Esophageal submucosal hematoma is rarely seen in clinical practice and its clinical presentations are untypical.Gastroscopy might injure the esophageal mucosa and cause bleeding.Computed tomography had the advantages of quick examination and formation of imaging,as well as non-invasiveness,which is helpful for the diagnosis and differential diagnosis of the esophageal submucosal hematoma.The clinical data of 9 patients with esophageal submucosal hematoma who were admitted to the Yueqing People's Hospital,the First Affiliated Hospital of Wenzhou Medical University,the First Affiliated Hospital of the Zhengzhou University and the Third People's Hospital of Wenzhou from July 2005 to February 2014 were retrospectively analyzed.The features of computed tomography examination of esophageal submocosal hematoma include the range of the esophageal submucosal hematoma exceeds 2 parts of the esophagus,the rip of the esophageal mucosa begins and ends at the physiological narrowing of the esophagus,thickening of the esophageal wall,stricture of the esophagus,annular thickening and eccentric thickening of the esophageal wall,crescent,spot or gas shadows of the esophageal cavity,the density of the hematoma decreases as the time passed by.These features of computed tomography are of great importance for the diagnosis of esophageal submucosal hematoma.

Immune tolerance after liver transplantation refers to discontinuing use of immunosuppressants in varying patterns and maintaining the long-term stability of liver function of the recipients. At present, immune tolerance may be achieved by passive immune tolerance, active operational immune tolerance and induced immune tolerance. Multiple clinical trials have confirmed the safety and feasibility of these approaches. Compared with adults, pediatric recipients undergoing liver transplantation have better potential of immune tolerance, especially the living donor liver transplant recipients. Nevertheless, it remains a challenge to predict whether a certain individual may achieve immune tolerance. In this article, research progresses on the characteristics of immune tolerance in pediatric recipients, induction of immune tolerance, operational immune tolerance, induced immune tolerance, screening of recipients and tolerance markers were reviewed, aiming to provide reference for the formulation of postoperative immunosuppressant regimens, reduce the overall exposure to immunosuppressants and lower the risk of adverse reactions induced by immunosuppressants in children undergoing liver transplantation.

Objective:To learn about the epidemic dynamics and spatial epidemic characteristics of human brucellosis in Gansu Province.Methods:Data on human brucellosis in Gansu Province reported by China Disease Control and Prevention Information System from January 2016 to December 2020 were collected and analyzed by descriptive epidemiology and spatial clustering analysis.Results:A total of 10 025 cases of human brucellosis were reported in Gansu Province from 2016 to 2020, with a statistically significant difference in incidence rate between years (χ 2 = 242.86, P = 0.001). The incidence was the lowest in 2018 (6.03/100 000), and the highest in 2020 (11.39/100 000). The reported cases were concentrated in 45 - 55 years old, accounting for 34.52% (3 461/10 025); the male to female ratio was 2.91 ∶ 1.00 (7 458/2 567); farmers were the main occupation, accounting for 82.11% (8 232/10 025). Among the 86 counties (cities, districts) in Gansu Province, Yongchang County had the highest number of reported cases in 2020 (339 cases), and Sunan Yugur Autonomous County had the highest incidence in 2020 (190.89/100 000). Spatial autocorrelation analysis showed that there was significant spatial positive correlation between the incidence rate of human brucellosis in Gansu Province from 2016 to 2020 (global Moran's I > 0, Z > 1.96, P < 0.05), showing a spatial clustering distribution. The high-high clustering areas were concentrated in Yongchang County and Sunan Yugur Autonomous County. Conclusion:In Gansu Province, the main population of human brucellosis is middle-aged male farmers, and the incidence of brucellosis is spatially clustered.

Objective:To analyze the changes of spatial, seasonal, and age distribution of brucellosis among humans and animals in Gansu Province and to provide a reference for the next step in formulating prevention and control measures.Methods:Reported data of brucellosis of humans and animals in Gansu Province from 2018 to 2020 were collected. The human epidemic data were obtained from "China Disease Control and Prevention Information System", and the positive data of animals were obtained from the monthly report provided by Gansu Animal Disease Control Center. Human brucellosis was classified and analyzed according to year, month, age and region, and livestock brucellosis was classified according to year, month, population and region. ArcGIS 10.2 software was used to analyze the spatial epidemiological characteristics of the data. Measuring Geographic tool was used to calculate the shifting distance of the center of the disease incidence in humans and animals from 2018 to 2020.Results:From 2018 to 2020, a total of 6 375 cases of human brucellosis were reported in Gansu Province. The 40 - 59 age group accounted for 54.96% (3 504/6 375), 1 584 cases were reported in 2018, 1 787 cases were reported in 2019, and 3 004 cases were reported in 2020. The high incidence time of human brucellosis was July and November. A total of 48 180 brucellosis-positive animals (heads) were detected, of which 47 342 were positive sheep, accounting for 98.26% (47 342/48 180). The high incidence time of brucellosis among animals was October. Among the 14 cities (prefectures), the top cities of livestock brucellosis reported were Qingyang City, Zhangye City and Jiuquan City. The center of disease incidence among humans was located in Gulang County, Wuwei City. The center of disease incidence among animals was located in Wuwei City in 2018 and Qingyang City in 2020.Conclusions:The cases of brucellosis in humans and animals in Gansu Province are on the increase. In some areas, there are problems of separation of human and animal epidemics. It is necessary to actively strengthen monitoring and implement measures to prevent and control brucellosis in humans and animals in high-risk areas to curb the spread of the epidemic.

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 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.