Streptococcus pneumoniae is a common infectious pathogen in children and the main cause of death in children under 5 years of age.It can lead to non-invasive pneumococcal diseases such as sinusitis and otitis media, as well as invasive pneumococcal diseases(IPD) such as meningitis, sepsis and pneumonia.IPD is a serious infectious disease in children, with high morbidity and mortality.However, the incidence of IPD in children varies significantly among different ages, genders and regions.Penicillin used to be the first choice for the treatment of IPD.With the widespread use of antibiotics in clinical practice, the problem of drug resistance of Streptococcus pneumoniae continues to increase.The situation of antibiotic resistance of Streptococcus pneumoniae in China has been very serious, and some data show that the multiple drug resistance rate of Streptococcus pneumoniae is as high as 88.7%.As a result, streptococcus pneumococcal vaccines have emerged as the primary means of reducing the incidence of IPD, in addition, it is effective in reducing the spread of drug-resistant strains.This article reviews the epidemiological characteristics, pathogenesis, common invasive pneumococcal disease in children, laboratory diagnosis, treatment and prevention of IPD in children.

Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.

Objective To study changes of glial fibrillary acidic protein (GFAP) expression and neural apoptosis in rat hippocampus and cortex of cesarean delivered offspring.Methods Thirty-eight pregnant SD rats were randomly allocated into 2 groups: 19 rats in vaginal delivery (VD) and 19 rats in cesarean section (CS).Forty-eight fetuses born by VD were kept intact, 40 fetuses were delivered by CS on day 21 of gestation.The fetal brain tissues were taken out on postnatal day 30 and 115, the expression profiles of GFAP in hippocampus and cortex were measured by immunohistochemical staining and western blot Apoptotic cells were detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining.Results (1) The expression profiles of GFAP: on postnatal day 115, the mean number of GFAP-immunoreactive astrocytes of hippocampus 29.7 ± 10.9 in VD group was significantly lower than 36.2 ± 2.8 in CS group ( P ＜ 0.05 ).The average GFAP-positive cells in the cortex of frontal lobe of 23.2 ±4.6 in VD group was significantly lower than 36.8 ± 5.9 in CS group (P ＜0.01 ).Likewise, on postnatal day 30, the mean number of GFAP-immunoreactive astrocytes of frontal cortex of 27.8 ± 6.0 in VD group was remarkably lower than 39.4 ± 4.5 in CS group ( P ＜ 0.01 ).The average GFAP-positive cells in the hippocampus of 31.5 ±3.5 in VD group were not significantly lower than 37.2 ±7.0 in CS group ( P ＞0.05 ).The expression of GFAP was detected in hippocampus and frontal cortex by western blot, however,there was no significant different expression of GFAP between VD group and CS group.(2) Neuronal apoptosis: TUNEL staining results indicated that, on postnatal day 115, fewer apoptotic cells scattered in offspring hippocampas subregion were only shown in CS group, never in VD group.No TUNEL positive staining cells were labeled in hippocampal subregion in VD group, therefore significantly lower than that of CS group ( P ＜ 0.05 ).Conclusions There were different influences of cesarean section on GFAP expression in hippocampus or cortex in different developmental stage of offspring Cesarean section might increase GFAP expression in the hippocampus and frontal cortex, even trigger neuronal apoptosis of hippocampus region.

Objective:To study the relationship between neutrophil to lymphocyte ratio (N/L) and traditional cardio‐vascular risk factors among community 35~64‐year‐old residents .Methods :A total of 1884 residents (548 males and 1336 females) from urban Shenyang city received baseline condition questionnaire on cardiovascular diseases and re‐lated diseases from Apr 2011 to Feb 2012. According to presence of cardiovascular risk factors or not ,subjects were divided into healthy control group (n=675) and risk factor group (n=1209);according to number of risk factors , risk factor group was further divided into one risk factor group (n=491) ,two risk factors group (n=263) and ≥3 risk factors group (n=455) .Morning blood sample and urine sample were retained to measure blood and urine rou‐tine ,blood glucose and blood lipid profile etc in all subjects .N/L was compared and analyzed among all groups .Re‐sults:Among patients with only one of following risk factors [hypertension ,diabetes mellitus (DM) ,dyslipidemia and obesity] ,N/L levels of patients with hypertension or DM were significantly higher than that of healthy control group [1.55(1.15 ,1.95) ,1.60(1.21 ,2.07) vs .1.45(1.09 ,1.91)] , P<0.05 both ,and there were no significant difference between any other one risk factor group and healthy control group , P>0.05 all .Among risk factor sub‐groups ,N/L level of ≥3 risk factors group was significantly higher than that of two risk factors group [1.57(1.16 , 2.04) vs .1.41(1.07 ,1.89) ,P<0.05] ,and there was no significant difference between any other two groups (P>0.05) .Conclusion:N/L significantly related to hypertension or DM ,and N/L level of ≥3 risk factors group was sig‐nificantly higher than that of two risk factors group ,N/L is helpful to assess risk of cardiovascular diseases .

Bronchial asthma is one of the most common childhood chronic respiratory diseases characterized by airway hyperresponsiveness and reversible airflow limitation.Air pollution, especially PM2.5(fine particle size ≤2.5 microns)has a significant effect on asthma, through oxidative stress, immune inflammatory injury, airway hyperresponsiveness and other mechanisms.This paper describes the source, composition, physical and chemical properties of PM2.5, the mechanism of PM2.5 induced asthma, and its effects on acute bronchial asthma attack, acute outpatient consultation rate, hospitalization rate, lung function and exhaled nitric oxide(FeNO).

Objective: To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children′s Hospital. Method: E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test. Result: A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ²=13.266, P<0.05), and the values of MIC₅₀, MIC₉₀ and the maximum values of MIC(mg/L) of penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ²=1.172, 1.198, both P>0.05). On the other hand, the values of MIC₅₀, MIC₉₀ and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0.750, 4.000, 32.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to the rest antibiotic. Based on the same examining standard of CSF, the antimicrobial sensitivity(isolates(%)) of the non-invasive isolates to ceftriaxone, cefotaxime, SMZ-TMP were respectively 281(46.3%), 278(45.8%), 78(12.9%), were significantly lower than the susceptibility rate of the invasive isolates from non-CSF (28(70%), 28(70%), 14(35%), χ²=8.453, 8.817, 15.094, all P<0.012 5), and lower than the invasive isolates from CSF (18(75%), 18(75%), χ²=7.631, 7.905, P<0.012 5; 11(45.8%), P=0.001). The sensitivity of the isolates to the rest antibiotics were similar(P>0.05). Conclusion More than 95.0% strains of the streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital were sensitive to vancomycin, linezolid, levofloxacin, and the susceptibility rate of penicillin, ceftriaxone, cefotaxime were 88.7%, 76.9%, 76.3%. However, less than 20.0% of streptococcus pneumoniae were sensitive to erythromycin, clindamycin, SMZ-TMP and tetracycline. The susceptibility rate of penicillin of non-invasive Streptococcus pneumoniae declined by these years, and the differences to ceftriaxone and cefotaxime can be neglected, but the values of MIC₅₀, MIC₉₀ and the maximum value of MIC of all were linearly rising. The susceptibility rate of antibiotics to ceftriaxone and cefotaxime of the non-invasive isolates was lower than the invasive isolates.

The incidence of refractory asthma in children is increasing year by year, bringing a heavy disease burden to families and society.As the immunological, pathophysiological and neurological mechanisms of asthma be elucidated, typeⅠallergic reactions mediated by the immunoglobulin E play an important role in the development of asthma.Omalizumab, targeting IgE, is using in clinical.This paper reviews the mechanism of action and clinical efficacy of omalizumab based on a review of the pathogenesis of refractory asthma, with the aim of guiding the individualized treatment of children with refractory asthma, improving the overall control rate.

Streptococcus pneumoniae infection is a common respiratory disease in children. Globally，invasive pneumococcal disease（IPD），which is caused by Streptococcus pneumoniae infection，is one of the leading causes of death in children. The use of Streptococcus pneumoniae vaccine has provided protection for children to some extent，but the prevalence of pathogenic and drug-resistant non-vaccine type（NVT）Streptococcus pneumoniae poses a grave threat to children's health. Due to the different use of vaccines and antibiotics in different regions，there are regional variations in the NVT distribution. This paper reviews the pathogenic process of Streptococcus pneumoniae，the mechanism of NVT production，the geographical distribution and the pathogenic condition of NVT，in order to fully understand the pathogenicity and harm of NVT，to provide data support for the adjustment of health strategy，and to provide reference for clinical diagnosis and treatment and future vaccine development and use.

Objective To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children′s Hospital.Method E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014.The antimicrobial sensitivity and minimum inhibitory concentration ( MIC ) of Streptococcus pneumoniae to the conventional antibiotics were analyzed , in order to compare the annual trends of non-invasive isolates , while the differentiation of sensitivity from specimens .The comparison of rates was performed by Chi-squared test and Fisher's exact test.Result A total of 671 isolates of streptococcus pneumoniae were obtained , which could be divided as non-invasive isolates(607),invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid (CSF)(24).The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin (SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ2 =13.266, P<0.05), and the values of MIC50, MIC90 and the maximum values of MIC (mg/L) of penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014.There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years ,(χ2 =1.172, 1.198, both P>0.05).On the other hand, the values of MIC50 , MIC90 and the maximum value of MIC ( mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0.750, 4.000, 32.000 in 2014.There was no significant difference in the susceptibility rate of non-invasive isolates to the rest antibiotic .Based on the same examining standard of CSF, the antimicrobial sensitivity (isolates(%)) of the non-invasive isolates to ceftriaxone, cefotaxime, SMZ-TMP were respectively 281(46.3%), 278(45.8%), 78(12.9%), were significantly lower than the susceptibility rate of the invasive isolates from non-CSF (28(70%), 28(70%), 14(35%),χ2 =8.453, 8.817, 15.094, all P<0.012 5), and lower than the invasive isolates from CSF (18(75%), 18(75%),χ2 =7.631, 7.905, P<0.012 5; 11(45.8%), P=0.001).The sensitivity of the isolates to the rest antibiotics were similar(P>0.05).Conclusion More than 95.0%strains of the streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital were sensitive to vancomycin , linezolid, levofloxacin , and the susceptibility rate of penicillin , ceftriaxone , cefotaxime were 88.7%, 76.9%, 76.3%.However, less than 20.0% of streptococcus pneumoniae were sensitive to erythromycin , clindamycin, SMZ-TMP and tetracycline.The susceptibility rate of penicillin of non-invasive Streptococcus pneumoniae declined by these years , and the differences to ceftriaxone and cefotaxime can be neglected , but the values of MIC 50 , MIC90 and the maximum value of MIC of all were linearly rising .The susceptibility rate of antibiotics to ceftriaxone and cefotaxime of the non-invasive isolates was lower than the invasive isolates .

Objective: To investigate current status and associated factors of preschool children’s physical fitness, in order to provide scientific basis for improving preschool children’s physical fitness. Methods: A total of 3 240 preschool children aged 3-6 years old in Kunshan city were selected through cluster sampling method. They were surveyed about physical fitness and influencing factors. Results: The number of excellence of preschool children’s physical fitness was 269, and the rate was 8.30 percent. The excellence rates of preschool children’s physical fitness in girls, high grade, non-residency in Jiangsu Province were higher(10.87%, 10.96%, 14.88%), and the excellence rate of preschool children’s physical fitness in premature group was lower(4.31%)(P<0.05). Further unconditioned logistic regression analysis found that girls, middle and high grade and non-residency in Jiangsu Province were the protective factors for the excellence of preschool children’s physical fitness, OR values were 1.96, 1.94, 2.45 and 1.87, respectively; premature was a risk factor for the excellence of preschool children’s physical fitness, OR value was 0.47. Conclusion Preschool children in Kunshan have poor physical fitness, especially in boys, low grade and premature groups. Education department and health department should work together to improve the preschool children’s physical fitness.