It has been revealed that most patients with severe hand,foot and mouth diseases are infected with enterovirus 71 (EV71).The death usually occurs with brain stem encephalitis and neurogenic pulmonary edema.Treatment of hand,foot and mouth disease should be stage-based,mainly includes antivirus treatment and management of impaired cardiopulmonary functions.Neurological damage may regress or disappear with disease recovery in most children,but sequelae may also exist in a few critical cases.This paper reviews the research progress on pathogenesis and treatment of severe hand,foot and mouth diseases.

Objective To investigate the changes of cytokines in hand-foot-and-mouth disease( HFMD) patients.Methods Retrospective analysis was performed on the clinical data of 262 cases of HFMD.All 262 children with HFMD were divided into two groups:severe cases and non-severe cases.Five cytokines( IL-2,IL-6,IL-10,TNF-αand IFN-γ) simultaneously were detected by luminex multiplexed assays.Results There were 153 severe cases and 109 non-severe cases,The results showed that the levels of IL-2,IL-6,IL-10,TNF-αin severe cases were higher than non-severe cases,and the differences were significant (18.02 ng/L vs 22.71ng/L, 28.42 ng/L vs 53.76 ng/L,17.92 ng/L vs 42.37 ng/L,102.29 ng/L vs 207.99 ng/L,P<0.05 ) .No significant difference of IFN-γlevel was found between the two groups(325.51 vs 373.78 ng/L,P>0.05).In 40 critical cases,plasma levels of IL-2,IL-6,IL-10,TNF-α,and IFN-γwere significantly decreased after administration of intravenous immunoglobulin( P<0.05 ) .Conclusion Some cytokines increase in children with severe HFMD, indicating that inflammatory and anti-inflammatory reaction may play importent roles in the pathogenesis of se-vere HFMD.The findings suggest that intravenous immunoglobulin might play a therapeutic role in severe HFMD.

Objective To investigate clinical features and treatment experience of severe cases of influenza A H 1N 1.Methods A retrospective analysis of 78 severe cases of influenza A H1N1 admitted in Beijing You'an Hospital from June 2009 to January 2010 were performed.Clinical manifestations,laboratory tests and imaging characteristics were summarized and discussed.Results The mean value of incubation period of severe cases was 2.1 days (range 1-7 days).The main clinical manifestations were fever,red throat and cough,mostly complicated with pneumonia.The mortality is higher in the elders and patients with underlying diseases.Chest X-ray showed unilateral or bilateral patchy shadows in lungs.Conclusion Severe influenza A H1N1 is a dangerous illness with high mortality.Close attention should be paied to the elder and patients with underlying diseases.It is important to take antiviral treatment in time.

End-stage liver disease is often accompanied by various complications, among which sarcopenia is a common complication in patients with end-stage liver disease and is often neglected by clinicians, and in fact, sarcopenia also affects the prognosis of patients with end-stage liver disease. This article elaborates on the definition, evaluation method, and diagnostic criteria for sarcopenia and the association of sarcopenia with various liver diseases. It is pointed out that further studies are needed to explore the role of sarcopenia in the development of liver diseases, so as to provide new ideas for the diagnosis and treatment of liver diseases.

Objective To investigate the incidence and potential risk factors of linezolid (LZD) related thrombocytopenia (TP) in patients with liver cirrhosis (LC). Methods Clinical data of LC patients treated with LZD for at least 1 dose (600 mg per 12 h) between January 2013 and May 2017 were retrospectively collected and analyzed to investigate the incidence and risk factors of LZD-related TP defined as platelet count during LZD therapy ≤ 50×109/L or a decline by ≥25％ of the baseline level. Results A total of 52 patients with LC were included in this study. The cumulative incidence of LZD-related TP was 51.9％ (27/52), of which 85.2％ (23/27) was severe TP (decline of platelet count by ≥50％ of the baseline level). Multivariate logistic regression analysis showed that the baseline platelet count ≤110 ×109/L (OR=6.989, 95％ CI: 1.192-40.971, P=0.031), LZD course ≥ 7 d (OR=9.478, 95％ CI: 1.349-66.587, P=0.024) and LZD dose ≥ 17 mg·kg-1·d-1 (OR=0.062, 95％ CI: 0.010-0.383, P=0.003) were independent risk factors of LZD-related TP in LC patients. Kaplan-Meier analysis revealed that the overall median time from the initiation of LZD therapy to in-hospital death was 18 days in TP patients and 13 days in non-TP patients without significant difference (P＞0.05). Cox proportional-hazards regression revealed no significant correlation between the in-hospital mortality and LZD-related TP in LC patients (P＞0.05). Conclusions Patients with LC are at high risk of LZD-related TP, but not associated with organ hemorrhage during LZD therapy and in-hospital mortality. Platelet count should be monitored more closely during LZD therapy for LC patients with lower baseline platelet count and longer LZD course.

Objective:To analyze the clinical features of an outbreak of extensive drug resistant typhoid fever, and to provide experience for the diagnosis and treatment of drug resistant typhoid fever.Methods:Seven patients with confirmed diagnosis of extensive drug resistant typhoid fever who visited Beijing You′an Hospital, Capital Medical University, from January 27 to February 15, 2022 were included. The clinical characteristics, drug sensitivity tests, consultation and treatment history and prognosis of the patients were analyzed through descriptive study.Results:Of the seven extensive drug resistant typhoid fever patients, three were male and four were female, one of whom was pregnant (at 32-week gestation), aged (29.8±6.8) years, with a range of 22 to 42 years. There were seven cases with fever, and the course of fever ranged from six to 20 days. There were five cases with diarrhea and lack of typhoid-specific manifestations such as rose spot, apathetic facial expression and relatively slow pulse. Four cases were complicated with intestinal bleeding and six cases developed liver function injury. Six cases had loss or decrease in eosinophil ratio and two cases had decreased white blood cell count. The results of drug susceptibility tests showed that seven strains of Salmonella typhi were resistant to chloramphenicol, ampicillin, sulfamethoxazole-trimethoprim, quinolones, ceftriaxone, cefepime, ceftazidime, cefuroxime, and sensitive to carbapenem antibiotics, tigecycline and piperacillin/tazobactam. All seven cases had a history of antimicrobial use before admission. One case was administered with intravenous ceftizoxime for seven days after admission. After discharge, cefixime was administered orally for seven days. Six patients were given intravenous piperacillin sodium/tazobactam sodium for 14 days. All blood/fecal cultures were negative and the patients were cured and discharged. During the follow-up, one patient developed splenic abscess. All the seven patients were residents of the same apartment in Beijing City, and there were water cuts and turbid odors in the incubation period, which were considered as typhoid fever outbreak caused by waterborne transmission. Conclusions:With the use of antimicrobial agents, the typical clinical manifestations of typhoid fever are absent, and the drug resistance rates to quinolone and third-generation cephalosporins increase. Appropriate antimicrobial agents should be selected and the anti-infection course should be prolonged.