2017年 · 第55卷第06期

Type 2 diabetes refers to diabetes caused by insulin resistance and insufficient insulin secretion, or insufficient insulin secretion with or without insulin resistance. In recent years, the incidence of type 2 diabetes has been on the rise, and it has become one of the most challenging problems in the field of pediatric endocrinology in China in the 21st century. Adult endocrinology specialty in China has obtained high-quality research results on type 2 diabetes^[1,2,3]However, the research on type 2 diabetes in children and adolescents is very limited, the national epidemiological data is still blank, the evidence based on clinical research of evidence-based medicine is insufficient, and high-quality basic research is even more scarce. Therefore, we need to focus on and solve the following issues.

Childhood and adolescent obesity has become a serious global public health problem, followed by a sharp rise in the incidence of type 2 diabetes mellitus in children and adolescents^[1]。 According to the report of the International Diabetes Federation in 2015, the total number of diabetes and economic expenditure in the world are rising year by year, especially in developing countries, while China's rising rate ranks first in the world.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disease that reduces the production of reduced nicotinamide adenine dinucleotide phosphate (NADPH), a coenzyme of glutathione reductase, in the pentose phosphate pathway of erythrocytes due to the G6PD deficiency in erythrocyte membrane, which reduces the production of reduced glutathione, which maintains the stability of erythrocyte membrane, but cannot resist oxidative damage, and finally leads to erythrocyte destruction and hemolysis^[1]。 G6PD gene is located on the X chromosome, which is an X-linked genetic disease. Patients often suffer from eating faba beans, commonly known as "faba bean disease". Some severe patients can cause severe hyperbilirubinemia in the neonatal period, or induce non-immune hemolysis under certain conditions (oxidative stress, food or drugs), which is life-threatening. This disease focuses on prevention.

A 1-year-old and 11-month-old male was admitted to the Pediatric Hematology and Oncology Ward of Peking University First Hospital in June 2013 due to "intermittent fever with oral ulcer for 1 year and 6 months and left frontotemporal swelling for more than 10 days". From 5 months after birth, the child repeatedly developed high fever, gum redness and swelling, oral ulcer and submandibular lymph node swelling without inducement, and improved after antibiotic treatment. It occurred 1~2 times a month on average, and the absolute values of white blood cells and neutrophils were significantly reduced by multiple blood tests in local hospitals. More than 10 days ago, several symmetrically distributed blisters appeared on the head, face and bilateral external auditory canals of the child. Two days later, the blisters in the left frontal and temporal regions increased and gradually subsided. The child had fever again, body temperature as high as 39.4 ℃, accompanied by red and swollen gums and swollen lymph nodes in the neck. The local hospital gave a variety of antiviral and bacterial drugs successively, but there was no improvement. Blood routine showed white blood cells 3.0×10⁹/L, lymphocytes 0.45, neutrophils 0.06, hemoglobin 95 g/L, platelets 393×10¹²/L, absolute neutrophil value 0.17×10⁹/L. B-ultrasound and CT: Left frontal and temporal soft tissue infection. Parents deny consanguineous marriage and family history of similar diseases.

A 9-year-old male was admitted to the Second Xiangya Hospital of Central South University for treatment on May 17, 2016 due to "repeated rash for half a year, fever with shortness of breath for more than 20 days". Since the first half of the year of admission, the child repeatedly appeared red plaques and crusts on his limbs, without itching or tenderness. More than 20 days before admission, he developed fever, shortness of breath and edema of both lower limbs. The examination in an outside hospital revealed "multiple serous effusion". After symptomatic treatment such as anti-infection and diuresis, his condition improved and edema subsided, but he still had repeated fever, and his weight decreased significantly in the past six months. Nothing special in the past. Physical examination: body temperature 37.6 ℃, pulse 140 beats/min, breathing 30 beats/min, blood pressure 110/74 mmHg (1 mmHg =0.133 kPa), weight 24 kg, thin body shape, scattered plaques of different sizes in old and new stages can be seen on the limbs and buttocks, the maximum is about 2 cm ×2 cm, bright red, bruised or tan, and the fresh plaques have nodules under the skin when touched, with infiltration feeling, and a small amount of ulceration with exudate (Figure 1), superficial lymph nodes were unpalpable and enlarged, the respiratory sounds of both lungs were coarse, no rales were heard, the heart sounds were strong, the rhythm was uniform, the abdomen was swollen, the abdominal wall varices were visible, the liver was palpable 4 cm below the right costa and the spleen was palpable 6 cm below the left costa, homogeneous medium, blunt, no tenderness, and the abdominal mobile voices were positive.

congenital lung malformations (CLMs) are a group of congenital diseases with abnormal development of airways, lung parenchyma and pulmonary vessels, including congenital pulmonary airway malformation (CPAM), broncho-pulmonary sequestration (BPS), congenital high airway obstruction syndrome, bronchogenic cysts and congenital emphysema, among which CPAM is the most common and was previously called congenital cystic adenomatous malformation of the lung^[1]。 CLMs accounts for 5% to 18% of congenital developmental malformations, and the cumulative incidence is 30/100 000 to 42/100 000^[2], and the incidence showed a gradual upward trend^[1,3]。 Clinical manifestations of CLMs vary widely, with outcomes ranging from natural remission to death^[1]It may also develop pleuropulmonary blastomas (PPB) or bronchoalveolar carcinoma^[4]。 The development of imaging technology has improved the diagnosis level of CLMs, and the progress of surgery has also improved the prognosis of CLMs. However, the prenatal and postnatal management strategies of this disease are still controversial. The progress in diagnosis and treatment of CLMs is presented.

Hand, foot and mouth disease is a common infectious disease in children caused by various human enterovirus (EV) infections. It is usually a self-limiting disease, with fever, oral ulcer, and hand and foot herpes as the main symptoms. However, some patients will progress to severe hand, foot and mouth disease, which can develop serious complications such as aseptic meningitis, encephalitis, acute retarded paralysis, neurogenic pulmonary edema, and even lead to death. Enterovirus 71 (EV71) is the main pathogen of severe hand, foot and mouth disease, but its mechanism of causing severe hand, foot and mouth disease is still unclear. The research progress of EV71 exhibiting its pathogenicity by blocking the RIG-I-like receptors (RLRs) signaling pathway, thereby inhibiting the innate immune mechanism is reviewed below.

The eosinophil count in the peripheral blood of normal body was (0.05~0.50) ×10⁹/L, when the eosinophil count of the body is ≥0.5×10⁹/L or the manifestation of tissue infiltration is eosinophilia^[1]。 According to the absolute eosinophil count of peripheral blood, it can be divided into mild [(0.5~1.5) ×10⁹/L], moderate [(1.5-5) ×10⁹/L], severe (≥5×10⁹/L) increased^[2]。 Increased absolute eosinophil count is common in allergic reactions, parasitic infections, autoimmune diseases, malignant tumors, immunodeficiency diseases, etc. Some primary immunodeficiency diseases (PIDs) have increased eosinophilia. In the analysis of 88 hospitalized children with eosinophilia, primary immunodeficiency diseases accounted for 3.4%, and the absolute count of peripheral blood eosinophils increased moderately to severely^[3]。

The design of clinical research can be roughly divided into three core contents: top-level design, protocol selection and protocol detail design. In the choice of research design scheme, because the scheme to solve the same scientific problem is not unique, but the authenticity of conclusion and the difficulty of implementation are hugely different, often make researchers feel at a loss. Therefore, we should comprehensively consider the demand for authenticity of scientific problems and the actual ability of researchers to choose the scheme. Based on the existing methodological rules and previous research results, the scheme selection can start from the following three factors.

Professor Yu Wenliang, corresponding editorial board of the 15th editorial board of Chinese Journal of Pediatrics, chief physician of the Department of Emergency Medicine and Critical Care Medicine, Children's Hospital affiliated to Nanjing Medical University, and master's tutor, died in Nantong, Jiangsu Province on April 18, 2017 at the age of 53 due to illness.