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06 March 2013, Volume 28 Issue 03 Previous Issue    Next Issue

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Antibiotic resistance and molecular epidemiology of serotype 19F Streptococcus pneumoniae isolated from children in Beijing. LI Quan-hua， YAO Kai-hu， YU Sang-jie， HE Ming-ming， SHI Wei，YANG Yong-hong. 2013, 28(03): 179-183.  Abstract ( )   Abstract：Objective    To investigate the genetic structure of Streptococcus pneumoniae serotype 19F isolates from children in Beijing. Methods    A total of 130 isolates were identified as serotype 19F among 1033 S. pneumoniae strains collected from 1997 to 2006 and 2010. There were 120 isolates characterized by antibiotic susceptibility， macrolide resistance gene and multilocus sequence typing（MLST）. Results    Among the 120 strains， only five strains were nonsusceptible to penicilln and the nonsusceptibility rate to cephalosporins increased from 1997 to 2010. There were 119（99.2%） strains resistant to erythromycin； 115（96.6%） carried the ermB gene and 64（53.8%） carried mefA gene， 60（50.4%） carried both genes. All isolates belonged to 31 sequence types， ST983 was the most prevalent ST， followed by ST271. From 1997 to 2010， the percentage of CC271 increased from 14.3% in 1997-1998 to 92% in 2010， whereas CC983 decreased from 64.3% to 0%. CC271 showed higher nonsuscetibility rate to β-lactam antibiotics than CC983. Conclusion       The prevalence of serotype 19F of S.pneumoniae increases from 1997 to 2010 in Beijing. The increase of nonsusceptibility rate to β-lactam antibiotics is associated with the spread of international resistance clone CC271 due to the selection of antibiotics overuse.

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The clinical study on classification and diagnostic procedures of diffuse parenchymal lung disease/interstitial lung disease in 349 children.   ZHANG Jing-ying， LIU Xiu-yun，PENG Yun， ZHOU Chun-ju. 2013, 28(03): 184-188.  Abstract ( )   Objective    To better understand the spectrum of the disease and to explore the clinical significance of diagnostic procedures in clinical application.Method    The medical records of 349 children with diffuse parenchymal lung disease /interstitial lung disease admitted to Beijing Children’s hospital from July 2001 to September 2011 were studied retrospectively. The diagnostic approaches were applied，including the history ， physical examination ， non-invasive examination and invasive examination. Result    The 321 cases were made specific diagnosis through the diagnostic procedures and 28 cases were unclassified. The classification of the 349 cases were as follows:146 cases were  with primary lung diseases，14 cases were with lung disease secondary to systemic disease， 161 cases had the lung disease of  known causes， and the 28 cases were unclassified.The 160/349（45.85%） cases were diagnosed based on the noninvasive examination， including all 147 cases of bronchiolitis obliterans，3 cases of  hypersensitive pneumonitis，2 cases secondary to aspiration，2 cases of systemic lupus erythematosus， 2 cases of juvenile rheumatoid arthritis，1 case infected by CMV， 1 case of Langerhans cell histocytosis，1 case of undifferentiated connective tissue disease and 1 case of Wegener's granulomatosis. The others were diagnosed by invasive examination， including 2 cases of Langerhans cell histocytosis and 1 case of dermatomyositis by skin biopsies， 1 case of Langerhans cell histocytosis by lymphaden biopsy ，all 113 cases of idiopathic pulmonary hemosiderosis， 2 cases of eosinophilic pneumonia and 2 cases of hypersensitive pneumonitis by bronchoalveolar lavage fluid；40 cases were diagnosied by the lung biopsy， including 23 cases of idiopathic interstitial pneumonia. Conclusion    Diffuse parenchymal lung disease in children is a heterogeneous group of respiratory disorders . Bronchiolitis obliterans， idiopathic pulmonary hemosiderosis and idiopathic interstitial pneumonia are the most common disease in the diffuse parenchymal lung disease of the children. The procedural diagnosis method could make specific diagnosis for 321/349（91.98%） cases with parenchymal lung disease in this study. The 45.85% of whem are diagnosied by the noninvasive examination，and the other cases such as the idiopathic pulmonary hemosiderosis and the idiopathic interstitial pneumonia were confirmed by the invasive method.

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Effect of meteorological environment warning forecast technology on quality of life in children with asthma.       ZHANG Jing1， WU Yu-fen1， YUAN Shu-hua1， YIN Yong1， WANG Wei1，ZHANG Lei1，LIU Shi- 2013, 28(03): 189-192.  Abstract ( )   Objective    To explore the effect of meteorological environment warning forecast technology intervention on the symptoms and quality of life in asthmatic children. Method    A total of one hundred and sixty six children with asthma， aged 2-12，were recruited from the community in Shanghai from Jan. 2011 to Dec. 2011. They were divided into 2 groups， intervention group （n = 80） and matched control group （n = 86）. Finally， 71 cases in intervention group and 63 cases in control group finished the follow-up process completely. Children-the Asthma Control Test （C-ACT） and Pediatric Quality of Life Inventory were done before and after intervention in both groups. The intervention group accepted meteorological environment warning forecast technology intervention by short message service and E-mail everyday for 3 months. Results    There was no significant difference between the intervention group and the control group in the general condition except the family structure（P＞0.05）. The meteorological environment warning forecast technology intervention increased the physiological function， emotional function and school performance of the intervention group （P＜0.05）； A multivariate logistic regression model showed  there was no significant difference of C-ACT score （F = 0.263，P = 0.610） in the two groups. Conclusion    Asthmatic children are told the risk of asthma attacks and receive appropriate protection by using meteorological environment warning forecast technology. It can prevent asthma acute attack，alleviate the symptoms and improve physiological function and the quality of life.

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Gene expression and its clinical implications of CDX2 and WT1 gene in children with acute leukemia. LIYing-xia*， HUANG Jia-li， QIAN Xin-hong*， ZHAO Xiao-li*， FAN Fang*， PAN Kai-li* 2013, 28(03): 195-199.  Abstract ( )   Objective    To study the expression of caudal-related homeodomain transcription 2 （CDX2） gene in Children with acute leukemia（AL） and its clinical implications ，and compare with those of Wilms’ tumor 1 （WT1） gene. Methods Both of the genes were detected by semi-quantitative reverse transcriptase polymerase chain reaction （RT-PCR） in bone marrow（BM） and peripheral blood（PB） samples of 57 cases of children with acute leukemia---39 cases of non-remission acute leukemia （AL） consisting of 35 cases of the newly diagnosed （25 cases of ALL， 10 cases of AML） and 4 cases of the relapsed，18 cases of the remission. In addition ， 25 cases of healthy people were enrolled as control. Results    The overexpression（0.6187±0.2170）of CDX2 was found in 82.1% （32/39） AL， with the positive rate being 89.3% （25/28） in ALL and 63.6% （7/11） in AML ，which showed no statistical difference （P＞0.05） and so was the expression level （0.6181 ± 0.2342 VS 0.6230 ± 0.2441） （P＞0.05）. In addition，CDX2 was not detectable in both the remission group and the control. Detecting samples of BM and PB from the same period of 9 newly diagnosed AL patients by semi-quantitative RT-PCR， the average CDX2 expression level was （0.4083 ± 0.2279） and （0.4124 ± 0.1749），which was of no statistical difference（P＞0.05）.  In compariing CDX2 with WT1 in children with AL， positive rates in non-remission group （48.7% VS 82.1%） had statistical difference（P＜0.05），and those in ALL group （46.4% VS 89.3%） also showed statistically significant difference（P＜0.05），while those in AML group（54.5% VS 63.6%） were of no statistical difference（P＞0.05）.In CDX2 positively and negatively expressed patients， positive rates of WT1 were respectively 46.8%（15/32）and 57.1%（4/7），which suggested no statistical correlation between the expression of CDX2 and that of WT1 in AL children. In the newly diagnosed AL children， rates of complete remission（CR） in the CDX2 positively expressed patients and negatively expressed ones （96.4% VS 100%） showed no statistical difference （P＞0.05）.For CDX2 and WT1，the comparison of CR rates between the double positive group and the double negative group was of no statistical difference （P＞0.05）， and so were the positive group and the single positive group （P＞0.05）， as well as the single positive group and the double negative group （P＞0.05）.  Nine newly diagnosed AL patients with positive CDX2 expression were followed up for 8 to 14 months. CDX2 in 5 patients gradually turned negative during day 13～19 and the remained four turned negative after induction. However， in CDX2 negatively expressed AL patients，CDX2 remained negative at CR till present. Conclusion    CDX2 gene may be more potential in children with AL and the expression level of CDX2 may have correlation with the load of leukemia ， which might be of better value than WT1 in MRD detection.

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Clinical characteristics and laboratory analysis of Epstein-Barr Virus infection and infectious mononucleosis in children.    TAO Jia，CHEN Fu-xiong，CHEN De-hui，HUANG Sui，LIANG Ming，WU Li-ping，YANG Shao-li 2013, 28(03): 200-203.  Abstract ( )   Objective    To investigate clinical characteristics and laboratory feature of Epstein-Barr Virus（EBV） infection and infectous mononucleosis in children. Method    A retrospective study was conducted in 108 hospitalized patients who were enrolled from Jan 2010 to May 2011.Among them 77 patients were diagnosed with IM. Results    In our investigation most of the IM was seen in preschool children（41.6%）and in young children（36.4%） . Eyelid edema was common clinical manifestations of  IM，the percentage of which was higher than enlarged spleen and rash in IM group.Increased ratio of atypical lymphocytes （≥10%） was seen in only 33.8% of the IM patients.The EBV-DNA level in plasm of IM patients was in the range of 1.04 × 103～2.88 × 105 copies/mL，with a mean value of 7.18 × 104 copies/mL. All of 3 cases of EBV-HLH in our study were negative in sera of anti-VCA-IgM， but were positive of EBV-DNA in plasma and mean EBV-DNA loads were 2.71 × 107 copies/mL. Conclusion    In our observation eyelid edema has the same diagnostic value as the other typical manifections in IM.The clinical significance of atypical lymphocyte in the diagnosis of IM，especially in infants and young children，needs to be further confirmed.EBV-DNA copy in peripheral blood seems to be closely related to the active infection of EBV and in EBV-HLH the diagnostic value of detection of EBV-DNA in serum by FQ-PCR should be emphasized.

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The technique of electric coagulation through the flexible bronchoscope for resecting central airway constriction in 12 children.  NI Cai-yun，LIU Xia，WANG Shao-chao，MA Jing，ZHANG Zhong-xiao，YAN Xiu-li，NIU Tie-hu 2013, 28(03): 204-206.  Abstract ( )   Objective    To explore the efficacy and safety of electric coagulation through the flexible bronchoscope in the treatment of the central airway constriction caused by the formation of granulation tissue and fibroplasia and the ventilation obstruction compelled by the occupying diseases of throat in children.Method    Twelve cases were treated using the electric coagulation through the flexible bronchoscope. Those cases included 3 cases blocked by bronchial foreign body，2 cases with atelectasis due to the formation of granulation tissue after endobronchial tuberculosis，5 cases who had decompensation caused by the gas channel fibroplasia after the trachea cannula and 2 cases of dyspnea caused by cysts in root of the tongue.The effect evaluation was performed before the operation and after the last electric coagulation.The size of the airway constriction was evaluated by bronchoscope and the degree of atelectasis and respiratory ventilation were separately estimatede by computer tomography and pulmonary function test.Result    Twelve patients seperately received electric coagulation procedures，11 patients had excellent treatment effect， and one with effective effect.The rate of effective therapy was 100%. No complications happened.Conclusion    The method of electric coagulation through the flexible bronchoscope for central airway obstruction caused by granulation，fibroplasia and the occupying diseases of throat is effective and convenient. However，the method has certain operation risk， so operators should be specially trained.

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A study on the relationship between the subcellular localization of glucocorticoid receptor and treatment sensitivity in child idiopathic thrombocytopenia purpura. ZHANG Xiao-yue，WANG Feng-yu，XUE Ai-ling. 2013, 28(03): 207-209.  Abstract ( )   Objectives    To evaluate the subcellular localization of glucocorticoid receptors α （GRα） in PBMCs and its clinical significance in children with idiopathic thrombocytopenic purpura （ITP）. Methods    Glucocorticoid receptor α（GRa） subcellular localization was examined by confocal microscopy. Protein phosphorylation was measured by means of Western blot. Results    The GRα of sensitive group localized in nucleus，but in the insensitive group the GR localized in cytoplasma after dexamethasone treatment.The expression of GRα showed no significant difference among the groups. Conclusion    The abrogation of GRα nuclear translocation may serve as a novel predictor of glucocorticoid resistance in patients with ITP.

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Analysis of one case of acute hemiplegia caused by Mycoplasma pneumoniae and review of the literature of 12 cases. LI Tian-hua， WANG Hai-li， LI Ming-lei， LI Zhi-yong. 2013, 28(03): 210-213.  Abstract ( )   Objective    To study the effect of Mycoplasma pneumoniae infection on the blood circulation of central nervous system. Methods    Data of a child with Mycoplasma pneumoniae infection who developed acute hemiplegia，including clinical manifestations and therapy，was collected，analyzed and the literature of 12 similar cases was reviewed. Results    Totally 13 cases were reported from 2001 to 2010 home and abroad ， including 10  children and 3 adults， female accounting for the larger part. There were 5 cases in China who are children，one at right middle cerebral artery and right vertebral artery（female），one at right middle cerebral artery（female），one at left internal carotid artery，anterior cerebral artery，middle cerebral artery bole and left middle cerebral artery（female），one at right internal carotid artery and right middle cerebral artery（male） and the last one at left internal carotid artery（female）.There also reported a four-year child from Taiwan（bilateral internal carotid artery and proportion vertebral artery），a seven-year old girl from Turkey（left internal carotid artery），a child from Greece （posterior cerebral artery），and an adult male from Japan（left middle cerebral artery）. Conclusion    It is indicated that clotting system may be activated by Mycoplasma pneumoniae infection. This may enhance the occurrence of thrombosis，which leads to hemiplegi and other ischemic attacks.

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Characteristics of MSCT manifestation of infants and young children with intra-thoracic tuberculosis.               SONG Min， LIU Wen， FANG Wei-jun， LI Zi-ping，FENG Hui-yong， LI Hui-ru， ZHANG Hui. 2013, 28(03): 214-218.  Abstract ( )   Objective    To investigate and analyze the characteristics of MSCT manifestation of infants and young children with intra-thoracic tuberculosis. Methods    A retrospective analysis of MSCT chest performances of 76 cases of infants and young children （ages 0-3 years）with intrathoracic tuberculosis from January 2010 to June 2012 in our hospital was done to find the characteristics and classify pulmonary lesions of it. Results    In this study， the male to female ratio was 48:28； 7 cases were miliary tuberculosis， 6 cases were with cavitates， 15 cases with tuberculous meningitis. 6 cases had no pulmonary lesions， 18 cases only had single lobe involved，and 31 cases had four or more than four lobes involved；among all the cases， the right upper lobe was involved in 48 cases， right middle lobe 43 cases， right lower lobe 53 cases， left upper lobe 36 cases， left lower lobe 40 cases. We classified cases of pulmonary lesions into five types based on the CT features: （1） nodular type: pulmonary lesions were mainly nodular， a total of 16 cases； （2） inflammatory type: pulmonary lesions were ground-glass opacities， patches， cords and （or） consolidation， 24 cases； （3） mass type: pulmonary lesions were mainly clumps， 19 cases； （4） military type: 7 cases； （5） endobronchial tuberculosis type: 4 cases.Totally 71 cases of hilar and mediastinal adenopathy were found， and mainly in 2R （75.00%）， 4R （76.32%）， district 5 （57.89%）， district 7 （76.32%）， 8 （68.42%） and 10R （75.00%）， 11R （64.47%）. Most of the swollen lymph nodes in plain CT scan were medium-density， and calcification was found in 40 cases. Totally 39 cases had enlarged axillary lymph nodes. There were 8 cases with left pleurisy， 9 cases with right pleurisy. Conclusion    The main MSCT manifestation of infants and young children with intra-thoracic tuberculosis is pulmonary lesions with hilar and mediastinal adenopathy， but the majority of pulmonary lesions of them on CT are different with primary complex， hilar and mediastinal adenopathy、enlarged axillary lymph nodes and lymph nodes with calcification are common，while endobronchial tuberculosis，pleurisy and cavitas are rare.