Childhood Urinary Infection Associated With Vesico-ureteric Reflux

Among 222 children investigated in hospital for urinary infection98 had vesicoureteric reflux only, and of these a group of 59has been followed at a special clinic for from three to 14 years(mean 5.4 years). Children with reflux had an earlier age ofonset and a greater likelihood of a family history of urinaryinfection than those with other diagnoses. Fifty-five were conservativelytreated, and more than half of these still had reflux at theend of the study. Children with severe grades of reflux andan early onset of symptoms had least chance of reacting favourablyto medical treatment. Evidence of renal deterioration was exceptionaland virtually confined to the pre-school age group. It is arguedthat severe grades of reflux in pre-school children should betreated surgically, and that voiding cystograms need only bepart of routine investigation in two circumstances, namely whenthe patient is under five, and on the very rare occasion whenan older child shows progressive renal damage in serial pyelograms.     

Relationship of increased renal cortical echogenicity with clinical and laboratory findings in pediatric renal disease

PURPOSE: To correlate the clinical and laboratory findings with increased renal cortical echogenicity in children with acute renal diseases. MATERIALS AND METHODS: Children with increased renal cortical echogenicity were evaluated retrospectively. Laboratory findings and final diagnoses were reviewed. Patients with increased echogenity were classified into group 1 (mild; grade I) or group 2 (more severe; grades II and III). RESULTS: There were 7 newborns and 114 children (67 male, 47 female) with increased renal cortical echogenicity with a mean (+/-SD) age of 7.0 (+/-4.4) years. The clinical diagnosis was anatomic abnormality (including vesicoureteral reflux, ureteropelvic junction obstruction, ureterovesical junction obstruction, double collecting system) in 9%, urinary tract infection in 21%, urolithiasis in 6%, nephrotic syndrome in 20%, glomerulonephritis in 32%, and other diseases in 12%. Hyperechogenicity was bilateral in 72%, right-sided in 19%, and left-sided in 9%. There were 81 patients in group 1 and 33 patients in group 2 (grade II, 29; grade III, 4). There was no statistically significant difference between the groups with regard to age, sex, and serum blood urea nitrogen level, serum creatinine level, uric acid level, urine pH, and specific gravity. Hematuria was more frequent in group 2, whereas proteinuria and pyuria incidences were similar in the 2 groups. In patients with hematuria, glomerulonephritis was the most common cause. CONCLUSIONS: Glomerulonephritis is the most frequent acute disease causing increased renal echogenicity in childhood, and higher echogenicity is more likely to be associated with hematuria.     

Pediatric urinary tract infection and reflux

Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the presence of reflux. Children who may be lost to follow-up and those who have recurrent urinary tract infections should also be evaluated. The preferred method for evaluation of urinary reflux is a voiding cystourethrogram. Documented reflux is initially treated with prophylactic antibiotics. Patients who have breakthrough infections on prophylaxis, develop new renal scarring, have high-grade reflux or cannot comply with long-term antibiotic prophylaxis should be considered for surgical correction. The preferred method of surgery is ureteral reimplantation. A newer method involves injection of the bladder trigone with collagen.     

Use of ultrasonography in the detection of ureteric reflux in children suspected of having urinary infection

The present study investigated whether ultrasonography was effective in detecting ureteric reflux in children suspected of having urinary infection. Seventeen children with febrile episodes and pyuria were enrolled. The ultrasound examination revealed ballooning of the renal pelvis during bladder contraction in 4 children, dilatation of the distal ureters in 6, and small kidney in 2. Cystography was performed on the 6 children with these ultrasound abnormalities and 1 child with two episodes of suspected urinary infection. Four children showed reflux. All of the 4 children had been found to have renal pelvic ballooning on ultrasound. None of the children who did not undergo cystography had recurrence of urinary infection or significant bacteriuria during a median follow-up period of 12 months. Thus, scanning during bladder contraction was effective in detecting significant ureteric reflux. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:195–199, 1997     

儿童百日咳181例临床分析

目的探讨儿童百日咳的临床特点。方法回顾性分析江西省儿童医院2017年1月至2020年1月收治的181例百日咳患儿的临床资料。按年龄分为≤3个月组（n=88）、>3个月组（n=93）;按有无接种百白破疫苗（DTP）分为免疫组（n=23）、未免疫组（n=137）,排除未接种完全16例,接种史不详5例;按有无混合其他病原菌感染分为无混合感染组（n=78）、混合感染组（n=103）。比较不同分组患儿的临床特点。结果≤3个月组痉挛性咳嗽、阵发性青紫、呼吸暂停、窒息、呼吸衰竭等临床症状发生率,并发重症肺炎、肺实变和（或）肺不张发生率,WBC计数及住院时间均显著高于>3个月组,差异有统计学意义（P<0.05）。阵发性青紫、呼吸暂停、呼吸衰竭、窒息、重症肺炎仅见于未免疫组,未免疫组重症肺炎、呼吸衰竭发生率,WBC计数及住院时间均显著高于免疫组,差异有统计学意义（P<0.05）。混合感染组肺实变和（或）肺不张发生率、WBC计数及住院时间均显著高于无混合感染组,差异有统计学意义（P<0.05）。结论≤3个月、未接种疫苗的百日咳患儿病情更重,住院时间更长;混合其他病原菌感染是影响百日咳患儿治疗效果的重要因素;WBC水平在一定程度上可提示患儿的预后。     

Diagnosis and treatment of urinary tract infections in children

Acute urinary tract infections are relatively common in children, with 8 percent of girls and 2 percent of boys having at least one episode by seven years of age. The most common pathogen is Escherichia coli, accounting for approximately 85 percent of urinary tract infections in children. Renal parenchymal defects are present in 3 to 15 percent of children within one to two years of their first diagnosed urinary tract infection. Clinical signs and symptoms of a urinary tract infection depend on the age of the child, but all febrile children two to 24 months of age with no obvious cause of infection should be evaluated for urinary tract infection (with the exception of circumcised boys older than 12 months). Evaluation of older children may depend on the clinical presentation and symptoms that point toward a urinary source (e.g., leukocyte esterase or nitrite present on dipstick testing; pyuria of at least 10 white blood cells per high-power field and bacteriuria on microscopy). Increased rates of E. coli resistance have made amoxicillin a less acceptable choice for treatment, and studies have found higher cure rates with trimethoprim/sulfamethoxazole. Other treatment options include amoxicillin/clavulanate and cephalosporins. Prophylactic antibiotics do not reduce the risk of subsequent urinary tract infections, even in children with mild to moderate vesicoureteral reflux. Constipation should be avoided to help prevent urinary tract infections. Ultrasonography, cystography, and a renal cortical scan should be considered in children with urinary tract infections.     

A Study of Fifty-eight Patients with Renal Scarring Associated with Urinary Tract Infection

Fifty-eight patients, three male and 55 female, with radiologicallyapparent renal scarring together with urinary tract infectionhave been followed for periods from five to 13 years. Controlof urinary infection has been attempted by antibacterial treatmentand prophylaxis, and radiological appearances, renal functionand blood pressure have been monitored. Urinary infection waseliminated in 50 patients (86 per cent), all of whom becamesymptom-free. Evidence of new renal scarring was not seen, butthree patients showed contraction of kidney size and three developedradio-opaque renal calculi. Vesico-ureteric reflux was demonstratedin 20 patients; surgical re-implantation of ureters was carriedout in four patients and the indications for this operationare discussed. Of the 12 patients who had a raised serum creatinineat some time during the study only three showed progressivedecline in renal function; the serum creatinine returned tonormal in seven patients when infection was controlled. Hypertensionwas more common in patients with bilateral than in those withunilateral scarring, and all patients with evidence of impairedfunction at any time developed hypertension. We conclude thatmost patients with scarred kidneys and urinary infection canbe rendered symptom-free by control of infection, and that thereis some evidence that renal function can be preserved in thisway.     

排尿性膀胱尿道造影筛查儿童原发性膀胱输尿管反流的意义

目的探讨排尿性膀胱尿道造影(micturating cystourethrography,MCU)筛查儿童原发性膀胱输尿管反流(vesi-coureteric reflux,VUR)的意义。方法选择40例经99Tcm-二巯基丁二酸(DMSA)显像后肾脏放射性摄取缺损或减少的尿路感染(urinary tract infection,UTI)患儿行MCU检查,依据国际反流性肾病协会提出的VUR分级标准评价MCU诊断结果。结果 40例MCU检查诊断原发性VUR 16例,检出率为40.0%,其中双侧9例,单侧7例;男8例,女8例;年龄<1岁13例。MCU检查共检出VUR 25个肾输尿管单位,其中Ⅱ级反流2支(8.0%),Ⅲ级反流5支(20.0%),Ⅳ级反流12支(48.0%),Ⅴ级反流6支(24.0%)。结论对UTI患儿进行规范的MCU检查可为原发性VUR诊断和治疗提供客观依据。     

Is serum procalcitonin able to predict long-term kidney morbidity from urinary tract infections in children?

A new diagnostic strategy for children with febrile urinary tract infections could be the routine use of procalcitonin assessment to identify children requiring closer follow-up since being at risk for kidney damage. A total of 11 studies were published between 1998 and 2007. Children with very high procalcitonin levels during urinary tract infections are likely to be at risk of renal damage and vesico-ureteral reflux. Therefore, the prediction of long-term renal damage showed contradictory results. However, high procalcitonin values at diagnosis and positive scintigraphic scans may suggest the need to investigate for vesico-ureteral reflux. Consequently, procalcitonin levels should be included in follow-up protocols for urinary tract infections to aid in decision making concerning scintigraphic scans and voiding cystourethrograms.     

Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset

OBJECTIVE: To describe neuropsychological profiles and their relationship to metabolic control in children with type 1 diabetes 6 years after the onset of disease. RESEARCH DESIGN AND METHODS: Children with type 1 diabetes (n = 90), aged 6-17 years, who had previously been assessed soon after diagnosis and 2 years later, were reevaluated 6 years after the onset of disease. Their neuropsychological profiles were compared with those of individuals in a community control group (n = 84), who had been assessed at similar intervals. Relationships between illness variables, such as age at the onset of disease and metabolic control history, and neuropsychological status were also examined. RESULTS: Six years after onset of disease, children with type 1 diabetes performed more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills. Attention, processing speed, and executive skills were particularly affected in children with onset of disease before 4 years of age, whereas severe hypoglycemia was associated with lower verbal and full-scale intelligence quotient scores. CONCLUSIONS: Neuropsychological profiles of children with type 1 diabetes 6 years after the onset of disease are consistent with subtle compromise of anterior and medial temporal brain regions. Severe hypoglycemia, particularly in very young children, is the most plausible explanation for neuropsychological deficits, but the contributory role of chronic hyperglycemia warrants further exploration.     

Urinary tract infections beyond the early post-transplant period in pediatric renal graft recipients

BACKGROUND: Urinary tract infection is a frequent bacterial complication after renal transplantation in adults and children, however there are only very limited data on children beyond the early post-transplant period. In this study we investigated urinary tract infections in pediatric outpatients who had received transplants more than six months previously. Incidence, risk factors and impact on short-term graft function were analyzed. METHODS: 47 children who had received a total of 58 allografts were analyzed between 1997 and 2000. At the time of analysis they had had their transplants for an average of 3.5 years (range 0.5-9.4). Urinary tract infection was defined as the presence of both significant bacteriuria (> 10(5) CFU/ml) and symptoms. RESULTS: Of the 47 patients, 15 (32%) had from 1 to 7 urinary tract infections each. In total 35 infections were recorded. Median age at urinary tract infection was 5.5 years (range 1.8-24.2). Gender, donor source, immunosuppression and underlying disease (urologic vs non-urologic) did not influence the incidence of urinary tract infection. Creatinine but not C-reactive protein rose significantly during the infection. CONCLUSIONS: Our data suggest that urinary tract infection remains a frequent but mostly benign complication in the pediatric transplant population, even beyond the early post-transplant period. More extended studies are needed to assess the long-term effects on graft function.     

起病时有肾脏增大的儿童急性淋巴细胞白血病的临床资料分析

目的总结起病时有肾脏增大表现患儿的急性淋巴细胞白血病（ALL）临床特点,并与起病时无肾脏增大表现的患儿进行临床资料及预后比较。 方法回顾性分析2010年至2019年北京大学第一医院儿科血液肿瘤专业病房（以下简称“我科”）收治的未经过任何治疗的初诊ALL患儿的临床资料及随访结果,将所有患儿根据初诊时治疗前的超声肾脏测量值分为初诊时有肾脏增大（肾脏超声长径≥同年龄儿童2倍标准差,肾脏增大起病组）及无肾脏增大表现（非肾脏增大起病组）2组并进行比较。 结果自2010年至2019年,我科收治确诊的初治ALL患儿规律治疗共69例,诊断时中位年龄4岁,起病时有肾脏增大共14例（20%）,其中,单侧肾脏增大3例,双侧肾脏增大11例。中位随访时间112个月。与非肾脏增大起病组相比,肾脏增大起病组患儿年龄偏小［（79.9±48.0）月龄vs（37.1±21.9）月龄,P＜0.05］;2组在性别构成、起病距确诊的时间、危险度分层、起病时髓外白血病侵犯情况、形态学完全缓解时间、无事件生存（EFS）时间方面,差异均无统计学意义（P＞0.05）。尽管2组患儿的肌酐及尿素水平差异无统计学意义（P＞0.05）,但考虑到2组患儿的年龄差异,认为肾脏增大起病组患儿的肾功能差于非肾脏增大起病组,但肾功能异常在治疗后均可恢复。E2A-PBX1融合基因阳性率在肾脏增大起病组患儿中占比高于非肾脏增大起病组（28.57% vs 5.36%,P＜0.05）。 结论初诊ALL患儿中起病时有肾脏增大表现的患儿比例高于既往文献报道,提示该现象较为普遍,起病时有肾脏增大的患儿年龄偏小。随着分层治疗的进一步优化,肾脏增大的患儿总体预后与起病时无肾脏增大的患儿相同,然而仍然要注意在初期治疗过程中注意肾功能的保护。     

儿童过敏性紫癜的临床特征与护理

目的探讨儿童过敏性紫癜(henoch-schnlein purpura,HSP)的临床特征,寻找与之对应的护理对策。方法回顾性分析2011年1-12月在上海交通大学附属儿童医院治疗的221例HSP患儿的发病特点、临床表现及肾损害原因。结果儿童HSP患儿发病年龄2～14岁,平均(7.02±2.7)岁,71.3%于冬春季节发病,79.6%患儿发病前有明确诱因。以呼吸道感染为主(72.8%),其中以胃肠道症状首发(21.3%)易发生误诊;胃肠道及关节受累发生率是62.4%和91.0%;所有患儿均有典型紫癜,主要分布于双下肢(98.6%);76.3%的紫癜于1个月内消退,而紫癜性肾炎发生率为38.9%,以皮肤紫癜为首发与非以皮肤紫癜为首发的HSP患儿的肾损害发生率分别为33.1%、48.2%,两者比较差异有统计学意义(χ2=5.044,P<0.05);临床类型以血尿和(或)蛋白尿(1～2级)最常见(62.8%),病理类型ISKDC分级以Ⅰ～Ⅲ级为主(94.1%),针对患儿的临床特征采取相应的护理对策取得满意的效果。结论 HSP为儿童常见病,以消化道症状首发时易误诊,也较严重;是否有紫癜性肾炎决定预后。不同临床表现的紫癜患儿予以个性化的护理,有利于患儿早日康复。     

Outcome of fetal renal pelvic dilatation diagnosed during the third trimester.

OBJECTIVES: The aim of this study was to evaluate renal function and the need for postnatal treatment--antibiotic therapy and/or surgery--in relation to the grade of fetal renal pelvic dilatation (RPD) found on third-trimester ultrasound examination. METHODS: The retrospective study included 78 children, born between 1995 and 2000, with 115 dilated fetal renal pelvic units. The children were allocated to three groups based on pelvic anteroposterior diameter (APD) detected on third-trimester ultrasound: APDs of 7-9.9 mm, 10-14.9 mm and > or = 15 mm were classified as mild dilatation, moderate hydronephrosis and severe hydronephrosis, respectively. Renal function was assessed by scintigraphy. RESULTS: None of the 20 children with mild dilatation experienced a urinary tract infection (UTI) or underwent surgery; two had associated renal or urinary tract abnormalities. In contrast, five out of 22 (23%) children with moderate hydronephrosis and 23 out of 36 (64%) with severe hydronephrosis had either a UTI or required surgery (P < 0.001); associated abnormalities were also more common (6 out of 22 and 15 out of 36, respectively). There was no significant correlation between the grade of antenatal RPD and postnatal ipsilateral renal function. CONCLUSIONS: The need for postnatal treatment increased significantly with the grade of antenatal RPD. Children with antenatal mild dilatation were discharged early from follow-up whereas those with moderate and severe fetal hydronephrosis needed close follow-up by a multidisciplinary team.     

Schonlein--Henoch Nephritis

We report the clinical and laboratory findings of 88 patientswith renal manifestations of Schönlein-Henoch syndrome,all of whom were studied by renal biopsy. Sixty-six were referredto us from other centres because of diagnostic or therapeuticproblems. The patients' ages ranged from two to 19 years. Evidenceof recent streptococcal infection was obtained in 33 children,but their illness was indistinguishable from that of the remainder.Serum C3 levels were normal in all patients. Differential renalclearances of plasma proteins showed moderately or poorly selectiveproteinuria in most patients and appeared to have little prognosticvalue. The clinical manifestations of renal involvement were usuallyapparent early in the course of the illness, occurring withinone month of onset in 75 patients. They ranged in severity frommicroscopic haematuria alone to a nephrotic syndrome which oftenfollowed an acute nephritic onset. Children with severe renalinvolvement tended to be older and to have more prolonged systemicmanifestations, as well as troublesome alimentary symptoms. Light microscopy of renal biopsy specimens revealed minimalchanges in 15 patients, the remainder showing proliferativeglomerulonephritis ranging in severity from minor lesions offocal distribution to diffuse involvement, including crescents.The Electronmicroscopic appearance in specimens from 33 patientsis also described. The duration of follwup ranged from three months to 16 yearsfrom onset. Three children died within nine months of onset;of 59 survivors who were followed up for more than two yfiirs,34 were normal when last seen, 17 had minor urinary abnormalities,six had heavy proteinuria with or without hypertension, andtwo had deteriorating renal function. It was not possible todemonstrate any favourable effect of corticosteroids or cytotoxicdrugs, used singly or in combination. There was a fairly good correlation between the severity ofclinical presentation and the morphological appearances. Nochild with microscopic haematuria alone showed more than minorfocal lesions while, on the other hand, the occurrence of epithelialcrescents in more than 45 per cent of glomeruli was invariablyassociated with a nephrotic syndrome. A clinical presentationwhich included both nephritic and nephrotic features, and theinvolvement of more than 45 per cent of glomeruli with crescentswere identified as the two factors of greatest prognostic significance. ¹Present address: Department of Paediatrics and Child Health,27 Blundell Street, Leeds LS1 3ET ²Present address: Derbyshire Children's Hospital, North Street,Derby     

外周血白细胞不高的脓毒症患儿84例临床分析

目的 了解外周血白细胞不高的脓毒症患儿临床特征及病原组成。方法 选取2013-2020年河北省儿童医院住院治疗的84例外周血白细胞不高的脓毒症患儿临床资料进行回顾性分析;将仅检出革兰阳性菌患儿分为革兰阳性菌感染组(n=27),仅检出革兰阴性菌患儿分为革兰阴性菌感染组(n=26),并比较两组临床资料。结果 84例患儿,发病年龄以0~<1岁为主(47例,55.9%);伴有发热81例(96.4%),出现精神状态改变80例(95.2%);外周血C-反应蛋白中位数为157.7 g/L,降钙素原中位数为12.66 μg/L;首发感染部位呼吸系统最常见(43例,51.2%);病原微生物仅检出细菌55例(65.5%),仅检出病毒6例(7.1%),仅检出肺炎支原体2例(2.4%),多种病原共检出21例(25.0%),检出细菌中以多重耐药菌为主;诊断严重脓毒症及脓毒性休克37例(44.0%);治愈58例(69.0%)。革兰阳性菌感染组与革兰阴性菌感染组相比,首发感染部位、外周血白细胞计数、中性粒细胞计数、中性粒细胞百分数方面差异有统计学意义(P<0.05)。结论 外周血白细胞不高的脓毒症仍以多重耐药细菌感染为主,发病年龄较小,病死率较高,可根据首发感染部位、外周血白细胞及中性粒细胞计数初步判断细菌分类,早期开展经验性治疗。     

Nephrotoxicity due to combination antibiotic therapy with vancomycin and aminoglycosides in septic critically ill patients

The aim of this prospective observational study was to evaluate the incidence of nephrotoxicity due to combination therapy with vancomycin and aminoglycosides in septic critically ill patients admitted to the intensive care unit. METHODS: Thirty consecutive critically ill patients were treated with vancomycin concurrent with aminoglycosides for sepsis. Inclusion criteria were: the need for mechanical ventilation and the presence of severe infection due to bacteria susceptible to vancomycin and aminoglycosides. Exclusion criteria were: age <18 years, impaired renal function (24-hour creatinine clearance <90 ml/min) or previous adverse reaction to either drug. Serum creatinine and urea concentrations, creatinine clearance, 24-hour urinary excretion of proteins, beta2-microglobulin and enzymes were measured immediately before starting therapy and at different times thereafter. RESULTS: Eleven of the 30 patients had a transient and modest increase in serum urea, 15 patients presented with urinary excretion of beta2-microglobulin and tubular enzymes, and 14 patients had urinary proteins.In the only patient with severe acute renal failure (serum creatinine 8.2 mg/dl), the clinical course was complicated by prolonged hypotension. CONCLUSION: Concurrent administration of vancomycin and aminoglycosides to critically ill septic patients with normal renal function at baseline induced mainly slight and transient toxic tubular effects. The only clinically significant nephrotoxic event occurred in a patient with septic shock.     

重庆地区748例儿童重症社区获得性肺炎病原学特点及耐药性分析

目的分析重庆地区748例儿童重症社区获得性肺炎(CAP)的病原学特点及耐药性。方法回顾性分析重庆市中医院2017年1月至2019年12月收治的748例重症CAP患儿的临床资料,分析患儿感染致病菌的病原学特征。结果细菌检出率从高到低为流感嗜血杆菌(29.1%)、金黄色葡萄球菌(15.9%)、肺炎链球菌(14.8%)。在<1岁和1~<3岁年龄段,流感嗜血杆菌占比最高,分别为32.0%及47.5%;在3~<6岁年龄段,以肺炎链球菌多见,占34.4%;在≥6岁年龄段,则以卡他莫拉菌为主,占50.0%。流感嗜血杆菌在冬季检出最多为54株(36.0%);金黄色葡萄球菌在秋季检出最多为26株(31.7%);肺炎克雷伯菌肺炎亚种在夏季检出最多为8株(40.0%)。不同季节之间细菌检出率比较,差异有统计学意义(χ^2=33.794,P<0.05)。革兰阴性菌中,流感嗜血杆菌、卡他莫拉菌、大肠埃希对第三代头孢菌素耐药率小于60%;革兰阳性菌中,金黄色葡萄球菌、肺炎链球菌对阿莫西林/棒酸、阿莫西林耐药率为24.4%、13.2%,未发现万古霉素的耐药菌株。结论重庆地区重症CAP患儿主要见于婴幼儿,不同年龄、季节,细菌的分布有所不同,临床经验性用药时应结合发病季节及患儿年龄进行选择。     

Serum angiogenin concentrations in young patients with diabetes mellitus

BACKGROUND: Angiogenin serum levels were measured in a large group of type 1 diabetic young patients, looking at whether increased Angiogenin concentrations are associated with long-term glycemic control and microvascular complications. MATERIALS AND METHODS: Four groups of patients were compared to 223 age- and sex- matched healthy controls: 196 type 1 diabetic patients (age range 3-24 years, onset of diabetes before the age of 12 years; duration of disease longer than 2 years), without microvascular complications were divided into three groups on the basis of age (group 1, n = 37, age < 6 years; group 2, n = 71, age 6-12 years; group 3, n = 88, age > 12 years); 53 adolescents and young adults (age 16.1-29.7 years) with diabetic microvascular complications (background, preproliferative or proliferative retinopathy, albumin excretion rate 20-200 microg min-1) (group 4). RESULTS: Angiogenin serum levels were significantly increased in diabetic pre-school and pre-pubertal children, and particularly elevated in pubertal subjects compared with age- and sex-matched controls. Adolescents and young adults with microvascular complications had very high angiogenin concentrations. One-year mean HbA1c values were correlated with angiogenin levels (r = 0.389; p < 0.01). In poorly controlled diabetics (HbA1c > 10%), long-term (2 years) improvement of glycemic control determined a significant reduction of angiogenin concentrations in both pre-school and pre-pubertal children as well as in pubertal youngsters. CONCLUSIONS: Angiogenin serum concentrations are increased in diabetic children even before puberty. Severity of microvascular complications is associated with markedly increased angiogenin serum levels. Long-term tight glycemic control determines a consistent reduction of angiogenin concentrations.     

莱芜市1954～2003年麻疹流行趋势

目的　分析莱芜市不同时期麻疹的流行特征 ,探讨加速麻疹控制的措施。方法　对莱芜市 195 4～ 2 0 0 3年麻疹流行病学资料进行分析。结果　自然感染期 (195 4～ 196 6年 )麻疹发病、死亡均居各种传染病之首 ;流行周期 1～ 2年 ;城市发病高于农村 ;发病高峰集中在春季 ,发病人群以学龄前儿童为主。计划免疫期 (1979～ 2 0 0 3年 )麻疹发病、死亡明显下降 ,流行减少 ,以散发为主 ;农村发病高于城市 ;发病季节高峰后移 ,峰值削平 ;发病人群集中在学龄前儿童和成人。结论　由于计划免疫的实施。莱芜市麻疹发病率大幅度下降 ,但仍有散在发生或流行。今后 ,应进一步健全麻疹监测系统 ,调整免疫策略 ,进一步提高免疫覆盖率 ,降低麻疹高发年龄段发病。