Child ; Hepatitis B ; immunology ; prevention & control ; Hepatitis B Vaccines ; administration & dosage ; therapeutic use ; Humans ; Patient Acceptance of Health Care ; Vaccination

Objective To investigate the mRNA response of type1 and type2 cytokines in immunization failure children who were infected hepatitis B virus (HBV) via placenta from HBV carrier mothers. Methods All subjects were born to HBV carrier mothers and received hepatitis B immunoprophylaxis treatment according to routine schedule. Interleukin-4 (IL-4) and interferon-gamma (IFN-?) transcription of peripheral blood mononuclear cells upon lectins or two-doses of HBsAg from 29 children with persistent HBV infection since birth (Nonresponders), 9 with transient HBV infection at birth and at less than 6 month of age (Responders) were analyzed by semi-quantitative RT-PCR. 25 children with positive anti-HBs response and never positive HBsAg were used as controls. Results Nonresponders expressed a marked higher spontaneous IFN-? mRNA transcription than controls (95% confidence interval is 1665～3089 in nonresponders,763～1609 in controls, P=0.008). Upon two doses of HBsAg stimulation, all three groups expressed a higher IFN-? mRNA transcription than spontaneous transcription, but the increase in nonresponders is lower than controls (95% confidence interval by low dose of HBsAg is 899～1703 in controls, 170～854 in nonresponders,P=0.004). The responders expressed a significant increase of IL-4 mRNA transcription upon high-dose HBsAg stimulation but not in nonresponders (95% confidence interval of the increase in controls is 213～861, P=0.011). Positive correlations were found between ALT level and the IFN-? mRNA transcription upon lectins stimulation and between ALT level and IFN-? mRNA/IL-4 mRNA ratio upon high-dose HBsAg stimulation.Conclusions Low responses of type 1 and type 2 cytokines transcription upon specific stimulation exist in intrauteral infected hepatitis B immunization failure children, and the over response of type 1 cytokine upon nonspecific stimulation may contribute to the liver injury in nonresponders.

In order to investigate the occurrence of chronic hepatitis B virus(HBV) infection in HB vaccine inoculated infants born to HBsAg positive mothers and its affecting factors and also to study the effect of combined use of HB immunoglobulin (HBIG) and HB vaccine on the blocking of perinatal transmission of HBV, we divided 624 infants born to HBsAg positive mothers into two groups randomly. The first group of infants were simply vaccinated with HB vaccine 20μg at,0, 1, 6 months old. The second group of infants were inoculated with HBIG 100 IU at their birth and further vaccinated with HB vaccine 20μg at 1,2,7 months old. The HBsAg of the two groups of infants was tested at the age of 1,3,6,12,18,24 months old and every year by EIA. They were all followed up for 6.34±1.71 years averagely. The follow-up results showed that there were 89 childeren infected chronically by HBV, among them 82% appeared to be HBsAg positive, firstly seen before the age of 6 months mainly attributing to uterus infection. The HBV chronic infection rate of infants born to HBsAg, HBeAg positive mothers (HB vaccine immunized, 24.5%; HBIG+HB vaccine, 10.6%, P<0.005) was higher than that of infants born to HBsAg positive mothers (HB vaccine immunized, 10.7%; HBIG+HB vaccine 3.8%, P<0.025). Moreover, the chronicity rate of the infants whose HBsAg firstly appeared within 6　　months and were born to HBsAg, HBeAg positive mothers was higher than that of the infants born to HBsAg positive months (68%,40% respertively in HB vaccine inoculated group, P<0.025). Infants immunized combinely with HBIG and HB vaccine had their chronic HBV infection decreased from 17.6% to 5.0% at l year old as compared with that of HB vaccine inoculated infants. The total chronic HBV infection rate in children born to HBsAg, HBeAg positive mothers decreased from 24.5% to 10.6% (P<0.005) and that in children born to HBsAg positive mothers decreased from 10.7% to 3.8% (P<0.025). The HBV chronicity rate of HBsAg positive infants born to HBsAg, HBeAg positive mothers also decreased and that of infants born with HBsAg negative, but became positive after 1-6 months decreased from 40.9% to 0% (P=0.0315). The HBsAg seronegative conversion rate in l month old infants born to HBsAg positive mothers increased from 26.4% to 58.8% (P<0.025). All these data indicated that infants born to HBsAg positive mothers, though had been HB vaccine immunized, still had chronic infection, that was chiefly due to chronic uterus infection by HBV. The single use of HB vaccine can not completely block the uterus infection of HBV, but when combinatively used with HBIG, the blocking effect is more efficient, the chronicity of HBV infection also can be avoided.

Chickenpox is an acute and highly infectious respiratory disease commonly seen in children.Varicela－zoster often results from the activation of latent virus in chickenpox called varicella－zoster virus（VZV）or called human herpesvirus type 3. Primary infection of VZV may induce typical disease of various severity and most healthy children infected with VZV have mild symptoms and good prognosis.But VZV infection，if occurs in special population such as persons of immune inhibition treatment will induce serious consequence or even death and it is as same serious as in adults.A detailed illustration of molecular biology，epidemiology，laboratory diagnosis，treatment and preventive strategy of the VZV were given.

Because of the information dissymmetry In the relationship between medical care providers and patients,patients are induction to adverse selection,and moral hazard behaviors are produced.Reasons for the information dissymmetry in the relationship between medical care providers were explored, and the main problems were expatiated in ethics opinion,some feasible suggestions were brought forward.

Objective To compare the influence of different feeding mode on the immunoprophylaxis efficacy of the babies born to hepatitis B (HB) carrier mothers. Methods The babies born to HB carrier mothers received HB vaccine alone routinely or HB immunoglobulin (HBIG) plus HB vaccine immunoprophylaxis were followed up. Among infants with HB vaccine alone, 21 were breastfed and 40 bottle-fed, among those with HBIG and HB vaccine, 33 were breastfed and 135 bottle-fed. Results Among babies receiving HB vaccine alone, the positive rates of anti-HBs at 1,3,6,12 month of age are 4.8%, 42.9%, 57.9%, 80.9% in breastfed group, and 12.2%, 26.3%, 60.5%, 73.2% in bottle-fed group. Among those with HBIG and HB vaccine, the positive rates of anti-HBs at 1, 4, 7, 12 month of age are 72.7%,75.8%,77.4%,90.9% in breastfed group, and 77.0%, 72.9%,76.2%,90.4% in bottle-fed group. With HB vaccine alone, 1 infant in breastfed group and 3 in bottle-fed group, and with HBIG and HB vaccine, 0 in breastfed group and 4 in bottle-fed group were chronically infected at 1-year of age. There are no significant differences of the incidence of anti-HBs and immunoprophylaxis failure between breastfed and bottle-fed babies. Conclusion Breastfeeding doesn't pose a negative influence on the response of anti-HBs and the failure rates of the HB immunoprophylaxis in the infants born to HB carrier mothers

Objective To observe the clinical effects of short-term intermittent ganeiclovir treatment on infants with cytomegalovirus (CMV) hepatitis. Methods The clinical data of infants with CMV hepatitis were analyzed retrospectively. The liver functions including total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltransferase (γ-GT) of the patients in treatment group (85 cases) and control group (37 cases) were collected before and after treatment. Meanwhile, the side effects of ganciclovir during treatment were observed. The measurement data were compared by analysis of variance and numeration data were compared by chi-square test. Results After short-term intermittent ganciclovir treatment in treatment group, TBil level was decreased from (109.1±677.8)μmol/L to (62.9±68.1)μmol/L (F=15.34,P<0.01); ALT level was decreased from (160.2±395.3) U/L to (68.1±56.0) U/L (F=4.73, P<0.05). In control group, TBil level was decreased from (94.9±647.4)μmol/L to (49.2±631.5) μmol/L (F=14.80, P<0.01) ; while ALT level was decreased from (131.6±206.2) U/L to (55.3±631.2) U/L (F=3.50, P=0.067). The readmission rate in control group was significantly higher than that in treatment group (21.6% vs 10.6%). Only one case (0.8%) received three times of intermittent ganciclovir treatment. The longest hospitalization time was six weeks. Conclusions Short-term intermittent ganciclovir treatment may be more suitable for infants with CMV hepatitis. There is no obvious side effect observed during the treatment and the hospitalization time can be shortened.

Objective To investigate the characteristic of rotavirus(RV) molecular epidemiology among infants and young children with nosoeomial diarrhea in Shanghai area. Methods Two hundred and twenty-six stool specimens collected from inpatients with nosocomial diarrhea from November 2006 to January 2008 were measured by colloidal gold assay and nested polymerase chain reaction (PCR). The positive samples were typed to investigate the clinical characteristics of patients. The data were shown with constituent ratio and positive detection rate. The analysis was done by using t test. Results RV was detected in 108 of 226 specimens (47.8%) by colloidal gold assay. The incidence was highest in infants younger than one year old. Neonatal cases with RV accounted for 32.4 % of all RV nosocomial infections recruited. The peak seasons were October and November. RV serotyping in 67 cases older than 1 year old by nested PCR showed that G3 was predominant and accounted for 46.3%, followed by G1 (23.9%), G2 (3.0%), G9 (1.5%), seven cases were coinfections with G1 and G3 (10.40%) and 10 couldn't be typed. Based on P typing, P [8] was predominant genotype with 90.0%, P[4] accounted for only 6.0% and 3 couldn't be typed. P[6], P[9] and P[10] haven't been detected. G3P[8] was the maior isolates which accounted for 61.2%, followed by G1P[8] (17.9 %), G1 and G3P[8] coinfection accounted for 9.5%. Two cases were infected with G2P[4] and G8P[9], respectively. Ten out of 32 neonatal specimens were typed successfully which were G1P [8]. Nosocomial RV diarrhea resulted in prolonged hospital stay and increased medical cost. Conclusions RV is the major etiological agent of nosoeomial diarrhea among infants and young children in Shanghai area. G3P[8] is the predominant serotype. And the outbreak of G1 epidemic strain infection should be monitored.

BACKGROUND: The anterior thoracolumbar internal fixation devices can be divided into two main categories: the stick system such as kaneda,and the plate system such as Z-plate. Both categories have satisfactory biomechanical properties, but the devices of these types are all imported and so expensive that they exceed the affordability of domestic patients:Based on various anterior throacolumbar internal fixation devices and the spinal characteristics of the Chinese people, the author designed a new brand of anterior thoracolumbar internal fixation device for Chinese people:New Ti-plate (NTP).OBJECTIVE: Biomechanical properties of three anterior thoracolumbar internal fixation devices were compared in an attempt to provide a scientific and theoretical basis for clinical applications.DESIGN: A sampling investigation.SETTING: The Department of Orthopaedics of the Second Affiliated Hospital of Soochow University and Department of Radiology of Nantong Hongqiao Hospital.PARTICIPANTS: This study was carried out at the Biomechanical Engineering Research Institute of Shanghai University between May and August 2003. Fifteen fresh spinal samples from the healthy adults (T12-S1) were used in this study.METHODS: Fifteen spinal (T12-S1) specimens were obtained from fresh bodies to induce injuries to anterior and middle columns, which were fixed with Dunn Ⅲ, NTP and Z-plate respectively to compare the strength, rigidity, and the stability of the spine.MAIN OUTCOME MEASURES: Changes of load-straining and loaddisplacement of the three groups of specimens under the conditions of axial decompression, anteflection, post-extention, and lateral flexion.RESULTS: Fifteen fresh adult spinal specimens were involved in this study and all entered the stage of result analysis. Under the maximal load of 500 N,the average straining for Z-plate, NTP and Dunn Ⅲ was 410 uε,430 uε, 477 uε respectively. The average longitude displacement for the above three devices was 2.23 mm, 2.38 mm and 2.85 mm respectively.The thoracolumbar fracture was fixed with three anterior internal fixation devices and it was proved that Z-plate and NTP fixations were better than fixation with Dunn Ⅲ in respect of spinal strength, rigidity and stability (P ＜ 0.05), but the difference between Z-plate and NTP had no statistical significance (P ＞ 0.05).CONCLUSION: NTP and Z-plate devices are conformed to the spinal biomechanical principles and were capable of reconstructing spinal biomechanical stability effectively, and it is a preferable anterior spinal internal fixation device.

Objective To understand the characteristics of molecular epidemiology of enterovirus 71(EV71) in children with hand, foot and mouth disease (HFMD) in Shanghai area during the first half year of 2009. Methods Seventy-three throat swabs and 38 stool samples were collected from 95 hospitalized children with clinical diagnosis of HFMD in Children's Hospital of Fudan University during April to May 2009. TaqMan real-time reverse transcription-polymerase chain reaction (RT-PCR) and nest RT-PCR were used to detect EV71 VP1, followed by gene sequencing analysis. Results Six of the 73 throat swabs were EV71 positive with the detection rate of 8.2%. In the 38 stool samples, 24 were EV71 positive with the detection rate of 63.2%. Twenty-eight nested RT-PCR positive samples were sequenced and the genetic analysis showed that 27 were C4 subtype,which were absolute dominant strain and the other one was C2 subtype. The isolated strain from a fatal case was C4 subtype and there was no obvious mutation found in VP1 region. Conclusions EV71 is an important pathogen in HFMD children in Shanghai area during April to May 2009. C4 subtype strains are absolutely dominant, and accompanied by epidemic strains of subtype C2.