Objective:To investigate the clinical characteristics of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants, and the impact factors of duration of cycle threshold (Ct) values turning to ≥35 detected by nucleotide test.Methods:Children aged 0 to 14 years with clinical symptoms of Omicron variants infection who admitted to designated hospital in Shanghai City (Renji Hospital, South Branch, Shanghai Jiao Tong University School of Medicine) from April 7 to June 2, 2022 were enrolled. The daily nasopharyngeal swab specimens were used for SARS-CoV-2 nucleic acid detecting by polymerase chain reaction and the results were expressed as Ct values. The T Ct≥ x was defined as from the symptom onset or first positive nucleic acid test results (the earlier data) to Ct≥ x of the open reading frame 1ab ( ORF1 ab) gene, which was the time duration from the initial to a specific Ct value.Clinical data were collected, including age, sex, vaccination and comorbidities.Cox model was performed to analyzed the impact factors of T Ct≥35. Results:A total of 871 pediatric cases with a median age of two years (ranging from one month to 14 years old) were included. Among them, 474 cases (54.4%) were male, and 89 cases (10.2%) had underlying diseases including congenital heart disease, solid tumors and epilepsy. There were 572(65.7%) mild cases, 298(34.2%) common cases, one (0.1%) severe case and no critical cases or deaths. The T Ct≥35 was 12(10, 14) days. Cox model indicated that compared to children aged one to 12 months, children aged 37 to 84 months and 85 to 168 months had shorter T Ct≥35 (hazard ratio ( HR)=1.55 and 1.84, respectively, both P<0.001). After adjusted with age, comparing to unvaccinated patients, patients with one or two shots vaccine had shorter T Ct≥35 (adjected hazard ratio (a HR)=1.49, P=0.011), and common patients had longer T Ct≥35 than mild patients (a HR=0.78, P=0.002), and patients with comorbidities had longer T Ct≥35than patients without comorbidities (a HR=0.38, P<0.001).The duration of T Ct≥28, T Ct≥30, T Ct≥33 and T Ct≥35 in children without underlying diseases were 7(6, 9) d, 9(7, 10) d, 10(8, 11) d and 12(10, 14) d, respectively. Conclusions:Age, vaccination, disease severity and underlying diseases could affect the duration of SARS-CoV-2 nucleotide turning to negative (Ct value≥35) in children infected with Omicron variants.

现报道1例以反复颈部肿物及间断发热7月余为主要临床表现的颈面部放线菌病病例，患儿入院后结合脓液穿刺病理涂片及脓液宏基因组学二代测序最终诊断为颈面部放线菌感染，确诊后先后予长疗程静脉氨苄西林舒巴坦及口服阿莫西林克拉维酸钾抗感染治疗后症状明显好转。儿科医师需提高对罕见放线菌病的认识。

Objective: To explore the value of metagenomic next-generation sequencing (mNGS) in the etiology diagnosis of bacterial meningitis in children. Methods: The etiological results of 189 children diagnosed with "bacterial meningitis" or "purulent meningitis" or "central nervous system infection" in the Children's Hospital of Fudan University from 1st January 2019 to 31st December 2020 were analyzed retrospectively. The cerebrospinal fluid (CFS) of the children with bacterial meningitis was detected by culture and mNGS respectively, and the difference of pathogen detection rate between the 2 methods was analyzed. According to the age at the time of visit, the children were divided into neonatal group (≤28 days of age) and non-neonatal group (>28 days of age), and χ2 test was used to compare the positive rate between the 2 groups. Taking CFS culture as the gold standard, the sensitivity and specificity of mNGS in the diagnosing of bacterial meningitis in children were analyzed. Results: Among these 189 children with bacterial meningitis, 116 were males and 73 were females. A total of 76 strains of pathogens were detected in blood and (or) CSF cultures, of which 50 strains (65.8%) were Gram-positive bacteria; among those, 18 strains (23.7%) of Streptococcus agalactiae, 17 strains (19.7%) of Escherichia coli and 15 strains (19.7%) of Streptococcus pneumoniae were detected with higher detection rate. The infection rate of Gram-positive bacteria in the non-neonatal group was higher than that in the neonatal group (76.0% (38/50) vs. 50.0% (13/26), χ2=5.24, P=0.020).The same CSF samples of 48 cases were tested by mNGS and culture at the same time, and the detection rate of mNGS was higher than that of CSF culture (20 cases (41.7%) vs. 12 cases (25.0%), χ2=16.45, P<0.001). The consistency of mNGS and culture results was 79.2% (38/48), and the same pathogen was detected in 11 children with both positive mNGS and CSF culture. Taking the results of CSF culture as the gold standard, the sensitivity of mNGS in the diagnosing of bacterial meningitis was 91.7%, and the specificity was 75.0%. Conclusions: The mNGS technology can improve the pathogen detection rate of bacterial meningitis in children, and has a high consistency with CSF culture. In suspected cases where the pathogen cannot be identified by traditional methods, CSF mNGS should be considered timely.

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.

Objective:To investigate the distribution and antimicrobial resistance patterns of common pathogens in children with urinary tract infections in a single center in Shanghai, and to provide basis for the selection of empirical antibiotics in the clinical practice.Methods:The clinical data, urine culture and drug sensitivity tests results of children with urinary tract infections between 0 to 14 years admitted to the Children′s Hospital of Fudan University from January 2016 to December 2019 were retrospectively analyzed. According to the time of onset and the complicated factors, the patients were divided into different groups. The distributions and antimicrobial resistance patterns of common pathogens were compared among the groups. The chi-square test was used for statistical analysis.Results:Among the 1 832 children, 1 042 cases had positive urine culture, with the culture positive rate of 56.9%. The top five pathogens detected were Escherichia coli (375 strains, 36.0%), Enterococcus faecium (164 strains, 15.7%), Klebsiella pneumoniae (133 strains, 12.8%), Enterococcus faecalis (95 strains, 9.1%) and Pseudomonas aeruginosa (44 strains, 4.2%). The annual detection rates of gram-negative bacteria (65.3% to 72.9%) were always higher than those of gram-positive bacteria (22.6% to 30.1%). The distributions of pathogens among the years were not significantly different ( χ2 =27.79, P=0.146). In patients with complicated urinary tract infections, the detection rates of Pseudomonas aeruginosa (5.8%(40/688) vs 1.1%(4/354)) and fungi (6.5%(45/688) vs 1.7%(6/354)) were significantly higher than those in patients with simple urinary tract infections ( χ2=12.68 and 11.79, respectively, both P<0.050). Both of Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin, which were 87.2%(301/345) and 87.1%(115/132), respectively. The resistance rates of Escherichia coli to amikacin, nitrofurantoin, fosfomycin, cefmetazole, piperacillin/tazobactam, ertapenem, imipenem and meropenem were 1.4%(5/345), 6.1%(21/345), 6.1%(21/345), 8.3%(11/132), 11.6%(40/345), 6.4%(22/345), 4.6%(16/345) and 4.6%(16/345), respectively. The resistance rates of Klebsiella pneumoniae to these drugs were 6.1%(8/132), 37.9%(50/132), 15.2%(20/132), 23.2%(13/56), 26.5%(35/132), 23.5%(31/132), 17.4%(23/132) and 16.7%(22/132), respectively, which were all higher than those of Escherichia coli, and the differences were all statistically significant ( χ2=6.02, 76.17, 9.99, 7.94, 16.04, 28.29, 20.79 and 18.84, respectively, all P<0.050). The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, piperacillin/tazobactam and ceftazidime were 6.8%(3/44), 4.5%(2/44) and 2.3%(1/44), respectively, while those to carbapenems, amikacin and ciprofloxacin were all 0(0/44). The resistance rate of Enterococcus faecium to ampicillin was 96.8%(153/158), while that of Enterococcus faecalis was 9.1%(8/88). There was no Enterococcus strain resistant to vancomycin, teicoplanin or linezolid. When dynamically comparing the trends of the antimicrobial resistance from 2016 to 2019, the resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams (including carbapenems) antimicrobial agents had shown a downward trend. Conclusions:Gram-negative bacteria are still the main pathogens of urinary tract infections in children, with a downward trend of drug resistance rates to β-lactams (including carbapenems) antimicrobial agents.

Objective:To understand the clinical and laboratory characteristics of primary Epstein-Barr virus (EBV) infection in children.Methods:Totally 210 cases with primary EBV infection from September 2016 to March 2017 in Department of Infectious Diseases, Children′s Hospital of Fudan University in Shanghai were retrospectively collected. The clinical information (fever, rash, etc), and laboratory data such as liver function, EBV test (serological test, polymerase chain reaction (PCR)-DNA) were analyzed.Results:The age of children with primary EBV infection was (4.2±2.4) years. Numbers of patients with fever, tonsil and/or pharynx exudation, cervical lymphadenopathy, eyelid edema and rash were 187 (89.0%), 130 (61.9%), 204 (97.1%), 95 (45.2%) and 21 (10.0%), respectively. A total of 120 cases (57.1%) presented with typical triplets of infectious mononucleosis. Absolute lymphocyte count ≥5.0×10 9/L was found in 177 cases (84.3%), and abnormal lymphocyte ratio≥0.10 was found in 184 cases (87.6%). Elevated transaminase level was found in 96 cases (45.6%), and 72 cases were followed until transaminase level back to normal, in whom 97.2% (70/72) patient returned to normal within six weeks. Epstein-Barr viral capsid antigen (EBV-VCA)-IgM was positive in 192 cases (91.4%). EBV-VCA-IgG and Epstein-Barr viral early antigen (EBV-EA)-IgG positive were presented in 182 cases (86.7%) and 62 cases (29.5%), respectively. Epstein-Barr viral nuclear antigen (EBV-NA)-IgG was negative in all cases. EBV DNA test was carried in 199 cases, of which 122 cases (61.3%) were positive. Conclusions:Pediatric primary EBV infection mainly occurs in preschoolers. Most patients are presented with enlarged cervical lymph nodes, fever, and positive EBV serological markers. Transient transaminase elevation is observed in some cases.

糖原累积病(glycogen storage disease,GSD)是一组由于先天性酶缺陷所造成的代谢性疾病,其共同特征是糖原代谢异常,导致糖原在肝脏、肌肉、肾脏等组织中贮积量增加.根据缺陷酶及发现的年代顺序糖原累积病分为12型.通过分析1例以“间断腹泻2个月,发现肝大伴肝功能异常18d”起病的糖原累积病Ⅸa型患儿的临床资料和基因特征,总结目前所报道我国的病例相关特点,并进行文献复习提高临床医师对GSDⅨa型的认识.

In May 2018, National Health Commission offically issued a new Guideline for the Diagnosis and Treatment of Hand Foot and Mouth Disease (2018 Version). As for etiological treatment of hand foot and mouth disease, this guideline indicates that IFN-α spray or atomization and early intravenous drip of ribavirin can be effective. In this paper, antiviral treatment of IFN-α, ribavirin and new anti-EV-A71 viral drugs are further elaborated, and general treatment of hand foot and mouth disease is interpreted. As for the treatment of severe hand foot and mouth disease, this guideline has described in detail and no repeated instructions will be given herein.

HBV 感染一直是威胁全球公共卫生健康的重要问题[1-4 ] .近年来 ,随着政府对疫苗接种的大力推广 ,我国H B V感染率已有大幅下降 ,其中年龄<15岁人群的降幅尤其明显 ,由1992年的10 .5％ 降至2014年的0 .8％ [5 ] .尽管如此 ,根据出生率和人口统计数据估算 ,全国仍有超过180万年龄< 15岁的儿童感染 HBV[5-6] ,每年有5万新生儿感染HBV[5] .

<正>手足口病的治疗原则为早发现、早诊断、早隔离、早治疗。目前临床尚无特异性肠道病毒抑制剂,在临床上多采取以广谱抗病毒药物和对症支持治疗为主的综合治疗措施。1一般治疗普通病例门诊治疗,注意隔离,避免交叉感染。清淡饮食,做好口腔和皮肤护理。积极控制高热,体温超过38.5℃者适当采用物理降温(温水擦浴、使用退热贴等)或应用退热药物治疗。常用药物:布洛芬口服,

Objective: To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children. Method: From November 2012 to September 2013, ten research units of large teaching hospitals or children's hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ(2) test or Kruskal-Wallis test or t test. Result: Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ(2)=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ(2)=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ(2)=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ(2)=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ(2)=9.217, P<0.05), and 91% (χ(2)=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ(2)=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ(2)=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ(2)=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ(2)=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ(2)=13.35, P<0.05) in infants (≤1 year old) and 93% (χ(2)=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ(2)=9.57, P<0.05) and 87% (χ(2)=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ(2)=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ(2)=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study. Conclusion:Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.

Objective To investigate the incidence and clinical presentation of breast milk transmitted cytomegalovirus (CMV) infection among preterm infants with birth weight≤1500 g.Methods Preterm infants enrolled in this study met the following inclusion criteria: birth weight≤1500 g, fed with CMV-positive breast milk and admitted into Neonatal Intensive Care Unit of Children's Hospital of Fudan University within 72 hours after birth from October 2015 to July 2016. And those with congenital digestive tract malformation or congenital CMV infection were excluded. Breast milk and infants' urine samples were regularly screened for CMV DNA by fluorescent quantitative polymerase chain reaction. Symptoms and laboratory findings in infants with CMV infection transmitted via breast milk were documented and analyzed. Differences in relevant parameters were analyzed usingChi-square test, Fisher's exact test,t test or Mann-WhitneyU test where appropriately.Results Sixty preterm infants breastfed with CMV DAN-positive milk were recruited. Among them, 19 (31.7%) developed breast milk-acquired CMV infection as their urine samples were positive for CMV DNA, while the others were negative for CMV DNA (infected group:n=19; non-infected group:n=41). The average CMV copies in breast milk, gestational age and birth weight of the infected group were all significantly higher than those of the non-infected group [3.76 (3.18-4.50) vs 3.47 (3.00-4.88) Log10 copies/ml,Z=-2.042;(30.4±2.1) vs (28.4±2.3) weeks,t=3.175; 1290 (750-1500) vs 1110 (575-1480) g,Z=-2.837; all P<0.05). Fewer infants in the infected group than in the non-infected group received blood transfusion [5/19 vs 56.1%(23/41),χ2=4.627,P<0.05]. Ages of the infants with CMV infection ranged from 26 to 164 days (median age of 92 days). Six out of the 19 infants had clinical symptoms concurrent with viral excretion in urine and the ages of these symptomatic infants of infection were earlier than those of the asymptomatic ones without significance [(72±34) vs (97±28) days,t=-1.710,P>0.05]. Four infants (21.1%, 4/19) had severe organ damage and/or positive IgM antibodies to CMV in serum, and were treated with antiviral therapy. Two had mild symptoms and were not given antiviral therapy. All of the six symptomatic infants were followed-up for one to six months, during which time the complete blood cell count and results of biochemical test and fundus examination were back to normal.Conclusions The incidence of breast milk-acquired CMV infection among preterm infants with birth weight≤ 1500 g was 31.7%, and no severe symptoms were reported in this study.

Objective To explore the treatment of children with EB virus infection accompanied by facial paralysis. Method The clinical data of a child with EB virus infection accompanied by facial paralysis was analyzed retrospectively, and the related literature were reviewed. Results A 2-year-old boy was admitted to hospital due to fever and mouth askew for 4 days. After admission, he was confirmed to have EB virus infection and viremia by serology and polymerase chain reaction, and then treated with acyclovir. The symptoms of facial paralysis and EB viremia disappeared completely 14 days after antiviral treatment. There was no recurrence in the short-term follow-up. Interestingly, the literature analysis shows that there is still limited evidence for the antiviral treatment by acyclovir in children with acute infection of EB virus associated with facial paralysis. Conclusion Antiviral treatment may be beneficial to EB viremia with facial paralysis.

艰难梭菌是一种专性厌氧革兰阳性芽孢杆菌，具有耐热、耐酸、抗消毒剂等特性，在环境中较难消灭。人体肠道菌群正常时，艰难梭菌不具致病性；当肠道菌群失调时，艰难梭菌异常增殖及产生毒素，产生一系列病理生理反应。艰难梭菌包括非产毒性和产毒性两种，非产毒性艰难梭菌不产生毒素，也不具有侵袭性，因此没有致病性；多数产毒性艰难梭菌能产生毒素 A 和毒素 B，少数仅产生毒素 B，部分（如 BI／NAP1／027）还产生二元毒素。目前认为毒素 A 和毒素 B 是艰难梭菌致病的主要因素，在艰难梭菌致病过程中具有协同作用，但二元毒素在艰难梭菌致病过程中的机制尚不清楚［1-3］。

Objective To study the clinical manifestations and laboratory findings like liver function,immunoglobulin and peripheral blood lymphocyte subsets,and to provide evidence for diagnosing and the therapy for acute Epstein-Barr virus (EBV) infection.Methods From July 2012 to June 2015,clinical data from 321 patients with acute EBV infection admitted to Children's Hospital of Fudan University for treatment were retrospectively analyzed.The clinical characteristics and the findings by liver function test,detection of virus,immunoglobulin and lymphocyte subsets were analyzed.The patients were divided into an abnormal liver function group (186 cases) and the normal liver function group (135 cases).The copy number of EBV-DNA,serum EBV-IgM,immunoglobulin,CD series between the 2 groups were analyzed.Stata 12.0 software was used for statistical analysis.Results (1) There were 321 cases diagnosed with acute EBV infection.Among them,the gender of 183 cases were boys,138 cases were girls,male to female ratio was 1.33:1.00.The average age of onset was (52.07 ± 35.05) months.There were 186 cases (57.94％) with abnormal liver function and 135 cases (42.06％) with normal liver function.(2) Clinical course was (9.11 ±8.21) days,and period of fever lasted (7.12 ±5.00) days;281 cases (87.54％) had fever,and the highest temperature reached (39.04 ± 0.69) ℃;lymphadenectasis occurred in 267 cases (83.18％),245 cases (76.32％) had angina,hepatomegaly occurred in 235 cases (73.21％),142 cases (44.24％) had splenomegaly,and rash occurred in 60 cases (18.69％);155 cases (48.29％) occurred trilogy of fever,lymphadenectasis and angina.(3) There were 186 cases had abnormal liver function without jaundice,and their levels of total bilirubin,direct bilirubin,total bile acid,albumin and coagulation function were normal.Alanine aminotransferase (ALT) increased from 40 to 400 IU/L in 125 cases,400 to 800 IU/L in 2 cases,and more than 800 IU/L in 6 cases.Aspartate aminotransferase(AST) increased from 40 to 400 IU/L in 157 cases,400 to 800 IU/L in 5 cases,more than 800 IU/L in 1 case.Ninety-seven cases were followed up for liver function,and the recovery time was 21-74 days.(4) In comparison of the abnormal liver function group to the normal liver function group,the differences were statistically significant in age,IgG,IgA,CD4 + T cell,the ratio of CD4 + T cell and CD8 + T cell (all P ＜ 0.05).The differences of gender,clinical course,fever period,IgM,IgE,positive rate of viral capsid antigen (CA)-IgM,and the copy number of EBV-DNA were not significant statistically (all P ＞ 0.05).Conclusions Children with acute EBV infection may have a high incidence of liver damage.The clinical manifestations are characterized by elevated transaminase and self-limiting.The occurrence of liver damage may be related to case of cell-mediated immunity

HCV 于1989年由 Choo 等［1］分离鉴定，属于黄病毒科丙型肝炎病毒属，为有包膜的单股正链 RNA 病毒。目前， HCV 感染已成为全球重要的公共卫生问题，是导致慢性肝病的重要病原体。据统计，全球 HCV 感染者超过1．7亿人［2］。HCV 感染易导致慢性化，55％～85％的成人急性感染后可发展为慢性丙型肝炎（chronic hepatitis C，CHC）［3］。采用聚乙二醇干扰素联合利巴韦林方案治疗的 CHC 患者中，约半数不能达到持续病毒学应答（sustained virological response，SVR）［4］。固有免疫应答是机体抵御病毒、细菌、真菌等病原体入侵的第一道防线。NK 细胞是机体固有免疫的重要承担者，不仅可清除癌细胞，对病毒等病原体亦具有很强的清除能力［5］。

Objective To establish the method of fluorescence quantitative PCR for detection of Cytomegalovirus (CMV) DNA from newborn dried blood spots (DBS) and evaluate the limit of detection (LOD),precision,specificity and clinical application.Methods Primers and probes were selected from CMV-gB segment and standard plasmids were constructed to detect concentration of CMV strains.The LOD,within-run and between-run precisions were obtained by detection of 10-fold serial dilutions of CMV strains in DBS with quantitative PCR.This assay was further evaluated by detecting CMV DNA from 10 DBS with confirmed congenital CMV infection newborns and 120 DBS from healthy infants who were born within three days from September 2011 to February 2013.Results The LOD of CMV DNA was 4.44 × 103 copies/ml and the sensitivity was 2.66 copies/25 μl reaction system.The within-run and between-run precisions were 0.74％ and 1.39％ at a CMV strain concentration of 4.44 × 106 copies/ml,respectively,and 1.04％ and 1.84％ at a CMV strain concentration of 4.44 × 104 copies/ml respectively.Eight of ten newborns with congenital CMV infection and two of 120 neonatal DBS from healthy population were CMV-positive.All the positive products were verified by nested PCR and sequencing.Conclusions A method of fluorescence quantitative PCR were established successfully for CMV test in dried blood spots.This assay displayed the advantages of rapidness,good sensitivity and precision and could be used for large-scale screening for CMV infections.

Objective To observe the short-term outcomes of cholecystojejunocolonic anastomo sis for patients with progressive familiar intrahepatic cholestasis (PFIC) or Alagille syndrome and to determine the possible prognostic factors.Methods Cholecystojejunocolonic anastomosis was performed on 11 patients with PFIC and 2 patients with Alagille syndrome from August 2010 to August 2012.Total bile acids (TBA) and total bilirubin (TB) were measured preoperatively,1 week,1,6 and 12 months postoperatively.Pre-and postoperative TBA,TB,pruritus scale and height Z value were compared.Results TBA decreased by ＞50％ 1 month after operation in 5 patients (group A).In group A,TBA decreased to (27.0 ± 6.4) ％,(24.4 ± 10.2) ％ and (40.4 ± 17.2) ％ and TB decreased to (51.6 ± 31.9) ％,(37.8 ± 36.5) ％ and (49.6 ± 21.5) ％ of the pre-operative concentrations at 1,6 and 12 months after operation.Pruritus scale decreased by (2.4 ± 1.3) and (1.5 ± 1.2) points at 6 and 12 months after operation.Height Z increased in 3 patients.In the rest 8 patients (group B),TBA,TB,pruritus scale and height Z did not improve after operation.Univariate analysis showed age,sex,pre-operative TB and TBA had no differences in group A and B,but only 1 patient in group A had persistent pre-operative jaundice which was significantly different from group B.Conclusions PIBD can relieve pruritus and jaundice for some patients with PIFC/AGS.Persistent pre-operative jaundice and a decrease of ＜50％ 1 month after operation are unfavorable prognostic factors.

抗生素问世已超过半个世纪,临床滥用抗生素的现象已十分普遍.抗生素的不良反应也越来越多见,如过敏、肝肾毒性、诱导耐药病原的出现并流行,已给医务工作者带来了极大的挑战.因此,合理使用抗生素,尤其是在特殊人群(主要包括粒细胞缺乏、重症监护室、肝肾功能减退以及GC应用的患者)中正确使用抗生素,不仅能提高感染性疾病的治愈率,还能避免诱导更多耐药病原体的产生和流行,值得临床医师的关注.

哪些人容易感染禽流感 主要是疫区内与活禽有密切接触者,如: 1.活禽(鸡鸭鸽鸟等)养殖业者及其贩卖者、运输者. 2.活禽宰杀者,如活禽宰杀人员或有机会接触未煮熟禽类的厨师等工作人员. 3.居住地或工作地周边有活禽养殖场或宰杀活禽者. 4.吃未煮熟禽肉或禽蛋者.