Diagnostic status and epidemiological characteristics of community-acquired bacterial meningitis in children from 2019 to 2020: a multicenter retrospective study.

Community-acquired bacterial meningitis (CABM) is the main cause of morbidity and mortality in children. The epidemiology of CABM is regional and highly dynamic. To clarify the diagnostic status and epidemiological characteristics of children with CABM in this region, and pay attention to the disease burden, so as to provide evidence for the prevention and treatment of CABM. By retrospective case analysis, the clinical data of 918 CABM cases in children aged 0-14 years in Zhejiang Province from January, 2019 to December, 2020 were collected. The etiological diagnosis rate of CABM in children was 23.1%, the annual incidence rate 4.42-6.15/100,000, the annual mortality rate 0.06-0.09/100,000,the cure and improvement rate 94.4%, and the case fatality rate 1.4%. The total incidence of neuroimaging abnormalities was 20.6%. The median length of stay for CABM children was 20(16) days, with an average cost of 21,531(24,835) yuan. In addition, the incidence rate was decreased with age. Escherichia coli(E.coli) and group B Streptococcus agalactiae(GBS) were the principal pathogens in CABM infant<3 months(43.3%, 34.1%), and Streptococcus pneumoniae(S. pneumoniae) was the most common pathogen in children ≥ 3 months(33.9%). In conclusion, the annual incidence and mortality of CABM in children aged 0-14 years in Zhejiang Province are at intermediate and low level. The distribution of CABM incidence and pathogen spectrum are different in age; the incidence of abnormal neuroimaging is high; and the economic burden is heavy.

Differential diagnosis between hepatic alveolar echinococcosis and intrahepatic cholangiocarcinoma with conventional ultrasound and contrast-enhanced ultrasound.

BACKGROUND: Misclassifications of hepatic alveolar echinococcosis (HAE) as intrahepatic cholangiocarcinoma (ICC) may lead to inappropriate treatment strategies. The aim of this study was to explore the differential diagnosis with conventional ultrasound and contrast-enhanced ultrasound (CEUS). METHODS: Sixty HAE lesions with 60 propensity score-matched ICC lesions were retrospectively collected. The 120 lesions were randomly divided into a training set (n = 80) and a testing set (n = 40). In the training set, the most useful independent conventional ultrasound and CEUS features was selected for differentiating between HAE and ICC. Then, a simplified US scoring system for diagnosing HAE was constructed based on selected features with weighted coefficients. The constructed US score for HAE was validated in both the training set and the testing set, and diagnostic performance was evaluated. RESULTS: Compared with ICC lesions, HAE lesions were mostly located in the right lobe and had mixed echogenicity, a pseudocystic appearance and foci calcifications on conventional ultrasound. On CEUS, HAE lesions showed more regular rim-like enhancement than ICC lesions and had late washout with a long enhancement duration. The simplified US score consisted of echogenicity, pseudocystic/calcification, bile duct dilatation, enhancement pattern, enhancement duration, and marked washout. In the testing set, the sensitivity, specificity, LR+, LR- and the area under the ROC curve for the score to differentiate HAE from ICC were 80.0, 81.3%, 4.27, 0.25 and 0.905, respectively. CONCLUSIONS: The US score based on typical features from both conventional ultrasound and CEUS could accurately differentiate HAE from ICC.

[Clinical effect of pidotimod oral liquid as adjuvant therapy for infectious mononucleosis].

OBJECTIVE: To study the clinical effect of pidotimod oral liquid as adjuvant therapy for infectious mononucleosis and its effect on T lymphocyte subsets. METHODS: A total of 76 children with infectious mononucleosis, who were admitted to the hospital between July 2016 and June 2017, were enrolled and randomly divided into two groups: conventional treatment and pidotimod treatment (n=38 each). The children in the conventional treatment group were given antiviral therapy with ganciclovir for injection and symptomatic treatment. Those in the pidotimod treatment group were given pidotimod oral liquid in addition to the treatment in the conventional treatment group. The course of treatment was two weeks for both groups. The two groups were compared in terms of the recovery of clinical indices and the changes in peripheral blood T lymphocyte subsets. RESULTS: Compared with the conventional treatment group, the pidotimod treatment group had significantly shorter fever clearance time, time to the disappearance of isthmopyra, time to the relief of lymph node enlargement, time to the relief of hepatosplenomegaly, and length of hospital stay (P<0.05). After treatment, the pidotimod treatment group had significant reductions in the percentages of CD3+ and CD8+ T cells and had significantly lower percentages of CD3+ and CD8+ T cells than the conventional treatment group (P<0.001). The pidotimod treatment group had significant increases in the percentage of CD4+ T cells and CD4+/CD8+ ratio after treatment, which was significantly higher than those in the conventional treatment group (P<0.001). The conventional treatment group had no significant changes in T lymphocyte subsets after treatment (P>0.05). CONCLUSIONS: Pidotimod oral liquid has a good clinical effect as the adjuvant therapy for infectious mononucleosis and can improve cellular immune function, so it holds promise for clinical application.

[A Retrospective Analysis on 47 Children with Paragonimiasis in Ningbo City].

A retrospective analysis was performed on 47 children diagnosed with paragonimiasis in Ningbo Women and Children's Hospital from January 2004 to December 2014. The 47 children comprised 32 boys （68.1%） and 15 girls （48.9%）, and 24 cases（51.1%） in urban areas and 23 （48.9%） in rural areas （P>0.05）. There was a trend of increase in paragonimiasis occurrence in preschoolers since 2010. Forty-three cases had a history of eating raw or wine-preserved crabs and 4 cases had a history of drinking raw stream water． There were 2 cases of paragonimus encephalopathy and one case accompanied by subcutaneous nodules. Thirty-nine cases showed increases in eosinophil number and proportion in peripheral blood, and 29 cases showed increased serum IgE level. Forty-seven cases had negative results for detection of paragonimus eggs in sputum and stool. The dot immuno-gold filtration-assay and ELISA showed a 100% positive rate for paragonimus serum antibody. All the 47 cases were administered with praziquantel after diagnosis, and no adverse effect was reported during the treatment.

Transcriptome response of Lactobacillus sakei to meat protein environment.

Lactobacillus sakei is a heterofermentative species of lactic acid bacteria that is used in industrial meat fermentation. To investigate adaptation in a meat environment, whole-genome DNA microarrays were used to analyze the gene expression related to growth and survival of L. sakei strain La22 when grown in sarcoplasmic (S-) or myofibrillar (M-) protein-supplemented chemically defined medium (CDM). Differential expression was detected in 551 genes. Genes encoding enzymes involved in peptide hydrolysis were differentially upregulated in M-CDM or/and S-CDM, and only oppB and oppC, involved in the amino acid and peptide transport system, were upregulated. Most genes related to metabolism of peptides, amino acids and related molecules were over-expressed in M-CDM and S-CDM, except for glnA and metK. Expression of certain genes was according to the differential substrate environment. The expression of genes involved in the stress response was not induced by growth in M-CDM.

Transnasal Endoscopic Orbital Decompression Combined with an Enhanced Recovery after Surgery Protocol in Graves Ophthalmopathy.

Objective: Although enhanced recovery after surgery (ERAS) was shown to improve patients' recovery after surgery and transnasal endoscopic orbital decompression has been associated with lesser risks of postoperative complications compared to other surgical techniques in treating Graves ophthalmopathy (GO), there are currently no clinical studies on the application of ERAS in transnasal endoscopic orbital decompression. This study aimed to investigate the potential effects of combining transnasal endoscopic orbital decompression with ERAS in the treatment of GO. Methods: A retrospective analysis was performed for 5 GO patients (10 eyes) treated with transnasal endoscopic orbital decompression from January 2021 to December 2021 at the Third Affiliated Hospital of Sun Yat-Sen University. All patients underwent ERAS, and the effects of ERAS on the postoperative complications and recovery of patients were evaluated. Results: Ophthalmological examination showed that GO patients had good correction of exophthalmos after surgery combined with ERAS. Specifically, the exophthalmos reduction in subjects was 0.9-2.1 mm, with a mean reduction of 1.23 mm. In addition, a visual acuity improvement of 0.15-0.4, with an average improvement of 0.23, was also observed. Further, the Scale of Quality of Life for Diseases with Visual Impairment (SQOL-DVI) showed that, compared with before surgery, the patients' QOL was significantly improved 2 weeks after surgery. Before surgery, there were 2 patients with diplopia and blurred vision, and after postoperative adaptive exercise, the symptoms of these 2 patients disappeared after 6 months of follow-up. As for the other 3 patients, they had no diplopia or blurred vision after surgery. Conclusion: This observational study found that transnasal endoscopic orbital decompression might be effective in treating GO, and ERAS might be considered an important adjunct to improving perioperative care and postoperative recovery.

[Clinical observation of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia].

OBJECTIVE: To explore clinical effect of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia. METHODS: From January 2018 to December 2019, 168 patients who met inclusion criteria and were underwent selective spine surgery, were double-blind divided into two groups according to central random system, 84 patients in each group. In control group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (53.83±9.17) years old, 37 patients were classified to typeⅠand 47 patients were typeⅡ according to American Society of Anesthesiologists (ASA) grading. In experiment group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (54.08±9.00) years old; 32 patients were classified to typeⅠand 52 patients were typeⅡ according to ASA grading. Both of two groups were obtained acupoint application before anesthesia induction, and acupoint application were put on Zhongwan (CV 12) and bilateral Neiguan (PC 6) for 6 h, changed after 24 h, last for 2 d. The drug prescription of plasters in experimental group was consist of Rhizome Pinelliae Preparata, Ginger and Clove. The plasters in control group was consistent with drug plasters in experimental group in appearance and smell to the greatest extent. The ingredients were flour and excipients with 10% of experimental drug concentration. Incidence of nausea vomiting, visual analogue scale (VAS) of narusea degree at 24 h and 24 to 48 h after operation between two groups were compared, SF- 12 simple quality of life score before operation, 24 and 48 h after operation were also compared by using R3.6.1 Rstudio software by the third-party. RESULTS: There were no statistical differences in incidence of nausea vomiting, VAS of narusea degree at 24 h after operation (P>0.05), while there were no differences in incidence of nausea vomiting, VAS of narusea degree at 24 to 48 h after operation (P>0.05) . There were no statistical differences in SF-12 before operation, 24 and 48 h after opertaion (P>0.05). CONCLUSION: The curative effect of acupoint application of traditional Chinese medicine on the prevention and treatment of postoperative nausea and vomiting is not obvious.

COVID-19 in Children: Clinical Characteristics and Follow-Up Study.

Since December 2019, the coronavirus disease 2019 (COVID-19) has spread globally. But the clinical symptoms and detailed follow-up of children with COVID-19 infection are lacking. Here, we conducted a retrospective study including children with confirmed COVID-19. We recorded patients' epidemiological, clinical features, and follow-up data after discharging in order to improve the awareness and treatment of children with COVID-19.

Enhanced recovery after surgery protocols in functional endoscopic sinus surgery for patients with chronic rhinosinusitis with nasal polyps: a randomized clinical trial.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are a series of perioperative care to optimize preoperative preparation, prevent postoperative complications, minimize stress, and speed up recovery. This study aimed to assess the impact of ERAS protocols for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: One hundred and two patients with CRSwNP undergoing FESS were randomly divided into the ERAS group and the control group. The outcomes of the Self-Rating Anxiety Scale (SAS), Visual Analogue Scale (VAS), Medical Outcomes Study Sleep Scale (MOS-SS) and Kolcaba Comfort Scale Questionnaire (GCQ) were determined in both groups. The serum levels of C-reactive protein (CRP) were compared preoperatively and 24 hours postoperatively. RESULTS: The ERAS group had a significantly better SAS scores than did the control group (28 [24, 35] vs. 43 [42, 47], Z = 5.968, P < 0.001). The rhinalgia and headache scores at 2, 24 and 48 hours postoperatively were lower in the ERAS group than that in the control group (all P < 0.001). The outcomes of the MOS-SS (43 [42, 39] vs. 28 [22, 35], Z = 7.071, P < 0.001) and GCQ (76 [68, 87] vs. 64 [50, 75], Z = 4.806, P < 0.001) were significantly different between the two groups. No significant difference was found in the preoperative CRP levels between the two groups (1.3 [0.6, 2.8] vs. 0.5 [0.5, 1.2], Z = 3.049, P > 0.05); However, the CRP level in 24 hours postoperatively was significantly lower in the ERAS group than that in the control group (2.5 [1.4, 3.9] vs. 6.6 [3.8, 9.0], Z = 5.027, P < 0.001). The incidence rates of complications, such as nausea/emesis (χ = 0.343, P > 0.05), hemorrhage, aspiration and tumble, were not increased in the ERAS group compared with those in the control group. The ERAS group had a significantly shorter length of hospital stay (5 [4, 5] days vs. 8 [8,9] days, Z = 8.939, P < 0.001) and hospitalization expenses ($ 2670 [2375, 2740] vs. $3129 [3116, 3456], Z = 8.514, P < 0.001). CONCLUSIONS: ERAS protocols might optimize FESS for patients with CRSwNP by reducing psychological and physical stress, shortening the length of hospital stay and lowering hospitalization expenses without increasing postoperative complications. TRIAL REGISTRATION: Chinese Clinical Trial Registry, No. ChiCTR1800015791; http://www.chictr.org.cn/showproj.aspx?proj=26872.

[Clinical observation of ultrasound guided popliteal sciatic nerve combined saphenous nerve block for hallux valgus patients with metatarsophalangeal joint dislocation].

OBJECTIVE: To explore clinical effects of ultrasound guided popliteal sciatic nerve combined saphenous nerve block in patients with anterior foot orthopedics. METHODS: From January 2017 to October 2017, 60 hallux valgus patients with metatarsophalangeal joint dislocation were randomly divided into experimental and control group according to random number table. Thirty patients in experimental group were treated by ultrasound guided popliteal sciatic nerve combined saphenous nerve block, including 13 males and 17 females, aged 31 to 76 years old with an average of (59.23±10.07) years old;and body mass index ranged from 21 to 30 kg/m² with an average of (24.57±1.85) kg/m²; 12 cases were grade I and 18 cases were grade II according to ASA grading. Thirty patients in control group were treated by spinal anesthesia, including 12 males and 18 females, aged from 20 to 74 years old with an average of (54.20±15.87) years old; and body mass index ranged from 20 to 29 kg/m² with an average of (24.43 ± 3.15) kg/m²; 11 cases were grade I and 19 cases were grade II according to ASA grading. Block time of anesthesia, onset time of sensory nerve block, onset time of motor nerve block, invalid time of motor nerve block, invalid time of sensory nerve block were compared between two groups. Hemodynamic changes before anesthesia(T0), 15 min after block(T1), 30 min after block(T2), at the beginning of the operation(T3), 30 min after the beginning(T4) of surgery and at the end of operation(T5), adverse reactions and subjective satisfactory between two groups were also recorded. RESULTS: Both of the anesthetic protocol could achieved satisfied clinical effects. In experimental group, block time of patients, onset time of sensory block, invalid time of motor nerve block and invalid time of sensory nerve block were longer than those in control group, and there were significant differences between two groups(P<0.001). There was no significant difference between two groups in onset time of motor nerve block(P> 0.05). There were no significant differences of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) in experimental group at different time points(P> 0.05). There were significant differences of SBP, DBP in control group at different time points (P<0.05). There was no significant difference of HR in control group at different time points(P> 0.05). CONCLUSIONS: Ultrasound guided popliteal sciatic nerve combined saphenous nerve block could meet demand of hallux valgus patients with metatarsophalangeal joint dislocation. Compared with lumbar anesthesia, it could maintain hemodynamic stability, prolong effective analgesia time after operation, and improve patients' overall comfort and safety for free activity above the knee joint.

[Schistosomiasis surveillance in mobile population of Xiuzhou District, Jiaxing City, 2013-2014].

OBJECTIVE: To understand the schistosome infection situation of mobile population in Xiuzhou District. METHODS: The data about the distribution of mobile population from the counties not reaching schistosomiasis transmission controlled in Xiuzhou District were collected, then the questionnaire survey combined with laboratory detection were used to investigate the situation of imported schistosomiasis in this district. In addition, the average infection rate and the estimated number of schistosomiasis patients were calculated. RESULTS: From 2013 to 2014, there were 15 940 people from the counties not reaching schistosomiasis transmission controlled in Xiuzhou District, among which, 4405 were investigated, and 124 of them had schistosomiasis and treatment history. Thirty-eight people were positive in serological tests, and 3 cases were positive in the etiological detection. The average infection rate of schistosome of the mobile population in Xiuzhou District was 0.068%, the calculated number of schistosomiasis patients was 11. CONCLUSIONS: The imported sources of infection are the main risk for the consolidation of the results of schistosomiasis control, which may result to the rebound of the endemic situation. So the management and surveillance of mobile population should be strengthened.

[Causation of Oncomelania snail recurrence in water-net areas of Jiaxing City].

From 2004 to 2012, fourteen Oncomelania snail remaining spots with an area of 31.954 hm2 were found in the historical snail areas of Xiuzhou District, Jiaxing City. The recurrence time of snails was 5-39 years. These spots were mainly distributed in the complex breeding environments, such as paddy fields (37.15%), nursery stock fields (36.93%), mulberry fields (16.09%), and ditches (6.82%). A total of 8 370 snails were dissected and no infected ones were found. It suggests that the nursery stock fields should be included in the key points for snail surveillance in water-net areas where schistosomiasis transmission has been interrupted.

Anti-tumor activity of Annona squamosa seeds extract containing annonaceous acetogenin compounds.

ETHNOPHARMACOLOGICAL RELEVANCE: Seeds of Annona squamosa L. have been used in the south of China as a folk remedy to treat "malignant sores" (cancer). AIM OF THE STUDY: To investigate the chemical constituents and the anti-tumor activity of the standardized A. squamosa seeds extract in vitro and in vivo. MATERIALS AND METHODS: Annonaceous acetogenin profiles of the standardized extract were determined by using Fourier transform infrared (FT-IR) and high performance liquid chromatography (HPLC) techniques. The anti-tumor activity of the extract was tested by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) cytotoxicity in vitro and H(22) hepatoma cells transplantation tumor model in vivo. RESULTS: The FT-IR spectroscopy showed the presence of annonaceous acetogenin compounds in the extract. Two major annonaceous acetogenins: 12, 15-cis-squamostatin-A and bullatacin were identified and quantified by HPLC. The seed extract showed significant anti-tumor activity against four human tumor cell lines, especially for MCF-7 (IC(50). 0.25 µg/ml) and Hep G2 (IC(50). 0.36 µg/ml) cells in vitro. The extract inhibited the growth of H(22) tumor cells in mice with a maximum inhibitory rate of 69.55% by oral administration. CONCLUSION: A. squamosa seed extract showed significant anti-tumor activities against human hepatoma cells in vitro and in vivo, indicating a potential for developing the extract as a novel anti-liver cancer drug.

Determination of bullatacin in rat plasma by liquid chromatography-mass spectrometry.

A liquid chromatography-mass spectrometry method has been developed and validated for the quantification of bullatacin, a bistetrahydrofuran annonaceous acetogenin, in rat plasma. Squamostatin-A was selected as the internal standard. Analytes were extracted from rat plasma by liquid/liquid extraction using ethyl acetate with high efficiency. The chromatographical separation was performed on an Agilent Zorbax SB-C18 column (150 mm × 2.1 mm, 5 µm). The mobile phase consisted of methanol and deionized water (95:5, v/v) containing 0.01% (v/v) formic acid. The chromatographic run time was 7 min per injection and flow rate was 0.2 mL/min. The retention time was 3.22 and 5.23 min for internal standard and bullatacin, respectively. The elutes were detected under positive electrospray ionization and the target analytes quantified by selected ion monitoring mode (645.9 m/z for bullatacin and 661.9 m/z for squamostatin-A). The method was sensitive with the limit of quantitation at 0.5 ng/mL in 100 µL of rat plasma. Good linearity (r²=0.9998) was obtained covering the concentration of 0.5-2000 ng/mL. The intra- and inter-day assay precision ranged from 3.2 to 8.7% and 2.7 to 9.2%, respectively. In addition, the stability, extraction recovery and matrix effect involved in the method were also validated. This method was applied to measure the plasma bullatacin concentrations after a single tail vein intravenous administration of bullatacin in rats.

[The correlational study of viral load of human bocavirus and clinical features in children with acute respiratory tract infection].

OBJECTIVE: To analyze the correlations between clinical features in paediatric patients with acute respiratory tract infection (ARTI) and viral load of human bocavirus. METHODS: A prospective study was conducted on 956 children < 5 years admitted with an acute respiratory tract infection from November 2009 to December 2010, and 251 healthy children conclused as control group in the corresponding period. Human bocavirus was investigated in nasopharyngeal aspirates (NPA) and throat swab by PCR, and viral load was detected by real-time polymerase chain reaction (RT-PCR) in HBoV positive sample. Clinical data were also prospectively recorded. RESULTS: A significant difference was found in HBoV positive rate between children with ARTI and control group at enrollment. There was a significant difference in HBoV viral load between children with upper respiratory tract infection and lower respiratory tract infection. HBoV viral load did not differ significantly between children with upper respiratory tract infection and control group. Among children with lower respiratory tract infection, no significant difference were detected between common and severe cases in HBoV viral load. HBoV viral load did not differ significantly whether the children were with or without co-infection. CONCLUSIONS: HBoV could be detected perennial and considered as a major pathogen associated with acute respiratory tract infection in children. However, HBoV may not be a independent factor in children with ARTI and the HBoV viral load was not associated with the severity of respiratory illness.

[Clinical observation of pentazocine for postoperative intravenous analgesia in patients with lumbar herniation].

OBJECTIVE: To observe the effects and side effects of Pentazocine for postoperative intravenous analgesia in patients with lumbar herniation, and to investigate the difference of Pentazocine with different doses. METHODS: From January 2009 to December 2009, sixty patients undergone laminectomy and pedicle internal fixation, who using equal analgesic dosage of Pentazocine and Sulfentanil, were retrospectively analysed. The patients including 34 males and 26 females, aged 40 to 65 (average 59), weighted 60 to 80 kg (average 71 kg), ASA I-II, were divided into Sufentanil group and Pentazocine group I and Pentazocine group II, with 20 cases each. The regimens of the three groups included: Sufentanil of 2 g/kg; Pentazocine group I of 3 mg/kg; Pentazocine group II of 5 mg/kg. All were diluted with saline into 100 ml and were continuously infused at the rate of 2 ml/h. Visual analogue scale (VAS), Ramsay sedation scale and side effects were recorded at 4, 8, 12, 24, 36, and 48 h postoperatively. RESULTS: The three groups had no significant difference in analgesic effects, VAS of all groups were below 3. The sedation scale of Pentazocine group II at 4, 8, 12 h was higher than that at 4 h, significantly different than the other two groups. The incidence of nausea, vomiting and pruritus in Sufentanil group were higher than that in the other two groups. The incidence of respiratory depression in Sufentanil group and Pentazocine group II were higher than that in Pentazocine group II. The incidence of dizziness in Pentazocine group II were higher than that in the other two groups. CONCLUSION: Pentazocine can produce reliable postoperative analgesia for patients with lumbar herniation, as same as the effect of sulfentanil in equal dose. And Pentazocine has fewer adverse effects compared with sufentanil. 3 mg/kg of Pentazocine is an optimal dose for postoperative intravenous patient-control analgesia.