Objective:To explore the clinical characteristics and risk factors of severe and critical influenza in children.Methods:The clinical data of 214 inpatient children with severe and critical influenza hospitalized in the Second Affiliated Hospital & Yuying Children′s Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2019 were retrospectively collected. The clinical characteristics including age, gender, symptoms, signs, underlying diseases, C-reactive protein (CRP), treatment and outcome of children with severe and critical influenza were compared. Chi-Square test was used for statistical analysis. A binary logistic regression model was constructed to analyze the risk factors for critically ill influenza.Results:Of the 214 children, 153 were male (71.5%), 177(82.7%) were under 5 years old. There were 52 children with underlying diseases. Fever occurred in 207 cases. Among the 54 cases that had convulsion during the course of the disease, three developed acute necrotizing encephalopathy. The influenza subtype was mainly type A, accounting for 190(88.79%). A total of 42(19.6%) children were critically ill. The incidence of critical influenza in children with underlying diseases (61.9%, 26/42) was higher than that in severe influenza children (15.1%, 26/172), and the difference was statistically significant ( χ2=40.175, P<0.01). The incidence of critical influenza in children with CRP≥40 mg/L was higher than that of severe influenza in children with CRP ≥40 mg/L (33.3%(14/42) vs 9.3%(16/172)), and the difference was statistically significant ( χ2=16.173, P<0.01). Multivariate logistic regression showed that underlying diseases (odds ratio ( OR)=8.794, 95% confidence interval ( CI) 3.845-20.111) and CRP ≥40 mg/L ( OR=5.050, 95% CI 1.966-12.970) were risk factors for critical influenza. All severe cases were improved and discharged.Among the 42 critically ill children, seven children died. Conclusions:Among the severe and critical influenza in children, the majority of children are under five years old.Underlying diseases and CRP ≥40 mg/L are risk factors for critical influenza.

Objective To investigate the efficacy of the clinical pathway introduced in children with Mycoplasma pneu-moniae pneumonia (MMP). Methods Based on a retrospective study, the length of hospital stay, hospital expenses and curative rate were compared between 145 MMP patients managed according to clinical pathway and other 45 MMP patients. The causes of variation were analyzed in the clinical pathway group as well. Results The length of hospital stay in clinical pathway group [9 (6~10) days] was significantly shorter than that in the control group [10 (7-12.5) days] (P=0.003). The curative rate (93.8%) was significantly higher than that in the control group (84.4%) (P=0.043). The hospital expenses [4 696.5 (3 608.3-5 677.6) CNY] was significantly higher than that in the control group [3175.3 (2490.8-4585.0) CNY] (P<0.001). The variation rate of clinical pathway was 48.3%(70/145 cases) in clinical pathway group. Conclusions The curative rate is improved and the length of hospital stay is shortened after the clinical pathway is introduced in MMP children. However, there is a high variation rate in the clinical pathway. It is necessary to optimize the clinical pathway before it is adapted in clinic.

Objective To investigate the pathogenic bacteria distribution, antibiotics resistance, and clinical features of childhood bacterial meningitis (BM). Methods Clinical data from BM children with positive cerebrospinal lfuid culture were retrospectively analyzed from March 2004 to March 2015. According to age, the BM children were divided into neonates group (0-28 days), infants group (—1 year), and children group (≥1 year). According to the onset time, the BM children were divided into the early group (March 2004 to March 2010) and the late group (April 2010 to March 2015). According to the clinical situation, the BM children were divided into the trauma and surgery secondary infection group and the control group. Results A total of 100 BM children were recruited. One hundred and two strains of pathogens were detected, 62 (60.8%) strains of Gram positive bacteria and 40 (39.2%) strains of Gram negative bacteria. The main pathogens were Streptococcus pneumoniae (33 strains), Escherichia coli (22 strains), and Streptococcus agalactiae (10 strains). The proportion of Streptococcus agalactiae was higher in the late group (18.8%(9 cases)) than that in the early group (1.9%(1 case)) (χ2=6.406, P=0.011). The proportion of coagulase-negative staphylococci was higher in the trauma and surgery secondary infection group than that in the control group (χ2=6.631, P=0.010). Drug sensitivity analysis found that 60.0%of Escherichia coli produced extended-spectrumβ-lactamases (ESBLs) in the control group, while the only one strain of Escherichia coli in the trauma and surgery secondary infection group was ESBLs negative. Streptococcus pneumoniae were sensitive to vancomycin and linezolid. Streptococcus agalactiae were all found in the control group, which were all sensitive to penicillin and linezolid. The sensitive rate to vancomycin was only 70%. The incidence of complications in neonates group, infants group, and children group was 55.0%(22/40), 78.6%(33/42), and 33.3%(6/18), respectively. The difference was statistically signiifcant (χ2=11.848, P<0.05). The most common complications in these three age groups were ventricular dilatation (40.9%), subdural effusion (45.5%), and hydrocephalus (40.0%), respectively. Thirty-ifve children were cured, 41 children were improved and discharged, 22 children were not cured and left the hospital, and 2 children died. Conclusions Streptococcus pneumoniae, Escherichia coli, and Streptococcus agalactiae were the predominant pathogens in childhood BM. The Streptococcus agalactiae infection is increased in the late group. The complications is varied in different age groups..

Objective:To investigate the effects of the anti-TLR2 antibody blocking TLR2 signaling pathway on inflammatory response in Staphylococcus aureus pneumonia murine models.Methods: Sixty C57BL/6J mice were divided randomly into normal control,SA pneumonia,and anti-TLR2 antibody group,killed 3 and 8 days after inoculation respectively.Normal control mice inoculated sterile PBS intranasally ,SA pneumonia mice inoculated SA ,anti-TLR2 antibody group of mice injected with anti-TLR2 antibody by tail vein and then inoculated SA intranasally.At the predetermined point , the colony-forming units ( CFU ) of bacteria were higher , leukocytes and neutrophil percentage were counted in bronchoalveolar lavage fluid ( BALF ) , the concentrations of KC and IL-10 in BALF and serum were assayed by ELISA ,changes in pulmonary histopathology were observed with HE staining and TLR 2 expression was detected by immunohistochemical.Results:3 days after intranasal inoculation ,the concentrations of KC and IL-10 in BALF and serum was increased in SA pneumonia mice , pulmonary histopathology changes significantly in HE staining.Compared with SA pneumonia mice,the CFU of bacteria were higher,leukocytes count and neutrophil percentage ,the concentrations of KC in BALF and serum,as well as HE pathological scores were reduced significantly in anti-TLR2 antibody group mice ,while no significant difference in IL-10.8 days after intranasal inoculation , HE pathological scores of anti-TLR2 antibody group mice were significantly lower than SA pneumonia group mice ,the CFU of bacteria in BALF were not statistically different between those two groups.Conclusion:Anti-TLR2 antibody attenuates the production of inflammatory mediators and inflammatory cell infiltration in SA pneumonia mice .

Objective To study the disseminated Staphylococcus aureus infection (DSAI) in children. Method Clinical features, treatment and prognosis data of 14 children with DSAI admitted to Yuying Children’s Hospital Afifliated to Wenzhou Medical University from January 2006 to December 2013 was retrospectively reviewed. Results 14 children with DSAI occurred in community, median age:15m (range 6d–13y);50%male (7 cases). All patients presented with fever. Addition to fever, the ifrst symptom was skin and soft tissue infections (SSTIs,6 cases) as well as limb and/or joint pain (5 cases). Among children with DSAI, white blood cell count and C-reactive protein values increased signiifcantly. Pyogenic infection site were skin and soft tissue in 12 cases (85.7%), pulmonary (12 cases), bone (4 cases), joint (3 cases), central nervous system (3 case), and pericardium (1 case). SSTIs concurrent with pulmonary infection was found in 10 cases (71.4%). Incision and drainage of skin and soft tissue abscesses were performed in 9 cases, joint debridement and vacuum sealing drainage (VSD) in 3 cases, osteomyelitis debridement and VSD in 3 cases, and closed chest drainage in 3 cases. All cases received vancomycin and/or linezolid treatment, 5 cases supplemented by rifampicin, and intravenous immune globulin therapy was administered in 11 cases. Clinical manifestations were cured or improved in 12 cases (85.7%). Conclusions Clinical diagnosis of DSAI in children needs to be vigilant. SSTIs, bone and joint infections were major precipitating factors. Intravenous immune globulin therapy was supplemented to the application of antibiotics, which might get better clinical outcomes in children.

Mycoplasma pneumoniae is a common pathogen of community acquired pneumonia in children.The imaging manifestations of Mycoplasma pneumoniae pneumonia in children varied,the understanding of the causes in clinical pediatrician is not sufficient.The common imaging appearances of chest X-ray,chest CT and chest magnetic resonance imaging (MRI) in children with Mycoplasma pneumoniae pneumonia attributed to age,course,clinical manifestations and severity of illness were summarized in this review.

Objective:To establish a common method for detecting serotypes of respiratory adenovirus, and to detect the main serotypes of respiratory human adenovirus (HAdV) infection in children in Wenzhou area.Methods:A multiplex PCR method based on capillary electrophoresis was developed to detect 12 common serotypes of respiratory adenovirus.A total of 1 059 children with acute respiratory infection who were admitted to Yuying Children′s Hospital Affiliated to Wenzhou Medical University from January 2018 to December 2019 with positive infection of HAdV detected by the direct immunofluorescence method were recruited and retrospectively analyzed.Multiplex PCR was performed to determine 12 serotypes of respiratory adenovirus, including HAdV-1, 2, 3, 4, 5, 7, 14, 21, 37, 40, 41 and 55.Meanwhile, some samples were randomly selected to examine the consistency in the detection result by the first-generation sequencing method.Results:A total of 1 059 specimens of respiratory secretions with positive HAdV antigen were collected.Detected by multiplex PCR method, 947 cases (89.4%) were positive for 1 serotype, 13 cases (1.2%) were mixed infection with 2 serotypes, and 24 cases (2.3%) were negative.In addition, 75 cases(7.1%) were positive but could not be serotyped.Among the 947 children with the positive infection of a single serotype, 415 cases (43.8%) were HAdV-3 in subgroup B, 318 cases(33.6%) were HAdV-7, 12 cases (1.2%) were HAdV-55, 2 cases (0.2%) were HAdV-21, 108 cases (11.4%) were HAdV-2 in subgroup C, 70 cases (7.4%) were HAdV-1, 16 cases(1.7%) were HAdV-5, and 6 cases(0.6%) were HAdV-4 in subgroup E. HAdV-14, HAdV-37, HAdV-40 and HAdV-41 were not detected.A total of 51 positive samples of HAdV infection detected by multiplex PCR were randomly selected to compare with the detection result by the first-generation sequencing, which were all consistent.Conclusions:This study successfully established a multiplex PCR based on capillary electrophoresis in diagnosing common serotypes of respiratory adenovirus infection in children.HAdV-3, HAdV-7 of subgroup B and HAdV-2 and HAdV-1 of subgroup C were the main serotypes of respiratory adenovirus infection in children of Wenzhou area.HAdV-14, HAdV-37, HAdV-40 and HAdV- 41 were not detected.