Characteristics of gastric microbiota in children with Helicobacter pylori infection family history / 北京大学学报(医学版)

OBJECTIVE@#To explore the characteristics of gastric microbiota in children with and without (Helicobacter pylori, H. pylori) infection who had family history of H. pylori infection.@*METHODS@#Mucosal biopsy samples of the gastric corpus and gastric antrum were collected during the gastroscope. And the gastric mucosa flora's information of the two groups of children were obtained after sample DNA extraction, PCR amplification of the 16S ribosomal DNA (rDNA) V3-V4 region, high-throughput sequencing and data processing. All the samples with family history of H. pylori infection were divided into two groups, the H. pylori infection group (n=18) and the H. pylori non-infection group (n=24). Then the α-, β-diversity and bacteria abundance of the gastric microbiota were compared between the H. pylori infection and non-infection groups at different taxonomic levels. The differential microbiota was found out by LEfSe analysis, and then the function of microbiota predicted using phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) method.@*RESULTS@#There was statistically significant difference in α-diversity (P < 0.05) between the two groups, indicating that the H. pylori non-infection group had higher microbial richness than the H. pylori infection group. Moreover, the β-diversity was significantly different as well (P < 0.05), which meant that the microbiota composition of the two groups was different. At the phyla level, Proteobacteria, Firmicutes, Bacteroides, Actinobacteria, and Fusobacteria were dominant in the two groups. At the genus level, Bacteroides, Prevotella, Streptococcus, and Neisseria, etc. were dominant in the H. pylori non-infected group. Meanwhile, Helicobacter and Haemophilus etc. were dominant in the H. pylori infected group. LEfSe analysis showed that the relative abundance of Bacteroides etc. at the genus level in the H. pylori non-infected group was significantly higher than that in the H. pylori infected group. Functional prediction showed that Bacteroides were positively correlated with amino acid and vitamin metabolism, mitogen-activated protein kinase (MAPK), mammalian target of rapamycin (mTOR) signaling pathway and ansamycin synthesis pathway.@*CONCLUSION@#The gastric microbiota between H. pylori positive and H. pylori negative in children with family history of H. pylori infection is significant different. Some gastric microbiota, such as Bacteroides, may have a potential relationship with H. pylori infection in children.

Expression of IL-10R1 in T lymphocytes in peripheral blood of children with food allergy / 中国实用儿科杂志

OBJECTIVE: To study on the expression and clinical significance of interleukin 10 receptor 1(IL-10R1)in T lymphocytes in peripheral blood of children with food allergy. METHODS: The food allergy group included 50 cases of children admitted in Department of Pediatrics of Peking University Third Hospital from July 1,2017 to December 31,2017 and were diagnosed with food allergy. A total of 25 cases of healthy children who visited Child Health and Development Center of Peking University Third Hospital in the same period with no food allergy manifestation were selected as a healthy control group. The clinical manifestations of food allergy in different age groups were compared.Flow cytometry was used to examine the expression of IL-10R1 in CD4~+T cells and CD8~+T cells in peripheral blood and the MFI. According to the results of allergen specific Ig E test,the food allergy children were classified as allergen specific Ig E positive group and negative group. The expression of l L-10R1 in the CD4~+T lymphocytes and CD8~+T lymphocytes in peripheral blood and the MFI of the two groups were compared. A severity index of clinical symptoms and signs of food allergy was used to grade illness severity of food allergy children. Then it analyzed the correlation between the expression rates of IL-10R1 in CD4~+T cells and CD8~+T cells in peripheral blood and the scores. RESULTS: The expression rates and MFI of IL-10R1 in CD4~+T cells in peripheral blood of food allergy group were lower compared to the control group. The median expression rates and MFI were 40.23 versus 45.32,12.18 versus 17.69(Z=-2.506,-5.547,P=0.012,0.000,respectively). The expression rates and MFI of IL-10R1 in CD8~+T cells in the peripheral blood of food allergy group were also lower than the control group. The median expression rates and MFI were 34.50 versus 39.46,12.47 versus 17.28(Z=-4.035,-5.226,P=0.000,0.000,respectively). IL-10R1 expression rates and MFI on CD4~+T cells and CD8~+T cells in peripheral blood of allergen specific Ig E positive group were similar to those of the negative group. The expression rates of IL-10R1 on CD4~+T cells and CD8~+T cells in peripheral blood of children with food allergy had no correlation with the symptom and sign scores of food allergy. CONCLUSION: The decrease of the expression of IL-10R1 in CD4~+T cells and CD8~+T cells in peripheral blood may be associated with food allergy of children;the expression of IL-10R1 may be involved in the pathogenesis of food allergy mediated by Ig E and non-Ig E,but it was not associated with the severity of food allergy.

Pediatric colonoscopy findings and changing patterns from Beijing in one institutional experience over 12 years / 北京大学学报(医学版)

OBJECTIVE@#To investigate the demographics and diagnostic yield in a cohort of Chinese pediatric patients undergoing colonoscopy in one institution over 12 years.@*METHODS@#The study participants were consecutive patients aged <18 years that underwent their first colonoscopy in the endoscopy center at Peking University Third Hospital between Jan. 1, 2005 and Dec. 31, 2017. Demographic, endoscopic, and pathological findings were collected. According to the age of the patients, they were divided into 0-3 year-old group, 4-6 year-old group, 7-14 year-old group and 15-17 year-old group. The patients were also divided into 2005-2011 group and 2012-2017 group, according to the time of colonoscopy.@*RESULTS@#The cohort consisted of 326 patients, including 205 boys (62.9%) and 121 girls (37.1%). In the study, 31 patients (9.5%) were in 0-3 year-old group, 28 (8.6%) were in 4-6 year-old group, 96 (29.4%) were in 7-14 year-old group and 171 (52.5%) in 15-17 year-old group. The terminal ileum intubation success rate was 90.5% (295/326). No serious complications such as hemorrhage or perforation occurred during the procedures. The cleaning effect was good in 92.3% (301/326) of the patients. A total of 204 patients (62.6%) received a positive diagnosis under colonoscopy. 27.0% (88/326) of the patients was diagnosed as nonspecific colitis or terminal ileitis. 46 (14.1%) with inflammatory bowel disease (IBD) and 39 (12.0%) with polyp. The diseases were significantly different among the different age groups. The highest IBD diagnostic rate was found in 0-3 year-old group (7/31, 22.5%), while the highest polyp finding rate was in 4-6 year-old group (8/28, 28.6%). The number of the patients in 0-3 year-old group was significantly increasing in 2012-2017 group compared with 2005-2011 group (27/191 vs. 4/135, P=0.001), while the terminal ileum intubation success rate was higher (179/191 vs. 116/135, P=0.037). However, comparisons between years 2005-2011 and 2012-2017 showed that neither IBD nor polyp detection rate changed significantly (P=0.850).@*CONCLUSION@#Colonoscopy in pediatric patients was a safe and effective procedure. Colitis or terminal ileitis was the primary finding during colonoscopy while IBD was the second one, and polyp was the third. However, the diagnostic yield did not change significantly. IBD was not as quickly increased in our hospital as it was in South China.

Neonatal food allergy / 中国当代儿科杂志

Food allergy is defined as abnormal immune response elicited by food intake, in which a variety of clinical symptoms will appear as a result of physiological dysfunction and/or tissue damage. Possible mechanisms for food allergy include gastrointestinal tract barrier damage, failure to induce oral immune tolerance, intrauterine sensitization, and allergen transmission during pregnancy and breastfeeding. Hereditary and environmental factors can also contribute to the disease. Gastrointestinal disorders are the main clinical manifestations of the disease. However, hypoalbuminemia, growth retardation, and even acute circulatory failure or shock may occur in severe cases. Oral food challenges are the "gold standard" for the diagnosis of food allergy. Avoidance and replacement of the responsible food are the only effective treatment options for neonatal food allergy. The use of probiotics can offer protection against the disease.

Relationship between Helicobacter pylori infection and histopathological features of nodular gastritis in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between Helicobacter pylori (Hp) infection and histopathological features of nodular gastritis (NG) in children.</p><p><b>METHODS</b>A total of 213 children who had undergone gastroscopy due to upper gastrointestinal symptoms were enrolled and were divided into NG and non-NG groups according to endoscopic appearance. The histopathological features of gastric mucosa were evaluated using the updated Sydney System. The rates of Hp infection, moderate to severe inflammation and lymphoid follicles formation of gastric mucosa were compared between the two groups.</p><p><b>RESULTS</b>Thirty-eight (17.8%) of the subjects were diagnosed with NG. The NG group had significantly increased rates of Hp infection (86.8% vs 14.3%; P<0.01), moderate to severe inflammation (81.6% vs 15.4%; P<0.01) and lymphoid follicles formation of gastric mucosa (52.6% vs 10.3%; P<0.01) compared with the non-NG group. NG had a high specificity (96.8%) and a positive predictive value (86.8%) for the diagnosis of Hp infection. NG was observed in 33 (56.9%) of 58 Hp-positive children and in 5 (3.2%) of 155 Hp-negative children (P<0.01). Hp-positive children had higher rates of moderate to severe inflammation (86.2% vs 5.2%, P<0.01) and lymphoid follicles formation of gastric mucosa (84.2% vs 14.9% P<0.01) compared with Hp-negative children. There were significant differences in Hp colonization, degree of inflammation and inflammation activity in gastric tissues between the NG and non-NG groups (P<0.01).</p><p><b>CONCLUSIONS</b>NG is a special sign of Hp infection in children, which mostly shows moderate to severe inflammation of gastric mucosa, and can be used as an endoscopic indicator of Hp infection. Hp eradication therapy should be considered in the treatment of NG.</p>

Clinical analysis of twin-twin transfusion syndrome complicated by cardiac abnormalities in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the complications of twin-twin transfusion syndrome (TTTS) in preterm infants and to analyze the clinical conditions and prognosis of cardiac abnormalities in TTTS recipients.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 17 pairs of preterm infants with TTTS born between June 2009 and December 2012.</p><p><b>RESULTS</b>Compared with the recipients, the donors had significantly lower body weights (1.4±0.6 kg vs 1.9±0.6 kg; P<0.05). With treatment during pregnancy, cardiac complications were found in 14 cases, and brain injuries in 12 cases. The proportion of recipients with cardiac abnormalities (60%) was higher than that of donors (24%). Among 10 recipients who had cardiac complications, cardiac abnormalities mainly included valve thickening, stenosis, or atresia (50%).</p><p><b>CONCLUSIONS</b>Among preterm infants with TTTS, the recipients are more susceptible to complications of valvular heart disease and cardiomyopathy. Fetal echocardiography, evaluation of cardiac function, and treatment should be performed for recipients as early as possible to improve the prognosis.</p>

Relationship between degree of white matter damage and EEG changes in premature infants early after birth / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between the degree of white matter damage and changes in brain function in premature infants early after birth according to amplitude-integrated electroencephalogram (aEEG) and raw EEG (with burst-suppression patterns).</p><p><b>METHODS</b>Thirty-eight premature infants of less than 32 weeks' gestational age and with white matter damage, including 20 cases of mild white matter damage and 18 cases of severe white matter damage, were included in the study. Forty-two premature infants without white matter damage were selected as a control group. After birth, they were examined using aEEG and brain ultrasound once a week until four weeks after birth or a corrected gestational age of 32 weeks. The white matter damage and control groups were compared in terms of aEEG patterns and amplitudes and burst suppression ratio (BSR) on EEG.</p><p><b>RESULTS</b>The white matter damage and control groups had highly discontinuous patterns and had no complete sleep cycles. The lower amplitude was significantly smaller in the severe white matter damage subgroup than in the mild white matter damage subgroup and control group. There was alternating burst-suppression activity on the raw EEG in the white matter damage and control groups; and the severe white matter damage subgroup had a significantly longer suppression time and a significantly higher BSR on EEG compared with the mild white matter damage subgroup and control group.</p><p><b>CONCLUSIONS</b>Brain function monitoring should be performed in premature infants with white matter damage early after birth so as to detect cases of severe white matter damage in time.</p>

Risk factors of developing infantile food allergy in low birth weight infants / 中华实用儿科临床杂志

Objective To investigate the risk factors of low birth weight infants with food allergy.Methods Forty-nine food allergy children who had been admitted to the neonatal intensive care unit(NICU) of Peking University Third Hospital from Jan.1,2007 to Dec.31,2011 and followed up in the Pediatrics Allergy Clinic after discharged from hospital were involved as food allergy group.Forty-nine children who had been admitted to the NICU of Peking University Third Hospital at the same time and followed up in the Child Health Care Clinic after discharged from hospital but had no manifestations of food allergy were selected by stratified sampling as control group.A questionnaire was designed to record the children's gender,gestation age,mode of delivery,feeding patterns after discharging from hospital,tobacco and alcohol consumption of their parents,allergy history of their parents,the intake of egg of the mother during lactation and the children's introduction of egg.At the same time,their hospital notes were investigated.The diseases they had and the application of parental nutrition,pulmonary surfactant and ventilator were all analyzed.Quantitative data were analyzed with Chi-square,qualitative data were analyzed with t-test.The risk factors of food allergy of the low birth weight infants were examined by unconditional Logistic regression.Results The birth weight,gender,mode of delivery,feeding patterns after discharging from hospital,parents,exposure to tobacco smoke and alcohol,the intake of egg of the mother during lactation and the children's introduction of egg between the 2 groups were no significantly different.The diseases they got and the application of parental nutrition,pulmonary surfactant and ventilator when they in hospital were no significantly different,too.The gestation age,parental history of allergy between the 2 groups were significantly different.The proportion of children of 33-35 weeks and 36-37 weeks gestation age in food allergy group were significantly higher than those in control group,while the 29-32 weeks gestation age were significantly lower than those in control group (x2 =10.312,P =0.016 ;x2 =20.753,P =0.000).But by unconditional Logistic regression analysis,only the one or both parents,history of allergy was the risk factor for the development of food allergy of the low birth weight infants(OR =5.574,P =0.004;OR =14.487,P =0.000).Conclusion Parents history of allergy is related to the development of food allergy of the low birth weight infants.

Relationship between ACE gene insertion or deletion polymorphism and left ventricular mass in newborns admitted to the neonatal intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and left ventricular mass (LVM) in newborns admitted to the neonatal intensive care unit (NICU).</p><p><b>METHODS</b>Seventy-two newborns admitted to the NICU were enrolled. ACE genotypes were determined by genomic DNA which was isolated from heel-prick blood. Disease status of the newborns was evaluated by the Neonatal Critical Score (draft) on postnatal day 1. LVM and LVM index (LVMI) were evaluated by echocardiography on postnatal days 1-3.</p><p><b>RESULTS</b>DD genotype was identified in 11 cases, ID genotype in 31 cases, and II genotype in 30 cases. There were no significant differences in clinical characteristics, critical score and body measurements in newborns with different genotypes. The DD genotype group showed significantly lower LVMI than the group with ID+II genotypes (29±4 g/m2 vs 35±8 g/m2; P<0.05).</p><p><b>CONCLUSIONS</b>ACE gene polymorphism is associated with the LVMI in newborns admitted to the NICU. The LVMI of DD genotype carriers is significantly lower than that of ID+II genotypes carriers, which suggests that D allele may be associated with the growth and development of left ventricular.</p>

Relationship of the disease severity with ACE gene polymorphism and serum ACE activity in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the relationship of disease severity with angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and serum ACE activity in preterm infants during the first 7 days of life.</p><p><b>METHODS</b>ACE genotypes were determined in 85 preterm infants admitted to the neonatal intensive care unit (NICU). Serum ACE activity was measured and disease severity was evaluated by the Neonatal Critical Score (draft) 1, 3 and 7 days after birth.</p><p><b>RESULTS</b>Of the 85 preterm infants, DD genotype was found in 19 cases, ID genotype in 34 cases and II genotype in 32 cases. On the 1st day of life, serum ACE activity in the DD genotype (33.42+/-7.93 U/L) and the ID genotype groups (31.53+/-7.56 U/L) were significantly higher than that in the II genotype group (25.53+/-7.56 U/L) (P<0.01). After 3 and 7 days of life, serum ACE activity decreased in the three groups, but the DD genotype group remained the highest ACE activity, followed by the ID genotype and the II genotype groups. On the 1st day of life, the critical score of the DD genotype group (87.37+/-8.30) was lower than the ID genotype (95.82+/-5.85) and the II genotype groups (95.88+/-6.85) (P<0.01). On the 3rd day, the critical score of the DD genotype group was still lower than the ID genotype group (92.95+/-7.10 vs 96.94+/-5.85) (P<0.05).</p><p><b>CONCLUSIONS</b>ACE gene I/D polymorphism may be associated with the disease severity in preterm infants. The DD genotype carriers present more severe disease status, with higher serum ACE activity. Although the disease status can influence serum ACE activity, serum ACE activity is determined by the ACE genotype.</p>

Serum gastrin levels and clinical conditions in response to early minimal feeding in premature infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To study serum gastrin levels in response to early minimal feeding in premature infants and evaluate the clinical effect of early minimal feeding.</p><p><b>METHODS</b>Premature infants with critical score < or = 90 were randomly assigned into two groups: early minimal feeding group (n = 48), non-early minimal feeding group (n = 47). Other premature infants (n = 30) without any complications (critical score > 90) were assigned as normal control group. The premature infants in normal control group were fed with water at 6 h after birth, 1 - 2 ml/kg every time, after once or twice, they were fed with formula, increasing in the amount of formula gradually, until adequate. The premature infants in early minimal feeding group were fed with formula within 72 h after birth, 0.5 - 1 ml/kg, once every 3 h, the amount of formula was increased gradually, until adequate. The premature infants without early minimal feeding were not fed with formula until the illness was stable, the amount of formula was increased gradually until adequate. Situation of gastrointestinal feeding tolerance, growth and development, and clinical symptoms were observed and recorded for the three groups. Serum gastrin levels were monitored at 1, 3, 7 day after birth by radioimmunoassay.</p><p><b>RESULTS</b>Serum gastrin concentrations in the three groups elevated from 1 to 7 days. In early minimal feeding group [(82.4 +/- 24.5) ng/L] and non-early minimal feeding group [(87.0 +/- 40.2) ng/L], the concentrations were significantly higher than those in normal control group [(66.4 +/- 19.7) ng/L] at day 1 (F = 3.36, P < 0.05). At day 3 and 7, the concentrations in early minimal feeding group [(96.3 +/- 14.6) ng/L, (113.0 +/- 16.5) ng/L] were significantly higher than those in non-early minimal feeding group [(73.9 +/- 13.5) ng/L, (92.4 +/- 12.2) ng/L] (P < 0.05). There were significant differences among the three groups in infants with feeding intolerance (2/30, 5/48, 14/47), the period reached full enteral feeding [(20.6 +/- 5.7) d, (27.8 +/- 6.1) d, (39.5 +/- 4.7) d], and in number of hospital day [(29.0 +/- 4.6) d, (39.0 +/- 4.8) d, (48.0 +/- 5.6) d] (P < 0.05). There were significant differences between early minimal feeding group and non-early minimal feeding group in the weight gain three and four weeks after birth [(19.1 +/- 2.4) g/d, (11.9 +/- 3.3) g/d], the period reached birthweight [(19.8 +/- 4.2) d, (25.2 +/- 5.1) d] (P < 0.05). There were no significant difference among the three groups in the weight gain in one and two weeks after birth [(5.9 +/- 2.9) g/d vs. (5.0 +/- 2.1) g/d], the numbers of premature infants with infection, anemia, apnea, or hypoglycemia.</p><p><b>CONCLUSION</b>Early minimal feeding in premature infants leads to secretion of gastrin, promotes the development of gastrointestine and may not be associated with occurrence of complications.</p>

Analysis of risk factors for diarrhea in breast fed infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze possible risk factors for diarrhea in breast fed infants and provide evidences for prevention and treatment of diarrhea, reducing allergic and other diseases in infants and for renewing the definition of "physiological diarrhea".</p><p><b>METHODS</b>Totally 334 infants (207 boys and 127 girls, mean age 3.0 +/- 0.4 months) who were solely breast fed and seen between August 2004 and June 2006 at the outpatient clinic of the Department of Pediatrics, the 3rd Hospital of Peking University were enrolled in this study. The following information concerning parental and the infants' possible risk factors was obtained through a questionnaire that included parents' age, education, smoking, alcohol consumption, weight, height, maternal pregnancy weight, weight gain and health status during pregnancy and family history of hypersensitivity, family history of digestive tract disease, diet of mother in lactation, the infants' age, height, weight, head circumference, chest circumference, rash, eczema, diet, vomiting, abdominal distention, and blubber. The levels of PGE(2), fat and lactose in breast milk, serum allergen and skin prick test were performed in all the 334 infants. Logistic regression analysis was performed by using the software SPSS 10.0.</p><p><b>RESULTS</b>Maternal smoking (OR = 2.3), hypersensitivity (OR = 2.7), family history of hypersensitivity (OR = 2.8), diet of mother included seafood (OR = 1.8), egg (OR = 2.3) and peanut (OR = 2.0), infants' eczema (OR = 2.9), blubber (OR = 2.7), high level of PGE(2) (OR = 2.4) and fat in breast milk (OR = 3.0), serum allergen positive (OR = 4.0), positive skin prick test (OR = 2.7) were the risk factors for diarrhea in breast fed infants (P < 0.05).</p><p><b>CONCLUSIONS</b>Diarrhea in breast fed infants is not a simple physiologic process. It may be associated with many factors and the underlying mechanism remains to be clarified via further studies.</p>

Clinical Characteristics of Functional Constipation Relating to Food Allergy in Infants / 实用儿科临床杂志

Objective To analyze the clinical characteristics of infants with functional constipation(FC)relating to food allergy(FA)and explore its ways of diagnosis and therapy.Methods The detail clinical information of the patients who corresponded to the criteria of diagnosis of FC and FA simultaneous from Mar.2007 to Dec.2009 were reviewed and analyzed.There were 496 cases of FA,in the FA joint clinic,gastroenterology clinic and pediatric ward,56 cases of them had the symptoms of FC(56/496 cases,11%),diets free and amino acid-based formulae were the treatments of the patients.The 56 cases were analyzed with skin-prick test(SPT),serum special IgE and serum special IgG,and the risk factors attributed to the no response to treatments with Logistic regression.Results Fifty-six cases opened the bowel less than twice a week,and companied with pain,8 patients with soiling once a week at least,10 patients with fecal retention,4 patients with large fecal in rectum.Mother or father with the history of allergy were 22 cases,17 cases,separately,both of mother and father with the history of allergy were 17 cases.The results of SPT,serum special IgE and serum special IgG showed that the patients with different allergens,cow's milk,egg,cod,especially.The patients with FC relating to FA were breast-feed,battle-feed or mix-feed.Treatment relied on amino acid-based formulae,as well as elimination diets in infants,80%of them(45/56 cases)improved.Introducing solid foods,the age of upsetting constipation and premature were the risk factors contributed to the no response to the diet free treatment.Conclusion FA should be consi-dered to contribute to the infants presenting with FC.Diets free and amino acid-based formulae may be effective.