2018年 · 第56卷第12期

This issue of "Chinese Journal of Pediatrics" published two national multi-center collaborative research articles, one of which is the manuscript of the Children's Drug Use Professional Group of the Expert Committee on Rational Drug Use of the National Health and Family Planning Commission "2016 Survey on Rational Use of Antibacterial Drugs by Chinese Pediatricians" (hereinafter referred to as "Situation Survey")^[1]The other article is "Drug Resistance Change of Carbapenem-resistant Enterobacteriaceae Clinically Isolated in Children" (hereinafter referred to as "CRE Resistance Change") submitted by China Bacterial Resistance Monitoring Network (CHINET)^[2]。 The common feature of these two articles is that they carry out national multi-center and interdisciplinary collaboration on clinical hot issues, with a large amount of data, representation and statistical analysis. The conclusions are more objective, and forward-looking questions are left for readers to think about, practice and study. The article reveals two practical problems in the clinical use of pediatric antimicrobial drugs: doctors' cognition, attitude and practice of rational use of antimicrobial drugs and the severe status of bacterial resistance.

Medical treatises often have a conventional and fixed structure, which generally includes five parts: foreword, object and method, result, discussion and references. When conducting paper writing and reporting, it is necessary to report separately according to the above 5 sections. However, different types of medical research papers often have different detailed requirements when writing. These detailed requirements can standardize the report form of papers well, so that the papers can be more comprehensive and detailed to readers. Based on the aforementioned purpose, many different types of paper reporting specifications have been formed in the field of medical research, which are used to guide the writing of medical papers.

This guide is for the European Society of Pediatric Gastrointestinal Hepatology and Nutrition (the European Society of Paediatric Gastroenterology, Hepatology and Nutrition, ESPGHAN), the European Society for Clinical Nutrition and Metabolism (ESPEN), the European Society of Paediatric Research (ESPR) and the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) jointly revised the 2005 edition of the European Pediatric Parenteral Nutrition Guidelines, aiming to provide the latest basis for medical professionals in giving parenteral nutrition (PN) support to infants, children and adolescents.

Example 1Male, 6 years old, was admitted to Beijing Children's Hospital in September 2016 due to "fever and cough for 14 days, and right ventricular space was found to occupy for 3 days". The child developed fever 14 days ago, with a maximum of 38.5℃, accompanied by paroxysmal cough and phlegm. The local hospital gave "cefoperazone and sulbactam sodium combined with erythromycin and methylprednisolone" treatment for 5 days. The child's body temperature dropped to normal and the cough improved slightly. 3 days ago, echocardiography showed hyperechoic mass in the right ventricular cavity (suspected space occupation). There was no chest pain, dyspnea, limb pain and mobility impairment in the medical history. For a definite diagnosis, he was transferred to our hospital. The child was in good health in the past, and denied the history of heart, blood system, rheumatic diseases, malignant neoplastic diseases and family history, and denied the history of taking special drugs.

ChildFemale, 5 years old, was admitted to Qingdao University Affiliated Hospital in June 2017 due to "fatigue accompanied by excessive weight gain for 2 months and facial acne for more than 10 days". In the past 2 months, the child has developed fatigue, hyperappetite, weight gain of 3 kg, facial hairiness gradually appeared, shortness of breath after activity, and occasionally tremor in both hands. In the past 10 days, facial acne appeared and gradually increased. The outpatient clinic was admitted to the hospital with Cushing's syndrome (CS). The child was the first child of her mother, and was delivered by cesarean section at full term. He had no birth injury and asphyxia, and had normal growth and development in the past. He denied history of endocrine and metabolic diseases and infectious diseases, and was vaccinated according to the planned immunization program. The parents are in good health and deny similar medical history in the family.

The incidence of congenital heart disease in live births is about 1%, and it is one of the most common birth defects^[1]。 Congenital heart disease is related to the complex development of cardiovascular system in the embryonic period, and the development of embryo is affected by cell proliferation, migration, differentiation, apoptosis and interaction between cells. Polypeptide hormones are an important signaling molecule, especially endogenous polypeptides play an important role in life activities. It has been found that the small molecule hormone Elabela is one of the ligands of apelin receptor (Aplnr)^[2,3,4], has important physiological functions, such as regulating embryo and heart development, regulating cardiorenal function and participating in neuroendocrine signal transduction^[2,5,6,7,8]。 Elabela is expressed in early developing embryos and has an important effect on the migration of mesodermal cells and cardiovascular development^[9]。 This paper reviews the role of small molecule hormone Elabela in cardiovascular development from four aspects: its origin, basic properties, expression and effect on cardiovascular system, which is helpful for the in-depth study of Elabela and provides new strategies for the prevention, diagnosis and treatment of clinical congenital heart disease.

Intestinal microecology is the largest and most complex biological system of human body. It not only plays an important role in the establishment of gastrointestinal tract function, metabolism, formation and regulation of immune system, but also affects cranial nerves and behaviors. It has been found that mental illnesses such as autism spectrum disorder (ASD) are often accompanied by dysbiosis and gastrointestinal symptoms^[1]； Gastrointestinal diseases such as necrotizing enterocolitis (NEC), functional gastrointestinal disease (FGID), and inflammatory bowel disease (IBD) can be accompanied by neuropsychiatric symptoms or complicated by long-term nervous system damage^[2,3,4]。 These clinical phenomena suggest that there is a two-way information exchange network between the intestine and the brain. The brain can regulate the function of the gastrointestinal tract from top to bottom, while the intestine participates in the regulation of emotions and behaviors from bottom to top. Intestinal microorganisms play an important role in it. Accordingly, researchers put forward the concept of "microbiota-gut-brain axis" (MGBA). Compared with adults, children's gastrointestinal tract development is still immature, and many factors can affect the intestinal flora, leading to the occurrence of diseases. The role of MGBA in childhood diseases has also attracted increasing attention from the industry. The mechanism of the interaction between the intestine and the brain is not very clear, but may involve immune, endocrine, metabolic and neurological factors. This paper mainly reviews the interaction mechanism of MGBA and the relationship between MGBA and childhood diseases.