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06 February 2017, Volume 32 Issue 2 Previous Issue    Next Issue

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Evidence-based guidelines to the clinical application of probiotics in pediatrics Pediatric Group of Microecology Branch of Chinese Preventive Medicine Association 2017, 32(2): 81-90.  DOI: 10.19538/j.ek2017020601 Abstract ( )

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Focusing on microbiota, microbiome and probiotics ZHENG Yue-jie*，HUANG Zhi-hua 2017, 32(2): 91-94.  DOI: 10.19538/j.ek2017020602 Abstract ( )   The human microbiota and microbiome have been focus in medicine. It has been recognized that the microbiota has an important effects on human growth and development，immune function，nutrition and metabolism，and the microbiota has  close association with infectious disease，chronic inflammatory bowel diseases，allergic diseases，autoimmune diseases，and metabolic disease such as obesity and diabetes. The knowledge of microbiota and probiotics have been changing. Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host，and it has been widely used for preventing and treating medical conditions. The concept，mechanisms，pharmacological properties and the safety of probiotics are being updated.

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Modulation of intestinal microbiota as treatment for irritable bowel syndrome CHEN Jie 2017, 32(2): 95-98.  DOI: 10.19538/j.ek2017020603 Abstract ( )   Irritable bowel syndrome（IBS） is a common cause of chronic abdominal pain in children with the high incidence and long-term negative impact on quality of life. The pathogenesis of IBS is unknown. Intestinal microecological imbalance has been found to be closely related to IBS in recent years. In IBS patients，the intestinal microbial colonization resistance is impaired（B/E value is decreased），the diversity and stability of intestinal microbiology is generally decreased，and the number of  E.coli and Enterococcus increased with bifidobacteria and lactobacilli decreased. There is no specific treatment for IBS，and modulation  of  intestinal micro-ecological  could be an important target for treatment of IBS. In detail，probiotics could be used as an adjunct to IBS therapy，while the exact efficacy need to be evaluated by high quality clinical trials. There is no evidence that prebiotics, synbiotics and FMT could be used to treat IBS. Whether rifaximin be effective for treatment of IBS or not need more evidence.

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Role of probiotics in antibiotic-associated diarrhea in children WU Qing-bin 2017, 32(2): 98-101.  DOI: 10.19538/j.ek2017020604 Abstract ( )   Antibiotic-associated diarrhea（AAD），which results from disturbance or destroying of balance in the gut microbiota caused by antibiotic therapy，is frequent pediatric complications. Clostridium difficile-associated diarrhea（CDAD） is considered a severe colitis type of AAD. Antibiotics administration can result in gut microbiota alterations，i.e， disturbance and redistribution in composition and significant drops in taxonomic diversity. Changes in the microbiota composition may lead to changes of host intestinal mucosal immune response pattern，being open to pathogen invasion binding sites，increased susceptibility to infection， and induction of antibiotic resistant strains of colonization. Microbiota alterations cause decreased bacterial carbohydrate and disturbances of bile acid metabolism. The early intervention of probiotics can effectively reduce the incidence of AAD and CDAD. Clinical application of antibiotics and the use of probiotics at the same time are reasonable and effective.

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Probiotics in inflammatory bowel disease of children XUE Ai-juan，HUANG Ying 2017, 32(2): 101-103.  DOI: 10.19538/j.ek2017020605 Abstract ( )   Inflammatory bowel disease（IBD），including ulcerative colitis（UC） and Crohn’s disease（CD），is a chronic relapsing inflammatory disorder of the gastrointestinal tract. Probiotics could be of benefit since involvement of the microbiota in the pathogenesis of IBD is evident. Although some promising studies are underway，the evidence for probiotics is still insufficient to recommend its use for IBD in daily clinical practice. Available data showed that the primary outcomes were correlated with probiotic strains and dosages. In general，probiotics have proven valuable in the management of ulcerative colitis. However，the probiotics seem to confer little benefit in Crohn’s disease.

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Probiotics in functional constipation of children WANG Bao-xi，GUO Hong-wei 2017, 32(2): 103-106.  DOI: 10.19538/j.ek2017020606 Abstract ( )   Functional constipation is a common functional disease of digestive system that arises in children of all ages. The symptoms include infrequent defecation，hard， painful stools that are difficult to pass，fecal incontinence and abdominal pain. These symptoms are known to have a significant impact on the mood，appetite and life quality of children. The pathogenesis underlying FC remains unclear，but with the development of the research in micro-ecosystem of intestines， more and more evidences support that an alteration of the gut microbiota may be a possible mechanism for the development of FC. Probiotics are live microorganisms that can enrich microorganism species， lower intraluminal pH and regulate intestinal immune function，which make it a good prospect in the treatment of FC. Then，this paper will make a brief introduction to the application of probiotics in children with FC by referring to its domestic and abroad research progresses.

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Probiotics in treatment of children with Helicobacter pylori infection XIONG Jing-jing，HUANG Yong-kun 2017, 32(2): 106-110.  DOI: 10.19538/j.ek2017020607 Abstract ( )   Helicobacter pylori（Hp） infection rate is high and has strong pathogenicity，so the eradication of Hp has great significance. The combination of a proton pump inhibitor with two antibiotics，or bismuth-based triple therapy or quadruple therapy is recommended as a alternate first-line regimen for treating Hp infection in children. In recent years，the success of eradication therapies has declined，party due to the increassing rate of Hp resistant strains. Hp eradication therapy with probiotics has received more and more attention. In this article，we comprehensively review the possible mechanisms of probiotics in treating Hp infection in children，and its advantage in the prevention of antibiotic-associated side effects is also discussed.

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Application of probiotics in the liver and biliary diseases of children GUO Shan*，SHU Sai-nan 2017, 32(2): 110-114.  DOI: 10.19538/j.ek2017020608 Abstract ( )   Probiotics are live，nonpathogenic bacteria with the function of improving  the micro-environment and promoting the health of the host. The "gut-liver axis" shows that there is complexed relationship between the liver/gallbaldder and gut microbiota. Alterations of the type and amount of the micro-organisms in the intestinal tract can result in liver dysfunction due to the production of ammonia and endotoxin. Some studies have confirmed the positive influence of probiotic strains on the prevention and treatment of liver and biliary diseases in children，such as nonalcoholic fatty liver disease，cholestasis，cirrhosis，and liver transplantation. Probiotic therapy，as a safe，inexpensive and noninvasive treatment strategy，can alleviate and improve the  pathophysiological courses and symptoms of different types of liver and biliary diseases without obvious side effects，which has great prospect of application .

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Application of probiotics in children with allergic disease ZHENG Yue-jie 2017, 32(2): 114-117.  DOI: 10.19538/j.ek2017020609 Abstract ( )   There is strong evidence implicating the intestinal flora disturbance in developing allergic disease including allergic rhinoconjunctivitis，asthma，eczema and food allergy. Experimental studies with animal model of allergy have shown that probiotics can improve allergic manifestations by induceing immune regulation Treg cell，inhibiting the secretion of allergen-induced IgE and Th2 cytokines，attenuating eosinophils infiltration and allergic inflammation in target organs. Probiotics have been proved effective in treatment of IgE-mediated eczema;however，because of the conflicting results，probiotics are recommended for prevention of allergy only in populations at high risk of allergy.

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Application of probiotics in children with recurrent respiratory tract infections WANG Wen-jian 2017, 32(2): 117-120.  DOI: 10.19538/j.ek2017020610 Abstract ( )   Immaturity of the immune system and exposure to infectious agents contribute to the susceptibility of RRTIs in children， and RRTIs are usually treated with immunomodulating agents. The administration of probiotics plays a role in modulation of immune responses by various methods, including colonization resistance， increased number and activity of natural killer cells， release of  cytokines， and enhanced antibody response， et al. Data show that probiotics may be bene?cial to preventing respiratory tract infections（RTIs）， reducing the number of episodes of RTIs， diminishing the severity of infection symptoms， and reducing duration of episodes， antibiotic use and the number of days absent from day care/school. Probiotics appear to be a feasible way to decrease the incidence of RTIs in children，but further well-designed studies are needed to evaluate the strains， dosing， and frequency in the use of probiotics for RRTIs.

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Application of probiotics in the neonatal necrotizing enterocolitis GUO Cheng，ZHANG Lin 2017, 32(2): 120-125.  DOI: 10.19538/j.ek20170206011 Abstract ( )   Necrotizing enterocolitis（NEC） is considered to be the most common gastrointestinal emergency among neonates. Although the pathogenesis of NEC is incompletely understood，there are several established risk factors，including prematurity，altered intestinal blood flow/oxygen delivery，formula feeding and bacterial infection. Recently，a large number of studies showed that intestinal flora imbalance had been implicated as key risk factor in the pathogenesis of NEC. After birth，the neonatal gut must acquire a healthy complement of commensal bacteria，which leads to deficient or abnormal microbial colonization of the gut，may protect the immature gut from inflammation and injury. Providing a healthy complement of commensal bacteria can maintain the intestinal microflora balance，shift the balance of intestinal microbiota from a pathegenic to protective complement of bacteria，protect the gut from inflammation and subsequent injury，and prevent NEC. We review the relationship between intestinal microbiota and NEC in preterm infants，the mechanism of probiotics in preventing NEC，and the efficacy and safety of probiotics in preterm infants.

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Prospect on the potential role of probiotics in treatment of autism spectrum disorders CHENG Qian 2017, 32(2): 125-128.  DOI: 10.19538/j.ek2017020612 Abstract ( )   Autism spectrum disorder（ASD）is a severe neurodevelopmental disease. At the present time, approved and recommended treatments for ASD are mainly based on rehabilitation and educational interventions. ASD is defined by core behavioural impairments, but gastrointestinal（GI） symptoms are commonly reported. And the GI symptoms are considered to relate to the dysbiosis of gut microbiota and a disorder of the microbiota-gut-brain axis. The alterations of epithelial integrity, immune function and neurotransmitter lead to GI symptoms and autistic behaviors associated with dysbiosis of the gut microbiota. Probiotics can be useful to restore the microbiota balance in the intestine，to alleviate GI symptoms and ameliorate behavioural symptoms associated with some ASD. Although further research and rigorous clinical trial should be required  to study the effect and mechanism of probiotics in the treatment of ASD，they can be considered potential effect on ASD.

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Fecal microbiota transplantation in children 2017, 32(2): 129-132.  DOI: 10.19538/j.ek2017020613 Abstract ( )   The history of fecal microbiota transplantation （FMT）can be traced back to more than 1700 years ago. However， FMT has got unparalleled development only in the recent years. The recent studies report that FMT plays an important role in the treatment of Clostridium difficile infection，inflammatory bowel disease，irritable bowel syndrome，allergic diseases，obesity，autism and other diseases. This article reviewed the history of FMT，and discussed its procedure and indications.

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Changes of plasma C-type natriuretic peptide during head-up tilt test in children with vasovagal syncope and its significance LI Hong-xia*， LIAO Ying， HAN Zhen-hui， et al 2017, 32(2): 133-136.  DOI: 10.19538/j.ek2017020614 Abstract ( )   Objective　To explore the changes of plasma C-type natriuretic peptide（CNP） in children with VVS. Methods　Thirty-one children（male 16， female 15） with VVS were included in the study，and all of them were diagnosed by detailed history taking， physical examination and related laboratory inspections as well as head-up tilt test. The mean age was （11±3） years. Another 32 healthy children（male 17，female 15） were taken as a control group，who were confirmed as healthy by detailed history，physical examination，and standing test，etc. Their mean age was（11±2） years. Finapres Medical System（Finapres Medical System-FMS，the Netherlands） was used to continuously monitor heart rate and blood pressure during HUTT，and ECG was performed. Sandwich immunoluminescence assay was used to test plasma CNP. Results　No differences were found in age，height，weight，supine systolic blood pressure，diastolic blood pressure and mean arterial pressure between VVS group and control group（P＞ 0.05）. The plasma CNP level in VVS group was higher than that of control group in supine position［（35.7±21.5）ng/L vs. （23.2±8） ng/L，P＜0.01］. The plasma CNP was positively correlated with syncope frequency in VVS group（r＝0.85，P＜0.05）. However，no significant differences were found in plasma CNP between supine position and positive response in HUTT in VVS group［（36.3±21） ng/L vs. （42±57） ng/L，P＞0.05］. Conclusion　The plasma CNP level in VVS group is higher than that of control group in supine position. The plasma CNP is positively correlated with syncope frequency in VVS group，which might play a role in the pathogenesis of VVS in children.

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Two cases of heredity pedigree investigation of surfactant protein C p.I73T mutation and the literature review    CHEN Jie-hua，ZHENG Yue-jie，MA Hong-ling，et al 2017, 32(2): 137-140.  DOI: 10.19538/j.ek2017020615 Abstract ( )   Objective    To investigate the clinical manifestations and prognosis of surfactant protein C gene c.218T＞C（p.I73T） mutation. Methods    Patients were screened for the entire coding sequence of SFTPC，and two cases who had mutation in p.I73T were followed up，and the clinical features，prognosis and the heredity pedigrees were investigated. The related literatures were also reviewed. Results    Case 1 was male， 23 months old；case 2 was female，11 months old. Both had chronic cough，tachypnea and anoxia，and was delayed in development. Chest computed tomography（CT） showed diffuse ground glass pattern；there was local emphysema and early sign of cyst formation in case 2. Case 1 was treated with prednisone for 6 months，the respiratory symptoms disappeared，but there still was diffuse ground glass pattern and emerging cyst formation in the chest CT. Case 2 received prednisone，but still had tachypnea and anoxia，and was given hydroxychloroquine for two months and alleviated. In heredity pedigree investigation，the father of case 1 had the same mutation，was asymptomatic，but had interstitial focus in chest. Case 2 was sporadic. Conclusion    The interstitial lung disease caused by surfactant protein C gene p. I73T mutation could be hereditary or sporadic，usually the onset being in infant. Clinical manifestations are chronic cough，tachypnea，hypoxia and growth retardation. Chest CT shows diffuse ground glass pattern，local emphysema，or cyst formation. Some have good response to prednisone and prognosis is good，but are different in different cases.

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Clinical features and prognosis of 80 cases of newborn gastrointestinal perforation CHEN Yuan-yuan，ZHANG Rong，ZHU Li，et al 2017, 32(2): 141-144.  DOI: 10.19538/j.ek2017020616 Abstract ( )   Objective    To compare the etiologic factors，clinical features and prognosis in newborns with gastrointestinal perforation. Methods    A retrospective study of the clinical data from 80 cases with diagnosis of gastrointestinal perforation collected from January 2004 to December 2015 was performed. Based on whether they were full-term，the cases were divided into two groups，then the clinical features，etiologic factors and prognosis were compared. Results    Among the 80 neonates with gastrointestinal perforation，there were 62 preterm infants and 18 full-term infants. The main causes of gastrointestinal perforation for the two groups was necrotizing enterocolitis，with the most frequent clinical symptom of abdominal distension.cases. Compared with full-term infants，the incidence of preterm shock，dyspnea，DIC，and poor reaction was significantly higher in preterm infants（P＜0.05）.The mean time period of perforation in preterm infants group was 9（1.75，20） d，while it was 4.5（1，7.75） d in full-term infants group.There were 62 cases that received surgical treatment，8 cases of which were gastric perforation and 54 cases were intestinal perforation. The exact site of perforation of the 18 cases who refused surgical treatment was not clear. Of all the cases，32 infants died with the overall mortality rate of 40%. For the preterm infants，the mortality was 41.9% （26 cases），while it was 33.3% （6 cases） in the full-term infants group. Conclusion    Neonatal gastrointestinal perforation is one of the serious diseases in neonatal period，which has a very high mortality rate. Early diagnosis，active treatment and timely surgical intervention can significantly improve survival rates and improve the prognosis.

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Research of plugging test in the diagnosis and interventional treatment of pediatric patients with patent duct arteriosus complicated with severe pulmonary hypertension CAO Li-ming*，WANG Feng-ming，QIN Yu-ming，et al 2017, 32(2): 145-148.  DOI: 10.19538/j.ek2017020617 Abstract ( )   Objective    To evaluate the effect of plugging tests in the diagnosis and interventional treatment of pediatric patients with patent duct arteriosus complicated with severe pulmonary hypertension （PAH）. Methods　All the clinical data of 5 patients of PDA with severe PAH were retrospectively reviewed，including the heart catheterization data，the relevant parameters before and after acute pulmonary vasodilator tests and the changes of Pp，Ps，PVRI，and aortic blood oxygen saturation before and after the plugging tests. Results　Only 1 patient was with dynamic PAH according to heart catheterization test；however，for the other 4 patients it was difficult to judge the property of PAH. Acute pulmonary vasodilator tests were performed in 5 patients and 4 were diagnosed with dynamic PAH. Plugging tests were conducted in 5 patients and all of them were diagnosed with dynamic PAH. All the patients underwent interventional therapy well and the follow-up results were good. Conclusion　For PDA patients with severe PAH，plugging test diagnosis can be made on the properties of the PAH and if the determination is dynamic，the intervention treatment can be completed at the same time. This method can effectively avoid the limitations of cardiac catheterization and acute pulmonary vasodilator testing evaluation of PAH properties.

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Effect of mizoribine in the treatment of children with frequently relapsing primary nephrotic syndrome ZHANG Jing*，LI Zhe，DANG Xi-qiang 2017, 32(2): 149-152.  DOI: 10.19538/j.ek2017020618 Abstract ( )   Objective    To observe the effect of mizoribine（MZR） in  the treatment of children with frequently relapsing primary nephrotic syndrome. Methods    Totally 21 children with frequently relapsing nephrotic syndrome were treated with mizoribine， and another 24 children were included as the control group. Observe the changes of relapse number，dosage of prednisone， glomerular filtration rate， serum albumin， urine protein， uric acid and other indicators. Results    After the treatment with mizoribine，the recurrence rate and the effective dosage of prednisone decreased， serum albumin level rose， and primary urinary protein decreased， but there were no significant changes in glomerular filtration rate and uric acid level. Conclusion    The mizoribine is effective in treatment of children with frequently relapsing primery nephrotic syndrome .

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Pathogenesis of nocturnal enuresis in children and the intervention strategies YAO Yong 2017, 32(2): 153-158.  DOI: 10.19538/j.ek2017020619 Abstract ( )

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Report on one case of Kawasaki disease with peritonitis as the first manifestation XIA Jing-yue，LIU Li，HU Jian 2017, 32(2): 159-160.  DOI: 10.19538/j.ek2017020620 Abstract ( )