广州地区1998～2003年儿童流行性感冒病毒监测结果分析

目的研究1998-2003年广州地区儿童流感病毒(流感)感染的流行情况。方法对流感样症状的儿童取咽分泌物,接种到狗肾细胞(MDCK)上,在33℃温箱培养48-72h。MDCK细胞上清液进行血凝试验。结果3444例中264例分离出流感病毒,流感病毒分离总阳性率7.7%。1998、1999年流感阳性率分别为16.8%、7.4%,H3N2是强势株;2000年流感分离阳性率8.4%,出现H1N1亚型;2001年流感分离阳性率3馏%,未分离到H3N2亚型;2002年流感分离阳性率7.3%,B型流感病毒为强势株;2003年分离阳性率1.7%。1998-2001年广州地区儿童B型流感病毒流行为Yamagata型,2002-2003年流行为Victoria型。1999年发现禽流感H9N2亚型。结论1998年为流感流行较活跃年份,2001和2003年流感活动较平静;1998-2001年广州地区儿童B型流感流行Yamagata型,2002-2003年流行Victoria型。1999年发现儿童感染H9N2个案。     

实时荧光聚合酶链反应方法在2006年广州地区儿童流行性感冒病毒监测中的应用

目的 应用实时荧光聚合酶链反应(PCR)方法检测流感病毒,并对2006年广州地区儿童感染流感病毒进行流行病学分析.方法 以流感病毒的NP基因序列为参考,综合分析GenBank上的NP基因序列,使用引物和探针设计软件Primer Express设计A/B型流感病毒及A亚型流感病毒各1对特异性引物和1条TaqMan荧光探针,用于分别检测A/B型流感病毒及A亚型流感病毒,建立实时荧光PCR方法,进行灵敏度和特异性检测.采用实时荧光PCR方法,对来自2006年门诊或住院呼吸道感染患儿的12 301份咽拭子或鼻腔抽洗液样本进行检测,并与病毒分离方法进行对照.结果 实时荧光PCR方法共检出1687份阳性样本,总阳性率为13.71%,其中A型773份(45.8%),全部为H1N1型;B型914份(54.2%).1-4月份检出流感病毒阳性525例,其中B型流感病毒455例(86.7%),A型(H1N1)流感病毒70例(13.3%);5-8月份检出流感病毒阳性1118例,其中B型流感病毒419例(37.5%),A型(H1N1)流感病毒699例(62.5%).病毒培养分离阳性为1380份,均为实时荧光PCR方法阳性,占实时荧光PCR方法阳性者的81.80%.结论 实时荧光PCR方法应用于流感病毒的检测具有简便快捷、特异、敏感的特点,2006年广州地区儿童流行性感冒病毒的流行1-4月份以B型流感病毒为主,5-8月份以H1N1亚型流感病毒为主.     

2000-2006年北京地区婴幼儿乙型流感病毒感染的监测

目的 通过连续的监测,了解北京地区婴幼儿乙型流感的流行规律.方法 采集2000年11月-2006年6月间因急性呼吸道感染到门诊就诊和住院患儿的呼吸道标本10 770份,分别经传代狗肾细胞(MDCK细胞)进行病毒分离和(或)间接免疫荧光进行流感病毒的检测,分离阳性的病毒进一步用血凝抑制试验进行流感病毒株的型别鉴定.结果 从10 770份呼吸道标本中,检测到乙型流感病毒阳性标本384份(其中有376份分离出病毒),总阳性率为3.57%.2000年11月-2006年6月,每年有一个乙型流感病毒的流行峰,几乎都出现在流感流行季节的后期.除2003-2004年流行季节乙型流感病毒的最高阳性检出率为2.91%(2004年4月)外,其余各年份的最高阳性检出率都高于10.00%.2005-2006年流行季节乙型流感病毒的最高阳性检出率达到历年的最高峰(23.69%,2006年3月).每年的乙型流感病毒的流行高峰检出的病例都以门诊患儿为主.乙型流感病毒阳性的门诊患儿中,＞3岁的患儿占77.6%(264/340),乙型流感病毒阳性的住院患儿中,＜3岁的患儿占66.0%(29/44).乙型流感病毒与其他呼吸道病毒的合并感染少见.监测期间乙型流感病毒与甲3型流感病毒的阳性检出率相差不大,但2005年9月-2006年5月期间,乙型流感病毒的阳性检出率明显高于甲3型(23.9%对1.1%).2000-2002年流行季节北京地区婴幼儿中流行的乙型流感病毒为B/Yamagata/16/168系,2002-2003年流行季节B/Victoria/2/87系乙型病毒占优势,2003年以后的流行季节同时流行着以上两个系的乙型流感病毒,但以B/Yamagata/16/168系为主.2005-2006年流行季节B/victoria/2/87系乙型病毒占优势.结论 2000年11月-2006年6月每年2-5月份都有一次乙型流感病毒的流行(除2002-2003年流行季节为2002年12月),检测阳性的患儿以门诊患儿为主;目前北京地区B/Yamagata/16/168系和B/Victoria/2/87系乙型流感病毒同时流行.     

2006至2014年北京单中心儿童乙型流感病毒流行的监测

目的 了解北京单中心儿童乙型流感病毒的流行趋势,为流感的防控提供数据支持。方法 2006年9月至2014年5月对首都儿科研究所附属儿童医院门诊和急诊采集流感样病例的咽拭子标本,采用传代狗肾细胞(MDCK细胞)行流感病毒和副流感病毒的分离,并用特异性血清对分离到的流感病毒进行凝集抑制试验鉴定型别。同时接种人喉癌细胞（HEp-2）行呼吸道合胞病毒和腺病毒的分离。分为8个监测年度,以2006年9月至2007年8月（2006至2007年）为1个监测年度,余7个年度类推。对8个监测年度乙型流感病毒的流行特征行描述性分析,并与同期甲型流感病毒的流行特点进行比较。结果 6 150份咽拭子标本检测了流感病毒,分离到乙型流感病毒345株（5.6％）,其中166株（48.1%）B/V系毒株和179株（51.9%）B/Y系毒株。①8个监测年度,出现5个乙型流感病毒的流行高峰。除2006至2007年外, 2007至2008、2009至2010、2011至2012和2013至2014年的流行高峰呈隔年流行的特点,月阳性率最高可达46.2%（2008年1月和2012年2月）。2006至2007、2009至2010、2010至2011和2013至2014年,甲型流感病毒阳性率高于乙型流感病毒,且乙型流感流行高峰均出现在甲型流感流行高峰后;2007至2008和2011至2012年,乙型流感病毒阳性率高于甲型流感病毒,且乙型流感病毒流行高峰均出现在甲型流感流行高峰前。②8个监测年度中2006至2007、2007至2008、2010至2011和2011至2012年B/V系和B/Y系乙型流感病毒同时流行,余4个年度为其中之一流行株流行。2009至2010、2011至2012和2013至2014年的流行株与WHO推荐的流感疫苗中的乙型流感病毒型别相匹配。③345例乙型流感病毒阳性患儿中,～12岁以下组中随着患儿年龄增大而乙型流感病毒阳性率增高。结论 2006年9月至2014年5月北京地区儿童乙型流感病毒的流行基本呈现隔年出现高峰的流行趋势。在2个谱系同时流行的4个流行季中,分别以B/V或B/Y系乙型流感病毒为主要流行株。     

2004年11月～2005年3月北京地区儿童流行性感冒病原学检测分析

目的对北京地区2004年11月～2005年3月流行性感冒患儿进行病原学检测及分析。方法狗肾传代细胞（MDCK）进行流感病毒分离，用血凝试验、血凝抑制试验进行型和亚型的鉴定；用快速酶联免疫法检测A型及B型流感病毒抗原试剂盒检测患儿咽拭子中的流感病毒抗原。结果217例患儿中111例检测出流感病毒，检出率为51％（111／217），流感病毒A型28例（28／111），占检出数的25．3％，流感病毒B型82例（82／tit），占检出数的73．8％，流感病毒A＋B型1例（I／111）。占检出数的0．9％。111例流感病毒检测阳性患儿中病毒分离与快速诊断二项同时阳性75例。二者阳性符合率67．5％。结论北京地区2004年11月～2005年3月流感流行季节流感病毒以B型为优势株。流感快速诊断试剂盒可快速、准确地检测出流感病毒及型别。     

2016—2019年苏州大学附属儿童医院呼吸道感染住院患儿流感监测分析（附742例报告）

目的　探讨苏州大学附属儿童医院呼吸道感染住院患儿流感监测情况。方法　分析2016年1月至2019年12月在苏州大学附属儿童医院呼吸科7322例因急性呼吸道感染（ARTI）住院患儿流感病毒感染资料。采用RT-PCR法进行流感病毒的检测,并进行A/H1N1及A/H3N2、B/Victoria及B/Yamagata的亚型鉴定。结果　（1）7322例住院患儿中,共检出流感病毒阳性742例（10.1％）,2016—2019年各年分别为10.4%、8.6%、6.0%、15.2%。（2）流感病毒-A检出阳性率（6.7%）高于流感病毒-B（3.6%）,以A/H1N1亚型最常见（45.0%）,其他依次为B/Victoria（26.4%）、A/H3N2（19.1%）、B/Yamagata（7.5%）,有4例A/H1N1+B/Yamagata混合感染、10例A/H3N2+ B/Victoria混合感染。（3） ＞3～5岁组流感病毒阳性率最高（14.3%）,其次是＞1～3岁组（12.0%）,流感病毒-B发病年龄［38.0（13.0,56.0）个月］大于流感病毒-A［16.0（7.0,38.0）个月］（Z＝-6.456,P＜0.001）。（4）以冬季阳性检出率最高,占流感总检出率的54.9%,其次是春季（36.0%）,2017年12月至2018年2月有一流行高峰。（5）流感病毒易发生混合感染（64.4％）,最常见的混合感染病原是流感嗜血杆菌（21.2%）,其次是肺炎链球菌（17.5%）和肺炎支原体（15.0%）。（6）95.8%的住院患儿流感合并肺炎,最主要的症状是发热（86.7%）、咳嗽（98.1%）,其次是消化道症状（51.5%）。结论　流感病毒是苏州大学附属儿童医院呼吸道感染住院患儿的重要病原,以A/H1N1亚型最常见,不同年份、季节、月份及年龄流行的流感病毒亚型存在一定差异。＞3～5岁年龄组最多,冬季发病率最高,以肺炎为主要疾病表现,主要临床表现是发热和咳嗽,流感病毒易发生混合感染,多数患者预后良好,均未发生死亡。     

2001-2005年北京地区婴幼儿甲型流感病毒感染的研究

目的 通过连续的监测,了解北京地区婴幼儿甲型流感的流行规律。方法 2001年10月—2005年8月,采集门诊和住院急性呼吸道感染患儿的标本7338份,分别经传代狗肾细胞进行病毒分离和（或）间接免疫荧光、血凝抑制试验进行流感病毒型别鉴定,采用RT-PCR方法,扩增甲3型流感病毒流行株的血凝素基因HA1区,进行序列分析。结果 （1）从7338份临床标本中,检出甲型流感病毒347份,总阳性率为4．7％。347份甲型流感病毒中,甲1型48份（13．8％）;甲3型273份（78．7％）;暂时无法鉴定亚型的26份（7．5％）。（2）2001-2004年的流行比较局限在当年10月至次年4月,2004年8月—2005年8月均有甲型流感病毒被检测到,在夏季仍可检测到相当多的甲型病毒,尤其是2005年8月甲3型的阳性率达到14．2％,相当于2003-2004年的流行最高峰。4年中每个流行季节都以甲3型流感病毒的流行为主,只在2001-2002年和2004-2005年的流行季节出现了甲1型流感病毒的流行峰。（3）甲1和甲3型流感病毒在门诊患儿中的阳性检出率均高于住院患儿的阳性检出率。在2003年11月—2005年8月期间的236例甲3型感染患儿中,≤2岁者占46．6％,〉5岁者占14．0％;而31例甲1型感染患儿中≤2岁者只占6．5％,〉5岁者占48．0％。（4）对1998-2005年的甲3型流感病毒血凝素基因HA1区的序列分析显示,每一年的甲3型病毒都会出现位于其抗原决定簇关键位点的氨基酸突变。结论2001年10月—2005年8月,北京地区婴幼儿中有甲1和甲3型流感不同程度的流行,甲3型为优势流行株;2004-2005年北京地区甲型流感呈全年的流行态势;氨基酸序列分析提示,1998-2005年期间甲3型流感病毒的抗原性在持续不断地发生漂移。     

有限认识儿童H7N9禽流感的危害

流感病毒H7N9亚型自2013年3月在中国上海等地首次报告感染类以来,已经出现2例儿童患者和1例健康携带者。本文简要描述3例儿童的基本情况,结合文献讨论了禽流感病毒的变异,小聚集尚不能确定有人传人传播,H7N9人禽流感感染的防治链与预防措施,还介绍了早期使用达菲及重度阶段应用帕拉米韦等药物的应用方法。     

南京地区住院儿童副流感病毒感染监测

目的监测南京地区儿童急性呼吸道副流感病毒感染的特征,了解副流感病毒流行情况,为临床诊治提供依据。方法采集2009年3月至2012年2月住院的急性呼吸道感染患儿7830例鼻咽分泌物,用直接免疫荧光法检测呼吸道病毒,包括副流感病毒1、2及3型抗原(HPIV1、2、3)等。结果 7830份标本中呼吸道病毒检出最高为呼吸道合胞病毒(RSV),达2 527例(占32.27%)。副流感病毒病原检测阳性776例(总阳性率为9.91%),其中以副流感病毒3型为主,达504例,占副流感病毒检测阳性的64.95%;副流感病毒2型感染最少,仅44例占5.67%。副流感病毒检出率在婴儿组和幼儿组较高,分别为366例(46.86%)和249例(31.88%);春季检出率最高;所致疾病中以支气管肺炎最为多见。结论南京地区住院儿童副流感病毒感染以HPIV3为主,婴儿感染率较高,儿童HPIV1、HPIV3病毒感染好发于春夏季节,HPIV2散发感染。     

2005年苏州地区呼吸道感染儿童中流感病毒的检测与分析

目的对2005年苏州地区呼吸道感染儿童中流感病毒进行流行季节的监测和分析。方法用直接免疫荧光法（DFA）结合胶体金免疫技术对患儿鼻咽分泌物进行流感病毒A、B型抗原检测（DFA同时也检测呼吸道合胞病毒RSV等病毒抗原）;用一步法逆转录聚合酶链（RT-PCR）反应对上述两法同时检出流感病毒A型者标本进行亚型鉴定;同时对确诊流感患儿血清用酶联免疫吸附法（ELISA）进行肺炎支原体（MP）抗体滴度测定。结果746例标本共检出流感病毒58株,其中A型47株（H1亚型28株、H3亚型19株）,B型11株（1株为A与B混合）,总阳性检出率7.77%,与2001年（16.75%）比较,差异有统计学意义（P〈0.01）;流感病毒与RSV等混合感染率为18.97%、与MP混合感染率为27.59%;2005年流感病毒检出率女童高于男童（P〈0.05）,高发年龄集中于3～7岁。结论2005年苏州地区儿童流感发病较稳定,10月份后优势株由H3亚型转为H1亚型;流感病毒易出现与MP、RSV混合感染现象;2005年苏州地区流感儿童发病以3岁以上女童占明显优势,与往年无明显性别差异。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.