Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Home-Nebulized Inhaled Glucocorticoid Therapy in Pediatric Respiratory Diseases

Objective:To evaluate the therapeutic effect of home-nebulized inhaled glucocorticoid therapy in pediatric respiratory diseases.Methods:60 cases of children with respiratory diseases admitted between October 2022 and October 2023 were selected as study subjects and randomly divided into the control group and the observation group,30 cases each.The control group was provided with conventional treatment only,while the observation group was provided with home-nebulized inhalation glucocorticosteroid treatment,and the treatment effects,clinical symptom relief time,disease recurrence rate,and treatment satisfaction of the children’s families were recorded and compared between the two groups.Results:A comparison of the two groups in terms of gender and age showed that the differences were not statistically significant(P>0.05).In terms of clinical efficacy,the total effective rate of the observation group was 90.00%,which was significantly higher than that of the control group of 66.67%(P<0.05).Compared with the control group,the disappearance time of the clinical symptoms of the observed group was significantly shortened(P<0.05).In addition,the satisfaction scores of the families of the children in the observation group were significantly higher than those of the control group(P<0.05).Conclusion:Home-nebulized inhalation glucocorticoid therapy shows significant clinical efficacy in pediatric respiratory diseases,significantly reduces the time of disappearance of clinical symptoms,and improves the satisfaction of patients’families,which provides an effective treatment option for children.

Health Systems Strengthening to Tackle the Global Burden of Pediatric and Congenital Heart Disease: A Diagonal Approach

1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].

Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

Liver transplantation for pediatric inherited metabolic liver diseases

Liver transplantation(LT)remains the gold standard treatment for end stage liver disease in the pediatric population.For liver based metabolic disorders(LBMDs),the decision for LT is predicated on a different set of paradigms.With improved outcomes post-transplantation,LT is no longer merely life saving,but has the potential to also significantly improve quality of life.This review summarizes the clinical presentation,medical treatment and indications for LT for some of the common LBMDs.We also provide a practical update on the dilemmas and controversies surrounding the indications for transplantation,surgical considerations and prognosis and long terms outcomes for pediatric LT in LBMDs.Important progress has been made in understanding these diseases in recent years and with that we outline some of the new therapies that have emerged.

Pediatric multisystem inflammatory syndrome associated with COVID-19: Insights in pathogenesis and clinical management

The pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has been a major challenge to be faced in recent years.While adults suffered the highest morbidity and mortality rates of coronavirus disease 2019,children were thought to be exclusively asymptomatic or to present with mild conditions.However,around April 2020,there was an outbreak of a new clinical syndrome related to SARS-CoV-2 in children-multisystemic inflam-matory syndrome in children(MIS-C)-which comprises a severe and uncon-trolled hyperinflammatory response with multiorgan involvement.The Centers for Disease Control and Prevention considers a suspected case of MIS-C an individual aged<21 years presenting with fever,high inflammatory markers levels,and evidence of clinically severe illness,with multisystem(>2)organ involvement,no alternative plausible diagnoses,and positive for recent SARS-CoV-2 infection.Despite its severity,there are no definitive disease management guidelines for this condition.Conversely,the complex pathogenesis of MIS-C is still not completely understood,although it seems to rely upon immune dysregu-lation.Hence,in this study,we aim to bring together current evidence regarding the pathogenic mechanisms of MIS-C,clinical picture and management,in order to provide insights for clinical practice and implications for future research directions.

Efficacy of early treatment with infliximab in pediatric Crohn’s disease

AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn’s disease activity index score in each group at 12 and 24 mo. RESULTS: At the 1 year follow-up, the relapse ratee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B. CONCLUSION: Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.

Assessing disease activity using the pediatric Crohn’s disease activity index:Can we use subjective or objective parameters alone?

BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive assessment of disease activity,and how subgroups of subjective and objective items reflect change in disease state over time.METHODS Selective raw data from three prospectively collected datasets were combined,including 703 children with full PCDAI data at baseline,at 3-mo(Q1,n=670),and 1-year(Q4,n=474).Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.RESULTS Abdominal pain,well-being,weight,and stooling had the highest change scores over time.Objective indicators including albumin,abdominal exam,and height velocity followed.Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4(P<0.001 and P<0.05).Subjective and objective subgroups of items predicted less variance(18%and 22%)on total PCDAI scores at Q1 and Q4 compared to the full PCDAI,or a composite scale(both 32%)containing significant predictors.CONCLUSION Although subjective items on the PCDAI change the most over time,the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone.Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.

Comment on pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality

Since the first successful liver transplantation was performed five decades ago,pediatric liver transplantation has become the gold standard treatment choice for pediatric liver disease,including metabolic diseases,liver tumors,and some acute liver failure.With improvements in immunosuppression,surgical techniques,and postoperative medical care,long-term outcomes of patients after liver transplantation have markedly improved,especially in pediatric patients.

Effects of slanted bilateral lateral recession vs conventional bilateral lateral recession on convergence insufficiency intermittent exotropia:a prospective study

AIM:To observe the surgical effects of slanted bilateral lateral recession(S-BLR)versus conventional bilateral lateral recession(C-BLR)in convergence insufficiency intermittent exotropia(CI-IXT).METHODS:Using a randomized,double-blind,prospective design,22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included.Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery.All patients were followed up for 12mo.Near deviation,distant deviation,and neardistance difference(NDD)were measured in all patients.RESULTS:Twelve months after surgery,NDD improvement was 10(8,13)prismatic degrees(PD)in S-BLR group and 3(1,6)PD in C-BLR group(P=0.011).The near deviation of S-BLR group was 0(-2,2)PD,while that of C-BLR group was-4(-6,-3)PD(P=0.005).Before and after surgery,the difference in the distant deviation between the two groups was not statistically significant.There was no statistically significant difference in near stereopsis between the two groups(P=0.380)at 12mo.The success rate at 12mo after operation was 90.91%and 72.73%in the two groups(P=0.280).CONCLUSION:CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR,which indicates S-BLR is a safe and effective operation pattern.

The Development of Early Life Microbiota in Human Health and Disease

The colonization of the human microbiota in early life has long-lasting health implications.The status of the initial intestinal microbiota determines human growth and development from infancy to adulthood,and thus represents a crucial window in our long-term development.This review aims to summarize the latest findings on the symbiotic gut microbiota early in life and its vital role in metabolic-,allergic-,and auto-immune-disorder-related diseases,including obesity,diabetes,allergy,autism,inflammatory bowel disease,and stunting.It discusses the development process and various factors shaping the gut micro-biota,as well as the crosstalk between the gut microbiota and the host’s physiological systems(especially intestinal immune development and homeostasis,and the central nervous system in the course of neu-rodevelopment),during the early life establishment of the gut microbiota,in order to decipher the mech-anisms of diseases associated with the intestinal microbiome of early life.In addition,it examines microbiota-targeted therapeutic methods that show promising effects in treating these diseases.The true process of gut microbiome maturation,which depends on genetics,nutrition,and environmental factors,must be scrutinized in order to monitor healthy gut microbiome development and potentially correct unwanted courses by means of intervention via methods such as novel probiotics or fecal microbiota transplantation.

Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases

Background Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades,but its use has only recently been explored by pediatric rheumatologists.The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases.Data sources We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far,on the applications of ultrasound in juvenile idiopathic arthritis(JIA),systemic lupus erythematosus,dermatomyositis,enthesitis,Sjogren's syndrome,and other rheumatic diseases.In addition,articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed.Results In JIA,ultrasound can be used to detect subclinical synovitis,to improve the classification of patients in JIA subtypes,to capture early articular damage,to monitor treatment response,and to guide intraarticular injections.Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms,assessment of parotid gland pathology,and measurement of skin thickness and pathology.Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders.Conclusions Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders.However,standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.

Consensus for criteria of running a pediatric inflammatory bowel disease center using a modified Delphi approach

Background Good quality of care for inflammatory bowel disease(IBD)depends on high-standard management and facility in the IBD center.Yet,there are no clear measures or criteria for evaluating pediatric IBD(PIBD)center in China.The aim of this study was to develop a comprehensive set of quality indicators(QIs)for evaluating PIBD center in China.Methods A modified Delphi consensus-based approach was used to identify a set of QIs of structure,process,and outcomes for defining the criteria.The process included an exhaustive search using complementary approaches to identify potential QIs,and two web-based voting rounds to select the QIs defining the criteria for PIBD center.Results A total of 101 QIs(35 structures,48 processes and 18 outcomes)were included in this consensus.Structure QIs focused on the composition of multidisciplinary team,facilities and services that PIBD center should provide.Process QIs highlight core requirements in diagnosing,evaluating,treating PIBD,and disease follow-up.Outcome QIs mainly included criteria evaluating effectiveness of various interventions in PIBD centers.Conclusion The present Delphi consensus developed a set of main QIs that may be useful for managing a PIBD center.

Likelihood of hospitalization for a chronic respiratory condition following pediatric infection with enterovirus and rhinovirus strains

Background:Rhino-enteroviruses,particularly enterovirus strain D68(EV-D68),have been associated with severe respiratory distress in children.The goal of this study was to compare the long-term outcomes of children with EV-D68 infection to that of children with other enterovirus/rhinovirus.Methods:Nasopharyngeal swabs from 174 children presenting with respiratory distress were tested by PCR for respiratory viruses.The primary outcome was diagnosis of a chronic respiratory condition within the followup period.Admission to intensive care,and length of stay were recorded.Odds ratios were determined using multinomial logistic regression.Results:During 5 years of follow-up,the crude odds of diagnosis with a chronic respiratory condition were significantly more likely in EV-D68 cases(OR:1.95,95%CI:1.02,3.82),but failed to remain significant after adjusting for a past history of asthma.Upon admission for a primary concern of asthma,length of stay both in hospital and intensive care were significantly longer in EV-D68 cases(OR:2.10[95%CI:1.56,2.82,p<0.001])and(OR:5.18[95%CI:1.90,6.28,p<0.001]),respectively.After adjustment for a history of asthma,EV-D68 cases had significantly longer length of stay in hospital,admitted for 1.94 days for each day that controls were admitted(95%CI:1.40,2.68).In admissions to intensive care,EV-D68 cases spent 2.74 days for each day of admission in controls(95%CI:1.62,4.97,p<0.001).Conclusions:Ours is first study to assess prognostic respiratory outcomes of patients infected with EV-D68 in childhood.Our study finds that EV-D68 cases were significantly more likely be hospitalized for longer than other enterovirus/rhinovirus controls in subsequent admissions for respiratory distress.Need for intensive care was significantly longer in EV-D68 infections.Our next steps will be validation in a larger sample size.

A short history of Chinese Society of Pediatric Nephrology

It was not until 1970s that the subspecialty of pediatric nephrology was initiated on the foundation of general pediatrics in China. In 1977, Cooperation Group on Childhood Renal Diseases was organized by Prof. WANG Bao-lin （Beijing）, Prof. JIANG Xin-qiu （Nanjing） and Prof. GUO Yi-qing （Shanghai）, which was a milestone for pediatric nephrology in China.

The correlation between plasma cytokine levels in jaundice-free children with biliary atresia

Background:T helper(Th)cell cytokines modulate inflammation and play a role in biliary atresia(BA).The aim of the study is a cross-sectional assessment of the levels of Th cytokines in the jaundice-free post Kasai procedure patients.Methods:There were 40 jaundice-free patients with BA and 28 normal controls enrolled.Patients were divided into 3 groups,including normal liver function,impaired liver function,and portal hypertension.Plasma concentration of Th1[interferon-γ(INF-γ),interleukin(IL)-2],Th2(IL-4,IL-10),Th3[transforming growth factor-β1(TGF-β1)],Th17(IL-17)cytokines,and stromal cell-derived factor-1α(SDF-1α)were investigated.Results:The IFN-γ level was significantly higher in the BA patients with impaired liver function and portal hypertension than controls(P<0.0001 andP<0.0001,respectively).There was a signifi cantly increase of TGF-β1 in all BA groups compared with controls(P=0.003).The reduction of SDF-1αexpression was found in BA groups(P<0.0001).IL-10 levels significantly correlated with aspartate aminotransferase to platelet ratio index(r=0.496,P=0.001).For the cytokine correlations,there were no correlations of Th1,Th2 and Th17 cytokine with the other measured cytokines,but TGF-β1 was negatively correlated with SDF-1αlevels(r=-0.327,P=0.039).Conclusions:IFN-γand IL-10 are likely to be involved in the disease progression in BA.Besides,TGF-β1 is found to be a suppression marker associated with SDF-1αlevels and reduced production of TGF-β1 may be associated with the disease progression.