AIM: To investigate the change of estrogen receptor (ER) in hippocampus, hypothalamus and pituitary of female rats exposed to psychological stress, and to illuminate the mechanism of dysfunction on ovarian reproductive endocrine function. METHODS: Sound, light and electricity were combined into a psychological stressful stimulus to induce female rat dysfunction on ovarian reproductive endocrine function. Immunohistochemical technique and image analysis were used to assess the expression levels of ER in hippocampus, hypothalamus and pituitary. RESULTS: When exposed to compound stressful stimulus of sound, light and electricity for 20 days in female rats, the expression levels of ER in hippocampus, hypothalamus and pituitary dropped. CONCLUSION: The decrease in estrogen receptor expression in hippocampus, hypothalamus and pituitary of female rats exposed to psychological stress may be one of the mechanisms of ovarian reproductive endocrine dysfunction.

Objective To investigate the clinical significance of nuclear factor ( NF)-κB activation in peripheral blood mononuclear cells (PBMCs) and the serum levels of correlated inflammatory cytokines in children with infant muggy syndrome(IMS).Methods Blood samples from 100 patients with IMS and those from 32 healthy infants( control group)were detected by ELISA for amount of NF-κB activation in PBMCs and for serum levels of interleukin ( IL ) -17,IL-6,tumor necrosis factor ( TNF ) -α and IL- 10 respectively from Jan 2008 to Jan 2011.At the same time,blood samples from 46 out of the above 100 patients with IMS and those from the 32 controls for positive rate of activation of NF-κB in PBMCs were detected by flow cytometry as well.The relationship between all the data and multiple organ dysfunction syndrome( MODS ) were analyzed respectively.Results As compared with that of control group,the percentage of activated NF-κB in PBMCs in 100 patients with IMS detected by ELISA [ ( 11.042 ± 6.792 ) ％ vs ( 4.528 ± 1.378 ) ％ ] and the positive rate of NF-κB activation in 46 patients with IMS detected by flow cytometry [ ( 28.780 ± 13.820 ) ％ vs (7.078 ±5.395)％ ] were both significantly higher ( P ＜0.01 ).The serum levels of IL-17,IL-6 and IL-10were also significantly higher in patients with IMS than those in control group( P ＜0.01 ).The serum level of TNF-α was higher in patients with IMS than that in control group but without significance( P ＞ 0.05 ).The percentage of activated NF-κB [ ( 14.591 ± 7.626) ％ vs ( 8.576 ± 4.851 ) ％ ],the positive rate of NF-κB activation [ ( 36.087 ± 12.056) ％ vs ( 23.590 ± 11.263 ) ％ ],and the serum levels of IL- 17,IL-6,TNF-α and IL-10 were all significantly higher in IMS patients with MODS than those in IMS patients without MODS ( P ＜ 0.01 ).Conclusion The inflammatory factors of NF-κB activation in PBMCs and the high serum levels of IL-17 and IL-6 are potent to cause inflammatory damage in IMS patients,and the serum level of IL-10 is not able to compensate the damage.The activation of NF-κB and high serum levels of IL-17,IL-6 and TNF-α are correlated with MODS.

Objective To investigate molecular epidemiology and antimicrobial susceptibility of Salmonella spp. isolates recovered from the stool samples of children with diarrhea. Methods Seventy-two isolates of Salmonella spp. were collected from children with diarrhea. The serum type of Salmonella spp.was determined by serology agglutinating method. Antimicrobial susceptibility was determined by K-B disk diffusion method and MICs of cefotaxime and ceftazidime were measured by agar dilution method for Salmonella spp. isolates. PCR and DNA sequencing were used for detecting ESBL, ISEcpl and AmpC genes; The transfer of cefotaxime resistance was determined by conjugation experiments. PFGE was performed for determining the homogeneity of the S. typhimurium isolates. Results A total of 72 isolates of Salmonella spp. were collected, among which S. typhimurium accounted for 86 % (62/72) and was the main serum type. S. typhimurium isolates and S. thompson isolates were often resistant to most of clinically used antimicrobial agents. Resistance of S. thompson isolates to ampicillin was the highest (90%, 56/62),followed by tetracycline (81%, 50/62), trimethoprim/sulfamethoxazole (74%, 46/62) and chloramphenicol (66%, 41/62). Seventeen S. typhimurium isolates (27%, 17/62) and two S. thompson isolates were resistant to cefotaxime. Forty-nine S. typhimurium isolates and two S. thompson isolates were positive for blaTEB-1b and resistant to ampicillin. Thirteen ESBL-producing S. typhimurium isolates (21%, 13/62) were positive for blaCTX-M (eight for blaCTX-M-14, three for blaCTX-M-15, one for blaCTX-M-55, one for both blaCTX-M-14 and blaCTX-M-55). All isolates harboring blaCTX-M genes were positive for upstream insert sequence ISEcpl. blaDHA-1was detected in a cefoxitin-resistant S. thompson isolate. Two main clones (PFGE type A and D) accounting for 19% (12/62) and 50% (31/62) respectively were found among 62 S. typhimurium isolates. Seven CTXM-producing isolates belonged to PFGE type D. Conclusions The multi-resistance to antimicrobial agents and high prevalence of blaCTX-M genes are found among S. typhimurium and S. thompson clinical isolates. blaCTX-M-55 is first found in S. typhimurium isolates and blaDHA-1 is found in S. thompson isolates. Clonal spread is responsible for the dissemination of S. typhimurium isolates.

Objective To quantitatively analyze the early warning value of laboratory indexes for death risk in children with criti ‐cal hand foot and mouth disease (HFMD) .Methods The univariate and multivariate Logistic regression analysis were conducted to explore the independent risk factors of death in critical HFMD children .Then the area under receiver operating characteristic curve (AUC) was applied to give the comprehensive assessment of the test model ,as well as the early warning capacity and the optimal cut‐off level of laboratory indexes in critical HFMD children .Results The AUC of the Logistic regression model (Y ) established based on white blood cell ,neutrophil ,myoglobin ,creatinine for early predicting the death risk in critical HFMD children patients was 0 .847 (95% CI :0 .783 - 0 .911) ,which indicating that its diagnostic value was superior to single index .Conclusion The diag‐nostic value of the Y model established based on four indexes of white blood cell count ,neutrophile granulocytes count ,myohemo‐globin and creatinine is superior to any single index ,which has the better early warning value for the death risk in children with crit‐ical HFMD .

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.

Objective To explore the genetic variation in children patients with esophageal atresia (EA ) to provide a prophase basis for further studying EA pathogenesis .Methods Ten children cases of EA were collected from the neonatal surgery department of our hospital .The high-throughput whole-exon sequencing was used to study the genetic variations ,and their clinical significance was analyzed by the bioinformatics methods .Results In the high quality sequencing data ,the effective clean reads accounted for 85 .36% ,in which 97% of the clean reads could participate in the comparison with the reference genes .The comparison analysis obtained 520541 single nucleotide polymorphism sites ,in which single nucleotide variation(SNV) occurred at 149622 sites ,including synonymous mutation ,nonsynonymous mutation ,stop codon gain ,stop codon loss ,frameshift insertion ,nonframeshift insertion ,unknown mutation ;meanwhile ,598 copy number variation genes were detected .The functional cluster analysis revealed that the mutant genes were closely related to cell biology .Conclusion The SNV occurrence may influence the expression and function of body various proteins and may play an important role in EA pathogenesis .

Objective:To compare the in vitro antibacterial activities of Cefpodoxime proxetil and Cefixime against common pathogens of community acquired pneumonia in children, and to provide basis for guiding the rational use of antibiotics in clinical practice. Methods:The pathogens of 100 cases of community acquired pneumonia in Children′s Hospital of Jiangxi Province from June 2018 to October 2019 were analyzed retrospectively.The sensitivity and resis-tance of these pathogens to Cefpodoxime proxetil and Cefixime were measured separately by the broth dilution method (tube) recommended by the Clinical & Laboratory Standards Institute (CLSI), and the results were compared.Results:(1)The 50% minimum inhibitory concentration(MIC 50) and MIC 90 values of Cefpodoxime proxetil to Streptococcus, Haemophilus influenzae and Moraxella catarrhalis were all within the sensitive range, showing that Cefpodoxime proxetil had a strong antibacterial effect.The MIC 50 values of Cefixime to Streptococcus pneumoniae and Haemophilus influenza were within the sensitive range, while the MIC 90 values showed that these two types of bacteria were resistant to Cefixime.The remaining bacteria were resistant to Cefpodoxime proxetil and Cefixime to varying degrees.(2)The minimum bactericidal concentration (MBC) ranges of Cefpodoxime proxetil to Streptococcus pneumoniae and Haemophilus influenzae were significantly lower than those of Cefixime to these two types of bacteria, indicating that Cefpodoxime proxetil had stronger bactericidal activities than Cefixime.The MBC 50 and MBC 90 values of the two drugs to Moraxella catarrhalis, β-Streptococcus pyogenes and Streptococcus lactis were still within the sensitive range of MIC, suggesting that both drugs had a strong bactericidal effect.The remaining bacteria showed resistance to the two drugs to varying degrees.(3)The sensitivity rates of 100 selected pathogens to Cefpodoxime proxetil and Cefixime were 70.00% (70/100 strains) and 57.00% (57/100 strains), respectively.The resistance rates of the 100 pathogens to the two drugs were 22.00% (22/100 strains) and 39.00% (39/100 strains), respectively, and the difference between the two groups was statistically significant ( χ2=7.40, P=0.03). Conclusions:Cefpodoxime proxetil has high sensitivity to common pathogens of children with community-acquired pneumonia, so it can be used as the initial empirical treatment of respiratory tract bacterial infection in children.It is also an appropriate sequential antibiotic therapy for common respiratory tract bacterial infection in children.

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 biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.