ZHANG Zhengzheng, WANG Ying, LI Ying, ZHANG Chenmei, PAN Guoquan, MIAO Hongjun, ZHANG Yucai, ZHU Xiaodong, CHEN Yang, YAN Gangfeng, CHENG Ye, CHEN Weiming, LU Guoping
Background: In China, it is resigned and difficult for PICU doctors to accept discharge against medical advice.
Objective: To explore the clinical characteristics of dead and surviving children who left PICU against medical advice, and analyze the factors influencing the post-discharge death.
Design: Multicenter prospective cohort study.
Methods: Consecutive patients discharged against medical advice were recruited from PICU of 8 children's specialty hospitals in the East China from August 1, 2016 to July 31, 2017 as the cohort population. The outcome of survival or death according to the telephone follow-up within 28 days after discharge was the cohort's end points. Demographic data, clinical symptoms, reasons for discharge, and evaluation parameters for PCIS and PRISMⅢ were collected. The logistic risk model was used to analyze the influencing factors of post-discharge death.
Main outcome measures: Mortality rate within 28 days of children discharged from the PICU against medical advice.
Results: A total of 4,952 cases from PICU of 8 hospitals were included into analysis with in-hospital mortality rate of 5.6%(279/4,059). Among the 893 cases(18.1%) discharged from the hospital against medical advice, there were 518 males(58.0%) and 375 females, with a median age of 1.4 years. Three cases were lost to follow-up within 28 days after discharge. In total, 550 cases(61.6%) died and 340 cases survived. The proportion of discharged cases in rural areas was higher than that in cities(62.2% vs 378%), and the proportion of death cases was higher than that of survival cases(65.0% vs 57.8%) in rural areas during the 28-day follow-up. The differences were statistically significant. The main cause of death in discharged cases was infection accounting for 49.2%, followed by unknown causes, tumor, congenital malformation and genetic metabolism accounting for about 10%, respectively. There was a statistically significant difference in the PRISMⅢ scores between death and survival of discharged cases ［8(3,15) vs 3(0,7)］ . A single factor analysis was performed on the clinical characteristics of discharged deaths and hospital deaths. Variables with statistically significant differences were entered into logistic regression analysis. The risk of discharged rural cases was 55% higher than that of urban cases(OR=1.554, 95%CI: 1.112-2.173). The risk of discharged cases without medical insurance increased by 169% compared with those with medical insurance(OR=2.686, 95%CI: 1.910-3.778). The risk of death from hospital discharge was reduced by 53% for children with a history of cardiopulmonary resuscitation before hospitalization(OR=0.467, 95%CI: 0.271-0.802). For every 1 point reduction in the severity of disease score PRISMⅢ, the risk of death from hospital discharge was reduced by 4%(OR=0.962, 95%CI: 0.946-0.978).
Conclusion: The fatality rate excluding cases discharged against medical advice in PICU of 8 hospitals in East China was 5.6%(279/4,059), while the general one was 16.8%(829/4,959). Living in rural areas and no medical insurance increased the risk of post-discharge death. A history of cardiopulmonary resuscitation before hospitalization could reduce the risk of death.
Background: In March and July of 2021, there were two outbreaks of COVID-19 epidemic in Ruili City, Yunnan Province and there were continuous reports in China of imported infection cases from other countries or regions.
Objective: To explore the epidemiological and clinical characteristics of local COVID-19 cases of adults and children and provide reference for the prevention and treatment of COVID-19.
Design: Case series report.
Methods: We retrospectively collected the local cases of adults and children infected by imported cases, admitted to Chinese Medicine and Dai Medical Hospital,a designated hospital for COVID-19 in Ruili City, from March 29 to April 30 (referred to as 3-29, SARS-CoV-2) and from July 4 to July 31 (referred to as 7-4, delta-CoV).Demographic, epidemiological history and clinical characteristics data of these cases were collected.
Results: A total of 208 cases were included with 192 adults cases (3-29: 112 cases, 7-4: 80 cases) and 16 children (3-29: 5 cases, 7-4: 11 cases). None of the children were vaccinated. For adults, there were 15 cases (7-4, 18.8%) for 1 dose of vaccine, 19 cases for the first dose, and 14 cases (17.5%) for the second dose. According to epidemiological surveys, among 3-29 and 7-4 adults and children, close contacts accounted for 3.6% and 40.0%, and 20.2% and 54.5%, respectively. There were no critical or fatal cases in adults and children during these two outbreaks. Adults were mainly mild and common types, and children were mainly asymptomatic infections, mild and common types. 3-29 adults with underlying disease (17.0%) accounted for a higher proportion than those of 7-4 (13.8%), and there was 1 child(7-4) with the underlying disease of hepatitis B. Fever cases of 7-4 adults (41.2%) accounted for a higher proportion than those of 3-29 (15.2%), and children fever cases accounted for 45.4% in 7-4. There was a higher proportion of fatigue and pharyngeal discomfort in 7-4 adults than that of 3-29, and children mainly had cough and pharyngeal discomfort. The number of adult cases of lymphopenia in 7-4 adults was more than that of 3-29, and only one child case of lymphopenia was found in the group of 7-4. The proportion of adults with elevated LDH, ALT, AST, CRP and D-dimer was higher in the group of 7-4 than that of 3-29, and for children there were 2 cases (7-4) in elevated LDH, AST, CRP and D-dimer respectively, accounting for 18.2%. CT scan showed that children were mainly characterized by multiple ground-glass shadows and infiltration shadows in both lungs. In addition, adult cases also showed multiple small patch shadows and interstitial changes outside the lungs. No children received oxygen therapy. The oxygen therapy time for 7-4 and 3-29 adults was 150 h and 96 h, respectively. The time for nucleic acid test results turning negative was close (19 d vs 22 d) in the adults during the two outbreaks, while for children, the time for 7-4 (32 d) was longer that of 3-29 (15 d).
Conclusion: The clinical manifestations of local adults and children infected by delta-CoV were more severe than those infected by SARS-CoV-2. The clinical manifestations of adult cases were more severe than that of children. The time for nucleic acid test results turning negative was shorter in children compared with adults. During the epidemic of delta-CoV, the proportion of vaccine breakthrough infections in 7-4 adults was up to 36.3%.
Background: There have been no longitudinal studies of ADC values under different intracranial complications of neonatal purulent meningitis.
Objective: To retrospectively summarize the cranial MR of neonatal purulent meningitis in different course of disease, and analyze the variation characteristics of ADC value in brain tissue with different course of disease and its relationship with myelination process under different intracranial complications.
Design: A case-control study.
Methods: Full-term neonates who had purulent meningitis and cranial MR were taken as the case group and divided into 4 case groups according to intracranial complications——case group 1 of cerebral parenchymal lesions (-) and hydrocephalus (-), case group 2 of cerebral parenchymal lesions (+) and hydrocephalus (-), case group 3 of cerebral parenchymal lesions (-) and hydrocephalus (+) and case group 4 of cerebral parenchymal lesions (+) and hydrocephalus (+) . According to the interval between onset time and MR, disease course was divided into 0-7 days, -28 days, -60 days and -120 days, which were named as group A to D respectively. According to the age at the time of taking MR, course A was divided into course A1 (0-14 days) and course A2 (-28 days), and course B was divided into course B1 (-28 days) and course B2 (-60 days), and 20 normal infants were included in each group as the control group.
Main outcome measures: Trends of ADC value in brain parenchyma of patients with neonatal purulent meningitis evaluated by MR at the same age or course of disease.
Results: Totally 173 cases of neonatal purulent meningitis met the inclusion criteria of the case group. The maximum age and course of this study was 120 days. Therefore, MR examinations in the case group were 302 times. The ADC values of 241 MR in course A~D were analyzed in different case groups. The ADC values of the control group and the case group decreased with the increase of age. In the comparison of results of different course of disease (with the same age), there was no statistical significance in the ADC values of cerebral cortex and deep white matter in different course of disease, except for part of the course of splenium of corpus callosum. During the course of 0-60 days, the ADC value of subcortical white matter in case 2 and 3 groups was significantly lower than that in control group, and the ADC value of subcortical white matter in case 3 group and part of the course of case 2 group was significantly lower than that in case 1 group. During the course of 61-120 days, the ADC values of subcortical white matter in case 2 and 3 groups were not significantly different from those in control group, while the ADC values of subcortical white matter (except parietal white matter) in case 1 group were significantly higher than those in control group. During the course of disease 0-30 days, the deep gray matter ADC value in case 1, 2 and 3 groups was significantly lower than that of the control group. During the course of disease 31-120 days, the deep gray matter ADC value in case 1, 2 and 3 groups was not significantly different from that of the control group.
Conclusion: In patients with neonatal purulent meningitis, subcortical white matter showed decreased ADC values within 1-2 months of the course of disease, and normal or increased ADC values at 3-4 months of the course of the disease, which suggested that the process of myelination was affected. Deep gray matter showed decreased ADC values within 1 month, and normal ADC values at 2-4 months of the course of the disease. MR DWI quantitative ADC is helpful to evaluate the micro injury of neonatal meningitis without brain parenchymal structure injury.
Background: Neuromyelitis optica spectrum disease (NMOSD) is divided into AQP4-IgG positive, MOG-IgG positive and serological negative cases according to the serology. The differences in clinical and imaging characteristics of patients with different serological NMOSD are not clear yet.
Objective: We established a long-term follow-up cohort of pediatric patients to understand the differences among different serological NMOSD.
Design: Dynamic bidirectional cohort study.
Methods: Children diagnosed with NMOSD in the Department of Pediatrics, Peking University First Hospital from January 2012 to March 2021 were enrolled in the cohort, and information on clinical characteristics was collected based on a pre-designed clinical observation scale, with retrospective collection of previous clinical data (clinical symptoms and signs since the first diagnosis, and previous clinical characteristics for those diagnosed in other hospitals), and observation of clinical characteristics at hospital follow-up. The cohort endpoint was time from onset to last follow-up ≥6 months. The cohort was divided into 3 groups as AQP4-IgG-positive, MOG-IgG-positive and serologically negative (negative for both antibodies).
Main outcome measures: Clinical characteristics of different serological NMOSD children.
Results: Of the 46 cases of NMOSD, there were 21, 12 and 13 cases in the MOG-IgG-positive, AQP4-IgG-positive and serologically negative groups, respectively, with no statistically significant differences in age at onset, median disease duration from onset to final follow-up and number of episodes in the 3 groups, and statistically significant differences in sex composition ratios, with AQP4-IgG-positive being more common in females. There were 74 clinical phenotypes for the first attack, and the differences in cerebral syndrome and brainstem symptom in the 3 groups were statistically significant.Cerebral syndrome was common in the MOG-IgG-positive group (42.9%) and the serology-negative group (43.8%), and brainstem symptom was common in the AQP4-IgG-positive group (33.3%) and the serology-negative group (23.1%).During the course of the disease, there were 196 phenotypes in total, and the differences between the 3 groups were statistically significant for different serotypes of TM, cerebral syndrome, brainstem symptom, and postrema symptom, with TM being the most common phenotype in the AQP4-IgG-positive group (43.9%), brain syndrome common in the MOG-IgG-positive group (36.2%) and serology-negative group (34.4%), brainstem symptom common in the AQP4-IgG-positive group (17. 1%) and serologically negative group (18.0%), and postrema symptom common in the AQP4-IgG-positive group (12.2%). A total of 134 sites of brain MR involvement were acquired, mainly in the subcortical white matter (59.0%) and brainstem (47.8%) and a total of 42 sites of spinal MR involvement were acquired, with statistically significant differences in the subcortical white matter, paraventricular white matter, corpus callosum, thalamus, basal ganglia, and brainstem among the three groups with different serotypes.Subcortical white matter was more prevalent in the MOG-IgG-positive and serologically negative groups, paraventricular white matter was more predominant in the AQP4-IgG positive and serologically negative groups, corpus callosum was common in the AQP4-IgG positive group, thalamus was common in AQP4-IgG positive and MOG-IgG positive groups, basal ganglia was common in MOG-IgG positive group, and brainstem was common in AQP4-IgG positive group. Statistically significant differences were found among three groups with different serotypes of thoracic and longitudinally extensive transverse myelitis.The differences were statistically significant and were commonly involved in all 3 groups, with AQP4-IgG positive being more common (94.1% and 100%). A total of 94 acute cerebrospinal fluid and 46 autoimmune antibody data were collected, and the differences in number of nucleated cells of different serotypes, proteins and different autoimmune antibodies were not statistically significant in the 3 groups. Final follow-up EDSS scores were obtained from 46 cases with a median score of 1.5 (0-4.5) and no statistically significant differences were found among the 3 different serotypes.
Conclusion: AQP4-IgG positivity was more common in females. Cerebral syndrome was common in MOG-IgG-positive and serologically negative NMOSD. Postrema syndrome was common in AQP4-IgG-positive children. Subcortical white matter involvement was the most common in MOG-IgG-positive and antibody-negative children, and longitudinally extensive transverse myelitis was the most common in children with AQP4-IgG-positive.
Background: Carbapenem-resistant organism (CRO) infections have been increasing in recent years and associated with significant, severe infection and mortality.
Objective: To assess the risk factors and prognosis of CRO infections in children with acute leukemia and to provide reference for its prevention.
Design: Case-control study.
Methods: The data of in-patients with acute leukemia, except for acute promyelocytic leukemia, infected by CRO or carbapenem-susceptible organism (CSO) were recruited from Department of Hematological Oncology at Children's Hospital of Shanghai, Shanghai Jiaotong University School of Medicine between January 2012 and December 2019 to retrospectively analyze their clinical characteristics, prognosis factors and rate of severe infections.
Main outcome measures: Risk factors for CRO infection and the incidence of severe infection within 72-hour of empirical anti-infection treatment.
Results: A total of 101 samples (91 patients) with Gram-negative organism infections were included into the study, including 76 CSO and 25 CRO. There were 67 cases of acute lymphoblastic leukemia (66.3%) and 34 cases of acute myeloid leukemia (33.7%). Multivariate logistic analysis indicated that carbapenems used for more than 10 days within 1 month before sample collection (OR=6.201，95%CI：1.339-28.729， P=0.020) was an independent risk factors for CRO. The severe infection rate within 72 hours of empirical anti-infection treatment was 24.7% (25/101), which of the CRO group (14/25, 56.0%) was higher than the CSO group (11/76, 14.4%). The difference was statistically significant (χ2= 17.417, P=0.000). Five cases died during hospitalization, all of whom were children with CRO.
Conclusion: Acute leukemia in children had high severe infection rate caused by CRO infections. Carbapenem exposure for more than 10 days within one month prior to infections was an independent risk factor.
Background: A great number of studies have shown that glucagon-like peptide-1 (GLP-1) receptor agonists not only exert significant hypoglycemic effects, but also have important effects on losing weight. For the special group of children and adolescents who are still in the growth and development stage, the response and tolerability of GLP-1 receptor agonists are different from those of adults, and the long-term efficacy and safety are still not very clear.
Objective: To systematically review and meta-analyse the efficacy and safety of GLP-1 agonists in children and adolescents with obesity.
Design: System review/Meta analysis.
Methods: PubMed, Cochrane, Embase, Web of Science, CNKI, Wanfang and VIP database were searched to collect the randomized controlled trial (RCT) evaluating the effects of glucagon-like peptide-1 receptor agonists on children and adolescents with obesity from April 1, 2005 to August 1, 2021. After literature screening and data extraction, the meta-analysis was performed by RevMan 5.3 software.
Main outcome measures: The efficacy and safety of GLP-1 agonists in children and adolescents with obesity.
Results: A total of 9 RCTs were included in the meta-analysis with 2 cross-over randomized controlled trials and 7 parallel randomized controlled trials. A total of 565 children and adolescents with obesity were enrolled, including 293 cases in the experimental group (235 cases of liraglutide and 58 cases of exenatide) and 272 cases in the placebo group. They were between 7 and 19 years old, and the study period was 5 to 56 weeks. The risk of literature bias was low to moderate. Pooled analysis suggested that GLP-1 receptor agonists were superior to placebo with regard to the change from baseline in the BMI (MD=-1.46 kg·m-2, 95%CI: -1.93--0.98, P<0.05), body weight (MD=-2.29 kg, 95%CI: -3.68--0.90, P<0.05), waist circumference (MD=-242 cm, 95%CI: -4.36--0.47, P<0.05) and glycated hemoglobin (MD=-0.91%, 95%CI: -1.05--0.77, P<0.05). Compared to placebo, more participants in GLP-1 receptor agonists groups had hypoglycemia (OR=2.00, 95%CI: 1.20-3.34, P<0.05) and gastrointestinal symptoms including nausea (OR=3.83, 95%CI: 2.43-6.04, P<0.05) and vomiting (OR=4.32, 95%CI: 1.87-10.02, P<0.05).
Conclusion: For children and adolescents with obesity, the use of GLP-1 receptor agonists based on lifestyle modification can significantly reduce the body weight and BMI. But at the same time, there is also a higher proportion of gastrointestinal side effects and the incidence of hypoglycemia.
Background: There are few clinical studies on the efficacy and safety of exon 51 skipping therapy for Duchenne muscular dystrophy(DMD)，and the efficacy and safety are not clear.
Objective: To systematically evaluate the efficacy and safety of exon 51 skipping therapies for DMD.
Design: Systematic review and meta-analysis.
Methods: PubMed, Embase, The Cochrane Library, clinicaltrials.gov, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect RCTs related to exon 51 skipping Eteplirsen, Drisapersen, Suvodirsen and SRP-5051 for DMD. The retrieval period was from the establishment of the database to October 21, 2021. The risk of bias assessment tool for RCT recommended by the Cochrane Handbook was used to evaluate the the included literature. Then meta-analysis was performed using RevMan 5.3 software.
Main outcome measures: Changes in 6-minute walk test (6MWT) and North Star Ambulatory Assessment (NSAA) scores from baseline to 24 weeks after treatment.
Results: A total of 5 RCTs involving 322 DMD children were included, investigating Eteplirsen in one study and Drisapersen in 4 studies. As for literature risk of bias evaluation, the specific method of randomization and whether allocation concealment was implemented were not explained in one literature about Eteplirsen. Except for one study that did not blind the evaluator of outcome, all the other studies were blind to the study object, the study implementor and the study evaluator, and the risk of implementation bias and measurement bias was low. All 5 RCTs were registered with no missing data, so the risk of loss of follow-up bias and reporting bias were low. The results of meta-analysis showed that there were no significant differences in changes in 6MWT(MD=-9.16, 95%CI: -21.94~3.62, P=0.16) and NSAA scores (MD=1.20, 95%CI: -2.35~4.75, P=0.51) between the treated group and placebo group. Incidence of renal toxicity （29.0% vs 16.0%, RR=2.2, 95%CI:1.2~4.0, P=0.01）and injection site reactions （52.4% vs 12.0%, RR=7.4, 95%CI:3.4~15.7,P<0.001） in the Drisapersen group was higher than that in placebo group, and the difference was statistically significant.
Conclusion: The therapeutic effect of exon 51 skipping on DMD at 24 week is not significant, and there may be side effects such as renal toxicity and injection site reactions.
Background: IgA nephropathy is the most common primary glomerulonephritis in Asian population. Kidney biopsy is the gold standard for diagnosing the disease. The exploration and discovery of non-invasive markers with diagnostic value of the disease is still a hot research topic.
Objective: To investigate the diagnostic value of serum IgA and IgA/C3 ratio in children with primary IgA nephropathy and its relationship with pathological grade.
Design: Diagnostic test accuracy.
Methods: Taking renal biopsy pathology as the gold standard, children undergone kidney biopsy were divided into primary IgA nephropathy (true positive) and non-IgA primary glomerulonephritis (true negative). Taking IgA and IgA/C3 ratio as the test standard, a diagnostic model for predicting primary IgA nephropathy in children was established.
Demographic characteristics, serum immunoglobulin and complement test results, renal biopsy pathological examination reports and other laboratory test results were intercepted. According to age, children were divided into 1-4 years old, -7 years old, -11 years old and -18 years old subgroups and according to the 24 h urinary protein level at the time of admission, children were divided into two subgroups of <50 and ≥50 mg·kg-1·d-1.
Main outcome measures: The diagnostic power of serum IgA and IgA/C3 ratio for primary IgA nephropathy.
Results: A total of 150 cases in the primary IgA nephropathy group and 474 cases in the non-IGA nephropathy group were included into analysis. The serum IgA and IgA/C3 ratio in primary IgA nephropathy group was higher than that in non-IgA nephropathy group, and the proportion of serum IgA elevation in all ages was higher than that in non-IgA nephropathy group. The AUC of serum IgA and IgA/C3 ratio was 0.824 and 0.851, the sensitivity was 80.0% and 74.3%, and the specificity was 73.1% and 82.7%, respectively. The AUC of IgA and IgA/C3 was the largest in 1-4 years old subgroup. The diagnostic cutoff values of IgA and IgA/C3 increased with age. The sensitivity of serum IgA and IgA/C3 ratio in the subgroup with 24 h urinary protein level <50 mg·kg-1·d-1 was 90.3% and 93.5% respectively. The sensitivity ranged from 86.8% to 100% in different age subgroups of children with 24 h urinary protein level <50 mg·kg-1·d-1 , indicating that serum IgA and IgA/C3 ratio had a high recognition degree in the subgroup with 24 h urinary protein level <50 mg·kg-1·d-1, and the diagnostic cutoff values were also increased with age. There were no significant differences in gender, age, serum IgA, C3 and IgA/C3 ratio between children with MESTC score < 4 and ≥4, or between children with LEE grade Ⅰ-Ⅱ and Ⅲ-Ⅴ.
Conclusion: Serum IgA/C3 ratio and IgA elevation are important for differential diagnosis of primary IgA nephropathy, especially in patients with 24 h urinary protein level < 50 mg·kg-1·d-1.
Background：The colonization of Staphylococcus aureus (SA) on the mucosal and skin surface may increase the risk of SA infection in neonates. To understand the SA colonizing, molecular characteristics and drug resistance of SA strain in hospitalized neonates will facilitate the development of rational therapeutic strategies.
Objective：To explore the colonization, molecular characteristics and drug resistance of SA isolates from neonates hospitalized in the neonatal intensive care unit (NICU).
Design：A cross-sectional study.
Methods：Neonates with age on admission ≤ 28 d and gestational age ≥28 week admitted to the NICU of Beijing Children's Hospital between August 1st, 2020 and January 31st, 2021 were enrolled. Clinical data were collected. The swab samples of the nasal cavity, axilla, root of the umbilicus and groin were collected for culture within the first 12 h after admission.The SA strain identification was completed by using a Staphytect Plus kit and the PCR amplification of nuc gene. Drug resistance of each colonized SA strain to antibiotics was tested.
Main outcome measures：Molecular characteristics and drug resistance of the colonized SA at mucosal and skin surface of NICU hospitalized neonates.
Result：sA total of 766 children were included, of which 257 (33.6%) had SA colonization at one or more sites. There were 135 (52.5%), 65 (25.2%),and 57 (22.3%) children who had 1, 2, and ≥ 3 sites colonization, respectively. Among them, the clinical characteristics (male, admission age, C-section rate, exclusive breast-feeding rate before admission, antibiotics exposure before admission, ventilation support on admission, and total hospital stay in days), categorization of methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA), sarA gene expression were not significantly different (all P>0.05). There was significant difference in PVL positive rates. To compare 1 site colonization with 2 sites colonization, the positive rates of both PVL ［23 (17.0%) vs. 39(32.0%), P=0.005］ and sarA ［56 (41.5%) vs. 83(68.0%),P<0.01］were significantly different. There were 176, 124, 72, and 76 SA strains isolated from nasal mucosal cavity, root of umbilicus, axillary cavity, and groin region, with MSSA being the dominant categorization (82.4%, 77.4%, 80.6%, and 80.3%), respectively. There was no significant difference between MRSA and MSSA categorizations at each site (all P >0.05). The commonest MSSA clone was ST398-t309, and the commonest MRSA clone was ST59-SCCmecIV-t437. Among strains with PVL , sarA , and PVL + sarA positive expression, there was no significant difference between MRSA and MSSA categorizations. All strains were sensitive to Mupirocin, Linezolide, and Vancomycin. Totally 15 SA strains were insensitive to Meropenem, among which 14 were MRSA (1 was drug-resistant, 13 was medium sensitive) and 1 was MSSA (medium sensitive). The incidence of resistance to other antibiotics was 78.1% for Penicillin, 55.1% for Erythromycin, 19.8% for Ceftriaxone and 15.3% for Oxacillin, respectively.
Conclusion：The SA colonization rate is 33.6% in relatively stable neonates in NICU. The positive rate of PVL 和 sarA in patients with SA colonization at ≥2 sites was higher than that at 1 site. The commonest MSSA clone was ST398-t309, and the commonest MRSA clone was ST59-SCCmecIV-t43. All strains were sensitive to Mupirocin, Linezolide, and Vancomycin. There were MRSA strains insensitive to Meropenem.
Background：The incidence of stroke in children has increased significantly in recent years and arterial ischemic stroke is the most common one. The causes of ischemic stroke in children are different from those in adults. Early recognition and timely treatment can significantly reduce the disability rate.
Objective：To analyze the etiology, clinical features, imaging characteristics, treatment and prognosis of ischemic stroke in children in order to provide reference to early diagnosis.
Design：Case series report.
Methods：The clinical data of 50 children with arterial ischemic stroke who were hospitalized in Beijing Tiantan Hospital Affiliated to the Capital Medical University from April 2017 to July 2019 were analyzed retrospectively.
Main outcome measures：Etiology and clinical manifestations of arterial ischemic stroke in children.
Results：There were 29 boys and 21 girls with mean onset age of 8.8±3.9 years (9 months to 17 years old). The peak incidence was in children aged 7 to 10 years (21 cases, 42%). Etiology included moyamoya disease(78%), infection (10%), trauma(6%), vascular disease(2%), cardiac disease(2%). One case had no identifiable cause. The most frequent clinical manifestation was hemiplegia (94%). Abnormal feeling and language disorder were found in 9 cases(18%), respectively. Other neurological manifestations included central facial paralysis, disturbance of consciousness and epilepsy. Neuroimaging results showed that the cerebral infarction was located in multiple lobes for 19 cases (38%), basal ganglia for 15 cases (30%), single lobes for 10 cases (20%) , brain stem for 1 case (2%) , and multiple lesions (basal ganglia, lobe, cerebellum and brainstem) for 5 cases (10%). Digital subtraction angiography (DSA) showed that anterior circulation was involved in 34 cases with 23 of middle cerebral artery stenosis or occlusion.
Conclusion：The peak onset of arterial ischemic stroke in children occurred in school age. Hemiplegia is the most common neurological manifestation. Moyamoya disease and infection were the main causes of stroke in this group. Anterior circulation is more easily involved than posterior circulation and ischemic infarction is the most common in the middle cerebral artery blood supply area.
Objective：To summarize the clinical features of Hashimoto's encephalopathy (HE) in children.
Methods：Children diagnosed with HE hospitalized in the Department of Neurology at Hebei Children's Hospital from January 2017 to December 2020 were selected. The clinical characteristics, laboratory examination results, imaging results, treatment and prognosis of the disease were retrospectively analyzed.
Results：Among the 7 HE patients, there were 5 males with onset age of 5 to 12 years. Three cases had fever at the onset of the disease. Before the onset of the disease, infection, viral encephalitis, hyperappetite and increased defecation, and epilepsy were found in 1 case, respectively. Three cases had depileptic seizure and 2 of them were epileptic status. Three cases had abnormal mental behavior and 3 had consciousness change. One patient had cranial nerve injury. One case had increased WBC and CRP. CSF cells increased in 3 cases, and CSF protein increased in one case. The oligoclonal bands were positive in 2 of 5 cases receiving the examination. Thyroid peroxidase (TPO) antibodies were normal in 4 patients at the onset of the disease, but increased when the disease was aggravated within two weeks. Three cases had increased TPO antibodies at the onset of the disease. There were 2 cases of hyperthyroidism, 2 cases of central hypothyroidism, 1 case of low T3 syndrome, and 1 case of reduced free T3 and T4. One patient had normal thyroid function at the time of admission and central hypothyroidism occurred later. Thyroid ultrasound showed polycystic nodules in two cases. Three cases had cranial MR abnormality. Seven cases were abnormal in video electroencephalogram, showing different degrees of slow wave release, and 1 case was epileptic. All 7 cases were treated with immunoglobulin shock combined with high-dose methylprednisolone sodium succinate. The symptoms of 6 cases were relieved after 3 to 8 days of treatment and 1 case remained unchanged after 1 month of shock treatment, whose symptoms were relieved after 7 days of the second round of hormone shock treatment. Seven cases had been followed up for 1 to 4 years. One case recurred twice, and the symptoms were relieved after hormone or immunoglobulin shock treatment. Three patients with abnormal cranial MR were followed up within 2 months, and the imaging returned to normal. TPO antibodies were reexamined in 4 cases, thyroid function was followed up in 3 cases, and the relevant indexes returned to normal within 1 year.
Conclusion：The clinical manifestations, laboratory indicators and imaging characteristics of HE are not specific, so it is necessary to distinguish it from various diseases. For pediatric patients with unknown encephalopathy, the possibility of HE should be considered after excluding autoimmune encephalitis, inflammation and demyelination diseases , and TPO antibodies should be detected for many times to assist in the diagnosis.
Background：There are significant differences in the prognosis, treatment and follow-up of Duchenne muscular dystrophy(DMD) and Becker muscular dystrophy(BMD). At present, there is still no consensus on the diagnosis of presymptomatic progressive muscular dystrophy(PMD) at home and abroad.
Objective：To study the clinical and test results of pre symptomatic PMD in infants and analyze the accuracy of serum muscle enzyme level in distinguishing DMD and BMD.
Design：Case series report.
Methods：Children diagnosed with presymptomatic PMD at Jiangxi Children's Hospital between January 2016 to July 2020 were included in the study to have their clinical and test results of presymptomatic PMD analyzed. The DMD and BMD were distinguished by gene results. The maximum value of yoden index was taken as the diagnostic standard by ROC curve analysis. The consistency and accuracy of gene diagnosis and muscle enzyme diagnosis were compared.
Main outcome measures：Clinical manifestations, gene results and serum enzyme(AST, ALT，LDH，CK，CK-MB).
Results：The study collected 24 children with 18 cases of DMD and 6 cases of BMD. In total, 91.7%(22/24) came to hospital because of elevated aminotransferase and 8.3%(2/24) came to hospital because one of their relatives was diagnosed as PMD. There was a significant increase in CK-MB, CK, LDH, AST and ALT in PMD children with higher levels in DMD group compared to those of BMD group(P<0.05, except for AST). When ALT>224.5 U·L-1、CK>11 069 IU·L-1、CK-Mb>204 IU·L-1、LDH>1 349.5 IU·L-1, it is more likely to be DMD especially with the high specificity of LDH>1 349.5 IU·L-1.
Conclusion：Higher level of muscle enzyme than healthy people is the main manifestation in the early stage of symptoms in PMD children. LDH>1 349.5 IU·L-1 is highly specific for the diagnosis of DMD.
