Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

Objective: To evaluate the main triggers of recurrent cardiac events in patients with symptomatic congenital long QT syndrome (cLQTS). Methods: In this retrospective case analysis study, clinical characteristics were reviewed from 38 patients with recurrent cardiac events after first visit out of 66 symptomatic cLQTS patients. General clinical data such as gender, age, clinical presentation, family history and treatment were collected, auxiliary examination results such as electrocardiogram and gene detection were analyzed. LQTS-related cardiac events were defined as arrhythmogenic syncope, implantable cardioverter defibrillator (ICD) shock, inappropriate ICD shock, aborted cardiac arrest, sudden cardiac death or ventricular tachycardia. Results: A total of 38 patients with recurrent symptoms were enrolled in this study, including 30 females (79%) and 14 children (37%). The average age of onset was (15.6±14.6) years, and the recurrence time was (3.6±3.5) years. Subtype analysis showed that there were 11 cases (29%) of LQT1 (including 2 cases of jervel-Lange Nielson syndrome), 19 cases (50%) of LQT2, 5 cases (13%) of LQT3 and 3 cases (8%) of other rare subtypes (1 LQT5, 1 LQT7 and 1 LQT11) in this patient cohort. LQT1 patients experienced recurrent cardiac event due to drug withdrawal (6 (55%)), specific triggers (exercise and emotional excitement) (4 (36%)) and medication adjustment (1 (9%)). For LQT2 patients, main triggers for cardiac events were drug withdrawal (16 (84%)), specific triggers (shock, sound stimulation, waking up (6 (32%)). One patient (5%) had recurrent syncope after pregnancy. One patient (20%) had inappropriate ICD shock. For LQT3 patients, 4 (80%) patients developed syncope during resting state, and 1 (20%) developed ventricular tachycardia during exercise test. One LQT5 patients experienced syncope and ICD shock under specific triggers (emotional excitement). One LQT11 patient had repeated ICD shocks under specific inducement (fatigue). One LQT7 patient experienced inappropriate ICD shock. Left cardiac sympathetic denervation (LCSD) significantly alleviated the symptoms in 2 children with Jervell-Lange Nielson syndrome (JLNS) post ineffective β-blocker medication. Nadolol succeeded in eliminating cardiac events in one patient with LQT2 post ineffective metoprolol medication. Mexiletine significantly improved symptoms in 2 patients with LQT2 post ineffective β-blocker medication. Conclusions: Medication withdrawal is an important trigger of the recurrence of cardiac events among patients with symptomatic congenital long QT syndrome.
Adolescent ; Adult ; Child ; Child, Preschool ; Death, Sudden, Cardiac ; Electrocardiography ; Female ; Heart ; Humans ; Infant ; Long QT Syndrome ; Retrospective Studies ; Young Adult

Humans ; Immunoblastic Lymphadenopathy/diagnosis* ; Inflammation ; Lymphoma, T-Cell, Peripheral ; Prognosis ; Retrospective Studies

Objective To understand the status and main causes of death among children under five years old in Yuyao County from 2013 to 2017, and to provide scientific basis to formulate relevant intervention measures． Methods Data monitoring deaths among children under five years old from 2013 to 2017 in Yuyao were collected. Trend of death, death rank, regional difference and utilization of pre-death health care services for children under 5 years old were retrospectively analysed using SPSS 18.0. Results From 2013 to 2017, the mortality rate in newborns, infants, 1-4 years old children and children under 5 years old (U5MR) decreased in Yuyao county(P=0.016, 0.002, 0.038, ＜0.001). Based on monitored 263 cases of deaths,the majority of deaths of children under 5 years old occurred in infants, accounting for 68.82% (181/263). Congenital malformation and unintentional injury were the main causes of death for children under 5 years old. The deaths of children under 5 years old mainly occurred in medical institutions, and 93.54% of the children were treated before death. The mortality rate of boys under 5 years old was 10.50‰, which was 1.54 times of the mortality of girls ( χ2=11.693, P<0.001). The trend Chi-square test showed that the U5MR in local residents had no obvious downward trend in the past 5 years ( χ2trend =0.195, P=0.658), while the U5MR in floating population significantly decreased with fluctuation ( χ2trend =17.706, P<0.001). Conclusion The key to reduce U5MR in Yuyao is to reduce infant mortality, and the key content of death intervention is to prevent congenital malformations and unintentional injuries. Improving maternal and child health care and developing safety education for migrant children are two effective measures to reduce U5MR.

Objective To investigate the macular vascular density after successful repair of rhegmatogenous retinal detachment (RRD) for one year using optical coherence tomography angiography (OCTA),and discuss the correlation between the macular vascular density and visual acuity.Methods Totally 42 patients of the RRD (42 eyes),their contralateral eyes (A group) and 42 patients of the normal eyes (B group) were recruited into this study.All participants underwent examination with best corrected visual acuity (BCVA) and OCTA.The difference in macular vascular density was compared and the correlation between BCVA and the vascular density was analyzed.Results The macular vascular density of superficial layer,deep layer and choroidal capillary layer was 0.422 4 ±0.089 3,0.4836 ±0.0748,0.527 1 ±0.039 0 in RRD group,respectively,0.469 3 ±0.112 5,0.550 0 ±0.074 0,0.546 2 ±0.034 3 in A group,respectively,0.5619 ±0.053 7,0.611 2 ±0.035 2,0.562 6 ±0.030 4 in B group,respectively.The macular vascular density was significantly decreased in RRD group when compared with A and B groups (all P ＜ 0.05).There was a positive correlation between BCVA and the macular vascular density in the deep layer and choroidal capillaries layer (r =0.629,0.654,both P =0.000).However,there's no correlation between the macular vascular density of superficial layer and BCVA (P =0.103).Conclusion All the macular vascular densities are decreased in patients of RRD after successful repair of retinal detachment one year later,which indicated that the blood flow does not completely recover.And there is a positive correlation between BCVA and macular vascular densities in deep layer and choroidal capillaries layer.And meanwhile,OCTA can objectively and effectively quantify the status of macular region blood flow.

Objective: To observe the lumen structural changes of radial artery (RA) in patients with transradial coronary intervention and the impact of nitroglycerin on the structure by optical coherence tomography (OCT). Methods: A total of 20 patients with transradial coronary intervention were enrolled for OCT imaging to observe and compare the lumen structures of RA between the basic condition and nitroglycerin treated condition. Results: OCT imaging found that 15/20 patients had radial spasm and 1 had intimal tear. Compared to basic condition, with nitroglycerin treatment, the mean lumen diameter, lumen area and total vascular area were increased in the distal, middle and proximal portion of RA, all P<0.001; the intima-media thickness was decreased in the distal, middle and proximal portion of RA, all P<0.001; while the cross section area of tunica media, intimal thickness and extravascular membrane thickness were similar between the basic condition and nitroglycerin treated condition, all P>0.005. Conclusion: Vasodilatation drug may obviously enlarge RA lumen area and total vascular area in patients after transradial coronary intervention.

Objective To investingate the possible predictory of radial artery occlusion(RAO) after transradial approach and its preventive measures.Methods We prospectively assessed the occurrence of RAO in 669 consecutive patients undergoing transradial approach and 63 patients were excluded from the final study (24of them did not meet the inclusion criterium,31 patients converted to other artery approaches,6 patients lost clinical follow-up and 2 patients died).Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.The risk factors of RAO including sex,body mass index (BMI),smoking,hypertension,diabetes,dyslipidemia,puncture site,vessel spasm,and artery diameter/ sheath ratio were evaluated using a multivariate model analysis.Results Among the 606 patients,RAO occurred in 56 patients.There were no differences in sex,age,BMI,coronary lesions,rates of vessel spasm,vessel length,medication given and operation time between the 2 group of patients with vs without ROA (all P＞0.05).Univariate logistic analysis showed puncture site at 0 cm away from radial styloid and artery diameter/sheath ratio ≤ 1 were possible risk factory and puncture site ＞ 4 cm from radial styloid was possible protective factor.Further multivariate analysis showed the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P=0.033) and 8.90 (P=0.040),respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤ 1 (OR=2.45,P=0.004).Conclusions Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.

BACKGROUNDThe risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.

METHODSWe prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.

RESULTSOf the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2-5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).

CONCLUSIONDistal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.

TRIAL REGISTRATIONClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.

Aged ; Arterial Occlusive Diseases ; etiology ; Cardiac Catheterization ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Punctures ; Radial Artery

OBJECTIVETo investigate the prevalence, current treatment, and clinical characteristics of asthma, as well as the risk factors for this disease, among children aged 0-14 years in 2010 in urban Zhongshan, China.

METHODSA total of 10 336 children aged 0-14 years were selected from urban Zhongshan by cluster random sampling. The Third National Childhood Asthma Epidemiological Questionnaire 2010 was used to analyze the prevalence, current treatment, and clinical characteristics of childhood asthma, as well as the risk factors for this disease.

RESULTSAsthma was diagnosed in 179 cases (1.73%). The prevalence of asthma in male children was significantly higher than that in female children (2.25% vs 1.16%; P<0.01). Of the 179 patients, severe attacks were common in 104 cases (58.1%), 110 cases (61.5%) had slow onset, 102 cases (57.0%) had gradually relieved conditions, 61 cases (34.1%) suffered from asthma during seasonal transition, and 150 cases (83.8%) developed asthma due to respiratory tract infection. Among all asthmatic children, 71.5% had been treated with inhaled corticosteroids, and 71.5% had been treated with bronchodilator. The multivariate logistic regression analysis showed that a history of penicillin allergy, a family history of allergy, food allergy, eczema, allergic rhinitis, cesarean delivery, family mould, and perinatal passive smoking were independent risk factors for childhood asthma.

CONCLUSIONSThe prevalence of childhood asthma in urban Zhongshan is on a high level, and is associated with gender. The treatment of asthma has been standardized, but still needs further improvement. The onset of asthma attack is influenced by various factors.

Adolescent ; Asthma ; epidemiology ; etiology ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Risk Factors ; Seasons ; Time Factors