The present study assessed the variation of measles viruses (MV) and its association with clinical manifestations in patients with MV. A total of 38 pediatric patients with MV at the acute infection stage were selected and 2 ml venous blood was collected from each of them. Serum immunoglobulin M antibodies were determined by ELISA. Urine specimens were collected from 30 of the 38 patients and associated genetic structures were detected by reverse-transcription polymerase chain reaction mapping. At the same time, clinical epidemiological manifestations were collected to perform an epidemiological analysis. The MV-positive rate within the cohort determined in serum was 100%. Seven MV strains were isolated from urine specimens of 30 patients and the positive rate was 23.33%. Four MV strains were randomly selected from the 7 strains and the results revealed that they were all of the H1a genotype. In addition, there was no significant correlation between clinical manifestation of pediatric patients with measles and the genotype of the MV. In conclusion, the preponderant genotype of MV in Kunming was H1a and there was obvious nucleotide or amino acid mutation. The clinical manifestation of MV infection in pediatric patients was not associated with the MV genotype.

INTRODUCTION:Laggera pterodonta, a traditional Chinese medicine, has been commonly used in respiratory tract infections for more than hundreds of years without any randomized controlled trials to evaluate its efficacy and safety.OBJECTIVES:To evaluate the efficacy and safety of Laggera pterodonta in hospitalized children aged 3-24 months with acute bronchiolitis.METHODS:A double-blind, randomized-controlled trial was conducted in three tertiary hospitals of Kunming, China. A total of 133 acute bronchiolitis children with an initial episode of wheezing were randomly assigned to a control mixture or Laggera pterodonta mixture. All recruited patients were given three doses of the mixture every 24 h for 5 days. Clinical symptoms and responses including adverse events in both groups were assessed and laboratory tests were done at enrolment and then after 120 h. Analysis was performed based on an intention-to-treat principle.RESULTS:Significantly more hospitalized children fulfilled the discharge criteria at 96 h and 120 h in the Laggera pterodonta mixture group compared to the control group (97% vs 75.8% P < 0.001 and 98.5% vs 89.4% P = 0.03), respectively. Better responses on clinical severity score, respiratory rate, oxygen saturation, wheezing and heart rate were also detected in the Laggera pterodonta mixture group along with lower white blood cell count, platelet count and aspartate aminotransferase. Vomiting and diarrhea were more common in the control group.CONCLUSION:Laggera pterodonta mixture is effective and safe to be prescribed in hospitalized children with acute bronchiolitis.

目的研究臭灵丹乙醇提取物体外抑制甲1型流感病毒感染药效.方法采用细胞病变抑制法,在预防和治疗2种试验策略下,探讨臭灵丹乙醇提取物体外对流感病毒的抑制作用及环节.结果臭灵丹乙醇提取物的TC50为3.07 mg/m L,在预防模式和治疗模式中,臭灵丹对甲1型流感病毒PR8株均有抑制作用,IC50分别为0.31 mg/m L,0.73 mg/m L,选择指数（SI）分别为9.90和4.21.结论臭灵丹乙醇提取物体外对甲1型流感病毒感染具有一定的抑制作用,在预防模式下效果较好.

目的 通过检测蒲公英不同的萃取物体外抗甲型H1N1流感病毒作用,探讨其在甲型H1N1流感治疗上的应用.方法 首先用乙醇萃取而得到蒲公英的乙醇萃取物,然后依次采用乙酸乙酯、正丁醇、石油醚、水萃取蒲公英的乙醇萃取物,得到不同溶剂的萃取物;选用狗肾传代MDCK细胞作为病毒的宿主对病毒进行培养和扩增;通过血凝效价和Real time RT-PCR实验,间接或直接检测蒲公英不同萃取物对病毒的中和作用和增殖抑制作用.结果 4种不同溶剂的蒲公英萃取物作用病毒后,只有石油醚、乙酸乙酯组的血凝效价数值出现了一定程度的下降,其中乙酸乙酯萃取物组的值下降了2～4倍;而石油醚萃取物在96 h时,中和实验组和增殖抑制组的血凝效价值分别下降了256倍和128倍.Real time RT-PCR检测表明,石油醚和乙酸乙酯萃取物明显抑制病毒的扩增量.作用96 h时,无论是中和实验还是增殖抑制实验,石油醚萃取物的作用都是最显著的,病毒扩增率较阳性对照分别减少了92.4％和95.6％.结论 蒲公英乙酸乙酯萃取物和石油醚萃取物在体外有明显的抗甲型H1Ni流感病毒的作用.

Objectives: To evaluate the satisfaction, concerns, and preference for Traditional Chinese Medicine (TCM) drugs among guardians of children with acute bronchiolitis, assess the agreement between satisfaction and preference, and explore the factors associated with satisfaction. Design: A cross-sectional study was conducted in three main tertiary hospitals in Kunming, China, from September 2012 to July 2013 by structured questionnaire interviews. The characteristics of children and their guardians and guardians' satisfaction with and preference for TCM drugs were collected and analyzed by using chi-square or Fisher exact test. The agreement of satisfaction and preference was assessed by κ and prevalence-adjusted κ coefficients. Multiple logistic regression was used to identify factors associated with satisfaction. Results: A total of 286 guardians were enrolled in the study. Most children (97.6%) were younger than age 2 years. In total, the rates of satisfaction and preference for TCM drugs were 75.5% and 73.1%, respectively, and preference and satisfaction levels did not significantly differ between TCM and non-TCM hospitals. Guardians with higher socioeconomic status were more satisfied with TCM drugs, and the most common reason for preference for TCM drugs was that they had less toxicity or fewer adverse effects. Guardians were concerned most about safety and least concerned about cost. The agreement between satisfaction and preference was moderate in general (prevalence-adjusted κ=0.42). Conclusions: Three fourths of the Chinese guardians of children with acute bronchiolitis were satisfied with and preferred the TCM drugs. Moderate agreement between satisfaction and preference was shown.

Laggera pterodonta is commonly used for treating influenza in Southwest China, especially in Yunnnan province. The main clinical effects of L. pterodonta include anti-influenza, anti-microbial, anti-inflammatory. To investigate the anti-influenza A (H1N1) virus effect of L. pterodonta, neutralization inhibition and proliferation inhibition tests were performed. MDCK culture method was used to observe the cytopathic effect (CPE) of extracts from L. pterodonta in inhibiting influenza A (H1N1) virus and haemagglutination titre of H1N1 virus in vitro. The culture medium were collected at 24 h, 48 h, 72 h, 96 h, and detected by Real time RT-PCR, in order to compare the effect of different extracts from L. pterodonta on in vitro proliferation of H1N1, virus. The result of neutralization inhibition test showed that hemagglutination titer of ethyl acetate extract were 8 times lower at 72 h; in proliferation inhibition test, hemagglutination titer of ethyl acetate extracts reduced by 2 and 4 times. According to the results of Real time RT-PCR test, the H1N1 inhibition ratio of ethyl acetate extract was 72.5%, while the proliferation inhibition ratio of ethyl acetate extract was 25.3%; as for petroleum ether extracts, the H1N1 inhibition ratio was 60.2%, while the proliferation inhibition ratio was 81.4%. In conclusion, both ethyl acetate extract and petroleum ether extract of L. pterodonta have significant neutralization and direct proliferation inhibition effects on influenza A virus.

OBJECTIVE:To investigate the effect of cesarean delivery and other predisposing factors of respiratory syncytial virus (RSV)-positive acute bronchiolitis in children.MATERIAL AND METHOD:The case-control study was conducted in three main tertiary hospitals in Kunming, China between September 2012 and July 2013. Children with first episode of wheezing diagnosed as bronchiolitis and testedfor RSV were included RSV was detected by real-time reverse transcription polymerase chain reaction. Mode ofdelivery and characteristics of children, parents, and household were interviewed and analyzed with RSV-positive status by multiple logistic regression.RESULTS:Of 265 children, RSV-positive was found in 75.5%, and the majority of children (83.3%) were younger than 12 months. Compared to vaginal delivery, the odds of RSV-positive detection were double in children born by elective cesarean delivery (adjusted odds ratio 2.32; 95% confidence interval 1.19-4.52). Children aged less than 6 months, born in the rainy season, having maternal history of asthma and living in family that smoked more than 20 cigarettes per day were more likely to be RSV-positive.CONCLUSION:Children born by elective cesarean delivery increased the risk of RSV-positive acute bronchiolitis after adjusting for age, birth season, maternal asthma, and family smoking status.

目的 了解云南省边境一线乡村医生(村医)的基本情况,分析儿童疾病综合管理(IMCI)培训后的效果,为进一步扩展儿童疾病综合管理的培训以及探索适合我国村医的培训模式提供依据.方法 选取云南省普洱市所有边境一线村医,集中在普洱市,分2期进行为期3d的短期儿童疾病综合管理的培训.培训严格按照由卫生部、WHO、UNICEF编写的IMCI教材、练习册、图册、教学录像进行.培训前对村医进行问卷调查了解其基本信息；IMCI情景病例考核,以及IMCI基本知识测试,了解其临床知识能力.培训3个月后,随访小组对村医进行随访、调查,在所属乡镇卫生院按照相同考核过程评估培训效果.结果 思茅市边境一线村医以少数民族为主,受教育水平绝大多数为初中及中专.根据情景病例考核,村医识别危重症、及时转诊的知识水平培训后与培训前比较有明显统计学差异(p＜0.001).对于腹泻并轻度脱水的评估、ORS及锌剂的使用认知水平亦有明显统计学差异(P＜0.001).结论 IMCI是加强儿童卫生服务的一个有效策略,对边境一线村医实行的短期培训效果显著,值得进一步扩展应用.

Objective To investigate the detection of pathogen from children with hand-foot-mouth disease(HFMD) in Kunming,in order to provide evidence for HFMD prevention and dynamic monitoring.Methods From April to August in 2011,83 specimens including 73 throat swabs and 10 vesicle fluid were collected from 73 patients with HFMD in Kunming.CoxA16 and EV71 were detected by real-time RT-PCR.Three specimens randomly sampled from the positive amplified products of EV71 were bi-directly amplified.Nucleotide sequence of the products was analyzed and compared with reference virus strain of GenBank.The phylogenetic analysis was based on VP1 gene of enterovirus.Meanwhile,epidemiological data were collected and analyzed.Results The positive detection rates of throat swab and vesicle fluid specimens were 80.82%(59/73) and 100%(10/10),respectively;the difference was statistically significant(χ2=6.997,P0.01).The viral loads of throat swab and vesicle samples were(1.42±2.71)×104 and(1.24±1.57)×104,respectively,and there was no significant difference.In 73 patients,the positive rates of CoxA16 and EV71 were 80.82%(59/73) and 20.55%(15/73),respectively,and the rate of mixed infection with CoxA16 and EV71 was 12.33%(9/73).VP1-based phylogenetic analysis showed that three isolated strains of EV71 have a high degree(94.0%-98.4%) of homology with subgenogroup C4 and belong to the same branch as the 11th strain of subgenogroup C4.Among 73 children with HFMD,there were 50(68.49%) mild cases including 40(80%) infected with CoxA16 and 1 mixedly infected with CoxA16 and EV71,and 23 severe cases including 9 infected with CoxA16,5 infected with EV71,and 9 mixedly infected with CoxA16 and EV71.Conclusions CoxA16 and EV71 were the important pathogens of HFMD epidemic in Kunming during 2011;the positive detection rate of virus from vesicle fluid was higher than from throat swabs.

OBJECTIVE:Evaluate the clinical competency in detection and management complicated pneumonia, diarrhea, and measles cases of trainees who were village doctors in Puer city of Yunnan province, China.MATERIAL AND METHOD:One hundred fifty four village doctors working in the border areas were trainedfor 5-day Integrated Management of Childhood Illness (IMCI) training, which was adapted to World Health Organization (WHO) guidelines. Pre- and post-training assessment based on a modified WHO package was carried out.RESULTS:Statistically significant improvements in almost allperformances were observed. However, the level of post-training achievement was still low. Correct classifications of severe pneumonia, measles, and diarrhea were found in 63.0% 54.3% and 83.5%, respectively in the post-training periodCONCLUSION:The training package needs to be further strengthened.

Objective To investigate genotype of wild-type measles viruses circulated in Kunming,and provide scientific evidences for surveillance and prevention of measles.Methods A total of 30 cases of measles were enrolled,male 18,female 12,aged 51-day to 3-year,19 cases of 0-1(≤ 1) year,9 cases of 1-2(≤ 2) years,and 2 cases of 2-3(≤ 3) years,mean aged 15-month.The 2 mL venous blood specimens of 30 cases during the acute contagious period were collected,then IgM antibody against measles virus in serum specimens was detected by enzyme-linked immunosorbent assay(ELISA).Meanwhile,urine specimens of the children were collected and the COOH-terminal 543 nucleotide of nucleoprotein(N) gene of these isolates were amplified by reverse transcription-polymerase chain reaction(RT-PCR).The amplified products were sequenced and sequences were compared with references viruses from Genebank.Results The 7 measles viruses were isolated from 30 cases of pattents and the virues could be detected in the urine specimen within 6-day after rash.Sequence of COOH-terminal 543 nucleotides of N gene from 4 wild strains of measles viruses were compared with that from 23 reference stains and it was found that the average genetic distances of 4 stains to H1 genotype and H2 genotype reference strains of China 93-7,China 94-1 and H1a were 0.031-0.047,0.332-0.398 and 0.010-0.033,respectively.The homology of nucleotide sequences of 4 strains were 96.0 %-98.9 %.The homology of nucleotide sequences were 95.9 %-99.7 % and 96.9 %-99.8 % when compared with that of H1 genotype(China 93-7) and H1a genotype(China 93-2).Conclusion It is demonstrated that the major genotypes of wild-type measles viruses investigated in Kunming in 2008 are H1a genotype.

Objective To evaluate the efficacy and safety of inhaled 4% hypertonic saline solution with salbutamol,budesonide for infant wheezing.Methods A total of 90 infants with bronchiolitis,asthmatic bronchitis,bronchopneumonia with wheezing were randomly divided into two groups by the sequence of admittance to hospital:treatment group(n=46) and control group(n=44).Salbutamol and budesonide mixtured with 2.5 ml 4% hypertonic saline solution were inhaled for treatment group.The two groups received inhalation for the base of routine therapy.Inhalation was repeated for three times every day until wheezing relieved.Results The clinical score of two groups on the third,fourth,fifth and seventh day had significant difference(P﹤0.05).The score of wheezing on the third,fourth,fifth,sixth and seventh day in treatment group was significantly lower than that in control group(P﹤0.05).The mean length of hospital stay in the treatment group and control group showed different(P﹤0.05).The mean length of hospitalization in the treatment group had a relevant 15.6% reduction as compared with control group.The success rate of sputum induction in treatment group and control group was 60.9% and 22.7%,respectively.There was significant difference between the two groups(P<0.01).Conclusion Nebulized 4% hypertonic saline with salbutamol,budesonide in infant wheezing can decrease length of hospitalization,improve respiratory symptoms of wheezing,cough and asthmatic noise,induce sputum.

Objective To investigate the prevalence,epidemiology and clinical features of Human Bocavirus(HBoV)and Human Metapneumovirus(hMPV)infection in children with respiratory tract infection in Kunming.Methods From October 2009 to December 2010,550 nasal swab samples were collected from children under 5 years with respiratory tract infection.Multiplex polymerase chain reaction was used to detect 21 common pathogens including HBoV and hMPV.At the same time,the baseline characteristics of children and clinical manifestation were recorded by researchers through structure questionnaire.SPSS software was used to analyze data.Results Out of 550 nasopharyngeal swab specimens,18 specimens were detected with HBoV infection and 29 samples were detected with hMPV infection.The positive rate of HBoV and hMPV was 3.3% and 5.3%,respectively.Among 18 HBoV positive samples,there were 17 samples mixed other pathogen infection.The mixed infection rate of HBoV accounted for 94.4%.Meanwhile,among 29 hMPV positive specimens,the co-infection rate was 58.6%.The most common pathogens of mixed infection with HBoV and hMPV were respiratory syncytial virus,rhinovirus,influenza A virus and Haemophilus influenza.Infant got higher HBoV infection.There was no significant difference between different age groups of hMPV infection.The peak of positive infection rate of HBoV and hMPV were both in autumn and winter.Fever,cough and wheezing were the major clinical manifestation of children with HBoV and hMPV infection.Conclusions HBoV and hMPV are important pathogens of acute respiratory tract infection in children in Kunming.The prevalent seasons are autumn and winter for the two virus infection.

BACKGROUND:Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas.METHODS:The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics.RESULTS:The study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling.CONCLUSION:There is a need to improve health finance and clinical competency of the village doctors in the study area.

Objective To learn health HR status quo of front-line village clinics in the border of four counties,such as: Lancang,Ximeng,Menglian and Jiangchen in Puer.For exploring country health workers training model which is suited in minority nationality regions.Methods We do the questionnaire surveys to all registered health workers in 20 border townships in above four counties by WHO investigation methods and relevance questionnaire data.Results There are 87 village clinics and 137 village health workers.The average is 1.57 country health workers per village,94% of them are minority nationality health workers,village health workers sex ratio is 1.45:1.Most of them are graduated from the middle school and health school.Average age is 34 years old.Their medical professional level is low,especially to children’s disease and prevention health care.Conclusions The number of health workers are satisfied the requirement in front-line village clinics in Puer of Yunnan province.Age structure and sex ratio are reasonable.The gaps of their medical professional level is large,and the low education background has not be solved too.It’s necessary that the health workers professional training should be expanded and strengthened.

Objective To observe efficacy and safety of traditional Chinese medicine in Yunnan-GanMaoXiaoYan tablets in treatment of children with influenza A(H1N1)infection.Methods According to the case inclusion criteria,we collected influenza A(H1N1)suspected cases and randomly divided them into treatment group and control group.Patients in treatment group and control group were given treatment drug and control drug,respectively.We detailedly recorded the clinical information,collected nasal swabs before and after treatment and continuously followed up with real-time RT-PCR on nasal swabs for pathogen detection.Results The thermal annealing time(h)of patients in treatment group and control group was 13.09±7.02,and 22.13± 15.55(P<0.05),respectively.The sore throat relief time(h)was 20.36±7.91 and 27.20±12.30(P<0.05),respectively.The cough relief time(h)was 51.20±13.81 and 53.25±16.50(P>0.05),respectively.There was significant difference in the H1N1 quantitative PCR results and positive to negative rate between treatment group and control group(P<0.05).Conclusions GanMao XiaoYan tablets with the main characteristics of Chinese medicine in Yunnan Province is safe and efficient in the treatment of influenza A(H1N1)infection,able to quickly alleviate the influenza-induced fever,sore throat and other symptoms.It can reduce the viral load in respiratory secretions quickly,and speed up the virus turn to negative.

Objective To explore the efficacy of nasal continuous positive airway pressure (NCPAP) combined with pulmonary surfactant (PS) and intravenous drip large dose of ambroxol hydrochloride to treat neonatal hyaline membrane disease (HMD). Methods From September 2007 to March 2010, 68 neonates with neonatal hyaline membrane disease were enrolled in this study. They were randomly divided into treatment group (n=34) and control group (n=34) on the base of same combined therapy between two groups. Treatment group used nasal continuous positive airway pressure combined with pulmonary surfactant (100 mg/kg, dripped through trachea) and large dose ambroxol hydrochloride [30 mg/(kg • d) + 10% glucose and saline (GS)10 mL, intravenous drip, for four times]. Control group used same treatment except ambroxol hydrochloride. The clinical symptom before and after treatment, chest X-radiography, nasal continuous positive airway pressure machine parameters, blood gases, transcutaneous oxygen saturation (TcSo2), complications, length of stay of two groups were observed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of The 2nd Affiliated Hospital of Kunming Medical University. Informed consent was obtained from the parents of each participating neonate. There were no significance of sexuality, gestational age, mode of delivery, Apgar score, birth weight, day ages onset time and chest X-ray classification of neonates between two groups (P>0.05). Results The clinical symptoms and signs chest X-radiograph, nasal continuous positive airway pressure machine parameters, arterial blood gas indicators, transcutaneous oxygen saturation, complications and length of hospital stay in treatment group improved more significantly than those in control group (P<0.05). Conclusion The efficacy of nasal continuous positive airway pressure combined with pulmonary surfactant and intravenous drip large dose ambroxol hydrochloride to treat neonatal hyaline membrane disease is remarkable. Key words: ambroxol hydrochloride; pulmonary surfactant (PS); nasal continuous positive airway pressure (NCPAP); hyaline membrane disease (HMD); neonate

为了探讨循证医学教学模式的应用价值,于2008年在儿科见习中应用了循证医学的理念。把05级临床医学二系儿科见习的两个大班随机地分为实验组和对照组,实验组应用循证医学理念,对照组采用传统式教学方法。用问卷调查表,理论考试及病历书写评价其效果。结果:循证医学教学模式对提高学习兴趣,培养良好的临床思维和学习方法具有积极作用。

Objective Human enterovirus 71(EV71)and coxsakievirus A16(CoxA16)are two major causes of hand-foot-and-mouth disease(HFMD).Since poliovirus has been eradicated,EV71 has come to medical attention as the most important enterovirus related to severe complications and sequelae.This study was conducted to investigate the casual causes of HFMD in children during an epidemic from April to June of 2008 in Kunming.Methods 58 specimens that include vesicle fluid,urine and throat swabs,were collected from 25 patients with HFMD.Those suspected people were diagnosed through RT-PCR.Results 13 patients were identified as positive for CoxA16 and 5 patients were identified as positive for EV71,the rate of CoxA16 and EV71 was 52% and 20% respectively.Conclusions The major causes of HFMD in this epidemic CoxA16 and EV71,and clinicians can hardly distinguish these two viruses through clinical manifestations. Vesicle swabs give a high diagnostic yield in this study.

<正>临床医学是一门实践性非常强的学科.因此,培养和训练医学生理论联系实际的能力尤为重要.临床实习教学则是临床医学教育实现这一目标的重要组成部分,而临床教学查房是其中的重