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Objective:To investigate the application effect of flipped classroom combined with micro-lectures in the teaching of pediatric infectious diseases.Methods:A total of 199 five-year students in the class of 2019 from Department of Pediatrics of Chongqing Medical University were divided into 14 groups. Each group selected a micro-lecture theme targeting the key and difficult points of the course and produced an original micro-lecture video through flipped classroom, which was then uploaded to Chaoxing platform for evaluation by teachers and students. At the end of the course, a questionnaire survey was performed to investigate the teaching effect, and final examination score and department examination score during internship were compared between the students in the class of 2019 and those in the class of 2018. SPSS 22.0 was used to perform the t-test, the Wilcoxon rank-sum test, the chi-square test, and the Fisher's exact test. Results:A total of 14 flipped micro-lecture works were completed by the students. The questionnaire survey showed that 98.47% (193/196) of the students thought that this model was helpful to master the key and difficult points; 93.88% (184/196) of the students thought that the flipped micro-lecture works had better originality and quality than reading reports and literature reviews in the past; 94.90% (186/196) of the students were more willing to accept the mode of flipped classroom combined with micro-lectures. Compared with the students in the class of 2018, the students in the class of 2019 had significantly higher final examination score (79.32±7.53 vs. 76.06±12.01, P<0.001), theoretical score of department examination (88.68±4.87 vs. 87.15±4.09, P<0.001), and operation score of department examination (84.93±7.56 vs. 82.08±9.10, P<0.001). Conclusion:Flipped classroom combined with micro-lectures can effectively solve the key and difficult points in the teaching of pediatric infectious diseases, and it can also stimulate the interest in independent learning and help to improve learning performance among students. Therefore, it holds promise for clinical application.
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At present, the routine specialized training for primary pediatricians (focusing on theoretical learning of public subjects) cannot meet the needs of primary pediatricians. In order to promote the development of children's medical care at the grassroots level and improve the quality, medical and clinical research abilities of regional pediatric medical personnel, the Children's Hospital of Chongqing Medical University has designed and built a "hierarchical training model for improving the professional ability of pediatricians" from the aspects of training objectives, training contents, training methods, construction and evaluation of training programs, and quality control. In addition, the 8-month "Pediatric Professional Basic Training" and the 9-month "Pediatric Professional Ability Improvement Training" were respectively carried out in Xianyang Children's Hospital. In the "Professional Basic Training", 88 trainees were comprehensively evaluated after training, 53 of whom were qualified or above. In the "Ability Improvement Training", 26 of the 29 students actually participated in the evaluation and reached the qualified level or above. Learners provided feedbacks that they have effectively improved their own knowledge structure, expanded their clinical diagnosis and treatment thinking and clinical research ideas, and provided some guidance for clinical work.
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Objective To analyze the epidemic characteristics of imported dengue fever in Pudong New Area of Shanghai from 2008 to 2020，and to explore its prevention and control strategy and measures． Methods The data of dengue fever cases in Pudong New Area from 2008 to 2020 were collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the epidemic characteristics. Results A total of 45 cases of dengue fever were reported in Pudong during 2008-2020, all the cases were mild, and no deaths were reported．The male-to-female ratio was 2.46:1. The group aged 20-49 years accounted for 86.67%．The most common occupation was commercial service personnel and cadres (25 cases, accounting for 55.56%). The peak of incidence was from July to October with a total of 35 cases (77.78%). All the cases were imported from abroad, mainly from Southeast Asia and South Asia (43 cases, 95.56%). 15 cases (33.33%) had been ill before entry. 22 cases (48.89%) were first treated in tertiary hospitals. The median time intervals from onset to first clinic visit, from first clinic visit to diagnosis, and from onset to diagnosis were 1.0 d, 5.0 d, and 7.0 d, respectively. Serotypes of dengue virus were mainly Type I, Type III and Type II, which were 9 cases, 7 cases, and 6 cases, respectively. Conclusion The epidemic situation of dengue fever in Pudong New Area from 2008 to 2020 is relatively stable, all imported from abroad. The focus of the prevention and control is to promote the health education for overseas travelers, strengthen the monitoring sensitivity at border ports, enhance the diagnostic level of medical institutions, and timely find and report cases.
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Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.
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Immunology is a kind of important basic subject for medical education, involving theories and technologies covering many aspects of disease occurrence, diagnosis, prevention and treatment, and is also the source of new means of medical treatment in the future. Therefore, successful teaching of medical immunology is associated with high-level medical undergraduate education. An appropriate textbook is critical for curriculum construction of immunology. However, little analysis of immunology textbooks has been published. We selected several famous and popular English immunology textbooks and compared their teaching objectives, methods, and contents, concluding the features and targeting readers of each textbooks. Our research results could provide some advices for students to learn immunology theory and researchers to utilize immunology methods, and also give a glimpse of the development trend and direction of immunology.
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Objective:To investigate the value of D-dimer, carbohydrate antigen 199 (CA199) and insulin-like growth factor binding protein 2 (IGFBP2) for postoperative monitoring and prediction of survival time in patients with resectable pancreatic cancer.Methods:The data of 119 patients with pancreatic cancer who were admitted to the First Hospital of Qinhuangdao from May 2010 to January 2014 were collected. Immunoturbidimetry was used to determine the level of D-dimer before surgery, at postoperative stable disease stage and disease progression stage; electrochemiluminescence was used to determine the level of CA199, and enzyme-linked immunosorbent assay (ELISA) was used to determine the serum IGFBP2 level. A total of 30 healthy people and 40 patients with pancreatic serous cystadenoma were treated as the controls. The correlations of the levels of preoperative D-dimer, CA199 and IGFBP2 with clinicopathological characteristics and survival time of patients with pancreatic cancer were analyzed.Results:The levels of preoperative D-dimer, CA199, IGFBP2 in patients with pancreatic cancer were higher than those in the both control group (all P < 0.01). The levels of serum D-dimer, CA199 and IGFBP2 after the progression of pancreatic cancer were higher than those at postoperative stable disease stage [1 496.0 ng/ml (590.0 ng/ml, 2 280.4 ng/ml) vs. 578.1 ng/ml (381.7 ng/ml, 671.5 ng/ml), 207.0 U/ml (54.5 U/ml, 736.5 U/ml) vs. 31.9 U/ml (14.1 U/ml, 44.0 U/ml), (435±107) ng/ml vs. (249±83) ng/ml, all P < 0.01]. There were no statistical differences in the proportion of pancreatic cancer patients stratified by different clinicopathological factors with the increased levels of D-dimer before operation (all P > 0.05). The proportion of the increased levels of CA199 and IGFBP2 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis (both P < 0.05); there was no association of the increased levels of CA199 and IGFBP2 with other factors (all P > 0.05). The preoperative progression-free survival (PFS) time and overall survival (OS) time of pancreatic cancer patients with elevated D-dimer level was shorter than that for those with normal D-dimer level [(10.6±1.2) months vs. (20.4±2.4) months, (18.9±1.9) months vs. (29.2±2.6) months, both P < 0.01]. When the threshold value of CA199 was 37 U/ml, there was no correlation between CA199 and survival of pancreatic cancer patients (all P > 0.05); when the threshold value was 253.8 U/ml (median CA199 for the enrolled patients) and 1 000 U/ml, patients with elevated CA199 level had shorter OS time and PFS time compared with the patients with normal CA199 level [253.8 U/ml: (11.5±1.5) months vs. (21.0±2.6) months, (19.9±2.1) months vs. (29.0±2.7) months, both P < 0.01; 1 000 U/ml: (8.9±1.9) months vs. (19.1±1.9) months, (15.5±2.3) months vs. (28.0±2.0) months, both P < 0.01]. When the threshold value of IGFBP2 was 339.1 ng/ml, patients with elevated preoperative IGFBP2 level had shorter PFS time and OS time compared with the patients with normal IGFBP2 level [(10.8± 1.1) months vs. (21.1±2.6) months, (18.9±1.8) months vs. (30.3±2.8) months, both P < 0.01]. Cox multivariate analysis showed that preoperative D-dimer and IGFBP2 levels were independent factors affecting PFS and OS in patients with pancreatic cancer (D-dimer: HR = 0.561, 95% CI 0.336-0.936, P = 0.027; HR = 0.515, 95% CI 0.303-0.874, P = 0.014; IGFBP2: HR = 0.430, 95% CI 0.253-0.731, P = 0.002; HR = 0.361, 95% CI 0.202-0.644, P = 0.001). Conclusions:For patients with resectable pancreatic cancer, D-dimer, CA199 and IGFBP2 can be used for postoperative condition monitoring, and preoperative D-dimer and IGFBP2 can be used for survival time prediction.
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Objective To explore the efficacy and safety of apatinib combined with S-1 in patients with advanced NSCLC without sensitive gene mutation or unknown mutation status.Methods One hundred and four patients with advanced NSCLC without sensitive gene mutation or unknown mutation status were selected from the oncology department of the First Hospital of Qinhuangdao City,Hebei Province from April 2015 to April 2017.All patients refused intravenous chemotherapy.One hundred and four patients were randomly divided into treatment group (apatinib combined with S-1 group) and control group (S-1 alone group) by 1:1 digital method.However,two patients in the treatment group transferred to the control group for personal reasons.There is 50 cases in apatinib combined with S-1 group and 54 cases in S-1 group.The efficacy and adverse reactions of the two groups were evaluated.Results The objective remission rate was 48.0％ (24/50) and 27.8％ (15/54) (x2=4.530,P =0.033),the disease control rate was 82.0％ (41/50) and 74.1％ (40/54) (x2=0.947,P=0.331),the median PFS was 6.6 months and 3.4 months (t=25.555,P =0.000),the median OS was 16.0 months and 10.5 months (t =59.439,P =0.000),respectively.The overall incidence of adverse reactions was 82.0％ (41/50) and 70.4％ (38/54) respectively (x2 =1.923,P=0.166),of which 18.0％ (9/50) and 13.0％ (7/54) were more than grade 3 respectively (x2 =0.506,P =0.477).There was no death caused by treatment-related adverse reactions in both groups.Conclusion Appatinib combined with S-1 capsule has good short-term and long-term efficacy in the treatment of advanced non-small cell lung cancer without gene mutation or unknown mutation.The adverse reactions are tolerable and can be used as first-line treatment for patients unwilling to receive intravenous chemotherapy.
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With the deepening of the reform of management system of higher medical education in China and the comprehensive advancement of quality education , the teaching laboratories in medical colleges have evolved from traditional laboratories serving the needs of a single discipline to medical laboratory centers classified by subject groups and their corresponding functions. Applying the concept of collaborative innovation, practical explorations in such aspects as building a "big experimental teaching center", establishing a new system of experimental teaching courses, exploring a new model of innovative practical education, and building an excellent teacher team engaging in experimental teaching by means of synergic work have been made by the Army Medical University in its construction of an experimental teaching center for basic medical sciences, which also provides practical reference for the construction of experimental teaching centers in the future.
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Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.
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Objective@#To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children.@*Methods@#The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children′s hospitals from 2014 to 2018 were analyzed retrospectively.@*Results@#Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced β-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively.@*Conclusions@#Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.
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Objective@#To understand clinical characteristics of children with pneumococcal meningitis (PM) in China and to analyze the drug sensitivity of Streptococcus pneumoniae isolates and associated impacts on death and sequelae.@*Methods@#The clinical data, follow-up results and antimicrobial sensitivity of isolated strains of 155 children (including 98 males and 57 females, age ranged from 2 months to 15 years) with PM in 10 tertiary-grade A class hospitals of Infectious Diseases Surveillance of Pediatrics (ISPED) from 2013 to 2017 were collected and analyzed retrospectively. Patients were divided into different groups according to the following standards: ≤1 year old group,>1-3 years old group and >3 years old group according to age; death group and non-death group according to the death within 30 days after PM diagnosis; complication group and non-complication group according to the abnormal cranial imaging diagnosis; sequelae group and no-sequelae group according to the follow-up results. Bonfereoni chi-square segmentation and Kruskal-Wallis H test were used for statistical analysis.@*Results@#There were 64 cases (41.3%) in the ≤1 year old group, 39 cases in the >1-3 years old group (25.2%), and 52 cases (33.5%) in the >3 years old group. The most common clinical manifestation was fever (151 cases, 97.4%). The mortality was 16.8% (26/155) during hospitalization. The neurological complication rate was 49.7% (77/155) during hospitalization, including the most common complication, subdural effusion and (or) empyema in 50 cases (32.3%) and hearing impairment in 6 cases. During follow-up after discharge, no death was found and focal neurological deficits were found in 47 cases (30.3%), including the frequent neurological sequelae: cognitive and mental retardation of different degree in 22 cases and hearing impairment in 14 cases (9.0%). The rate of cure and improvement on discharge was 74.8% (116/155) and the lost to follow-up rate was 8.4% (13/155). The proportions of died cases, neurological complications during hospitalization and proportions of peripheral white blood cell count <12 × 109/L before admission in ≤1 year old group were significantly higher than those in >3 years old group (25.0% (16/64) vs. 5.8% (3/52), 75.0% (48/64) vs. 25.0% (13/52), 48.4% (31/64) vs. 15.4% (8/52), χ2=7.747, 28.767, 14.044; P=0.005, 0.000, 0.000). The proportions of headache, vomiting, neck resistance and high risk factors of purulent meningitis in >3 years old group were significantly higher than those in ≤ 1 year old group (67.3%(35/52) vs. 1.6%(1/64), 80.8% (42/52) vs. 48.4% (31/64), 69.2% (36/52) vs. 37.5% (24/64), 55.8% (29/52) vs. 14.1%(9/64), χ2=57.940, 12.856, 11.568, 22.656; P=0.000, 0.000, 0.001, 0.000). Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 152/152), linezolid (100.0%, 126/126), moxifloxacin (100.0%, 93/93) and ofloxacin (100.0%,41/41); highly sensitive to levofloxacin (99.3%, 142/143) and ertapenem (84.6%, 66/78); moderately sensitive to ceftriaxone (48.4%, 45/93), cefotaxime (40.0%, 44/110) and meropenem (38.0%, 38/100); less sensitive to penicillin (19.6%, 27/138) and erythromycin (4.2%, 5/120). The proportions of non-sensitive strains of penicillin (21/21) and meropenem (17/18) in the death group were significantly higher than those (90/117, 45/82) in the survived group(χ2=4.648 and 9.808, P=0.031 and 0.002).@*Conclusions@#The children′s PM is mainly found in infants under 3 years old in China. Death and neurological complications are more common in PM children under 1 year old. The clinical manifestations and peripheral blood inflammatory markers of PM patients under 1 year old are not typical. Fever is the most common clinical manifestation and subdural effusion and (or) empyema is the most common complication. Long-term hearing impairment is common in PM and the follow-up time must be prolonged. The dead PM cases had high in sensitive rates to penicillin and meropenem.
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Hand,foot and mouth disease (HFMD) is characterized by skin rashes in palms,feet and mouth ulcers and a few with complication even died.It occurs mainly children aged less than 5 years,especially in infants and young children aged 1-3 years.There are more than 20 kinds of enterovirus cause HFMD in children,and the main etiologic agents are human enterovirus 71 (EV71) and Coxsackievirus 16 (CA16).EV71 infection is more frequently associated with severe central-nervous-system complications in HFMD patients and thereby is a major cause of fatalities.Innate immunity plays an important role in anti-EV71 infection as the first immune barrier.And its main function is realized by natural immune cells,including monocytes/macrophages,dendritic cells,natural killing cells and invariant natural killer T cells and their secreted cytokines and chemokines.At present,more studies have shown that natural immune cells participate in the development of hand,foot and mouth disease caused by EV71.
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Objective@#To improve the understanding of clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in children.@*Methods@#A retrospective study was conducted to analyze the clinical data of STSS caused by S. pyogenes (culture-confirmed) in 7 tertiary hospitals during 2010—2017 in China. Clinical and laboratory data were collected by reviewing the medical records.@*Results@#Fifteen cases of STSS, including 9 males, were confirmed and the ages of the patients ranged from 6 months to 15 years, with median age of 3 years. All cases had the positive blood culture for S. pyogenes and only 3 cases had short course of β-lactam treatment before blood culture. Medical evaluation was initiated within (5.1±4.6) days after symptom onset. All patients had fever, and 13 patients had multiple organ dysfunction and 10 patients had disseminated intravascular coagulationl (DIC). Twelve cases had severe pneumonia with or without skin and (or) soft tissue infections. Underlying conditions included giant hemangioma of the skin in 2 patients and varicella in 1 patient. All isolated strains in 14 cases were sensitive to penicillin G, ceftriaxone/cefotaxime, vancomycin, but 12 and 13 isolates were resistant to clindamycin and erythromycin, respectively. Eight patients died, and 5 of them died within 24 hours after admission. One patient was lost to follow-up after intended discharge against medical advice.@*Conclusion@#STSS caused by S. pyogenes in children is a severe syndrome with rapid clinical progression and high mortality rate, and thus the pediatricians should be aware of STSS and immediately initiate aggressive treatment for the suspected cases.
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Objective@#To describe the clinical characteristics of pneumococcal infections and drug resistance of Streptococcus pneumoniae isolates from children's hospitals, which would provide reference for preventing and treating pneumococcal diseases.@*Methods@#This was a prevalence survey. In this study, the age, specimen type, monthly distribution characteristics, and antimicrobial resistance of Streptococcus pneumoniae isolates from 9 children's hospitals in China were investigated between January 1, 2016 and December 31, 2016. The WHONET 5.6 software was used to analyze the antibiotic susceptibility of Streptococcus pneumoniae. The comparison of rates was performed by Chi-square test.@*Results@#A total of 6 200 isolates of streptococcus pneumoniae were obtained, namely, 95.1% (5 876/6 177) from the respiratory tract specimens, 2.2% (136/6 177) from blood specimens and 0.4% (24/6 177) from cerebrospinal fluid specimens. The isolates were mainly from children older than 1 and younger than 5 years (54.7%, 3 381/6 185) . Most of strains (33.2%, 1 184/3 563) were isolated in November, December and January. Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 6 189/6 189) , linezolid (100.0%, 6 030/6 030) , moxifloxacin (100.0%, 3 064/3 064) , highly sensitive to levofloxacin (99.8%, 5 528/5 540), ertapenem (98.8%, 3 024/3 061) and lowly sensitive to erythromycin (1.7%, 102/6 016), clindamycin (3.7%, 116/3 136), and tetracycline (5%, 244/4 877), respectively. According to the parenteral susceptibility breakpoints for non-meningitis isolates, the sensitivity of Streptocococus pneumoniae to penicillin from children's hospital of Chongqing Medical University (49.3%, 892/1 809) was significantly lower than those of other hospitals (χ2=1 268.161, P<0.05) .@*Conclusions@#Streptococcus pneumoniae is mainly isolated from respiratory tract, from children older than 1 and younger than 5 years and during November to January in tertiary children's hospital of China. The Streptococcus pneumoniae from children is highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin. There are also significant differences in the sensitivity of penicillin for Streptococcus pneumoniae from different hospitals.
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Objective@#To analyze the antimicrobial resistance profile in Chinese children.@*Methods@#This was a prevalence survey. From January 1 through December 31, 2016, the isolates were collected from 10 tertiary children hospitals in China. Antimicrobial susceptibility testing was carried out by routine laboratory methods. The penicillin susceptibility of streptococcus pneumonia and Meropenem susceptibility of gram-negative bacteria were detected by E-test and disk diffusion method respectively. Antimicrobial susceptibility results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) Guideline 2016. The data of antimicrobial susceptibility testing of isolates from either the different patients (neonatal group and non-neonatal group) or various sources were analyzed by WHONET 5.6 software.@*Results@#A total of 56 241 isolates were collected, of which 41.5% (23 328 isolates) were gram-positive organisms and 58.5% (32 886 isolates) gram-negative organisms. The five leading pathogens were Escherichia coli (7 995/56 214, 14.2%), Straphylococcus aureus (6 468/56 214, 11.5%), Streptococcus pneumonia (6 225/56 214, 11.1%), Haemophilus influenza (5 435/56 214, 9.7%) and Klebsiella pneumonia (4 523/56 214, 8.0%). The Meropenem resistance rates of Klebsiella pneumonia, Enterobacter cloacae, Escherichia coil, Pseudomonas aeruginosa, Acinetobacter baumonia isolates were 27.4% (326/1 189) , 8.1% (29/358) , 2.0% (27/1 362) , 19.5% (34/174) , 49.7% (230/463) in neonatal group and 15.4% (512/3 327) , 4.8% (40/841) , 2.3% (151/6 564) , 13.7% (252/1 840) , and 53.4% (860/1 611) in non-neonatal group. The Methicillin-resistant Staphylococcus aureus (MRSA) rates of neonatal group and non-neonatal group were 46.2% (649/1 404) and 33.3% (1 668/5 010) . The penicillin non-susceptible rates of Streptococcus pneumonia in the two groups were 17.6% (6/34) and 18.2% (1 121/6 158) respectively. The β-lactamase positive rates of Haemophilus pneumonia isolates in the neonatal group and non-neonatal groups were 33.8% (47/139) and 44.4% (2 345/5 282) respectively.@*Conclusion@#This investigation highlights the worrisome trend of antimicrobial resistance in children, especially among neonatal patients in China.
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Objective To study the anti-HCV-IgG antibody and serum HCV-RNA value in the diagnosis of hepatitis c.Methods From December 2015 to December 2006,76 patients with hepatitis C were enrolled in this study.All patients were tested for serum anti-HCV-IgG antibody and serum HCV-RNA,and the positive detection rate of hepatitis C was detected by two methods alone.Results 76 specimens of anti-HCV IgG antibody testing positive rate was 27.63％,the detection of serum HCV-RNA positive rate was 25.00％,the two kinds of joint detection positive rate was 22.37％,the three methods positive rate were relatively close,but there was no significant difference(P＞0.05).According to different loads interval differentiate HCV-RNA virus detection rate of rising,anti-HCV-IgG five interval were 60.00 ％,83.33 ％,100.00 ％,100.00 ％,100.00 ％.Conclusion The detection of single anti-HCV IgG antibody or serum HCV RNA in the diagnosis of hepatitis c have limitations,the joint detection can effectively reduce the missed diagnosis and improve positive rate and provide a reliable basis for clinical diagnosis of hepatitis C.
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Objective To explore the mediating effect of the regulatory emotional self-efficacy be-tween mindfulness and the level of anxiety in nurses. Methods A total of 1 124 clinical nurses were meas-ured with five facet mindfulness questionaire(FFMQ),regulatory emotional self-efficacy scale(RES),and Self-rating Anxiety Scale(SAS). Results The scores of mindfulness,regulatory emotional self-efficacy and anxiety were(118.75±10.70),(42.29±6.40)and(45.93±10.00)respectively.Mindfulness was positively correlated with the regulatory emotional self-efficacy(r=0.351,P<0.01)while negatively correlated with nur-ses' anxiety(r=-0.249,P<0.01).The regulatory emotional self-efficacy was negatively correlated with nur-ses' anxiety(r=-0.264,P<0.01).The regulatory emotional self-efficacy played a partial mediating role be-tween mindfulness and nurses' anxiety,which could explain 28.2% of the total effect.Conclusion The reg-ulatory emotional self-efficacy is a partial mediator between mindfulness and nurses' anxiety.
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Objective To study the anti-HCV-IgG antibody and serum HCV-RNA value in the diagnosis of hepatitis c.Methods From December 2015 to December 2006,76 patients with hepatitis C were enrolled in this study.All patients were tested for serum anti-HCV-IgG antibody and serum HCV-RNA,and the positive detection rate of hepatitis C was detected by two methods alone.Results 76 specimens of anti-HCV IgG antibody testing positive rate was 27.63％,the detection of serum HCV-RNA positive rate was 25.00％,the two kinds of joint detection positive rate was 22.37％,the three methods positive rate were relatively close,but there was no significant difference(P＞0.05).According to different loads interval differentiate HCV-RNA virus detection rate of rising,anti-HCV-IgG five interval were 60.00 ％,83.33 ％,100.00 ％,100.00 ％,100.00 ％.Conclusion The detection of single anti-HCV IgG antibody or serum HCV RNA in the diagnosis of hepatitis c have limitations,the joint detection can effectively reduce the missed diagnosis and improve positive rate and provide a reliable basis for clinical diagnosis of hepatitis C.
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Objective@#To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children.@*Method@#From November 2012 to September 2013, ten research units of large teaching hospitals or children′s hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ2 test or Kruskal-Wallis test or t test.@*Result@#Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ2=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ2=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ2=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ2=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ2=9.217, P<0.05), and 91% (χ2=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ2=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ2=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ2=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ2=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ2=13.35, P<0.05) in infants (≤1 year old) and 93% (χ2=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ2=9.57, P<0.05) and 87% (χ2=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ2=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ2=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study.@*Conclusion@#Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.
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Objective To study the clinical value of ultrasonography in the diagnosis of ketamine associated cystitis. Methods 60 cases were confirmed by pathological examination to determine the occurrence of ketamine associated cystitis in clinic, all patients underwent ultrasound examination, recording bladder morphology, wall thickness, cavity size (thickness, diameter, length and diameter), calculation of residual urine volume and bladder capacity according to the relevant data. The pictures were assigned to 2 or more specialists, and the double blind scan was used. The ultrasonographic findings of 60 patients with ketamine associated cystitis were recorded and compared with the pathological diagnosis. Results 60 cases of ketamine related cystitis were successfully examined with no interruption and withdrawal. The success rate of ultrasonography was 100.00％. The analysis showed that the coincidence rate of ultrasonography and pathological diagnosis was 60 (91.67％ and 8.33％) respectively, and there was no significant difference between the two groups. Conclusion the use of ultrasound has a detection rate of ketamine associated cystitis ideal, to provide a reliable basis for the diagnosis and treatment of ketamine associated cystitis doctor, has important value on the quality of life of patients with treatment effect and security.