Effectiveness of eradication regimen based on the bacterial susceptibility and CYP2C19 genotype in children with refractory Helicobacter pylori infection / 中华儿科杂志

Objective@#To evaluate the effectiveness of eradication therapy based on Helicobacter pylori (Hp) susceptibility and CYP2C19 genotype in children with refractory Hp infection.@*Methods@#In this prospective observational cohort study, 156 children with Hp refractory to amoxicillin+clarithromycin+omeprazole triple regimen in Baoding Children′s Hospital from December 2017 to May 2018 were enrolled. Ninety-two of them underwent Hp culture and CYP2C19 detection. Seventy-five cases with positive Hp culture were defined as culture successful group and were treated according to Hp susceptibility and CYP2C19 genotype. Seventeen cases with negative Hp culture were defined as culture failed group and were treated only based on the results of CYP2C19 genotype. Sixty-four children who did not have Hp culture and CYP2C19 gene testing were defined as the empirical eradication therapy group and were treated with quadruple regimen (amoxicillin+metronidazole+omeprazole+bismuth). Bacterial resistance, CYP2C19 polymorphism and therapeutic effectiveness between the three groups were compared using chi-square test.@*Results@#Among the 75 positive Hp culture results, 72 (96%) were resistant to clarithromycin, 3 (4%) were resistant to metronidazole, 5 (7%) were resistant to levofloxacin, 5 (7%) were resistant to rifampicin, 1 (1%) was resistant to tetracycline, and none was resistant to amoxicillin and furazolidone. The CYP2C19 polymorphism in 92 patients showed that 43 (47%) were extensive metabolizer (EM), 9 (10%) were poor metabolizer (PM), and 40 (43%) were intermediate metabolizer (IM). In terms of the effectiveness, eradication rate in the culture successful group,culture failed group and empirical eradication therapy group were 99% (74/75), 88% (15/17) and 72% (46/64), respectively (χ2=21.325, P<0.05). The eradication rate in the culture successful group was significantly higher than that in empirical eradication therapy group (χ2=21.005, P<0.05), while there was no difference between empirical eradication therapy group and culture failed group (χ2=1.154, P=0.283).@*Conclusion@#Eradication regimen based on bacterial susceptibility and CYP2C19 genotype should be considered in children with refractory Hp infection.

Follow-up study of children with gastroesophageal reflux disease / 中华实用儿科临床杂志

Objective To study the prognosis of gastroesophageal reflux disease ( GERD) in children, and explore the factors which impacts on the prognosis of GERD. Methods One hundred and thirteen children with GERD were enrolled on the basis of positive result of 24-hour pH-monitoring between January 2007 and November 2011. The number of patients who were followed up was 87,and the parents of children were contacted with the telephone. The prognosis was evaluated by comparing the degree of patients′symptom relief,and the cumulative symptom relief rate was calculated by Kaplan-meier product limit method. The univariate Log-rank test and the COX proportional hazardmodel multivariate analysis were applied to detect the factors impacting on the prognosis,including age,gender,the regularity of treatment,reflux index,and Boix-Ochoa standard score,with esophageal hiatal hernia or without,receiving surgical treatment or not,the diet and lifestyle improved or not,receiving anti-acid treatment or not,as well as with allergies his-tory or without. Results At last,76 out of 87 children had symptom relieved. Survival curve showed the cumulative symptom relief rate at different time points,the median cumulative symptom relief rate reached 6 months,the final relief rate was close to 90. 0%,and the continuous treatment time was 44 months. The study showed that 14. 9% (13/87 ca-ses) of children′s growth and development were affected and the life and learning in 16. 1% (14/87 cases) of children were impacted. Age (P=0. 012,Wald=6. 376) and the regularity of treatment (P=0. 000,Wald=13. 059) were the risk factors in the prognosis of GERD. Conclusions Age and the treatment regularity were the factors in the prognosis. The children aged more than 1-year old have poor prognosis compared with those less than 1-year old,and the irregular treatment is the risk factor in the prognosis.

Clinical analysis of 29 cases of chronic pancreatitis in children / 中华实用儿科临床杂志

Objective To investigate the etiology and clinical characteristics of chronic pancreatitis (CP) in children,so as to improve its diagnosis and treatment.Methods The etiology,clinical characteristics,radiological records and therapy were retrospectively analyzed in children with CP who were admitted to Beijing Children's Hospital Affiliated to Capital Medical University from July 2006 to May 2014.Results A total of 29 medical records of children with CP,including 19 male and 10 female,with a mean age of (8.5 ± 3.7) years,and the youngest case was a 2-year-old child,the oldest case was a 15-year-and-2-month-old child.The main etiological factor was idiopathic pancreatitis (51.7％,15/29 cases),and 9 cases were caused by anatomical anomalies (31.0％,9/29 cases).The main symptoms included abdominal pain (89.7％,26/29 cases),malnutrition (48.3％,14/29 cases),nausea and vomiting (31.0％,9/29 cases),and chest distress and dyspnea (17.2％,5/29 cases).The serum amylase level in 18 cases (62.1％) increased.The positive diagnostic rate of transabdominal ultrasound was 96.6％ (28/29 cases),and dilations of pancreatic ducts or/and intraductal stones were 82.8％ (24/29 cases).The positive rate by magnetic resonance cholangio-pancreatography (MRCP) for morphological changes in pancreas was 88.5％ (23/26 cases),and dilations of the pancreatic ducts were 80.8％ (21/26 cases).A total of 10 endoscopic retrograde cholangio-pancreatography (ERCP) procedures were performed on 6 children,and pancreatic ductal stenosis or dilations were detected in them.All the patients were treated conservatively at first,and then 7 cases of them had surgical therapy (oledochojejunostomy,choledochoduodenostomy,choledochocystectomy,etc.),aud 6 cases had stent insertion by ERCP.Conclusions The main causes of CP in children are idiopathic and anatomical anomaly,and its diagnosis is based on symptoms and imaging changes;surgical or endoscopic therapy can be used if internal therapy is not effective.

Clinical analysis of 2 cases with chylothorax due to primary lymphatic dysplasia and review of literature / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and diagnosis of 2 cases with chylothorax due to primary lymphatic dysplasia and to elevate pediatrician's recognition level for this disease.</p><p><b>METHOD</b>Clinical manifestations of the children were retrospectively analyzed. Primary lymphatic dysplasia was diagnosed by lymphoscintigraphy.</p><p><b>RESULT</b>The first patient was a male aged 2-year-7-month who presented with a history of tachypnea for 43 days, fever and sore throat for 5 days at the early stage of the illness. He had a history of external injury before his illness. Physical examination showed his left chest bulging and left side diminished breath sound. His pleural effusion showed dark red (It was divided into two layers after standing, the upper layer turned into milky white, and the lower turned into hemorrhagic liquid) . White blood cell (WBC) count was 9 000×10(6)/L, mononuclear cell was 0.9, polykaryocytes was 0.1, triglyceride was 12.37 mmol/L in the pleural effusion. Contrast-enhanced lung CT (revascularization) showed pericardial effusion and a massive left sided pleural effusion. The second patient was a male aged 9 years and 6 months, who presented with a history of cough for 24 days, intermittent fever, vomiting, abdominal pain for 19 days, and edema of lower limbs for 4 days. Physical examination showed edema in both eyelids, lower extremities and scrotum. The level of albumin was 14 g/L and the titer of Mycoplasma pneumoniae IgM was 1: 320 in the serum. His hydrothorax pleural effusion showed milk white. White blood cell (WBC) count was 74×10(6)/L, mononuclear cell was 0.78, polykaryocytes was 0.22, triglyceride was 1.01 mmol/L in the pleural effusion. Chyle test showed positive in his pleural effusion and seroperitoneum. High-resolution CT of the lung revealed bilateral interstitial and parenchymal infiltration and both sided pleural effusion. Abdominal ultrasound showed giant hypertrophy of the gastric mucosa and massive ascites. Gastroscopy showed giant hypertrophy of the gastric mucosa. Lymphoscintigraphy revealed primary lymphatic dysplasia in both children.</p><p><b>CONCLUSION</b>Primary lymphatic dysplasia might occur in children and result in dropsy of serous cavity (chylothorax, chylopericardium, chylous ascites). Dropsy of serous cavity showed bloody or milk white. WBC count might elevate with lymphocyte increasing mostly, triglyceride was often higher than 1.0 mmol/L in dropsy of serous cavity. Primary lymphatic dysplasia can be diagnosed by lymphoscintigraphy.</p>

Clinical characterization of patients with lymphatic malformation / 基础医学与临床

Objective To study the clinical characteristics of lymphatic malformation(LM).Methods Clinical data of 14 cases with LM were analysed and literatures were reviewed.Results ①Among the 14 cases,6 were diagnosed as primary intestinal lymphangiectasia(PIL)and 8 as primary lymphedema(PL);②The major manifestations of PIL are symmetry edema,diarrhea,lymphocytopenia,hypoproteinemia and chylopericardium.The manifestations of PL included asymmetry edema of lower limbs and respiratory symptoms;③Directed oil-contrast lymphography and isotope techniques demonstrated absence of contrast in some lymphatic segments and blockage of chylous reflux;④White opaque spots were found on the duodenal and intestinal mucosa in the endoscopy of 6 cases of PIL indicating lacteal vessels dilation.Pathological examinations revealed intestinal lymphangiectasia;⑤Six cases of 14 patients were treated with surgical therapy and 8 cases were treated with conservative therapy including medium chain triglyceride(MCT).Conclusion LM should be diagnosed on the bases of typical clinical manifestations specific laboratory findings and by lymphography and pathology.Combination of surgical therapy and conservative therapy is recommended to treat the LM patients.