�㽭��ѧҽѧԺ������ͯҽԺ2007—2014��546��������Ѫ�˾���ҩģʽ�������ص��о�

??Objective To investigate the antibiotic resistance patterns and epidemiological features of Haemophilus influenzae??HI?? strains??and to provide reference for choosing antibiotics in clinical treatment. Methods A total of 546 strains were identified from 2007 to 2014 in Children’s Hospital??Zhejiang University School of Medicine and 98.7% were isolated from respiratory tract specimens. Three hundred and forty-eight isolates??63.7%?? were from boys and the male-female ratio was 1.76??1. The age of the infected children ranged from 7 days to 13 years. Haemophilus influenza strains were cultured in Haemophilus selective medium. All strains were identified with ?? factor and ?? factor requirement test and the drug-sensitivities tests were performed with disk diffusion method. Cefinase was used to detect β-lactamase. Results Most of the strains??331 isolates??60.6%?? were isolated in spring??while only 23??4.2%?? were isolated in autumn. The β-lactamase positive strains increased annually and the total rate was 26.7%??146???? and 28.0%??153 strains?? were resistant to ampicillin. The multi-resistance strains were 60??11.0%?? and the major multi-resistance type was those resistant to ampicillin??trimethoprim-sulfamethoxazole and clarithromycin at the same time??and the multi-resistance rate in β-lactamase-positive strains were significantly higher than that in β- lactamase- negative strains??χ2??145.1??P??0.005??. Conclusion Most of the Haemophilus influenzae strains are isolated from respiratory samples in children younger than 1 year old in our hospital??and the peak months were February??March??April and May. The resistance rate to ampicillin of HI strains has increased annually??whereas to the second generation of cephalosporin??HI strains are still sensitive and they can be used in clinical treatment as the first choice.     

��ͯ����ϸ���԰�����4���ٴ�����

??Objective??To investigate the clinical features??diagnosis??treatment and prognosis of eosinophilic cystitis in pediatric population. Methods??The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results??All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition??odynuria??dysuria??suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms??peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years??two cases had are recurrence and one case had two recurrences. Conclusion??Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.     

�ֲ��������ƿ����ڸ�Σ��Ѫ���򻼶�����ѪҺ������Ӧ�ù۲�

??Objective To investigate the safety and efficacy of application of regional sodium citrate anticoagulation in children with high risk of bleeding in the continuous blood purification??CBP??. Methods A total of 11 patients with severe hepatic dysfunction and severe bleeding due to different diseases were treated with regional sodium citrate anticoagulation during CBP from March 2015 to May 2016. The changes of ACT??serum calcium and arterial blood gas before and after treatment of CBP were monitored??and the clinical bleeding performance and the operation status of the filter were observed. Results??After the application??the ACT value after the filter during the treatment with regional citrate was significantly longer than the ACT value before the filter??before the filter??the ACT values before treatment and after treatment had no significant changes. During the treatment??the value of calcium ions after the filter was significantly lower than the value before the filter??and the value of 2 cases after the filter was once lower than 0.2 mmol/L??then was corrected by slowing down the citrate solution dripping. Before the filter??the values of calcium level in 8 cases had no significant changes before the treatment and during treatment. All cases completed CBP treatment successfully withould severe bleeding or aggrevation of bleeding. Conclusion The clinical effect of regional sodium citrate anticoagulation in pediatric critical ill patients with CBP is effective. It has the advantages of less influence on the systemic coagulation and higher safety. It is suitable for the children with hepatic dysfunction??severe bleeding or who are not suitable for heparin anticoagulation. It is an effective and feasible??safe anticoagulation method in critical ill children with CBP.     

����ҽ�ƴ�ѧ������ͯҽԺ�����Ա��׻��������Ա�Ӧԭ��Ӧ�������ʱ仯���Ʒ���

??Objective To understand the trend of inhaled allergen positive rate among 0-12-year-old children from 2006 to 2013 in Chongqing Children’s Hospital??and to provide evidence for preventing allergic rhinitis in children. Methods??All cases were collected from Otorhinolaryngological Department of the Children’s Hospital of Chongqing Medical University from 1st January??2006 to 29th October??2013. Totally 10983 children with allergic rhinitis aged 0-12 years old in Chongqing urban districts were enrolled. All the patients underwent skin prick test??SPT?? with 13 standardized common inhalant allergens. Then the children were divided into the infants group??aged??3 years????preschool children??3 years≤aged??7 years?? and school-age children??7 years≤aged??12 years?? according to age. The trend of inhaled allergen positive rate over 8 years was observed. Results From 2006 to 2013??the SPT positive rate increased sharply??then tended to be stable??and then decreased slowly??Curve Estimation??R 2??0.836??adjustment R 2??0.770. ANOVA test??F??12.727??P??0.011??. It may be related to meteorological factors. With the growth of age??the positive rates of Dermatophagoides pteronyssinus??Dermatophagus farinae??Blomia tropicalis??Cockroaches??cat fur??dog fur and mugwort increased??which were 121.200??123.060??103.237??104.784??17.042??8.515 and 11.256??respectively????P was 0.000??0.000??0.000??0.000??0.000??0.014 and 0.004??respectively??. Conclusion ??Meteorological factors and age may have effects on allergic rhinitis??AR?? in children??with the growth of age??the positive rates of inhaled allergens have tendency variation.     

��ͯ����������ϸ���ۺ���13���ٴ�����

??Objective To investigate the clinical characteristics and treatment of hypereosinophilic syndrome??HES?? in children. Methods The clinical manifestations?? laboratory examinations??gastroscopy and imaging features??pathological results and therapy experience in 13 HES children admitted in Beijing Children’s Hospital??Capital Medical University from January 2009 to February 2016 and related literatures were analyzed retrospectively. Results Of the 13 patients evaluated?? 7 were male??54%?? and 6 were female??46%??. The median age at diagnosis was 9.6 years old??ranging 3 to 14 years old??. The median course of disease was 23 months??ranging 1 to 72 months??. The peripheral eosionophil counts ranged ??4.5—29.2??×109/L??mean 13.5×109/L??. Gastrointestinal tract was the most commonly involved organ?? and was reported in 92%??12/13?? of patients. It was followed in frequency by urinary system??84%????pulmonary??53%????cardiac??23%????and skin??8%?? and liver??8%??. A total of 2 sites were involved in 6 patients??3 sites were involved in 5 patients and 4 sites were involved in 2 patients. Treatment of oral prednisone therapy was given and follow-up of 10 patients had no clinical symptoms??2 patients had stopped prednisone??. But eosionophil counts still increased to varying degrees. Three patients were lost to follow-up. Conclusion HES in children is more common in school age and adolescent children. Gastrointestinal tract??urinary system and pulmonary involvement are more common. Glucocorticoid treatment is effective??which requires to be maintained in small dose in the long term.     

��ͯ�����Ը�˥���˹�������

??The true incidence of fulminant hepatic failure in the pediatric population is unknown?? though fulminant hepatic failure is a rare but devastating syndrome??such as hepatic encephalopathy??DIC??MODS?? that results in the death of most children affected. The mainstay of the treatment is liver transplantation??however?? organ shortage limits its use.The purpose of this review is to introduce the current situation of fulminant liver failure in children??focusing on assessing the application of artificial liver??which is considered to play a pivotal role in the treatment of fulminant liver failure.According to its classification??we mainly discussed the application of non-biological artificial liver?? including its indications??advantages and disadvantages??especially the MARS. At present?? the artificial liver treatment also faces many problems. None of the ELS techniques has yet been evaluated systematically in children??and survival benefits have not yet been demonstrated.     

��Ī���ѪҩŨ��������ϲ���ҩ�������ϵ�о�

??Abstract??Objective To study the effectiveness of the antiepileptic lamotrigine ??LTG?? and the relationship between the plasma concentration and oral dosage?? co-medication and patients age. Methods Totally 111 epileptic patients were divided into 2 groups?? LTG monotherapy group ??n=58?? and LTG??VPA ??Valproate??VPA?? group ??n=53??. LTG??VPA group was divided into three subunits in terms of plasma concentration of VPA. LTG monotherapy group was divided into two subunits?? older ??7??18 y?? n=40?? and younger ??3????7 y?? n=18?? group. The dosage was then increased to target dose gradually. Blood specimens were collected more than one month after LTG target dose or when effective maintenance dosage was achieved. The serum concentrations of LTG and VPA were determined by high performance liquid chromatography. Results The effect of the LTG was 82.9%.VPA combination enhanced LTG blood concentration. The ratio of serum level and dose of LTG did not vary with the range of the serum concentration of VPA 0.28??0.62mol/L.In younger group the relativity between blood concentration of LTG and LTG maintaining dose didn’t exist. However?? there was a positive correlation in the older group. Conclusions When we prescribe LTG??we should consider epilepsy type?? co-medication and individual difference as a whole.Therefore TDM??therapeutic drug monitoring??TDM??is an essential tool to control seizure and avoid side effects.     

����ʱ�������﷢���ٴ����񾭵������о�

??Abstract??Objective To study the clinical and neuro-electrophysiological features of transient epileptic seizures by using polygraphic channel VEEG—EMG monitoring. Methods The information of 51 epilepsy children with rapid falling??nodding or limb shaking in video electroencephalogram was collected in the Department of Pediatric Neurology?? Peking University First Hospital from June 2012 to March 2013.The clinical features??EEG and EMG patterns were analyzed retrospectively. Results Totally 745 seizures were found in 51 patients. The seizures included 391 epileptic spasms??52.5%????138 myoclonic seizures??18.5%????117 atonic seizures??15.7%????61 negative myoclonus??8.2%????27 tonic seizures??3.6%??and 11 myoclonic atonic seizures??1.5%??.Different clinical manifestations were with different clinical-EEG-EMG patterns.According to the duration of EMG changes??patients were divided into EMG-burst group and EMG-static group. Conclusions Epileptic seizures with rapid falling, nodding or limb shaking are most affected by epileptic spasms??myoclonic seizures??atonic seizures??negative myoclonus??tonic seizures and myoclonic atonic seizures.Their common feature is rapid and transient??which makes them difficult to be diagnosed only by illness history.But by performing VEEG-EMG??we can accurately identify the types of seizures??which will be helpful in the diagnosis and treatment.     

miR-125b�Զ�ͯ���ͼ���������ϸ����Ѫ����Ӱ��

??Abstract??Objective To explore the role of miR-125b in pediatric classical APL?? in order to seek new therapeutic strategies for drug resistant APL. Methods The target genes of miR-125b were predicted online?? validated by Dual-luciferase assay and western blot assay. MiR-125b expression levels were measured in 33 matched-pair APL samples??treated in the First Affiliated Hospital of Sun Yat-sen University and other members of South China Children APL Cooperative Group from March 2007 to September2012??at initial diagnosis and complete remission ??CR?? and in 5 relapsed patients by qRT-PCR. Proliferation and apoptosis were analyzed respectively using the RNA transfection?? MTT assay and flow cytometry. Results The expression of miR-125b was up-regulated in pediatric APL at diagnosis and relapse bone marrow samples?? but returned to normal after complete remission?? miR-125b could promote leukemic cell proliferation and inhibit cell apoptosis by regulating the expression of tumor suppressor Bak1. Remarkably??it was also found to be up-regulated in leukemic drug-resistant cells??NB4-R1??NB4-R2??HL-60/DOX???? and overexpression of exogenous miR-125b could increase their resistance to therapeutic drugs. Conclusion MiR-125b can regulate pediatric classical APL cells proliferation?? apoptosis and drug resistance by repressing BAK1 protein expression.