Crohn's disease is a transmural and chronic granulomatous inflammation and it can easily complicated with enterostasis,intestinal obstruction,intestinal perforation,fistula,abscess and massive hemorrhage of gastrointestinal tract.Therefore,patients with Crohn's disease often need surgery,but the surgical indications and postoperative management is still full of challenge.Preventing postoperative recurrence and reducing the complications is essential.

Objective To investigate the genotype and drug resistance of extended-spectrum beta-lac-tamases(ESBLs) -producing Shigella in pediatric patients.Methods A total of 59 strains of Shigella were isolated from stool specimens of hospitalized children with shigellosis in Beijing Children's Hospital from January 2004 to December 2008.Phenotypic confirmatory test,which is based on Clinical and Laboratory Standards Institute(CLSI),was used to detect the ESBLs-producing strains.Agar dilution method was used to determine the minimal inhibitory concentration (MIC).PCR amplification was performed for ESBLs producers to determine the genotype.PCR product was sequenced and then analyzed to confirm the subtype of ESBLs.Results Of the 59 isolates,21 (35.6%) strains were identified as ESBLs producers.The 21 strains of ESBLs-producing Shigella all carried the genes of CTX-M as shown by PCR,and CTX-M-1,CTX-M-9 accounted for 6,15,respectively.Among the 21 CTX-M producers,there were 4 strains accompanied by TEM-type and 6 strains accompanied by OXA-type.Nucleotide sequence analysis showed that there were CTX-M-3 (n = 1),CTX-M-15 (n = 2),CTX-M-57(n =3) of the 6 CTX-M-1-producing isolates.The subtypes of CTX-M-9,TEM,OXA were all CTX-M-14,TEM-1,OXA-1,respectively.The sensitive drugs to ESBLs producers were imipenem,meropenem,piperacillin/tazobactam,cefoperazone/sulbactam and cefoxitin,with resistance rate all less than 15%.The resistance to ceftazidime was remarkably variable among different CTX-M producers.Conclusion The prevalence of ESBLsproducing Shigella is in a high level in pediatric patients in this area.The genotypes of ESBLs are all CTX-M.Most of them are CTX-M-14,but some are CTX-M-3,CTX-M-15 and CTX-M-57.Most ESBLs-producing strains are multidrug resistant.Carbopenems should be the first choice for ESBLs producers.

Objectives To evaluate the effect and safety of Xiao Er Fu Xie Tie in children with acute diarrhea. Methods A multicenter, randomized, open-label, active-controlled clinical trial was carried out in three hospitals from March 2011 to December 2012. Children with acute diarrhea were enrolled and divided randomly into two groups, the observation group (treated with Xiao Er Fu Xie Tie) and the control group (treated with smectite powder). Boths groups received oral rehydration salts treatment. Symptoms and signs were recorded before and after therapy. The therapeutic effect was evaluated at 3 and 5 days after therapy. All of the adverse drug reactions were recorded during the study. Results In 197 children who completed the study, 100 children received Xiao Er Fu Xie Tie and 97 received smectite powder. Both groups were similar in age and gender distribution, weight, duration and frequency of diarrhea, times of vomiting, degree of dehydration and so on (P>0.05). After therapy, effective rates of the observation group at 3 days (97%) and 5 days (100%) were similar to those of control group (P>0.05). The effective rate for relieving vomiting in the observation group was higher than that in control group (P<0.05). No obvious adverse drug reactions were found during the study. Conclusions Xiao Er Fu Xie Tie has the same effect as smectite powder for treatment of acute diarrhea in children and is more effective in vomiting. Furthermore, no obvious adverse drug re-actions were found.

Amitriptyline ; therapeutic use ; Child ; Constipation ; drug therapy ; Dyspepsia ; drug therapy ; Gastrointestinal Agents ; therapeutic use ; Gastrointestinal Diseases ; drug therapy ; therapy ; Humans ; Hypnosis ; methods ; Irritable Bowel Syndrome ; therapy ; Polyethylene Glycols ; therapeutic use ; Randomized Controlled Trials as Topic ; Research Design

Clostridium difficile is a gram-positive,obligate anaerobic bacillus,which is one of the most common pathogenic bacteria of antibiotic associated diarrhea,and can cause Clostridium difficile-associated diarrhea.In recent years,the incidence of Clostridium difficile infection has increased significantly in the world with the excessive use of broad-spectrum antibiotics,the increase of strains resistance,and the emergence of hypervirulent strains.This paper presents a brief review on research progress of Clostridium difficile-associated diarrhea.

Objective Set up a new performance management system with JCI standard that designed for improvement of nursing research.Methods Based on JCI standard,the new system was designed to be performed separately.Re-design a performance appraisal plan that will take account into nursing workload,care quality,nursing risk,nursing research,personal comprehensive quality etc.Results The average performance of the nurses in 42 wards had increased by 24.64％.In this system,research project application,and paper publishing was significantly improved.Projects Standardization was also improved.Enthusiasm of continuing education increased.Conclusions The system is helpful to improve the quality of nursing research.It can also help to assure the occupational stability of the clinical nurses and enthusiasm of nursing research.

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.

Objective To analyze the antibiotic resistance of the carbapenem no-susceptibility Enterobacteriaceae isolated from pediatric patients and the resistant genes of carbapenemase-producing.Methods In all,46 carbapenem no-susceptibility Enterobacteriaceae strains were isolated from patients at Beijing Children's Hospital between January 2008 and December 2010.Agar dilution method recommended by the Clinical and Laboratory Standards Institute was used to examine the minimum inhibitory concentrations (MICs) of 14 antimicrobial agents.Phenotypic testing for carbapenemase-producing was conducted using Hodge test and double-disk synergy test.PCR was used to detect the expression of the carbapenemase-related genes KPC,GES,IMI/NMC-A,SME,IMP,VIM,GIM,SPM,SIM and OXA.WHONET5.6 was used to perform resistance analysis.Results Among 46 carbapenem no-susceptibility Enterobacteriaceae strains,26 (56.5％) were Klebsiella pneumoniae strains,13(28.3％ ) were Enterobacter cloacae and 7( 15.2％ ) were Escherichia coli.The rates of imipenem and meropenem no-susceptibility Klebsiella pneumoniae were 69.2％ and 80.8％,Enterobacter cloacae were 76.9％ and 100％ and Escherichia coli were 85.7％ and 100％,respectively.40(87.0％ ) strains were positive of Hodge test.41 (89.1％) strains were positive of doubledisk synergy test.38 (82.6％) were positive for the IMP genotype.The carbapenemase-related genes were not found in other 8 strains.Conclusion The prevalence of carbapenem no-susceptibility Enterobacteriaceae strains in Klebsiella pneumoniae isolates is relatively high in children.Resistance to imipenem was lower than that to meropenem from Klebsiella pneumoniae,Enterobacter cloacae and Escherichia coli strains.Many carbapenem no-susceptibility Enterobacteriaceae isolated from pediatric patients carry the blaIMP gene.No the KPC gene was found.

Objective To study the current status of catheter - related thrombosis(CRT)in Chinese children through a retrospective analysis of the inpatients in the Department of Medicine,Beijing Children's Hospital Affiliated to Capital Medical University. Methods The clinical data of the inpatients with CRT from November 2010 to November 2013 were collected retrospectively,and the causes,clinical symptoms,diagnosis,treatment and prognosis were ana-lyzed. Results There were 42 cases of children with CRT in Beijing Children's Hospital Affiliated to Capital Medical University. Among the cases,the male to female ratio was 1. 0:0. 5;the median age of onset was 88(2 - 186)months with ﹤ 1 year old counted for 16. 7%(7 / 42 cases)and 13 - 14 years old counted for 11. 9%(5 / 42 cases);the distri-bution differences between the male and the female age were not significant(P = 0. 826). The median time from cathe-terization to CRT onset was 9(1 - 81)days,0 - 10 days after catheterization was the peak of onset(52. 5% ,21 / 40 ca-ses)followed by 10 - 20 days(35. 0% ,14 / 40 cases). The protopathy was usually hematologic tumor,kidney disease or deep fungal infection. Slightly more cases developed CRT on the right side(57. 1% ,24 / 42 cases)than on the left side (38. 1% ,18 / 42 cases). All cases were diagnosed by using B - ultrasound,of whom 28. 6%(12 / 42 cases)were symp-tom - free. After being diagnosed,7. 1%(3 / 42 cases)were treated with conservative methods such as immobilization of the affected limbs and hot compress;7. 1%(3 / 42 cases)had catheter removed;anticoagulant and/ or thrombolytics after catheter removal used in 33. 3% patients(14 / 42 cases). After 1 week,22 cases were reviewed,of whom 54. 5%(12 / 22 cases)had thrombosis reduced(all with intervention),thrombosis growing in 22. 7% patients(5 / 22 cases), and thrombosis did not change in 22. 7% patients(5 / 22 cases). Three cases needed re - catheterization after catheter removal,and all of 3 cases had CRT recurrences(100% ). Conclusions CRT is more common among infants and senior children. CRT usually develops within 20 days after catheterization. Children with hematologic tumor,kidney disease or deep fungal infection are more likely to have CRT. Routine ultrasound test should be conducted to monitor CRT in catheterized children. Once CRT is diagnosed,patients need to be treated with anticoagulants and/ or thrombo-lytics. Catheter should also be removed if necessary. Recatheterization can result in CRT recurrence.