Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

Objective:To explore the influencing and prognosis factors of emphysematous urinary tract infection (EUTI).Methods:The baseline clinical data of the patients admitted to Shandong University Qilu Hospital (Qingdao) from December 2013 to June 2020 and diagnosed with EUTI were analyzed retrospectively. The patients with non-EUTI (NEUTI) during the same period were selected as the control group. The baseline characteristics between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of EUTI.Results:(1) 24 EUTI patients and 53 NEUTI patients were included in the present study. Compared with the NEUTI group, the hemoglobin level was lower ( t=-5.245, P<0.001) and the levels of blood urine nitrogen ( Z=-4.361, P<0.001), serum creatinine (Scr, Z=-4.543, P<0.001), blood glucose ( Z=-2.608, P=0.009), and triacylglycerol ( Z=-2.408, P=0.016) were higher in the EUTI group. The proportions of diabetes mellitus ( χ2=13.453, P<0.001) and chronic kidney disease ( χ2=17.936, P<0.001) in the EUTI group were higher than those in the NEUTI group. Increasing Scr was the risk factor of EUTI in patients with urinary tract infection ( OR=1.011, 95% CI 1.001-1.020, P=0.025). (2) Escherichia coli ( E.coli, 14 cases, 58.3%) was the most common causative organism. The other causative organisms included Klebsiella pneumoniae (2 cases, 8.3%), Enterococcus faecium (1 case, 4.2%), Pantoea (1 case, 4.2%), and mixed bacteria of E.coli and Enterococcus faecium (1 case, 4.2%). Ten cases of E.coli were extended-spectrum β-lactamases (ESBL)-positive. (3) Of the 24 patients with EUTI, 4 patients had adverse outcomes. The length of stay ( Z=-2.457, P=0.014), blood urea nitrogen ( t=2.432, P=0.024), shock ( P=0.002), autoimmune disease ( P=0.022), and white blood cell count ( Z=-2.091, P=0.036) were statistically different between good prognosis group ( n=20) and poor prognosis group ( n=4). However, logistic regression analysis results showed that neither was the influencing factor of poor prognosis of EUTI. Conclusions:The elevated Scr level is the independent influencing factor of EUTI among urinary infection patients. E.coli is the most common pathogenic bacteria, and ESBL-positive bacteria are common.

Objective: To evaluate the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in prophylaxis neutropenia after chemotherapy in patients with lymphoma. Methods: This was a multicenter, single arm, open, phase Ⅳ clinical trial. Included 410 patients with lymphoma received multiple cycles of chemotherapy and PEG-rhG-CSF was administrated as prophylactic. The primary endpoint was the incidence of Ⅲ/Ⅳ grade neutropenia and febrile neutropenia (FN) after each chemotherapy cycle. Meanwhile the rate of antibiotics application during the whole period of chemotherapy was observed. Results: ①Among the 410 patients, 8 cases (1.95%) were contrary to the selected criteria, 35 cases (8.54%) lost, 19 cases (4.63%) experienced adverse events, 12 cases (2.93%) were eligible for the termination criteria, 15 cases (3.66%) develpoed disease progression or recurrence, thus the rest 321 cases (78.29%) were into the Per Protocol Set. ②During the first to fourth treatment cycles, the incidences of grade Ⅳ neutropenia after prophylactic use of PEG-rhG-CSF were 19.14% (49/256) , 12.5% (32/256) , 12.18% (24/197) , 13.61% (20/147) , respectively. The incidences of FN were 3.52% (9/256) , 0.39% (1/256) , 2.54% (5/197) , 2.04% (3/147) , respectively. After secondary prophylactic use of PEG-rhG-CSF, the incidences of Ⅳ grade neutropenia decreased from 61.54% (40/65) in the screening cycle to 16.92% (11/65) , 18.46% (12/65) and 20.75% (11/53) in 1-3 cycles, respectively. The incidences of FN decreased from 16.92% (11/65) in the screening cycle to 1.54% (1/65) , 4.62% (3/65) , 3.77% (2/53) in 1-3 cycles, respectively. ③The proportion of patients who received antibiotic therapy during the whole period of chemotherapy was 34.39% (141/410) . ④The incidence of adverse events associated with PEG-rhG-CSF was 4.63% (19/410) . The most common adverse events were bone pain[3.90% (16/410) ], fatigue (0.49%) and fever (0.24%) . Conclusion During the chemotherapy in patients with lymphoma, the prophylactic use of PEG-rhG-CSF could effectively reduce the incidences of grade Ⅲ/Ⅳ neutropenia and FN, which ensures that patients with lymphoma receive standard-dose chemotherapy to improve its cure rate.

Objective To observe the efficacy and safety of topical 2％ propranolol cream for strawberry hemangiomas in proliferative phase.Methods Sixty infants with strawberry hemangiomas in proliferative phase were included in this study.There were 18 males and 42 females aged 30 days to 12 months.The lesions were located in head and neck (n=30),trunk (n=19) and extremities (n =11).All the infants received the 2％ propranolol cream treatment three times per day.The infants were required a regular return visit every month.The changes of tumor size,texture and color were monitored and recorded.The adverse effects after medication were observed and managed accordingly.The short-term results were evaluated using a 4-grade system.Results All the infants were followed up for 12 months.Among 60 infants,the Ⅰ,Ⅱ,Ⅲ and Ⅳ grade curative effects were 2,17,33 and 8 cases,respectively.All the infants had no drug adverse reaction.Conclusions The effect of topical 2％ propranolol cream for strawberry hemangiomas in proliferative phase is reliable,with little side effects.It will be popularized in clinical application.

Objective: To evaluate the clinical efficacy of posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafing in the treatment of thoracolumbar fractures .Methods :The clinical data of 30 patients with thoracolumbar fractures ,who were admitted and treated with posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafting during June 2011 and June 2013 ,were retrospectively analyzed .The operation time ,intra‐operational bleeding amount , preoperative and postoperative visual analogue scale (VAS ) score ,the ratio of anterior and posterior vertebral height ,Cobb angle ,neurological function(Frankel grade) and complications were recorded .Results:All the cases had been followed up for 14 .6 months averagely(range from 6 to 23 months) .There was significant difference between the VAS score at the last follow‐up and the preoperative one (P<0 .05) .The ratio of anterior and posterior vertebral height as well as the Cobb angle improved significantly at the 3rd day after operation and the last follow‐up as compared with preoperative ones(P<0 .05) .The ratio of anterior and posterior vertebral height as well as Cobb angle at the 3rd day after operation was not significantly different from that at the last follow‐up(P>0 .05) .The postoperative Frankel grade in patients with neurological function damage improved significantly .There was no breakage or loosening happened with the internal fixation .Conclusions :The posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafting can reconstruct vertebral body height ,rebuild anatomic form of vertebra ,obtain better kyphosis correction ,maintain the correction effect and avoid the long term lumbago and back pain .This surgical method is safe and effective .

OBJECTIVE: To investigate the clinical diagnosis, treatment and prognosis of carcinoma showing thymus-like differentiation (CASTLE) of thyroid, and to improve the understanding of CASTLE. METHOD: In 6 patients with CASTLE, we performed region VI lymph node dissection, the lesion resection of thyroid lobe and isthmus. After the operation, except one case of 68 years old patient, the rest patients were treated with radiotherapy 60 Gy in anterior cervical region after third week of operation and 5 courses of chemotherapy with cisplatin, each interval of 2 weeks. Insist on the oral Euthyrox. RESULT: All patients were alive without recurrence and metastasis. CONCLUSION The diagnosis of CASTLE depends on the histology and immunohistochemistry. Operation was the main treatment. CASTLE is a rare type of thyroid carcinoma with slow progress and good prognosis.
Carcinoma ; diagnosis ; therapy ; Humans ; Immunohistochemistry ; Neck Dissection ; Neoplasm Recurrence, Local ; Prognosis ; Thyroid Neoplasms ; diagnosis ; therapy

Chilaiditi Syndrome ; diagnosis ; diagnostic imaging ; Female ; Humans ; Middle Aged ; Radiography

OBJECTIVETo investigate the substance basis and the mechanism of pseudoanaphylactoid reactions (PR) induced by Shuanghuanglian injection (SHLI).

METHOD(1)The study of PR and the substance basis of PR of SHLI: ICR mice were divided into different test groups, the mice were intravenously injected with solutions of different concentration of SHLI, baicalin, forsythin, caffeotannic acid, positive control Compound 48/80 and normal sodium. All test substances were mixed with 0.4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after SHLI injection. (2) The study of mechanisms: Mice were pretreated with an oral administration of Astemizol, intraperitoneal injection of cyclophosphamide 75 mg x kg(-1) or Compound 48/80 4 mg x kg(-1), then mice were intravenously injected with SHLI. At last, vascular permeability of the ears in pretreated groups was compared with SHLI treatment alone group.

RESULTSHLI of 300 mg x kg(-1) and 600 mg x kg(-1) caused obvious vascular hyperpermeability, but baicalin, forsythin and caffeotannic didn't cause vascular hyperpermeability in the ears. The Astemizol can decrease the degree of SHLI-induced vascular hyperpermeability of the ears in the mice. After intraperitoneal injected with cyclophosphamide, there was a slight decrease in the degree of SHLI-induced vascular hyperpermeability, but there was no marked changes in the degree of the SHLI-induced vascular hyperpermeability after the mice were pretreated with Compound 48/80.

CONCLUSIONSHLI in clinic equivalent dose can cause vascular hyperpermeability. Baicalin, forsythin and caffeotannic may not result in the PR of SHLI. The mechanism of the PR maybe relate to that SHLI stimulates histamine release, the activation of leucocyte maybe take part in the SHLI-induced PR, too. Antihistamine drug can prevent the genesis of PR which induced by SHLI.

Anaphylaxis ; chemically induced ; pathology ; physiopathology ; Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; chemistry ; Injections ; Mice

Objective To explore the toxicity and safety of 32P-CP-PLLA seeds interstitial implantation. Methods 30 beagle dogs were randomly divided into 10 groups according to different drugs (32P-CP-PLLA and 32P-CP),different doses (185, 370 and 740 MBq) and different sites (gluteus and liver). At different time-points after surgery, the weights of dogs were measured. The blood routine and blood biochemical indexes,PC Ⅲ ,HA,CG,PCⅣ and LN were examined. ECT imaging was performed and histology was observed dynamically. Blood, urine and faeces were measured continuously for 12 weeks and 30 days, respectively. Results ECT imaging demonstrated in seed groups and 32P-CP muscle groups radioactivity concentrated continuously in the area of implantation, without liver imaging. 471.67 MBq/m2 of 32 P-CP was injected in liver,while the absorbed dose was 31 Gy,without significant liver damage. When the dose was 794. 28 MBq/m2 , the absorbed dose was 56 Gy,with strong liver and systemic toxicity. But implanting seeds at the same or higher dose, the absorbed dose was 89.83-178.68 Gy in the area of implantation, and the rest liver was 1.09-2. 18 Gy,without liver damage. Dogs in liver group died at 23, 29 and 45 d, respectively, and the inspections of liver fibrosis were higher than the means of the other groups.Blood routine and blood biochemistry indexes between the other groups showed no significant differences.Effective half-life of 32P-CP-PLLA was 11.78 d, while that of 32P-CP was 6. 82 d in liver, and 8. 73 d in gluteus. Mild to moderate injury were found in liver group at 4 weeks. Moderate to serious injury were found. Liver cell necrosis and proliferation were found at 4-6 weeks in other liver groups. In muscle groups,only cellular edema was found in muscle groups at 2 week. The radioactivity count rate in blood for seed groups showed slowly jagged decreasing over time, and decreased exponentially for 32PCP groups. The radioactivity count rate in urine and faeces were multi-peak descending in seed groups. Conclusions 32P-CP-PLLA seeds have the advantages of suitable target location, degradable, non-migration and easy to protection, and it could be used in treatment for different blood supply types of solid tumors. Liver of beagle dog could endure the dose from 32 P-CP-PLLA seed twice as 32P-CP lethal dose.

Objective To explore the possibility and safety of ~(32)P-colloidal chromic phosphate interstitial injection.Methods Ten Beagle dogs were randomly divided into 5 groups (n ＝ 2) according to different doses (185 and 370 MBq) ,different sites (gluteus maximus and liver) and cold colloid as a control group.At different time-points after surgery,the weights of dogs were measured,and the blood and blood biochemical inspections were examined.ECT imaging was performed and histomorphology was observed dynamically.The radioactive counts of body surface for 90 days,blood for 12 weeks and urine and feces for 30 days were measured continuously.Measured data were expressed by mean ±standard error ((x) ±s) and SPSS 13.0 software was used for statistical analysis.Results ECT imaging demonstrated that the whole liver imaging was obtained although the radioactive distribution was uneven in liver groups,and the radioactivity concentrated continuously in the area of injection,but no liver imaging in muscle groups.Dogs in group 4 lost weight progressively and reduced by 2.7 kg till 45 d after operation.While the mean weight increments in the other groups were 3.0,1.6,0.8 and 3.1 kg in order.In group 4,PLT and RBC reduced obviously.Dogs died at 23 or 45 d.AST and ALT were elevated sharply before death.In the other groups,blood and blood biochemistry inspection showed there were no significant statistical differences.The highest radioactive counts after operation were obtained from the injection spot,while the urinary bladder and the spleen were followed.The peak of blood cpm in liver groups presented at 5 min.Peak values were 0.5 × 10~7/min and 1.0 × 10~7/min,respectively.The blood cpm in the muscle groups was always maintained at 3 × l0~5/min.Histology study showed the hyperemia dropsy changes in muscle groups and 185 MBq liver group in 4 weeks,while after 8 weeks the organizational structure restored normally.There were partial liver cells necrosis in 4 weeks,and the massive liver cells balloon type changes in 6 weeks,as well as obvious hyperemia dropsy and the hepatic lobe structure unclear in 370 MBq liver group.For the radioactive counts of urine and excrement,the peak appeared at 13 and 12 d respectively,and the peak values were (42.0 ±3.3) × 10~4 and (29.6 ±4.5) ×10~4 /min in muscle groups,respectively ;while the peak appeared at 5 and 9 d,respectively and the peak values were (49.0 ± 10.2) × 10~4 and (28.5 ± 7.1) × 10~4 /min in liver groups,respectively.Cumulative excretion ratios in urine and excrement were 36.58% and 10.62% in muscle groups,respectively and 23.48% and 8.76% in liver groups till 30 d,respectively.The liver absorbed doses were 30.6 and 55.6 Gy in liver groups,while those were 2.3 and 6.5 Gy in muscle groups.The maximus absorbed doses of gluteus were 53.4 and 98.1 Gy in muscle groups.Conclusions When ~(32)P- colloidal chromic phosphate of 794.39 MBq/m~2 was injected into the liver of Beagle,the liver absorbed dose was 56 Gy,which could be lethal dose for its strong liver toxicity and systemic side effects.Injection of 463.98-772.93 MBq/m~2 in muscle of Beagle could be safe.~(32) P-colloidal chromic phosphate interstitial injection is secure to treat the solid tumors with poor and middle blood supply which could be reached by puncture.