2018年 · 第56卷第01期

Farewell to the old and welcome the new, 2017 is gradually drifting away in the busy figure of every pediatric medical colleague, and 2018 has arrived. Since its founding in 1950, Chinese Journal of Pediatrics has experienced 68 years. As an important academic journal in the field of pediatrics in China, we have always been committed to spreading innovative ideas, standardizing clinical practice, promoting academic exchanges, and making important contributions in promoting and exchanging innovative achievements in pediatrics, and leading the academic development of pediatrics. In 2017, this journal continued to win the honor of 100 Chinese Outstanding Academic Journals, the 4th Chinese Excellent Academic Journals, and one paper won the honor of "China's 100 Most Influential Domestic Academic Papers". In the past year, the Chinese Journal of Pediatrics published more than 20 review articles, and nearly 20 articles on clinical guidelines, expert consensus and clinical standards. Organized cross-professional topic selection, formulated relevant guidelines, conducted 6 lecture tours on national pediatric clinical guidelines, and organized 2 national academic conferences, which contributed to standardizing pediatric clinical practice and promoting academic exchanges. In the new year, we look forward to making better achievements and looking forward to more outstanding scientific research achievements with good innovation, strong scientific nature and high academic value being published in this journal, which will help the continuous development and innovation of pediatrics in China.

Cardiovascular diseases seriously affect children's physical and mental health. In recent years, with the joint efforts of pediatric cardiovascular colleagues, great progress has been made in the field of children's cardiovascular diseases. The research on the pathogenesis of cardiovascular diseases has been deepened, new diagnosis and treatment technologies have emerged and been further standardized and popularized, and the exploration and prevention of disease risk factors has been continuously improved. However, there is still a long way to go in the future clinical research in the field of pediatric cardiovascular.

syncope is a common emergency in childhood. vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the common causes of syncope in children, especially in school-age and adolescent children (accounting for 70% ~80%)^[1,2,3,4]。 Since the diagnostic guidelines for syncope in children in China were published in the Chinese Journal of Pediatrics in 2009^[1]The diagnostic efficiency of syncope in children in China has been significantly improved, but there is no unified consensus on the treatment of syncope in children in China. In recent years, the research results of the treatment of VVS and POTS in children in China have been recognized by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society. and the guidelines of the Canadian Cardiovascular Society and the Canadian Pediatric Cardiology Association^[5,6,7]。 In order to standardize the treatment of VVS and POTS in children, and further unify and improve the treatment level of syncope in children in China, the Cardiovascular Group of Pediatrics Branch of Chinese Medical Association, the Editorial Committee of Chinese Journal of Pediatrics, the Cardiovascular Group of Pediatrics Branch of Beijing Medical Association, the Children's Syncope Professional Committee of Pediatrics Branch of Chinese Medical Doctors Association, and the Children's Cardiovascular Professional Committee of Cardiovascular Physicians Branch of Chinese Medical Doctors Association jointly formulated this consensus.

vasovagal syncope (VVS) is an autonomic nerve-mediated syncope induced by the vagal nerve reflex; postural tachycardia syndrome (POTS) is a group of clinical syndromes characterized by orthostatic intolerance and significantly increased heart rate after orthostasis. As the most common cause of syncope in childhood, the diagnosis and treatment efficiency of VVS and POTS determines the diagnosis and treatment level of syncope in children. In recent years, the related research work of syncope in children in China has gained widespread international attention and recognition. The Chinese Journal of Pediatrics has successively published the "Diagnostic Guidelines for Syncope in Children" in China^[1,2]And "Expert Consensus on Treatment of Vasovagal Syncope and Orthostatic Tachycardia Syndrome in Children" (hereinafter referred to as "Consensus"), which is an important milestone in clinical and scientific research of syncope in children in China. The "consensus" is formulated according to the current guidelines for diagnosis and treatment of syncope at home and abroad and related research, reflecting the trend of individualized treatment. Now, the content of the "consensus" is further interpreted in order to better serve clinical work.

Example 1Male, 4 months old, was admitted to Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University mainly because of "cough and shortness of breath for 2 weeks". First birth, first birth, full term natural birth, birth weight 2.95 kg, no history of asphyxia, no special maternal pregnancy history. Both parents are in good health, unrelated marriage, and deny a history of genetic diseases in the family. Physical examination: slight nasal flapping, shortness of breath 70 beats/min, positive triple concave sign, coarse auscultation breathing sounds in both lungs, no moderate and fine wet rales and wheezing sounds, heart rate 152 beats/min, no murmur, soft abdomen, insufficient liver and spleen, normal muscle strength and muscle tone of limbs. Auxiliary examination: Chest CT revealed bilateral diffuse pulmonary lesions, mainly interstitial changes (Figure 1）。 Blood routine white blood cells 17.5×10⁹/L, absolute neutrophil value 2.27×10⁹/L, hemoglobin 116 g/L, C-reactive protein (CRP) 0.33 mg/L; Blood gas analysis pH 7.45, partial pressure of arterial blood carbon dioxide (PaCO₂) 40 mmHg (1 mmHg =0.133 kPa), arterial oxygen partial pressure (PaO₂) 48 mmHg; Organ function and coagulation function were normal; Humoral immune IgM 2.63-5.45 (reference range: 0.24-0.88) g/L, IgG 0.88-1.26 (reference range: 3.06-7.74) g/L, IgA 0.07-0.40 (reference range: 0.07-0.41) g/L; The peripheral blood lymphocyte count was in the normal range; Normal range of respiratory burst functional stimulation index (SI); Tuberculosis antibody was negative, fungal dextran, endotoxin and procalcitonin were normal, human immunodeficiency virus (HIV) antibody test was negative, tuberculin test (PPD) 72 h was negative, and throat swab and alveolar lavage fluid showed adenovirus DNA positive. Fungal findings in sputum and alveolar lavage fluid were negative. Alveolar lavage fluid smear and culture showed no abnormalities. Urinary metabolic profiling (GC/MS) showed no abnormalities; Cardiac color ultrasound and abdominal ultrasound showed no abnormalities. The gene sequencing of children and their parents is presented inFigure 2。

Female, 8 years old, was admitted to the Department of Pediatrics of the General Hospital of the Armed Police in October 2013 due to "abdominal pain with vomiting for 3 days". The child has no fever, fatigue, diarrhea, abdominal distension, can spontaneously exhaust and defecate, and there is no obvious weight loss in the past 3 months. No previous history of other diseases.

Female, 15 years old and 5 months old, came to the Department of Endocrinology, Genetics and Metabolism of the Children's Hospital affiliated to Suzhou University for absence of menstrual cramps and mental retardation. The child developed breast 2 years ago, but had no menstrual cramps, had a special face, was 156.9 cm tall, had a bone age of 14 years, and had a small uterus and ovaries. Now in junior high school, my academic performance is poor, I can communicate with people simply, but I am poor in words. Two years ago, I took a Wechsler intelligence test in a local hospital and my IQ was 36. The child had twice twitching of half limbs within 1 year of age, and once fainting before this admission, which can be relieved by itself. The child was the first birth of the mother, with a birth weight of 3.1 kg and no history of asphyxia rescue. 17-month-old can call mother, 26-month-old can walk, 4-year-old can talk, parents are in good health, non-close marriage, parents have normal intelligence, and have no family history of related diseases.

Female, 2 years and 6 months old, admitted to hospital with "intermittent foam urine for 1 year" as the main complaint. One year ago, the child was found to have foamy urine, and the urine routine showed positive urine glucose and negative urine protein; Blood glucose was normal and untreated until admission. The child was the first birth of the mother, and it was delivered naturally at full term. The mother has a smooth pregnancy period, with a birth weight of 3,000 g. She can raise her head at 4 months, sit at 6 months, stand up and call her parents at 10 months, and walk at 18 months. Intellectual development is like normal children of the same age. The parents are non-consanguineous marriage, and they deny similar medical history and genetic history in the family.

hepatitis B virus (HBV) is a hepatodna-trophic virus. The pathogenic mechanism of HBV is not fully understood. Commonly used antiviral drugs such as interferon and nucleoside analogues can inhibit virus replication, but they cannot cure most HBV infected patients^[1]。 It is estimated that there are about 350 to 400 million chronically infected people with HBV worldwide, and 500,000 to 1.2 million people die of HBV-related cirrhosis, primary liver cancer and other diseases every year^[2,3]。 The HBV genome contains four open reading frames (ORFs), namely pre-S/S, pre-C/C, X, and P, among which X gene is the smallest gene^[4,5], this gene encodes HBV X protein (HBx), a trans-activator of various viruses, cellular promoters and enhancers, whose transcriptional activity is required for HBV replication^[6]。 Understanding the interaction between virus and host can help to reveal the pathogenic mechanism of HBV infection and discover novel antiviral therapies.

heart arrest (HA) refers to a near-death state in which the pumping function of the heart suddenly stops, and the whole body blood circulation is immediately interrupted, which leads to respiratory arrest and loss of brain function. Immediate intervention is required, otherwise the patient will die in a short time. After decades of research and practice, the survival rate of HA patients is still low, and it is easy to leave neurological sequelae. Foreign research data show that the survival discharge rate of children with in-hospital cardiac arrest (IHCA) is about 40%^[1,2]While the survival discharge rate of out-of-hospital cardiac arrest (OHCA) patients is only about 10%^[3,4,5]The corresponding survival and discharge rate of domestic children is lower. As the most serious and complex pathological state, the guarantee of all links in the life chain is still the most basic resuscitation process of HA. Evaluating the relevant factors affecting the resuscitation effect can help to improve the resuscitation prognosis. Foreign studies have shown that systemic factors such as age, etiology and ventilation status may be correlated with the success of resuscitation in HA patients^[1,6]。 The study also suggests that there are differences in the etiology and success rate of HA treatment in children and adults^[3]。 Therefore, understanding the epidemiological characteristics of HA in children and exploring its regularity will help to identify and intervene in early clinical stage, and further improve the success rate of rescue in children. The epidemiological characteristics of HA in children at home and abroad are reviewed in order to improve the understanding of the etiology and prognostic factors of HA among clinicians.

obstructive sleep apnea syndrome (OSAS) refers to a series of pathophysiological changes caused by frequent partial or total upper airway obstruction during sleep, which disturbs normal ventilation and sleep structure of children^[1]Epidemiological data show that the incidence of OSAS in children is 1.5% to 5.7%^[2]。 The main clinical manifestations of OSAS are snoring at night, mouth breathing, holding breath, repeated awakening, and sleepiness during the day. Untimely treatment of OSAS may lead to an increase in the incidence of neurocognitive deficits, cardiovascular diseases and metabolic diseases^[3]。 Among them, vascular endothelial cell dysfunction, as an early manifestation of many cardiovascular diseases, has important clinical significance in disease prediction and early intervention. The research progress of the effect of OSAS on the function of vascular endothelial cells is reviewed.

The 6th National Academic Conference on Children's Syncope was held in Beijing on September 23, 2017. The conference was jointly sponsored by the Children's Syncope Professional Committee of Pediatricians Branch of Chinese Medical Doctors Association, the Children's Cardiovascular Professional Committee of Cardiovascular Physicians Branch, the Cardiovascular Group of Pediatrics Branch of Chinese Medical Association and its Functional Cardiovascular Disease Collaboration Group, the Cardiovascular Group of Pediatrics Branch of Beijing Medical Association, the Capital Institute of Pediatrics and the First Hospital of Peking University. More than 220 expert representatives attended the event. The meeting conducted in-depth exchanges around the pathogenesis, diagnosis and prevention of syncope in children.

A retrospective study of medical records refers to a type of clinical study conducted from the use of already collected data or databases as the basic data source. The data includes electronic medical records of hospitals, information reported by monitoring and data from other studies. With the popularization of hospital electronic information system, it becomes more convenient to use medical record information for clinical research. It only needs to read medical records from medical record department or derive relevant electronic medical record information to information center, and the cost of information use is low; Because of ethical concerns, certain prospective clinical studies cannot be conducted in children, and retrospective study of medical records is the best choice. The shortcomings of this kind of research are also obvious, such as incomplete retrieval of medical records, lack of important data in medical records, inaccurate information collection and low degree of information standardization, which may lead to more bias. In order to control selection bias and information bias, some requirements for the research implementation process are formed.