Objective:To study the macrolides resistance of Mycoplasma pneumoniae(MP) in Suzhou area, and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia (MPP) from October 2013 to September 2014 in Suzhou area, 48 children were treated with Azithromycin (10 mg/kg, once a day, intravenous drip for 5-7 days), and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP, and 34 children who were successfully treated with macrolides antibiotics (MA) were clinically diagnosed as general MPP (GMPP). MP DNA was extracted from the airway secretion of children in the two groups, and the point mutations of 2063 and 2064 of 23S rRNA were sequenced, and according to the MP 23S rRNA sequencing results, the children were divided into macrolides antibiotic resistant MP group (MRMP) and macrolides antibiotic sensitive MP group (MSMP). The clinical characteristics of the two groups were compared. Results:In the MRMP group, the incidence of RMPP was 62.2% (46/74 cases), while in MSMP group, the incidence of RMPP was 25.0% (2/8 cases). The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP ( χ2=2.719, P=0.099). Compared with MRMP group, MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination, as well as some laboratory results, including the total number and classification of white blood cell (WBC), C-reactive protein (CRP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB). Conclusions:The fever duration of MPP lasted more than 1 week, suggesting the possibility of macrolides resistance of MP, but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.

Objective Based on the multi-camera digital image correlation (DIC) method, the dynamic deformation characteristics of human hand during grasping were studied. Methods A continuous four-camera DIC system was established to measure surface strain of the skin on the back of the hand during grasping process, and then through the connection between skin, joints, bones and muscles, the regular pattern of muscle deformation could be known indirectly. Results Four grasping postures (medium cylinder, lateral pinch, index finger extension, power sphere) were measured. It was found that the increases of strain magnitude were different at different positions on back surface of the hand under different grasping postures, and the maximum principal strains were between 0.1 and 0.3. The movement characteristics for each muscle group of the hand under different grasping postures were obtained through analysis. Conclusions This method has the characteristics of non-contact, full field, intuitive results, which provides a new way for in vivo measurement of dynamic deformation during grasping.

Objective To analyze the epidemiological characteristics of Streptococcus pneumonia (SP) in children with respiratory tract infection in Suzhou area,and the correlation between the air pollutants and the epidemiological characteristics of SP.Methods The real-time air quality test data of Suzhou in Jiangsu province was recorded from January 2012 to December 2014,and sputum specimens of 6 653 cases of hospitalized children with respiratory tract diseases in the same period were collected.The SP detection content and the correlation between SP and the concentration level of PM2.5,PM 10,nitrogen dioxide (NO2),sulfur dioxide (SO2),carbon monoxide (CO),ozone (O3) in Suzhou were analyzed.Results The SP detection rate was 9.94％ in 6 653 children.The SP detection rates were respoctively 7.69％ (183/2 381 cases),10.87％ (235/2 161 cases),11.51％ (243/2 111 cases) between 2012 and 2014.The SP detection rates of children at the age of ≤ 1 year old,＞ 1-3 years old,＞ 3-＜ 7 years old and ≥ 7 years old more respectively were 7.11％ (227/3 192 cases),13.48％ (244/1 810 cases),13.76％ (168/1 221 cases),5.12％ (22/430 cases).The SP detection rate of children at the age of ＞ 1-3 years old and ＞3-＜7 years old was higher than that of ≤ 1 years old and ≥7 years old,and the difference was significant (x2 =84.980,P ＜ 0.001).The SP detection rates in spring,summer,antumn and winter respectively were 9.79％ (173/1 768 cases),7.66％ (130/ 1 697 cases),11.76％ (187/1 590 cases),10.70％ (171/1 598 cases).The SP detection rate of children in summer was the lowest (x2 =4.897,15.839,9.165,all P ＜ 0.05).The concentrations of PM2.5,PM 10,SO2,NO2,CO and O3 were in a state of fluctuation during the survey period.The SP detection rate had positive correlation with the concentration of PM2.5,PM10,SO2,NO2,CO and O3 (r =0.650,0.586,0.680,0.467,all P ＜ 0.005),and there was no obvious correlation between the SP detection rate and the concentration of CO,O3 (all P ＞ 0.05).Conclusions SP is one of the important pathogens of respiratory tract infection in children in Suzhou area,and the detection rate in infants and preschoolers is higher but the detection rate in summer is lower.The SP detection rate is closely correlated with the concentration of PM2.5,PM10,SO2,NO2.

Objective To explore the influence of coinfection with other pathogens on human metapneumovirus (hMPV) infection in children.Methods A total of 11 299 children admitted to the Department of Respiratory Disease,Children's Hospital of Soochow University between June 2010 and May 2015 were enrolled in this study.Sputum specimens were collected and multiple pathogenic joint detection was done,including peripheral blood,and blood routine,C reactive protein (CRP),hepatic function and cellular immunity.Patients' clinical data were collected.Results Among 11 299 hospitalized children,hMPV was positive found in 222 children (1.96％).One hundred and fourteen children (51.4％) had hMPV simple infection and 108 cases of them (48.6％) were coinfected with other pathogens.The hMPV coinfected with bacteria (63 cases,28.4％)was most common.The average age of multiple coinfected children was older than that of simple hMPV infection in children [(2.43 ± 2.47) years old vs.(1.27 ± 1.30) years old],and the difference was significant (Z =-2.360,P ＜ 0.05).Fever seemed to be more common in children coinfected with bacteria or multiple coinfection (63.5％ and 70.0％) compared with those with simple hMPV infection (43.0％),and the differences were significant (x2 =6.827,4.986,all P ＜ 0.05).There was no significant difference in other clinical features among 5 groups (all P ＞ 0.05).Multiple coinfection children had a higher percentage of neutrophils (0.50 ± 0.18) than that in simple hMPV infection children (0.37 ± 0.19),children coinfected with bacteria (0.39 ±0.19) or other virus (0.35 ±0.19),and the differences were significant (all P ＜0.05).CRP was elevated in 30.2％ (19/63 cases) of children coinfected with bacteria,which was significantly higher than that of simple hPMV infection children (16.7 ％,19/114 cases),and the difference was significant (x2 =4.381,P ＜ 0.05).CD3 + CD4 + was significantly lower in multiple coinfection children (0.31 ± 0.07),but there were no significant difference compared with other groups (all P ＞ 0.05).CD19 + CD23 + was significantly higher in children coinfected with other virus com pared with that of simple hMPV infection group,hMPV coinfected with bacteria,hMPV coinfected with Mycoplasma pneumonia and multiple coinfect group (0.37 ± 0.10 vs.0.30 ± 0.09,0.30 ± 0.08,0.29 ± 0.07,0.29 ± 0.09),and the differences were significant (all P ＜ 0.05).Conclusions It is suggested that hMPV seems easily coinfected with other pathogens,especially with bacteria.It should be on high alert that bacteria coinfection is accompanied with high percentage of neutrophils and high level of CRP.Coinfection does not significantly exacerbate the clinical symptoms of hMPV infection,but may exacerbate the cellular immune disorders to a certain extent.

Objective To analyze the correlation between response to hepatitis B virus (HBV) vaccine and cellular immunity and clinical characteristics in children with respiratory infection.Methods Nine hundred and sixty children in Department of Respiratory in Children's Hospital of of Soochow University,who were over 7 months old and had full course of HBV vaccination between January and December 2015 were enrolled in this study.Peripheral blood (1-2 mL) was collected,and antigen-antibody of HBV was detected by using enzyme-linked immunosorbent assay and PCR included HBV surface antigen,hepatitis B antibody,HBV e antigen,HBV e antibody,HBV core antibody,and HBV nucleic acid.According to the results,these children were divided into 4 groups:non response group,low response group,normal response group and high response group according to their responses to HBV vaccine.Cellular immunity was detected by using flow cytometry and patients' clinical data was collected.Results There was no statistical differences of CD3 + CD4 +,which were (3.43 ± 0.28) ％,(3.42 ± 0.30) ％,(3.43 ± 0.36) ％ and (3.52 ± 0.29) ％,among the four groups (F =0.520,P =0.669).CD3 + CD8 + in non response group was (3.18 ±0.28)％,which was significantly higher than that in low response group,normal response group and high response group [(3.08 ± 0.36)％,(3.05 ±0.34)％,(2.93 ±0.30)％],the differences were significant (all P＜0.05);CD4/CD8 in non response group (0.26 ± 0.43) were significantly lower than that in normal response group (0.40 ± 0.50),the differences were significant (P =0.001).There was no significant difference of CD3 +,CD3 + CD8 + and CD4/CD8 among low response group,normal response group and high response group (all P ＞ 0.05).CD3-CD19 + and CD19 + CD23 + level were lowest in non response group [(3.00 ± 0.57) ％,(2.25 ± 0.67) ％] and highest in high response group [(3.33 ± 0.45) ％,(2.57 ± 0.38) ％],the differences were significant (all P ＜ 0.05).Among the 4 groups,children in normal response group had the shortest average hospitalization days [(1.88 ±-0.31) d],which was significantly shorter than that in non response group,low response group and high response group [(1.96 ± 0.39) d,(1.95 ± 0.38) d,(1.96 ±0.15) d],the differences were significant (all P ＜0.05),there was no significantly difference of average hospitalization days among other 3 groups (all P ＞ 0.05).Proportion of severe pneumonia was significantly higher in non response group [6.1％ (22/363cases)] and high response group [13.3％ (2/15 cases)] compared to those in normal response group [2.6％ (7/274cases)],the differences were statistically significant (x2 =4.417,P =0.036;x2 =5.476,P =0.019).The total white blood cell number was lowest in non response group (F =4.695,P =0.003).Platelet number was increased with higher degree of response to HBV (F =6.598,P ＜ 0.001).Conclusions Cellular immunity is lower in respiratory infection children with non response or low response to HBV vaccine.After they have respiratory infection,children with non response to HBV vaccine may have a longer course of disease and worse condition.

Objective To study the characteristics of etiology of lobar pneumonia in hospitalized children.Methods Medical history and sputum specimens were collected from 1 179 hospitalized children with lobar pneumonia from January 2006 to December 2015.Multiple pathogenic joint detection combined with the history data were used for analysis.Seven kinds of common respiratory virus were detected by direct immunofluorescence.Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP) and human Bocavirus (hBoV) were detected by fluorescence quantitative polymerase chain reaction (PCR).Human Rhinovirus (HRV) and human Metapneumovirus (hMPV) were detected by reverse transcription PCR.Aspirates were cultured for bacteria.MP specific antibody IgG and IgM were tested by enzyme-linked immunosorbent assay (ELISA).Positive rates of each group were compared by χ2 test or Fisher exact test.Results Total etiology detection rate of lobar pneumonia in hospitalized children was 83.9% (989/1 179).The etiology detection rate of MP, virus, bacteria and streptococcus pneumoniae (SP) were 74.0%, 14.2%, 18.3% and 12.2%, respectively.The virus detection rate in 1-3 years old group was the highest, and that in ≥6 years old group was lower than other group (χ2=70.095, P<0.01).The MP detection rate increased with age (χ2=119.777, P<0.01).The bacteria detection rate in ≥6 years old group was significantly lower than those of <1 years old group, 1-3 years old group and 3-6 years old group (χ2=8.939, 14.319, 45.738, all P<0.01).The detection rates of total virus, MP, bacteria and mixed infection had no statistical difference in the four seasons (all P>0.05).The MP detection rate was above 70% in every season.The detection rates of SP and hBoV were basically the same in every season.The detection rate of HI was higher in spring, Pinf 3 and SA were higher in summer, HRV was higher in autumn, and respiratory syncytial virus (RSV) and moraxella catarrhalis (MC) were higher in winter.Conclusions Lobar pneumonia occurs more common in elder children.MP is the major pathogen of lobar pneumonia, and SP is the second.The MP detection rate increases with age.The pathogen detection rate varies with age, but the effect of seasonal factor is not obvious on pathogen detection in lobar pneumonia.

OBJECTIVEThe aim of this study was to evaluate the effect of postoperative adjuvant therapy on the survival in patients with N1 lymph node metastasis of esophageal squamous cell carcinoma (ESCC).

METHODS110 patients with positive N1 lymph node metastasis of esophageal squamous carcinoma were included in this study. The surgery group included 46 cases and the postoperative adjuvant therapy group included 64 cases (24 cases in the adjuvant chemotherapy subgroup and 40 cases in the adjuvant concurrent chemoradiotherapy). The disease-free survival (DFS) and overall survival (OS) of the two groups were compared and the prognostic factors were analyzed by multivariate Cox model.

RESULTSIn the postoperative adjuvant therapy group, the DFS (16.8 months) and OS (21.3 months) were significantly prolonged compared with those in the surgery group (10.6 months, P=0.007) and (13.7 months, P=0.001), respectively. Postoperative adjuvant chemotherapy significantly extended the OS (31.1 months) of N1-positive patients compared with 13.7 months (P=0.002) in the surgery group. But there were no significant differences between the DFS in the two subgroups (16.3 and 16.8 months, P=0.346) and between the OS (23.4 and 21.3 months, P=0.491). Postoperative adjuvant therapy was an independent prognostic factor in the ESCC patients with N1 lymph node metastasis.

CONCLUSIONPostoperative adjuvant therapy can improve the prognosis and prolong the survival time in ESCC patients with positive N1 lymph node metastasis.

Carcinoma, Squamous Cell ; mortality ; secondary ; therapy ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Esophageal Neoplasms ; mortality ; pathology ; therapy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Postoperative Care ; Prognosis ; Retrospective Studies

Objective To explore the non-bacteria pathogens of acute laryngitis in children. Methods The clinical data and sputum sample were collected from 325 patients hospitalized due to acute laryngitis in consecutive 10 years from January 2006 to December 2015 . The multiple non-bacteria pathogens were detected and analyzed with clinical data. Seven types of respiratory viruses were detected by direct immunolfuorescence. Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP), and Boca virus (HBoV) were detected by lfuorescence quantitative PCR. The rhinovirus (HRV) and human metapneumovirus (hMPV) were detected by RT-PCR. Venous blood was collected within 24 h after hospitalization and 7-10 d after treatment. The MP antibody of IgG and IgM were detected by ELISA. Results The detection rate of non-bacteria pathogens was 46 . 2%in 325 children with acute laryngitis ( 150/325 ), including 76 cases ( 23 . 4%) of virus and 99 cases ( 30 . 5%) of MP. Virus detection rate in 1-3 year old children was obviously higher than in 0-1 year old children and over 3 years old children (χ2?=?9 . 527 , P=?0 . 009 ). With the increase of age, the detection rate of MP increased gradually (χ2?=?10 . 132 , P=?0 . 006 ). The detection rates of RSV and hBoV were higher in under 3-year-old children. The detection rates of virus in winter and spring were signiifcantly higher than those in summer and autumn (χ2?=?5.064, P=?0.024). The detection rates of MP in winter, spring, summer, and autumn was 13.1%, 25 . 0%, 38 . 2%, and 44 . 9%respectively, and the MP detection rates were increased gradually over seasons (χ2?=?4 . 438 , P=?0 . 035 ). The detection rate of RSV was higher in winter, and hBoV was higher in summer. Conclusion Acute laryngitis mainly occurred in children under 3-years-old children, and the detected non-bacteria pathogens were different among different ages and seasons. Virus was the major pathogens in young children, while MP was more common in older children.

Objective To explore the level of expression, clinical signiifcance of sB 7-H 3 in the bronchoalveolar lavage lfuid (BALF) of refractory Mycoplasma pneumoniae (MP) pneumonia (RMPP) in children and the relationship between sB7-H3 and various cytokines. Methods The BALF of forty-three hospitalized children with RMPP (RMPP group) were collected for the diagnosis and treatment. Thirteen cases were lavaged only once and the other thirty cases had collected the BALF twice. The BALF of iffteen hospitalized children with bronchial foreign body were collected as control group. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF were detected by enzyme-linked immunosorbent assay. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF at the acute phase were compared with control group and the group after treatment. Analyzed the correlation between the level of sB 7-H 3 and IL-1β, IL-2 , IL-36 in the BALF of RMPP children at acute stage. Results The levels of sB 7-H 3 , IL-1β and IL-36 in the BALF of the ifrst lavage group were higher than those of single lavage group and control group (all P<0 . 05 ). The levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF of single lavage group were higher than those of control group (all P<0 . 05 ). The levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF of the second lavage group were lower than those of the ifrst lavage group (all P<0 . 05 ).The levels of sB 7-H 3 , IL-2 in the BALF of the second lavage group were higher than those in the control group (both P<0 . 05 ), but the levels of IL-1β, IL-36 in the BALF showed no difference between the second lavage group and the control group (both P>0 . 05 ). The levels of sB 7-H 3 had positive correlation with the levels of IL-1β, IL-2 and IL-36 (all P<0 . 001 ). Conclusions sB 7-H 3 may control the secretion of IL-1β, IL-2 and IL-36 , and participate in immune response and lung injury after MP infection, which may lead to occurrence and development of RMPP.

Objective To analyze the epidemiological characteristics of Mycoplasma pneumoniae (MP) infection in children with respiratory tract diseases ,and to provide scientific basis for clinical diagnosis and treatment and to formulate control measurements for the administrative department of public health .Methods Sputum specimens of 20 021 cases of hospitalized children with respiratory tract diseases from October 2005 to December 2014 in Suzhou were collected .MP DNA was detected by fluorescence quantitative polymerase chain reaction .At the same time ,venous blood was collected within 24 h after admission and 7-10 d of treatment .Specified MP antibodies IgG and IgM were tested by enzyme-linked immunosorbent assay to analyze the detection rate of MP . The positive rates between groups were compared using chi-square test or Fisher exact test .Measurement data were compared using Wilcoxon test .Results The MP infection rate was 36 .08% (7 224/20 021 cases) in 20 021 children .The MP infection rate of girls was 40 .81% (3 057/7 490) ,which was significantly higher than that of boys (33 .25% [4 167/12 531] ,χ2=116 .20 ,P<0 .01) .The MP infection rates of children at the age of less than six months ,6 months to 1 year old ,1-3 years old ,3-7 years old and older than 7 years old were 18 .35% ,29 .39% ,43 .93% ,54 .10% and 64 .48% ,respectively ,which increased with age (χ2 =1 949 .65 , P<0 .01) .The MP infection rates in spring ,summer ,autumn and winter were 31 .97% ,41 .57% , 40 .88% and 29 .90% , respectively . The MP infection rate of children in summer and autumn was significantly higher than that in spring and winter (χ2 =234 .61 , P<0 .01) .The MP infection rate was highest in the autumn of year 2008 (55 .07% ) and lowest in the spring of year 2010 (18 .48% ) for the decade .The MP infection rate showed fluctuations with different degrees in four seasons except in 2007 . In the past ten years ,the MP infection rate in Suzhou area was at a higher level in 2008 ,2009 ,2012 and 2013 ,which were 46 .03% ,46 .60% ,39 .28% and 47 .40% ,respectively .The MP infection rate was the lowest (25 .24% ) in 2011 in the decade ,and maintained around 30% in the rest years .Conclusions The MP infection rate in children with respiratory tract diseases is at a high level in Suzhou area .The MP infection rate of girls is higher than that of boys .MP infection could occur among all age groups ,and the MP infection rate increases with age .MP infection rate peaks in summer and autumn .MP infection has a small prevalence every two or three years ,which could sustain about two years .