Objective To investigate the chronic obstructive pulmonary disease with acute exacerbation(AE-COPD) of eonseiousneas. Methods For January 2004 to June 2008, AECOPD clinical data were reviewed retroepec-tively. Results 5 yeats treated 310 eases with AECOPD,impaired consciousness occurred in 16. 8% (52/310) : 29cases of pulmonary encephalopathy, hypotonic encephalopathy 12 cases ,5 cases of cerebral infarctinn,4 cases of drug-induced;clinical symptoms often show a variety,may be characteristic,but the cause of death by up to 55.6% of the total number of deaths(10/18). Conclusion AECOPD had high incidence of disturbance of eonseiousneas,and it isdiflleult to avoid completely;should pay attention to identify,first perform head CT or MR/examination to exclude or-ganic brain disease,according to arterial blood gas analysis,bloed electrolyte,to further determine the cause.

Objective To investigate pulmonary heart disease acute exacerbation of changes in the characteristics of thyroid function and significance. Methods Pulmonary heart disease with acute exacerbation of 200 cases as the observation group,in the same period 200 cases of healthyas control group, observation euthyroid sick syndrome (euthyroid sick syndrome, ESS) occurred, compared the observe and control groups, observer group in the survival group died with the group,ESS thyroid hormone treatment before and after the test results,ESS and death. Results Pulmonary heart disease with acute exacerbation of ESS incidence of 42. 5% (85/200) ;section observe the admission T3 ,FT3 lower than the control group;observer group in the survival group died and TSH group no significant difference,the group died T3 ,FT3 ,T4 ,FT4 were lower than the survival group( P＜0. 05 ) ;improvement in the treatment of primary disease, thyroid hormone, or return to near normal ; ESS mortality occurred in 30. 59% higher than a change of 13.04% mortality rate. Conclusion Serum thyroid hormone levels to reflect changes in the pulmonary heart disease in patients with acute exacerbation of the state of the body and severity of the dynamic serum levels of thyroid hormone can observe the development of pulmonary heart disease and prognosis.

Objective To study the changes of Neuroendocrine immunology sensitive indicators in children with Hand-Foot-and-Mouth Disease (HFMD) and values of determining the patient′s conditions. Methods The children with HFMD were divided into three groups , the common group , severe group and risk group according to the clinical diagnosis and classification standards, meanwhile, the healthy children were enrolled as control group. Peripheral blood samples were collected from the case groups and control group , concentrations of cortisol (COR), β-endorphin (β-EP), interleukin-13 (IL-13), interferon-γ (IFN-γ), immunoglobulin (IgG, IgA, and IgM), and the relative contents of T cell subsets, B cells and NK cells were tested respectively. Results Compared with the control group, the levels of COR, β-EP, IL-13, IFN-γ and IgG, IgA, IgM all significantly increased in the three groups of HFMD. All the differences were statistically significant (P < 0.01), except the difference of IgG, and IgA between the ordinary type and the control group. Compared with the common group, the percentage of NK and B cells dramatically increased, meanwhile, compared the other two types with the control group , the percentage of T cell subsets and NK cells significantly decreased , but B cells significantly increased, and there were all significant difference (P < 0.01). Conclusions HFMD caused by EV71 infection is the result of the combined effect of changes in nervous system , immune system and endocrine system. It is extremely important to detect early the sensitive indicators in children with HFMD , such may help to find the risk cases and carry on early intervention for patients′ recovery.

Escherichia coli is a common intestinal colonization bacterium in human body.It causes infectious diarrhea if it turns into a pathogenic bacterium under certain conditions.In a few cases, it can cause extraintestinal infections, such as bacterial meningitis, lower respiratory tract infection, biliary tract infection, and urinary tract infection, etc.With the increasing of antibiotic abuse, the pathogenesis of Escherichia coli in different infectious diseases has its own characteristics.The hazards, pathogenesis and treatment progress of different infectious diseases were reviewed in this paper.

Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.