2015年 · 第53卷第07期

In July 1950, the Chinese Journal of Pediatrics was founded, and New China has its own high-level pediatric academic journal since then. Over the past 65 years, batches of pediatric experts and editors with noble medical ethics, exquisite medical skills and persistent pursuit of medical development have worked hard, united and cooperated, adhered to the academic orientation of the journal, and tracked the advanced academic level at home and abroad. It is their excellence, hard work and selfless dedication that make this journal play an important role in the clinical level, scientific research, international exchange and talent training of pediatrics in China. We would like to express our deep respect and gratitude to all the experts and editors who have made selfless contributions to the development of this magazine over the past 65 years.

In 2015, the Chinese Medical Association celebrated its centenary. As the fourth journal founded by the Chinese Medical Association and the first clinical medicine specialist journal in China, Chinese Journal of Pediatrics celebrated its 65th birthday on July 1, 2015.

Helicobacter pylori (Helicobacter pyloriHp) is a gram-negative, spiral, microaerobic bacterium, which is closely related to the occurrence of chronic gastritis, peptic ulcer, gastric cancer, and mucosa associated lymphoid tissue (MALT) lymphoma. Therefore, it was listed as a grade I carcinogen by the World Health Organization (WHO) in 1994. Children in developing countries are at high risk of Hp infection. Epidemiological data of adults show that most adult Hp infection is acquired in childhood. Once infected, it is rarely eradicated naturally. In severe cases, it can cause tissue malignancy^[1]。 Hp infection in children differs from adults in many aspects, such as infection rate, complication rate, age-related diagnostic methods, resistance rate of eradication therapeutic drugs, etc. Hp infection in children rarely causes malignant gastric lesions. Therefore, studies and consensus in adults do not fully apply to children. In view of this, in 2015, the Gastroenterology Group of the Pediatric Branch of the Chinese Medical Association and its Hp Collaborative Group, based on the guidelines for the diagnosis and treatment of Hp in children and adults at home and abroad, combined with the actual situation in China, and after many discussions and deliberations by the expert group, formulated the "Expert Consensus on the Diagnosis and Treatment of Helicobacter Pylori Infection in Children"^[2](abbreviated as "expert consensus"), in order to guide and standardize the clinical practice of pediatricians in China. The purpose of this "Expert Consensus" is to focus on three issues.

Helicobacter pylori (Helicobacter pyloriHp) infection is a common problem in pediatrics, which is closely related to chronic gastritis, peptic ulcer and other diseases in children. Due to the characteristics of children's own growth and development and drug metabolism, the guidelines for the diagnosis and treatment of adult Hp infection are not fully applicable to children. In order to standardize the diagnosis and treatment of Hp infection in children in China, an expert consensus on the diagnosis and treatment of Hp infection in children is specially formulated.

In 2008, the European Association of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Association of Pediatric Infectious Diseases (ESPID) published evidence-based guidelines aimed at helping healthcare workers at all levels in Europe, including primary care doctors, pediatricians and family doctors, to treat acute gastroenteritis (AGE) in children. This guideline has had a significant impact on the clinical diagnosis and treatment of gastroenteritis.

A 14-year-old male was admitted to hospital for "repeated abdominal pain and diarrhea for 1 week". One week before admission, the child had abdominal pain without obvious trigger, mainly around the umbilical cord, severe, paroxysmal, gradually aggravated, accompanied by diarrhea, watery stool, no mucus, pus and blood, large amount, 2 to 3 times/d, no nausea, vomiting, no abdominal distension, no fever, no rash, joint swelling and pain, no weight loss, visited the outpatient clinic of our hospital, blood test routine: white blood cells 14.32×10⁹/L, neutrophils 0.066, monocytes 0.026, eosinophils 0.337, red blood cells 6.02×10¹²/L, hemoglobin 170 g/L, platelets 368×10⁹/L. Urinary amylase was 4 386 U/L, blood amylase was 152 U/L, and blood lipase was 408 U/L. For further diagnosis and treatment, the outpatient clinic was admitted to the hospital with "acute pancreatitis". Past history, personal history and family history: No special, no history of drug and food allergy, and no history of special food intake before the onset of the disease.

Crohn's disease (CD) is a kind of inflammatory bowel disease (IBD). It is a chronic granulomatous inflammation. The lesions are transmural, mostly segmental and asymmetrically distributed, and can involve various parts of the gastrointestinal tract and extraintestinal organs, mainly in the terminal ileum and nearby colon. The main clinical manifestations are abdominal pain, diarrhea, fistula formation and anal lesions. The current incidence of CD among children worldwide is (2.5 to 11.4) /100 000^[1]With an estimated prevalence of 58/100 000^[2]And the number of cases of CD in children in China is also increasing year by year. In 2010, the Gastroenterology Group of the Pediatric Branch of the Chinese Medical Association published the expert consensus opinion on the diagnostic standards of IBD in children in China, and clarified the standards and contents of CD diagnosis^[3]。 In the treatment of CD, there are currently mainly nutritional support, drugs, surgery and psychotherapy. In view of the long-term and complex nature of CD drug treatment and medical management, there is no consensus or guidelines related to children's treatment in China. In October 2014, the European Organization for Crohn's Disease and Colitis (ECCO) and the European Association for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) jointly published the "Consensus on the Treatment of Crohn's Disease in Children"^[4](hereinafter referred to as the consensus). This consensus provides a good treatment reference for pediatric gastroenterologists. Now, the background, main points and characteristics of the consensus are interpreted.

Clostridium difficile is an anaerobic gram-positive bacillus, which is a conditional pathogen. When Clostridium difficile proliferates and releases toxins in large quantities, it can lead to Clostridium difficile infection (Clostridium difficileinfection, CDI). The main form of transmission of this bacterium is spores, which have strong resistance to a variety of antimicrobial drugs and disinfectants, and can be repeatedly infected with a recurrence rate of up to 20%. With the extensive use of broad spectrum antibiotics, the incidence of CDI is increasing worldwide, which gradually attracts the attention and attention of clinical medical workers. From 1998 to 2009, CDI hospitalizations in the United States increased four-fold from 25,200 to 110,600, as well as increases in severity and mortality. Although the reported CDI infection rate in Asia is much lower than the world average, the number of resistant strains of Clostridium difficile in clinical isolation has gradually increased in recent years, and the resistance genes of the corresponding antimicrobial drugs can be detected^[1]。 Therefore, the early diagnosis and early treatment of CDI should be paid enough attention. In this paper, the laboratory diagnosis, clinical diagnosis and detection of drug resistance genes of Clostridium difficile were reviewed.

dried blood spots (DBS) method is a convenient technique for collecting and transporting clinical blood samples. It not only ensures the biological stability of samples to be tested, but also facilitates storage and transportation. It is an effective tool for screening and diagnosis of rare genetic metabolic diseases. DBS has been used for neonatal screening for phenylketonuria as early as the 1960s^[1]。 In recent years, with the development of automated test technology, the application value of DBS in the diagnosis and screening of genetic and metabolic diseases has become increasingly prominent^[2]。 Gaucher's disease is a rare autosomal recessive metabolic disease with multiple organ involvement and progressive exacerbation, which can be life-threatening. The development of DBS technology has made great progress in the screening and diagnosis of Gaucher's disease. Many research centers have continuously optimized the methods, which has greatly improved the accuracy of clinical screening and diagnosis of Gaucher's disease. At present, many countries have carried out large-scale Gaucher's disease screening for newborns, which has greatly improved the treatment of Gaucher's disease. This paper reviews the screening and diagnosis of Gaucher disease carried out by DBS as a carrier, and provides reference for the screening of newborns and high-risk patients with Gaucher disease.

Retinopathy (ROP) is a serious complication of premature infants. Most patients have mild symptoms and do not need treatment. However, severe patients can cause retinal detachment and vision loss, and it is still an important factor of blindness in children worldwide. Findings from a multi-center study of 17 hospitals in 16 provinces, municipalities and autonomous regions in China^[1]The incidence of ROP was 15.84%; And the smaller the gestational age, the higher the incidence of ROP, and the gestational age<The overall incidence of ROP at 34 weeks was 19.17%. At present, there is no epidemiological data on the incidence and blindness rate of ROP based on population in China. With the development of neonatal medicine and the improvement of diagnosis and treatment level in neonatal intensive care unit, the survival rate of premature infants is increasing year by year, and ROP is still a refractory disease to be solved urgently^[1]。

Professor Duan Shucheng, female, born in March 1922 (died in 2007), is a native of Dingzhou City, Hebei Province. She is a member of the Communist Party of China, a graduate tutor, a famous expert in pediatric infectious diseases, diarrhea diseases and hepatology, and a pioneer in pediatric digestion in China. He once served as vice president of Pediatric Hospital affiliated to Fudan University, deputy director of pediatric teaching and research department and director of infectious diseases department.

Randomization is a frequently used grouping method in clinical studies. Its core idea is to assign the research subjects to the experimental group and the control group according to the principle of equal opportunity by random assignment method, and obtain two groups of research subjects with similar characteristics for clinical research. Many pediatricians are often troubled by some problems during research. For example, when evaluating the efficacy of two antibiotics in the treatment of pediatric pneumonia, factors such as different age composition and severity of the disease between the two groups may interfere with the evaluation of efficacy. Randomization made the age composition and disease severity of the children in the two groups very similar and balanced between the groups. Therefore, the results obtained by randomized controlled studies have good internal authenticity, can avoid the interference of potential confounding factors on the results, and are considered as high-quality clinical research protocols.