The severe hand,foot and mouth disease(HFMD) caused by Enterovirus 71 (EV71) has become a serious threat to children's health.It is an important issues which need to be faced and resolved by pediatrician and disease prevention and control system,especially pediatric critical care specialist.The pathogenesis of severe HFMD caused by EV71 has not been clearly defined so far,and the clinical treatmnent is controversial.So,to further explore the mechanism of EV71 infection in severe HFMD and explore new effective prevention and control methods,have important significance in reducing the mortality and improve the quality of life of patients with severe HFMD.

OBJECTIVETo investigate the pathogenic and clinical presentation and laboratory tests of bullous rash in hand, foot and mouth disease (HFMD) in Xi'an from January 2013 to December 2014 by retrospective analysis.

METHODA total of 224 specimens were collected from clinically diagnosed HFMD cases who were characterized by widespread mucocutaneous bullous reactions in Xi'an Children's Hospital from January 2013 to December 2014, the identification and subtyping of the isolates were conducted with real-time fluorescent quantitative RT-PCR. A retrospective analysis was performed to analyze the clinical presentation, laboratory tests and late follow-up problems of the HFMD.

RESULTIn the clinically diagnosed HFMD cases who were characterized by widespread mucocutaneous bullous reactions, 207 were caused by coxsackievirus A6 (CA6), accounting for 92. 4% of all cases with bullous, 4 were caused by enterovirus 71 (EV71), accounting for 1.8%, 10 were caused by coxsackievirus A16 (CA16), accounting for 4. 5%; 4 cases were negative for these viruses. In the cases positive for intestinal virus-nucleic acid, 130 were male, 90 were female; male to female ratio was 1. 44: 1, 203 were <5 years old, accounting for 92. 3%. Leukocytosis was found in 75 cases (34. 1%); high-sensitivity C-reactive protein (hsCRP) increased in 200 cases (90. 9%); elevated myocardial enzyme CK-MB was found in 35 cases (15. 9%), alanine aminotransferase increased in 15 cases (6. 8%); 187 cases had fever (85. 0%). None of the cases had serious complications such as encephalitis or myocarditis. In the course of the critical phase bullous rash or large vesicle-like changes, obvious itching, and facial rash appeared. After the fluid in the bullae was absorbed or the bullae ruptured or became ulcerated, scar formation and large areas of exfoliation occurred, with no effusion on the newly formed epithelium in the base, without significant pigmentation on later follow-up. In the late follow up process, 52 cases in CA6-positive patients (25. 1%) developed onychomadesis within 2-4 weeks after onset, 1 to 8 nails, an average of 4. 3 fell off, new nails grew, the nail bed showed no structural abnormalities and hyperplasia after falling off, the surface was smooth, had no hypertrophy, left no sequelae.

CONCLUSIONThe pathogen in HFMD characterized by widespread bullous reactions was mainly the CA6, this kind of HFMD was mainly mild type, with significant itching, later the bullae may have scar formation and skin exfoliation, in some cases onychomadesis may occur.

Child ; Enterovirus A, Human ; Enterovirus Infections ; pathology ; Exanthema ; pathology ; Female ; Fever ; Hand, Foot and Mouth Disease ; pathology ; Humans ; Male ; Pruritus ; Retrospective Studies

Objective:To study the relationship between the level of high mobility group protein 1(HMGB1)and the severity of hand, foot and mouth disease (HFMD).Methods:A total of 150 children with enterovirus 71(EV71) HFMD admitted to Xi′an Children′s Hospital from April 2018 to December 2019 were selected as the study objects, including 100 mild cases(normal group) and 50 severe cases(severe group). Meanwhile, 50 healthy children during the same period were selected as control group.The level of HMGB1 in plasma was detected by ELISA.The clinical data and laboratory examination of the case group were collected.The factors that may affect the conversion of HFMD to severe were analyzed by single factor and multi-factor Logistic regression analysis.The risk factors of conversion of HFMD to severe and the correlation between the level of HMGB1 in plasma and the severity of HFMD were discussed.Results:The level of HMGB1 in EV71 HFMD children in the acute stage[(13 700±3 036)pg/mL] was significantly higher than that in the control group[(10 116±2 435) pg/mL]( t=5.913, P<0.05). After treatment, the level of HMGB1 decreased in the convalescence period[(10 658±2 349) pg/mL], and the difference was not statistically significant compared with the control group ( t=2.515, P>0.05). Blood glucose, white blood cell count and HMGB1 level in the severe group were all higher than those in the normal group (all P<0.05). Multivariate Logistic regression analysis found that the levels of blood glucose >8.3 mmol/L, peripheral blood leukocyte >15×10 9/L, and HMGB1≥ 13 110 pg/mL were the risk factors for severe aggravation of HFMD in children.The receiver operating characteristic curve analysis showed that when HMGB1 was 13 110 pg/mL, the Yoden index was the highest, with a sensitivity of 81.6% and a specificity of 72.0%. Conclusion:WBC>15×10 9/L, blood glucose>8.3 mmol/L and HMGB1≥13 110 pg/mL are the risk factors of HFMD.When HMGB1 is higher than, it suggests that HFMD may develop to severe.

Calcitonin gene-related peptide( CGRP) is the strongest vasodilator discovered to date,the synthesis and release of CGRP are regulated by multiple factors.CGRP possesses multiple biological func-tions,such as vasodilator,myocardial strengthener,lung protector,brain protector,immunomodulator.It plays an important role in regulating the function in the body.

Objective It's not clear why the severity of hand-foot-mouth disease (HFMD) caused by enterovirus 71 (EV71) was varied clinically.In this study,the relation between the virus load of EV71 and the severity of HFMD was analyzed and the foundation for HFMD control and treatment were laid.Methods Two hundred and fortyseven patients with HFMD caused by EV71 from Jan.2012 to Sep.2013 in Xi'an Children's Hospital were enrolled and clinical data were collected,including age,gender,clinical symptoms,signs,routine blood count,fasting glucose,C-reactive protein and enterovirus.The EV71 virus loads of 247 patients with HFMD were measured by real-time PCR assay.Meanwhile,the effect of EV71 RNA on the severity of HFMD was analyzed.Results In this study,121 mild cases and 126 severe cases with HFMD limb shaking,fasting glucose,lymphocyte and neutrophil percentage were statistically significant between the 2 groups (all P ＜ 0.05).The counts of EV71 RNA from all of the 247 throat swab samples were more than 100 copies/mL,and the highest virus load was 1.1 × 105 copies/mL.The highest value of EV71 RNA was 9.32 × 104 copies/mL and 1.1 × 105 copies/mL in mild and severe cases,respectively,there was no significant difference between the 2 groups (P ＞ 0.05).Conclusions The results of EV71 RNA by RT-PCR are visualized and convenient.The virus loads of EV71 are not associated with the severity of HFMD,but further studies need to analyze.

Vitamin D is a fat-soluble steroid hormone, which has a wide range of physiological effects in human body.It has been found that vitamin D not only plays an important role in diseases of skeletal system, cardiovascular system and immune system, but also participates in the occurrence and development of infectious diseases.In infectious diseases, vitamin D regulates innate and adaptive immune responses by regulating a variety of immune cells and cytokines, and also plays a bactericidal role by mediating the expression of antimicrobial peptides.This paper briefly introduced the relationship between vitamin D deficiency and infectious diseases in children.

Insulin like growth factor-1(IGF-1) has been found to be a cell proliferation regulator that promotes cell differentiation and proliferation.In recent years, IGF-1 has been found to play an important role in infectious diseases, participating in the occurrence and development of a variety of infectious diseases.This review briefly summarized the research progress on IGF-1 in infectious diseases, providing new ideas for the application of IGF-1 in clinical diagnosis and treatment of infectious diseases.

High mobility group protein box 1 (HMGB1) is a highly conserved DNA binding protein, which is found in the nucleus of a variety of cells in the body, regulating the transcription of cell genes.It plays a role of nuclear binding protein in physiological state.Once released into the cell gap, it performances the role of inflammatory mediators.Recent studies showed that pathogenesis of HMGB1 not only involved in sepsis, autoimmune diseases, chronic liver disease, malignant tumor, but also involved in cell injury repair,which plays important role in a variety of diseases, organ damage, repair process.

Objective To evaluate the effect of comprehensive schistosomiasis control measures based on infection source control in Hanchuan City marshland and lake endemic regions . Methods The data of comprehensive schistosomiasis control in Hanchuan City from 2004 to 2013 were collected and the change trends of the Oncomelania hupensis snail status and the in?fection situation of human and livestock were analyzed to evaluate the control effect. Results After the implementation of the comprehensive measures the infection rates of residents and cattle decreased from 6.38%and 8.11%in 2004 to 0.16%and 0 in 2013 respectively. There were no acute schistosomiasis patients since 2007 no new infection cases since 2011 and no infected snails since 2012. Compared with 2004 the occurrence rate of frames with living snails and the average density of living snails decreased by 56.78%and 68.35% respectively but the snail area and susceptible area increased by 0.62%and 7.10% respec?tively. In 2013 all the 367 endemic villages in 26 townships reached the criteria of transmission controlled. Conclusions The comprehensive schistosomiasis control measures based on infection source control can control the schistosomiasis transmission effectively in marshland and lake endemic regions. When consolidating the achievement the snail area in inner embankment should be compressed to prevent the schistosome re?infection in human and livestock.

Objective:In this study, the clinical data of biliary atresia(BA) and infant intrahepatic cholestasis(IHC) was reviewed, and the utility of gamma-glutamyl transpeptidase(GGT) and liver Young′s modulus in the differential diagnosis of BA and IHC in infants was discussed.Methods:Based on the clinical data of 120 infants with cholestasis treated in the Children′s Hospital Affiliated to Xi′an Jiaotong University, from September 2017 to December 2019, the infants were divided into two groups according to the results of intraoperative cholangiography and follow-up: BA group( n=50); IHC group( n=70). The age, clinical manifestations, laboratory examination results, gallbladder contraction rate, hepatobiliary scintigraphy, liver Young′s modulus, and medical treatment effects were compared between the two groups.The utility of GGT and liver Young′s modulus in the differential diagnosis of BA and IHC was analyzed. Results:The age, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bile acid, fasting blood glucose, blood ammonia and splenomegaly between the two groups were compared and the results showed no statistical significance( P>0.05). In contrast, there were statistically significant differences( P<0.001) in stool color, liver size, total bilirubin(TB), direct bilirubin(DB), GGT, liver Young′s modulus, positive hepatobiliary scintigraphy, gallbladder contraction rate at 1 hour after meal, and medical treatment effect between the two groups.TB, DB, GGT, liver Young′s modulus and GGT combined with liver Young′s modulus were analyzed using ROC curves, and the area under the curve(AUC) were 0.820, 0.809, 0.906, 0.876 and 0.926, respectively.When GGT exceeded the cut-off value of 198.85 U/L, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 82.0%, 84.3%, 78.8%, 86.8% and 83.3%, respectively.When liver Young′s modulus exceeded the cut-off value of 8.6 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 88.0%, 80.0%, 75.9%, 90.3% and 83.3%, respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of GGT combined with liver Young′s modulus in diagnosing BA were 98.0%, 68.6%, 69.0%, 98.0% and 80.8%, respectively.Multivariate logistic regression analysis found that DB>115.55 μmol/L, GGT>198.85 U/L, and liver Young′s modulus>8.6 kPa were risk factors for BA( OR=9.510, P=0.001; OR=24.634, P<0.001; OR=21.469, P<0.001). Conclusion:GGT and liver Young′s modulus are useful in the differential diagnosis of BA and IHC.If GGT and liver Young′s modulu sexceed the threshold values of 198.85 U/L and 8.6 kPa respectively, it can effectively indicate that the child is BA.