Evidence-based guidelines for food allergy of children in China / 中华实用儿科临床杂志

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

Clinical analysis and literature review of adult onset Still's disease with interstitial lung diseases / 中华风湿病学杂志

Objective@#To analyze the clinical characteristics of patients with adult onset Still's disease (AOSD) with interstitial lung diseases (ILD), and review the literature.@*Methods@#The medical records of inpatients with AOSD and ILD from January 2000 to October 2017 were retrospectively analyzed, and pa-pers were searched and summarized with the key words "adult onset Still's disease" and "interstitial lung diseases". Kolmogorov-Smirnov test was used to test if variables met normal distribution. Measurement data which was normally distributed was described as Mean±SD. Measurement data which was not normally distributed was described as median and interquartile range.@*Results@#Among the 15 patients included in the study, six were male, and nine were female, and the mean age was (50±12) years. All of the 15 patients had fever, and the average temperature was (39.4±0.4) ℃. Eleven patients had rash, and 12 patients had arthralgia, seven patients presented with cough, and eight patients presented with short of breath. The high resolution computed tomography of the chest presented as ground glass opacity in nine patients, grid shadow in three patients and consolidation in three patients. All the 15 patients received glucocorticoids, and 10 patients received immunosuppressants at the same time. One patient was lost to follow up, four patients died (three patients died of respiratory failure and one patient died of myocardial infarction), 10 patients improved.@*Conclusion@#Patients with AOSD can also have ILD, which should be alerted by clinicians. Early treatment with glucocorticoids and immunosuppressants if infection is excluded may bring good prognosis, and it is easy to relapse when glucocorticoids is tapered off.

Clinical analysis and literature review of adult onset Still's disease with interstitial lung diseases / 中华风湿病学杂志

Objective To analyze the clinical characteristics of patients with adult onset Still's disease (AOSD) with interstitial lung diseases (ILD),and review the literature.Methods The medical records of inpatients with AOSD and ILD from January 2000 to October 2017 were retrospectively analyzed,and papers were searched and summarized with the key words "adult onset Still's disease" and "interstitial lung diseases".Kolmogorov-Smirnov test was used to test if variables met normal distribution.Measurement data which was normally distributed was described as Mean ±SD.Measurement data which was not normally distributed was described as median and interquartile range.Results Among the 15 patients included in the study,six were male,and nine were female,and the mean age was (50±12) years.All of the 15 patients had fever,and the average temperature was (39.4±0.4) ℃.Eleven patients had rash,and 12 patients had arthralgia,seven patients presented with cough,and eight patients presented with short of breath.The high resolution computed tomography of the chest presented as ground glass opacity in nine patients,grid shadow in three patients and consolidation in three patients.All the 15 patients received glucocorticoids,and 10 patients received immunosuppressants at the same time.One patient was lost to follow up,four patients died (three patients died of respiratory failure and one patient died of myocardial infarction),10 patients improved.Conclusion Patients with AOSD can also have ILD,which should be alerted by clinicians.Early treatment with glucocorticoids and immunosuppressants if infection is excluded may bring good prognosis,and it is easy to relapse when glucocorticoids is tapered off.

Clinical analysis of patients with connective tissue diseases and autonomic neuropathy / 中华风湿病学杂志

Objective To summarize the clinical characteristics of patients with connective tissue diseases (CTD) and autonomic neuropathy. Methods The medical records of inpatients with CTD and autonomic neuropathy from 2005 to 2015 were retrospectively analyzed including clinical manifestations, laboratory examinations, treatment and outcome. Categorical data were expressed in percentages. Kolmogorov-Smirnov test was used to examine normal distribution. Continuous data of normal distribution were expressed as x ±s deviation, while data without a normal distribution were described as median and interquartile range (P25, P75). Results Among the nine patients included in this study, all were female, and the median age was 42 years (32~50 years old). Four patients (4/9) were systemic lupus erythematosus (SLE), three patients (3/9) were primary Sj?gren's syndrome (pSS), two patients (2/9) were rheumatic arthritis (RA), and four patients were secondary Sj?gren's syndrome (SS) (two with SLE and two with RA). Five patients (5/9) had autonomic nervous dysfunction before they were diagnosed of CTD, while four patients (4/9) developed autonomic nervous dysfunction after diagnosis of CTD. The most common symptom of autonomic nervous dysfunction was postural hypotension (9 patients, 9/9), followed by hypohidrosis (4 patients, 4/9), urinary retention (2 patients, 2/9), gastrointestinal dysmotility (2 patients, 2/9) and tonic pupil (1 patient, 11%). After treatment of CTD, autonomic symptoms of three patients improved, while the others didn't. Four of the remaining 6 patients improved after receiving other assistant treatments including vasoconstrictor, pyri-dostigmine bromide, and plasma exchange. Conclusion Patients with CTD could present with autonomic neuropathy, which is mainly characterized with postural hypotension. If patients had related symptoms, clinicians should pay more attention to whether CTD exists. If treatment for CTD couldn't improve patients' condition, other assistant treatment might be considered.

The 452th case:rash, hypotension, abdominal pain and headache / 中华内科杂志

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements.Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of digestive system involvement in SLE.We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day.She had rashes at onset,and developed fever,stomachache,hypotension and headache.Physical examination at admission indicated blood pressure 76/47mmHg(1 mmHg =0.133 kPa),heart rate 107 beats/min,warm acra.Murphy's sign was positive.Ultrasound suggested the enlarged gallbladder with surrounding hypoecho band yet no biliary calculi were found.A diagnosis of SLE was made,characteristic with distributive shock at the onset and AAC,complicated with neuropsychiatric lupus and lupus nephritis.She had an acute and severe course of disease,which had been relieved after treatment of high dose glucocorticoid and immunosuppressants.This case arouses clinicians to pay more attention to AAC as a rare form of disease flare in SLE.Early diagnosis of AAC is crucial to a favorable prognosis and in avoid of abdominal surgery.

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital, a General Tertiary Hospital in Beijing / 中国医学科学杂志(英文版)

Objective s To investigate the positive rate of different hepatitis B virus (HBV) serological markers, and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), HBV core antibody (HBcAb), and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and de- partment, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included, 2681 (9.8%) were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%,5.8%,and 4.7%, respectively. The positive rate of HBsAg of males (13.3%) was higher than that of females (7.3%, P=0.000). Among the 2681 HBsAg (+) patients, 1230 (45.9%) had HBV-DNA test, of whom 564 (45.9%) were positive. Patients with HBsAg (+), HBeAg (+), and HBcAg (+) result usually had high positive rate of HBV-DNA Results (71.8%, P=0.000).Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.