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06 August 2011, Volume 26 Issue 8 Previous Issue    Next Issue

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Research on virulence genes and associated mobile genetic elements in Staphylococcus aureus causing pediatric infections.　 LI Xiang-mei*，WU De-Jing，GENG Wen-jing，LIU Ying-chao，WANG Chuan-qing，DENG Qiu-li 2011, 26(8): 572.  Abstract ( )   Abstract：Objective　To study the presence of virulence genes and associated mobile genetic elements in Staphylococcus aureus causing pediatric infections. Methods　A total of 109 Staphylococcus aureus strains collected between June 2005 and July 2009 were detected for the presence of 19 superantigen genes，2 exfoliative toxin genes and 3 adhesin genes by polymerase chain reaction. The distribution of virulence genes was analyzed between strains collected from different infections. Results　60 Staphylococcus aureus strains were isolated from children with pneumonia，49 from children with skin and soft tissue infections. Of the strains，90.8% harbored superantigen genes，with sek and seq as the most frequent genes （57.8%），followed by seb （45.9%） and sea （40.4%）. The sed and etd genes were not found in any of the strains tested. Thirty-seven superantigen genotypes were observed，of which the genotypes seb-sek-seq （ 20.2%） were the majority. About 78.4% （29/37） of the superantigen genotypes could be considered combinations of the superantigenic toxin gene-encoding profiles of mobile genetic elements. sek-seq without seb was found in 12 strains，Seb-seq without sek and seb-sek without seq was respectively found in 1 strain.10 of the tst-1-positive strains harbored seb. 4 of the sej-positive strains harbored ser.3 adhesin genes bbp、sdrE and cna were present in 91.7%、77.1%、30.3% of the strains，respectively. Seb，seq，bbp，sdrE were significantly associated with skin and soft tissue infections（P < 0.05）. Seg，sei，sen，seo and cna were significantly associated with pneumonia（P < 0.05）. Conclusion　The distribution of superantigen genes in Staphylococcus aureus isolated from children with pneumonia and skin and soft tissue infections implies the existence of new types or variants of mobile genetic elements in these strains. The frequencies of carriage of the 3 adhesin genes differ from other geographic areas. The roles of virulence genes in these two kinds of infections need further study.

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The relationship between single nucleotide polymorphism of IL-10 and the susceptibility of hand，foot and mouth disease. HE Jun-feng， SHAN Feng，ZHAO Na，ZHANG Ping，CHEN Zong-bo 2011, 26(8): 578.  Abstract ( )   Objective　To explore the possible relationship between the level of IL-10 in blood plasma and hand，foot and mouth disease（HFMD） and to investigate whether the single nucleotide polymorphism （SNP） of IL-10 -1082 G/A correlates with HFMD. Methods　By reverse transcription polymerase chain reaction（RT-PCR）， we used of specific primers to detect enterovirus71（EV71） and coxsackievirus A16（CA16） in the faeces of HFMD children. The levels of IL-10 in blood plasma were detected by enzyme-linked immunosorbent assay. The genotypes of IL-10 gene -1082 site G/A were detected by the PCR techniques in EV71 patients， CA16 patients and normal children. Results　①EV71 was detected positive in 82 specimens from 178 acute-stage children with HFMD. The positive rate was 46.07%. CA16 was detected positive in 67 specimens from 178 acute-stage children with HFMD. The positive rate was 37.64%.②Compared with the normal children， the level of IL-10 was significantly decreased（P < 0.05）.③The difference of IL-10 gene -1082 site genotypes was statistically significant in EV71 group，CA16 group and control group（P < 0.05）；A allele frequency was higher in EV71 group than in normal group（P < 0.05），while A allele frequency was of no significant difference between CA16 group and control group （P > 0.05）. IL-10 gene -1082 site A allele frequency was higher in encephalitis group than in HFMD group（P < 0.05）. Conclusion　Genotype of IL-10 gene -1082 site， the level of IL-10 in plasma might have relationship with the generation of HFMD， and A allele of IL-10 gene -1082 site might be the genetic risk factors of encephalitis occurrence.

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Resistance analysis of Streptococcus pneumoniae in children with lower respiratory tract infection in Wenzhou area between 2005 and 2009. SHI Yan-hua，LI Chang-chong，ZHANG Hai-lin，LIN Li，HU Xiao-guang，ZHANG Wei-xi 2011, 26(8): 582.  Abstract ( )   Abstract： Objective　To examine the resistance of Streptococcus pneumoniae （SP） to common antimicrobial drugs in children with lower respiratory tract infection in Wenzhou area between 2005.1 and 2009.12. Methods　Susceptibility data of lower respiratory tract infection by Streptococcus pneumoniae in children discharged from Jan.2005 to Dec.2009 were reviewed. The children hospitalized in Yuying Children's Hospital affiliated to Wenzhou Medical College.Lower respiratory tract infection included bronchitis，bronchiolitis and pneumonia. Results　Totally 643 strains of Streptococcus pneumoniae were found；in the 5 years，the order of top ten rates in the drug resistance was as follows：erythromycin 99.3%，azithromycin 98.6%，chlorine lincomycin Su 98.3%，sulfamethoxazole 95.0%，cefaclor 94.6%，cefuroxime 94.1%，tetracycline 93.6%，penicillin 93.2%，meropenem 87.4%，cefotaxime 77.9%.There was non-Vancomycin-resistant strain. The comparisons between penicillin-susceptible streptococcus pneumoniae and penicillin non-susceptible streptococcus pneumoniae to erythromycin，cefuroxime，cefotaxime，cefepime，cefaclor，ceftriaxone，amoxicillin/clavulanic acid，amoxicillin and meropenem were all P < 0.05.However，the comparisons to clindamycin，ampicillin，tetracycline，sulfamethoxazole，ciprofloxacin，spectinomycin，levofloxacin and azithromycin were all P > 0.05. The comparisons between erythromycin-susceptible streptococcus pneumoniae and erythromycin non-susceptible streptococcus pneumoniae to clindamycin，penicillin，tetracycline and azithromycin were all P < 0.05. And the comparisons to cephalosporins，sulfamethoxazole，ciprofloxacin，amoxicillin/clavulanic acid，levofloxacin，amoxicillin，chloramphenicol and meropenem were all P > 0.05. Conclusion　The situation of SP resistance in children from Wenzhou with lower respiratory tract infection is grim. The levels of different drugs increased year by year in different degrees，which should be paid enough dinical attetion.

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Research into abnormal glucose and lipid metabolism in early diagnosis and intervention in obese children and adolescents. MU Ya-ping*，ZHAO Fang，MA Hong-gang，LIU Li-min，LI Na，WANG Yan，LI Bin，GUAN Li-jun， 2011, 26(8): 587.  Abstract ( )   Abstract：Objective　To explore the relationship between obesity and glucose and lipid metabolism ，and the damage of the related target organs such as liver and heart in order to take early intervention. Methods　Totally 516 children with simple obesity made up obesity group， 100 normal-weight children as a control group. Detect the fasting plasma glucose （FPG）， triglyceride （TG）， total cholesterol （TC）， alanine aminotransferase （ALT）， fasting insulin （FINS） and other projects； calculate the insulin resistance index （HOMA-IR） and insulin value of β-cell function （HOMA-β）； oral glucose tolerance test （OGTT） and insulin release test were done in obese children； perform liver and heart ultrasonography in all children. Results　Obese children‘s systolic and diastolic blood pressure were higher than the control group （P < 0.05），hypertension was detected in 12.0% （62/516）of obese children； the FBG， FINS， HOMA-IR and HOMA-? of obese children were higher than the control group （P < 0.05）；the TC， TG， LDL-C were higher than the control group， while HDL-C lower than the control group， the differences being significant （P < 0.05）； the incidence of fatty liver of the light moderate and severe groups were significantly different （P < 0.001）. With the increase of the obesity degree， fatty liver was significantly increased （χ2 = 12.97， P < 0.001）. External fat thickness of the pericardium increased in 268 cases of obese group， external fat thickness of the pericardium being 3.372 ± 0.098 （mm）；compared with the control group the difference was significant （P < 0.001）. Early joint intervention was done in 97 MS patients， including dieting and increasing physical activity， combined with oral metformin drugs，and the FINS and HDL-C improvement was of significant difference （P < 0.001） .Conclusion The risk of hypertension in obese children is higher than non-obese children.Abnormal glucose metabolism is more comman in obese children than in non-obese children；children with mild obesity can have abnormal glucose metabolism such as IFG、IGT、IR 、HINS and reduced β-cell function.Obese children have dyslipidemia. Fatty liver is likely to occur in obese children，and the incidence of fatty liver and obesity level of severity is relevant. After the age of 10， fatty liver in obese children was significantly higher.Left ventricular hypertrophy and fat thickness of external pericardial are more often seen in fat group than children of normal weight. With the degree of obesity increaseing， the proportion of cardiac change is also increasing. Metformin treatment of obesity and other joint intervention can significantly reduce the FINS and increased HDL-C values，which can prevent the development of IGT and diabetes.

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The expression and clinical significance of the IL-2 and IL-6 in serum and induced sputum in the children with Mycoplasma pneumoniae pneumonia. LIU He-lin*，WANG Li-suo，ZHENG Shen-jian，WEI Xiao，GAN Bin 2011, 26(8): 592.  Abstract ( )   Abstract： Objective　To study the level of the IL-2 and IL-6 in serum and induced sputum in the children with mycoplasma pneumoniae pneumonia，then approach the role and clinical significance in the nosogenesis of the mycoplasma pneumoniae pneumonia. Methods　Fifty-six children with mycoplasma pneumoniae pneumonia were collected from June 2009 to December 2010 in our hospital and the mass concentration of the IL-2 and IL-6 from fifty-six serum and forty-two induced sputum specimens was detected with enzyme linked immunosorbent assay，then the level of the IL-2 and IL-6 in serum and induced sputum were compared in different stages and mild and severe case with t-test. Results　The level of the IL-2 of the children with mycoplasma pneumoniae pneumonia in serum and induced sputum in acute stage was lower than the convalescence stage and normal control group’s（P < 0.05）. The level of the IL-6 was higher than the convalescence stage and normal control group’s（P < 0.05）. The level of the IL-2 of the mild case with mycoplasma pneumoniae pneumonia in acute and convalescence stage was higher than the severe case’s（P < 0.05）. The level of the IL-6 of the mild case was lower than the severe case’s（P < 0.05）. The detection results of the two specimens from serum and induced sputum were accordant and the level of the IL-2 and IL-6 in induced sputum was higher than the level of the serum group，both positively related. Conclusion　The level of the IL-2 and IL-6 in serum and induced sputum could be detected in infection incipient stage with mycoplasma pneumoniae so that the severity level and prognosis of the pathogenetic condition could be evaluated and judged.Meanwhile the evidences could be provided for the earlier immunologic intervention treatment.

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Prospective study on monitoring of exhaled nitric oxide in the management of childhood asthma. LIU Can-xia，BAO Yan-min，WANG Li，LIU Ping，ZHOU Ya-yan，ZHENG Yue-jie. 2011, 26(8): 596.  Abstract ( )   Abstract：Object　To evaluate the role of FeNo monitoring in the management of asthma. Methods　After 10 months of treatment，the symptoms. Forty-one children with asthma were allocated to a FeNO group （n = 20） and to a control group （n = 21）. β-agonist use， lung function，and FeNO were studied. Results　After 10-months therapy， frequency of respiratory symptoms， β-agonist use，FEV1%Ppredicted， MEF50%predictted and the frequency of exacerbations were similar between two groups. Patients in the FeNO group received higher doses of inhaled corticosteroids（ICS）（ FeNO group：290±75， control group：225±50），with statistically significant difference. Conclusion　We could not demonstrate a clinical benefit of including FeNO into asthma monitoring in asthma children on inhaled steroid. A longer follow-up might be necessary to demonstrate improved outcome.

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Relationship between total and specific IgE in patients with asthma WANG Wei，WANG Fang，LIU Zhe-wei 2011, 26(8): 600.  Abstract ( )   Abstract : Objective　To investigate the relationship between total immunoglobulin E （tIgE） and specific immunoglobulin E （sIgE） in serum，and verify whether the elevation of serum tIgE directly depends on increasing sIgE against the dominant allergen in the environment. Methods　Totally 219 out-patients or in-patients with asthma or cough variant asthma（CVA） were selected randomly in our hospital from January 2007 to June 2010. There were165 male and 54 female patients，with age ranging from 3 to 16 （mean : 6.5）. With blood samples，tIgE and sIgE directly against mixed molds （mx1），dermatophagoides pternonyssinus （d1），dermatophagoides farinae （d2），cat （e1），dog （e5），and artemisia vulgaris （w6） respectively were assayed by fluoroenzyme-immunometric assay，UniCAP100. Results　We observed that in 219 patients，sIgE positive rates were 45.7% for mx1，32% for d1，31.5% for d2，25.1% for e1，18.7% for e5 and 21.5% for w6，respectively. ① The elevation of tIgE was highly related to sIgE directly against mx1，d1，d2，e1，e5 and w6 respectively （t = 0.000，P < 0.01）. ② When tIgE was more than 200 U/mL，we observed that sIgE could lead to tIgE increasing significantly in c1 an e5 group （P < 0.01），but not in d2，d2 and w6 （P > 0.01）. Conclusion　It is not a universal phenomenon that the dominant allergen in the environment could lead to tIgE increasing strongly.

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Clinical analysis of birth defects in 476 cases of hospitalized children from 2001 to 2010. ZHU Ke，REN Rong-na 2011, 26(8): 603.  Abstract ( )   Abstract：Objective　To compile the prevalence and factors of birth defects on hospitalized children of Pediatrics in our hospital from 2001 to 2010 and provide some examples for reducing birth defects. Methods　Data of birth defects of all hospitalized children from January 1， 2001 to December 31， 2010 were reviewed. Types of birth defects and prenatal exposure to risk factors were retrospectively analyzed. Results　The prevalence rate of birth defects on hospitalized children over the past 10 years was 16.41 per l 000.The risk factors influencing the incidence of birth defects were the age of parturient under 20 and over 35 ，preterm birth（birth less than 37 weeks after conception），sick in early pregnancy，taking medicine in early pregnancy， spontaneous abortion， current family history of congenital defect，but the prevalence rates were no significance between urban and suburb and between male and female.Congenital heart diseases were the most common types of birth defects. Conclusion　The surveillance and intervention program of birth defects and tertiary preventions shall be performed to decrease preference of birth defects on perinatal fetuses.

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Attention-deficit hyperactivity disorder in children with focal epilepsy and the impact on quality of life. CHEN Qian，YAN Xiu-xian，JIANG Li-li，ZHANG Gui-zhen，WANG Yang，LI Er-zhen，YANG Jian 2011, 26(8): 606.  Abstract ( )   Abstract：Objective　We aimed to clarify the prevalence of attention-deficit hyperactivity disorder（ADHD） and the characteristics of clinical subtype and attention and response control assessment and the role of ADHD in quality of life in children with focal epilepsy（FEP）. Methods Totally 120 children with FEP underwent interview to identify the presence and type of DSM-Ⅳ defined ADHD；attention and response control assessment was measured by integrated visual and auditory continuous performance test （IVA-CPT）；the quality of life was evaluated in 112 cases by the Quality of Life in Epilepsy Inventory（QOLIE-31）. Results　Twenty-one cases out of 120 children with FEP met the diagnosis criteria of ADHD，the comorbidity rate being 17.5%；among FEP ADHD+ children，81%（17/21） were inattentive subtype，19%（4/21） were combined subtype but there were no hyperactivity subtype case.There was no difference in the rates of ADHD comorbidity among three groups of different therapy stages（P > 0.05）. IVA-CPT was measured in 120 children with FEP and 60 Benign epilepsy with centro-temporal spikes cases. The quotients of attention and response control from the there groups were not different（P > 0.05）. The comorbid ADHD was associated with the low quality of life，which was significantly lower in FEP ADHD+ children compared to PEP ADHD- group. Negative impact was on the total score of quality of life and cognitive subitem（P < 0.05）. Conclusion　ADHD is considerably more prevalent in children with FEP，characterized predominantly by the inattentive variant.ADHD is associated with poor quality of life，especially the negative impact on the cognitve. To treat epilepsy is beyond seizure freedom， and the ADHD comorbidity require further attention and essentail therapy.

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Comparation in preterm newborn with periventricular leukomalacia in the diffusion-weighted imaging and ultrasound imaging. ZHANG Lei，LI Ming- xia，WANG Li. 2011, 26(8): 610.  Abstract ( )   Abstract：Objective　To study the diffusion-weighted magnetic resonance imaging （DWI） in preterm children with periventricular leukomalacia diagnosis. Methods　we collected suspected PVL children with hypoxia who were treated in the First Affiliated Hospital of Xinjiang Medical University NICU from January 2008 to January 2009. The 55 cases who accept ultrosound inspection are divided into PVL group （15 cases） and control group （40 cases）. Simultaneously we used DWI to examine all of the infants and tested ADC value in order to analysis the sensitivity and specificity. Results　The sensitivity was 66.7%，specificity was 95%. Conclusion　DWI can be used as a premature imaging method in children in the early diagnosis of PVL.

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Clinical observations  on children with pneumonia accompanying sepsis. ZHAO Ying，LIU Chun-feng，XU Wei. 2011, 26(8): 613.  Abstract ( )   Abstract : Objective　To evaluate the value of pneumonia accompanying sepsis in evaluating patients condition by monitoring inflammatory factors，pathogen and prognosis. Methods　A total of 73 children with pneumonia were divided into two groups ： sepsis group and non - sepsis group . CRP，blood glucose，lactic acid，creatine kinase and other factors，sputum bacterial culture and blood bacterial culture were evaluated in all the children. All the children were given antibiotics，expectant treatment and support treatment. Observe the condition of organ function. Results　（1）In non-sepsis group，the incidence rate of organ dysfunction was 15.4%，and no patient died. But in sepsis group，the incidence rate of organ dysfunction was 38.2%，and there were 4 MODS cases and 1ARDS case. Besides，5 patients died in this group. The differences between two groups were significant （P < 0.05）. （2）In non-sepsis group，23.08% of cases were with increased CRP，25.64% with increased blood lactic acid and 7.69% with increased blood glucose. In sepsis group，there was 85.29% with increased CRP，73.53% with increased blood lactic acid and 58.82% with increased blood glucose. The differences between two groups were significant （P < 0.01）.（3） In non-sepsis group，bacterium culture of all cases were negative. In sepsis group，there were 15 cases with positive bacterial culture in which 12 cases were sputum bacterial culture（1 case died） and 3 cases were blood bacterial culture（2 cases died）. Conclusion　Cases of pneumonia accompanying sepsis have worse prognosis. It suggests that pneumonia accompanying sepsis could be an important evidence in evaluating patients’ condition and prognosis.