Objective To examine the diagnosis and treatment of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia and improve the awareness of the pathogen in clinical and laboratory practice.Methods A case of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia in Shanghai Children's Hospital was retrospectively analyzed,including diagnosis and treatment details.Similar cases were identified from PubMed,Wanfang Data,VIP,and CNKI databases since database establishment until June 30,2024,using search terms"Enterocytozoon bieneusi".The relevant literature was reviewed.Results This child had acute lymphoblastic leukemia as the underlying disease and was admitted to hospital for antimicrobial treatment due to fever and abdominal discomfort.The case was considered bacterial infection complicated with Enterocytozoon bieneusi infection,confirmed by detection of Klebsiella pneumoniae in blood and detection of Enterocytozoon bieneusi in blood and ascites by metagenomic next-generation sequencing(mNGS).The treatment was switched to tigecycline plus trimethoprim-sulfamethoxazole at a sufficient dose,which resulted in resolution of symptoms.Six months later,the patient suffered from acute lymphoblastic leukemia and bone marrow depression,Enterocytozoon bieneusi disseminated infection,septic shock.Her family gave up treatment and the child died.Literature review indicated that most patients infected with Enterocytozoon bieneusi had underlying conditions such as organ transplantation,AIDS,and leukemia associated with poor immunity.The onset symptoms are diarrhea,abdominal discomfort,and fever.Enterocytozoon bieneusi was detected by using methods such as modified Masson's trichrome stain,fluorescent calcofluor white staining,molecular detection techniques,and immunofluorescence.The patients were treated with drugs such as albendazole,nitazoxanide,fumagillin,and trimethoprim-sulfamethoxazole.Conclusions Enterocytozoon bieneusi is an opportunistic pathogenic fungus that infects immunocompromised patients and can cause abdominal discomfort,diarrhea,fever,and even disseminated infection and death.Conventional laboratory methods cannot culture Enterocytozoon bieneusi.Molecular detection techniques can be used to identify the pathogen early.

Objective To examine the diagnosis and treatment of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia and improve the awareness of the pathogen in clinical and laboratory practice.Methods A case of disseminated infection caused by Enterocytozoon bieneusi in a child with leukemia in Shanghai Children's Hospital was retrospectively analyzed,including diagnosis and treatment details.Similar cases were identified from PubMed,Wanfang Data,VIP,and CNKI databases since database establishment until June 30,2024,using search terms"Enterocytozoon bieneusi".The relevant literature was reviewed.Results This child had acute lymphoblastic leukemia as the underlying disease and was admitted to hospital for antimicrobial treatment due to fever and abdominal discomfort.The case was considered bacterial infection complicated with Enterocytozoon bieneusi infection,confirmed by detection of Klebsiella pneumoniae in blood and detection of Enterocytozoon bieneusi in blood and ascites by metagenomic next-generation sequencing(mNGS).The treatment was switched to tigecycline plus trimethoprim-sulfamethoxazole at a sufficient dose,which resulted in resolution of symptoms.Six months later,the patient suffered from acute lymphoblastic leukemia and bone marrow depression,Enterocytozoon bieneusi disseminated infection,septic shock.Her family gave up treatment and the child died.Literature review indicated that most patients infected with Enterocytozoon bieneusi had underlying conditions such as organ transplantation,AIDS,and leukemia associated with poor immunity.The onset symptoms are diarrhea,abdominal discomfort,and fever.Enterocytozoon bieneusi was detected by using methods such as modified Masson's trichrome stain,fluorescent calcofluor white staining,molecular detection techniques,and immunofluorescence.The patients were treated with drugs such as albendazole,nitazoxanide,fumagillin,and trimethoprim-sulfamethoxazole.Conclusions Enterocytozoon bieneusi is an opportunistic pathogenic fungus that infects immunocompromised patients and can cause abdominal discomfort,diarrhea,fever,and even disseminated infection and death.Conventional laboratory methods cannot culture Enterocytozoon bieneusi.Molecular detection techniques can be used to identify the pathogen early.

Guillain-Barré syndrome (GBS) defines a kind of Immune-mediated acute inflammatory peripheral neuropathy. Miller-Fisher Syndrome (MFS) is a special variant of GBS, with mostly one-way course and rare clinical recurrence. Only a few recurrent cases have been reported in China. Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness, acute onset, with symptoms of upper respiratory tract infection before onset, accompanied by pupil abnormalities and autonomic nervous dysfunction, who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy. The patient had a triad of “ataxia, areflexia and ophthalmoplegia”. Cerebrospinal fluid showed protein-cell separation. Serum anti-Sulfatides antibody IgM, anti-GT1a antibody IgG, anti-GQ1b antibody IgG and anti-GM3 IgM were positive. Recurrent MFS was diagnosed and the symptoms improved after immunotherapy. This case suggests that MFS is clinically heterogeneous, a few patients can present with relapse and generally have a better prognosis with immunotherapy. Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.

Objective : To investigate the injury characteristics among primary and middle school students in Panyu District, Guangzhou City, so as to provide the evidence for developing the strategies for prevention and control of injuries. Methods: The data of 6 to 18 years old primary and middle school students with initial diagnosis of injury at Panyu District Central Hospital from 2014 to 2019 were collected. The basic characteristics of injury cases, the causes, time and place of injury development were analyzed by a descriptive epidemiological method. Results: Totally 10 833 primary and middle school students with injury were reported in Panyu District from 2014 to 2019, including 7 401 boys and 3 432 girls, with a boy/girl ratio of 2.16∶1. The injury predominantly occurred in primary school students (6 903 cases, 63.72%). The causes of injury mainly included fall (4 457 cases, 41.14%), animal injury (2 593 cases, 23.94%), blunt injury (1 682 cases, 15.53%), knife/sharp instrument injury (923 cases, 8.52%) and traffic injury (731 cases, 6.75%). The place of injury development mainly included home (4 267 cases, 39.39%), school and public place (3 184 cases, 29.39%), and road/street (1 854 cases, 17.11%). The injury predominantly occurred from August to October (3 289 cases, 30.36%), and the activities at the time of injury mainly included leisure activities (3 860 cases, 35.63%), life activities (2 662 cases, 24.57%) and sports (1 929 cases, 17.81%). The characteristics of injury mainly included contusion/abrasion (4 528 cases, 41.80%), sharp instrument/bite/open injury (4 019 cases, 37.10%) and fracture (871 cases, 8.04%), and the upper limb was the main injury site (3 552 cases, 32.79%). There were 9 877 cases with mild injuries (91.18%), and 10 451 cases left hospitals after seeing a doctor (96.47%). Conclusions Fall is the main causes of injury among primary and middle school students in Panyu District, and boys and primary school students are high-risk groups for injury. Family prevention should be emphasized, and health education pertaining to injury should be intensified among students during the long holidays and leisure activities.

Objectives:To study the molecular characteristics, virulence gene and resistance profiles of Staphylococcus aureus ( S. aureus, SA) isolates from bloodstream infections (BSI), so as to further understand the molecular characteristics of S. aureus in pediatric patients. Methods:A total of 53 S. aureus strains in bloodstream infections from Shanghai Children′s Hospital between 2016 and 2021 were collected. Antimicrobial susceptibility test were adopted by instrumental and disk diffusion method. Thirty-two kinds of virulence genes were detected by PCR and underwent multi-locus sequence typing (MLST), Staphylococcus protein A (spa) typing and staphylococcal chromosome cassette (staphylococcal cassette chromosome mec, SCCmec) typing characterizing methicillin-resistant Staphylococcus aureus (MRSA). Statistical analysis was performed using χ 2 test or Fisher exact test. Results:MRSA isolates accounted for 50.94% of the total(27/53), with ST398-t034-SCCmecV (6/53, 11.32%) and ST59-t437-SCCmecIV (4/53, 7.55%) as the most common MRSA clones. Methicillin-sensitive Staphylococcus aureus (MSSA) isolates occupied 49.06% (26/53), among which typing ST22-t309 (3/53, 5.66%) and ST7-t091/t1685 (2/53, 3.77% each) were prevalent. Of the 53 strains, all carried ≥6 virulence genes, 33 strains (62.26%) carried ≥10 virulence genes, including 18 strains of MSSA (69.23%) and 15 strains of MRSA (55.56%). The carriage rate of pvl gene in MSSA was higher than that of MRSA isolates (12/26, 33.33% vs. 6/27, 22.22%), and sasX was only detected in MRSA isolates (4/53, 7.55%). The resistant rates of BSI-SA isolates to penicillin, erythromycin and clindamycin were 98.11%, 49.06% and 41.51%, respectively. MRSA were more resistant to clinical antimicrobial agents than MSSA. Conclusions:MRSA strains cover a high proportion in S. aureus bloodstream infection of children, with ST398-t034 and ST59-t437 being the most common clones. The virulence gene carrying rate for BSI-SA was high with a greater pvl gene carrying rate in MSSA isolates while sasX was only detected in MRSA isolates. More clinical attention should be paid to the high resistance status and virulence genes characteristics of BSI-SA.

Although the neuropathologic changes and diagnostic criteria for the neurodegenerative disorder Alzheimer′s diseasehave been established, the clinical symptoms are very different largely.The clinical symptoms of its special type frontal lobe variant and behavioral variant frontotemporal dementia are very similar, which brings great challenges to the differential diagnosis.Therefore, we report a patient with progressive cognitive impairment, early significant executive dysfunction and abnormal behavior, and magnetic resonance imaging showed significant frontotemporal atrophy.It is easy to be misdiagnosed as behavioral variant frontotemporal dementia.However, multimodal functional neuroimaging results show that neuropathological changes are more likely to be frontal variant Alzheimer′s disease.This study shows that the use of detailed neuropsychological tests, biological markers and multimodal neuroimaging to identify these atypical syndromes will help to improve the accuracy of diagnosis and patient management.

Objective:To investigate the imaging and clinical characteristics of posttransplantation lymphoproliferative disorders (PTLD) after liver transplantation in children.Methods:From February 2017 to November 2020, the imaging and clinical data of 17 children with PTLD after liver transplantation confirmed by pathology or clinical diagnosis were retrospectively analyzed in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University. The site, range, density/signal/echo of the lesions were observed.Results:The mean age at transplantation was 8 (7, 11) months, and 14 patients were younger than 1 year old. The interval between liver transplantation and PTLD diagnosis was 22 (10, 34) months, ranging from 3 to 54 months. The interval was less than 1 year in 6 patients (early onset) and equal or greater than 1 year in 11 patients (late onset). Fifteen patients had Epstein-Barr virus infection. Among the 12 pathologically confirmed PTLD cases, 8 cases were diffuse large B-cell lymphoma, 3 cases were Burkitt lymphoma, and 1 case was reactive plasma cell hyperplasia. Among the 17 children with PTLD, 8 cases demonstrated involvement of lymph nodes and 16 cases had extranodal involvement. The latter included 15 cases of abdominal involvement. Abdominal sites involved included small intestine in 14 cases, colon in 7 cases, mesentery in 4 cases, kidney in 3 cases, liver in 2 cases, abdominal lymph nodes in 2 cases, peritoneum in 1 case, and stomach in 1 case. The sites of extra-abdominal involvement included lymph nodes in 7 cases, lung in 3 cases, skull in 1 case, brain in 1 case, pleura in 1 case, chest wall in 1 case, and nasopharynx in 1 case. The most common abdominal imaging abnormalities were thickening of the intestinal wall, eccentric mass and dilation of the lumen. Both small intestines and colons could be involved, and the former more commonly. Multiple masses were found in patients with liver and kidney involvement. The most common imaging manifestation of PTLD outside the abdomen was lymph node enlargement, which was found in 7 cases, and the most common was in the neck. The manifestation was shorter diameter of lymph nodes>10 mm, uniform density and signal, with mild enhancement.Conclusions:PTLD can occur months to years after liver transplantation in children, which can affect many parts of the whole body. Extranodal lesions are more than intranodal lesions. Abdominal involvement is most common in PTLD, and the infection rate of EB virus is high. Combined with medical history, EB virus infection status and imaging examination are helpful for early diagnosis.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Objective To investigate the distribution and resistance profile of bacterial isolates in Shanghai Children's Hospital. Methods Antimicrobial susceptibility of all isolates was determined by Kirby-Bauer disk diffusion method according to 2016 CLSI standard. The data were analyzed by WHONET 5.6 software. Results A total of 23 259 non-duplicate strains were isolated from 2011 to 2016, including 10 885(46.8％)gram-postive cocci and 12 374(53.2％)gram-negative bacilli. The average prevalence of methicillin-resistant S. aureus(MRSA)and coagulase-negative Staphylococcus(MRCNS)was 35.8％ and 82.2％, respectively. The prevalence of MRSA rose from 27.4％ in 2011 to 42.9％ in 2016. The resistance rate of MRSA and MRCNS strains were significantly higher than methicillin sensitive strains. The resistance rate of Enterococcus faecium strains was significant higher than Enterococcus faecalis. The prevalence of non-susceptible Streptococcus pneumoniae was 31.2％(908). No gram-positive strain was resistant to vancomycin or linezolid. The prevalence of carbapenem resistance increased in gram-negative strains. The resistance rate of Klebsiella pneumoniae to imipenem and meropenem rose from 3.1％ and 4.8 ％ in 2011 to 28.7％ and 37.4％ in 2016, respectively.The rate of Pseudomonas aeruginosa resistance to imipenem and meropenem rose from 13.8％ and 16.5％ in 2011 to 18.8％ and 19.4％ in 2016, respectively, while Acinetobacter baumannii showed resistance rate of 38.3％ and 39.9 ％ in 2011 to 68.4％ and 69.7％ in 2016. Conclusions Increasing prevalence of MRSA, carbapenem-resistant K. pneumoniae, extensively drug-resistant A.baumannii has become a concern in clinical practice. Therefore, antimicrobial resistance surveillance should be highly strengthened in children's hospital.

Objective: To explore the effect of metabolic syndrome(MetS) and its individual components on cognitive impairment and neurological dysfunction in patients after acute ischemic stroke. Methods: A total of 733 patients with acute ischemic stroke aged 60 to 83 years admitted in Tianjin Huanhu hospital from January 2010 to May 2018 were enrolled in this cross-sectional study.The patients were divided into the non-metabolic syndrome(non-MetS) group and the metabolic syndrome(MetS) group according to the diagnostic criteria of metabolic syndrome.Cognitive functions were evaluated by using the Montreal Cognitive Assessment(MoCA) and Mini-Mental State Examination(MMSE). Neuropsychiatric behavior was assessed by using the Neuropsychiatric Inventory(NPI) questionnaire.Emotional state was examined according to the 21-item Hamilton Depression Rating Scale(HAMD-21). The degree of neurological impairment after stroke was evaluated by using the National Institutes of Health Stroke Scale(NIHSS). The activity of daily living was evaluated by Barthel index and the Activity of Daily Living(ADL) scale.The overnight fasting blood samples were obtained in order to determine biochemical indicators. Results: The average age of first-onset of ischemic stroke was earlier, and the body mass index(BMI) was higher in the MetS group than in the non-MetS group(P<0.05). The levels of high sensitivity C-reactive protein(hs-CRP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), homocysteine(Hcy), fasting plasma glucose(FPG) and haemoglobin A1c(HbA1c) were higher, and the level of high-density lipoprotein cholesterol(HDL-C) was lower in the MetS group than in the non-MetS group(P<0.05). In addition, the proportions of patients with hypertension, type 2 diabetes and smokers were higher in the MetS group than in the non-MetS group(P<0.05). The scores of MMSE, MoCA and BI were lower and the scores of NIHSS, NPI-Q and HADM-21 were higher in the MetS group than in the non-MetS group.MetS could increase the risk of cognitive impairment in patients after acute ischemic stroke(OR=3.169, 95% CI: 1.110-9.048). After adjusting for socio-demographic and clinical covariates, the estimated OR value for increasing the risk of cognitive impairment was further increased in MetS(OR=4.741, 95% CI: 2.027-7.427). Furthermore, the increased numbers of MetS components were significantly associated with the cognitive impairment in patients after stroke.With the increasing number of MetS components, the scores of MoCA and BI were decreased, and the scores of ADL, NIHSS, NPI-Q, HADM-21 and Hachinski ischemic scale(HIS) were increased.With the increasing number of MetS components, the degree of neurological impairment and the risk of injury were increased. Conclusions MetS is associated with the decline of cognitive function, neuromotor dysfunction and the increased risk for neuropsychological disorders in patients after acute ischemic stroke.