Background:Idiopathic cardiac osseous metaplasia in the right atrium of a 9-year-old boy, accompanied by right atrial Chiari network and right pulmonary artery embolism. This case is rare and can easily be misdiagnosed. Case Description:We encountered a case of a 9-year-old boy with a 3.5 cm diameter neoplasm in the right atrium. Preoperative imaging diagnosis could not determine the nature of the tumor, and the initial clinical suspicion of cardiac myxoma. After admission, a cardiotomy to remove foreign bodies and a pulmonary artery thrombectomy were performed. Conclusions:Idiopathic cardiac osseous metaplasia is relatively rare, and it is even rarer to be accompanied by a Chiari network in the right atrium. Due to the location and characteristics of the lesion in this case, it is easy to be misdiagnosed as atrial myxoma in clinical practice. Whether it is idiopathic osseous metaplasia or myxoma, it needs to be performed surgical treatment and pathological examination can easily rule out the diagnosis of myxoma. However, as idiopathic cardiac metaplasia is difficult to encounter in clinical work and there are few reports in the literature, clinicians and pathologists need to consult more relevant literature. Learn to understand and master the disease through multi-party consultation.

Calcifying fibrous tumors are rare benign fibrous tumors that rarely occur in the heart. We report a 33-year-old woman who was found to have a benign pericardial tumor on health checkup, which was highly suspected to be a teratoma in clinical and imaging examination. After cardiac tumor resection, histopathological features showed scattered foci of psammoma bodies or calcification among collagenized fibrous connective tissues and foci of inflammatory cell infiltration in the interstitium. The pathological diagnosis was a calcifying fibrous tumor.

Thrombocytopenia is a major and fatal complication in patients with acute myeloid leukemia (AML), which results from disrupted megakaryopoiesis by leukemic niche and blasts. Our previous research revealed that elevated interleukin-4 (IL-4) in AML bone marrow had adverse impact on multiple stages throughout megakaryopoiesis including hematopoietic stem cells (HSCs), but the specific mechanism remains unknown. In the present study, we performed single-cell transcriptome analysis and discovered activated oxidative stress pathway and apoptosis pathway in IL-4Rα high versus IL-4Rα low HSCs. IL-4 stimulation in vitro led to apoptosis of HSCs and down-regulation of megakaryocyte-associated transcription factors. Functional assays displayed higher susceptibility of IL-4Rα high HSCs to tunicamycin and irradiation-induced apoptosis, demonstrating their vulnerability to endoplasmic reticulum (ER) stress injury. To clarify the downstream signaling of IL-4, we analyzed the transcriptomes of HSCs from AML bone marrow and found a remarkable down-regulation of the proteasome component Psmd13, whose expression was required for megakaryocytic-erythroid development but could be inhibited by IL-4 in vitro . We knocked down Psmd13 by shRNA in HSCs, and found their repopulating capacity and megakaryocytic differentiation were severely compromised, with increased apoptosis in vivo. In summary, our study uncovered a previous unrecognized regulatory role of IL-4- Psmd13 signaling in anti-stress and megakaryocytic differentiation capability of HSCs.

目的 对胎儿先天性肺动脉起源异常进行分析,提高该疾病诊断的精准性.方法 回顾性分析8例胎儿先天性心脏畸形病例,均经尸体解剖证实,检查胎儿心血管畸形及内脏的畸形情况,对肺动脉异位起源进行分析总结.结果 肺动脉异位起源8例,其中男胎4例,女胎4例,孕期为孕21～28周.右肺动脉起自升主动脉1例,同时存在主-肺动脉间隔缺损、主动脉弓离断并室间隔完整,即Berry综合征.双侧肺动脉融合起自左头臂干1例,患者伴肺动脉闭锁等多种心血管畸形及心外脏器畸形.左肺动脉和右肺动脉分别起自不同主动脉或分支3例,均伴随肺动脉闭锁,1例左肺动脉起自左头臂干,右肺动脉起自降主动脉及右侧动脉导管;1例左肺动脉起自右动脉导管,右肺动脉起自右锁骨下动脉;1例左肺动脉起自左动脉导管,右肺动脉起自降主动脉.左肺动脉吊带3例,肺动脉主干发出右肺动脉,右肺动脉发出左肺动脉形成血管环.结论 胎儿肺动脉异位起源是一种少见血管畸形,其走行复杂多样,可伴随心内畸形及心外脏器畸形.

Introduction. Cardiac amyloidosis is a lethal disease, the incidence of which is increasing every year. Early diagnosis and treatment are the keys to reducing the mortality of this disease. Methods. Relevant English literature published in Embase, PubMed, Cochrane Library, and Web of Science were searched until December 1, 2022. Meta-analysis was performed with Stata 17.0 software. Results. A total of 1060 patients with 5 articles were included in this study. The sensitivity of abdominal fat aspiration biopsy for the diagnosis of cardiac amyloidosis was 0.66 (0.48–0.84) and the sensitivity for light chain amyloidosis cardiomyopathy and transthyretin amyloidosis cardiomyopathy was 0.90 (0.80–0.97) and 0.39 (0.18–0.60), respectively. Conclusion. Abdominal fat aspiration biopsy has high sensitivity and clinical value in the diagnosis of light chain amyloidosis cardiomyopathy, whereas there are limitations in the diagnosis of transthyretin amyloidosis cardiomyopathy.

本文报道1例26岁女性筛状-桑葚状甲状腺癌（cribriform-morular thyroid carcinoma，CMTC）病例。镜下组织形态：甲状腺滤泡上皮增生，滤泡上皮呈乳头状、筛状、梁索状及实性结构。肿瘤细胞拥挤折叠，部分细胞核呈毛玻璃样，可见核沟，部分细胞呈柱状及高细胞性。免疫组织化学结果：甲状腺转录因子1、β-catenin、雌激素受体、孕激素受体、galectin-3均阳性。基因检测：未检测到KRAS、NRAS及BRAF基因突变。筛状-桑葚状甲状腺癌罕见，诊断需结合病理学检查。.

To the Editors: Klebsiella variicola (K. variicola) is one of the seven species of Klebsiella pneumoniae species complex (KpsC).1 For KpsC species sharing overlapping phenotypic, biochemical and proteomic features, the identification of K. variicola remains a big challenge for clinical laboratories.2 Approximately 20% of the human isolates assumed to be K. pneumoniae are corresponded to other KpsC species.3 The misidentification of the K. variicola limits our knowledge for its molecular and clinical characteristics. Herein, we provided a rare case of pediatric K. variicola bacterial meningitis, the first report of K. variicola identified by metagenomic Next Generation Sequencing (mNGS). A 1-year and 8-month-old previously healthy girl presented with fever and vomiting for 1 day. She had increased levels of leukocyte count (22.33 × 109/L), C-reactive protein (91 mg/L) and procalcitonin (16.87 ng/mL). Cerebrospinal fluid (CSF) showed white blood cells of 4160 × 106/L, sugar of 0.56 mmol/L, protein of 755 mg/L and lactate of 9.47 mmol/L. She was diagnosed with bacterial meningitis and sepsis, empirically given intravenous vancomycin and meropenem. Magnetic resonance imaging indicated a long T2 signal in the posterior part of the cerebellar vermis (Fig. 1A) with cerebral and cerebellum pia mater enhancement. A skin hollow was found in the occipital region (Fig. 1B), and occipital dermal sinus was considered.FIGURE 1.: Occipital dermal sinus and genomics-based taxonomy. A: Magnetic resonance imaging indicated a long T2 signal in the posterior part of the cerebellar vermis. B: 2-mm skin hollow was found in the child’s occipital region. C: Excision of posterior occipital dermal sinus. D: Posterior occipital dermal sinus. E: Species identification based on DDH.Two consecutive CSF cultures turned to be K. pneumoniae identified by VITEK MS (France). The strain was sensitive to cefepime, ceftazidime, ceftriaxone and meropenem. Then, we discontinued meropenem and vancomycin to ceftriaxone. But the child did not respond to it well. On days 5–10, she was given gamma globulin intravenously. On day 9, although the fever slightly improved, reexamination of CSF showed that the white blood cells were higher than before with negative Gram stain and culture. So we sent mNGS, and ceftriaxone was taken placed with meropenem again. From that day on, her fever gradually improved. Surprisingly, the mNGS of CSF identified K. variicola. On day 19, the patient was afebrile and CSF improved dramatically. On day 23, an operation of excision of posterior occipital dermal sinus was performed successfully (Fig. 1C and D). The child went well with the follow-up. mNGS has the potential for discovery of unexpected pathogens, but we searched the PubMed with no language restrictions for “K. variicola and mNGS,” and no publication was found. To reinforce the result of mNGS, we used DNA-DNA hybridization (DDH) for species identification. DDH is “the gold standard” in prokaryote taxonomy.4 Digital DDH is the bioinformatics tool based on the principle of DDH with the species boundaries of 70%.4,5 When the genome of the causative strain (Klebsiella 20–27) was compared with nine K. variicola, the digital DDH values were 91.6%–97.0% (Fig. 1E). While the genome similaritis of Klebsiella 20–27 versus several K. pneumoniae strains did not reach the tax-onomy boundaries (DDH < 70%) (Fig. 1E). Klebsiella 20–27 was clearly assigned as K. variicola. In conclusion, we report the first case of K. variicola community-acquired bacterial meningitis in children by mNGS initially misidentified as “K. pneumoniae” by culture. The genome-based taxonomy confirmed K. variicola, indicating that mNGS may raise an effective role in the identification of K. variicola in clinical practice.

Objective:To determine whether these Streptococcus pneumoniae isolates identified by routine cli-nical methods that cannot be serotyped by the quellung reaction contain other species of viridans group streptococci and to determine the antibiotic susceptibility to provide reference for clinical medicine. Methods:A total of 105 isolates identified as Streptococcus pneumoniae by routine methods with negative quellung reaction results were enrolled in this study.Multilocus sequence analysis (MLSA) and matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF-MS) were used to identify species of these isolates.Broth microdilution method was used to detect susceptibilities of 14 antibiotics. Results:Twenty-four of the 105 isolates were identified as Streptococcus pseudopneumoniae by MLSA, and the remaining 81 were Streptococcus pneumoniae.Six isolates of Streptococcus pseudopneumoniae were misidentified as Streptococcus pneumoniae, and 3 isolates as Streptococcus mitis/ oralis by MALDI-TOF-MS; and 6 isolates of Streptococcus pneumoniae were misidentified as Streptococcus pseudopneumoniae.All isolates were susceptible to Vancomycin, Levofloxacin and Moxifloxacin.The non-susceptibility rates between Streptococcus Pneumoniae and Streptococcus pseudopneumoniae against Ceftriaxone(28.4% vs.58.4%), Chloramphenicol(39.5% vs.4.2%), Erythromycin(77.8% vs.95.8%) and Azithromycin(75.3% vs.95.8%) were obviously different. Conclusions:Routine clinical methods may misidentify some Streptococcus pseudopneumoniae as Streptococcus pneumoniae, and so does the MALDI-TOF-MS.In addition, Streptococcus pneumoniae isolates with negative results of the quellung reaction showed differences in antimicrobial resistance.And misidentification may affect the evaluation of pathogenic bacteria and antibiotic resistance.

Background: Isolated subclavian or brachiocephalic artery are uncommon aortic arch anomalies. Here we report the anatomy and histology of this disease. Methods: Four cases of congenital isolated subclavian or brachiocephalic artery in fetuses are described. Results: We identified one case of right aortic arch with isolated left subclavian artery associated with the tetralogy of Fallot, two cases of right aortic arch with isolated left brachiocephalic artery (one case with left retro-aortic brachiocephalic vein), and one case of left aortic arch with isolated right subclavian artery associated with coarctation of the aorta and cervical aortic arch. The proximal subclavian or brachiocephalic artery is arterial duct. Conclusion: Aortic arches with an isolated subclavian or brachiocephalic artery are often associated with the tetralogy of Fallot. It also can be associated with rare abnormalities such as left retro-aortic brachiocephalic vein or cervical aortic arch. Isolated LBA can be associated with microdeletion chromosome 22q11. (C) 2020 Elsevier Inc. All rights reserved.

Objective:To investigate the distribution of fungal species and their sensitivity to antifungal drugs in children with invasive fungal infections.Methods:All the fungal strains primarily isolated from the sterile parts of children in Beijing Children′s Hospital, Capital Medical University from January 2010 to December 2016 were analyzed.The sensitivity of strains to 5-Fluorocytosine, Fluconazole, Amphotericin B, Itraconazole and Voriconazole was tested using ATB-FUNGUS 3 yeast drug sensitivity test strip in accordance with the standards of Clinical and Laboratory Standards Institute M27-A2.Statistical analysis of data was performed using WHONET 5.6 software.Results:Among 236 fungi isolated from aseptic samples, 64.0% (151 strains) were from blood, 22.9%(54 strains) from cerebrospinal fluid, 3.8%(9 strains) from bone marrow, 3.8%(9 strains) from ascites, 3.4%(8 strains) from pleural effusion and 2.1%(5 strains) from tissues.The top 3 dominant species detected in the 236 strains of fungi were Candida spp.(175 strains, 74.2%), Cryptococcus neoformans (31 strains, 13.1%), and Saccharomyces spp.(9 strains, 3.8%). Among the Candida spp., the main isolates were Candida albicans (107 strains, 61.1%), Candida parapsilosis (33 isolates, 18.9%), and Candida tropicalis (13 isolates, 7.4%). Rare fungi of Penicillium marneffei, Exophiala spp.and Rhizopys spp.were also detected. Candida spp.was 100% sensitive to Amphotericin B. Cryptococcus neoformans was 100% sensitive to Fluconazole, Voliconazole and Amphotericin B. Conclusions:The most common strain isolated from pediatric patients with invasive fungal infections is Candida spp., especially Candida albicans. Cryptococcus neoformans causes central nervous system and systemic disseminated infections that can′t be ignored.Amphotericin B has higher antibacterial activity against Candida spp.and Cryptococcus neoformans.Separation of species of invasive fungal infections and monitoring of drug resistance in children should be strengthened to effectively control invasive fungal infections and facilitate rational use of antifungal drugs.

目的 运用 TaqMan 探针分子检测方法分析首都医科大学附属北京安贞医院消化系统疾病患者幽门螺杆菌(Helicobacter pylori,Hp)感染现状、分布特征及不同分子分型构成,从而为防治Hp感染以及临床用药提供理论依据.方法 选取2018年4月至2019年9月行胃镜检查的患者10 839例为研究对象,行Hp分子检测,并进行分子分型和感染程度分级,同时分析不同季节、性别及年龄段Hp的检出率及分子分型构成.结果 10 839例研究对象中,Hp阳性检出率为33.76％,男性高于女性(P<0.05).Hp的检出率夏季最高,且随着年龄的增长,呈现先增加后减少的趋势,在31～40岁年龄段,检出率达到高峰,季节、年龄段间Hp的检出率差异有统计学意义(P<0.05).Hp的两种分子分型中男性的Ⅰ型检出率高于女性(P<0.05).结论 男性Hp的检出率高于女性;Hp的检出率与季节、年龄相关;Hp的两种分子分型中,Ⅰ型的Hp检出率较高.

患者男性,26岁,体检时发现心脏肿物,超声及影像学检查均提示为恶性肿瘤可能性大.行心脏移植手术,见右心增大,心脏前壁心包腔内有一结节状肿物,将心脏挤向右后侧方,肿物切面呈鱼肉状,并浸透右心室漏斗部左前侧心壁全层,呈结节状凸入右心室漏斗部腔内.病理诊断为心包单相性滑膜肉瘤.原发性心脏滑膜肉瘤较为罕见,确诊需要结合病理组织形态学、免疫组织化学及SS 18-SSX融合基因检测综合判断.本报道旨在加深对心脏滑膜肉瘤的认识.

Objective To study the clinical and molecular characteristics of Staphylococcus aureus (S. aureus ) isolated from neonates of Beijng Children's Hospital. Methods The clinical information of S. aureus infection in newborns of Beijing Children's Hospital from February 2016 to January 2017 was collected. The molecular biological characteristics of S. aureus isolates were detected. Methicillin-resistant S. aureus ( MRSA) and methicillin-susceptible S. aureus ( MSSA) were identified,using the cefoxitin disc method and the detection of the mecA gene. Multilocus sequence typing( MLST) and spa typing were ana-lyzed using the PCR,and the staphylococcal chromosomal cassette mec(SCCmec) type was analyzed for the MRSA isolates. Eleven adhesion gene and three virulence genes(pvl,psma,hlα )were also detected by PCR. Antimicrobial susceptibility testing was performed by agra dilution method or E-test method. Results The total of 57 cases of neonatal S. aureus infection were collected during the study. The most common clinical di-agnosis was 38 cases (66. 7%) of pneumonia and 28 cases (49. 1%) of skin infection syndrome (SSTI). There were 31 cases (54. 4%) with MRSA infection and 26 cases (45. 6%) with MSSA infection. The pro-portion of SSTI in the MRSA group (64. 5%) and the infection of more than 2 sites (61. 3%,19/31) were significantly higher than those in the MSSA group (30. 8%,8/26 and 23. 1%,6/31). There were 16 MLST types and 29 spa types,the most common ones were ST59 (40. 4%) and t437 (33. 33%),respectively. The most common popular clones of MRSA and MSSA were ST59-SCCmecIVa-t437 (54. 8%) and ST22-t309, respectively(11. 5%). The sdrE carrying rate of MRSA was higher than that of MSSA,while the sdrD and cna carrying rates were lower than those of MSSA (P<0. 05). The other adhesion and virulence gene carry-ing rates were not significantly different between the two strains. The multi-drug resistance rate of all strains was 61. 4%(35/57). Except for lactam antibiotics, the most common resistant phenotypes of MRSA and MSSA were ERY-CLI,accounting for 74. 2% and 26. 9%,respectively. Conclusion The main types of neo-natal S. aureus infection in our hospital were pneumonia and SSTI. SSTI and multi-site infections of MRSA infection are more common. MRSA and MSSA isolates have clonal dissemination characteristics. The most common clones are ST59-SCCmecIVa-t43 and ST22-t309,which show no significant differences in the status of carrying virulence factors between them. The multi-drug resistance rate of neonatal S. aureus isolates is higher.

目的 通过病例报道和文献回顾总结儿童眶蜂窝织炎的临床特征.方法 对北京儿童医院感染内科2014年1月-2016年11月收治的23例眶蜂窝织炎患儿的临床资料进行总结,复习2006年以来发表的141篇文献.结果 按影像学分类眶隔前蜂窝织炎4例(17％)、眼眶蜂窝织炎19例(83％).男13例(57％),女10例(43％).＜5岁19例(83％),≥5岁4例(17％),平均年龄为3.7岁.秋冬季发病15例(65％).致病途径包括:眼眶周围组织感染蔓延17例(74％)、血流感染5例(22％)和额部撞伤1例(4％).血培养阳性5例(24％):肺炎链球菌、耐甲氧西林金黄色葡萄球菌(MRSA)、星座链球菌、铜绿假单胞菌、表皮葡萄球菌各1例;眼/鼻分泌物培养阳性5例:MRSA 2例,凝固酶阴性葡萄球菌、草绿色链球菌、铜绿假单胞菌各1例;脓液培养阳性2例:MRSA、脑膜败血伊丽莎白菌、屎肠球菌混合感染1例,啮蚀艾肯菌、模仿葡萄球菌混合感染1例.所有病例入院血常规白细胞总数、中性粒细胞比例、C反应蛋白均明显增高,均给予静脉应用抗生素治疗,其中外科治疗3例(13％).平均住院时间为14 (4～32)d.检索2006年至今文献发现:儿童眶蜂窝织炎发病率低,主要病因是鼻窦炎和上呼吸道感染,主要病原菌是葡萄球菌和链球菌属.结论 儿童眶蜂窝织炎多见于5岁以下者,经验用药应覆盖葡萄球菌和链球菌属,较大脓肿及时切开引流有助于避免严重并发症.

目的:探讨以动脉栓塞为首发症状的心脏黏液瘤患者的临床、病理特征及鉴别诊断.方法:7例经手术治疗证实以动脉栓塞为首发症状的心脏黏液瘤病例,回顾其临床资料,并对其临床表现、影像学特征及病理学改变进行分析.结果:①7例均因动脉栓塞症状就诊,其中肺动脉栓塞3例,腹主动脉及髂动脉栓塞2例,股总动脉栓塞1例,腘动脉及胫后动脉栓塞1例,经病理学检查证实为黏液瘤栓塞.②7例中男性5例,女性2例,平均年龄为(47.57±10.39)岁.③3例伴有肺动脉栓塞表现,2例有非特异性全身症状,1例只出现下肢动脉栓塞症状,无心内梗阻及非特异性全身表现,另1例无任何症状,系外伤后出现动脉栓塞症状入院.④超声心动图提示,左心房黏液瘤4例,右心房黏液瘤2例,右心室黏液瘤1例.结论:心脏黏液瘤引起的栓塞的临床表现,主要取决于栓塞部位,与血栓栓塞性疾病难以鉴别,常易导致误诊及漏诊,因此,遇到动脉栓塞的患者时要排除心脏黏液瘤引起的栓塞的可能,并充分结合影像学检查做出准确、及时的诊断.

目的:对胎儿先天性心脏病主动脉弓异常进行分析,提高该疾病诊断的精准性.方法:回顾近几年我院经超声心动图畸形筛查发现胎儿先天性心脏畸形引产而进行尸体解剖病例,对其主动脉弓走行进行分析总结,主动脉弓畸形分为6类:主动脉弓分支变异、双主动脉弓、左位主动脉弓、右位主动脉弓、主动脉弓其他异常及肺动脉异常起源.结果:胎儿先天性心脏病尸体解剖400例,主动脉弓异常144例,其中主动脉弓分支变异5例,双主动脉弓3例,左位主动脉弓畸形34例,右位主动脉弓畸形44例,其他畸形55例,肺动脉异常起源5例.左位主动脉弓畸形中动脉导管缺如11例,动脉导管闭锁4例,右锁骨下动脉迷走18例,孤立右锁骨下动脉1例.右位主动脉弓畸形镜面右位主动脉弓33例,左锁骨下动脉迷走7例,孤立左锁骨下动脉1例,孤立无名动脉2例,4支动脉分支对称发出1例.其他畸形包括主动脉弓缩窄45例,主动脉弓离断9例,颈部主动脉弓1例.肺动脉起源异常包括肺动脉吊带3例,Berry综合征1例,肺动脉起源于降主动脉1例.结论:主动脉弓畸形复杂多样,以主动脉弓缩窄最多见,左位主动脉弓畸形以右锁骨下动脉迷走多见,右位主动脉弓畸形主要是镜面右位主动脉弓.

Objective:To improve the accuracy diagnosis of atrial isomerism by analyzing characteristics of atrial isomerism autopsy cases of fetus.Methods:All reviewed 391 autopsy cases of congenital heart diseases were examined by echocardiography during pregnancy.The autopsy process included checking the cardiac abnormalities,the vessel malformations,and the deformity of the internal organs.Results:There were 17 (4.345％) cases of atrial isomerism in 391 cases of fetal congenital heart disease including 12(3.017％) patients in the right atrial isomerism group and left in 5(1.238％) patients.In the right atrial isomerism group,there were 8 cases with persistent left superior vena cava,7 cases with atrial septal defect,6 cases with pulmonary atresia,9 cases with pulmonary venous malformation,6 cases with single ventricle,5 cases with right aortic arch and 12 cases with asplenia.In the right atrial isomerism group,there were 5 cases with interruption of inferior vena cava and 4 cases with polysplenia.Conclusion:①Patients with atrial isomerism is often accompanied with complex and severe cardiac malformations.②The higher prevalence (3.017％) of right atrial isomerism was found in our study.

目的 分析分离自住院患儿的肺炎链球菌的血清型分布,评估肺炎链球菌结合疫苗(PCV)预防感染的价值.方法 以2013年3月-2017年12月从北京儿童医院住院的751例患儿临床标本分离出的肺炎链球菌菌株为研究对象,采用荚膜肿胀试验对菌株进行血清分型.结果 5年共收集非重复病例肺炎链球菌751株,其中非侵袭性菌株684株,侵袭性菌株67株.非侵袭性菌株主要分离自呼吸道分泌物(52.3％)和支气管灌洗液(44.4％),侵袭性菌株主要来自血液(50.7％)、胸腔积液(25.4％)和脑脊液(23.9％).751株菌株中常见血清型为19F(37.0％)、19A(14.2％)、23F(9.5％)、14(7.9％)、6A(7.7％)和6B型(5.2％),共占总血清型的81.5％.PCV10、PCV13和PPV23的覆盖率分别为61.5％、84.3％和82.6％.非侵袭性菌株常见血清型为19F(37.3％)、19A(13.5％)、23F(9.5％)、6A(8.0％)、14(7.0％)和6B(5.6％),PCV10和PCV13的覆盖率分别为60.8％和83.0％.侵袭性菌株常见血清型为19F(34.3％)、19A(22.4％)、14(16.4％)、23F(9.0％)、6A(4.5％)、9V(3.0％)和1型(3.0％),PCV10和PCV13的覆盖率分别为68.7％和95.5％.结论 北京儿童医院住院患儿分离的肺炎链球菌以19F、19A、23F、14、6A和6B型常见,PCV13覆盖率超过80％,在侵袭性感染株中更高,推广接种PCV13能够预防绝大多数肺炎链球菌感染.

血流感染是一种严重的全身感染性疾病 ,细菌是导致血流感染最常见的病原体 . 医院内常因侵入性操作 、免疫抑制治疗 、抗菌药物使用 、生命支持等 ,致使血流感染发生 . 在英国 ,住院患者中约有 6 .4％ 的患者发生医院感染 ,ICU 比例最高 ,为 23 .4％ ;而医院感染患者中 ,约 7 .6％ 为血流感染[1] .文献报道 ,单次血流感染事件的病死率为 21％ ～ 69％ ,花费23000 ～ 56000 美元 ,延长住院时间 2 ～ 32 d[2] .对于血流感染患者 ,病原明确前往往已经给予经验性治疗 ,但不恰当的抗感染治疗造成血流感染病死率高 ,住院时间延长 ,抗菌药物耐药性增加 ,医院感染的增多 ,增加了血流感染整体的疾病负担[3-5] .

目的 探讨肾素瘤的临床表现、病理特征、诊断及鉴别诊断、治疗及预后.方法 回顾性分析1例经组织学诊断为肾素瘤患者的临床资料,并复习相关文献.结果 患者女性,16岁,体检发现高血压1个月余,血压180/110mmHg,血钾2.5 mol/L.腹部增强CT示左肾近下极附近见类圆形低密度影,边界尚清.肉眼见肾脏下极附近一大小3 cm×1.5cm× 1.2 cm肿物,包膜完整,与周围肾组织分界清楚.镜下见均匀一致的圆形瘤细胞呈实片状、条索状排列,细胞间分界不清,胞质嗜酸性,核圆形、椭圆形,核仁、核分裂象罕见,间质血管丰富.免疫表型:CD34、vimentin和Syn均(+),SMA、CD117(散在+),Ki-67增殖指数约1％.术后患者血压及血钾水平恢复正常.结论 肾素瘤是较为罕见的良性肿瘤,一般认为来源于肾小球旁细胞,主要临床表现为高血压及低血钾,确诊需结合临床表现、影像学资料和病理特征,保留肾单位的肿瘤切除即可治愈.