Objective To investigate the pathotypes,epidemiological characteristics and antimicrobial resistance of diarrheagenic Escherichia coli (DEC) in children with acute bacterial diarrhea in Shanghai.Methods A total of 2 071 outpatient children with probable acute bacterial diarrhea referred to the enteric clinic of Children's Hospital of Fudan University during June 2012 to June 2014 were enrolled in our study.The stool samples were processed for routine microbiologic and biochemistry tests to identify enteric bacteria,including enteropathogenic Escherichia coli (EPEC),enterotoxigenic Escherichia coli (ETEC),enteroinvasive Escherichia coli (EIEC) and enterohemorrhagic Escherichia coli (EHEC).Kirby-Bauer method was used to identify the antibiotic sensitivity.Difference of means between groups was compared by chi-square test.Results Of 2 071 enrolled children,DEC were identified in 145 (7.0 ％)cases.148 strains were isolated with three of mix infection strains.All DEC isolates in this study included 106 (71.6％) EPEC,24 (16.2％) ETEC,16(10.8％) EIEC and 2(1.4％) EHEC.The median ages of diarrheal children with DEC infections were 14 months (range:3 months to 13 years) and 62.8％ of them were ＜2 years.Among 125 DEC isolates tested for antimicrobial susceptibility,the rates of resistance to ampicillin,trimethoprim-sulfamethoxazole,cefotaxime,cefepime,gentamicin,ceftazidime,amoxicillinclavulanate,ciprofloxacin,and ofloxacin in a descending order were 55.2％,35.2％,28.0％,27.2％,23.2％,8.8％,5.6％,4.0％ and 4.0％,respectively.Resistance rates of EIEC to cefotaxime,cefepime and ceftazidime were 50.0％,43.8％ and 25.0％,respectively,which were higher than those of EPEC,ETEC and EHEC.Conclusion DEC is the important enteric bacteria that causes bacterial diarrhea in children in this study.

Objective:To explore the influence on inflammation cytokines for anti-IL-1βand TNF-αIgY intranasal treatment in guinea pigs with allergic rhinitis.Methods:The allergic rhinitis model in guinea pigs was established using ovalbumin(OVA).Hartley guinea pigs were randomly divided into the control group(group C,n=17),the allergic rhinitis model group(group M,n=27),the 0.1%anti-IL-1βand TNF-αIgY treatment group(group Z1,n=21)and the fluticasone propionate treatment group(group Z2,n=21). At 2 h,4 h and 8 h after the last treatment,blood was got by heart puncture,as well as nose was lavaged using 0.9% saline and the nasal lavage fluid( NLF) was collected.The level of cytokines was examined using ELISA kits.Results: In the peripheral blood, the levels of IL-1β,IL-5,IL-9,IL-13,IL-18,IL-33 and TGF-β1 from 2 h to 8 h;TNF-αand OVA-specific IgE from 2 h to 4 h;and IL-22 from 4 h to 8 h were significantly decreased in the 0.1%anti-IL-1βand TNF-αIgY treatment group compared with the allergic rhinitis model group(P<0.05).In the NLF,the levels of IL-1β,IL-5,IL-9,IL-13,IL-22,IL-33,TNF-α,TGF-β1 and OVA-specific IgE from 2 h to 8 h;and IL-18 at 2 h were significantly decreased in the 0.1% anti-IL-1βand TNF-αIgY treatment group compared with the allergic rhinitis model group ( P<0.05 ) .Conclusion: Anti-IL-1βand TNF-αIgY intranasal treatment can significantly reduce inflammation cytokine levels in allergic rhinitis guinea pigs.

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai .Methods An active surveillance study in Children′s Hospital of Fudan University between August 2013 and July 2014 was conducted .Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected .Pathogens including norovirus ,diarrheagenic Escherichia coli (DEC) , nontyphoidal Salmonella spp .(NTS),Campylobacter,Shigella,pathogenic vibrio and Yersinia enterocolitica were identified and typed .The χ2 test was used for statistical analysis .Results Of the 881 stool samples from enrolled children , the pathogens included into the target detection were identified in 246 (27 .92% ) cases . Norovirus ,DEC ,NTS ,Campylobacter and Shigella were detected in 98 (11 .12% ) cases ,74 (8 .40% ) cases , 61 (6 .92% ) cases ,34 (3 .86% ) cases and 2 (0 .23% ) cases ,respectively .Neither pathogenic vibrio nor Yersinia enterocolitica was identified .Children younger than 36 months old (3 .27% ,26/794) had a lower risk (χ2=7 .41 ,P=0 .006) of Campylobacter infection compared with older children (9 .20% ,8/87) .Vomiting (37 .76% ) and watery diarrhea (21 .34% ) were more commonly seen in children with norovirus infection;fever and mucous stool were commonly seen in diarrheal children with NTS infection (40 .98% and 21 .31% ,respectively) and Campylobacter infection (29 .41% and 26 .47% ,respectively) .Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai .Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children .

Objective To understand the clinical epidemiology and manifestation of nontyphoidal Salmonella (NTS)enteric infections and serotypes and antibiotic resistance patterns of NTS in children.Method All cases with probable acute bacterial inflammatory diarrhea were included into this study from the Children's Hospital of Fudan University during January 2012 through December 2014.Salmonella species and other major enteric bacteria were routinely isolated from the fresh stool sample of the enrolled patients at their first visit to the enteric clinic.Salmonella isolates were serotyped and tested for antimicrobial susceptibility testing using Kirby-Bauer method at the reference laboratory of Shanghai Municipal Center for Disease Control and Prevention.All enrolled cases had clinical records.The enumeration data were described by constituent ratio.Result Of the enrolled 3 143 patients,742 (23.6％) were confirmed to have Salmonella infections,and NTS was identified in 738 (23.5％) cases and Salmonella Paratyphi B was identified in 4 (0.1％) cases,respectively.The isolation rate of NTS exceeded diarrheagenic Escherichia coli (6.7％,182/2 727),Campylobacter (4.1％,129/3 143) and Shigella (2.4％,77/3 143).Nine serogroups and 41 serovars were identified in 742 salmonella isolates.Salmonella Enteritidis and Salmonella Typhimurium were the most common serovars,representing 42.6％ (316/742) and 28.2％ (209/742) of isolates,respectively.NTS infections were prevalent year-round with a seasonal peak from May to October.The common symptoms included tever (57.5％,424/738) and blood-in-stool (31.0％,229/738).Antimicrobial susceptibility showed only 8 (1.1％) of 742 isolates sensitive to 16 tested antibiotics.Resistance to the current first-line antibiotics such as the third-generation and (or) fourth-generation cephalosporins (cefotaxime and cefepime),ciprofloxacin was detected in 10.0％ (74/738),8.1％ (60/738) and 1.1％ (8/738),respectively.Conclusion NTS is the leading causative agent responsible for bacterial inflammatory diarrhea in Shanghainese children.The prevalence of NTS enteric infections show an increasing trend year by year.It is essential to continuously monitor the antimicrobial resistance of NTS and trace the source of infection to prevent and treat NTS infections in Shanghai.

Objective To explore the effects of cognitive behavioral therapy on negative emotions and treatment compliance in patients with coronary heart disease. MethodsFrom June 2015 to June 2017, we selected 86 patients with coronary heart disease at Beijing Longfu Hospital as subjects by convenience sampling. All of patients were divided into observation group (n=43) and control group (n=43) with the random number table. Control group carried out routine nursing. On the basis of routine nursing, observation group implemented cognitive behavioral therapy. The intervention effects were evaluated with the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and self-designed compliance questionnaire. ResultsAfter intervention, the scores of SAS and SDS of patients in observation group were lower than those in control group with statistical differences (P＜ 0.05). Patient compliance of observation group was better than that of control group after intervention with a statistical difference (P＜ 0.05).Conclusions Cognitive behavioral therapy can improve patients' anxiety, depression, patients' treatment compliance which has great clinical significance.

Objective To understand the regional epidemiology and antibiotic resistance pattern of diarrheagenic E .coli infection in children ,and to clarify the pathogenic association between diarrheagenic E .coli infection and childhood diarrhea .Methods Totally 680 diarrheal children in the outpatient setting and 680 non-diarrheal control children were enrolled prospectively .The stool samples were collected and the potential enteric pathogens were detected .Minimal inhibitory concentration (MIC) method was used to determine the antimicrobial susceptibility for diarrheagenic E .coli isolates .Results The isolation rates of diarrheagenic E .coli in diarrhea group and control group were 15 .6％ and 13 .1％ ,respecitvely ,and diarrheagenic E .coli was the most commonly detected enteric bacteria .Multivariate logistic regression analysis adjusted for age suggested no clinical association between diarrhea and infection with enteropathogenic E .coli (EPEC) (aOR=1 .2 ,95％ CI:0 .8-1 .8) ,enteroadhesive E .coli (EAEC) (aOR=1 .1 ,95％ CI:0 .7 -1 .6) and enterotoxigenic E .coli (ETEC) (aOR= 1 .8 ,95％ CI:0 .5 -6 .2) . Among 199 diarrheagenic E .coli strains ,the rates of resistance to ampicillin ,tetracycline ,trimethoprim-sulfamethoxazole ,azithromycin ,and ceftriaxone were 63 .8％ ,55 .8％ ,48 .2％ ,34 .2％ and 26 .6％ , respectively ,while the rates of resistance to ciprofloxacin , amoxicillin-clavulanate and cefoxitin were 4 .5％ ,1 .5％ and 0 .5％ ,respectively .Conclusions Diarrheagenic E .coli is the most common enteric bacteria detected in the stool samples from children with and without diarrhea in this study . The pathogenic role of infections with EPEC ,EAEC and ETEC in childhood diarrhea is not determined .EHEC and EIEC are rarely detected and further studies are needed to clarify the pathogenic association between infection with EHEC ,EIEC and childhood diarrhea .

Objective:To investigate the serum measles antibody in children with tumor and to provide the clinical evidence for measles vaccination strategy for this special population.Methods:From January 2016 to December 2018, the blood samples of children who were diagnosed with hematological malignancy or solid tumors and received chemotherapy in the Department of Hematology or Oncology Surgery of Children′s Hospital of Fudan University were collected. Enzyme-linked immunosorbent assay was used to quantitatively detect the level of measles IgG antibody, and dynamically monitor the changes of measles antibody level during chemotherapy. Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 441 children with tumors were enrolled, with the positive rate of measles antibody of 79.1%(349/441), and only 43.3%(191/441) of children had the protective level of IgG antibody. There was a statistically significant difference of the antibody protection rate in children aged0.05). The protection rate of serum measles antibody in children with hematological malignancy and solid tumor were 45.6%(78/171) and 41.9%(113/270), respectively, and there was no statistically significant ( P>0.05). There were 16.3%(16/98) of children who were observed to lose the pre-existing protective antibody during chemotherapy. There was no statistically significant difference of the protection rate of serum among children who had finished chemotherapy 0.05). Conclusions:Serum measles antibody is below the protective level in more than 50% of children with malignancy after chemotherapy. Chemotherapy can compromise the protective antibody against measles. It is recommended for this special population to re-schedule measles vaccine after individualized evaluation to acquire the immuneprotection against measles.

Objective:To describe the clinical features of liver involvement in children and adolescent with 2019-nCoV infection.Methods:The clinical data of 77 hospitalized cases admitted to the Children’s Hospital of Fudan University were collected from January 19 to November 28, 2020. The characteristics and risk factors of abnormal liver chemistries in children with laboratory-confirmed 2019-nCoV infection were analyzed.Results:Of the 77 cases, 44 were male (57.1%) and 33 were female (42.9%), with a median age of 10 years. 27(35.1%) were asymptomatic, 28(36.4%) had mild illness, 22(28.6%)had non-severe pneumonia. Hydroxychloroquine was used in 7 cases. Of the 75 children without underlying diseases, alanine aminotransferase was elevated in 1 case (1.5%, during hydroxychloroquine therapy), aspartate aminotransferase was elevated in 7 cases (10.3%), alkaline phosphatase was elevated in 7 cases (28%), and total bilirubin, direct bilirubin, albumin, international normalized ratio were in normal range. There was no statistical difference between the pneumonia group and the non-pneumonia group in term of liver chemistries ( P > 0.05), same as between the elevated erythrocyte sedimentation rate group and the normal group. There was no aggravation of liver injury in the child with biliary atresia. The child with epilepsy showed no abnormal liver chemistries after infection. Conclusion:Children with 2019-nCoV infection had mild clinical symptoms with few cases of liver injury. The abnormal liver chemistries in children with COVID-19 infection may be related to the underlying disease and the use of antiviral drugs.

Objective:To investigate the gap between the health education and the best evidence among nurses and patients with postdialysis fatigue (PDF) , find out the problems and analyze the reasons, and provide a reference and basis for future clinical nursing decisions among the dialysis room nurses.Methods:By searching the evidence-based guideline websites and integrating the best evidence comprehensively, a health knowledge questionnaire for dialysis room nurses and patients with PDF was made. In December 2018, a total of 7 nurses and 56 patients in the dialysis room of Dongzhimen Hospital, Beijing University of Chinese Medicine were selected by purpose sampling method, and they were investigated by the health knowledge questionnaire for dialysis room nurses and patients.Results:The score of the PDF knowledge questionnaire for the 7 nurses was (56.43±4.37) , with a highest score of 64 and a lowest score of 51, and the standard-reaching rate was 28.57% (2/7) . The score of the PDF knowledge questionnaire for the 56 patients was (52.41±9.54) , with a highest score of 70 and a lowest score of 20, and the standard-reaching rate was 28.57% (16/56) . Patients and nurses received verbal health education and small lectures in the department, and there was no unified education content.Conclusions:There is no unified and scientific education content nor standardized education model. Evidence-based health education should be carried out for nurses to improve the awareness of nurses and patients in this regard, thereby reducing patients' fatigue.