2011年 · 第49卷第07期

The child was a 10-year-old male. He was diagnosed with type 1 diabetes for 4 years and was admitted in December 2008 due to systemic progressive edema for 1 week. Poor glycemic control 3 months prior to admission, denial of previous kidney disease history, denial of family history of nephropathy. His identical twin brother was diagnosed with type 1 diabetes for 7 years, and his urine routine and urinary microalbumin were normal. No family history of diabetes mellitus.

A 15-month-old male from Jinzhou, Liaoning Province, was admitted to hospital for "cough with intermittent fever for 18 days". 18 days ago, cough, voice cough, no phlegm, accompanied by fever, 38.7℃, intravenous infusion of cefuroxime in the local hospital for 5 days, erythromycin 2 days later, the fever subsided, cough still, 2 days before admission, fever again, 38.4℃, persisted, admitted to our hospital. There was no vomiting, no wheezing, no rash, poor diet and sleep, and normal stool. The child was the first birth, first birth, premature at 32 weeks, with a birth weight of 2.3 kg, normal postnatal, denied history of asphyxia, and was breastfed. Children can raise their heads at 4 months, turn over at 7 months, sit at 10 months, stand alone at 14 months, can't walk independently, can't call "Dad" or "Mom", usually extend their tongue outside their mouth, suck strongly, can't chew food. The mother was pregnant at 22 years old, the father was 24 years old, the mother was healthy during pregnancy, and there were no patients with mental retardation and developmental retardation in the family.

The child was a girl, 10 months old. The main reason is "backward development and weakness". He came to our hospital for treatment in October 2009. Since birth, the child is weak, weak, backward in intellectual and motor development, less voluntary activity, and little crying. Convulsions occurred at 9 months and were generalized attacks, occurring every 2 to 3 days. Local hospital suspected "cerebral palsy, epilepsy", performing functional training and anti-epilepticTreatment, the effect is not good, and the condition gradually worsens. He came to our hospital at the age of 10 months. The child eats less milk, sometimes choking milk, no obvious spitting milk, and normal urine and stool.

With the development of social economy and the improvement of living environment, the disease spectrum of children has changed greatly, and the incidence of non-infectious diseases has increased obviously, including inflammatory rheumatism. A series of "Suggestions on Diagnosis and Treatment of Common Rheumatic Diseases in Children" jointly organized by the Immunology Group of Pediatrics Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Pediatrics came into being, aiming at improving the overall level of diagnosis and treatment of children's rheumatic diseases in China and promoting the development of children's rheumatic diseases in China.

With the continuous progress of medical science, under the influence of the professional development of adult rheumatology, more and more domestic pediatricians began to pay attention to children's rheumatic diseases. Especially in the past 20 years, in clinical diagnosis, treatment and basic research, my country has made certain achievements in the field of childhood rheumatism, but there is still a gap compared with developed countries.

juvenile idiopathic arthritis (JIA) is a group of autoimmune diseases characterized by chronic arthritis with systemic involvement of multiple systems. It is one of the most common rheumatic immune diseases in children. In recent years, its incidence has increased at home and abroad, which not only seriously affects the physical and mental health of children, but also makes the family of children bear a heavy mental and economic burden. Although traditional drugs [such as non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, antirheumatic drugs (DMARDs), etc.] can alleviate the disease and control clinical symptoms of some children, there are still a considerable number of children who are ineffective or tolerant to the above drugs, and their disease cannot be controlled or even serious adverse reactions occur. With the recent deepening of research, the main pathogenic molecules of JIA have been continuously clarified, and the biological agents developed thereby have come out one by one. The short-term, medium-and long-term efficacy of JIA children has undergone revolutionary changes. The research progress of biologics in the treatment of JIA is reviewed. For a brief introduction of commonly used biologics, seeTable 1。

At present, 34 weeks ≤ gestational age (GA) in foreign countries<Preterm Infants at 37 weeks were considered a subpopulation of Preterm Infants, defined as near term/Late Preterm Infants (LPIs)^[1]。 Because "late preterm" better reflects the higher risk of complications in the near-term population, it is recommended to use "late preterm" instead of "near-term"^[2]。 Although the incidence of late premature infants is slight compared to miniature infants with a birth weight of 600 g, their large numbers constitute a huge medical burden^[3]。 Compared to term infants, late preterm infants constitute a distinct clinical population and earn more clinical attention. The epidemiological characteristics, feeding problems, main clinical risks and prevention and treatment strategies of late premature infants are summarized below.

A proteome refers to all proteins expressed in a cell, organ, or tissue, including all subtypes and post-translational variants. Proteomics is the dynamic process of studying the proteome, which has the dual characteristics of time and site. Differential display proteomics or comparative proteomics is one of the most effective methods in clinical research, that is, to compare the difference in protein expression and abundance in two states (such as normal and sick people, young and old people, before and after treatment, etc^[1]。

This issue of "Suggestions for the Diagnosis and Treatment of Systemic Lupus Erythematosus in Children" is the first published suggestion for the diagnosis and treatment of common rheumatic diseases in children. After half a year of literature retrieval, screening, reading, writing and other intense work, the writing team submitted the first draft at the "National Academic Conference on Pediatric Immunity" in Zhongshan, Guangdong Province in October 2010 to fully listen to the opinions of doctors at all levels; After that, a questionnaire was developed to solicit the opinions of all members of the immunology group of the Pediatrics Branch of Chinese Medical Association; After repeated discussion and revision, the manuscript was reviewed again by adult rheumatology experts in March 2011. Although this recommendation has been repeatedly revised and discussed, the following situations are drawn to readers' attention: ① There are few high-quality multi-center studies in the field of children's rheumatology (especially in China), and some evidences for diagnosis and treatment are adopted in adult literature. Improving the quality of clinical research is also the future direction of children's rheumatology in China; ② This recommendation is not a legal or regulatory document, and is not binding by laws and regulations. It is only applicable to the clinical diagnosis and treatment reference of pediatricians with certain experience in the diagnosis and treatment of children's rheumatism; ③ Children's rheumatism is complicated, and it is necessary to formulate an individualized diagnosis and treatment plan based on this suggestion according to the specific situation of the child.

The "2010 National Academic Conference on Pediatric Immunity" jointly organized by the Immunology Group of Pediatrics Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Pediatrics was held in Zhongshan City, Guangdong Province on October 28-30, 2010. The number of delegates from 30 provinces, municipalities and autonomous regions across the country reached 177, the highest number of delegates in any previous national pediatric immunization conference. The conference invited five international pediatric immunology experts to give keynote lectures, four heads of the writing group of evidence-based diagnosis and treatment recommendations for rheumatism reported on the progress of the writing work, and two professors reported on the results of the national multi-center collaborative research on primary immunodeficiency diseases. Forty-eight delegates spoke at the congress, focusing on the pathogenesis, diagnosis and treatment of primary immunodeficiency diseases (PID), allergies, infectious immunity and rheumatic diseases. The main contents of the session are presented in the following sub-themes.

In 1997, the U.S. Food and Drug Administration (FDA) introduced the pediatric exclusive clause, which stipulated that if pharmaceutical companies conduct pediatric drug research, they can get six months of market protection, that is, market exclusive rights. The European Union stipulates that the application for new drugs from 26 July 2008 and the application for new indications from 26 January 2009 must be submitted to the Pediatric Research Plan (PIP)^[1]。 In recent years, clinical trials of pediatric drugs have been developed rapidly abroad. Because the physiology, pathology, pharmacology and psychology of minors are quite different from those of adults, and minors of all ages present different characteristics, the research of pediatric drug clinical trials should follow the basic medical ethics principles of new drug clinical trials, namely, "the principle of autonomy, respect, benefit, no harm and justice"^[2]But also has its own special requirements, so it is particularly attached importance. In recent years, the research of pediatric drug clinical trials in China has increased year by year, but the characteristics of ethical review of pediatric drug clinical trials, especially the ethical review content, risk-benefit analysis, program design, informed consent, etc. suitable for Chinese characteristics are not standardized enough. Children are a special group of people, so the ethical review of pediatric drug clinical research needs to be more strict and standardized. In 2010, the Ministry of Science and Technology of China noticed this problem, and provided special funding for the clinical research of pediatric drugs and the standardization of its platform, reminding the government to pay attention to this problem. Now, with reference to relevant foreign experience, combined with China's characteristics and our experience, this paper analyzes the basic principles and methods of ethical review of pediatric drug clinical trial research, aiming at inspiring ideas and raising the active participation and attention of pediatric colleagues.