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06 September 2023, Volume 38 Issue 9 Previous Issue   

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Expert consensus on pediatric clinical application of β -lactam-β -lactamase inhibitor compounds Pediatric Pharmaceutical Committee of Chinese Pharmaceutical Association, Clinical Pharmacology Group of Chinese Medical Association of Pediatrics, Pediatric Pharmaceutical Committee of Chinese Medical Association of Pediatrics, et al 2023, 38(9): 641-653.  DOI: 10.19538/j.ek2023090601 Abstract ( )   The compounds of β-lactamases and β-lactamases inhibitors is a commonly used drug to treat infectious diseases in children. Although there is a consensus on β-lactam compounds preparations for adults， because of children’s differences from adults in physiological characteristics， there is an urgent need for a guiding document concerning β-lactam compounds for children. This consensus gives comprehensive suggestions on the application of β-lactam compounds in children from the aspects of pharmacological characteristics， pharmacokinetic characteristics， pharmacodynamic characteristics of children， role in common infectious diseases of children and drug management， so as to standardize the appropriate use in pediatric clinics.

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Expert consensus on risk stratification and application of cardiac magnetic resonance in children with myocarditis Colla-borating Group of Pediatrics, Cardiovascular Imaging Speciality Committee, Chinese Research Hospital Association 2023, 38(9): 654-664.  DOI: 10.19538/j.ek2023090602 Abstract ( )   Myocarditis refers to the inflammatory injury of myocardial tissue caused by various reasons. The clinical manifestations of myocarditis are nonspecific and vary greatly. At present， the diagnosis of myocarditis mainly depends on auxiliary examinations， such as electrocardiogram， serological indicators， and echocardiography， but these examinations are limited in sensitivity and specificity， and have limited value in risk stratification. Cardiac magnetic resonance imaging （CMR） can detect pathological changes in the myocardium early， and has become the gold standard for evaluating such changes as myocardial congestion， necrosis， fibrous scars， and myocardial activity. It is strongly associated with adverse cardiovascular events， including cardiac function deterioration， heart failure， arrhythmia， cardiac arrest， and even cardiovascular death or all cause death. Therefore， rational application of CMR is helpful to the risk stratification of children with myocarditis.

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Interpretation of  Guidelines for Follow-up After Extracorporeal Membrane Oxygenation Therapy for Neonates and Children by Extracorporeal Life Support Organization（2021） LI Hui, DING Ya-ping, XIA Shan-shan, et al 2023, 38(9): 665-668.  DOI: 10.19538/j.ek2023090603 Abstract ( )   Children who survived extracorporeal membrane oxygenation might have neurodevelopmental problems. If they are not identified or receive targeted intervention in time， these problems may develop into serious neuropsychological sequelae over time， affecting the quality of life. Standardized follow-up is critical. The Extracorporeal Life Support Organization released the《Guidelines for Follow-up After Extracorporeal Membrane Oxygenation for Neonates and Children》in 2021， which made recommendations on the follow-up content， follow-up plan， follow-up service type selection， follow-up time and location， etc. This article interpreted this guideline in order to provide reference and guidance for the construction of a systematic follow-up plan in the domestic pediatric field.

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Research progress of genetic factors in atopic dermatitis LIU Xin-xin, GUAN Zhi-wei, LIN Yang-yang, et al 2023, 38(9): 669-674.  DOI: 10.19538/j.ek2023090604 Abstract ( )   Atopic dermatitis （AD） is a chronic itching and inflammatory disease caused by the interaction of genetic， immune， and environmental factors. The specific etiology and mechanism of AD are not completely defined. Due to the genetic predisposition of AD， the genetics and epigenetics studies have drawn much attention. Genetic research has identified multiple AD genetic susceptibility gene loci and related candidate genes. For example， the skin barrier dysfunction genes and Th2 immune genes were reported. These genetic studies are conducive to further clarifying the pathogenesis of AD and may provide new directions for the treatment of AD.

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Diagnosis and treatment of inflammatory nail disease in children LIU Yuan-xiang, XU Zi-gang 2023, 38(9): 674-679.  DOI: 10.19538/j.ek2023090605 Abstract ( )   Nail disease is one of the common skin diseases in children， which can be the manifestation of nail unit involvement alone or other skin diseases/systemic diseases combined with nail involvement. There are many diseases that affect children's nail units， mainly caused by infectious， inflammatory， neoplastic， congenital， and traumatic factors. In order to further understand nail diseases， this article mainly introduces common inflammation-related nail disease manifestations， mainly including non-specific inflammatory nail changes in atopic dermatitis/eczema， psoriasis nails， lichen planus nails and alopecia areata combined with nail changes in children， to further understand the diagnosis and treatment of inflammatory nail disease， in order to increase attention to nail involvement related diseases.

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New and emerging trends in the targeted treatment for atopic dermatitis  LYU Yu-xin, LUO Xiao-yan 2023, 38(9): 680-685.  DOI: 10.19538/j.ek2023090606 Abstract ( )   Atopic dermatitis （AD） is a common chronic inflammatory skin disease with a complex pathogenesis and different clinical phenotypes. AD treatment continues to be a challenge.With continuous deepening of the pathogenesis， more and more new therapeutic targets and drug candidates have emerged. Since the IL-4Rα inhibitor dupilumab has been approved in 2017， anti-IL-13 inhibitor tralokinumab and JAK1/2 inhibitor baricitinib were succes sively approved for use in moderate and severe AD in Europe. So far， more than 70 new compounds are in development or clinical application.This review summarizes the latest progress of targeted drugs developed based on different strategies，aiming to make it possible to achieve individualized precision treatment and long-term effective control of AD.

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Advances in the mechanism of oral tolerance induction for intervention combined with food allergy in atopic dermatitis  CAO Rong, QIAN Hua 2023, 38(9): 685-689.  DOI: 10.19538/j.ek2023090607 Abstract ( )   Atopic dermatitis is a recurrent， chronic and non-infectious inflammatory skin disease，which is common in children.AD has a close relationship with allergen sensitization. Oral tolerance induction therapy is an approach to establish immune tolerance by the active suppression of antigen-specific immune responses in the gastrointestinal tract. OTI has been used to intervene various atopic diseases， and may become a new strategy to prevent and treat AD.

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Research progress in the use of biological agents in the treatment of moderate-to-severe pediatric atopic derma-titis  ZHAO An-qi, PAN Chao-lan , LI Ming 2023, 38(9): 689-695.  DOI: 10.19538/j.ek2023090608 Abstract ( )   Atopic dermatitis （AD） is a chronic， relapsing， pruritic， and inflammatory skin disease that significantly affects patients' quality of life. Traditional treatment options， such as topical corticosteroids and topical calcineurin inhibitors， have limitations in the treatment of moderate-to-severe AD. With an improved understanding of the pathoge-nesis of AD， biological agents have emerged as a promising treatment option. This article aims to provide clinicians with current and relevant information on the use of biological agents in the treatment of pediatric AD by summarizing the clinlcal trials.

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Advances in the treatment of primary immunodeficiency diseases with atopic dermatitis-like skin manifestations JIN Liang, ZHANG Bin 2023, 38(9): 695-700.  DOI: 10.19538/j.ek2023090609 Abstract ( )   Primary immunodeficiency diseases （PIDs） represent a group of complicated inherited disorders characterized by immune system defects. The clinical manifestations of PID are diverse， such as recurrent severe infections， autoimmunity， auto-inflammation， tumors and atopic diseases. Atopic dermatitis （AD）-like manifestation is one of common characteristic skin lesions of PID. This review aims to provide new ideas and options for the treatment of these diseases by elaborating on the pathogenesis and clinical features of PID with AD-like lesions and reviewing in detail the advances in the treatment of these diseases.

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Research progress in epidemiology and burden of disease in atopic dermatitis WU Pan-qian, SHU Hong 2023, 38(9): 700-704.  DOI: 10.19538/j.ek2023090610 Abstract ( )   With the in-depth research on atopic dermatitis（AD）， it is now believed that AD is no longer a simple skin disease， but a systemic disease. Therefore， it is necessary to constantly update epidemiological data to enhance the importance of the disease， improve the study of disease burden and rationally allocate medical resources to better alleviate the patient's disease， and improve the efficacy of treatment and quality of life through effective patient education. This article reviews the relevant literature published in recent years， aiming to raise the attention of clinicians with a hope that more medical resources will be devoted to research， so as to further improve the treatment mode of AD.

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Skin microbiota and atopic dermatitis in children GUAN Zhi-wei, LIU Xin-xin, LI Qin-feng 2023, 38(9): 704-708.  DOI: 10.19538/j.ek2023090611 Abstract ( )   Atopic dermatitis is the most common chronic， recurrent and inflammatory skin disease in children， which seriously affects the quality of life of children and families. Its pathogenesis is not completely clear， including environmental factors， genetic susceptibility factors， skin barrier dysfunction and the interaction between the immune system. Recent studies have confirmed that the imbalance of skin microbiota is one of the key factors for the occurrence and development of atopic dermatitis. The decline of bacterial diversity and the sharp increase of the relative abundance of Staphylococcaceae are the main characteristics of the imbalance of its microbiota. Restoring the homeostasis of microbiota helps to manage and prevent and treat atopic dermatitis.

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Changes of cognitive function, sleep parameters and cortisol level in 50 children with insomnia XU Dan-fen, CHEN Xu, YU Chen-yi, et al 2023, 38(9): 709-713.  DOI: 10.19538/j.ek2023090612 Abstract ( )   Objective    To explore the influencing factors of cognitive impairment in children with insomnia by insomnia by analyzing the changes of sleep structure and salivary cortisol level in children with insomnia and their effects on cognitive function. Methods　Fifty children with insomnia who met the diagnostic criteria of the International Classification of Sleep Disorders （3rd edition） were selected as the study group. The control group consisted of 20 healthy children. All the children were assessed by the children’s Sleep Disorder Scale. The cognitive function was evaluated by the Chinese-version DN： CAS， and the salivary cortisol level was measured 30 minutes after waking up in the morning. Children in the study group were monitored by overnight polysomnographic sleep monitor （PSG） and sleep parameters were recorded. Results    In the study group， the score of numerical matching subtest in DN：CAS was significantly lower than that in control group ［（10.56±3.03） vs. （12.80±3.11）， t=-2.78， P < 0.01］， and the score of expressive attention subtest was significantly lower than that in control group ［（10.00±2.41） vs. （12.45±3.20）， t=-3.09， P < 0.01］， the score of digital detection sub-test was significantly lower than that of the control group ［（9.66±1.83） vs. （11.45±3.19）， t=-2.10， P < 0.05］. The salivation cortisol level in study group was significantly higher than that in control group ［（104.66±34.30）μg/L vs. （72.38±23.35）μg/L， P < 0.01］. Compared with the PSG sleep parameters of normal children， the objective sleep parameters of children in the study group were abnormal， the total sleep time （TST） was decreased， the sleep latency （SOL） and the percentage of waking time after sleep in TST （WASO%） were increased， and the sleep efficiency （SE） was lower. The percentage of stage 1 sleep in TST （N1%） increased， while the percentage of rapid eye movement sleep in TST （REM%） decreased. Conclusion　Objective sleep structure disorder and elevated salivary cortisol level are present in children with insomnia， which affects the corresponding cognitive function of each brain region.

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One case of primary endobronchial non-Hodgkin lymphoma in children misdiagnosed as pulmonary tuberculosis XING Yu, GUO Wei-wei, WU Hui-fang, et al 2023, 38(9): 714-716.  DOI: 10.19538/j.ek2023090613 Abstract ( )   Primary bronchial non-Hodgkin's lymphoma in children is a rare occurrence. This article reported the case of a child with bronchial lymphoma misdiagnosed as primary pulmonary tuberculosis.A 10-year-old male patient with intermittent fever and cough for more than 40 days was admitted to the hospital on February 17，2020.The patient had a history of close contact with tuberculosis， and the tuberculin test （PPD） was negative.Pulmonary CT showed lymph node enlargement in the mediastinum and right hilar of the lung. Primary pulmonary tuberculosis was clinically diagnosed. The symptoms did not improve after anti-tuberculosis treatment， and wheezing and dyspnea occurred.Fibrobronchoscopy revealed mass obstruction in the right middle lobe opening. A bronchial mucosal biopsy confirmed anaplastic lymphoma kinase （ALK） -positive anaplastic large cell lymphoma without involvement of external thoracic organs. After standard chemotherapy treatment，the child's symptoms disappeared and lung imaging returned to normal.It is suggested that bronchoscopy and tissue biopsy should be performed in time for PPD negative children with mediastinal/hilar lymph node enlargement.

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A case of generalized arterial calcification of infancy with rickets and hypertension REN Xiao-ya, GONG Chun-xiu, ZHANG Bei-bei, et al 2023, 38(9): 717-720.  DOI: 10.19538/j.ek2023090614 Abstract ( )   To explore the clinical manifestations， diagnosis and treatment of generalized arterial calcification of infancy （ GACI）， and to improve dictors’ understanding of the disease，the clinical data and gene test results of a pediatric case of GACI diagnosed in Beijing Children’s Hospital of Capital Medical University in November 2020 were analyzed retrospectively.A male patient of 6 years and 7months old was complicated with heart disease in the neonatal period， hypophosphatemic rickets in the childhood period， hypertension， multiple arterial stenosis such as celiac trunk and renal artery， and renal calcium deposition. The result of whole-exon test showed the ENPP1 compound heterozygous variation， and thus the patient was diagnosed with GACI.GACI is a rare autosomal recessive disease， which needs multidisciplinary treatment. ENPP1 gene is its pathogenic gene. This case expands the variation spectrum of ENPP1 gene.