Acute obstructive suppurative cholangitis (AOSC) is one of the most serious acute abdomen.The incidence of abdominal infection is significantly improved when patients were complicated with AOSC and diabetes mellitus,and then bile leakage,intestinal fistula and even death were induced by abdominal infection.The management of abdominal infection is very important for the prognosis of patients.One patient with AOSC and diabetes mellitus was admitted to the No.425 Hospital of PLA from May to July in 2013.Recurrent abdominal infection and abscess occurred after the operation due to his family members' refusal of surgery at early period and lax control of blood glucose before and after surgery,and then bile leakage and intestinal fistula were induced.The patient underwent operation for 3 times,and was cured after receiving fasting,gastrointestinal decompression,parental nutrition,somatostatin administration and antibiotic treatment.

Objective To study the localization of the foramen of Monro on magnetic resonance image (MRI) and its clinical significance.Methods Cranial MRI was observed for 30 normal healthy subjects to study their location,shape and size of the foramen of Monro,as compared to those in 22 patients with hydrocephalus and 14 cases with tumor around their foramen.Results The the foramen of Monro is located between the fornix and the anterior part of thalamus in the normal healthy subjects,with a transverse diameter of 2.8 mm and a vertical diameter of 2.1 mm in average on MRI.Y-shaped structure is formed between their bilateral the foramen of Monro and the 3rd cerebral ventricle.Very obvious changes in shape and size of the foramen of Monro can be observed in patients with hydrocephalus,which sometimes can integrated with the 3rd cerebral ventricle and lateral ventricle,forming a"rabbit-head sign".Meanwhile, imaging of the foramen of Monro varied in patients with tumor around the foramen,depending on its location and size.Conclusions The foramen of Monro has a relative constant position in the brain.Changes in its position,size and shape are important signs suggesting intracranial lesions.An individualized operation plan for a patient should be determined based on those changes.

Congenital cytomegalovirus (cCMV) infection is a most common congenital infection, which may seriously affect children’s health. The early diagnosis and timely treatment of cCMV are readily missed due to its concealed symptoms, delayed onset and long disease course, leading to long-term disability of the patients. The current screening method is sensitive, non-invasive, inexpensive and convenient, which can effectively reduce the missed diagnosis of cCMV. This article explains the importance of cCMV screening and full course management, focusing on the screening methods, strategies and current problems, as well as the plans of full course management at different stages.

Objective: To analyze the antimicrobial resistance profile in Chinese children. Methods: This was a prevalence survey. From January 1 through December 31, 2016, the isolates were collected from 10 tertiary children hospitals in China. Antimicrobial susceptibility testing was carried out by routine laboratory methods. The penicillin susceptibility of streptococcus pneumonia and Meropenem susceptibility of gram-negative bacteria were detected by E-test and disk diffusion method respectively. Antimicrobial susceptibility results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) Guideline 2016. The data of antimicrobial susceptibility testing of isolates from either the different patients (neonatal group and non-neonatal group) or various sources were analyzed by WHONET 5.6 software. Results: A total of 56 241 isolates were collected, of which 41.5% (23 328 isolates) were gram-positive organisms and 58.5% (32 886 isolates) gram-negative organisms. The five leading pathogens were Escherichia coli (7 995/56 214, 14.2%), Straphylococcus aureus (6 468/56 214, 11.5%), Streptococcus pneumonia (6 225/56 214, 11.1%), Haemophilus influenza (5 435/56 214, 9.7%) and Klebsiella pneumonia (4 523/56 214, 8.0%). The Meropenem resistance rates of Klebsiella pneumonia, Enterobacter cloacae, Escherichia coil, Pseudomonas aeruginosa, Acinetobacter baumonia isolates were 27.4% (326/1 189) , 8.1% (29/358) , 2.0% (27/1 362) , 19.5% (34/174) , 49.7% (230/463) in neonatal group and 15.4% (512/3 327) , 4.8% (40/841) , 2.3% (151/6 564) , 13.7% (252/1 840) , and 53.4% (860/1 611) in non-neonatal group. The Methicillin-resistant Staphylococcus aureus (MRSA) rates of neonatal group and non-neonatal group were 46.2% (649/1 404) and 33.3% (1 668/5 010) . The penicillin non-susceptible rates of Streptococcus pneumonia in the two groups were 17.6% (6/34) and 18.2% (1 121/6 158) respectively. The β-lactamase positive rates of Haemophilus pneumonia isolates in the neonatal group and non-neonatal groups were 33.8% (47/139) and 44.4% (2 345/5 282) respectively. Conclusion This investigation highlights the worrisome trend of antimicrobial resistance in children, especially among neonatal patients in China.

Objective: To describe the clinical characteristics of pneumococcal infections and drug resistance of Streptococcus pneumoniae isolates from children's hospitals, which would provide reference for preventing and treating pneumococcal diseases. Methods: This was a prevalence survey. In this study, the age, specimen type, monthly distribution characteristics, and antimicrobial resistance of Streptococcus pneumoniae isolates from 9 children's hospitals in China were investigated between January 1, 2016 and December 31, 2016. The WHONET 5.6 software was used to analyze the antibiotic susceptibility of Streptococcus pneumoniae. The comparison of rates was performed by Chi-square test. Results: A total of 6 200 isolates of streptococcus pneumoniae were obtained, namely, 95.1% (5 876/6 177) from the respiratory tract specimens, 2.2% (136/6 177) from blood specimens and 0.4% (24/6 177) from cerebrospinal fluid specimens. The isolates were mainly from children older than 1 and younger than 5 years (54.7%, 3 381/6 185) . Most of strains (33.2%, 1 184/3 563) were isolated in November, December and January. Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 6 189/6 189) , linezolid (100.0%, 6 030/6 030) , moxifloxacin (100.0%, 3 064/3 064) , highly sensitive to levofloxacin (99.8%, 5 528/5 540), ertapenem (98.8%, 3 024/3 061) and lowly sensitive to erythromycin (1.7%, 102/6 016), clindamycin (3.7%, 116/3 136), and tetracycline (5%, 244/4 877), respectively. According to the parenteral susceptibility breakpoints for non-meningitis isolates, the sensitivity of Streptocococus pneumoniae to penicillin from children's hospital of Chongqing Medical University (49.3%, 892/1 809) was significantly lower than those of other hospitals (χ²=1 268.161, P<0.05) . Conclusions Streptococcus pneumoniae is mainly isolated from respiratory tract, from children older than 1 and younger than 5 years and during November to January in tertiary children's hospital of China. The Streptococcus pneumoniae from children is highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin. There are also significant differences in the sensitivity of penicillin for Streptococcus pneumoniae from different hospitals.

Objective:To investigate the clinical and epidemiological features of acute respiratory adenovirus infection in children.Methods:Clinical data of 488 children with acute respiratory tract human adenovirus (HAdV) infection admitted in Children’s Hospital of Zhejiang University School of Medicine from September 2018 to August 2019 were retrospectively analyzed. Nasopharyngeal swabs or nasopharyngeal aspirates (NPAs) were collected and tested by direct immunofluorescence assay. Kruskal Wallis H test was used for quantitative data without normal distribution, and P<0.05 was considered to be statistically significant. The qualitative data were compared by chi-square test or Fisher’s exact test. Bonfereoni chi-square segmentation was performed for comparison between groups, and P<0.007 was considered statistically significant after correction. Results:A total of 488 HAdV positive cases were detected from 7 072 patients with acute respiratory tract infection (6.9%), including 305 males (62.5%) and 183 females (37.5%). The median age of HAdV positive children was 43 months (39 days to 12 years). The detection rate in 6 m-<2 y age group(8.7%, 123/1 408)was significantly higher than those in <6 m group (3.0%, 6/197)and ≥5 y group(4.6%, 89/1 948)( χ2=7.57, 23.98, P all <0.007). The detection rate in 2-<5 y group(7.7%, 270/3 519)was significantly higher than those in <6 m group and ≥5 y group ( χ2=5.809, 19.688, P all <0.007). The peak rate was detected in the winter [12.9%(238/1 840)] which was significantly higher than those in spring (4.7%), summer (3.9%), and autumn(5.5%)( χ2=103.477, 58.986 and 49.926, P<0.007). The average length of hospital stay was (6±4)d(1-41 d). 486 cases (99.5%) were discharged from hospital after treatment, and 2 cases died. There were 111 cases (22.7%) of acute upper respiratory tract infection, 34 cases (7.0%) of bronchitis and 343 cases (70.3%) of pneumonia; and severe pneumonia was diagnosed in 86 cases (25.1%, 86/343). The common clinical manifestations were fever 93.4% (456/488), cough 94.7% (462/488), wheezing 26.2% (128/488) and shortness of breath 14.8% (72/488). 138 cases (28.3%) had extrapulmonary symptoms, 78 cases (16.0%) had underlying diseases, among which congenital heart disease was most common (16, 3.3%). The average duration of fever was(8.8±2.4)d(5-17 d)in 456 fever cases, the duration between 7-10 d in 277 cases and >10 d in 96 cases; and 439 cases had hyperpyrexia(≥39 ℃). The single infection occurred in 275 (56.4%) cases and mixed infection in 213(43.6%) cases. The proportions of fever, hyperpyrexia, fever duration >10 d, severe pneumonia, wheezing and length of hospital stay in mixed infection group were significantly higher than those in the single infection group ( χ2/ Z=11.960, 6.494, 37.209, 72.841 and -8.805, P all <0.05). The length of hospital stay, proportion of fever time>10 d, wheezing, shortness of breath, hypersomnia/poor spirits, serous effusion, extrapulmonary symptoms, mixed infection, and underlying diseases in severe pneumonia group were significantly higher than those in the mild pneumonia group ( χ2/ Z=-9.182, 23.825, 49.094, 143.627, 219.659, 81.327, 8.080, 21.546 and 10.556, P all <0.05). The proportion of severe pneumonia in 6 m to <2 y group was higher than that in 2-<5 y group and ≥5 y group( χ2=20.709, 8.603, P all <0.007). Conclusions:HAdV is an important pathogen of acute respiratory infection in children. HAdV infection occurs mainly in children aged from 6 month to 2 years and has a high detection rate in winter. Children aged 6 months to 2 years with wheezing, shortness of breath, underlying diseases, extrapulmonary symptoms and mixed infections are more likely to develop severe pneumonia.

Objective: To explore the role of mobile phone addiction and anxiety symptoms in the relationship between childhood psychological abuse and depressive symptoms among college students, in order to provide a basis for mental health promotion. Methods: From February to May 2023, a stratified random sampling method was used to select 1 799 freshmen to juniors from a university in Wuhu City, Anhui Province. The questionnaire survey was conducted using the 2-item Patient Health Questionnaire (PHQ-2), Child Psychological Maltreatment Scale (CPMS), Mobile Phone Addiction Tendency Scale (MPATS), 2-item General Anxiety Disorder (GAD-2). Correlations among each variable were analyzed, and the chain mediating effect of mobile phone addiction and anxiety symptoms was explored. Results: The detection rate of depressive symptoms among college students was 9.7%, and the positive detection rate of childhood psychological abuse was 28.6%. Depressive symptoms were positively correlated with childhood psychological abuse, mobile phone addiction and anxiety symptoms ( r =0.28, 0.32, 0.27, P <0.01). Childhood psychological abuse was positively correlated with mobile phone addiction and anxiety symptoms ( r =0.29, 0.71, P <0.01). Mobile phone addiction and anxiety symptoms were positively correlated ( r =0.30, P <0.01). Childhood psychological abuse could effectively predict depressiove symptoms, mobile phone addiction and anxiety symptoms ( β =0.08, 0.06, 0.66, P <0.01). Mobile phone addiction and anxiety symptoms had a chain mediating effect between childhood psychological abuse and depression symptoms, with a total indirect mediating effect (effect=25.27%, P <0.05), accounting for 72.44% of the total effect. Conclusions Mobile phone addiction and anxiety symptoms play a chain mediating role between childhood psychological abuse and depressive symptoms. Focusing on childhood psychological abuse, mobile phone addiction and anxiety among college students are beneficial for depression symptoms prevention.

Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.

TORCH, which is considered as a series of pathogens, including the Toxoplasma gondii, Rubella virus, Cytomegalovirus or Herpes simplex virus, often infects the pregnant women to induce the the fetus or newborn infection by transplacental infection or exposure to contaminated genital tract secretions at delivery. Increasing evidence have been confirmed that the infection of TORCH may cause the miscarriage, premature birth, malformed fetus, stillbirth, intrauterine growth retardation, neonatal multiple organ dysfunction and other adverse pregnancy outcomes. For most TORCH-infections cases may lacking the effective treatments during pregnancy, and it is important to achieve the effacing monitoring of TORCH infections before and during pregnancy. The laboratory testing of TORCH has the great significance. However, the consensus opinions still need to improve the the standardization of TORCH testing process and the correct interpretation. Based on the characteristics of the TORCH detection method, this article gives a consensus opinion on the standardized detection and clinical application of TORCH from the laboratory perspective according to the characteristics and types of infection of different pathogens.

Objective To establish the musculoskeletal multi-body dynamic foot-ground contact model and explore its applicability at different speed. Methods The gait data of the subjects at different speed were collected, and the foot-ground contact model was established based on the full body model from the musculoskeletal multibody dynamic software AnyBody. Then the calculated ground reaction forces (GRFs) and ground reaction moments (GRMs) at different speed (slow walking, normal walking, fast walking and jogging) were compared with the measurements from the force plates. Results The predicted GRFs and GRMs correlated well with the experimental measurements at slow, normal and fast speed (stride speed ranged from 0.69 to 1.68 m/s). The correlation coefficients between predicted and measured GRFs were greater than 0.875 and the correlation coefficients for GRMs were greater than 0.9. Conclusions The developed foot-ground contact model could simultaneously predict GRFs and GRMs with good accuracy, thus eliminating the dependency on force plates. The model could be applied to low-speed gait conditions, such as the elderly and pathological gait.