2015年 · 第53卷第02期

In the early 1950s, most children in pediatric departments of county-level hospitals in China were treated by physicians. With the rapid development of China's economy, the number of pediatric visits in hospitals at all levels has increased rapidly. Facing the rapid development of medicine, pediatricians have further developed into different sub-specialties. In 1985, the Pediatrics Branch of Chinese Medical Association established 10 professional groups including cardiovascular group for the first time. Relying on the establishment of the Cardiovascular Group of the Pediatric Branch of Chinese Medical Association, the pediatric cardiovascular specialty in China has developed rapidly and achieved remarkable results in the past 30 years.

immune is the Greek word for "immunity", which in medicine means "immunity from disease". As early as 2000 years ago, China used pox liquid for smallpox patients to prevent the spread of diseases, and started anti-infection immunity, which is also the prototype of classical immunology. The progress of modern molecular biology and genetic theory and technology has greatly promoted the development of basic immunology, and transformed the classical immunological concept of simple resistance to infection into modern immunological theory: "identify yourself and exclude dissidents", so as to maintain the stability of the internal environment of the body. Some disciplines related to basic immunology have also emerged, such as molecular immunology, genetic immunology, cellular immunology, comparative immunology and microbial immunology. Infectious immunity is the driving force for the early development of clinical immunology. In 1952, Broton, a US naval doctor, discovered the first case of congenital agammaglobulinemia, which started the research of children's immunology, and pediatricians became the pioneers of clinical immunology. In the next 10 years, immunological knowledge has penetrated many aspects of the field of pediatrics. In 1968, the first edition of Immune Diseases in Children and Infants, edited by Professor Stiehm of the University of California, Los Angeles, was published, which marked the formation of childhood immunology as a relatively independent sub-specialty^[1]。

Since the founding of the People's Republic of China 65 years ago, China has made great achievements in the control of serious infectious diseases in children. Two serious infectious diseases common to children, such as smallpox and polio, have been eliminated. Other infectious diseases such as measles, neonatal tetanus, epidemic cerebrospinal meningitis, Japanese encephalitis, typhoid fever, scarlet fever, dysentery, malaria, viral hepatitis, tuberculosis and leptospirosis have also been effectively controlled, and the mortality rate has been greatly reduced. These achievements have all benefited from the continuous investment and widespread promotion of the planned free immunization project by the state, and the construction and improvement of the medical and health and disease control system and team; It is also permeated with the hard work, wisdom and selfless dedication of Chinese pediatricians; At the same time, it is pregnant with the growth and expansion of Chinese pediatric infection specialty.

Children's health science is a comprehensive medical discipline based on preventive medicine and clinical medicine, which studies the law of children's growth and development, nutrition and health, early prevention and treatment of diseases, health management and other related to children's survival, protection and development. From the perspective of clinical medicine, the child health care specialty belongs to the third level of clinical medicine, and is one of the distinctive sub-specialties of pediatrics. From the perspective of preventive medicine, children's health care belongs to the secondary discipline of preventive medicine, and is one of the main disciplines of children's health and maternal and child health care. Although the tasks and priorities of the child health care profession are different under the clinical medicine and preventive medicine systems, the child health care profession under the clinical medicine system cooperates closely with the pediatric clinical sub-specialties, so it can better cooperate with pediatric clinicians to integrate the early prevention strategies of pediatric diseases into the daily work of child health care; However, the child health care profession under the prevention system has a strong public health background, so it plays an important role in the prevention and management system of child health care diseases. Although the task is focused, its purpose is to make children of different ages physically and mentally healthy and have good social adaptability by exploring the laws of children's growth and development, taking measures such as protection, enhancement and prevention. Children's health care profession in China has experienced changes and development in different historical periods, and its development track has very distinct characteristics of the times.

Compared with other specialties, pediatric critical care medicine in China started relatively late. In the early 1980s, the first batch of pediatric intensive care units (PICU) in China was established, and it has gone through more than 30 years. Under the organization and guidance of Chinese Medical Association, pediatric critical care medicine, as a new discipline, has made rapid development in quantity, scale, hardware facilities, diagnosis and treatment technology and the number of professionals. As the main practice places of pediatric acute and critical care medicine, PICU and emergency department have been relatively mature. They have set up their own professional groups in Chinese Medical Association and achieved a consolidated academic position.

Developmental-Behavioral pediatrics (DBP) is another branch of pediatrics which is gradually developed according to the medical model, that is, from the biomedical model to the biological-psychological-social model. Its academic core is the development and behavior of children, and it focuses on the diversity, developmental and behavioral problems and various disorders of children in the development process.

A 9-year-old male was admitted to the hospital mainly for "fever for 10 days and cough for 7 days". Fever occurred 10 days before admission, with a maximum body temperature of 39 ℃, and no cough or expectoration. Blood test routine showed: white blood cells 14.74×10⁹/L, neutrophil ratio 0.813. Body temperature gradually improved after oral cefadroxil treatment. High fever appeared again 7 days before admission, showing persistent fever, accompanied by headache, cough and cough of yellow phlegm. Reexamination of blood routine showed: white blood cells 7.52×10⁹/L, neutrophil ratio 0.556, oral cefixime for 2 days, cough and expectoration progressively aggravated, perfect chest X-ray examination showed: left hilum and left heart shadow visible patch blurred shadow, azithromycin intravenous drip treatment for 3 days, the child still had persistent high fever, severe cough symptoms, admitted to hospital for treatment. Previous health, denied history of exposure to tuberculosis patients.

Child male, 1 d, 36^＋4Week premature infant, prenatal mother's color ultrasound showed neck occupation, due to her mother's pregnancy complicated with severe preeclampsia, delivered by cesarean section in the First Affiliated Hospital of Zhengzhou University, birth weight: 2.81 kg. Apgar score: 9 points for 1, 5, and 10 min (1 point deducted for skin color). Amniotic fluid is clear, excessive, the amount is about 2 500 ml, and the placenta and umbilical cord are normal. After birth, he was admitted to hospital because of "weak crying and hoarseness". Physical examination at admission: Scattered needle-like bleeding spots were visible throughout the body, and the anterior chest wall, back and buttocks were concentrated and dense. Thorax normal, dyspnea, positive triple concave sign. His mother had no history of exposure to toxic substances, radiation, drugs, etc. during pregnancy, and there was no history of hereditary diseases and tumors in her family. Auxiliary examination: Platelets: 20×10⁹/L, blood routine showed severe decrease in thrombocytopenia; Prothrombin time (PT): 22.0 s, partially activated thrombin time (APTT): 84 s, fibrinogen measurement: 0.43 g/L, D-dimer: 6.62 mg/L, fibrinogen degradation product (FDP): 28.70 mg/L, hemagglutination test showed low fibrinogen, significantly increased fibrinogen degradation product and D-dimer; CT of head and neck showed that there was a mixed density soft tissue mass at the right thoracic entrance, the trachea was displaced to the contralateral side, and no enlarged lymph nodes were seen in the sheath of bilateral carotid arteries. Treatment: Continuous oxygen inhalation in the box after admission, the child crying low and hoarse, obvious dyspnea, positive three concave sign, percutaneous oxygen saturation fluctuation of 88% ~95%, after the consultation of throat and head and neck surgery, it is recommended to perform "right neck mass resection", give symptomatic and supportive treatment such as frozen plasma, platelet-raising drugs, low-dose hormones, and anti-infection, correct thrombocytopenia and abnormal coagulation function, and perform the above-mentioned surgical treatment. After the operation, continuous ventilator-assisted ventilation, the child has excessive sputum, frequent decline in heart rate and oxygen saturation, and repeated withdrawal failed. A smooth mass can be seen near the epiglottis under the visual laryngoscope, which cannot be excluded from the incomplete resection or re-growth of the tumor. Again, the consultation of throat surgery recommended tracheotomy. The family refused to finally transfer to the local children's hospital, and the local hospital performed fiberoptic bronchoscopy. Report: An uneven mass can be seen on the outer wall of the trachea about 1 cm below the glottis protruding into the lumen, which is easy to bleed when touched, accounting for about 2/3 of the lumen, and the length is about 2.0 cm. The lumen of the trachea under the tumor is normal. The family eventually gave up treatment and was lost to follow-up. Pathological examination: Short spindle cell tumor: Kaposi type hemangioendothelioma; Microscopic examination: The tumor tissue is lobular or nodular, and the tumor cells are short fusiform vascular endothelial cells with characteristic glomerular-like structure, and there are fissured or crescent-shaped vascular lumens at the edges (Figure 1)。 Immunohistochemical staining: CD31 (+), CD34 (+), FLi-1 (+), Vim (+); smooth muscle actin (SMA) (focus +), D2-40 (focus +), Ki-67 (30% +); cytokeratin (CK) (−), epithelial membrane antigen (EMA) (−), desmin (−), S-100 (−) (Figure 2)。 Clinical diagnosis: Kaposi's type hemangioendothelioma (KHE) with K-M phenomenon.

Podocytosis is a general term for a class of kidney diseases whose lesions mainly involve glomerular podocytes. 1995, Floege et al.^[1]The expression "podocyte disease" was used for the first time in the study of glomerulosclerosis in mice. Pollak^[2]A series of glomerular diseases involving podocyte injury were first referred to as Podocytopathies in 2002. The pathology is characterized by a decrease in the number of podocytes, morphological changes with foot process fusion as the main form, and changes in the expression of molecules that are structural proteins of podocytes. Primary podocytosis includes minimal lesion disease (MCD), focal segmental glomerulosclerosis (FSGS), idiopathic membranous nephropathy (IMN), etc., while secondary podocytosis is common in infection-associated, drug-associated, metal-drug-associated, autoimmune, tumor-associated, kidney transplant-associated membranous nephropathy, etc. Proteinuria is the most important and fundamental clinical feature of podocytosis, and it is also an important risk factor for the progression of the disease to end-stage renal disease and various cardiovascular events. The production of glomerular proteinuria is mainly related to the impairment of the integrity of the glomerular filtration barrier^[3]。 Podocytes and their ancillary structures are the key physiological basis for maintaining glomerular filtration function^[4,5]Any factor that can lead to changes in the structure and function of podocyte may cause the occurrence of podocytosis and even glomerular lesions, including hereditary, endogenous and exogenous damage factors^[6,7]。 Among the exogenous injury factors, the exploration of the mechanism and clinical significance of soluble urokinase-type plasminogen activator receptor (suPAR) in the occurrence and development of podocyte-related diseases has been a hot spot in the research of renal diseases recently.

Orthostatic tachycardia syndrome (POTS) is a type of orthostatic intolerance with a higher incidence in school-age children, higher in girls than in boys (male-female ratio 1:1.5)^[1]。 In daily life, children may have burnout, morning discomfort and other manifestations, which seriously affect their study and life. Its diagnostic criteria are to meet the following three items at the same time^[2]: (1) dizziness or vertigo, syncope, chest tightness, nausea, palpitations, headache, blurred vision, trembling hands, cold sweat and other erectile intolerance manifestations after erecting; (2) positive for upright test and/or upright tilt test (HUT); (3) Except other underlying diseases that can cause symptoms of autonomic nervous system. The pathogenesis of POTS is complex and has not been fully clarified at present. The treatment methods mainly include non-drug therapy and drug therapy. The former mainly refers to autonomic nerve function exercise therapy, which is simple, easy to implement, high safety and good flexibility. It has been used in clinical practice for a long time and is used as an adjuvant therapy. Recently, clinical and basic experiments have shown that autonomic dysfunction plays an important role in the pathogenesis of POTS in children^{[3,4,5,6,7,8]}。 This provides a good theoretical support for the feasibility of non-pharmacological therapy to treat POTS in children, and it is of great significance to improve the quality of life of children with POTS. This paper summarizes the research progress of autonomic function evaluation methods, exercise methods and curative effects in children with POTS.

Exclusive breastfeeding in the early stages of birth has been recognized as the most appropriate feeding method for infants. During the first six months of life, all nutrients provided by breast milk, except vitamin D, can meet the full nutritional needs of an infant, and breastfeeding using an on-demand, unrestricted, infant-led mode of feeding has been widely accepted^[1]。 There is substantial evidence-based support for the short-term benefits of exclusive breastfeeding in an on-demand, unrestricted, infant-led mode for infants and mothers, as well as the long-term health effects.

The 19th National Conference on Pediatric Cardiovascular Diseases was held in Hefei, Anhui Province from June 18 to 21, 2014. More than 300 pediatric experts, scholars and medical staff from all over the country gathered to exchange information on academic progress in the field of pediatric cardiovascular diseases. The conference received a total of 291 academic papers, including 63 speeches, held two special exchange meetings on congenital heart disease (CAD) and pulmonary hypertension, held a seminar on "Expert Consensus on Pediatric Pulmonary Hypertension", and invited 24 experts to give wonderful academic lectures.

Sponsored by the Nephrology Group of Pediatrics Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Pediatrics, and co-organized by the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Women and Children Medical Center and Guangzhou First People's Hospital, the 16th National Pediatric Nephrology Academic Conference was successfully held in Guangzhou from November 13th to 16th, 2014. The number of participants reached a new high, with 367 delegates from 29 provinces, municipalities and autonomous regions, including representatives from the Hong Kong Special Administrative Region.

The main objective of the prognostic study is to understand the various prognostic factors that affect the course and outcome of the disease, and to provide a basis for doctors to predict the outcome of patients and select appropriate interventions. Prognostic studies are also an effective means to verify the practical effects of interventions, treatment measures and clinical diagnosis and treatment guidelines. The long-term prognosis of patients after treatment was evaluated to analyze the relationship between treatment, disease condition and other factors and disease prognosis. For general prognostic studies, the general method is survival analysis.