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    06 October 2017, Volume 32 Issue 10 Previous Issue    Next Issue

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    Expert consensus on the diagnosis,treatment and management of recurrent upper respiratory tract infection in children
    Ear-nose-throat Expert Committee,Pediatrician Branch,Chinese Medical Doctor Association
    2017, 32(10): 721-725.  DOI: 10.19538/j.ek2017100601
    Abstract ( )  
    Interpretation of the 2016 edition of ESCMID guideline:Diagnosis and treatment of acute bacterial meningitis 
    HU Jia-sheng,DENG Xiao-long,SUN Dan,et al
    2017, 32(10): 726-732.  DOI: 10.19538/j.ek2017100602
    Abstract ( )  

    Bacterial meningitis refers to the infectious inflammation of meninges and subarachnoid caused by bacterial infection,and the inflammation can also involve the cerebral cortex and other parts of the brain parenchyma. Community-acquired spontaneous bacterial meningitis,known as community-acquired bacterial meningitis,is a major concern of infectious diseases worldwide currently,despite there have been significant advances in the diagnosis and vaccination of community-acquired bacterial meningitis. In this paper,the new edition(2016) of ESCMID guideline:diagnosis and treatment of acute bacterial meningitis was interpreted in detail,including epidemic and epidemiological characteristics of bacterial meningitis,accuracy of diagnosis according to clinical features,how to choose antibiotics and the treatment course,time and methods of dexamethasone treatment,treatment of complications,and follow-up management. This paper aimed at improving the accuracy of diagnostic procedures to guide clinicians to rationalize the  use of drugs to improve the outcome of patients.

    To standardize the diagnosis and management of food allergy related digestive diseases
    LI Zai-ling
    2017, 32(10): 733-735.  DOI: 10.19538/j.ek2017100603
    Abstract ( )  

    Food allergy related digestive disease refers to damage of digestive tract mucosa caused by allergy,and digestive tract symptoms are the main manifestation. Including oral allergy syndrome,anaphylaxis,food protein-induced enteropathy,food protein-induced enterocolitis syndrome,food protein-induced proctocolitis,celiac disease,eosinophilic esophagitis,eosinophilic gastroenteritis. The diagnosis was based on history,manifestation,and food chanllenge. Skin prick test and specific serum IgE test are helpful for screening IgE mediated food allergy. Endoscopy should be based on different disease conditions. The management principles of these diseases include avoiding diet,choosing proper nutrition substitute,following up,carrying out nutrition monitoring and evaluation,and rationally using medicine.

    Oral allergy syndrome in children
    YANG Min
    2017, 32(10): 736-739.  DOI: 10.19538/j.ek2017100604
    Abstract ( )  

    Oral allergy syndrome(OAS) is an IgE-mediated acute oropharyngeal hypersensitivity to food,which is caused by cross-reactivity between proteins in fresh fruits or vegetables and pollens,with a prevalence of 5% to 24 % in children. A variety of food protein antigens have been implicated in OAS. The most classic of these cross-reactive antigens include birch antigen Betv1,profilin and lipid transfer proteins(LTPs). Symptoms are usually manifested as numbness,itching or swelling of the lips or mouth,itching or oedema of the lips, throat,palate or gingiva,erythema of the face and tightness of the throat. OAS can be diagnosed based on clinical history,antigen-specific immunoglobulin E testing,skin prick testing and oral food challenge. If the diagnosis is established,patients should be instructed to avoid the fresh fruits and vegetables that cause symptoms,and emergency administration of epinephrine should be given for severe,generalized reactions.

    Eosinophilic esophagitis in children
    LI Dong-dan,XU Xi-wei
    2017, 32(10): 739-743.  DOI: 10.19538/j.ek2017100605
    Abstract ( )  

    Eosinophilic esophagitis is a relatively rare chronic immune-mediated esophageal disease,which is associated with allergic diseases,and currently its etiology and pathophysiology mechanism is not yet clear. Clinical manifestations are esophageal dysfunction,and symptoms vary with age. Histopathology is necessary for diagnosis,but clinical manifestations and proton pump inhibitor responses also need to be consided. The basis of treatment is dietary therapy and/or drug therapy;dietary therapy is a first-line treatment for children,which can effectively relieve the disease. Swallowing fluticasone or budesonide local hormone therapy is very effective,however,the data of long-term safety and efficacy are not enough. For esophageal stenosis of EOE children,if necessary,endoscopic treatment may be performed. For other therapeutic agents,such as biological agents and immunological preparations,further study is needed.

    Eosinophilic gastroenteritis in children
    ZHANG Yan-ling*,SUN Ting-fang
    2017, 32(10): 743-746.  DOI: 10.19538/j.ek2017100606
    Abstract ( )  

    The eosinophilic gastroenteritis of children is a rare gastrointestinal disease,and its pathogenesis remains unclear. It’s very difficult to make early diagnosis because it can occur at any age with complicated clinical manifestations and no specifity. The diagnosis mainly depends on endoscopic biopsy and multi-point mucosal biopsy. Dietary therapy and glucocorticoids are the most common treatment for the disease. The cognition of eosinophilic gastroenteritis in children should be improved so as to guide clinical diagnosis and treatment.

    Food protein-induced enterocolitis syndrome in children
    WU Jie,CHEN Yun-yan
    2017, 32(10): 746-750.  DOI: 10.19538/j.ek2017100607
    Abstract ( )  

    Food protein-induced enterocolitis syndrome(FPIES)is a non-IgE mediated gastrointestinal allergic disorder,and the pathogenesis is still unknown. The clinical manifestations include repetitive severe vomiting and diarrhea. Acute FPIES can result in dehydration,lethargy and even shock. Chronic FPIES is mainly characterized by weight loss and growth retardation. FPIES mainly affects infants and toddlers. Common allergen includes milk,soybean,oats,fish and eggs. The diagnosis is based on typical clinical manifestations and the fact that avoiding possible food source can alleviate the symptoms. If necessary,oral food challenge(OFC) is required to confirm the diagnosis or to find out the food allergy sources. The key treatment measures are to avoid allergen food and to carry out symptomatic treatment during acute phase.

    Research advance of celiac disease in children
    SUN Mei, YE Xiao-lin
    2017, 32(10): 750-753.  DOI: 10.19538/j.ek2017100608
    Abstract ( )  

    Coeliac disease is an immune-mediated systematic disorder induced by ingestion of gluten. The typical clinical manifestations are gastrointestinal signs including diarrhea,bloating,weight loss and abdominal pain. It can also be manifested as extra-intestinal symptoms,such as iron-deficiency anemia,growth retardation,delayed puberty and recurrent mouth ulcers. Some children are considered to be at high risk of developing coeliac disease,such as those with a family history,who carry a susceptibility gene or have other autoimmune diseases. If the child is suspected with coeliac disease,serological screening with anti-tissue transglutaminase titers should be carried out first,and then the diagnosis may be confirmed by small bowel biopsy with a normal diet. For the treatment of celiac disease lifelong adherence to a gluten-free diet is needed,which can effectively relieve the clinical symptoms and prevent long-term complications. Therefore,clinicians should beware of the different clinical manifestations to ensure early diagnosis and timely application of gluten-free diet therapy.

    Epidemiology of Helicobacter pylori infection in asymptomatic children in Beijing areas
    ZHAO Shuai*,XU Xi-wei,LI Ai-hua
    2017, 32(10): 754-758.  DOI: 10.19538/j.ek2017100609
    Abstract ( )  

    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.

    Age characteristics of bone metabolic index in healthy children and adolescents aged 5 to 14 years
    JU Jun*,LIU Yu-tian*,GUO Guang-hong,et al
    2017, 32(10): 759-763.  DOI: 10.19538/j.ek2017100610
    Abstract ( )  

    Objective To study the gender and age distribution of bone metabolic markers in healthy children and adolescents(5-14 years old). Methods Detailed clinical documents were collected,and morning fasting 5 mL venous blood samples were drawn from 273 cases of the healthy volunteers and healthy school children. Automatic electrochemiluminescence immunoassay analyzer was applied for the tests of bone formation markers[Procollagen type 1 nitrogenous propeptides(P1NP),Osteocalcin(OC)] and bone resorption marker[β-Cross-linked C-terminal telopeptide of type 1 collagen(β-CTx)]. The bone metabolic markers were used to calculate percentile values for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles in the 3 age groups respectively. Results The variation trends of bone formation markers(P1NP,OC) and bone resorption marker (β-CTx) in two gender groups were similar:being relatively low in preschool age and school age period,gradually increasing during preadolescence,reaching peak in adolescence and declining rapidly after adolescence. There were no significant differences in bone formation markers P1NP(P=0.404) and OC (P=0.766) between male and female groups,but there was significant difference in bone resorption marker β-CTx(P=0.01). Conclusion There are no statistically significant differences in the serum levels of P1NP or OC between male and female groups in the bone formation markers of healthy children aged 5-14 years. There is significant difference in bone resorption marker β-CTx between the two groups,the level of the boys being higher than the girls. According to the age distribution of the reference values, the increasing trend of bone metabolic parameters of the female group will appear 1 or 2 years earlier,the peak value being lower.

    Clinical and genetic analysis of 10 patients with lymphocytosis-associated immunodeficiency disease
    HE Ting-yan,XIA Yu,QI Zhong-xiang,et al
    2017, 32(10): 764-767.  DOI: 10.19538/j.ek2017100611
    Abstract ( )  

    Objective To investigate the clinical and genetic features of patients with lymphocytosis-associated immunodeficiency disease. Methods Clinical manifestations,immunological and genetic examinations,treatment and prognosis of patients with lymphocytosis-associated immunodeficiency disease were analyzed retrospectively. Results A total of 10 patients were included,whose median onset age was 3-year-8-month. All patients manifested as hepatosplenomegaly or lymphadenopathy. Seven of them had reduction of peripheral blood cell. Five patients had EBV viremia or infection. One patient suffered from recurrent respiratory tract infection with bronchiectasis. IgG levels(9.14-53.27 g/L) and B cell proportion(10.6%-78.8%) in all patients were normal or significantly increasing. Genetic analysis of all patients showed PIK3CD,FASL,NRAS,KRAS,Caspase10 or XIAP gene mutations. All patients received individudized treatment,and visited the Outpatient Department of Immunology regularly. Conclusion Lymphocytosis-associated immunodeficiency disease often manifests as unexplained hepatosplenomegaly or lymphadenopathy,accompanied by reduction of peripheral blood cells,EBV viremia or infection. Early genetic examination will help to improve the diagnosis of the disease and make individualized treatment for each patient.

    Growth and development of symmetrical and asymmetrical full-term children born small for gestational age
    GUO Chong*,SHI Hui-qing,GE Pin,et al
    2017, 32(10): 768-771.  DOI: 10.19538/j.ek2017100612
    Abstract ( )  

    Objective To find the difference in growth and development of children between full-term symmetric growth restriction(FSGR) and full-term asymmetric growth restriction(FAGR) through a general investigation of children born small for gestational age in Shanghai. Methods This general investigation covered all children under 6 years old in Shanghai. Data on growth were retrospectively obtained from medical records. The P10 of birth head circumference/birthweight of the same gestational age and gender was used to distinguish FSGR and FAGR. Results The sample contained 10 188 full-term SGA children among whom 8049 were FAGR and 2139 were FSGR. Up to 3 years old,both FSGR and FAGR failed to catch up in weight,height,head circumference and chest circumference. Growth restriction in FAGR was more serious. Significant difference could be seen in weight(t=-3.412,P=0.001) and chest circumference(t=-2.526,P=0.012) between FSGR and FAGR at 3 years old. Regarding growth speed,the growth rate of weight (t=6.272,P<0.001),height (t=9.143,P<0.001),head circumference (t=6.063,P<0.001) and chest circumference (t=6.617,P<0.001) were higher in FAGR 6 months after birth,while there was no difference after that. The BMI of FAGR was significantly lower than FSGR before 2 years old. The proportion of children in danger of being overweight was significantly higher in FSGR (P<0.001). Conclusion Both FSGR and FAGR experience catch-up growth after birth,but not enough to catch up with normal children at 3 years old,especially in head circumference. In spite of severer growth restriction,the cath-up growth model of FAGR is superior to FSGR. The proportion of children in danger of being overweight is significantly higher in FSGR.

    Clinical features and SCN1A mutation in 60 patients with Dravet syndrome
    NI Yan,ZHANG Lin-mei,WU Bing-bing,et al
    2017, 32(10): 772-776.  DOI: 10.19538/j.ek2017100613
    Abstract ( )  

    Objective To study the clinical features and SCN1A genes detection results in children with Dravet syndrome in order to provide reference for clinical treatment. Methods The clinical data,SCN1A genes reports and antiepileptic drug effects of 60 DS children who were diagnosed from December 2013 to December 2015 were collected from the Children’s Hospital of Fudan University. Results The onset of seizures occured during 1-9 months with a median of 6 months and 83.3% of patients were febrile seizures at frist onset;they were heat sensitive,and hot water bath induced seizures in 63.3%(38/60). There were multiple phenotypes,including generalized tonic-clonic seizures(95.0%,57/60),partial seizures(alternating unilateral seizure)(78.3%,47/60),status epilepticus(65.0%,39/60),myoclonic seizures(65.0%,39/60),and atypical absence (63.3%,38/60). Seizure ouccurred most frequently(2-3 times per month) in 1-3 years of age. The median age of mental retardation was 18 months. The number of mental retardation and the positive rate of EEG increased with age. Dravet syndrome were intractable. In patients who used sodium ion blocking drugs 40.0%(24/60) children had aggravated seizures. 80.0%(48/60) patients had SCN1A mutation with missense and nonsense mutation accounting for over a half. There was no correlation between SCN1A mutations and onset age,sex,seizure type or seizure frequency. Conclusion Dravet syndrome is a childhood-onset epileptic encephalopathy,which is not rare in the national seizure center. The positive rate of SCNIA mutation is high,which can help the diagnosis of DS. Anti-epiletic drug treatment for DS is difficult and the misuse of drugs is in a high proportion,so the diagnosis and treatment level still needs to be improved.

    Analysis  of  transition  of  digestive  disease  spectrum  in  9  years  in  hospitalized  children  of  a  single-center in Liaoning province
    YANG Ping-ping,SUN Mei
    2017, 32(10): 777-780.  DOI: 10.19538/j.ek2017100614
    Abstract ( )  

    Objective To study the variation tendency of pediatric gastroenteric disease spectrum in order to provide scientific evidence for prophylaxis,treatment of disease, preventive health care and rational allocation of medical resources. Methods A retrospective analysis was perfomed about the disease species,constitute ratio,gender, age and area distribution of 16,127 children admitted to Department of Pediatric Gastroenterology, Shengjing Hospital, from January 2007 to December 2015,to analyze the spectrum trend and epidemiological characteristics. Results Boys were significantly more than girls,the ratio being 1.52∶1. The patients ranged from 1 month to 16 years old,the ratios of infants and toddlers being 39.39% and 26.25% respectively, who accounted for most part of total patients. Patients from the city of Shenyang accounted for almost half of total number(49.7%),with 42.6% from other cities and 7.7% from other provinces. Top five diseases were diarrhea(34.05%), Henoch Schonlein purpura(11.56%), jaundice(11.12%),infection-associated hepatitis(10.87%) and EB virus infection(7.19%). Functional gastrointestinal diseases were more commnon in girls. Conclusion During the 9 years,the patients’ number is increasing,the species and composition of the diseases have changed. Diarrhea is the top disease in hospitalized children,which shows a growing trend. The species difference in different age groups is significant,and infants and young children are at higher risk of diarrhea. The incidence of infection associated hepatitis,inflammatory bowel disease and cow’s protein allergy shows a rising trend.

    SCN1A gene mutation in a familial inherited Dravet syndrome with dizygotic twins and literature review
    YING Yan-qin,CUI Dong-yan,LIU Yan,et al
    2017, 32(10): 781-785.  DOI: 10.19538/j.ek2017100615
    Abstract ( )  

    Objective To study the clinical features and SCN1A gene mutation in a familial inherited Dravet syndrome family with dizygotic twins. Methods The clinical manifestations of dizygotic twins with Dravet syndrome and GEFS + mother were summarized and SCN1A gene was sequenced. The relationship between genotype-phenotype of SCN1A gene and Dravet syndrome was analyzed by literature. Results The dizygotic twins and their mother have de novo SCN1A gene mutant c.3624A>T(p.R1208S) at the second loop of Na+ channel α subunit. This is very rare compared to the usual mutation domain at S4 or S5-S6. It is the first report in China that  Dravet syndrome dizygotic twins inherited SCN1A gene mutation from their mother who was diagnosed as GEFS+. Point mutations of SCN1A were more common,accounting for 93.8%. The relationships between phenotype-genotype were very complex,since other pathogenic factors may be involved in.  Conclusion It is the first report in China that SCN1A gene mutation in a familial inherited Dravet syndrome with dizygotic twins and found a de novo SCN1A gene mutation of c.3624A>T(p.R1208S),which is located at the very rare region of the protein.

    Evaluation of cow’s milk-related symptom scores in the early identification of cow’s milk protein allergy in infants
    ZENG Yong-mei,ZHANG Ji-yong,DONG Guo-qing,et al
    2017, 32(10): 786-788.  DOI: 10.19538/j.ek2017100616
    Abstract ( )  
    Research progress in the treatment and prognosis of Dravet syndrome
    TIAN Xiao-juan,ZHANG Yue-hua
    2017, 32(10): 789-793.  DOI: 10.19538/j.ek2017100617
    Abstract ( )  
    Research progress in the etiology of biliary atresia
    ZHANG Tian-ao,DENG Zhao-hui
    2017, 32(10): 794-797.  DOI: 10.19538/j.ek2017100618
    Abstract ( )  
    Chronic hepatitis B complicated with hepatocellular carcinoma in children:A report of two cases
    WANG Li-min,ZHANG Hong-fei,DONG Yi, et al
    2017, 32(10): 798-800.  DOI: 10.19538/j.ek2017100619
    Abstract ( )