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Cow′s milk protein allergy (CMPA) is one of the most common presentations of food allergy seen in early childhood.It is an abnormal immune response caused by cow′s milk protein.CMPA can be clinically subdivided into either immediate-onset IgE mediated or delayed onset non-IgE mediated, or both.At present, concerns regarding the early and timely diagnosis of CMPA have been high-lighted over the years and there are many expert consensus on CMPA in China, but these consensus did not distinguish IgE mediated or non-IgE mediated CMPA.In view of the obvious clinical differences between the two type of CMPA and non-IgE mediated CMPA is more common in infancy, experts focus on pediatric gastroenterology, allergy/immunology, dermatology, nutrition and child healthcare convened by the Allergy Prevention and Control Professional Committee of Chinese Preventive Medicine Association present this guideline to help practitioners in primary care settings to early recognize and make suitable management of non-IgE mediated CMPA in China.The guideline incorporates the cutting-edge international guidance and the actual situation of Chinese children describing in detail the types, clinical features, diagnosis and nutritional intervention of non-IgE mediated CMPA.There are 42 recommendations in 7 categories in total referring to the common questions related to non-IgE mediated CMPA.
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Objective@#To investigate the incidence and risk factors of extraintestinal manifestations (EIMs) in children with inflammatory bowel disease (IBD).@*Methods@#The clinical data of 161 children with IBD was collected from the electronic medical records in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine from January 2012 to December 2017. These patients were divided into Crohn′s disease (CD) group and ulcerative colitis (UC) group, accounting for 82.0% (132 cases) and 18.0%(29 cases), respectively. The incidence of EIMs in each group was analyzed. The potential risk factors of EIMs including the IBD phenotype, gender, age, location of the CD lesion, disease activity of CD, and the presence of perianal lesion were analyzed with logistic regression model.@*Results@#Eighty-eight patients (54.7%) had EIMs. The main EIMs were immune-mediated EIMs and growth retardation, accounting for 41.0% (66/161) and 24.2% (39/161), respectively. Aphthous ulcer (39/161, 23.0%) was the most common symptom among immune-mediated EIMs, followed by arthropathy (20/161, 12.4%) and skin lesions (19/161, 11.8%). Forty-three patients (26.7%) had EIMs before being diagnosed as IBD. Fifty-eight (65.9%) patients had only one EIM during the whole course of IBD. By logistic regression analysis, CD (OR=5.536, 95%CI:1.825-16.788) and perianal disease (OR=1.969, 95%CI:1.035-3.746) were the risk factors of immune-mediated EIMs. Meanwhile, CD (OR=11.319, 95%CI: 1.487-86.179), younger than six-year-old at diagnosis (OR=8.556, 95%CI: 3.109-23.545), moderate to severe activity of CD (OR=3.447, 95%CI: 1.196-9.934) and perianal disease (OR=3.361, 95%CI: 1.720-7.793) increased the risk of growth retardation.@*Conclusions@#The children with IBD have a high incidence of EIMs, which were more common in CD than in UC. The risk factors of developing EIMs include CD, perianal diseases, younger than six-year-old at diagnosis and moderate to severe activity of CD.
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Objective@#To analyze the clinical characteristics of chronic pancreatitis (CP) and evaluate its impact on growth of children.@*Methods@#A retrospective study was conducted in 94 children (male 49 cases, female 45 cases) who were diagnosed with CP in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from August 2008 to July 2015. Clinical characteristics, such as features of abdominal pain, etiologies, image data, levels of serum amylase and lipase, and physical development data were extracted from electronic medical records. The comparison between groups based on etiology or with normal control was performed with student′s t test.@*Results@#The age of first episode was (8.2±3.7) years. There were 61 (65%) children diagnosed with idiopathic CP, and 25 (27%) with anatomic abnormalities. The age of onset in the group with anatomic abnormalities was lower than that in the idiopathic CP group ((6.3±3.5) vs. (8.9±3.4) years, t=3.211, P=0.002). There were 51 (54%) patients with serum amylase elevation, 41(44%) patients with lipase elevation, and 35 (37%) with elevation in both. The questionnaire showed that 28 out of 30 children had moderate to severe abdominal pain. The patients′ weight standard score (SDS) was significantly lower than the overall average in normal control (-0.4±1.1 vs. 0, t=-3.308, P=0.001). Meanwhile, the mean level of insulin like growth factor-1 (IGF-1) SDS of 35 children was significantly decreased (-1.8±1.8 vs. 0, t=-6.136, P<0.01). There were 69% (37/54) patients diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with magnetic resonance imaging (MRI), higher than that diagnosed by abdominal ultrasound (29%, 27/94).@*Conclusions@#Idiopathic CP and anatomic abnormalities were the two main etiologies. Normal level of serum amylase and lipase or negative finding of ultrasound cannot exclude CP, while MRCP and MRI should be considered to improve CP diagnostic rate. It is noteworthy that growth delay would happen in children with CP history.
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Objective To evaluate the clinical value and safety of endoscopic retrograde cholangiopancreatog-raphy(ERCP)in children with pancreaticobiliary diseases. Methods Retrospective review was conducted for the data of 196 patients younger than 18 years old who underwent ERCP between January 2008 and June 2016 at Shanghai Rui-jin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University. The data of indications,pathogenesis,thera-py,complications were collected and the relationship between ERCP treatment methods and post - operation complica-tions was analyzed. Results A total of 314 ERCP procedures were performed on 196 patients,with the success rate of 99. 0％ . There were 94 boys and 102 girls with the median age of (8. 7 ± 3. 7)years old(ranged 1. 1 - 16. 8 years old) at time of procedure. Indications included pancreatic diseases(156 cases)and bile duct diseases(40 cases). The ERCP findings were classified as follows:chronic pancreatitis(114 cases),acute recurrent pancreatitis(28 cases),bile duct stone(19 cases),acute pancreatitis(12 cases),cholangiectasis(8 cases),cholangitis(5 cases),congenital biliary dila-tion(5 cases)and other pancreaticobiliary. Furthermore,45. 9％ of the patients were proved to have structural abnor-malities after operation. The most common bile duct diseases were malfusion of pancreatobiliary ducts(60. 0％),and pancreas cleavage was the most common cause of recurrent pancreatitis,accounting for 22. 4％ . The total post - ERCP complication rate was 14. 3％,including 41 cases(13. 0％)mild to moderate post - ERCP pancreatitis,4 cases(1. 3％) gastrointestinal bleeding. All cases were cured by medical treatment except that one cases with duodenal minor papilla wound bleeding underwent emergent endoscopic hemostasis. No other serious complications occurred such as bile duct in-fection,postoperative perforation and severe pancreatitis related to ERCP. Statistical analysis showed that multiple repeated operations were the protective factor for post - ERCP pancreatitis and pancreatic stone removal was the risk factor. Conclusions The diagnostic and therapeutic utility of ERCP for pediatrics with pancreaticobiliary diseases is effective and safe.
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Celiac disease(CD) is a chronic intestinal malabsorption syndrome by ingestion of wheat bran material in a susceptible population which is immune-mediated.At present,the incidence of CD in North America and Europe has reached about 1％-3％,the disease is considered to be very rare in China,but now some studies have confirmed the existence of the disease.Children suffering from CD can lead to failure in growth and development,and patients can be significantly improved by gluten-free diet.Therefore,early diagnosis and timely treatment is great significance.
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Objective To investigate the incidence of extra intestinal organ damage in infants with acute rotavirus (RV) infection,the relative risk factors in patients with extra intestinal organ damage,the significance of procalcitonin(PCT)in those infants with multiple organ injury.Methods One hundred and three infants with acute diarrhea whose rotavirus antigens were positive and 65 negative ones were divided into two groups.The differences between these two groups in incidences of extra intestinal organ damage were analyzed.Meanwhile,variables from the clinical data that may lead to extra intestinal organ damage were analyzed.Then,the relationship of multiple organ damage and serum concentration of PCT was also analyzed.Results There were significant differences between positive group and negative group in the rates of respiratory system injury,myocardial damage and hepatic involvement (P ＜ 0.05).High fever was the only high risk factor in myocardial damage through multi factor Logistic regression analysis.There were also significant differences among the group with multiple organ damage and only one extra intestinal organ damage and no extra intestinal organ damage in serum concentration of PCT(P ＜ 0.05).Conclusion It is common to be attacked by extra intestinal organ damage in infants with acute rotavirus infection.High fever is the risk factor for RV enteritis complicated with myocardial damage.The elevation of PCT concentration suggest that multiple organ injury out of the intestinal tract may take place in infants with acute RV infection.
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Objective To study the clinical value and the safety of endoscopic retrograde cholangio-pancreatography(ERCP)for chronic pancreatitis in the pediatric population.Methods Clinical data,endo-scopic reports,and radiography of chronic pancreatic patients aged from 2 to 17 years old who underwent ERCP between Jan.1,2008 and Apr.30,2014 at Endoscopy Center of Ruijin Hospital were reviewed.These patients were divided into 3 groups,patients aged from 2 to 6 years old as children group(n =27),patients aged from 7 to 12 years old as juvenile group(n =35)and patients aged from 13 to 17 as adolescent group(n =25). Their clinical data and complications were analyzed by groups.Results A total of 170 ERCP procedures were performed in 87 patients,with the success rate of 99.4%(169 /170).All patients were diagnosed as having chronic pancreatitis by ERCP.Success rates of children group,juvenile group and adolescent group were 97.6%(40 /41),100.0%(72 /72)and 100.0%(57 /57)respectively.There was no statistically significance among the three groups(P =0.207).No serious complications like bleeding or perforation occurred.No proce-dure-related mortality occurred in this study either.The rate of post-ERCP adverse events in children group, juvenile group and adolescent group were 41.5%(17 /41),25.0%(18 /72)and 24.6%(14/57),respective-ly.Children group had more adverse events than the juvenile group(P =0.039)and adolescent group(P =0.045).Conclusion Pediatric ERCP is highly effective in the pediatric population with chronic pancreatitis. The incidence of post ERCP adverse events is higher among the youngest children.
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Objectives To evaluate the effect and safety of Xiao Er Fu Xie Tie in children with acute diarrhea. Methods A multicenter, randomized, open-label, active-controlled clinical trial was carried out in three hospitals from March 2011 to December 2012. Children with acute diarrhea were enrolled and divided randomly into two groups, the observation group (treated with Xiao Er Fu Xie Tie) and the control group (treated with smectite powder). Boths groups received oral rehydration salts treatment. Symptoms and signs were recorded before and after therapy. The therapeutic effect was evaluated at 3 and 5 days after therapy. All of the adverse drug reactions were recorded during the study. Results In 197 children who completed the study, 100 children received Xiao Er Fu Xie Tie and 97 received smectite powder. Both groups were similar in age and gender distribution, weight, duration and frequency of diarrhea, times of vomiting, degree of dehydration and so on (P>0.05). After therapy, effective rates of the observation group at 3 days (97%) and 5 days (100%) were similar to those of control group (P>0.05). The effective rate for relieving vomiting in the observation group was higher than that in control group (P<0.05). No obvious adverse drug reactions were found during the study. Conclusions Xiao Er Fu Xie Tie has the same effect as smectite powder for treatment of acute diarrhea in children and is more effective in vomiting. Furthermore, no obvious adverse drug re-actions were found.
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Objective To explore the role of dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) in the tubulointerstitial lesions of immune-mediated nephrotoxic nephritis (NTN) and the intervention regulation by anti-P-selectin lectin-EGF domain monoclonal antibody (PsL-EGFmAb). Methods WKY rats were randomly divided into control,NTN and PsL-EGFmAb-treated groups. The mrs in NTN group were injected with 1 ml nephrotoxic rabbit serum per kilogram of rat body weight; the ones in PsL-EGFmAb-treated group were injected with 2 mg PsL-EGFmAb per kilogram of rat body weight simultaneously and 2 h later after nephrotoxic rabbit serum injection; and those in control group were injected with equal volume of 0.9% saline. Renal function and pathology were observed at day 4, 7 and 14 after the induction of NTN. Distribution of DC-SIGN + dendritic cells (DCs) in renal tissues was measured by immunofluorescence. Real-time PCR was performed to examine the expression of P-selectin,RANTES, TNF-α, IL-10, IFN-γ and IL-4. Expression of MHC Ⅱ , CD80 and DC-SIGN on dendritic cells was analyzed by flow cytometry. Transendothelial migration was used to detect the ability of DCs migration. DCs ability to activate T cells was determined by mixed lymphocyte reaction (MLR). ELISA was used to detect the concentration of IFN-γ and IL-4 in the supernatant of MLR. Results At day 4, immature DC-SIGN+ DCs infiltrated the rat renal tubulointerstium of NTN group, matured at day 14, and enhanced the ability to migrate and activate T cells. The distribution of DC-SIGN + DCs was significantly related to the form of crescent, tubulointerstial lesions and renal function. In addition, expression of chemokine RANTES and proinflammatory cytokine TNF-α continuously augmented since day 4, while anti-inflammatory eytokine IL-10 decreased after markedly increased at day 4. At day 14, IFN-γ/IL-4 mRNA increased, which was obviously related to DCs maturation. The intervention of PsL-EGFmAb supressed the expression of DC-SIGN and CD80 on DCs, depressed DCs maturation, migration and ability to activate T cells,down-regulated proinflammatory cytokines and up-regulated anti-inflammatory cytokines in kidney,and thus regulated Th1/Th2 bias. At the same time, kidneys showed the decrease of crescents,improvement of tnbulointerstium damage and renal function. Conclusions DC-SIGN may mediate DCs tubulointerstitial infiltration. It may be also a potent regulator of local immune reaction imbalance and pathology of tubulointerstium. PsL-EGFmAb may depress DCs migration and downregulate DCs maturation and function through DC-SIGN, and thus having a role in prevention and treatment.