effects Bayesian meta-analysis of sensitivity and specificity.
Objective To introduce a model of meta-analysis, and to explain how to fit the model with bayesian Methods.Methods The normal-normal hierarchical model(NNHM)was explained. Random effects model was used to reanalyze two worked examples from literature in the framework of the NNHM. Bayesian Methods were used to fit the NNHM with the bayesmeta R package. The priors for the effect parameter μ and heterogeneity parameter τ were given different choice respectively.Results In the framework of NNHM, based on the different priors, the Results of data 1 were shown that point estimates and 95% credit interval(CI) of parameter μ using the bayesian method were -4.26(-6.97, -1.92) and -4.50(-9.27, -0.53) respectively and point estimates and 95%CI of parameter τ were 1.51(0.41, 2.75) and 2.28(0.00, 6.57) respectively. And the Results of data 2 were shown that point estimates and 95%CI of parameter μ were -4.07(-5.54, -2.71) and -4.12(-5.96, -2.46) respectively and point estimates and 95% CI of parameter τ were 1.54(0.78, 2.48) and 1.81(0.74, 3.51) respectively.Conclusion Different priors might have an effect on the estimation of parameters. Bayesian Methods were preferable for the meta-analyses of continuous data in single-arm trials within the framework of NNHM, and the bayesmeta package was allowed to perform bayesian random-effects meta-analyses because of its easy, quick, accurate and reproducible computation.
