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06 June 2022, Volume 37 Issue 6 Previous Issue    Next Issue

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Management of foreign bodies in the digestive tract of children in China：Ａ guideline for the patient and public（2022）  Pediatric Collaborative Group, Chinese Society of Digestive Endoscopology, Pediatric Digestive Endoscopy Professional Committee of Chinese Endoscopist Association, Alliance of Patient and Public Guidelines 2022, 37(6): 401-414.  DOI: 10.19538/j.ek2022060601 Abstract ( )   Foreign bodies in the digestive tract of children are emergencies，and prevention and timely management are essential. In order to help parents of children，caregivers and the public to raise their awareness of foreign bodies in digestive tract and disseminate knowledge on the prevention，diagnosis and treatment of foreign bodies in the digestive tract，the Management of foreign bodies in the digestive tract of children in China：A guideline for the patients and public （2022），which is appropriate to the national conditions of China，was developed with the participation of multidisciplinary experts，parents of children and representatives of public through the collection and selection of clinical questions from the parents of children and public，systematic search of evidence and Delphi investigations，and with reference to the reporting guidelines of patient and public guidelines.

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Advice on pediatric prescription pre-checking of microecological preparations National Children’s Medical Center (Beijing), Editorial Committee of Chinese Journal of Practical Pediatrics 2022, 37(6): 415-423.  DOI: 10.19538/j.ek2022060602 Abstract ( )

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Sinusitis oral solution in the treatment of children with rhinitis and nasal sinusitis：Expert consensus on the clinical application Pediatric Ear-Nose-Throat Committee of Chinese Society of Pediatricians, Pediatric Ear-Nose-Throat Head and Neck Surgery Branchof Asia-PacificAssociationofMedicineandBio-Immunology 2022, 37(6): 424-429.  DOI: 10.19538/j.ek2022060603 Abstract ( )

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Rational use of antiviral drugs in pediatrics LIU Xing-lou 2022, 37(6): 430-436.  DOI: 10.19538/j.ek2022060604 Abstract ( )   Viral infections are particularly common among children. In most cases，viral infections are not severe，and they are self-limiting and do not need antiviral drugs. However，in some cases，viral infections can be severe and lead to sequelae and adverse consequences. At present，there are only a few specific antiviral drugs in clinical practice，and the adverse reactions of these drugs limit their application in pediatrics. This article will focus on antiviral drugs currently approved for children. By introducing the mechanism，indications，usage and adverse reactions of these antiviral drugs，it is aimed to improve the understanding of pediatricians about antiviral drugs，and help pediatricians to use antiviral drugs more accurately，reasonably and in a standardized，which will be conducive to recovery from disease and healthy growth of children.

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Rational use of antifungal drugs in pediatrics XU Jun, YU Hui 2022, 37(6): 436-444.  DOI: 10.19538/j.ek2022060605 Abstract ( )   There has been a significant increase in the incidence of invasive fungal disease in children over the past 20 years because of the widespread use of broad-spectrum antibiotics，immunosuppressants，hormones，anti-tumor drugs and targeted biological agents as well as the advance of fungal detection techniques. Invasive fungal disease is one of the leading causes of death in immunocompromised children. In addition to primary immune deficiency，hematopoietic stem cell transplantation，solid organ transplant and HIV，infants themselves are also a risk factor for fungal infections. Therefore，early diagnosis and prompt application of effective antifungal drugs are an important measure to save the lives of children. As a special population the selection and dosage of antifungal drugs for children are different from those for adults. In this review，we summarize the appropriate strategy of antifungal prophylaxis and treatment in children.

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Rational medication for tuberculosis in children WANG Jiang-xia, XU Hong-mei 2022, 37(6): 444-450.  DOI: 10.19538/j.ek2022060606 Abstract ( )   Tuberculosis（TB），a major infectious disease，is a big threat to childrens health. The incidence rate of tuberculosis in children affects the number of adult tuberculosis patients in the future. It is of great importance to emphasize the control of tuberculosis in children. To control and eradicate tuberculosis，we must attach great importance to the prevention and treatment of childrens tuberculosis. However，the non-standard treatment will directly affect the therapeutic effect. This article expounds the rational drug use for childrens tuberculosis.

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Study on the association between severity of community acquired pneumonia and serum cytokines in children PENG Dan-yi, TAN Jun-jie, SHU Yi, et al 2022, 37(6): 451-457.  DOI: 10.19538/j.ek2022060607 Abstract ( )   Objective　To investigate the correlation between serum cytokines and the severity of pneumonia and other laboratory variables in children with community-acquired pneumonia （CAP）. Methods　The clinical data of 105 children with CAP hospitalized in childrens Hospital affiliated to Chongqing Medical University from Oct. 2020 to Jan. 2021 were retrospectively analyzed，and serum cytokines were compared between severe and non-severe CAP in the whole sample and among different subgroups. Results　In the whole sample，the serum IL-6 level of severe CAP was significantly higher than that of non-severe CAP，but with no statistically significance （14.98ng/L vs. 4.2ng/L，P=0.581）. There were no statistical difference in serum levels of IL-2，IL-4，IL-10，TNF-α，IFN-γ or IL-17A between severe and non-severe CAP patients. Among the subgroups of different disease course，in the early group （disease course＜14d） ，the IL-6 level of severe CAP was significantly higher than that of non-severe CAP ，but with no statistically significantce （34.97ng/L vs. 4.04ng/L，P=0.169）；while the IL-6 level in the later group （disease course≥14d） was similar between severe CAP and non-severe CAP. The correlation analysis showed that IL-6 level was significantly positively correlated with CRP only in the severe CAP subgroup and the early subgroup （r=0.521，P=0.008 and r=0.467，P=0.000）. Conclusion　Serum IL-6 level can be used as an auxiliary clinical indicator to reflect the severity of CAP in children with short disease course，but the clinical reference value of IL-6 level in patients with prolonged or chronic disease course remains to be discussed.

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Risk factors for ICU admission among  children with pertussis SHI Ting-ting, HUANG Li, JIANG Wen-hui, et al 2022, 37(6): 458-463.  DOI: 10.19538/j.ek2022060608 Abstract ( )   Objective　To analyse the risk factors for intensive care unit （ICU） admission among children with pertussis，in order to provide timely treatment and reduce the risk of death. Methods　The clinical data of 144 child patients with pertussis who were admitted to Guangzhou Women and Childrens Medical Centre between January 2016 and December 2019 were retrospectively studied.Patients were divided into general group and ICU group. The univariate Logistic regression analysis was used to determine the factors related to ICU admission .Multivariate Logistic regression analysis was used to determine the independent risk factor for ICU admission. Results　Totally 144 patients were enrolled （general group 106 cases，ICU group 38 cases）. Among the 144 patients，there were 69 boys and 75 girls，with the median age being 2 months，and there were 32 patients aged <3 months in ICU group. Totally 102 patients were unvaccinated for diphtheria-tetanus-pertussis （DTP）. The most common symptom was cough（99.3%），followed by cyanosis（45.1%），fever（31.9%） and shortness of breath（27.8%）.The most common complication was pneumonia （70.1%），followed by respiratory failure （24.3%），septic shock （10.4%），pleural effusion （9.7%），and pulmonary hypertension （9.0%）. The most common laboratory findings were increased WBC and absolute lymphocyte count，including 19 cases with WBC>50.0×109/L. The rate of ICU admission was 26.4%（38/144），the total mortality of pertussis was 9.0%，and the mortality of ICU group was 34.2%. The independent risk factors for the ICU admission among infants and young children with pertussis were WBC>30.0×109/L ，shortness of breath，respiratory rate > 70/min （≤1year old） or＞60/min （＞1year old），heart rate＞180/min （≤1years） or＞160/min （＞1year old），cyanosis，and oxygen saturation < 0.90. Conclusion　Severe pertussis of infant mainly occurred in children aged < 3 months. The presence of WBC>30.0×109/L，shortness of breath，respiratory rate > 70 /min （≤1year old） or＞60 /min （＞1year old），heart rate＞180/min （≤1years） or＞160/min （＞1year old），cyanosis，and oxygen saturation < 90% are independent risk factors for ICU admission among children with pertussis. Paediatricians should pay more attention to these symptoms，identify the severe cases in early stage，and transfer the patients to ICU as soon as possible.

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Clinical features，prognosis and gene analysis of glycogen storage disease type Ⅸa YANG Feng-xia, TAN Li-mei, YE Jia-wei, et al 2022, 37(6): 464-469.  DOI: 10.19538/j.ek2022060609 Abstract ( )   Objective　To summarize the clinical，laboratory examination and gene mutation characteristics and prognosis of glycogen storage disease type Ⅸa （GSD Ⅸa），and to strengthen the understanding of this type of disease. Methods　The clinical，laboratory examination，gene mutation and prognosis of 18 children with GSD Ⅸa who were genetically diagnosed at the Guangzhou Women and Childrens Medical Center from September 2016 to September 2020 were retrospectively analyzed. Results　The 18 children were all male，and the median age of onset was 1 year and 10 months. All children had hepatomegaly and elevated transaminase and there were 8 cases of short stature （44.44%），11 cases of hypoglycemia （61.11%），7 cases of hypertriglyceridemia （38.89%），6 cases of hypercholesterolemia （33.33%）and 12 cases of hyperlactic acidemia （66.67%）. A total of 17 mutations were detected，all of which were hemizygous mutations，and most were missense mutations；10 were unknown mutations not reported，of which 2 were novel mutations. Nine cases underwent liver biopsy，and the pathological results were consistent with typical GSD manifestations；4 cases （44.44%） were accompanied by focal fibrous hyperplasia in the portal area；6 cases （66.67%） had hepatocellular steatosis. Except for one untreated child，all the other children were given improved diet and oral raw corn starch，and their clinical and biochemical manifestations were improved. Conclusion　Hepatomegaly and elevated transaminases are highly correlated with GSD Ⅸa，and genetic testing can confirm the diagnosis and classification. Most of the disease has a good prognosis，but some may progress to liver fibrosis，and follow-up needs to be strengthened.

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Research progress in the mechanism of common components of extracellular matrix in regulating chondrogenesis and#br# endochondral ossification of growth plate#br# WANG Yi, GONG Chun-xiu 2022, 37(6): 470-475.  DOI: 10.19538/j.ek2022060610 Abstract ( )

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Application progress of endobronchial ultrasound-guided transbronchial needle aspiration in children with mediastinal diseases YAO Guo-hua, ZOU Ying-xue 2022, 37(6): 476-480.  DOI: 10.19538/j.ek2022060611 Abstract ( )