Clinical effect of sirolimus in treatment of blue rubber bleb nevus syndrome in children: a report of 2 cases and literature review / 中国当代儿科杂志

To study the clinical effect of oral sirolimus in the treatment of children with blue rubber bleb nevus syndrome (BRBNS) in the gastrointestinal tract, a retrospective analysis was performed on the clinical data and follow-up results of two children with BRBNS treated by sirolimus. The two children with BRBNS had gastrointestinal bleeding and anemia and were treated with sirolimus at a dose of 1 mg/day as part of treatment. The plasma concentration of the drug was maintained between 2.5-12.0 ng/mL. The children showed disappearance of gastrointestinal bleeding and improvements in anemia and coagulation function, and blood transfusion could be stopped during treatment, with no obvious adverse drug reactions. PubMed, Wanfang Data, and CNKI were searched for related articles on sirolimus in the treatment of BRBNS. A total of 26 cases of children with BRBNS, aged 0-18 years, were obtained. With the addition of the 2 cases in this study, sirolimus treatment achieved a satisfactory clinical effect in all 28 cases. Sirolimus may be effective and safe in the treatment of children with BRBNS, and further prospective studies are needed to evaluate the long-term efficacy of this drug.

Therapeutic effects of zinc supplement as adjunctive therapy in infants and young children with rotavirus enteritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of oral zinc supplement in infants and young children with rotavirus enteritis, and its preventive effects against diarrhea recurrence within 3 months after treatment.</p><p><b>METHODS</b>A total of 103 infants and young children with rotavirus enteritis were randomly divided into zinc supplement group (n=51) and conventional treatment group (n=52). Both groups were equally treated with a comprehensive therapy, besides which the zinc supplement group received zinc gluconate granules for 10 days. The treatment outcomes were examined at 72 hours after treatment, and the time required for the disappearance of positive symptoms and the recovery of injured extra-intestinal organs were determined. In addition, these patients were followed up for 3 months to determine the incidence of diarrhea recurrence after treatment.</p><p><b>RESULTS</b>The overall response rate in the zinc supplement group was significantly higher than that in the conventional treatment group (90% vs 75%; P<0.05). The durations of diarrhea, high fever, and vomiting in the zinc supplement group were significantly shorter than that in the conventional treatment group (P<0.05). In addition, the recurrence rate of diarrhea and the incidence of severe diarrhea within 3 months after treatment in the zinc supplement group were significantly lower than in the conventional treatment group (P<0.05).</p><p><b>CONCLUSIONS</b>Oral zinc supplement as adjunctive therapy is effective in treating infants and young children with rotavirus enteritis, and reducing the incidence and severity of diarrhea recurrence in the subsequent 3 months.</p>

Prevalence of celiac disease in children with chronic diarrhea in China / 中华儿科杂志

<p><b>OBJECTIVES</b>To investigate the prevalence of celiac disease in children with chronic diarrhea in China.</p><p><b>METHODS</b>Inpatients of the pediatric hospitals in Shanghai, Jinan, Wuhan and Chengdu who were diagnosed as chronic diarrhea were recruited from Jan. 2005 to Dec. 2008. Their clinical history, physical examination and laboratory data were collected. The SPSS version 11.5 statistical package for Microsoft Windows was used for statistical analysis.</p><p><b>RESULTS</b>Data of 199 patients and finally enrolled 118 hospitalized chronic diarrhea inpatients during the observation period were collected and 14 (12%) of the chronic diarrhea patients were suspected as having celiac disease and in one the diagnosis of celiac disease was confirmed. Gluten-free diet (GFD) treatment was effective. M/F: 12/2, the age ranged from 6 months to 12 years; 43% (6/14) had malnutrition, 29% (4/14) had anemia, villous atrophy was found in 4 patients by endoscopy. Duodenal biopsies revealed stage I in 1, stage II in 2, stage IIIa in 7, stage IIIb in 3 and stage IIIc in 1 patient according to the modified Marsh classification.</p><p><b>CONCLUSION</b>This study was the first time to report the research of celiac disease in children with chronic diarrhea in China. The percentage of suspicious celiac disease patients was 12% (14/118) in children and one was confirmed. CD exists in China. Chinese pediatricians should pay attention to the disease.</p>

Epidemiology of mild gastrointestinal disorders among infants and young children in Shanghai area / 中华儿科杂志

<p><b>OBJECTIVE</b>To determine the prevalence of functional gastrointestinal disorders in children in Shanghai.</p><p><b>METHOD</b>This study was conducted on the infants and young children who were below 24 months of age recruited consecutively from April 2008 to June 2008 from the 12 communities in Minhang district in Shanghai. The questionnaire on gastrointestinal symptoms and growth was sent to 5030 children < 24 months old. The age distribution of the 5030 children was: < 6 months: 1922 infants (38.2%), 6 - < 12 months: 1933 (38.4%) infants; 12 - < 18 months: 811 (16.1%) children; 18 - < 24 months: 364 (7.2%) children.</p><p><b>RESULT</b>Among the 5030 children, 1909 had gastrointestinal disorders (38.0%). There was no significant difference in the rate of the disorders between sexes (P = 0.06). Regurgitation was found in 899 (17.9%) infants/children, constipation in 690 (13.7%), 619 (12.3%) infants/children suffered from diarrhea and only 71 (1.4%) suffered from colic. The incidence of gastrointestinal disorders was significantly different among different age groups. The incidence of constipation and regurgitation decreased and the incidence of diarrhea increased with growth (P < 0.01). Infants growth parameters in the group with gastrointestinal disorders especially in those with regurgitation were lower than those without gastrointestinal disorders, the difference is statistically significant. The hospital visit rate of infants with diarrhea was 62.68%, which was higher than the rate of the other three symptoms (4.45% - 16.90%).</p><p><b>CONCLUSION</b>Gastrointestinal disorders are common in infants and young children in Shanghai and may have a great impact on growth. Early management could relieve the disorders and ensure infants to get normal growth and development.</p>

Forlax in the treatment of childhood constipation: a randomized, controlled, multicenter clinical study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To determine the therapeutic effectiveness and safety of polyethylene glycol 4000 (forlax) in the treatment of constipation in children over 8 years old.</p><p><b>METHODS</b>This study was designed as a randomized, positive medicine (lactulose) controlled multicenter trial. A total of 216 children with constipation from 8-18 years old from 7 hospitals across China who were matched with a uniform entry criteria were enrolled in this study. The 216 patients were randomized to receive either oral forlax (20 g/d, n=105) or lactulose (15 mL/d, n=111) for 2 weeks. The therapeutic effects, including bowel movement frequency, stool consistency, clinical complete remission rate of constipation and abdominal symptoms, and the safety of forlax and lactulose were evaluated at 1 and 2 weeks of treatment.</p><p><b>RESULTS</b>The median weekly frequency of bowel movement in the forlax group increased by 4 and 5 times respectively after 1 and 2 weeks of treatment, and increased by 3 and 4 times in the lactulose group (P < 0.05). The stool consistency of the two groups was both improved significantly after treatment. The Bristol score of stool consistency of the forlax and lactulose groups were 3.41+/-1.11 and 3.64+/-1.33 respectively (P < 0.05) after 1 week of treatment, and were 4.26+/-0.89 and 3.63+/-1.33 respectively (P < 0.05) after 2 weeks of treatment. The clinical complete remission rate of constipation in the forlax and lactulose groups was 70% and 40% respectively (P < 0.05) by week 1 of treatment, and that was 72% and 41% respectively (P < 0.05) by week 2 of treatment. Abdominal pain disappeared in 75% of patients in the forlax group but in only 57% in the lactulose group by week 2 of treatment (P < 0.05). No serious adverse events happened and no abnormalities were found in laboratory tests and physical examinations in the two groups after medication.</p><p><b>CONCLUSIONS</b>Forlax is safe and effective in the treatment of constipation in children over 8 years old.</p>

Expression of human intestinal trefoil factor in Pichia pastoris and its biological activity on intestinal epithelium in vitro / 生物工程学报

In order to produce relatively large amounts of recombinant human intestinal trefoil factor and assess its biological activity. The expression plasmid pPIC9-hITF containing AOX1 promotor and the sequences of secreting signal peptides was transformed into the yeast cells. Then through selection, positive transformants were cultivated in fermentation basal salts medium in a 5L fermenter to obtain large amount product with low cost. The secreted peptides were then purified by a combination of ionic exchange chromatography and molecular sieve. To verify the product, electrospray mass spectrometry analyses was used to determine the structure of rhITF and Western Blotting was performed to test the immunological activity. Furthermore, the biological activity of the peptide was examined by experiments from cell to tissue. The nucleotide sequence of rhITF was the same as expected. With a 5-L fermenter, 253mg of hITF was isolated at the purity of 96% from 3.5 L of yeast fermentation broth. The expression level for recombinant human ITF in this yeast system was 73.33mg/L. In our study, we provided a way to gain a production among milligram to gram of recombinant human ITF by the use of a yeast expression system. As human ITF are difficult to purify in any significant amount from tissue extraction, the way described may become a valuable tool in obtaining pure peptide for further studies of trefoil peptide function.

Application of double-balloon push enteroscopy in diagnosis of small bowel disease in children / 中华儿科杂志

<p><b>OBJECTIVE</b>Double-balloon enteroscopy is a new method that allows complete visualization of the lumen of small bowel. This study was conducted to evaluate safety, extent of observation and clinical efficacy of double-balloon push enteroscopy in diagnosis of patients with small bowel disease in children.</p><p><b>METHODS</b>Fourteen cases suspected of small bowel diseases with negative findings on examinations with various routine diagnostic modalities underwent double-balloon push enteroscopy from June, 2003 to May, 2005. Of the 14 cases, 13 had gastrointestinal bleeding and iron deficient anemia and 1 case had chronic diarrhea, the causes of these conditions were unknown.</p><p><b>RESULTS</b>The enteroscopy reached jejunal-ileum transitional area, middle or lower portion of ileum and terminal ileum in 2, 10 and 2 cases, and the examination time was 40-50 min, 55-70 min and 78-89 min, respectively. Lesions were detected in 12 of 14 the cases. The positive diagnostic rate was 85.7%. There were no relevant technical problems or severe complications.</p><p><b>CONCLUSION</b>Double-balloon push enteroscopy is a safe, reliable diagnostic modality of high clinical value for small bowel diseases in children.</p>

Correlation of intestinal mucosal injury with serum diamine oxidase / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between the changes of intestinal mucosal tumor necrosis factor alpha (TNF-alpha), plasma diamine oxidase (DAO) values and the degree of mucosal injuries in young rat model of colitis and thereby to explore if plasma DAO could be used as a potential index for monitoring intestinal mucosal injury.</p><p><b>METHODS</b>One hundred and four healthy young male Sprague-Dawley (SD) rats aged 5-6 weeks were randomly divided into three groups: zero time group (n = 8), model group (n = 48) and control group (n = 48). The model and control groups were further divided into 24 h, 72 h, 1 week, 2 weeks, 3 weeks and 4 weeks subgroups, respectively, with 8 rats in each. The rats in model group were given 2, 4, 6-trinitrobenzene sulfonic acid (TNBSA) via enema to induce colitis, while the rats in the control group were given normal saline (NS) solution in the same way and those in zero time group were not treated. TNF-alpha and DAO were measured by immunohistochemical technique and spectrophotometry.</p><p><b>RESULTS</b>The most serious enteric mucosal injury was seen 24 hours after giving TNBSA. Plasma DAO and TNF-alpha decreased as the intestinal mucosal injury was alleviated.</p><p><b>CONCLUSIONS</b>Plasma DAO values may be used as a marker for intestinal mucosal injury. TNF-alpha is a factor for causing mucosal injury. Young rat colitis model can be used to study intestinal mucosal injury.</p>

Long-term outcome after injection sclerotherapy for esophageal variceal bleeding in children with portal hypertension / 中华儿科杂志

<p><b>OBJECTIVE</b>Endoscopic sclerotherapy has emerged as an effective treatment for bleeding esophageal varices in adults and children but the long-term outcome is poorly defined in children. The present study aimed to study the long-term effect of endoscopic sclerotherapy in children with portal hypertension.</p><p><b>METHODS</b>Fifteen patients (age 3 to 14 years) with esophageal variceal bleeding underwent endoscopic injection treatments with 1% Aethoxy-sclerol since 1996. All subjects continued to receive the therapy by repeated intra and extravariceal endoscopic sclerotherapy at intervals of 3 - 4 weeks until the varices disappeared, and received regular endoscopic follow-up.</p><p><b>RESULTS</b>Fifteen patients had totally 43 injections, and were followed up from 40 to 86 months (mean 66 months) by endoscopy. Two patients received 2 injections and 5 received 3 before eradication of varices. The mean time needed for varices eradication was 3 to 6 months. Recurrence of varices and bleeding was seen in 3 patients who had duodenal ulcer.</p><p><b>CONCLUSION</b>Endoscopic sclerotherapy is a safe and effective treatment for pediatric esophageal varices.</p>

Etiologic Analysis of Recurrent Abdominal Pain in Children / 实用儿科临床杂志

Objective To investigate the characteristics of children′s recurrent abdominal pain(RAP) with gastroscopy and analyze the etiology.Methods Three hundred and thirteen children were investigated with gastroscopy.Gastric antrum mucosa was taken for histo-pathology and the determination of helicobacter pylori(Hp) antibody.Results Ninty-nine point six eight percent of the cases had lesions under the gastroscope.The former 4 cases had chronic superficial gastritis(CSG),CGS and bile reflux,CGS and duodenitis,CGS and bulb ulcer,and Hp infection rate was 31.36%,25%,38.64%,60.61%.Hp infection rates of active gastritis and inactive gastritis were 92% and 23.19%,which showed significant differences in 2 groups(P

Curative Effects of Triple Therapy in Children with Helicobacter Pyl ori Infection / 实用儿科临床杂志

Objective To study the effects of new triple therapy with clarithromycin plus amoxicillin and omeperazole combined into 3 therapeutic therapies, and 3 therapeutic courses to treat children with helicobacter pyloric(Hp) infection.Methods Two hundred and four patients who were diagnosed by gastroscopy as Hp-related gastroentestinal diseases and divided into 3 groups,randomly.Group A was treated with amoxicillin 50 mg/(kg?d)+bismuth citrate 7-8 mg/(kg?d)+metronidzole 15-20 mg/(kg?d) for six weeks;group B took the same drugs but for two weeks;group C was treated with clarithromycin 15 mg/(kg?d)+omeperazole 0.8 mg/(kg?d)+amoxicillin 50 mg/(kg?d) for 2 weeks.Results The rates of eradicate of Hp:group A 73.4%,group B 75%,group C 92%.The differences between group B and group C were very significant.Conclusion Triple therapy is more effective, less duration,well tolerated, less resistant,with higher rate of eradication.

Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps / 中华儿科杂志

<p><b>OBJECTIVE</b>With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety.</p><p><b>METHODS</b>Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed.</p><p><b>RESULTS</b>Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared.</p><p><b>CONCLUSION</b>Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.</p>