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Due to the high mortality rate of severe acute pancreatitis in children, early and adequate evaluation of children with acute pancreatitis, early identification of risk factors leading to severe acute pancreatitis, and active intervention therapy have important impacts on the outcome of acute pancreatitis.This review summarized clinical guidelines or consensus worldwide, and elaborated the diagnosis and treatment of severe acute pancreatitis in children from the aspects of epidemiology, clinical features, early screening evaluation and treatment measures.
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Objective:To summarize and analyze the clinical features of food protein-induced enterocolitis syndrome (FPIES).Methods:The medical history and follow-up data of 5 children with FPIES diagnosed in Department of Gastroenterology, Beijing Children′s Hospital of Capital Medical University from July 2018 to September 2019 were collected, and their clinical characteristics were summarized and analyzed.Results:Five children with FPIES were all infants, including 3 females and 2 males.Before the onset of the disease, the cases visited multiple departments and the average number of visits before diagnosis was 3.There were 4 cases of milk protein allergy and 1 case of egg white allergy.The patients had acute vomiting [5 cases (100%)], diarrhea [4 cases (80%)], early shock symptoms [5 cases (100%)], transient fever [2 cases (40%)]. Hematogenous leukocytes were increased in 3 cases (60%), C-reactive protein was increased in 1 case (20%), faecal leukocytes(+ )[2 cases (40%)], occult blood (+ ) [1 case (20%)]. Four cases were tested for food allergen specific IgE, of which 2 cases (40%) were positive for milk protein.After avoiding allergens, 3 patients (60%) needed intravenous rehydration treatment and 2 cases (40%) received oral rehydration treatment.The above 5 cases recovered quickly.Three patients (60%) used antibiotics.Four cases (80%) of the first-degree relatives of FPIES had a clear history of allergy.Families of children with FPIES had low awareness of the disease before the diagnosis was made, and the allergens were strictly avoided according to the doctor′s instructions after the diagnosis was made.Similar allergic reactions did not occur again, and complementary foods were gradua-lly added under the guidance of the doctor.Two patients had multiple food allergies.The body weight and length of 2 children with growth retardation were catching up with each other.Conclusions:FPIES is a serious food allergy related gastrointestinal disease which is easy to be misdiagnosed clinically.The diagnosis requires a combination of the family and personal allergy history, diet records, the characteristic performance of disease onset, the effect of diet avoi-dance and the necessary differential diagnosis.The long-term management and monitoring after diagnosis is also very important.
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Objective@#To increase the recognition of pancreatic cystic fibrosis (PCF) in children and facilitate diagnosing and treatment of this rare entity.@*Method@#This is a retrospective analysis of children who presented to Beijing Children′s Hospital affiliated to Capital Medical University from January 2010 to December 2015. We describe their clinical features, laboratory testing and management.@*Result@#Eleven children were diagnosed with PCF by genetic testing or sweat chloride test during these 5 years, including 4 boys and 7 girls. Their age ranged from 0.5-14.3 (mean 9.0±3.9) years. Family history was positive in 3 children. Significant clinical findings on presentation were: malnutrition 6, including 2 cases of mild, moderate and severe malnutrition each; diarrhea 4 (yellow mushy or watery stool with frequency ranging from 2-5 times a day), including 1 case of acute diarrhea and 3 of chronic diarrhea, 3 of them had steatorrhea; abdominal pain 3. All of them had pancreatic lesions shown by abdominal ultrasound. Blood tests showed 6 cases had elevated serum amylase and lipase. The main treatment was pancreatic replacement therapy and nutritional support.@*Conclusion@#PCF is rare in children. Malnutrition, diarrhea and abdominal pain are the main clinical manifestations. Treatment is mostly pancreatic enzymes replacement and supportive care.
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Objective@#To learn the colonization of Clostridium difficile in local healthy children and to investigate the colonization rate and toxin types of Clostridium difficile at different ages.@*Method@#From September 2014 to January 2015 in a case observational study, healthy children′s fecal specimens from the health care department of Beijing Children′s Hospital were collected. The children were divided into four groups according to age: <1 year old(n=53), 1-<3 years old(n=50), 3-<6 years old(n=50) and 6-<14 years old(n=50) respectively. Polymerase chain reaction (PCR) was used to detect Clostridium difficile toxin genes including tcdA, tcdB, binary toxin CDT (cdtA and cdtB), and toxin regulatory genes including tcdC, tcdD and tcdE. And then the positive samples were sequenced. Measurement data were compared by using t test and rank sum test, while, enumeration data were compared using chi-square test.@*Result@#Fifteen (7.4%) specimens were positive for Clostridium difficile toxin genes in 203 stool specimens. Of the 15 positive specimens, eight(53.3%) were tcdA+ tcdB-(A+ B-), four were A+ B+ , 3(20.0%) were A-B+ , the binary toxin-positive specimens were not detected. TcdC, tcdD, tcdE positive specimens were 8, 6 and 11, respectively. Gene mutations were not found in positive samples by DNA sequencing. In the 15 positive samples, four (7.5%) specimens were in <1 year old group; four (8.0%) specimens were in 1-<3 years old group; one(2.0%) specimen was in 3-<6 years old group; and 6(12.0%) specimens were in 6-<14 years old group. The colonization rate had no significance in different age groups.@*Conclusion@#The colonization rate of Clostridium difficile in healthy children was 7.4%. And toxigenic Clostridium difficile can be detected in all age groups.
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Objective To explore the clinical features,efficacy and prognosis of different treatments for children with achalasia of cardia(AC).Methods In this retrospective study,the clinical features,laboratory examination and treatment of 36 children with AC who had been admitted to Department of Gastroenterology,Beijing Children's Hospital,Capital Medical University from August 2006 to September 2015 were reviewed,and the efficacy and prognosis of different treatments were compared.The symptoms of the children were graded using the AC clinical symptom score(Eckardt score),and the Eckardt score ≤ 3 scores was defined as the effective treatment.SPSS 19.0 statistical software was used to analyze the data,and P<0.05 for the difference was statistically significant.Results Thirty-six children with AC included 24 boys and 12 girls.Ages ranged from 1.4 to 15.5 years old,with a mean age of(10.0±3.4)years old.Course of disease ranged from 1 month to 9 years,with a mean course of 0.5(0.2,3.0)years.In the 36 children,33 cases(91.7％)had vomiting,23 cases(63.9％)had dysphagia,16 cases(44.4％)had weight loss,and 9 cases(25.0％)had chest pain.The effective rates of treatment in surgical treatment group and drug treatment group were 100.0％(13/13 cases)and 71.4％(5/7 cases),respectively in 3 months,and there was no significant difference between the 2 groups(P=0.111).The effective rates of treatment were 100.0％(13/13 cases)and 50.0％(3/6 cases),respectively in 6 months,and the difference was statistically significant between the 2 groups(P=0.021).Within 12 months,there was no recurrence in surgical treatment group and the effective rate was 100.0％.Children in drug treatment group had 1 case who stopped taking medicine,while the other children received surgical treatment in other hospitals due to poor drug treatment.Conclusions Drug and surgical treatment of AC both have good short-term effect,however,the medium and long-term efficacy of surgical treatment is higher than that of drug treatment in children.Symptomatic relief is more stable,and symptom is not easy to relapse for the children with surgical treatment.
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Objective To determine the risk factors for coronary artery lesions (CALs) in patients with Kawasaki disease (KD).Methods The clinical records of 2331 patients with KD from January 2005 to December 2014 in Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.The relationship between the following factors and CALs was analyzed by univariate and multivariable Logistic regression analysis:age,gender,incomplete KD,total fever duration,intravenous immunoglobulin(IVIG) treatment resistance,white blood cell count,C-reactive protein (CRP),platelet count,sodium and albumin.Results The incidence of CALs was 36.0％(840/2331 cases).Univariate Logistic regression analysis indicated that male patients,incomplete KD,total fever duration ≥10days,IVIG treatment resistance,CRP＞100mg/L,platelet count＞300×109/L and albumin＜35 g/L were associated with CALs (all P＜0.05).Multivariable Logistic regression analysis identified that male patients (OR=1.698,95％ CI 1.383-2.084,P＜0.001),incomplete KD (OR=2.730,95％ CI 2.121-3.515,P＜0.001),total fever duration ≥10 days (OR=2.556,95％ CI 1.975-3.307,P＜0.001),CRP＞100 mg/L (OR=1.556,95％ CI 1.274-1.900,P＜0.001) and albumin＜35 g/L (OR=1.665,95％ CI 1.323-2.096,P＜0.001) were the independent risk factors for CALs.Conclusions The main damage in patients with KD is CALs.The male children with KD,incomplete KD,total fever duration ≥10 days,CRP＞100 mg/L and albumin＜35 g/L were prone to CALs.
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Background:Chronic atrophic gastritis(CAG)is a kind of chronic gastritis with atrophic changes of gastric mucosa. The studies on peripheral blood biomarkers in CAG are rare. Aims:To investigate the methylation of peripheral blood CpG sites in Runx3 gene promoter region in CAG patients. Methods:Eighty-two mild CAG patients,73 moderate to severe CAG patients from June 2013 to May 2014 at Daqing Oilfield General Hospital were enrolled,and 45 patients with normal gastric mucosa were served as controls. The methylation of CpG sites in Runx3 gene promoter region was measured by MALDI-TOF-MS. mRNA expression of Runx3 was determined by fluorescent quantitative PCR,and the protein expression of Runx3 was determined by Western blotting. Results:Compared with the control group and mild CAG group,methylation levels of CpG13,CpG14 and CpG15 sites in Runx3 gene promoter region were significantly increased in moderate to severe CAG group(P 0. 05 ). Conclusions:The hypermethylation of peripheral blood CpG13,CpG14 and CpG15 sites in Runx3 gene promoter region can inhibit the expression of Runx3 in CAG patients,and can be used potentially as the biomarker for clinical staging of CAG.
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<p><b>OBJECTIVE</b>Clostridium difficile is an obligate anaerobic Gram-positive bacillus, it can cause Clostridium difficile-associated diarrhea (CDAD). This study aimed to investigate the virulence genes and clinical features of CDAD in children by gene detection.</p><p><b>METHOD</b>From May 2012 to January 2013, the 121 inpatients in Beijing Children's Hospital who suffered from diarrhea after antibiotics treatment were detected for Clostridium difficile virulence genes including the five genes for pathogenic loci (tcdA, tcdB, tcdC, tcdD, tcdE) and the genes for binary toxin CDT (cdtA and cdtB) using polymerase chain reaction (PCR) in order to research the clinical features of CDAD, and analyze target products by sequencing.</p><p><b>RESULTS</b>In the 121 children with diarrhea, 60 (49.6%) were toxin B-positive,including 12 toxin A-positive and toxin B-positive (A+B+), 48 toxin A-negative but toxin B-positive (A-B+). The toxin A-positive but toxin B-negative (A+B-) specimens or binary toxin (cdtA and cdtB)-positive specimens were not detected. Of 60 tcdB-positive specimens, tcdC, tcdD and tcdE positive specimens were 24 (40%), 25 (42%), 24 (40%), respectively. The sequencing results of tcdA, tcdB, tcdC, tcdD, and tcdE gene were consistent with the reference sequence. In the 60 children with CDAD, infants (≤3 years) accounted for 62% (37/60). The duration of diarrhea was 3-77 days, and 42 (70%) cases had acute diarrhea; 39 (65%) patients had fever, 40 (67%) had anemia, 36 (60%) had abnormal white blood cell count, 30 (50%) had hypoalbuminemia, 25 (42%) had elevated C-reactive protein (CRP). The level of CRP in positive group was significantly higher compared to the negative group (45.0(16.0,89.0) mg/L vs. 19.0(14.5,41.5) mg/L, Z=-2.008, P=0.045). The level of plasma albumin in positive group was significantly lower compared to the negative group (35.3(29.7,39.8) g/L vs. 38.5(33.9,41.5) g/L, Z=-2.610, P=0.009). There were no significant differences in gender, age, duration of diarrhea, hospital staytime, time of using antibiotics and laboratory test between A+B+ group and A-B+ group (all P>0.05).</p><p><b>CONCLUSION</b>The main virulence genotype of Clostridium difficile was toxin A-negative but toxin B-positive in this research. The clinical features of CDAD in children were acute diarrhea with fever. Laboratory examination showed that white blood cell count was abnormal, CRP was increased, hemoglobin and plasma albumin were reduced.</p>
Subject(s)
Child , Humans , Infant , Anti-Bacterial Agents , Bacterial Toxins , Genetics , Beijing , C-Reactive Protein , Clostridium Infections , Microbiology , Clostridioides difficile , Genetics , Virulence , Diarrhea , Microbiology , Fever , Genes, Bacterial , Genotype , Leukocyte Count , Polymerase Chain Reaction , Virulence , GeneticsABSTRACT
Objective: To determine the effect of gene silencing of cyclophilin B (CypB) on growth and proliferation of gastric cancer cells. Methods: CypB siRNA lentivirus (LV-CypB-si) and control lentivirus (LV-si-con) were produced. CypB expression in gastric cancer cell lines was detected by Western blot. BGC823 and SGC7901 cells were chosen to be infected with LV-si-con and LV-CypB-si, and stable transfectants were isolated. The cell groups transfected with LV-CypB–siRNA, LV-siRNA-con and transfected no carrier were served as the experimental group, the implicit control group and the blank control group respectively. MTT and colony formation assays were used to examine the effect of CypB on the cell growth and proliferation in vitro. Cell cycle was analyzed with flow cytometry. The expression of VEGFR of BGC823-si and SGC7901-si was detected by Western blot. Results: Gene silencing of CypB can inhibit gastric cancer cell growth, proliferation, cell cycle progress and tumorigenesis. CypB expression level was obviously higher in SGC7901 and BGC823 than MKN28 and GES. These two cell lines were infected with LV-si-con and LV-CypB-si respectively. MTT and cloney formation assays showed a significantly decreased rate of cell proliferation from the forth day or the fifth day in cells transfected with LV-CypB-si (P<0.05). Down-regulation of CypB resulted in slightly decreased percentage of S phase and increased percentage of G1 (P<0.05). These findings indicated that CypB could promote the G1-S transition of gastric cancer cell. In addition, the expression of VEGF of BGC823 and SGC7901 transfected with CypB siRNA was reduced in comparison with the implicit control group and the blank control group. Conclusions: Gene silencing of CypB decreases gastric cancer cells proliferation and in vivo tumorigenesis. These findings indiccate CypB could be a potential biomarker and therapeutic target for gastric cancer.
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Objective:To explore the role of miR-214 in the progression of hepatocellular carcinoma (HCC) and its inhibitory mechanisms in depressing the signaling pathway ofβ-catenin, this study was conducted.Methods:We ectopically expressed miR-214 in HepG2 cells to obtain cell lines Lv-miR-214-HepG2 and their control Lv-control-HepG2. Differences between the two cell lines were compared in cell growth, proliferation, colony forming ability and cell cycles. RT-PCR method was applied for the quantification ofβ-catenin mRNA expression. Western-blot method was applied for the determination of the protein level ofβ-catenin and their downstream targets (ie. Cyclin D1, c-Myc and TCF-1). The effect of miR-214 on cells was further explored through RNA interference and restoring miR-214 expression.Results:In comparison with negative (Lv-control-HepG2) and blank (HepG2) control, a significant inhibition of cell growth and proliferation caused by miR-214 was observed after 48~72h of cell culture experiments (P0.05). By comparing to the RT-PCR and Western-blot results of control, the miR-214 treatment led to a slightly decrease in theβ-catenin mRNA expression (P>0.05), but an extremely inhibition in the protein level ofβ-catenin and its downstream targets Cyclin D1, c-Myc, and TCF-1 (P<0.05).Conclusions:miR-214 functions as a suppressor during the progression of HCC, and its inhibitory role was achieved by down-regulatingβ-catenin signaling pathway.
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Clostridium difficile is a gram-positive,obligate anaerobic bacillus,which is one of the most common pathogenic bacteria of antibiotic associated diarrhea,and can cause Clostridium difficile-associated diarrhea.In recent years,the incidence of Clostridium difficile infection has increased significantly in the world with the excessive use of broad-spectrum antibiotics,the increase of strains resistance,and the emergence of hypervirulent strains.This paper presents a brief review on research progress of Clostridium difficile-associated diarrhea.
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Objective To investigate the relationship between pleural resonance features and the chest volume and vital capacity in young male adults .Methods A total of 60 healthy young male adults were included in this study .Energy distribution of pleural resonance was measured with the multi-channel voice analysis system when they pronounced /a:/.The frequency spectrums were 0~999 Hz (FR1 ) ,1 000~1 999 Hz (FR2 ) ,2 000~2 999 Hz (FR3 ) ,3 000~4 000 Hz (FR4 ) .Fast 3D reconstruction of chest was detected by multi slice spiral CT to calcu‐late the chest volume .The vital capacity was evaluated by aerodynamics system .SPSS 18 .0 software was used to analyze the data .Results The vital capacity in healthy young male adults was 4 .31 ± 0 .63 L ,the chest volume was 5 .69 ± 0 .52 L .The frequency spectrum of FR1 was 53 .38% ± 2 .14% ,FR2 was 30 .72% ± 1 .59% ,FR3 was 10 . 53% ± 2 .75% ,FR4 was 5 .35% ± 2 .32% ,respectively .There was a highly positive correlation between the chest volume and FR1 (r=0 .854) ,moderately positive correlation between the volume and FR2 (r=0 .740) ,moderately negative correlation between the volume and FR3 (r= -0 .587) ,moderately negative correlation between the volume and FR4 (r= -0 .565);There was a highly positive correlation between the vital capacity and FR1 (r=0 .744) ,mod‐erately positive correlation between the volume and FR2 (r=0 .699) ,moderately negative correlation between thevolume and FR3 (r= -0 .632) ,weakly negative correlation between the volume and FR4 (r= -0 .429) .Conclusion There was a high correlation between the chest volume and pleural resonance ,high correlation between vital capacity and pleural resonance in young male adults ,which may be a influencing factor of pronunciation effect .