To explore the new trend of pathogens and antimicrobial resistance in children with urinary tract infection (UTI).Distribution of pathogens and their antimicrobial resistance in 85 culture-positive hospitalized children with UTI from 2008 to 2012 were analyzed.Urine culture was deemed positive with a pure growth 8 10S/ml (single organism).Among 85 strains of bacterium,gram-negative bacilli accounted for 92.9％ (with 64.7％ of E coli.),gram-positive cocci 2.4％ and fungi 4.7％.The resistance rates of Gram-negative bacilli to ampicillin,trimethoprim-sulfamethoxazole and ampicillin/sulbactam were 82.3％,63.3％ and 63.3％ respectively.The resistance rates of E coli.to 3rd and 4th generation cephalosporin were both over 60％.And 0％ and 5.5％ of E coli.UTIs were resistant to imipenem and amikacin respectively.It indicated that E coli.remained a dominant pathogen in childhood UTI.The resistance patterns were grave.Every hospital should monitor the resistance patterns of urinary pathogens on a regular basis and use antibiotics with a low resistance.

Objective To study the relationship between blood lipid levels, insulin therapy of pregnant women with abnormal glucose metabolism and perinatal outcomes. Methods 380 pregnant women who were diag-nosed and treated for abnormal glucose metabolism were enrolled in this study,including 24 cases with diabetes melli-tus(DM),164 eases with gestation diabetes mellitus (GDM), 192 cases with gestation impaired 81ucose tolerance (GIGT). Among the 380 cases, 136 cases were performed insulin therapy with diet controlling,244 cases diet control-ling. Results The incidence of pre-eclampsia and preterm labor in the DM group(41.7% and 41.7% )was higher than that in GIGT group(15.6% and 20.7%)and GDM group(15.9% and 18. 3%) (P<0.05). Among the three groups ,the incidence of macrosomia, polyhydranmios and fetal distress had no significant difference( P>0.05 ). While the incipience of neonatal asphyxia,hypoglycemia in the DM group were all higher than that in GDM and GIGT group ( P<0.01 ). The newborn weights in insulin therapy group( 2891.5±1330.4 g) was lower than that in diet controlling group(3751.2±1025.3 g) ( P<0.05 ). Conclusion The blood lipid level of pregnant women with gestational ab-normal glucose metabolism is one of the effective indexes to prognose perinatal outcomes. Reducing blood lipid levelcan decrease the incidence of pre-eclampsia and preterm labor,neonatal asphyxia and hypoglycemia significantly. Di-agnosing and beginning therapy as soon as possible and using insulin are important,especially to reduce the rate of macrosomia and newbem weights.

Objective To investigate the relationship between plasma rennin levels in ischemic stroke patients and aspirin-in-duced gastrointestinal bleeding .Methods 50 ischemic stroke cases in neurology department of the Second Affiliated Hospital of Chongqing Medical University from June 2012 to December 2012 were collected and divided into 2 groups depended plasma rennin levels :low rennin group and high rennin group .Low rennin group contained 21 cases and high rennin group containd 29 cases .Ap-pearance of haematemesis ,melena and fecal occult blood were considered as positive identification ,peptic ulcer bleeding in endoscope or death as the endpoint event in 1 year follow-up .Comparison of the incidence of gastrointestinal bleeding between 2 groups was made .Results The average age of patients in low rennin group was higher than that in high rennin group(P<0 .05);blood pres-sure of patients in low rennin group was higher than that of high rennin group(P<0 .05);gastrointestinal bleeding rate of low ren-nin group was higher than that of high rennin group(P>0 .05) .Conclusion Different plasma rennin levels in ischemic stroke pa-tients may be unrelated to aspirin-induced gastrointestinal bleeding .

The clinical data of 43 children diagnosed as idiopathic nephrotic syndrome (INS) with frequent relapse and treated with cyclophosphamide (CTX) or mycophenolate mofetil (MMF) were retrospectively analyzed.In this series of patients 18 were treated with CTX and 25 were treated with MMF.After CTX therapy the relapse-free period was round 6.0 months,the relapse rate decreased from 4.8 episodes/y to 1.1 episodes/y(P ＜0.001)and prednisone dose was reduced from 30.0 mg/d to 15.0 mg/d (P =0.002).After MMF therapy the relapse-free period was also round 6.0 months,the relapse rate decreased from 4.8 episodes/y to 1.6 episodes/y(P ＜0.001)and the prednisone dose was reduced from 37.5 mg/d to 12.5 mg/d(P ＜ 0.001).There were no significant differences in relapse-free period,relapse rate and reduction of prednisone dose (P ＞ 0.05) between MMF and CTX groups.This retrospective study shows that both MMF and CTX are effective immunosuppressive agents for children with frequently relapsing INS,however,MMF is more convenient and safe to administrate,it may be proposed before CTX.

The efficacy of standard triple therapy for Helicobacter pylori (Hp) eradication has been significantly decreased, or even less than 80%.Abroad studies have shown that Hp eradication rate of sequential therapy is significantly higher than that of triple therapy.At home, we lack a large sample of data analysis to clarify the efficacy of sequential therapy.Aims: To systematically review the efficacy of sequential therapy and triple therapy in Hp eradication at home and abroad.Methods: PubMed, Medline, Embase, Cochrane Library, CNKI, Wanfang, VIP and CBMdisc were retrieved to collect the randomized controlled trials (RCT) comparing sequential therapy and triple therapy in the treatment of Hp infection in last 7 years.Article selection, data extraction and quality evaluation were conducted independently by two reviewers.Meta-analysis was conducted by RevMan 5.3 software.Results: A total of 31 RCT involving 8 371 subjects were included.Meta-analysis showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (83.3% vs.74.7%;RR=1.13, 95% CI: 1.09-1.16).Sixteen domestic studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (88.1% vs.78.0%;RR=1.13, 95% CI: 1.10-1.16), fifteen abroad studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (79.0% vs.71.8%;RR=1.13, 95% CI: 1.06-1.20).No significant difference in incidence of adverse reactions was found between sequential therapy and triple therapy (20.7% vs.22.0%;RR=0.94, 95% CI: 0.86-1.03).Conclusions: Sequential therapy achieves higher Hp eradication rate than standard triple therapy, and no significant difference in incidence of adverse reactions is found between sequential therapy and triple therapy.Hp eradication rate of sequential therapy is significantly higher than that of triple therapy and is higher than 80% in China, which can be recommended as a Hp eradication supplement of bismuth quadruple therapy.

Objective To evaluate the efficacy of levofloxacin-based triple therapy and bismuthbased quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens.Methods Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed,Cochrane Library,SPRINGER,VIP database,WanFang database and CKNI database.The literature quality was evaluated by the improved Jadad criterion.RevMan5.3 sofeware was applied to data analysis.The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis.Publication bias assessed with funnel plots.Results Ultimately seventeen literatures were included for meta-analysis,the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant (77.0％ vs 68.7％,OR =1.52,95％ CI 0.96-2.42,P =0.34).In European countries,levofloxacin-based triple therapy was more effective than quadruple therapy(80.6％ vs 68.5％,OR =2.18,95％ CI 1.25-3.81,P ＜ 0.05),while eradication rates of two groups in Asian countries were similar.The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy,whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy (87.7％ vs 61.3％,OR =4.92,95％ CI 3.09-7.82,P ＜ 0.05).The efficacy was not influenced by the dose of levofloxacin.The adverse effects were significantly lesser(19.1％ vs 29.5％,OR =0.47,95％ CI 0.26-0.82,P ＜ 0.05),whereas the compliance rate was significantly higher in levofloxacin group (96.0％ vs 89.9％,OR =2.27,95％ CI 1.33-3.87,P ＜ 0.05).Conclusions Comparing with bismuth-based quadruple therapy,levofloxacinbased triple therapy has higher eradication rate,compliance rate and lesser side effects,so we recommend it as a second-line rescue therapy after front-line Hp eradication failure.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.

Objective To analyze the pathogenesis,initially diagnosed symptoms and clinical manifestations of children with chronic kidney disease (CKD) at stage 2 to 5.Methods The data of 108 children who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2007 to April 2016 with CKD stage 2 to 5 were retrospectively analyzed.The etiologies,clinical manifestations and examinations were summarized,and the clinical manifestations were compared between the congenital hereditary urinary diseases group and the acquired urinary diseases group.Results (1) In the 108 cases collected,66 cases were male,42 cases were female,aged from 3 months to 15 years and 1 month old.Twenty-four cases were diagnosed at stage 2,26 cases at stage 3,35 cases at stage 4,and 23 cases at stage 5.(2) Twenty-eight kinds of illness were involved in the cause of CKD.Among them,57 cases (52.8％) had congenital anomalies of the kidney and urinary tract,5 cases(4.6％) had hereditary kidney diseases,41 cases (38.0％) had other primary or secondary kidney diseases,and in 5 cases (4.6％) the causes of disease were unknown.(3) For the initially diagnosed symptoms,29 cases(26.9％) were due to complaints associated with kidney disease,36 cases (33.3％) were of other outside kidney symptoms,and 43 cases (39.8 ％) were of negative symptoms.The results of urinary ultrasound were abnormal in 79 cases(73.1％) and 87 cases(80.6％) showed abnormality in urinary analysis.There were 105 cases (97.2％) with abnormal manifestations either in urinary tract ultrasound or in urinary analysis.(4)The ages on diagnosis as CKD in children with congenital hereditary urinary diseases(5.89 years old) were younger than that of children with acquired urinary diseases (9.20 years old),and the difference was significant(Z =-3.434,P =0.001).The frequency of cases with short stature or lower-weight in group of congenital hereditary urinary diseases[66.1％ (41/622 cases),64.5％ (40/62 cases)] were significantly higher than those of the acquired urinary diseases group[43.9％ (18/41cases),43.9％ (18/41 cases)],and the differences were statistically significant(x2 =4.983,4.263,P =0.026,0.039).Conclusions The causes of CKD are complicated,and the congenital anomalies of kidney and urinary tract are the major causes of CKD at stage 2 to 5 in the cases.The initially diagnosed symptoms of CKD are insidious and atypical.The children with congenital hereditary urinary diseases tend to have more serious growth retardation.Urinary analysis and ultrasound may have an important significance for early diagnosis of CKD in children.

Objective To examine the relationship between UAE and fibrinolytic activity in patients with type 2 diabetes.Methods 129 type 2 diabetic patients recruited and subgrouped by UAE,and the UAE,FBS,lipids,renal function and the activity of t-PA and PAI-1 were conducted in these patients and 40 health people.Results Compared to control group,the activity of PAI-1 was increased and the activity of t-PA decreased dramaticlly in type 2 diabetic group(P＜0.05);there was significant difference in the ratio of PAI-1 and t-PA between three diabetic groups(P＜0.05),of three group the ratio of PAI-1 and t-PA was most highest in the patients with macroal buminuria,and simple correlation analysis showed positive correlation between UAE and the ratio of PAI-1 and t-PA,especially in the patients with microalbuminuria(r=0.321,P＜0.05).Conclusion The UAE is closely relatedto fibrinolytic activity in patients type 2 diabetes.

Objective To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms.Methods PubMed,CENTRAL,Embase,CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H.pylori eradication treatment and those without treatment.The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring.A Meta-analysis was conducted by using RevMan 5.20 software.Results Twenty RCTs involving 6 575 cases were included.Meta-analysis showed that:(1) There was a positive link between H.pylori eradication and endoscopic reflux esophagitis.The diagnostic rate of endoscopic reflux esophagitis after H.pylori eradication therapy was higher than that of control group(7.25％ vs 4.20％;OR =1.62,95 ％ CI 1.20-2.19,P =0.002).Subgroup analysis found that Asian patients,40 to 50 years old,followup time more than 1 year,and peptic ulcer had higher incidence of endoscopic reflux esophagitis;(2) The incidence of reflux symptoms was not significantly different between H.pylori eradication group and control group (25.2％ vs 24.6％;OR =1.03,95％ CI 0.87-1.21,P =0.76).Further analysis indicated that reflux symptoms were not related to some relevant factors,such as races,age at diagnosis,follow-up time and underlying diseases.Conclusions The eradication of H.pylori is considered as one of risk factors for GERD,especially in Asian populations,long time follow-up,40 to 50 years old and patients with peptic ulcer.Meanwhile,the eradication of H.pylori does not suggest the correlation with reflux symptoms.H.pylori eradication therapy should be administrated according to patients' individual conditions.

Objective To evaluate clinical efficacy of shoulder dislocation combined with reverse Hill-sachs injury treated with Neer modified McLaughlin procedure. Methods Clinical data of seven patients for shoulder dislocation combined with reverse Hill-sachs injury in our hospital from October 2013 to June 2016 were retrospectively analyzed. All of the patients were received Neer modified McLaughlin procedure with defect area of humeral head from 25%to 40%. The clinical outcomes were evaluated with plain radiographs, subjective satisfaction, range of shoulder motion, University of Califonia Los Angeles (UCLA) shoulder scale and constant score, which were recorded at the final follow up. Results The mean follow-up period was (12.3 ± 4.3) months. No recurence of shoulder dislocation was found. At the final follow up, a patient was found a slight osteoarthritis based on radiographs. Two patients were very satisfied with the surgery and five patients were satisfied. The average anterior flexion, abduction and external rotation of shoulder were 145.7° ± 12.7° and 148.6° ± 15.7° and 47.1° ± 5.7° respectively. The average UCLA score and constant score were (26.6 ± 2.8) and (78.6 ± 7.2) respectively. Conclusion The Neer modified McLaughlin procedure shows a remarkable clinical effect for shoulder dislocation combined with reverse Hill-sachs injury. The short and mid-term effects are definite with few complications.