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06 November 2018, Volume 33 Issue 11 Previous Issue    Next Issue

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Expert consensus on standardized procedures in gastroscopy and endoscopy for children in China 2018, 33(11): 817-820.  DOI: 10.19538/j.ek2018110601 Abstract ( )

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null WANG Bao-xi 2018, 33(11): 821-824.  DOI: 10.19538/j.ek2018110602 Abstract ( )   null

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Advantages of painless digestive endoscopy in the diagnosis and  treatment  of  digestive  tract  diseases  in  children GUO Cheng，ZHANG Lin 2018, 33(11): 825-828.  DOI: 10.19538/j.ek2018110603 Abstract ( )   With the development of digestive endoscopy，it plays a more and more important role in children’s digestive system diseases. It can relieve the pain of children with digestive system diseases and avoid the pain of surgery，and improve the overall diagnosis and treatment level of children’s digestive tract diseases. Children are often agitated and resistant to fear，pain or discomfort due to their younger age，which poses a risk to the operation. Painless digestive endoscopy greatly reduces the pain of children，improves the acceptance of children receiving digestive endoscopy.

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Endoscopic removal of special foreign bodies in the digestive tract of children and matters needing attention REN Xiao-xia，FANG Ying 2018, 33(11): 828-831.  DOI: 10.19538/j.ek2018110604 Abstract ( )   The foreign body of digestive tract is a kind of object which is swallowed by mistake or deliberately swallowed into the digestive tract，which can not be digested，nor can it pass through the digestive tract in time，so it belongs to the emergency department of children. One of the main causes of accidental injury is children’s curiosity. Diagnosis depends on history，clinical manifestation and X-ray examination. Special foreign body needs CT and endoscopy diagnosis. For foreign bodies which can not be discharged by themselves，endoscopic therapy has been the primary method of diagnosis and treatment of foreign bodies in digestive tract. The success rate of the treatment is high，the complications are less，and it is easy to implement，which has been more and more widely used.

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Endoscopic therapy for colorectal polyps in children LI Xiao-qin，WANG Yue-sheng 2018, 33(11): 831-836.  DOI: 10.19538/j.ek2018110605 Abstract ( )   Hematochezia，abdominal pain and anal tumor are the main clinical complaints of colonic polyps in children. Classification is made according to clinical manifestation and histological structure difference，and growth and development and nutrient absorption are not affected by early diagnosis and treatment. Polyps should be removed by endoscopic polypectomy，if juvenile polyps are combined with adenoma or adenomatous polyp，regular colonoscopy should be done. At present，endoscopic high-frequency electrocoagulation combined with metal titanium clip is one of the main methods for the treatment of colorectal polyps in children.

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Application of tunnel endoscopy in the treatment of pediatric digestive diseases HAN Ya-nan*，FANG Ying，ZHOU Ping-hong 2018, 33(11): 836-840.  DOI: 10.19538/j.ek2018110606 Abstract ( )   Tunnel endoscopy is one of the new and rapidly developing endoscopic treatment technologies in recent years. In the field of adult endoscopy，tunnel technology has been developed in full swing due to its advantages of safety，minimal invasion，quick recovery and short hospital stay. Because there are many differences in the anatomy of digestive tract and disease spectrum between children and adults，the application of this technique in pediatric digestive system is different. We review the application of tunnel endoscopy in pediatric digestive system in order to improve pediatricians’ awareness of the technique，hoping to promote its clinical application，so that more children can benefit from the technique.

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Endoscopic treatment for esophageal stenosis in children XU Jun-jie，ZHU Li-ping，ZHANG Le 2018, 33(11): 840-845.  DOI: 10.19538/j.ek2018110607 Abstract ( )   Childhood esophageal stenosis is mainly benign stenosis. According to the cause of the stenosis，the nature of the lesion and the morphological structure of the lesion，formulating appropriate endoscopic treatment strategy is the key to successful treatment. Endoscopic treatment for esophageal stricture includes endoscopic balloon dilatation，endoscopic radial incision，medical treatement，endoscopic stenting，magnetic compression anastomosis and so on. All of these methods have their advantages and disadvantages. The treatment for benign stenosis needs to be repeated multiple times with certain risks. According to the characteristics of lesions，different treatment methods should be combined to achieve the best therapeutic effect. Therefore，preoperative evaluation of esophageal stenosis and selection of appropriate treatment methods are important for reducing the incidence of complications，reducing costs，and ensuring the basic nutritional supply of children.

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Progress in endoscopic diagnosis and treatment of nonvariceal upper gastrointestinal bleeding in children YOU Jie-yu，JIANG Na 2018, 33(11): 845-848.  DOI: 10.19538/j.ek2018110608 Abstract ( )   The causes of upper gastrointestinal bleeding in children are numerous and vary with age. According to hemorrhagic causes and pathogenesis，upper gastrointestinal bleeding can be classified into two categories：nonvariceal and variceal. The clinical presentation of gastrointestinal bleeding in children ranges from asymptomatic microcytic anemia to hypovolemic shock. Because of the relatively small blood volume and poor blood loss tolerance of children，even a small amount of bleeding is prone to serious complications，so reasonable diagnosis and treatment are necessary. Endoscopic examination can enable us to make diagnoses and perform hemostasis treatment for children， which has the advantages of being simple，with little trauma and quick effect. With the development of endoscopic technology，the surgery rate and fatality rate of upper gastrointestinal bleeding have significantly decreased.

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Perioperative management of digestive endoscopy in children ZHU Zhong-sheng，WANG Zhao-xia 2018, 33(11): 848-852.  DOI: 10.19538/j.ek2018110609 Abstract ( )   Endoscopic diagnosis and treatment is the most common and reliable method in digestive system disease. As an advanced medical treatment method，digestive endoscopy has been widely used in pediatrics. Digestive endoscopy has positive effects on the diagnosis and treatment of pediatric digestive system diseases. Children have poor tolerance， low ability of self-regulation and strain capacity，and rapid disease progression. The perioperative management must be done carefully. In the current review，preoperative assessment and preparation，management of surgical procedures，postoperative management were discussed.

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Common complications and management of gastrointestinal endoscopy in children LIU Zhi-feng，JIN Yu 2018, 33(11): 852-855.  DOI: 10.19538/j.ek2018110610 Abstract ( )   Gastrointestinal（GI） endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. Complications during the operation of digestive endoscopy are unavoidable. The incidence of complications of diagnostic endoscopy in children is very low，but the incidence of complications is obviously increased in recent years，because of the development of endoscopic treatment in children. Following strict operation indications and contraindications of GI endoscopy，standardized operation process，and skilled pediatric endoscopists are the key to reducing complications. Early identification and timely management of complications after endoscopy is essential to ensuring the safety of children and maintaining harmonious doctor-patient relationship.

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Role of endoscope-guided placement of feeding tubes in enteral nutrition support JIANG Xun 2018, 33(11): 855-858.  DOI: 10.19538/j.ek2018110611 Abstract ( )   Nutrition support is an essential management of critically ill patients，and enteral nutrition conforms to the physiological state of the body，which can maintain the integrity of intestinal mucosal structure and function，thus ensure the enough intake of calories and protein and preventing the risk of intestinal bacterial translocation effectively. Endoscope-guided placement of feeding tubes is a kind of simple，direct and accurate method to establish enteral nutrition in clinic. The method has high success rate，relatively simple operation. Thus，it is a safe and effective treatment for enteral nutrition, which is worthy of clinical application.

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Diagnostic and therapeutic value of enteroscopy in pediatric small bowel disorders WANG Yu-huan，HUANG Ying 2018, 33(11): 858-862.  DOI: 10.19538/j.ek2018110612 Abstract ( )   Enteroscopy has high diagnostic and therapeutic value in adult intestinal diseases and is a safe and effective method. However，enteroscopy is rarely used in children. Enteroscopy is used for the diagnosis and treatment of obscure gastrointestinal bleeding，intestinal polyps，Crohn’s disease，intestinal stenosis and biliary stricture in children. The paper summarizes the clinical application of enteroscopy in small bowel disorders in pediatric patients.

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Diagnostic value of capsule endoscopy in children with gastrointestinal disorders FENG Yu-ling，LIU Hai-feng 2018, 33(11): 862-866.  DOI: 10.19538/j.ek2018110613 Abstract ( )   Capsule endoscopy has been widely used in clinic. As the technology matured，it has applied to detect the adult’s whole diagnostic tract，including the physical examinations，disease screening and surveillance. The medical technology has gradually applied to children. Since adults and children have different disease spectrums，the application of capsule  endoscopy in children’s gastrointestinal disorders shows its age characteristics. The review discusses the development of capsule endoscopy，its clinical application and diagnosis in children，as well as the advantages and disadvantages of capsule endoscopy and its future development trend.

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Difficulties and prospects of gastrointestinal endoscopy for neonates GENG Lan-lan， GONG Si-tang 2018, 33(11): 866-869.  DOI: 10.19538/j.ek2018110614 Abstract ( )   At present，some domestic children’s hospitals and a few large hospitals have carried out neonatal gastrointestinal endoscopy. Experienced gastrointestinal endoscopy physicians can successfully complete the neonatal gastrointestinal endoscopy by ultrathin gastroscope. Early Indications for examination are mainly upper gastrointestinal bleeding，and gastroscopy finds that the majority of lesions are stress-induced duodenal mucosal injury. For these patients，proton pump inhibitors can be used empirically and many patients can avoid gastroscopy. The difficulties in this field are mainly the improvement of equipment and the expansion of indications，so as to improve the level of diagnosis and treatment of neonatal digestive tract diseases. Endoscopic treatment for congenital malformation of digestive tract is the future development direction of this field.

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The establishment of diagnostic criteria for asthma in children aged＜6 years 2018, 33(11): 870-876.  DOI: 10.19538/j.ek2018110615 Abstract ( )   Objective　To establish diagnostic criteria for asthma in children aged＜6 years in China. Methods　From October 2016 to July 2017，a total of 785 wheezing children aged ＜6 years were enrolled from a asthma clinic for children in Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine. The questionnaire was used to collect data for a database of childhood asthma. The method of literature search and expert consultation was used to select parameters for the diagnosis of asthma. Univariate analysis was first applied to study the significance of these parameters，and multivariate logistic regression analysis was then performed to establish diagnostic model for asthma in children. According to the β value of the regression model，the scoring system was established. Area under receiver operating characteristic curve was used to test the differential diagnostic efficacy of the scoring system. Results　The diagnostic criteria for asthma in children aged＜6 years was developed based on the logistic regression model，and the scoring system was established according to the β value of the model. The main contents included accumulated times of wheezing attacks ≥ 4（3 points）；the existence of reversible airflow limitation（3 points）；the existence of allergic rhinitis and/or atopic dermatitis（1 point）；the existence of allergic history among first-degree relatives（1 point）；positive allergen test in vivo or in vitro（1 point）. The area under ROC curve of the scoring system was 0.908，indicating that the diagnostic model and scoring system was of great value in diagnosis of asthma in children aged＜6 years. Based on the ROC curve，the optimal cut-off value for asthma diagnosis was four points，with a sensitivity of 95.8% and a specificity of 85.9%. Conclusion　The diagnostic criteria for asthma in children aged＜6 years has been established preliminarily，which is simplified and practical and need a large-scale prospective study for further validation and optimization before clinical application.

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Clinical value of chronotropic competence in children with vasovagal syncope ZHANG Qing-you*，LIU Yan-xia，LIAO Ying，et al 2018, 33(11): 877-880.  DOI: 10.19538/j.ek2018110616 Abstract ( )   Objective　To evaluate the chronotropic competence in children with vasovagal syncope （VVS）. Methods　Thirty-nine patients（17 males，22 females，age ranging from 8-16 years） with syncope were included in the study，and 28 were diagnosed with VVS，including 15 cases of vasodepressor type，9 cases of mixed type，and 4 cases of cardioinhibitory type；11 were with unexplained cause of syncope. A treadmill test was performed and heart-rate response during exercise was evaluated by the chronotropic reserve. Demographic data and change of heart rate，blood pressure during test and CRI were compared between the 2 groups and different types of VVS. Furthermore，based on CRI，patients with VVS were divided into the normal chrontropic group（n＝10） and CI group（n＝17）. By following the recurrence of syncope of 2 groups，the effect of CI on the prognosis of VVS in children was observed. Results　There were no significant differences between children with VVS and with unexplained syncope in sex，age，BMI，baseline heart rate，MaxMET or baseline blood pressure. But during exercise test，peak heart rate and CRI were significantly lower in children with VVS than in unexplained syncope. The incidence of CI in children with VVS was significantly higher than that in children with unexplained syncope（64.3% vs. 27.3%，P＜0.05）. The incidence of CI in VVS with vasodepressor-type in children was significantly lower than those with cardioinhibitory-type and mixed-type. During following-up period，the recurrence rate of syncope in VVS children with CI was significantly higher than that of children without CI. Patients with CI had significantly worse prognosis compared to those without CI（Log-rank：P＝0.028）. Conclusion　Chrontropic competence is significantly altered in children with VVS，especially in cardioinhibitory-type and mixed-type in children. CI is the significant predictor for poor prognosis in children with VVS.

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Effect of percutaneous interventional treatment for coarctation of aorta in children：A report of 22 patients SUN Chun-ping，XIE Yu-mei，QIAN Ming-yang，et al 2018, 33(11): 881-885.  DOI: 10.19538/j.ek2018110617 Abstract ( )   Objective　To evaluate the safety and curative effect of percutaneous interventional treatment for coarctation of aorta in children. Methods　Retrospectively analyze the data of 22 children who were treated with percutaneous interventional treatment for coarctation of aorta from February 2007 to May 2017 in our institute.The general clinical data，echocardiography，cardiac CT， angiography，interventional results， the procedure-related complications and follow-up results were assessed. Results　A total of 22 patients consisting of 13 boys and 9 girls underwent the procedure，with mean age of （8.7±5.7） years（ranging from 9 months to 17 years） and the mean body weight of （30.7±20） kg（ranging from 9.5 kg to 80.0 kg）. Totally 16 patients accepted balloon angioplasty and 6 patients accepted membrane-covered stent implantation. The catheter-measured narrowest aortic peak systolic gradient was successfully relieved in all the patients，decreasing from （52.7±25.0） mmHg to （9.7±11.4） mmHg immediately after percutaneous interventional treatment（t＝8.326，P＝0.000）. The diameter was increased from （5.3±1.9） mm to （10.0±3.8） mm immediately（t＝-6.996，P＝0.000）. During the procedure，two patients had limited aortic aneurysm，which disappeared after 3 to 6 months of follow-up without intervention. One needed surgery for left subclavian artery interrupted by stent； however，there were no deaths. The follow-up period was 3 months to 9 years. All patients hadn’t accepted interventional therapy or surgery again， and the stents had no deformation or restenosis. Conclusion　Percutaneous balloon angioplasty and stent implantation have reliable early and medium-term effect and high security for children’s aortic coarctation. Percutaneous balloon angioplasty also is a safe and acceptable option for restenosis after surgery.

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Clinical features and prognosis of children with acute lymphoblastic leukemia combined with myelofibrosis：An analysis of 208 cases CHEN Xiao-juan，LI Zhan-qi，YANG Wen-yu，et al 2018, 33(11): 886-889.  DOI: 10.19538/j.ek2018110618 Abstract ( )   Objective　To study the clinical features of childhood acute lymphoblastic leukemia（ALL） with secondary myelofibrosis. Methods　The clinical data of 208 cases of newly diagnosed childhood ALL were analyzed retrospectively，who had difficulty in sucking the bone marrow fluid and underwent bone marrow biopsy from November 2001 to September 2012 in Hematology Hospital of Chinese Academy of Medical Sciences. The clinical characteristics and prognosis of childhood ALL patients with and without myelofibrosis were compared. Results　All the cases were separated into two groups，group A included 33 cases，who were diagnosed with ALL combined with bone marrow fibrosis confirmed by pathology；175 patients diagnosed with ALL without bone marrow fibrosis were enrolled into group B. From November 2001 to December 2007，we treated patients using CAMSBDH-ALL regimen，and from January 2008 to September 2012 we used CCLG-ALL 2008 regimen. In group A，42.4% of patients showed pancytopenia of peripheral blood. The 5-year overall survival rate（OS） was 64.3%. The 5-year OS was 58.3% in the patients treated with CAMSBDH-ALL regimen. In group B，15.6% of patients showed pancytopenia of peripheral blood，lower than that of group A. The 5-year OS was 85.0%，which was significantly higher than that of group A （P＝0.010）. The 5-year OS was 68.8% in the patients treated with CAMSBDH-ALL regimen，which was significantly lower than that of patients treated with CCLG-ALL2008 regimen （5-year OS being 87.2%）  in group B （P＝0.044）. Conclusion　Pancytopenia in childhood ALL with myelofibrosis are more common and with poorer prognosis than those without myelofibrosis. The overall survival of ALL patients without bone marrow fibrosis can be improved by modifying the treatment strategies，but the prognosis can’t be improved for those ALL patients with myelofibrosis.

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Clinicopathological features and treatment outcome of idiopathic membranous nephropathy in children: A report of 22 cases GUO Hai-yan，LI Qian，ZHEN Jun-hui，et al 2018, 33(11): 890-894.  DOI: 10.19538/j.ek2018110619 Abstract ( )   Objective　To summarize the clinicopathological features，treatment and prognosis of childhood idiopathic membranous nephropathy（IMN）. Methods　The clinical manifestations，pathologic features，treatment and prognosis of 22 IMN children who were diagnosed by pathology from January 2005 to February 2017 were retrospectively analyzed. Results　Twenty-two children（12 males and 10 females） had an onset age range of 3 to 15 years. Clinical manifestations：hematuria and proteinuria in 4 cases（18.18%）；nephrotic syndrome（NS） in 18 cases（81.82%）. Renal biopsy results：8 cases（36.36%） in stageⅠ，5 cases（22.73%） in stage Ⅰ-Ⅱ，5 cases（22.73%） in stage Ⅱ，1 case（4.54%） in stage Ⅱ-Ⅲ，atypical membranous nephropathy in 3 cases（13.64%）. Among them，12 cases（54.54%） of M-type phospholipase A2 receptor（PLA2R） positive were detected and 83.33%（10/12） PLA2R positive children with an onset age older than 10 years old. Immunofluorescence showed predominantly IgG and C3 deposition. Treatment programs：in the 4 cases whose clinical manifestations were hematuria and proteinuria，2 cases were given glucocorticoid and ACEI drug treatment，the other 2 cases were given ACEI drugs alone，and they had complete remission. The 18 patients with NS all were treated with glucocorticoid and ACEI，and immunosuppressive agents were given to steroid-resistant patients. During the follow-up，18 cases（81.82%） were completely relieved，3 cases（13.64%） were partially relieved，and 1 patient（4.54%） was lost of follow-up. Conclusion　Clinical manifestations of IMN are mostly nephritis nephrotic syndrome，mainly steroid-resistant nephrotic syndrome. Pathological performance mainly isⅠ-Ⅱstage. The positive rate of PLA2R in junior age was lower than adolescence. Glucocorticoid combined with immunosuppressive agents has a higher response rate.

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Features of clinical phenotype in children with Alport syndrome with COL4A5 mutations：A report of 31 cases ZHOU Qian，KUANG Xin-yu，SUN Lei，et al 2018, 33(11): 895-899.  DOI: 10.19538/j.ek2018110620 Abstract ( )   Objective　To analyze the features of clinical manifestions and gene mutations of Chinesse children with X-linked Alport syndrome（XLAS）. Methods　Retrospectively analyze the clinical and pathological features of 31 patients with Alport syndrome with COL4A5 mutations，who were treated in Shanghai Children’s Hospital from June 2011 to June 2016. Results　Of these 31 cases，there were 12（38.7%） females and 19（61.3%） males，and the average age of onset was 2.6 years old. Thirteen patients had an onset of hematuria and proteinuria and 22（70.9%） patients had family medical history. One patient presented ocular changes and 2 patients had hearing loss. Renal pathology showed that 15 of them had minimal change disease（MCD） and 5 mesangial proliferative glomerulonephritis，and only 6 had typical pathologic changes of Alport syndrome. We identified 31 different mutations in all patients，and there were 19（61.3%） cases of missense mutations，2（6.5%）cases of large deletion mutations，4（12.9%） cases of spice-site mutations and 6（19.3%） cases of frame shift mutations. Among these 19 missense mutations，16（84.2%） cases were Gly-X-Y mutations. Conclusion　Most of XLAS children show MCD in renal biopsy and had missense mutations in COL4A5 gene. Clinical symptoms and pathology are not typical， resulting in the difficulities in diagnosis of Alport syndrome.

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Characteristics of pathogen of hospital infection in children with refractory Mycoplasma pneumoniae pneumonia and related factors JI Zheng-xi*，YAO Jin，SUN Zu-yin 2018, 33(11): 900-903.  DOI: 10.19538/j.ek2018110621 Abstract ( )   Objective　To explore the pathogen characteristics and risk factors of nosocomial infection in children with refractory pneumonia caused by Mycoplasma pneumoniae. Methods　A total of 160 children［nosocomial infection（45 cases） as observation group，no nosocomial infection（115 cases） as control group］ with refractory MPP who were admitted from January 2015 to January 2018 were selected for pathogen detection and pathogen species analysis. Analyze the differences of two groups to detect the risk factors of hospital infection by means of univariate and multivariate logistic analysis. Results　According to the analysis of the pathogens，32 of them were bacterial infections（71.1%），and Gram-negative bacteria were the main pathogens，including Haemophilus influenza（9 cases），Klebsiella pneumonia（7 cases），Escherichia coli （5 cases） and Legionella pneumophila（2 cases）；13 of them were viral infections（28.9%），including influenza B virus（6 cases），respiratory syncytial virus（5 cases）and adenovirus（2 cases）. After univariate and multivariate logistic analysis，no differences were found in sex，age，congenital heart disease or anemia between observation group and control group（P＞0.05）. However，the length of hospitalization，season of onset，invasive procedures，non-single ward，and the irrational use of antibiotics in the two groups had significant differences（P＜0.05）. Conclusion　The main infection pathogen of children with refractory MMP in nosocomial infection is Gram-negative bacteria. The risk factors of nosocomial infection are the length of hospitalization， season of onset，invasive procedures，non-single ward，and the irrational use of antibiotics.

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Core subunit defect of mitochondrial enzyme and cardiomyopathy in children ZHANG Ya-wen，GUI Yong-hao 2018, 33(11): 904-908.  DOI: 10.19538/j.ek2018110622 Abstract ( )

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Research progress in the individualized treatment for postural tachycardia syndrome in children TAO Chun-yan，DU Jun-bao 2018, 33(11): 909-913.  DOI: 10.19538/j.ek2018110623 Abstract ( )

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Research progress in the relationship between hyperuricemia and hypertension in children XU Jie，MAO Jian-hua 2018, 33(11): 914-919.  DOI: 10.19538/j.ek2018110624 Abstract ( )

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Eosinophilic granulomatosis with polyangiitis in children：A report of 1 case ZHOU Yang，LI Xiao-qing，ZHANG Cui，et al 2018, 33(11): 920-923.  DOI: 10.19538/j.ek2018110625 Abstract ( )

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Clinical characteristics and analysis of a generalized epilepsy with febrile seizures plus family with variations of KCNQ3 and SCN3A genes YU Shu-jie，BAO Xin-hua，QI Ying，et al 2018, 33(11): 924-926.  DOI: 10.19538/j.ek2018110626 Abstract ( )