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Objective To investigate the risk factors of drug resistance in patients with ischemic stroke by clopidogrel therapy and provide references for promoting clinical individualized drug therapy. Methods A total of 202 inpatients diagnosed with ischemic stroke were admitted and given dual anti-treatment (aspirin+clopidogrel). CYP2C19 genotype was detected by microarray hybridization during hospitalization, and CYP2C19 gene polymorphisms were classified into fast metabolism group, medium metabolism group and slow metabolism group according to the type of drug metabolism. Patients were tested for platelet inhibition induced by adenosine diphosphate (ADP) according to thromboelastographic (TEG) on 7~14 d of drug administration. ADP <30% was classified as clopidogrel drug resistance group and ADP ≥30% as non-resistance group. Logistic regression analysis was used to study the risk factors for the development of clopidogrel resistance. Results Among 202 patients with ischemic stroke, 87 were in the resistant group and 115 in the non-resistant group. The proportion of patients with clopidogrel resistance combined with diabetes and the level of white blood cell count were higher than that in the non-resistant group, and the differences were statistically significant (P<0.05).The proportion of patients with clopidogrel resistance in the CYP2C19 intermediate metabolism group was significantly higher than that in the fast metabolism group, and the rate of platelet inhibition was also significantly lower than that in the fast metabolism group, all with statistically significant differences (P<0.05). Conclusion Combined diabetes mellitus, high white blood cell count levels and CYP2C19 mid-metabolic phenotype are independent risk factors for the development of clopidogrel resistance in patients with ischemic stroke.
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Objective:To determine the erythromycin resistance of Bordetella pertussis isolates and their ptxP1 and ptxP3 phenotypic composition and compare clinical manifestations of children with pertussis caused by the two types of strains. Methods:This was a cross-sectional study, the pertussis cases diagnosed using bacterial culture from January 2019 to December 2022 in Beijing Children′s Hospital and the First People′s Hospital of Wuhu were collected.Any suspected Bordetella pertussis colonies were identified by the slide agglutination test.The susceptibility of isolates to erythromycin was detected by the E-test and K-B test.The ptxP gene was amplified by polymerase chain reaction and sequenced to determine its genotype. t-test, Mann-Whitney U-test, Chi-square test and Fisher′s exact test were use to statistical analysis. Results:A total of 192 strains of Bordetella pertussis were identified, including 188 (97.9%) erythromycin-resistant strains.Among the 188 strains, 30.3%(57/188) belonged to the ptxP1 genotype and 69.7%(131/188) belonged to the ptxP3 genotype.In children aged below 1 year old, the incidence of paroxysmal cough caused by infection with the ptxP3 strain was higher than that with the ptxP1 strain (57.1% vs.29.4%, P<0.05), and children infected with the ptxP3 strain were more likely to develop apnea or asphyxia (23.8% vs.17.6%), post-tussive vomiting (44.4% vs.32.4%), whooping cough (72.0% vs.50.0%) and pneumonia or bronchitis (85.7% vs.73.5%) compared to those infected with the ptxP1 strain, but the differences were not statistically significant(all P>0.05). In children aged 1 year old and above, the white blood cell count of children infected with the ptxP1 strain was higher than that of infections with the ptxP3 strain [13.5(9.9, 24.5)×10 9/L, 10.3 (7.0, 16.4)×10 9/L, P<0.05], and children infected with the ptxP1 strain were more likely to contract other pathogen infections than those infected with the ptxP3 strain (17.4% vs.4.4%, P>0.05). Conclusions:ptxP3 erythromycin-resistant Bordetella pertussis has become the main pathogen of pertussis.Infants with pertussis caused by the ptxP3 erythromycin-resistant strain show more significant manifestations and a higher possibility of severe symptoms than those infected with the ptxP1 erythromycin-resistant strain.
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Objective:To study the effects of group B streptococcus (GBS) colonization during late pregnancy on vaginal microbiota and neonatal outcomes.Methods:From September 2020 to September 2021, pregnant women receiving prenatal care and delivered in our hospital were prospectively enrolled. They were assigned into GBS(+) group and GBS(-) group based on the results of GBS culture and/or PCR tests of vaginal secretions. The mothers were also assigned into early-onset infection(EO) group and non-early-onset infection(non-EO) group based on the presence or absence of early-onset infection of their neonates. The vaginal microbiota and neonatal outcomes were compared between these groups.Results:A total of 125 cases were enrolled, including 65(52.0%) in GBS(+) group and 60(48.0%) in GBS(-) group. 24 cases (19.2%) were in EO group and 101 cases (80.8%) in non-EO group. The incidences of premature rupture of membranes (PROM), amniotic fluid contamination, chorioamnionitis and early-onset neonatal infection in GBS(+) group were significantly higher than GBS(-) group(all P<0.05).The abundances of Streptococcus and Ureaplasma in vaginal flora of GBS(+) group were higher than GBS(-) group ( P<0.01), whereas Rhodococcus, Phyllobacterium and Bifidobacterium were lower than GBS(-) group ( P<0.05).The EO group had significantly higher abundance of enterococcus than the non-EO group ( P<0.05). Mothers with GBS colonization and neonates with early-onset infection had the highest abundance of Escherichia/Shigella ( P=0.04). Mothers with GBS colonization and neonates without early-onset infection showed the highest abundance of Gardnerella ( P=0.04). Conclusions:GBS colonization during late pregnancy increases the incidences of PROM, amniotic fluid contamination, chorioamnionitis and early-onset neonatal infection. GBS colonization causes abnormal vaginal flora in pregnant women. The increases of Ureaplasma, Streptococcus, Escherichia/Shigella and Enterococcus in vaginal microbiota maybe associated with early-onset neonatal infection.
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Objective:To investigate the application effect of CBL teaching based on mind mapping combined with know-want-learned (KWL) chart in standardized nursing training for neonatal infection.Methods:A total of 58 students who participated in standardized training in Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, were included in the study and were divided into control group and observation group using a simple random number table, with 29 students in each group. The students in the control group were given traditional teaching, and those in the observation group were given CBL teaching based on mind mapping combined with KWL chart. Assessment score was compared between the two groups, and the two groups were compared in terms of self-directed learning ability, critical thinking ability, and evaluation of teaching effectiveness. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Both groups had significant increases in the scores of theoretical knowledge (91.65±5.17 vs. 84.58±9.14), clinical skills (89.16±6.24 vs. 83.34±7.40), Self-Rating Scale of Self-Directed Learning (257.23±25.79 vs. 241.56±22.74), and Critical Thinking Disposition Inventory-Chinese Version (317.14±38.50 vs. 285.78±34.71) after training, and the observation group had significantly higher scores than the control group ( P<0.05). The observation group had a significantly higher evaluation of teaching effectiveness than the control group ( P<0.05). Conclusion:CBL teaching based on mind mapping combined with KWL chart can improve the assessment scores of students and improve their self-directed learning ability and critical thinking ability, and students have a high evaluation of teaching effectiveness.
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Escherichia coli is an important pathogen causing neonatal infectious diseases, such as neonatal meningitis and sepsis, and poses a great threat to the health of neonates. Currently, no effective screening and prevention measures are available. This article briefly reviews the rates of Escherichia coli colonization in pregnant women and newborns, the risk factors of colonization and transmission from mother to infant and the influences of Escherichia coli on pregnancy outcome, especially the harm to newborns. In clinical practice, more attention should be paid to high-risk pregnant women and the possible adverse pregnancy outcomes. For newborns born to mothers with Escherichia coli colonization, the possibility of Escherichia coli infection should be considered first if early meningitis and septicemia occur, which would be of great significance for the selection of antibiotics.
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Objective:To investigate the incidence and risk factors of hypertensive disorders in pregnancy (HDP) in high altitude areas and their influence on maternal and infant outcomes.Methods:This was a retrospective case-control study. A total of 220 newborns were selected as the high altitude group, who were born to 216 mothers with HDP and admitted to the Neonatal Intensive Care Unit of the Lhasa People's Hospital from June 1, 2018, to June 1, 2020. The low altitude group consisted of 235 newborns born to 231 mothers with HDP and admitted to the Department of Neonatology of the Children's Hospital Affiliated to Beijing Capital Institute of Pediatrics from January 1, 2018, to December 31, 2021. Differences in the types of HDP between the two groups and the risk factors for the high incidence of preeclampsia-eclampsia and early-onset preeclampsia in high altitude area were analyzed. The influences of HDP in high and low altitude areas on maternal and infant outcomes were compared. Statistical analysis was performed using t-test, Mann-Whitney U test, Pearson Chi-square test, or continuous correction Chi-square test, and univariate and multivariate logistic regression analysis. Results:Maternal age and the proportions of primiparae and women of advanced age or having irregular prenatal examination were greater in the high altitude group than those in the low altitude group (all P<0.05). Besides, the incidence of early-onset preeclampsia, eclampsia, preeclampsia-eclampsia, and chronic hypertension complicated by preeclampsia were also higher in the high altitude group (all P<0.05). Multivariate logistic regression analysis showed that high altitude was a risk factor for the development of preeclampsia-eclampsia ( OR=4.437, 95% CI:2.582-7.626). Adverse pregnancy history ( OR=2.576, 95% CI:1.217-5.452) and irregular prenatal examination ( OR=2.862, 95% CI:1.412-5.800) were independent risk factors for early-onset preeclampsia in pregnant women in high altitude areas. Twin-pregnancy was a protective factor for early-onset preeclampsia in pregnant women in high altitude areas ( OR=0.183, 95% CI: 0.054-0.623). The incidence of maternal heart failure [7.9% (17/216) vs 0.4% (1/231), χ2=15.98], placental abruption [7.9% (17/216) vs 3.5% (8/231), χ2=4.11], hemolysis, elevated liver function and low platelet count syndrome [14.4% (31/216) vs 1.7% (4/231), χ2=24.64], premature delivery [86.1% (118/216) vs 73.6% (170/231), χ2=10.79], fetal growth restriction [52.3% (115/220) vs 18.7% (44/235), χ2=56.26], fetal distress [18.2% (40/220) vs 8.1% (19/235), χ2=10.26], neonatal asphyxia [29.5% (65/220) vs 11.1% (26/235), χ2=24.26], severe asphyxia [8.6% (19/220) vs 2.6% (6/235), χ2=8.10] and the proportion of neonates requiring mechanical ventilation within 24 h after birth [69.5% (153/220) vs 42.6% (100/235), χ2=33.54] as well as neonatal death within 7 d after birth [5.5% (12/220) vs 1.3% (3/235), χ2=6.22] in the high altitude group were significantly higher than those in the low altitude group (all P<0.05). Conclusion:High altitude is a risk factor for preeclampsia-eclampsia, and the adverse effects of HDP on mothers and infants are more severe in high altitude areas.
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Respiratory syncytial virus (RSV) can easily cause respiratory infection in neonates, and involve other organs in severe cases.The specific pathogenic mechanism is complex, which may be closely related to the properties of virus and the inadequate or dysregulated host innate and adaptive immune response against RSV.At present, the treatment strategy of neonatal RSV infection is mainly symptomatic support.Some European countries and the United States have successively approved the Nirsevimab for preventing neonatal RSV infection.This article reviews the molecular characteristics of RSV and its interacting mechanism with host innate and adaptive immunity.
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Objective:To evaluate the impact of different methods of human milk fortifier (HMF) on the growth and development of preterm infants.Methods:Computer searches were conducted in PubMed, Embase, Clinicaltrials, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP Database, and China National Full-text Database for biomedical literature from database inception to December 1, 2022. The inclusion criteria encompassed randomized controlled studies (RCTs) involving infants with a gestational age of less than 37 weeks who were subjected to HMF. The quality of included studies was assessed using the Cochrane bias analysis tool. Meta-analyses were performed using RevMan 5.3 software to compare individual fortification with standard fortification, targeted fortification with adjusted fortification of breast milk, and their effects on preterm infant weight gain, length, head circumference growth rates, as well as the incidence of bronchopulmonary dysplasia, osteopenia, feeding intolerance, and necrotizing enterocolitis.Results:A total of 11 RCTs were included, with 10 having low to moderate bias risk and 1 having a high bias risk. The results of meta-analysis showed that compared to standard fortification, individual fortification led to an increase in the weight gain rate of preterm infants ( SMD=0.87,95% CI 0.36-1.38 ,P<0.001), with no statistically significant differences observed in the effects on length and head circumference growth rates ( SMD=0.64,95% CI -0.07-1.34, P=0.08; SMD=0.58, 95% CI -0.06-1.22, P=0.08). The incidence of feeding intolerance and necrotizing enterocolitis in the individual intensive group was lower than that in the standard intensive group ( RR=0.45, 95% CI 0.22-0.89, P=0.02; RR=0.32, 95% CI 0.13-0.78, P=0.01), but no statistically significant difference in the incidence of bronchopulmonary dysplasia ( RR=0.93, 95% CI 0.76-1.20, P=0.67). Only two studies compared targeted fortification with adjusted fortification for growth and development outcomes in preterm infants, but the results were not consistent. Only one RCT showed no statistically significant difference in the incidence of osteopenia between the targeted fortification and adjusted fortification groups. Conclusions:Compared with standard fortification, individual intensive breastfeeding appears to promote the early growth and development of preterm infants. However, the effect of targeted and adjustable fortification on the growth and development of preterm infants is not significantly different.
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ObjectiveTo observe the effects of Dendrobium polysaccharides on the secretion of inflammatory cytokines and Toll-like receptor 4 （TLR4）/nuclear factor （NF）-κB pathway in 16HBE cells exposed to cigarette smoke extract （CSE）. MethodThe 16HBE cells were classified into the control， CSE， and CSE+ Dendrobium polysaccharides （100， 200， 400 mg·L-1） groups. The cell-counting kit-8 （CCK-8） assay was employed to measure the cell viability， and a microscope was used to observe the cell morphology. The enzyme-linked immunosorbent assay was employed to measure the levels of interleukin （IL）-8， IL-1β， IL-4， IL-13， and transforming growth factor （TGF）-β in cell culture supernatants. Real-time PCR was carried out to determine the mRNA levels of Toll-like receptor 4 （TLR4）， nuclear factor-κB （NF-κB）， and IL-4. Western blot was employed to determine the protein levels of interleukin-4 receptor （IL-4R）， TLR4， myeloid differentiation primary response protein 88 （MyD88）， NF-κB， phosphorylated nuclear factor-κB （p-NF-κB）， and nucleoproteins nuclear factor-κB （NEs-NF-κB）. The immunofluorescence assay was employed to measure the nuclear translocation of NF-κB. ResultCompared with the control group， the CSE group showed elevated levels of IL-8， IL-1β， IL-4， IL-13， and TGF-β in the cell culture supernatants （P<0.05， P<0.01）， up-regulated expression levels of TLR4， MyD88， NF-κB， p-NF-κB， NEs-NF-κB， and IL-4 （P<0.01）， and significant nuclear translocation of NF-κB. Compared with the CSE group， Dendrobium polysaccharides increased the cell survival rate， recovered the cell activity， lowered the levels of IL-8， IL-1β， IL-4， IL-13， and TGF-β， down-regulated the expression of TLR4， MyD88， NF-κB， p-NF-κB， NEs-NF-κB， and IL-4 （P<0.05， P<0.01）， and reduced the nuclear translocation of NF-κB. ConclusionDendrobium polysaccharides showed significant protective effects on the 16HBE cells exposed to CSE by inhibiting the TLR4/NF-κB signaling pathway.
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【Objective】 To explore the effect of inspection sheet on improving the quality of apheresis platelet, the satisfaction of blood donors and the cooperation ability of phlebotomists in the process of apheresis platelet collection. 【Methods】 Apheresis platelet donors from May to August 2021 in our center were selected as control group(without inspection sheet) and those from September to December 2021 were included in the observation group (with inspection sheet). The incidence of abnormal collection and the causes during collection process were compared between the two groups.And 100 first-time blood donors in each group were randomly selected for satisfaction survey. The questionnaire was made to investigate the phlebotomists’ recognition on the implementation of inspection sheet. 【Results】 The number of blood donors in the two groups were 6 673 and 6 559, with 111 and 49 abnormal cases, respectively. The total incidence of abnormal cases during blood collection before and after the implementation of inspection sheet was 1.66% and 0.75%, respectively, with the latter significantly lower than the former(P<0.001). The most common causes of abnormal conditions were repetitive puncture, followed by adverse reaction of blood donation, red blood cells contamination in platelet and fatty blood. The satisfaction of first-time blood donors was higher than before the implementation, and the recognition of phlebotomists on the inspection sheet was more than 90%. 【Conclusion】 The implementation of inspection sheet helps to regulate the collection process, strengthen the responsibility and service consciousness of phlebotomists, improve the satisfaction of blood donors, reduce the incidence of adverse events, and improve the quality of platelet products, which is worth popularizing in blood collection and supply institutions.
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Objective:To study the application value of flipped classroom teaching mode in clinical teaching of gynecological operating room.Methods:A total of 146 cases of gynecological operating room intern nursing students in The People's Hospital of Liaoning Province from January 2020 to April 2020 were selected as the research objects and divided into two groups according to different time. Before the flipped classroom teaching mode was carried out from January 2020 to February 2020, 73 cases were included in the control group, and after the flipped classroom teaching mode was carried out from March 2020 to April 2020, 73 cases were included in the observation group. The theory and operation scores of the two groups before and after teaching were compared, and the satisfaction of the practice nurses to the teaching and the evaluation of the observation group to the flipped classroom teaching mode were observed. After the teaching, the performances of the two groups of nursing students and the teaching satisfaction were compared using SPSS 22.0 to conduct t test, chi-square test and rank sum test. Results:The theoretical results[(88.52±8.99) points] and operational results[(89.79±7.51) points] of the observation group were significantly higher than those[(72.40±7.45) points and (73.66±7.77) points] of the control group, with statistical significance ( P<0.05). The teaching methods and self-evaluation satisfaction of the observation group were significantly higher than those of the control group ( P<0.05). Conclusion:The application of flipped classroom teaching mode in the teaching of nursing students in gynecological operating room can improve the students' operation and theoretical level, and the students have a high degree of recognition and satisfaction with the teaching mode.
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Objective:To analyze the risk factors and clinical features of premature infants with bronchopulmonary dysplasia(BPD)at high altitude in Tibet and low altitude in Beijing.Methods:A retrospective case-control study was conducted.The clinical data of children with gestational age ≤32 weeks admitted to the Department of Neonatology of Lhasa People′s Hospital(altitude of 3 600 m)and the Department of Neonatology of Children′s Hospital Affiliated to Capital Institute of Pediatrics(altitude of 50 m)from January 1, 2018 to December 31, 2021 were collected.Cases were divided into BPD group and non-BPD group.Premature infants with BPD were divided into high altitude group and low altitude group according to different altitudes.The clinical characteristics and high risk factors of BPD were analyzed.Results:There were 379 premature infants with gestational age ≤32 weeks, 351 were included in the study, including 110 cases in group and 241 cases in non-BPD group.There were 48 cases in high altitude group and 62 cases in low altitude group.The incidence of BPD in high altitude areas(Lhasa)was 38.7%(48/124), among which mild, moderate and severe BPD accounted for 75.0%(36 cases), 18.8%(9 cases)and 6.3%(3 cases), respectively.The incidence rates of BPD were 100%(2/2), 86.7%(13/15)and 38.7%(33/107) in gestational age <28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks, respectively.There was a statistically significant difference among different gestational age groups( χ2=19.696, P<0.001). The incidence of BPD in low altitude areas(Beijing)was 27.3%(62/227), among which mild, moderate and severe BPD accounted for 74.2%(46 cases), 4.8%(3 cases)and 21.0%(13 cases), respectively.The incidence rates of BPD in gestational age<28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks were 100%(15/15), 45.6%(36/79)and 8.3%(11/133), respectively.There was a statistically significant difference among different gestational age groups( χ2=77.474, P<0.001). The incidence of BPD in high altitude areas was significantly higher than that in low altitude areas( χ2=4.841, P=0.028). Multivariate regression analysis showed that high altitude( OR 146.893, 95% CI 19.044-1 133.064), birth weight( OR 0.996, 95% CI 0.993-0.999), asphyxia( OR 4.187, 95% CI 3.020-21.670), non-invasive mechanical ventilation( OR 1.171, 95% CI 1.106-1.240)and invasive mechanical ventilation( OR 1.198, 95% CI 1.065-1.347)were significantly correlated with the occurrence of BPD.The gestational age at birth, small for gestational age infant, the fraction of inspired oxygen and the incidence of pregnancy induced hypertension in pregnant women in high altitude group were higher than those in low altitude group( P<0.05). The incidence of patent ductus arteriosus, the use time of noninvasive and invasive mechanical ventilation, the length of hospital stay, the age of mother, the application of prenatal hormone and the twin ratio in high altitude group were significantly lower than those in low altitude group( P<0.05). Conclusion:High altitude in Tibet is a high-risk factor for the occurrence of BPD in preterm infants.Strengthening maternal health care in high altitude areas of Tibet and doing a good job in asphyxia resuscitation in delivery room may be important measures to reduce BPD in preterm infants.
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Pneumonia is a common disease and a leading cause of death in children.Bacterial meningitis is a severe infectious disease in children, featured by high morbidity, high mortality, and high incidence of sequelae. Streptococcus pneumoniae (SP)is the main pathogenic bacteria causing community-acquired pneumonia, otitis media, sepsis, bacterial meningitis and other bacterial infectious diseases in children.The pathogen of SP should be identified before the rational use of antibiotics in clinical practice.Bacterial culture method is still the " gold standard" for the identification of SP infection pathogen, but it is not applicable to the rapid detection of SP due to the shortcomings of a low positive rate and being time consuming.Immunochromatographic tests, enzyme-linked immunosorbent tests, latex particle agglutination tests and other immunological methods have the advantages of fast detection, strong specificity, high sensitivity, and easy operation, and they are free from the influence of antibacterial agents, so they are supplement to the bacterial culture method for detection of SP infection.
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Objective:To explore the MRI features of neonatal deep cerebral arterial infarctions.Methods:The medical and MRI datas of 23 neonates with deep cerebral arterial infarctions from January 2011 to December 2018 in Beijing Children′s Hospital, Capital Medical University were retrospectively analyzed. Both 11 males and 12 females with ages between 1-28 d were recruited and MRI were performed within 2-20 d after symptom onset. The MRI featurs including location, morphology, signal characteristics, enhancement features and other accompanied signs were reviewed.Results:A total of 15 cases with arterial infarction and 8 cases with complication of purulent meningitis were identified. The median age at presentation were 2 d and 7 d respectively. The unilateral involvement were demonstrated in all neonates with arterial infarctions. Among them, 11 had deep infarcts and the main branch of the middle cerebral artery was involved in 4 neonates. MRI showed slightly hypo-intensity on T 1WI and slightly hyper-intensity on T 2WI with indistinct boundary and focal punctate hyper-intensity on T 1WI and hypo-intensity on T 2WI. In 8 cases secondary to purulent meningitis, unilateral involvement was found in 5 cases and bilateral involvement in 3 cases. All cases showed hypo-intensity on T 1WI and hyper-intensity on T 2WI with indistinct boundary. Among them, 7 cases were heterogeneous, with small cystic changes which appeared as slightly hyper-intensity on T 1WI and slightly hypo-intensity on T 2WI peripherally, as well as nodular or patchy restricted diffusion. Marked swelling of the lesion was found in 6 cases. Multiple patchy or ring enhancement was revealed in 5 cases. Iso-intensity and restricted diffusion in posterior horn of the lateral ventricle were found in 2 cases. Restricted diffusion in frontotemporal subarachnoid space was found in 5 cases. One case showed subdural effusion. Conclusion:Neonatal deep cerebral arterial infarctions have certain characteristic appearance on MRI. Lesions secondary to purulent meningitis can be bilateral involvement with heterogeneous MRI intensities, and different period of infarction signs could be found concurrently. MRI is beneficial to the differential diagnosis.
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Objective:To have a better understanding of congenital leukemia by summarizing its clinical features and prognosis.Methods:This study retrospectively recruited 10 neonates with congenital leukemia treated in Beijing Children's Hospital, Capital Medical University from January 2006 to December 2018. Clinical data including clinical manifestations, laboratory examinations, treatment and follow-up were described.Results:The 10 patients consisted of six boys and four girls. In all cases, symptoms presented within 11 d after birth. The admission complaints were jaundice ( n=4), polypnea ( n=3), fever ( n=2) and rash ( n=2). Physical examinations of the 10 patients showed eight with splenomegaly, seven with hepatomegaly and seven with petechia/skin rash. All patients had significantly increased white blood cell count (from 45.8×10 9/L to 553.0×10 9/L), complicated by different degrees of anemia and thrombocytopenia. By bone marrow biopsy, two cases were diagnosed as acute lymphoblastic leukemia and the other eight cases as acute myeloid leukemia. All cases refused chemotherapy on the preliminary diagnosis. Three cases lost follow-up and six died within two months after discharge requested by their parents. One baby had spontaneous remission, but relapsed two years later. Complete remission was achieved after strict management and no relapse was reported until ten years old. Conclusions:Congenital leukemia is a severe condition with high mortality. Some cases may achieve spontaneous remission, but long-term follow-up is needed.
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Objective:To analyze the diagnosis and treatment of neonatal neuroblastoma (NB) by summarizing its clinical characteristics.Methods:This study retrospectively recruited 14 neonates with NB in Beijing Children's Hospital (National Center for Children's Health) from February 1, 2015, to February 1, 2020. Medical records and follow-up data as of February 29, 2020, were collected, and clinical staging based on International Neuroblastoma Staging System, risk grouping based on American Childhood Oncology Group risk grouping system, diagnosis, treatment, and prognosis were analyzed. According to whether surgical treatment was performed in the neonatal period or not, these subjects were divided into surgical and non-surgical groups. A descriptive statistical analysis was used for data analysis.Results:(1) Neonates with NB accounted for 0.063% (14/22 006) of the total number of newborns admitted to the hospital during the same period. The 14 cases were all full-term aged 15 d (8 h-23 d) at admission. Tumors were found in seven cases in prenatal examinations, while others presented with shortness of breath (three cases), abdominal distension (two cases), fever (one case), and dysuria and difficult defecation after birth (one case). (2) The primary tumor sites included the adrenal gland (eight cases), posterior mediastinum (three cases), retroperitoneum (two cases), and sacrococcygeal (one case). Three cases had extensive diffuse liver metastasis at admission. (3) Except for two cases who refused to examine, the serum neuron-specific enolase of 12 cases was 57.2 ng/ml (35.9-158.3 ng/ml) during hospitalization, and the urine vanillyl-mandelic acid creatinine of four cases was 2 304.940 (685.748-9 595.314). (4) Primary tumor sites were found in 14 cases by imaging examination. Bone scanning was performed in three cases, including one with a concentrated shadow of the right sacroiliac joint and two with no abnormalities. Ten cases underwent bone marrow aspiration and all with normal results. (5) Of the ten neonates received surgery (the surgical group), nine had the primary tumor wholly removed, without chemotherapy after the operation, and the tumor-free survival period was 19 months (1-45 months). One case (case 5) had a substantial primary tumor that could not be completely resected. The patient underwent a second surgery five months after the first operation due to disease progression and received postoperative chemotherapy. The child had stopped chemotherapy for 24 months and survived without a tumor. (6) In the non-surgical group (cases 11 to 14), the tumor in case 11 who refused chemotherapy shrank spontaneously after discharge, and the patient survived for 20 months with the tumor. The parents of the case 12 withdrew treatment during hospitalization, while the primary tumor and metastases disappeared after discharge, and the specific tumor markers gradually decreased to normal levels. The patient has been tumor-free survived for 25 months. Case 13 received mediastinal tumor resection and chemotherapy during infancy. At the end of the follow-up, chemotherapy had been stopped for 12 months, and the patient survived without a tumor. Case 14 withdrew treatment and died. (7) Among the ten cases in the surgical group, one patient's pathological result indicated a composite tumor, while the others were low differentiated neuroblastoma. There was no MYCN gene amplification, 1p36 deletion, or 11q23 deletion in the ten cases. (8) Among the ten children in the surgical group, nine were in stage 1, and one was in stage 4S (case 5). Nine cases were classified into extremely low-risk groups, while the other was in the low-risk group. The four cases in the non-surgical group could not be grouped by risk. Conclusions:Clinical manifestations of neonatal NB are often atypical. NB in stage 4S might resolve spontaneously, and expectant observation may be considered. The overall prognosis of neonatal NB is generally good, but further researches are needed.
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Objective@#To evaluate the performance of multiplex polymerase chain reaction-based reverse line blot hybridization (mPCR/RLB) in the detection of pathogens causing neonatal bacterial meningitis and associated drug resistance genes.@*Methods@#Clinical data and cerebrospinal fluid (CSF) samples were collected retrospectively from 80 cases diagnosed with neonatal bacterial meningitis in Beijing Children's Hospital from January 1, 2012 to December 31, 2018. A total of 100 CSF samples were obtained including 80 samples collected after admission (12 before and 68 after antibiotic treatment) and 20 recollected at follow-up. All CSF samples were analyzed by conventional culture, susceptibility test and mPCR/RLB. Differences in the detection of pathogens and drug resistance genes were analyzed by Chi-square test.@*Results@#(1) Among the 80 first-collected CSF samples, mPCR/RLB revealed significantly higher positive rate than conventional culture [26.3% (21/80) vs 7.5% (6/80), χ2=10.025, P=0.002]. No significant difference was showed between the two methods in analyzing the 12 samples collected before antibiotic therapy (9/12 vs 5/12, χ2=1.543, P=0.214), while the positive rate in 68 samples collected after antibiotic intervention detected by mPCR/RLB was obviously higher than that by conventional culture [17.6% (12/68) vs 1.5% (1/68), χ2=13.176, P<0.001]. (2) Conventional culture results of the 20 samples collected during follow-up were all negative, but four were positive using mPCR/RLB, which were also positive previously. Furthermore, the results of both methods in previous detections were identical. (3) According to the conventional culture results, the pathogens were Escherichia coli (three cases), Group B Streptococcus (two cases) and Listeria monocytogenes (one case), while mPCR/RLB detected Escherichia coli (four cases), Group B Streptococcus (five cases), Listeria monocytogenes (four cases), Neisseria meningitidis (four cases), Haemophilus influenzae b (one case), Gram-negative bacteria (one case), Gram-positive bacteria (one case), and Listeria monocytogenes and Haemophilus influenzae b coinfection (one case) in 80 first-collected CSF samples. (4) Antibiotic susceptibility test showed that one Escherichia coli strain produced extended spectrum beta-lactamases. Drug resistance gene detection by mPCR/RLB showed that acrA, acrB, CTX-M (consistent with antibiotic susseptibility test) and TetM genes were positive in three, two, one and one case, respectively.@*Conclusions@#mPCR/RLB is of great clinical value due to its higher detection rate and better accuracy compared with bacterial culture and can also detect drug resistance genes.
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Objective@#To study the clinical and molecular characteristics of Staphylococcus aureus(S.aureus ) isolated from neonates of Beijng Children′s Hospital.@*Methods@#The clinical information of S. aureus infection in newborns of Beijing Children′s Hospital from February 2016 to January 2017 was collected.The molecular biological characteristics of S. aureus isolates were detected.Methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus(MSSA)were identified, using the cefoxitin disc method and the detection of the mecA gene.Multilocus sequence typing(MLST)and spa typing were analyzed using the PCR, and the staphylococcal chromosomal cassette mec(SCCmec) type was analyzed for the MRSA isolates.Eleven adhesion gene and three virulence genes(pvl, psma, hlα )were also detected by PCR.Antimicrobial susceptibility testing was performed by agra dilution method or E-test method.@*Results@#The total of 57 cases of neonatal S. aureus infection were collected during the study.The most common clinical diagnosis was 38 cases (66.7%) of pneumonia and 28 cases (49.1%) of skin infection syndrome (SSTI). There were 31 cases (54.4%) with MRSA infection and 26 cases (45.6%) with MSSA infection.The proportion of SSTI in the MRSA group (64.5%) and the infection of more than 2 sites (61.3%, 19/31) were significantly higher than those in the MSSA group (30.8%, 8/26 and 23.1%, 6/31). There were 16 MLST types and 29 spa types, the most common ones were ST59 (40.4%) and t437 (33.33%), respectively.The most common popular clones of MRSA and MSSA were ST59-SCCmecIVa-t437 (54.8%) and ST22-t309, respectively(11.5%). The sdrE carrying rate of MRSA was higher than that of MSSA, while the sdrD and cna carrying rates were lower than those of MSSA (P<0.05). The other adhesion and virulence gene carrying rates were not significantly different between the two strains.The multi-drug resistance rate of all strains was 61.4%(35/57). Except for lactam antibiotics, the most common resistant phenotypes of MRSA and MSSA were ERY-CLI, accounting for 74.2% and 26.9%, respectively.@*Conclusion@#The main types of neonatal S. aureus infection in our hospital were pneumonia and SSTI.SSTI and multi-site infections of MRSA infection are more common.MRSA and MSSA isolates have clonal dissemination characteristics.The most common clones are ST59-SCCmecIVa-t43 and ST22-t309, which show no significant differences in the status of carrying virulence factors between them.The multi-drug resistance rate of neonatal S. aureus isolates is higher.
الملخص
Objective@#To analyze the epidemiological characteristics, clinical manifestations and imaging charac-teristics of 76 cases with neonatal cerebral infarction, in order to provide evidence for the diagnosis, treatment and prognosis for neonal cerebral infarction.@*Method@#Newborns with cerebral infarction admitted into the Neonatal Center, Beijing Children′s Hospital, Capital Medical University from January 2007 to December 2017 were enrolled.According to neurological sequelae, the participants were divided into good prognosis group and poor prognosis group for retrospective analysis, and their cranial magnetic resonance imaging(MRI) changes and mental development were followed up.@*Results@#The incidence of convulsion was the highest in 76 cases (73.7%, 56/76 cases), among which unilateral limb twitching was characteristic in 39.2% (22/56 cases). Clinical physical examination showed no significant positive signs in 13.2%(10/76 cases) of the patients, but middle cerebral artery involvement accounted for 80.3% (61/76 cases), and there was no abnormal discharge of electroencephalogram in 29.2% (19/65 cases) of the patients.Among 41 children (29.3%) received follow-up, 12 cases had neurological sequelae, and 15 cases (36.6%) received anticoa-gulant therapy.The median area of original damage of T2 sequence cerebral infarction was 10.3%, the median area of diffusion weighted image damage was 2.0%, and the median area of damage of T2 sequence was 1.0%.The median ratio of craniocerebral lesion damage was 8.4%.The ratios of poor prognosis were 14.9%, 4.8%, 0.5% and 14.4%, respectively.@*Conclusions@#Neonatal convulsion is the most common manifestation of neonatal cerebral infarction.Unilateral limb clonus is characteristic.The larger the infarct involvement area and the larger the intracranial lesion change area through reexamination, the poorer prognosis of the children.Early anticoagulant therapy could not improve the prognosis of neonatal cerebral infarction.
الملخص
Objective To analyze the epidemiological characteristics,clinical manifestations and imaging characteristics of 76 cases with neonatal cerebral infarction,in order to provide evidence for the diagnosis,treatment and prognosis for neonal cerebral infarction.Method Newborns with cerebral infarction admitted into the Neonatal Center,Beijing Children's Hospital,Capital Medical University from January 2007 to December 2017 were enrolled.According to neurological sequelae,the participants were divided into good prognosis group and poor prognosis group for retrospective analysis,and their cranial magnetic resonance imaging (MRI) changes and mental development were followed up.Results The incidence of convulsion was the highest in 76 cases (73.7 ％,56/76 cases),among which unilateral limb twitching was characteristic in 39.2％ (22/56 cases).Clinical physical examination showed no significant positive signs in 13.2％ (10/76 cases) of the patients,but middle cerebral artery involvement accounted for 80.3％ (61/76 cases),and there was no abnormal discharge of electroencephalogram in 29.2％ (19/65 cases) of the patients.Among 41 children (29.3 ％) received follow-up,12 cases had neurological sequelae,and 15 cases (36.6％) received anticoagulant therapy.The median area of original damage of T2 sequence cerebral infarction was 10.3％,the median area of diffusion weighted image damage was 2.0％,and the median area of damage of T2 sequence was 1.0％.The median ratio of craniocerebral lesion damage was 8.4％.The ratios of poor prognosis were 14.9％,4.8％,0.5％ and 14.4％,respectively.Conclusions Neonatal convulsion is the most common manifestation of neonatal cerebral infarction.Unilateral limb clonus is characteristic.The larger the infarct involvement area and the larger the intracranial lesion change area through reexamination,the poorer prognosis of the children.Early anticoagulant therapy could not improve the prognosis of neonatal cerebral infarction.