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??In 2014??a total of 359 000 cases of tuberculosis??0-14 years old?? in children were reported worldwide??accounting for 6.5 percent of the registered TB cases. According to China’s research data in 2013??the PPD positive??≥10 mm??rate of children aged 5 to 15 in different TB epidemic areas was 8.09% to 21.26%. In 2015??6 861 cases of tuberculosis in children were reported nationwide??with a incidence of 3.03/100 000. In 2014??the national TB mortality rate among children aged 0 to 14 was 0.12/100 000. The diagnosis of childhood tuberculosis should be based on a comprehensive assessment of evidence such as contact history??clinical examination and related examinations. The principles of childhood TB treatment are the same as those of adults. At present the state council issued a national tuberculosis control program??put forward to improve the prevention and treatment of tuberculosis in children??to provide technical training to pediatricians on TB control??and to standardize the diagnosis and treatment of childhood tuberculosis.     

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??In the third international consensus definitions for sepsis and septic shock??sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This new definition is similar to severe sepsis in the past. This article describes the epidemiological characteristics of this disease??including etiology??underlying diseases??organ dysfunctions??prevalence and prognosis.     

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??Abstracts?? Objective To explore the prevalence and risk factors of asthma in children aged 0??14 years old in Changle rural area?? providing data for prevention and treatment of childhood asthma in rural area. Methods Multi-stage?? stratified and random cluster sampling was used to recruit children. The same screening questionnaires for the national epidemiological survey of children’s asthma were distributed among parents of children aged 0??14 years old at schools??kindergartens and communities. Asthmatic children were picked among the screening-positive children based on on-the-spot inquiries??physical examinations??medical records and supporting test results??Further survey of asthmatics was carried out to investigate the diagnosis and treatment status of childhood asthma and other associated allergic diseases. Results Among a total of 6000 questionnaires?? 5860 were completed with a response rate of 96.67%; and 135 ??2.3%??children were recognized as asthma??typical asthma??n=119??2.03%???? cough variant asthma??n=13??0.22%?? and suspected asthma??n=3??0.05%????. The prevalence of asthma was higher in boys??n=81??2.51%?? than in girls??n=38?? 1.44%?? ??χ2=8.27??P??0.05??. Conclusions The prevalence of asthma is 2.03% in children under 14 years old in Changle rural area and it varies in children with different genders and ages??Taking the age of onset into account?? the asthma prevalence was lowest in the children aged 0??1 years old??0.37%??2/533???? and highest??5.32%??20/376????in those aged 3??4 years old??The main cause of asthma in children is upper respiratory tract infection?? and the important risks include individual allergic history?? family history and genders.     

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目的探讨甲型H1N1流感患儿感染后细胞免疫功能的变化。方法回顾性分析2009年10月至2010年1月苏州大学附属儿童医院收治的86例甲型H1N1流感确诊病例(分成危重组和重症组)的临床资料;采用流式细胞仪检测患儿外周血T淋巴细胞、B淋巴细胞和NK细胞亚群比例。以23例外科住院患儿的淋巴细胞亚群作为对照组来观察甲型H1N1流感患儿的细胞免疫功能变化特征。结果 (1)CD3+、CD3+CD4+、CD3+CD8+亚群百分比:重症组和危重组较对照组明显降低,而该两组之间差异无统计学意义;(2)CD3-CD19+、CD19+CD23+亚群百分比统计结果示危重组>重症组>对照组,各组间比较有统计学意义(P<0.05);(3)CD3-CD16+CD56+亚群百分比在重症患儿和对照组之间差异无统计学意义,危重组较其他两组均有显著下降;(4)CD4+/CD8+比值在各组之间差异无统计学意义。结论甲型H1N1流感患儿感染后细胞免疫功能存在明显紊乱:T淋巴细胞受到全面抑制,B淋巴细胞激活参与病毒的清除,NK细胞比例的降低与危重患儿的病情相关。     

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??To explore the epidemiology and etiology of chronic diarrhea diseases??CDD??in children?? and understand the incidence?? etiology and clinical manifestation. Methods??Clinical data of 179 cases of CDD hospitalized between January 1996 and January 2006 were retrospectively reviewed. Results??Morbidity of CDD was 4. 8% during these 10 years??among which 50. 3% were less than 1-year- old infants ?? and 62.2% were less than 3-year-old children. Common complications included anemia??46. 4%?? ??malnutrition??45. 3%???? growth and development retardation??24. 0%???? hypoalbuminemia??36. 3%???? etc. Totally 154 cases had been found with clear etiology?? and final diagnosis rate was 87. 7%. The first 3 causes were inflammatory bowel diseases??IBD?? ??35. 2%???? infectious diseases?? 17.3%?? and immunodeficiency diseases ??15. 6%??. Unknown pathology ??including refractory diarrhea 7 cases?? occupied 12. 3%. Conclusion??Infant and young children?? especially the infants often suffer from CDD?? and are easily complicated with malnutrition?? etc. Etiology of CDD is various??and the most common one is non-infectious diseases. IBD is the most important reason of children CDD.     

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??Objective??To study the current status of common blood purification therapy for childhood-onset severe systemic lupus erythematosus??SLE?? in China. Methods??The questionnaire was discussed and set by Pediatric Blood Purification Specialist Committee??the data of 127 hospitalized children with blood purification therapy in 22 units were collected and analyzed from January 1??2012 to December 31??2017. Results????1??Among the 127 cases??including 28 males and 99 females??between 4 to 16 years old. 63 cases were treated by plasma exchange??PE?? for 180 times??41 cases were treated by DNA immunoadsorption??DNA-IAS?? for 106 times??11 cases were treated by hemodialysis??HD?? for 112 times??12 cases were treated by hemoperfusion??HP?? for 32 times. ??2??PE and DNA-IAS can alleviate the clinical symptoms effectively??causing the systemic lupus erythematosus disease activity index??SLEDAI????ANA titer??antidouble-stranded DNA antibodies??immunoglobulin to decrease and complement to increase significantly. HD for children with renal insufficiency was effective??HP can eliminate inflammatory factors and relieve clinical symptoms of children. The remission rates of PE??DNA-IAS??HD and HP were 87.30%??87.80%??72.73% and 75.00% respectively. Conclusion??PE and DNA-IAS therapy can remove the immune substances in the blood of children with severe SLE quickly and relieve the disease??HD therapy is mainly used for children with severe edema and renal insufficiency??HP therapy can eliminate inflammatory factors effectively and improve clinical symptoms. For children with severe SLE??different blood purification mode should be selected according to the difference of the children’s condition.     

Epidemiology and prevention of caustic ingestion in children

A total of 102 children less than 16 years of age admitted for caustic ingestion in the period 1976–1991 were registrated. The annual incidence rate of hospitalizatiotl was 10.8:100000 for the city of Aarhus, Denmark. Esophageal burns occurred with a frequency of 5.0:100000 per year. Ninety-four percent of the children were less than 5 years old. For this age group, the incidence rates of admission and esophageal burns were 34.6:100 000 and 15.8:100 000, respectively. All ingestions were accidental. The incidence rates of esophageal burns in children 0–4 years old ( p = 0.019) decreased significantly during the period studied. The cause of this decrease is not clear, but a change in the spectrum of household products and the gradual introduction of child-proof caps are possible explanations. To minimize the frequency of accidents, an information campaign directed specifically at parents of toddlers is recommended. Information material should stress that caustics should always be inaccessible to children and stored separately, and should never be decanted.     

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??Objective To strengthen the cognition about the epidemiological characteristics of influenza in children and to provide reference for its prevention and control. Methods Analyze the data of influenza-like cases in Shanghai Children’s Hospital from 2011 to 2013. Results A total of 29 524 influenza-like cases were surveyed. The patients who were less than 5 years old occupied the largest proportion ??74.40%??. A total of 3168 pharyngeal swabs were collected and 559 influenza viruses were checked out ??17.65%??. Totally 232 ??41.5%?? of these influenza viruses were identified as influenza A ??H3N2?? virus?? 229 ??40.97%?? as influenza B virus and 98 ??17.53%?? as novel influenza A ??H1N1?? virus. The differences of the virus types were statistically significant each year??P??0.01??. The higher positive detection rates occurred from January to April in 2011 ??20.51%~45.89%???? from December 2011 to April 2012 ??28.77%~57.65%???? from July to August in 2012 ??44.74%??35.14%?? and in December 2013??52.29%??. Conclusion The children with influenza surveyed in 2011—2013 are infected by influenza A ??H3N2?? virus?? influenza B virus and novel influenza A ??H1N1?? virus. The epidemic strains change every year. The types of influenza viruses are popular alternatively. The influenza is with high incidence in winter-spring commonly?? but can also be popular in summer. Children less than 5 years old are more susceptible to influenza.     

儿童过敏性鼻炎的流行病学

过敏性鼻炎（allergic rhinitis,AR）是儿童常见的慢性疾病之一。经全球流行病学调查,不同年龄段、不同地区之间的儿童AR患病率都有差异,AR患病率整体呈现缓慢增加的趋势。但不同地区过敏原种类分布不一,在欧美及我国新疆地区,以植物类为主要过敏原;我国其他地区则以螨类为主要过敏原。     

无锡地区儿童幽门螺杆菌耐药性及治疗分析

目的 分析江苏省无锡地区门诊儿童幽门螺杆菌（Hp）感染及耐药情况,并探讨抗菌药物合理使用策略。方法 回顾性分析2018年12月至2021年7月,因上消化道症状在消化内科门诊就诊并行胃镜检查患儿的临床资料。结果 采集患儿胃窦黏膜标本716例。其中男392例、女324例;中位年龄11.0(9.0～13.0)岁,≤12岁454例、>12岁262例。Hp培养阳性260例（36.3%）,男132例、女128例;≤12岁148例、>12岁112例;>12岁患儿Hp阳性率（42.7%）明显高于≤12岁患儿（32.6%）,差异有统计学意义（P<0.05）。药敏试验结果显示,对6种抗菌药物均敏感的菌株占10.4%(27/260),甲硝唑耐药率为75.4%(196/260),克拉霉素耐药率为37.7%(98/260),左氧氟沙星耐药率为20.8%(54/260),未发现对呋喃唑酮、阿莫西林、四环素耐药的菌株;76例对两种抗菌药物耐药,其中克拉霉素+甲硝唑双重耐药45例,克拉霉素+左氧氟沙星双重耐药11例,甲硝唑+左氧氟沙星双重耐药20例;对克拉霉素、甲硝唑和左氧氟沙星三重耐药19例...     

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??Objective??To investigate the current rate of Helicobacter pylori infection in asymptomatic children residing in Beijing urban area and to discuss the risk factors that predispose children to such infection. Methods??A total of 1196 asymptomatic children aged from 1 month to 18 years were selected from urban schools in Beijing areas. A face to face interview was conducted with a specially designed standard questionnaire. We performed enzyme-linked immunoadsorbent assay ??ELISA?? for H.pylori stool antigen test to determine H.pylori infection status. Results??The overall prevalance of H.pylori was 10.6%. On univariate analysis??risk factors for H.pylori infection included age??poor hygienic habits??lower socioeconomic status??and positive family history of gastrointestinal diseases. Multivariate logitstic regression identified that age??poor hygienic habits??economic status??number of people in the same house??house area??and positive family history of gastrointestinal diseases were the independent risk factors of H.pylori infection. Conclusion??H.pylori infection rate among these children is high??and increases with age. H.pylori infection clusters within families and is closely associated with personal and familial hygienic habits.     

儿童社区获得性肺炎诊治研究

目的探讨2013年儿童社区获得性肺炎(CAP)管理指南(简称2013版指南)应用于儿童CAP诊断和治疗中的思考与经验。方法回顾性分析209例不同年龄儿童非重症CAP的临床特征,以及采用阿奇霉素为一线抗生素的治疗效果。结果在209例患儿中,春夏季发病94例,秋冬季发病115例;51例(24.4%)患儿WBC计数≥10.0×109/L,91例(43.5%)患儿中性粒细胞绝对计数(ANC)≥5.0×109/L;199例(95.7%)患儿出现C反应蛋白(CRP)增高(≥3 m g/L);94例患儿MP-Ig M阳性(45.0%)。173例(82.8%)患儿的胸片为单侧炎症病变,以右侧为多见。婴幼儿组、学龄前期组和学龄期组患儿之间发病季节(秋冬季和春夏季)的分布差异无统计学意义(P0.05)。不同年龄组之间,WBC计数增高(≥10×109/L)比例的差异有统计学意义(P=0.002),以婴幼儿组比例为最高。MP-Ig M阳性组患儿春夏季发病比例高于MP-Ig M阴性组,差异有统计学意义(P0.01)。以阿奇霉素作为一线抗生素的总有效率为98.1%(205/209),MP与非MP肺炎的总有效率的差异无统计学意义(P0.05)。结论 2013版指南对儿童CAP的诊断和治疗有指导价值,但本地区儿童CAP也有其独特性。     

The burden of influenza in children under 5 years admitted to the Children's Hospital at Westmead in the winter of 2006

Objective: Active surveillance to determine influenza disease burden in children admitted to hospital with influenza‐like illness (ILI). Methods: A prospective hospital‐based cohort study conducted June–October 2006 in children <5 years hospitalised at The Children's Hospital at Westmead with ILI (fever and respiratory symptoms). Influenza and other viral infections were diagnosed either by antigen detection using immunofluorescence or nucleic acid amplification testing of nasopharyngeal aspirates. Data were collected using researcher‐administered questionnaires. Main outcome measures include proportion of hospitalisations with influenza, vaccination and treatment, risk factors for influenza and associated medical and social burdens. Results: Data on 275 children with ILI aged <5 years were analysed. Thirty‐one (11%) children with ILI had influenza (22 had influenza A and 9 had influenza B). Thirty‐five percent were under 6 months of age and 61% under 1 year. Twenty‐nine percent of children with influenza A were born prematurely. The mean duration of hospital stay for influenza was 2.8 days (95% confidence interval 2.1–3.4) and 26% had a lumbar puncture. Although 68% received intravenous antibiotics, only 3% (one case) was given an antiviral. Eighty‐four percent had visited their local doctor before admission and all came through the emergency department. On average, in one‐third (32%) of families of children with influenza a parent developed, ILI during admission or soon after hospital discharge resulted in an average of 3.2 days of work absenteeism. Only 3.5% (7/199) of children older than 6 months with ILI received any influenza vaccination. Conclusions: Both the burden of influenza in childhood morbidity and its social impact are substantial. There is considerable room for improvement in both the prevention and early recognition (trigger treatment with antivirals) of influenza. Our data will inform decisions regarding the value of a universal influenza vaccine programme.     

Treatment and prevention of malaria in children

Malaria is a tropical disease. However, due to travel, cases can be imported into countries with temperate climates. For instance there are 1300–1800 cases imported into the UK each year. Three-quarters of reported malaria cases are caused by Plasmodium falciparum, which is capable of causing severe or life-threatening disease. Roughly 10% of cases occur in children. Malaria in children often presents with misleading symptoms and the presentation of malaria can be delayed for many months. Therefore a travel history is important in all children presenting with fever. Awareness and early diagnosis using thick and thin blood films or rapid diagnostic tests is crucial in improving outcomes. Uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy (ACT), quinine with doxycycline or clindamycin, or atovaquone-proguanil. Severe or complicated malaria in children should be treated with intravenous artesunate or intravenous quinine if artesunate is not available. Children with severe malaria should be managed in a high-dependency or intensive care setting. Either an oral ACT or chloroquine can be used for the treatment of non-falciparum malaria. Dormant parasites (hypnozoites) may persist in the liver after treatment of P. vivax or P. ovale so primaquine may be required to prevent relapse. Prevention of malaria in children involves the use a combination of bite prevention strategies and chemoprophylaxis. Recent vaccine developments have seen WHO approving the malaria vaccine RTS,S/AS01 for prevention in children living in regions with high transmission in sub-Saharan countries. This short article gives practical advice to health care professionals caring for children who return from malaria endemic areas to countries where the condition is far less common.     

儿童幽门螺杆菌感染的临床表现、诊断及治疗

我国是幽门螺杆菌(Helicobacter pylori,H.pylori)感染率较高的国家。儿童H.pylori感染不仅与消化性溃疡、慢性胃炎、胃癌等胃肠道疾病密切相关,还可能与多种胃肠道外疾病有关。但目前H.pylori感染的多种诊断方法各有利弊,各种治疗药物在不同地区显示出不同程度的耐药性。文章回顾了近年国内外儿童H.pylori感染流行病学、临床表现、诊断方法及其治疗方案的最新研究进展。