Objective To explore the diagnostic significance of fecal calprotectin(FC)in infectious diarrhea in children.Methods A total of 190 children with infectious diarrhea who were hospitalized in Hangzhou Children's Hospital from August 2021 to July 2024 were selected and divided into bacterial group(115 cases)and viral group(75 cases)according to type of pathogen.48 children who underwent health examination in the hospital during the same period were included in control group.The FC,white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of three groups of children were detected.The diagnostic efficacy of FC,WBC,CRP and PCT for bacterial infectious diarrhea was evaluated by using the receiver operating characteristic(ROC)curve.Results The proportions of fever and hematochezia,the highest body temperature,frequency of defecation,and fecal white blood cells in bacterial group were significantly higher than those in viral group,while the proportion of vomiting was significantly lower than that in viral group(P＜0.05).There were statistically significant differences in levels of WBC,CRP,PCT and FC among three groups of children(P＜0.05),and the levels were all in the order of bacterial group＞viral group＞control group.The results of ROC curve showed that area under the curve(AUC)of FC for diagnosing bacterial diarrhea was 0.941,with a sensitivity of 87.0％and a specificity of 85.4％.The AUC,sensitivity and specificity of the diagnosis by FC combined with CRP were 0.987,93.0％and 97.9％respectively.Correlation analysis indicated that FC was positively correlated with WBC and CRP levels(r-0.221,0.159,P＜0.05).Conclusion FC is helpful in differentiating bacterial diarrhea from viral diarrhea,and the combined detection of FC and CRP can effectively improve the effectiveness of differential diagnosis and reduce the misdiagnosis rate.

Objective To explore the diagnostic significance of fecal calprotectin(FC)in infectious diarrhea in children.Methods A total of 190 children with infectious diarrhea who were hospitalized in Hangzhou Children's Hospital from August 2021 to July 2024 were selected and divided into bacterial group(115 cases)and viral group(75 cases)according to type of pathogen.48 children who underwent health examination in the hospital during the same period were included in control group.The FC,white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of three groups of children were detected.The diagnostic efficacy of FC,WBC,CRP and PCT for bacterial infectious diarrhea was evaluated by using the receiver operating characteristic(ROC)curve.Results The proportions of fever and hematochezia,the highest body temperature,frequency of defecation,and fecal white blood cells in bacterial group were significantly higher than those in viral group,while the proportion of vomiting was significantly lower than that in viral group(P＜0.05).There were statistically significant differences in levels of WBC,CRP,PCT and FC among three groups of children(P＜0.05),and the levels were all in the order of bacterial group＞viral group＞control group.The results of ROC curve showed that area under the curve(AUC)of FC for diagnosing bacterial diarrhea was 0.941,with a sensitivity of 87.0％and a specificity of 85.4％.The AUC,sensitivity and specificity of the diagnosis by FC combined with CRP were 0.987,93.0％and 97.9％respectively.Correlation analysis indicated that FC was positively correlated with WBC and CRP levels(r-0.221,0.159,P＜0.05).Conclusion FC is helpful in differentiating bacterial diarrhea from viral diarrhea,and the combined detection of FC and CRP can effectively improve the effectiveness of differential diagnosis and reduce the misdiagnosis rate.

Objective To investigate the positive detection and epidemic characteristics of enter ovirus(EV),the pathogen of hand-foot-mouth disease(HFMD),in Hangzhou,and to provide scientific basis for formulating prevention and control strategies of HFMD in the future.Methods From January 2016 to December 2022,14 259 positive cases of enterovirus universal nucleic acid detected in Hangzhou Children's Hospital were collected and analyzed retrospectively by age,gender,detection time and other factors.Results The average positive detection rate of EV was 45.48%(14 259/31 354),among which the positive detection rate of boys was 27.20%and that of girls was 18.28%,the difference was statistically significant(P<0.01).The positive detection rate of EV in children of different ages decreased with the increase of age,and the positive detection rate of EV in children under 5 years old accounted for 90.38%of all positive children.Seasonally,enteroviruses were detected throughout the year,but the incidence was high in summer,and the total positive number from May to July accounted for 49.16%of the total detected number.In terms of year,the positive detection rate of EV has shown a downward trend year by year since 2016.Conclusion There are gender differences in enterovirus infection in Hangzhou,and boys are more susceptible to enterovirus infection,especially children under 5 years old need to pay attention to EV protection.In addition,HFMD has a certain seasonality,with a high incidence in summer,and the annual detection rate has declined year by year since 2016,which may be related to the promotion of vaccines and the improvement of health awareness.

Bacterial infection is the main cause of infectious diseases in children. Antibacterials play an important role in anti infection treatment of children. At present, the treatment of antimicrobial drugs in children is facing a severe situation of bacterial resistance. In January 2020, a children′s specialized hospital carried out the practice of precise management of antibiotics in combination with key performance indicators. Through the multi sectoral linkage of management and technology, eight key performance indicators and assessment methods were set up from three levels of antibiotic use, bacterial resistance and hospital infection, to standardize the clinical application of antibiotics and continue to promote the rational use of antibiotics. This practice had improved the performance indicators of antibacterial management. Among them, the use intensity of antibacterial drugs for inpatients decreased from 40.07 DDD in 2019 to 29.00 DDD in 2021, the use rate of antibacterial drugs for inpatients decreased from 81.32% to 64.40%, the percentage of antibacterial drug expenses in total drug expenses decreased from 35.41% to 26.82%, the use proportion of non restricted antibacterial drugs in antibacterial drugs increased from 71.30% to 82.21%, and the drug resistance rate of Salmonella to β-Lactam/enzyme inhibitors decreased from 4.84% to 0.03%, and the incidence of hospital infection decreased from 1.16% to 0.96%. The precise management of antibiotics in combination with key performance indicators improved the level of rational use of antibiotics, effectively curbed bacterial resistance, achieved phased results, so as to provide a reference for the scientific management of antibiotics in children′s hospitals.

Objective:To investigate the clinical features and etiology of 176 children with liver dysfunction, and to provide reference for the diagnosis and treatment of children with liver dysfunction.Methods:From April 2017 to February 2019, 176 children with liver function abnormalities from 2 months to 13 years old who were admitted to Hangzhou Children's Hospital were selected inthe study.The pathogens of the children's secretions were detected by fluorescence quantitative method.The blood was tested for hepatitis B virus, hepatitis C antibody and hepatitis A antibody, and blood culture method was used to detect and identify bacteria, and blood genetic metabolism and coagulation function were also screened.According to the age of the children, they were divided into infant group, toddlergroup, preschool group and school age group.Results:Among the 176 children, the infants had the most abnormal liver function, 93 cases(52.84%), followed by 43 children (24.43%) in the toddler group.Causes of the disease: 138 cases (78.41%) of the original diseases, 8 cases (4.55%) of non-infectious diseases, 30 cases (17.04%) of the undetected pathogens.Among the 138 cases with liver function abnormality due to infectious diseases, 123 cases (89.13%) were infected with virus, 8 cases (5.80%) were infected with bacteria, 6 cases (4.35%) were infected with mycoplasma, and 1 case (0.72%) was infected with Toxoplasma gondii.Among the 123 cases of liver dysfunction caused by viral infection, cytomegalovirus was detected in 62 cases (50.41%), followed by EB virus in 38 cases (30.89%), rotavirus in 10 cases (8.13%), and EV71 virus in 5 cases (4.07%), 4 cases of common enterovirus (3.25%), 2 cases of respiratory syncytial virus (1.63%), 1 case of herpes simplex virus and Coxsackie A16 virus (0.81%). Pre-school and above were mainly infected with EB virus; the age>1 year-old liver function abnormality was 37.10% (23/62) due to cytomegalovirus, and the proportion of EB virus infection was 92.11% (35/38). Compared with 62.90% and 7.89% of age 2 months to 1 year, the difference was statistically significant (χ 2=29.27, P=0.00). Eightcases of liver infection caused by bacterial infection: 3 cases of Staphylococcus aureus, 2 cases of Streptococcus pneumoniae, 2 cases of Escherichia coli, and 1 case of Pseudomonas aeruginosa.There were 3 cases of genetic metabolic diseases, including 2 cases of hepatolenticular degeneration and 1 case of glycogen accumulation.Characteristics of liver function abnormalities in children: the main clinical manifestations of children were jaundice, splenomegaly and hepatomegaly, cough, diarrhea, etc.Outcome: 98 cases (55.68%) were healed, 60 cases (34.09%) were improved, and 17 cases (9.66%) were aggravated, 1 case of death (0.57%). Conclusion:The abnormal liver function of infants was mainly caused by virus infection, especially cytomegalovirus.Infants and young children have no obvious symptoms in the early stage of the disease, severe cases can be manifested as jaundice and hepatosplenomegaly, mainly mild, with a good prognosis.

Objective To investigate the epidemiological characteristics of hand,foot and mouth disease (HFMD) in Hangzhou in 2016,so as to provide evidence for prevention and control of HFMD.Methods The clinical data of HFMD diagnosed in outpatient and inpatient department of Hangzhou Children's Hospital were retrospectively analyzed.At the same time,we investigated their family health and environment,and whether there was any silent infection among family members who were closely contacted with HFMD cases.Results There were 14 600 cases of HFMD diagnosed,including 1 492 hospitalized patients in 2016.The peak of cases occurred from May to July.Of the 1 492 hospitalized cases of HFMD 1 374 were positive for enterovirus,accounting for 92.1％.Of all positive specimens,266 cases were positive for EV-A71,accounting for 19.36％,151 cases were positive for coxsackievirus A16 (CV-A16),accounting for 10.99％,and 957 cases were positive for other enterovirus,accounting for 69.65％.A total of 108 family members who had close contact with 75 EV-A71 positive children were investigated.Among them,31 fecal specimens were positive for EV-A71 nucleic acid,accounting for 28.7％ (31/108).There were 54 cases of children without breastfeeding,accounting for 36％ (54/150),83 children living in rural and suburban areas,accounting for 55.3％ (83/150),87 children with poor health conditions,accounting for 58％ (87/150),112 families had 3 or more family menbers,accounting for 74.7％ (112/150),90 main family caregivers were educated at high school or below,accounting for 60％ (90/150),36 families have kindergarten children in family members and he/she was ill at that time,accounting for 64.3％ (36/56),115 families had no accepted knowledge of HFMD,accounting for 76.7％ (115/150).Conclusions The etiology of HFMD in Hangzhou in 2016 is mainly other enterovirus,and family factors may have certain correlation in the pathogenesis and transmission of HFMD.

Objective To investigate the influence of high-fat diet on liver function and intestinal bacte-rial community through building rat models. Methods 20 rats of 21 days old were divided into two groups ran-domly as normal diet group fed with standard chow diet and high-fat group fed with high-fat diet. After 6 weeks, feces of rats in both groups were obtained for 16S rRNA high-through sequencing of the intestinal bacterial com-munity. Results After 6 weeks high-fat diet, total protein (TP) (55. 79±3. 75, P=0. 002), globin (GLB) ( 34. 9±2. 53, P<0. 001), albumin (ALB) /GLB (. 60±0. 02, P<0. 001), alkaline phosphatase (ALP) (373. 80±63. 05, P<0. 001), total cholesterol (TC) (1. 94±0. 23, P<0. 001), low density lipoprotein (LDL) (0. 76±0. 93, P<0. 001), LDL/high density lipoprotein (HDL) (1. 43±0. 22, P<0. 001), and tri-glyceride (TG) (1. 48±0. 50, P=0. 015) increased compared with the normal diet group. Additionally, intes-tinal bacterial diversity and evenness decreased significantly. The dominant bacteria were Bacteroidetes, Firmi-cutes, and Proteobacteria, with averaged relative abundances as 56. 36%, 35. 31%, and 6. 61%, respectively. The relative abundances of Bacteroidetes deceased (P=0. 007), those of Firmicutes increased (P=0. 020), and those of Proteobacteria were kept stable (P=0. 928) after a 6-week high-fat diet. Furthermore, the intesti-nal bacterial community structure changed distinctly between the two groups by 16s rRNA high-through sequen-cing. Conclusion High-fat diet can lead to change of intestinal bacterial community structure and further result in liver function damnification as well as obesity.

Objective: To observe the intestinal viral shedding time in patients with hand, food and mouth disease (HFMD) induced by coxsackievirus A6 (CA6). Method: Throat swab specimens and stool specimens of HFMD children were collected from those admitted to Hangzhou Children′s Hospital between May and October 2015, while fluorescence quantitative PCR was used to detect the viral load.Eeighteen cases of HFMD children were followed up, who were confirmed as CA6 infection via laboratory tests.Stool specimen was collected every 4-7 days, and fluorescence PCR was used for virus nucleic acid detection until the stool viral nucleic acids of infected children turned to be negative.The intestinal virus shedding time of CA6-infected HFMD was compared with the intestinal virus shedding time of 65 children with enterovirus 71 (EV71) infection and 44 children with coxsackievirus A16 (CA16) infection of the previous studies (from May to September 2012). Result: The median stool viral load was 25×10⁵ copies/ml (55×10⁴ copies/mL, 9×10⁶ copies/ml) in CA6-infected children.The numbers of stool virus nucleic acid turning negative were 0 case, 4 cases, 9 cases, 3 cases and 2 cases in 18 children at 1st, 2nd, 3rd, 4th, 5th weeks. At 5th week, the stool virus nucleic acid of children in CA6 group all turned to be negative.The positive rates of stool virus nucleic acid in EV71 group and CA16 group at the 5th week, however, were 31% and 27% respectively.There were statistically significant differences in distribution of positive rate of stool virus nucleic acid between CA6 infected children with EV71 and CA16 infected children (χ²=13.894, 10.698, P<0.05). Conclusion The longest intestinal virus shedding time for CA6-infected HFMD children was 5 weeks, which is obviously shorter than that of EV71- infected children and CA16-infected children.

Objective To investigate the role of heme oxygenase-1 ( HO-1 ) and carbon monoxide ( CO) in children with mycoplasma pneumoniae infection. Methods A total of 198 cases with mycoplasma pneumoniae infection under 3 years were enrolled in this study. According to whether with wheezing,all cases were divided into wheezing group( n=58 ) and no wheezing group ( n=140 ) . According to having hypox-emia,wheezing group was divided into mild wheezing group(n=34) and severe wheezing group(n=24). And no wheezing group was set as control group. The serum COHb levels were measured by dual-wavelength spectrophotometry. The serum HO-1 were measured by ELISA. Results The levels of serum HO-1 and COHb% in severe wheezing group were ( 2 734. 10 ± 707. 59 ) ng/L, ( 3. 88 ± 0. 83 )%, and ( 1 130. 03 ± 671. 02) ng/L,(1. 16 ± 0. 63)% in mild wheezing group,and(931. 32 ± 451. 67) ng/L,(1. 04 ± 0. 37)% in no wheezing group,respectively. There were significant differences in serum HO-1 and COHb% between se-vere wheezing group and mild wheezing group(P<0. 01,respectively),and there were no significan differ-ences in serum HO-1 and COHb% between mild wheezing group and no wheezing group( P>0. 05,respec-tively). There was significant positive correlation between serum HO-1 and COHb%(r=0. 875,P<0. 01). Conclusion With mycoplasma pneumoniae infection,the expression of HO-1 and COHb% increase by the wheezing disease progression. HO-1 and CO may participate in the development process of infantile wheezing diseases.