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Wang CY, Xu HM, Liu G, Liu J, Yu H, Chen BQ, Zheng G, Shu M, DU LJ, Xu ZW, Huang LS, Li HB, Wang D, Bai ST, Shan QW, Zhu CH, Tian JM, Hao JH, Lin AW, Lin DJ, Wu JZ, Zhang XH, Cao Q, Tao ZB, Chen Y, Zhu GL, Xue P, Tang ZZ, Su XW, Qu ZH, Zhao SY, Pang L, Deng HL, Shu SN, Chen YH. [A multi-center epidemiological study on pneumococcal meningitis in children from 2019 to 2020]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:131-138. [PMID: 38436309 PMCID: PMC10921867 DOI: 10.7499/j.issn.1008-8830.2308090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of Streptococcus pneumoniae (SP) isolates in Chinese children. METHODS A retrospective analysis was conducted on clinical information, laboratory data, and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country. RESULTS Among the 160 children with PM, there were 103 males and 57 females. The age ranged from 15 days to 15 years, with 109 cases (68.1%) aged 3 months to under 3 years. SP strains were isolated from 95 cases (59.4%) in cerebrospinal fluid cultures and from 57 cases (35.6%) in blood cultures. The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87) and 27% (21/78), respectively. Fifty-five cases (34.4%) had one or more risk factors for purulent meningitis, 113 cases (70.6%) had one or more extra-cranial infectious foci, and 18 cases (11.3%) had underlying diseases. The most common clinical symptoms were fever (147 cases, 91.9%), followed by lethargy (98 cases, 61.3%) and vomiting (61 cases, 38.1%). Sixty-nine cases (43.1%) experienced intracranial complications during hospitalization, with subdural effusion and/or empyema being the most common complication [43 cases (26.9%)], followed by hydrocephalus in 24 cases (15.0%), brain abscess in 23 cases (14.4%), and cerebral hemorrhage in 8 cases (5.0%). Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old, with rates of 91% (39/43) and 83% (20/24), respectively. SP strains exhibited complete sensitivity to vancomycin (100%, 75/75), linezolid (100%, 56/56), and meropenem (100%, 6/6). High sensitivity rates were also observed for levofloxacin (81%, 22/27), moxifloxacin (82%, 14/17), rifampicin (96%, 25/26), and chloramphenicol (91%, 21/23). However, low sensitivity rates were found for penicillin (16%, 11/68) and clindamycin (6%, 1/17), and SP strains were completely resistant to erythromycin (100%, 31/31). The rates of discharge with cure and improvement were 22.5% (36/160) and 66.2% (106/160), respectively, while 18 cases (11.3%) had adverse outcomes. CONCLUSIONS Pediatric PM is more common in children aged 3 months to under 3 years. Intracranial complications are more frequently observed in children under 1 year old. Fever is the most common clinical manifestation of PM, and subdural effusion/emphysema and hydrocephalus are the most frequent complications. Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates. Adverse outcomes can be noted in more than 10% of PM cases. SP strains are high sensitivity to vancomycin, linezolid, meropenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.
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Affiliation(s)
- Cai-Yun Wang
- Department of Infectious Diseases, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China (Chen Y-H, . cn)
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- Department of Infectious Diseases, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China (Chen Y-H, . cn)
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Wang CY, Xu HM, Tian J, Hong SQ, Liu G, Wang SX, Gao F, Liu J, Liu FR, Yu H, Wu X, Chen BQ, Shen FF, Zheng G, Yu J, Shu M, Liu L, Du LJ, Li P, Xu ZW, Zhu MQ, Huang LS, Huang HY, Li HB, Huang YY, Wang D, Wu F, Bai ST, Tang JJ, Shan QW, Lan LC, Zhu CH, Xiong Y, Tian JM, Wu JH, Hao JH, Zhao HY, Lin AW, Song SS, Lin DJ, Zhou QH, Guo YP, Wu JZ, Yang XQ, Zhang XH, Guo Y, Cao Q, Luo LJ, Tao ZB, Yang WK, Zhou YK, Chen Y, Feng LJ, Zhu GL, Zhang YH, Xue P, Li XQ, Tang ZZ, Zhang DH, Su XW, Qu ZH, Zhang Y, Zhao SY, Qi ZZ, Pang L, Wang CY, Deng HL, Liu XL, Chen YH, Shu S. [A multicenter epidemiological study of acute bacterial meningitis in children]. Zhonghua Er Ke Za Zhi 2022; 60:1045-1053. [PMID: 36207852 DOI: 10.3760/cma.j.cn112140-20220608-00522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ2=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
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Affiliation(s)
- C Y Wang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - H M Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - J Tian
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - S Q Hong
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - G Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - S X Wang
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - F Gao
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - J Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha 410007, China
| | - F R Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha 410007, China
| | - H Yu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - X Wu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - B Q Chen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei 230022, China
| | - F F Shen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei 230022, China
| | - G Zheng
- Department of Neurology, Children's Hospital of Nanjing Medical University,Nanjing 210008, China
| | - J Yu
- Department of Neurology, Children's Hospital of Nanjing Medical University,Nanjing 210008, China
| | - M Shu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610044, China
| | - L Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610044, China
| | - L J Du
- Department of Neurology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - P Li
- Department of Neurology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Z W Xu
- Department of Infectious Diseases, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - M Q Zhu
- Department of Infectious Diseases, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - L S Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - H Y Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - H B Li
- Department of Pediatrics, the First Hospital of Jilin University, Changchu 130061, China
| | - Y Y Huang
- Department of Pediatrics, the First Hospital of Jilin University, Changchu 130061, China
| | - D Wang
- Department of Neurology, the Affiliated Children's Hospital of Xi'an Jiao Tong University, Xi'an 710002, China
| | - F Wu
- Department of Neurology, the Affiliated Children's Hospital of Xi'an Jiao Tong University, Xi'an 710002, China
| | - S T Bai
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J J Tang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Q W Shan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021, China
| | - L C Lan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021, China
| | - C H Zhu
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Y Xiong
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - J M Tian
- Department of Infectious Diseases, Children's Hospital of Soochow University,Suzhou 215002, China
| | - J H Wu
- Department of Infectious Diseases, Children's Hospital of Soochow University,Suzhou 215002, China
| | - J H Hao
- Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng 475000, China
| | - H Y Zhao
- Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng 475000, China
| | - A W Lin
- Department of Infectious Diseases, Children's Hospital Affiliated Shandong University, Jinan 250022, China
| | - S S Song
- Department of Infectious Diseases, Children's Hospital Affiliated Shandong University, Jinan 250022, China
| | - D J Lin
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - Q H Zhou
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - Y P Guo
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - J Z Wu
- Department of Pediatrics, Women's and Children's Hospital Affiliated to Xiamen University, Xiamen 361003, China
| | - X Q Yang
- Department of Pediatrics, Women's and Children's Hospital Affiliated to Xiamen University, Xiamen 361003, China
| | - X H Zhang
- Department of Neonatology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Y Guo
- Department of Neonatology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Q Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - L J Luo
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Z B Tao
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - W K Yang
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Y K Zhou
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Y Chen
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - L J Feng
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - G L Zhu
- Department of Infection and Digestive, Qinghai Province Women and Children's Hospital, Xining 810007, China
| | - Y H Zhang
- Department of Infection and Digestive, Qinghai Province Women and Children's Hospital, Xining 810007, China
| | - P Xue
- Department of Pediatrics, Taiyuan Maternal and Child Health Care Hospital, Taiyuan 030012, China
| | - X Q Li
- Department of Pediatrics, Taiyuan Maternal and Child Health Care Hospital, Taiyuan 030012, China
| | - Z Z Tang
- Department of Pediatrics, the First People's Hospital of Zunyi, Zunyi 563099, China
| | - D H Zhang
- Department of Pediatrics, the First People's Hospital of Zunyi, Zunyi 563099, China
| | - X W Su
- Department of Pediatrics, Inner Mongolia People's Hospital, Inner Mongolia 750306, China
| | - Z H Qu
- Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Y Zhang
- Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - S Y Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou 310005, China
| | - Z Z Qi
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou 310005, China
| | - L Pang
- Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - C Y Wang
- Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - H L Deng
- Department of Pediatrics, Xi'an Central Hospital, Xi'an 710004, China
| | - X L Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y H Chen
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Sainan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Yi LP, Xue J, Ren SL, Shen S, Li ZJ, Qian C, Lin WJ, Tian JM, Zhang T, Shao XJ, Zhao G. [Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1448-1454. [PMID: 36117353 DOI: 10.3760/cma.j.cn112338-20220321-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To describe the clinical characteristics of Mycoplasma pneumoniae infection and analyze the factors associated with co-infections with other pathogens in children, and provide evidence for improvement of community acquired pneumonia (CAP) prevention and control in children. Methods: Based on the surveillance of hospitalized acute respiratory infections cases conducted in Soochow University Affiliated Children's Hospital (SCH), the CAP cases aged <16 years hospitalized in SCH between 2018 and 2021 were screened. The pathogenic test results of the cases were obtained through the laboratory information system, and their basic information, underlying conditions, and clinical characteristics were collected using a standardized questionnaire. The differences in clinical characteristics between M. pneumoniae infection and bacterial or viral infection and the effect of the co-infection of M. pneumoniae with other pathogens on clinical severity in the cases were analyzed; logistic regression was used to analyze the factors associated with the co-infections with other pathogens. Results: A total of 8 274 hospitalized CAP cases met the inclusion criteria. Among them, 2 184 were positive for M. pneumoniae (26.4%). The M. pneumoniae positivity rate increased with age (P<0.001), and it was higher in girls (P<0.001) and in summer and autumn (P<0.001). There were statistically significant differences in the incidence of wheezing, shortness of breath, wheezing sounds and visible lamellar faint shadow on chest radiographs, as well as fever and hospitalization days among M. pneumoniae, bacterial, and viral infection cases (all P<0.05). In the cases aged <60 months years, co-infection cases had higher rates of wheezing, gurgling with sputum and stridor; and in the cases aged ≥60 months, co-infection cases had a higher rate of shortness of breath (all P<0.05). Multifactorial logistic regression analysis showed that being boys (aOR=1.38,95%CI:1.15-1.67), being aged <6 months (aOR=3.30,95%CI:2.25-4.89), 6-23 months (aOR=3.44,95%CI:2.63-4.51), 24-47 months (aOR=2.50,95%CI:1.90-3.30) and 48-71 months (aOR=1.77,95%CI:1.32-2.37), and history of respiratory infection within 3 months (aOR=1.28,95%CI:1.06-1.55) were factors associated with co-infections of M. pneumoniae with other pathogens. Conclusions: M. pneumoniae was the leading pathogen in children hospitalized due to CAP. M. pneumoniae infections could cause fever for longer days compared with bacterial or viral infections; M. pneumoniae was often co-detected with virus or bacteria. Being boys, being aged <72 months and history of respiratory infection within 3 months were associated factors for co-infections.
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Affiliation(s)
- L P Yi
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - J Xue
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - S L Ren
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - S Shen
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - Z J Li
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - C Qian
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - W J Lin
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - J M Tian
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - T Zhang
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - X J Shao
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China Shanghai Institute of Infectious Disease and Biosecurity, Shanghai 200032, China
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Cheng FF, Zhang BB, Cao ML, Zhang Q, Chen QH, Hui ZF, Tian JM, Yan WH. Clinical characteristics of 68 children with atypical hand, foot, and mouth disease caused by coxsackievirus A6: a single-center retrospective analysis. Transl Pediatr 2022; 11:1502-1509. [PMID: 36247893 PMCID: PMC9561509 DOI: 10.21037/tp-22-352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CV-A6) has become prevalent in many parts of the world. It is commonly referred to as atypical HFMD which more likely to present as bullous lesions. Compared with traditional HFMD, its misdiagnosis rate is relatively high, which brings difficulties to clinical diagnosis. We retrospectively analyze the clinical characteristics of children with HFMD with bullous lesions caused by CV-A6. METHODS The study included 68 children with atypical HFMD caused by CV-A6 who were hospitalized from 2018 to 2020. Data of the children including age, sex, month of HFMD onset, the morphologies and distribution of rashes, the details of fever, the presence or absence of onychomadesis, and laboratory test results were analyzed and compared between an infant group (<1 year), a toddler group (1-<3 years), and a preschool group (3-<6 years). RESULTS Of the 68 children, 67 were younger than 5 years old, with a male to female ratio of 1.62:1. The disease peaked in the period from June to September. With 75.0% of the infant group had more than three kinds of rashes; 95.0% of the preschool group had rashes in more than five locations. These differences were statistically significant (P<0.05). All children had fever. The peak fever in the toddler group was lower (P=0.033). No critical cases were observed in any of the groups. Of the 61 children who were successfully followed up, 68.9% developed onychomadesis within 2-3 weeks. The proportion of cases with abnormal liver function was 83.3%, 41.7%, and 10.0% in the infant, toddler, and preschool groups (P<0.001). The proportion of cases with increased serum creatine kinase MB isoenzyme (CK-MB) were significantly higher in the toddler group (P<0.05). CONCLUSIONS Atypical HFMD caused by CV-A6 infection usually occurred in children under 5 years old. The morphologies of the rashes in the infant group changed more, while the rashes in the preschool group was more widely distributed. The incidence of critical cases was low. More than half of the cases can develop onychomadesis in the recovery period. Organ damage was relatively mild in the preschool group.
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Affiliation(s)
- Fang-Fang Cheng
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Bing-Bing Zhang
- Neurology Department, Children's Hospital of Soochow University, Suzhou, China
| | - Meng-Lu Cao
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Qian Zhang
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Qing-Hui Chen
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Zhao-Fang Hui
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Jian-Mei Tian
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Wen-Hua Yan
- Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
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Ji H, Fan H, Ai J, Shi C, Bi J, Chen YH, Lu XP, Chen QH, Tian JM, Bao CJ, Zhang XF, Jin Y. Neurocognitive Deficits and Sequelae Following Severe hand, foot, and mouth disease from 2009 to 2017, in JiangSu Province, China: A Long-Term Follow-Up Study. Int J Infect Dis 2021; 115:245-255. [PMID: 34910955 DOI: 10.1016/j.ijid.2021.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the long-term sequela and cognitive profile resulting from severe hand, foot and mouth disease (HFMD) with central nervous system (CNS) involvement. METHODS Two-hundred-and-ninety-four HFMD cases were included in a retrospective follow-up study. Physical examination were conducted. The Chinese Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to assess intelligence. RESULTS Fifty-eight mild HFMD cases and 99 severe HFMD cases with mild CNS involvement did not present any neurological sequelae. While the sequelae incidence of severe HFMD with more severe CNS complications were 50.0%. The proportion of full scale intelligence quotient (FSIQ) impairment was 45.0%. In the 2:6-3:11 age group, severe HFMD with more severe CNS complications and lower maternal education level were risk factors for verbal comprehension disorder. Urban-rural residence and lower paternal education level were risk factors for FSIQ disorder. Furthermore, in the 4:0-6:11 age group, severe HFMD with more severe CNS complication was a risk factor for visual spatial disorder and fluid reasoning disorder. Lower paternal education level was a risk factor for FSIQ disorder. CONCLUSION Early assessment and intervention among severe HFMD patients with more severe CNS involvement at a very young age will prove beneficial for their future performance.
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Affiliation(s)
- Hong Ji
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009; Medical School of Nanjing University, Nanjing 210093, China
| | - Huan Fan
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Jing Ai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Chao Shi
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi 214023, China
| | - Jun Bi
- Xuzhou Municipal Center for Disease Control and Prevention, Xuzhou 221006, China
| | - Yin-Hua Chen
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xiao-Peng Lu
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Qin-Hui Chen
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Jian-Mei Tian
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Chang-Jun Bao
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Xue-Feng Zhang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009.
| | - Yu Jin
- Medical School of Nanjing University, Nanjing 210093, China; Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
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Zhang WQ, Chen LL, Cheng FF, Dai ZR, Feng S, Zhang J, Tian JM, Zhang T, Zhao GM. [Study on clinical symptoms and influencing factors of influenza-associated severe acute respiratory illness in children younger than 5 years old in Suzhou of China, 2011-2017]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1044-1049. [PMID: 34814504 DOI: 10.3760/cma.j.cn112338-20200831-01113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To study the influencing factors of influenza-associated severe acute respiratory illness (SARI) in children younger than 5 years of old in Suzhou, and to provide evidence to support the improvement of prevention and control strategies for influenza in children. Methods: We conducted a prospective influenza surveillance for hospitalized SARI and outpatient influenza-like illness (ILI) at Children's Hospital of Soochow University from April 2011 to March 2017. We compared the clinical and other characteristics of influenza-positive patients with SARI to those with ILI to find the differences and to identify influencing factors of influenza-associated SARI, using χ2 test and unconditional logistic regression. Results: We found 786 cases of influenza-associated ILI and 413 cases of influenza-associated SARI during the study period. Cough, runny nose, shortness of breath, asthma or wheezing were more common in influenza-associated SARI than in influenza-associated ILI (P<0.01). Univariate and multivariate logistic regression showed that the influencing factors which significantly associated with increased risk of influenza-associated SARI were as follows: younger age (<6 months OR=3.6, 6-23 months aOR=2.5), respiratory infection history within 3 months (aOR=4.5), chronic lung disease history (OR=3.4), fever above 39.0 ℃ (39.0-39.9 ℃ aOR=2.4, ≥40.0 ℃ aOR=6.0), and the presence of A/H1N1 (aOR=2.3), A/H3N2 (aOR=1.9). Conclusion: Children younger than 2 years old, with a history of chronic lung disease, a history of respiratory infection within 3 months, or with a fever peak above 39.0 ℃ should seek medical advice as soon as possible or receive annual influenza vaccination to reduce the incidence of influenza-associated serious outcomes.
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Affiliation(s)
- W Q Zhang
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - L L Chen
- Department of Infectious Disease Prevention and Control, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - F F Cheng
- Department of Infection, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Z R Dai
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - S Feng
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - J Zhang
- Department of Infectious Disease Prevention and Control, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - J M Tian
- Department of Infection, Children's Hospital of Soochow University, Suzhou 215003, China
| | - T Zhang
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - G M Zhao
- Department of Epidemiology, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
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Cheng FF, Zhan SH, Xie AW, Cai SZ, Hui L, Kong XX, Tian JM, Yan WH. Anxiety in Chinese pediatric medical staff during the outbreak of Coronavirus Disease 2019: a cross-sectional study. Transl Pediatr 2020; 9:231-236. [PMID: 32775241 PMCID: PMC7347772 DOI: 10.21037/tp.2020.04.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Our study aimed to explore the anxiety levels and possible associated factors in the pediatric medical staff in Jiangsu province during an outbreak of Coronavirus Disease 2019 (COVID-19). METHODS Pediatric medical staff (n=534) from nine hospitals in Jiangsu province were enrolled. Their anxiety levels and quality of sleep were assessed using the online SAS and PSQI questionnaires. RESULTS The prevalence of anxiety was 14.0% among the medical staff. In children's hospital staff, anxiety levels in outpatient and emergency departments were significantly higher than those in inpatient departments, except for the intensive care unit. The SAS scores were significantly associated with educational background, professional title, lifestyle, and physical condition. Stepwise multiple linear regression showed that physical condition, lifestyle, attention to the epidemic, professional title, and educational background all had a linear relationship with the individual's anxiety levels. Pearson correlation analysis showed that sleep quality was moderately associated with anxiety levels. CONCLUSIONS The prevalence of anxiety was 14.0% in pediatric medical staff in Jiangsu province during an outbreak of COVID-19. Department, professional title, and educational background were associated with anxiety levels in these workers. More attention should be paid to staff who are in poor health, and this anxiety can also be accompanied by poor sleep quality. Peer support can assist with anxiety relief.
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Affiliation(s)
- Fang-Fang Cheng
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - Shi-Hong Zhan
- The Neonatal Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - An-Wei Xie
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - Shi-Zhong Cai
- Child Healthcare Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - Li Hui
- The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Xiao-Xing Kong
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - Jian-Mei Tian
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou 215002, China
| | - Wen-Hua Yan
- Cardiovascular Department, Children's Hospital of Soochow University, Suzhou 215002, China
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Li JQ, Tian JM, Fan XR, Wang ZY, Ling J, Wu XF, Yang FY, Xia YL. miR-106b-5p induces immune imbalance of Treg/Th17 in immune thrombocytopenic purpura through NR4A3/Foxp3 pathway. Cell Cycle 2020; 19:1265-1274. [PMID: 32323598 DOI: 10.1080/15384101.2020.1746485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immune imbalance of regulatory T cells (Treg)/T helper 17 cells (Th17) contributes to the development of immune thrombocytopenic purpura (ITP). The dysregulation of miRNAs is important in the development of ITP. However, the role of miR-106b-5p in Treg/Th17 imbalance remains unknown in ITP. MATERIALS AND METHODS Peripheral blood was collected from patients with ITP and healthy controls, and CD4 + T cells were further isolated. miR-106b-5p, nuclear receptor subfamily 4 group A member 3 (NR4A3), forkhead box protein 3 (Foxp3), IL-17A, and TGF-β expressions were detected by qRT-PCR, western blot, or ELISA. The effect of miR-106b-5p on NR4A3 was detected by dual-luciferase reporter gene assay. RESULTS Compared with healthy controls, miR-106b-5p was elevated in peripheral blood of patients with ITP, and NR4A3 expression was decreased. sh-NR4A3 significantly decreased Foxp3 and TGF-β expressions, indicating that NR4A3 may regulate Treg differentiation via Foxp3. Additionally, NR4A3 was identified to be a target of miR-106b-5p, and miR-106b-5p was able to negatively modulate NR4A3 expression. Moreover, we found miR-106b-5p induced immune imbalance of Treg/Th17 through NR4A3. In vivo experiments revealed that silencing miR-106b-5p promoted Treg differentiation and increased the number of platelets, suggesting the relief of ITP. CONCLUSION miR-106b-5p regulated immune imbalance of Treg/Th17 in ITP through the NR4A3/Foxp3 pathway.
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Affiliation(s)
- Jian-Qin Li
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Jian-Mei Tian
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Xiao-Ru Fan
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Zhao-Yue Wang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University , Soochow, Jiangsu, China
| | - Jing Ling
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Xiao-Fang Wu
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Fei-Yun Yang
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
| | - Ya-Lin Xia
- Department of Hematology, Children's Hospital of Soochow University , Soochow, Jiangsu, China
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Zhang WQ, Yu J, Chen LL, Cheng FF, Zhang R, Gao JM, Zhang J, Zhao GM, Tian JM, Zhang T. [Hospitalization rates for influenza-associated severe acute respiratory illness in children younger than five years old in Suzhou of China, 2016-2018]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 53:1056-1059. [PMID: 31607055 DOI: 10.3760/cma.j.issn.0253-9624.2019.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analyzed the influenza surveillance data of Children's Hospital of Suzhou University from 2016 to 2018 and estimated the hospitalization burden of children under 5 years old due to influenza infection in Suzhou. The results showed that the influenza virus positive rate of 1 451 severe acute respiratory infection (SARI) cases in Children's Hospital of Suzhou University was 13.6% (95%CI: 11.8%-15.3%; 197 cases), among which the influenza pandemic intensity in 2017-2018 was relatively high, and A/H1N1 was the main pandemic virus. It was estimated that the hospitalization rate of influenza-related SARI in children under 5 years old in Suzhou was 6.9‰ (95%CI: 6.6‰-7.2‰), among which the hospitalization rate of children aged<6 months was higher, up to 11.4‰ (95%CI: 9.9‰-12.8‰).
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Affiliation(s)
- W Q Zhang
- School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - J Yu
- School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - L L Chen
- Department of Prevention and control, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - F F Cheng
- Department of infection, Soochow University Affiliated Children's Hospital, Suzhou 21500, China
| | - R Zhang
- United States and China program office for emerging and re-emerging infectious diseases, China Center of Disease Control and Prevention, Beijing 100050, China
| | - J M Gao
- School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - J Zhang
- Department of Prevention and control, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - G M Zhao
- School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - J M Tian
- Department of infection, Soochow University Affiliated Children's Hospital, Suzhou 21500, China
| | - T Zhang
- School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
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Yu J, Zhang T, Wang Y, Gao JM, Hua J, Tian JM, Ding YF, Zhang J, Chen LL, Li JQ, Zhao GM. [Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017]. Zhonghua Liu Xing Bing Xue Za Zhi 2018; 39:847-851. [PMID: 29936759 DOI: 10.3760/cma.j.issn.0254-6450.2018.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.
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Affiliation(s)
- J Yu
- School of Public Health, Fudan University, Shanghai 200032, China
| | - T Zhang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Y Wang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - J M Gao
- School of Public Health, Fudan University, Shanghai 200032, China
| | - J Hua
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - J M Tian
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - Y F Ding
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - J Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou 215000, China
| | - L L Chen
- Suzhou Center for Disease Control and Prevention, Suzhou 215000, China
| | - J Q Li
- Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - G M Zhao
- School of Public Health, Fudan University, Shanghai 200032, China
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Abstract
Objective: To explore the clinical features, diagnosis, treatment and the prognosis of Farber disease by case report and literature review. Method: The clinical information of a case with farber's disease diagnosed in October 2015 at Peking University First Hospital was collected and analyzed, including clinical manifestation, electrophysiology, magnetic resonance imaging, pathology, treatments and prognosis.ASAH1 gene mutational analysis was conducted in the patient and her parents.By using "Farber's disease, ASAH1" as keywords, literature was searched from Pubmed, CHKD and HGMD database from January 1951 to January 2016. Result: The girl, 2 years 2 months old, was sent to our hospital in October 2015, with complains of "joint swelling for 17 months, development regress of intelligence and movement for 11 months, intermittent seizures for 2 months" .The clinical manifestation of the patient was characterized by painful and deformed joints, subcutaneous nodules, progressive hoarseness, and the progressive neurological system deterioration.Joints swelling and deformity behave as the first symptoms.A series of electroencephalogram showed slow background and spike wave.Visual evoked potential was significantly abnormal.Brain magnetic resonance imaging (MRI) showed hypomyelination and progressive diffuse brain atrophy.Histology of subcutaneous nodule showed proliferation of the connective tissue with hyalinization, cholesterol crystal like changes, and a large number of foamy cell infiltration.Compound heterozygous mutations of ASAH1 gene, c. 304_305 ins A (p.T102Nfs14) and c. 314T>C (p.L105p), were found in the patient, and the former is inherited from her mother, the latter from her father.Antiepileptic treatment and other symptomatic treatments were delivered to the patient, but the effectiveness was poor.One reference from China hownet and 35 references from Pubmed have reported a total of 26 cases.Twenty out of 26 patients (77%) had the onset under 1 year of age.By region, there were 12 patients (12/26, 46%) from India, and the others around world.Among these 12 indian patients, 10 lack of complete clinical data.Among the rest 16 patients, 4 patients' parents were consanguineous; 8 patients with the main clinical manifestation of painful and deformed joints, subcutaneous nodules, and hoarse cry; 4 patients with hepatic failure and impaired spleen; 5 patients with rapid neurological deterioration; 1 patient with bone destruction; 7 patients under liver and skin biopsies, pathologically showing a large number of foam cells and "Farber bodies" . There are 33 genetic mutations, and 45% (15/33) mutations are concentrated in ASAH1 exon 6-10. Conclusion: Farber disease is a rare autosomal recessive disease caused by deficiency of lysosomal acid ceramidase.Histopathology of granulomatous tissue plays an important role in the early diagnosis.
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Affiliation(s)
- X H Bao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
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12
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Tang JH, Tian JM, Sheng M, Hu SY, Li Y, Zhang LY, Gu Q, Wang Q. Study of Posterior Reversible Encephalopathy Syndrome in Children With Acute Lymphoblastic Leukemia After Induction Chemotherapy. J Child Neurol 2016; 31:279-84. [PMID: 26060305 DOI: 10.1177/0883073815589758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/21/2015] [Indexed: 12/16/2022]
Abstract
Increasing occurrence of posterior reversible encephalopathy syndrome has been reported in children with acute lymphoblastic leukemia. However, the etiology of posterior reversible encephalopathy syndrome is not clear. To study the possible pathogenetic mechanisms and treatment of this complication, we reported 11 cases of pediatric acute lymphoblastic leukemia who developed posterior reversible encephalopathy syndrome after induction chemotherapy. After appropriate treatment, the clinical symptoms of posterior reversible encephalopathy syndrome in most cases disappeared even though induction chemotherapy continued. During the 1-year follow-up, no recurrence of posterior reversible encephalopathy syndrome was observed. Although the clinical and imaging features of posterior reversible encephalopathy syndrome may be diverse, posterior reversible encephalopathy syndrome should be recognized as a possible important complication of acute lymphoblastic leukemia when neurologic symptoms appear. In line with previous reports, our study also indicated that posterior reversible encephalopathy syndrome was reversible when diagnosed and treated at an early stage. Thus, the occurrence of posterior reversible encephalopathy syndrome should be considered and investigated to optimize the early induction scheme of acute lymphoblastic leukemia treatment.
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Affiliation(s)
- Ji-Hong Tang
- Department of Neurology, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Jian-Mei Tian
- Department of Internal Medicine, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Mao Sheng
- Radiology Department, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Shao-Yan Hu
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Department of Neurology, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Li-Ya Zhang
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Qing Gu
- Department of Neurology, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Qi Wang
- Radiology Department, Children's Hospital Affiliated to Soochow University, Suzhou, China
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Wang KK, Tian JM, Gorospe E, Penfield J, Prasad G, Goddard T, Wongkeesong M, Buttar NS, Lutzke L, Krishnadath S. Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus. Dis Esophagus 2012; 25:349-55. [PMID: 22409514 PMCID: PMC4134126 DOI: 10.1111/j.1442-2050.2012.01342.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The management of high-grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high-grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio-frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett's esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long-term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients.
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Affiliation(s)
- K K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55934, USA.
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Wang L, Zhu HY, Tian JM, Huang SD, Kong LS, Lu JP. Magnetic resonance imaging in determination of myocardial ischemia and viability: comparison with positron emission tomography and single-photon emission computed tomography in a porcine model. Acta Radiol 2007; 48:500-7. [PMID: 17520425 DOI: 10.1080/02841850701280783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In patients with chronic left ventricular dysfunction, the size of the viable cardiac muscle is correlated with the prognosis and the outcome of myocardial revascularization. PURPOSE To evaluate the diagnostic value of various imaging techniques in determination of myocardial ischemia and viability. MATERIAL AND METHODS A chronic myocardial ischemia animal model was established, in which 10 pigs underwent magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (201Tl SPECT) before and 1-2 months after modeling. The size of myocardial ischemia and necrosis was judged, and the imaging manifestations were compared with pathologic findings. RESULTS Seven of the 10 animals completed all examinations uneventfully. On dobutamine-stressed cine MRI, 10 (8.93%) segments were found to be akinetic. Perfusion was abnormal in 34 (30.35%) segments. Delayed hyperenhancement was observed in 12 (10.71%) segments. PET detected myocardial necrosis in 17 (15.18%) segments, and SPECT detected myocardial necrosis in nine (8.04%) segments. Histological examination with triphenyltetrazolium chloride (TTC) showed pale necrosis in 14 (12.50%) segments. The number of necrotic segments detected by PET was significantly greater than that by contrast-enhanced MRI (chi2 = 5, P = 0.0253, kappa = 0.8028) and cine MRI (chi2 = 7, P = 0.0082, kappa = 0.7079). It was also greater than that by TTC (chi2 = 3, P = 0.0833, kappa = 0.8879), although the difference was statistically insignificant. The number of necrotic segments detected by SPECT was significantly smaller than that by TTC (chi2 = 5, P = 0.0253, kappa = 0.7590), as was the number of necrotic segments detected by cine MRI (chi2 = 4, P = 0.0455, kappa = 0.8100). There was no statistically significant difference in the detection of necrotic segments between contrast-enhanced MRI and TTC (chi2 = 2, P = 0.1573, kappa = 0.9130). CONCLUSION Cardiac MRI can determine viable myocardium and clearly delineate the location and degree of myocardial necrosis. PET slightly overestimates the extent of the necrotic myocardium and is unable to distinguish transmural necrosis from subendocardial necrosis.
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Affiliation(s)
- L Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Liu Q, Lu JP, Wang F, Wang L, Tian JM. Endovascular graft exclusion for abdominal aortic aneurysms: 3D contrast-enhanced MR angiography. ACTA ACUST UNITED AC 2005; 31:347-60. [PMID: 16317493 DOI: 10.1007/s00261-005-0361-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Q Liu
- Department of Radiology, Changhai Hospital, Second Military Medical University, 174 Changhai Rd, Shanghai 200433, China.
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Lu J, Lu WW, Tian JM, Li LY. [Effect of Rg2 on hemodynamics of hemorrhagic shock and its antioxidation in dogs]. Zhongguo Zhong Yao Za Zhi 2001; 26:556-8. [PMID: 12776372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To investigate the protective effect of Rg2 on hemodynamics of hemorrhagic shock and its antioxidant properties. METHOD Twenty mongrel dogs were randomly divided into Rg2 group, Shen Mai group and control group. The hemorrhagic shock model was built in all dogs by artery bleeding and mean arterial blood pressure was kept < 5.33 kPa for 4.5 hours. Rg2 0.5-1.0 mg.kg-1 and Shen Mai 100 mg.kg-1 were intravenously administered after hemorrhagic shock appeared. RESULT Rg2 significantly enhanced blood pressure, LVSP and +/- dp/dtmax on hemorrhagic shock dogs who had lost compensation ability. Rg2 0.5-1.0 mg.kg-1 could reduce serum MDA, increase superoxide dismutase activity and prolong survival rate of dogs after shock. All these data have statistically significant when compared to control group (P < 0.05, P < 0.01, P < 0.001). CONCLUSION These results suggest that Rg2 is more potent and effective than Shen Mai in improving hemodynamic state and activiting SOD on hemorrhagic shock dogs.
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Affiliation(s)
- J Lu
- Norman Bethune University of Medical Sciences, Changchun 130021, Jilin, China
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Abstract
We modified Ti surfaces by implantation of amino (NH(2+)) groups at 10(16) and 10(17) cm(-2). The implanted surfaces were characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), scanning Auger electron spectroscopy (AES), and second ion mass spectroscopy (SIMS). The experimental results showed that the implanted Ti specimens were covered by a dominant hydrocarbon overlayer due to contamination and the surface oxide layer of implanted specimens became thicker. XPS, AES, and SIMS depth profiles showed that implanted elements had a typical ion implantation distribution and that titanium nitride (TiN) was formed.
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Affiliation(s)
- Y Z Yang
- Beijing Fine Ceramics Laboratory, State Key Laboratory of New Ceramics and Fine Processing, Institute of Nuclear Energy Technology, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, PRChina.
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Abstract
Graded porous titanium coatings have been deposited on titanium substrates for dental implants by plasma spraying in an argon atmosphere. X-ray diffraction (XRD), scanning electron microscopy (SEM), surface roughness measurement, and tensile strength tests were performed on graded porous coatings. The results showed that Ti(3)O(5) was formed in the outermost surface of the porous coatings due to oxidation. The graded porous coatings consisted of three layers. The outer layer was full of macropores with a surface roughness of approximately 100 microm. The diameter of many macropores reached and even surpassed 150 microm, which could be beneficial for tissue to grow into the coating. The middle layer consisted of a mixture of micropores and macropores. The inner layer was a very dense and tight interface layer that included mechanical, physical, and metallurgical bonding. In tensile strength tests, testing bars peeled off the coatings, because the adhesive agent fractured, but the coatings remained intact.
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Affiliation(s)
- Y Z Yang
- Beijing Fine Ceramics Laboratory, Key State Laboratory of New Ceramics and Fine Processing, Institute of Nuclear Energy Technology, Tsinghua University, Beijing, 100084, P.R. China.
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Galli T, Zahraoui A, Vaidyanathan VV, Raposo G, Tian JM, Karin M, Niemann H, Louvard D. A novel tetanus neurotoxin-insensitive vesicle-associated membrane protein in SNARE complexes of the apical plasma membrane of epithelial cells. Mol Biol Cell 1998; 9:1437-48. [PMID: 9614185 PMCID: PMC25366 DOI: 10.1091/mbc.9.6.1437] [Citation(s) in RCA: 251] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The importance of soluble N-ethyl maleimide (NEM)-sensitive fusion protein (NSF) attachment protein (SNAP) receptors (SNAREs) in synaptic vesicle exocytosis is well established because it has been demonstrated that clostridial neurotoxins (NTs) proteolyze the vesicle SNAREs (v-SNAREs) vesicle-associated membrane protein (VAMP)/brevins and their partners, the target SNAREs (t-SNAREs) syntaxin 1 and SNAP25. Yet, several exocytotic events, including apical exocytosis in epithelial cells, are insensitive to numerous clostridial NTs, suggesting the presence of SNARE-independent mechanisms of exocytosis. In this study we found that syntaxin 3, SNAP23, and a newly identified VAMP/brevin, tetanus neurotoxin (TeNT)-insensitive VAMP (TI-VAMP), are insensitive to clostridial NTs. In epithelial cells, TI-VAMP-containing vesicles were concentrated in the apical domain, and the protein was detected at the apical plasma membrane by immunogold labeling on ultrathin cryosections. Syntaxin 3 and SNAP23 were codistributed at the apical plasma membrane where they formed NEM-dependent SNARE complexes with TI-VAMP and cellubrevin. We suggest that TI-VAMP, SNAP23, and syntaxin 3 can participate in exocytotic processes at the apical plasma membrane of epithelial cells and, more generally, domain-specific exocytosis in clostridial NT-resistant pathways.
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Affiliation(s)
- T Galli
- Centre National de la Recherche Scientifique Unité Mixte de Recherche 144 "Compartimentation et Dynamique Cellulaires," Institut Curie, F-75248 Paris Cedex 05, France.
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Li LY, Ye JM, Yin H, Zhu YM, Tian JM, Gao F. [Effect of Leontopodium leontopodioides (Willd.) Beauv. on inflammation induced by animal reversed passive arthus (RPA)]. Zhongguo Zhong Yao Za Zhi 1994; 19:174-6, 192. [PMID: 7945846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The extract from Leontopodium leontopodioides 50-100mg/kg ip has been proved able to suppress the swelling of normal or adrenalectomised rat hind paws induced by RPA, and strongly inhibit the cutaneous hemorrhage of animals induced by RPA, lysosome or lysosome of broken membrane. It has also been shown that the extract 100 mg/kg ip can markedly inhibit the migration of leukocytes. These suggest that the anti-inflammatory properties of the extract are not dependent on the pituitary-adrenal system or membrane of lysosome.
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Affiliation(s)
- L Y Li
- Jilin Provincial Academy of Traditional Chinese Medicine and Materia Medica, Changchun
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Abstract
Hepatocyte nuclear factor 1 (HNF-1) is a transcriptional regulatory protein possibly involved in the activation of many liver-specifically expressed genes. HNF-1 mRNA is restricted to a small number of tissues, suggesting that the HNF-1 gene itself is regulated at the transcriptional level. We have isolated and characterized the promoter region of this gene and have determined its transcriptional potential in several cell types by cell-free transcription and transient transfection experiments. In in vitro transcription assays, an HNF-1 promoter is active in nuclear extracts from liver and kidney, two tissues that contain HNF-1, but silent in nuclear extracts from spleen and lung, which are devoid of this transcription factor. Likewise, in transfection experiments, HNF-1 promoter-chloramphenicol acetyltransferase (CAT) fusion genes are expressed in Hep G2 cells, which express HNF-1, but not in mouse L cells or Hela cells, which do not express HNF-1. In both cell-free transcription and transient transfection assays, a relatively short promoter segment located between positions -82 and -40 is necessary and sufficient to direct cell type-specific HNF-1 transcription. This region contains a single site for a DNA-binding protein that has been tentatively identified as hepatocyte nuclear factor 4, a member of the steroid hormone receptor family.
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Affiliation(s)
- J M Tian
- Département de Biologie Moléculaire, Sciences II, Université de Genève, Switzerland
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