Objective To explore fecal bacteria transplantation for the treatment of severe gastrointestinal disease caused by food allergy. Method The therapeutic process of fecal bacteria transplantation for treatment of severe food allergy gastrointestinal disease was retrospectively analyzed, and the related literature was reviewed. Results A 2-year-old boy had onset of intestinal infection and diarrhea was persistent even though he had received adequate anti-infection therapy and supportive treatment. Finally, the patient received the treatment of fecal bacteria transplantation and the symptoms were then improved. No adverse reactions were observed in 2 months of follow-up. In foreign literature, fecal bacteria transplantation in children is mainly applied to clostridium difficile infection (CDI) and inflammatory bowel disease (IBD), with efficiency of 90%- 100% and 55.6% - 100%, respectively. While in the domestic literature, fecal bacteria transplantation in children is mainly used in CDI and antibiotic associated diarrhea, and the effective rate is 100%. No serious adverse reactions were found in all the researches. Conclusion Fecal transplantation is safe and effective in the treatment of children with severe gastrointestinal disease caused by food allergy, but its application in children is not yet mature and needs more in-depth researches.

Objective To investigate the clinical features and antibiotic susceptibility of osteomyelitis infected by Gram-negative bacteria (G-) in patients suffered from diabetic foot ulcers (DFU). Methods The clinical data of 91 DFU pa-tients accompanied with osteomyelitis (DFO) were retrospective studied. These patients hospitalized in the Tianjin Metabolic Diseases Hospital were divided into two groups, Gram-negative bacteria (G-) group (n=44) and Gram-positive bacteria (G+) group (n=42), respectively. The clinical features were compared between two groups. Logistic regression analysis was used to determine the risk factors for Gram-negative bactreial infection. The Gram-negative antibiogram was summarized. Results A total of 112 pathogens were isolated from 91 patients. G-bacteria were the most frequent pathogens (48.2%), following by G+ bacteria (47.3%) and fungi (4.5%). Pseudomonas aeruginosa was the majority of the G-bacteria. Comparing the two groups, the rate of antibiotic use within the previous 6 months was significantly higher in G-group (75.0%) than that of G+group (52.4%, P<0.05). There were no significant differences in the other indicators between two groups. The Logistic re-gression analysis revealed that the history of antibiotic use was the independent risk factor of G-bacterial infections in DFO patients. Antibiotics susceptibilities reflected G- bacteria were more prevalent to resist to cephalosporins and quinolonem, but sensitive to imipenem, ceftazidine and cefperazone-sulbactam. Conclusion Gram negative bacteria were not only the main pathogens isolated from DFO patients, but also frequently resistant to several popular antibiotics in China. The proper bacteria culture and antibiotic sensitivity test are especially emphasized to patients with DFU.

Objective:To investigate the changes of sTim-3,HMGB1 and TGF-β in the brucellosis patients and to analyse the relationship between the changes of these molecules and brucella infection. Methods:28 cases of brucellosis patient untreated and 28 healthy control cases in the age and gender matched with brucellosis cases were collected. The serum levels of sTim-3 and HMGB1 were detected by ELISA,and the levels of Spot forming cells secreting TGF-β were measured by ELISPOT in patients and healthy control group. Results: Compared with healthy controls, sTim-3/HMGB1 expression levels and Spot forming cells secreting TGF-β were significantly increased in the brucellosis patients ( P<0. 01 ) . The changes of Spot forming cells secreting TGF-β were positively correlated with the levels of HMGB1 (P<0. 05). Conclusion:The serum levels of sTim-3/HMGB1 and Spot forming cells of secreting TGF-β from peripheral blood mononuclear cell are significantly increased in the brucellosis patients. Those molecules may be involved in the process of brucella infection and may play a significant role in the immune escape of patients infected with brucella.

Objective To establish the pipeline and evaluate the feasibility of high-throughput sequencing method used in the detection of severe pneumonia pathogens.Methods Clinical control study was used.Bronchi alveolar lavage fluids (BALF) samples from 76 patients with severe pneumonia (treatment group) and 18 patients with tracheal malacia (control group) and without clinical detected pathogens were collected during March 2015 to December 2016 in Shenzhen Children′s Hospital.The pathogens in the samples were detected using clinical tests and high-throughput sequencing respectively.The results of high-throughput sequencing were confirmed by real-time quantitative PCR and the high-throughput sequencing method used in the detection of severe pneumonia pathogens was evaluated.The χ2 test was used to analyze the correlation of detection rate between the high-throughput sequencing group and the non high-throughput sequencing group.Results The pipeline and method of high-throughput sequencing used in the severe pneumonia pathogens detection was established.The pipeline included sample collection, DNA extraction, library construction, sequencing, and bioinformatic analysis.In 76 cases of patients with severe pneumonia, the results of high-throughput sequencing in 66 cases of bronchoalveolar lavage fluid specimens were positive.The sensitivity was 86.84%, which was significantly higher than the total sensitivity of traditional clinical detection methods including bacterial culture, immunofluorescence and quantitative PCR(68.42%,52/76),χ2=7.426,P<0.001.A total of 13 pathogens were detected in 66 positive samples of high-throughput sequencing, including Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae and adenovirus, etc.Nine kinds of pathogens were detected in these samples through non-high-throughput sequencing.In the experimental group, the results obtained by clinical test and high-throughput (80.26%) were entirely consistent in 61 samples and not completely consistent in 15 samples (19.74%) specimens.These inconsistent results were mainly concentrated in the detection of adenovirus, Streptococcus pneumoniae and Haemophilus influenzae through high-throughput sequencing, whereas clinical cultures and immunofluorescence methods were not able to detect these pathogens.PCR validation showed that there was no significant difference between the results of high-throughput sequencing and the PCR tests (χ2=0.517,P=0.472), and the difference between the results of high-throughput sequencing and traditional clinical detection methods was statistically significant (χ2=11.671,P<0.001).Conclusion The method for the detection of severe pneumonia pathogens based on high-throughput sequencing is highly sensitive and can detect unknown pathogens, which is superior to those used in traditional clinical detection.

Objective:To explore the clinical characteristics and appropriate treatment of occult pneumococcal bacteremia (OPB) in children.Methods:The clinical characteristics, drug sensitivity and antibiotic use of 39 children with OPB who met the inclusion criteria in the Pediatric Internal Medicine Ward of Shenzhen Children′s Hospital from January 2013 to December 2018 were retrospectively analyzed.Results:The median age of onset in OPB in children was 2 years and 4 months, and 74.4% of children(29/39 cases) were between 6 months and 3 years.The average total fever duration was 3.69 days (1-14 days), and the average hospital stay was 6.74 days.Peripheral blood white blood cell count was >15×10 9/L in 89.7% (35/39 cases) of the children, C-reactive protein was increased in 76.9% (30/39 cases) of the children, and procalcitonin > 2 mg/L in 38.9% (14/36 cases) of the children.During hospita-lization, all the children received the treatment of intravenous antibiotics.The antibiotics used initially included Cefuroxime in 11 cases (28.2%), Amoxicillin sulbactam sodium in 10 cases (25.6%), Ceftriaxone sodium in 7 cases (17.9%) and Meloxicillin sulbactam in 6 cases (15.4%). The average fever clearance time after the antibiotic therapy was 1.4 days, and the average intravenous antibiotics treatment time was 6.2 days.The results indicated that the insensitivity rate of Penicillin was 46.2%, the insensitivity rate of Amoxicillin, Ceftriaxone and Cefotaxime were 22.2%, 10.3% and 17.9%, respectively, Erythromycin resistant rate was 100.0%, and no patient was resistant to Vancomycin and Linezolid. Conclusions:OPB occurs most frequently in infants aged from 6 months to 3 years old, with low drug resistance to Amoxicillin, Ceftriaxone and Cefotaxime.Children with complete immunity have shorter fever duration and good prognosis after antibiotic treatment.

Objective:To explore expression of Siglec-7 on monocytes in peripheral blood of patients with brucellosis and cor-relation between Siglec-7+monocytes and Th1/Th2 cells,and to analyze clinical significance of Siglec-7 molecule in patients with bru-cellosis.Methods:Fifty patients with newly diagnosed Brucella infection(BI group)and 46 healthy controls(control group)were in-cluded.Flow cytometry was used to detect expression of Siglec-7 on monocytes,and correlation between Siglec-7+monocytes and clini-cal indicators of patients with brucellosis were analyzed.Flow cytometry was used to detect Th1/Th2 cells levels,and CBA method was used to detect IFN-γ and IL-4 in peripheral serum.Correlation between Siglec-7+monocytes and Th1/Th2 cells,IFN-γ/IL-4 were ana-lyzed.Results:Siglec-7+monocytes level in BI group was significantly higher than that in control group(P<0.001);Siglec-7+mono-cytes level in patients with abnormal liver function and lung X-ray were higher than those in patients with normal liver function and lung X-ray(P<0.001,P<0.05);Compared with control group,Th2 cell and IL-4 levels were significantly increased(P<0.05),while Th1 cells and IFN-γ levels were significantly reduced(P<0.001);Th1/Th2 and IFN-γ/IL-4 were also significantly reduced(P<0.001).Siglec-7+monocyte level was negatively correlated with Th1 and IFN-γ(r=-0.651,r=-0.407),while was positively correlated with Th2 and IL-4(r=0.706,r=0.530).Conclusion:During Brucella infection,increased percentage of Siglec-7+monocytes may be involved in Th1/Th2 cell imbalance.

Objective To compare the performance of colitis induced by dextran sulfate sodium (DSS) between Lnk-knockout mice and wild-type mice. Methods The C57 BL/6 mice with similar week age were divided into wild type group (WT), wild type mouse with colitis group (WT +DSS), Lnk-knockout group (KO) and Lnk-knockout mouse with colitis group (KO + DSS). WT and KO mice were admitted to drink water freely, WT + DSS and KO + DSS mice was allowed to drink2. 5％ DSS aqueous solution freely. The experiment was carried out for 7 days to observe daily weight change, fecal texture (soft or hardness) and intestinal hemorrhage in mice, and to evaluate the disease activity index (DAI). After 7 days, the peripheral blood was collected to detect the regulatory B-cell (Breg) frequency by flow cytometry in the peripheral blood of WT mice and KO mice. The mouse was sacrificed, and the bowel was taken to observe the shape, color and measure the length of the intestine. The colonic tissue was produced by histological sections and HE staining, and histological changes were observed under the microscope. Results The bowel movement was normal in WT group and KO group, and the mice in KO + DSS group and the WT + DSS group had manifestation of earlier diarrhea and blood-draining. In the experimental period, the weight of KO + DSS group was significantly lower than the other 3 groups, and DAI in the KO + DSS group increased significantly with time. Breg cells frequency in KO group was significantly lower than WT group. In the KO +DSS group, colon obviously shortened, microscopic examination of HE tissue section showed erosive bleeding congestion, multiple lesions shallow ulcer, inflammatory cell infiltration mucosa and submucosa with involvement of the muscle layer, which indicated increased inflammatory response.Conclusion Lnk deficiency can aggravate the performance of DSS-induced colitis in mice, which may be related to the decrease of Breg cells frequency and negative regulation of inflammatory response in Lnk KO mice.

Objective To compare the performance of colitis induced by dextran sulfate sodium (DSS) between Lnk-knockout mice and wild-type mice. Methods The C57 BL/6 mice with similar week age were divided into wild type group (WT), wild type mouse with colitis group (WT +DSS), Lnk-knockout group (KO) and Lnk-knockout mouse with colitis group (KO + DSS). WT and KO mice were admitted to drink water freely, WT + DSS and KO + DSS mice was allowed to drink2. 5％ DSS aqueous solution freely. The experiment was carried out for 7 days to observe daily weight change, fecal texture (soft or hardness) and intestinal hemorrhage in mice, and to evaluate the disease activity index (DAI). After 7 days, the peripheral blood was collected to detect the regulatory B-cell (Breg) frequency by flow cytometry in the peripheral blood of WT mice and KO mice. The mouse was sacrificed, and the bowel was taken to observe the shape, color and measure the length of the intestine. The colonic tissue was produced by histological sections and HE staining, and histological changes were observed under the microscope. Results The bowel movement was normal in WT group and KO group, and the mice in KO + DSS group and the WT + DSS group had manifestation of earlier diarrhea and blood-draining. In the experimental period, the weight of KO + DSS group was significantly lower than the other 3 groups, and DAI in the KO + DSS group increased significantly with time. Breg cells frequency in KO group was significantly lower than WT group. In the KO +DSS group, colon obviously shortened, microscopic examination of HE tissue section showed erosive bleeding congestion, multiple lesions shallow ulcer, inflammatory cell infiltration mucosa and submucosa with involvement of the muscle layer, which indicated increased inflammatory response.Conclusion Lnk deficiency can aggravate the performance of DSS-induced colitis in mice, which may be related to the decrease of Breg cells frequency and negative regulation of inflammatory response in Lnk KO mice.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.