Journal of Clinical Pediatrics

Primary pediatrician instruction for the diagnosis and treatment of novel coronavirus infextion in children

CAO Ling, CHEN Qiang, CHEN Xing, et al

Journal of Clinical Pediatrics. 2020, 38(2): 81. doi:10.3969/j.issn.1000-3606.2020.02.001

Abstract ( 549 )

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Diagnostic value of the ratio of α1-microglobulin to microalbumin in acute interstitial nephritis

ZHANG Hongwen, LIU Xiaoyu, SU Baige, et al

Journal of Clinical Pediatrics. 2020, 38(2): 86. doi:10.3969/j.issn.1000-3606.2020.02.002

Abstract ( 522 )

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Objective　To explore the diagnostic value of the ratio of α1-microglobulin to microalbumin in acute interstitial nephritis. Methods　Data were collected from 12 childhood acute interstitial nephritis patients from Jan. 1, 2014 to Dec. 31, 2017. The ratio of α1-microglobulin to microalbumin, and urine protein electrophoresis were monitored and analyzed. Each 10 cases of Dent disease, nephrotic syndrome, IgA nephropathy, Henoch-Sch?nlein purpura nephritis, lupus nephritis and Alport syndrome were included at the same duration as control group. Results　In all the 12 cases, α1-microglobulin was increased apparently, the ratio of α1-microglobulin to microalbumin was much higher than 1, and was closely related to the percentage of low molecular weight protein in urine protein electrophoresis (P<0.05), the same as Dent disease, while the ratio was about zero in other glomerular disease groups. Conclusions　The ratio of α1-microglobulin to microalbumin, if over 1, can be used as a diagnostic criteria for tubuloproteinuria.

Congenital nephrogenic diabetes insipidus caused by AVPR2 gene mutation ：two cases report and literature review

Wang Chuankai，Wang Chunlin，Liang Li

Journal of Clinical Pediatrics. 2020, 38(2): 90. doi:10.3969/j.issn.1000-3606.2020.02.003

Abstract ( 487 )

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Objective　To analyze the clinical characteristics，genetic diagnosis and treatment of congenital nephrogenic diabetes insipidus (CNDI). Methods　Clinical data of two patients diagnosed as diabetes insipidus was retrospectively analyzed. The first patient was a five-year-old boy with a history of polydipsia and polyuria for three years and of growth retardation for half a year. The second patient was first admitted at the age of 3 years and 2 months old with a history of polydipsia and polyuria for two years. Fluid deprivation test and dDAVP intranasal test confirmed both patients had persistent low urine specific gravity. Then peripheral blood samples of two patients and their parents were collected, and genetic test for diabetes insipidus was performed. Two patients were both treated with hydrochlorothiazide combined with indomethacin and therapeutic effect was followed up one year later. Results　Depending on polydipsia, hyperuresis and results of fluid deprivation test and dDAVP intranasal test, CNDI was clinically confirmed. Gene sequencing found a novel c.650C>T hemizygous mutation in the exon 2 of AVPR2 of the first patient, and a novel large deletion included exon 1 and exon 2 region of AVPR2 gene in the patient 2. His mother was a mutation carrier, no mutation was found in his father. Both patients were treated with hydrochlorothiazide and indomethacin for one year. Then follow-up found urine volume and nocturia were reduced and no electrolyte disturbance and renal function damage in two patients. Conclusion　AVPR2 gene was a main disease-causing gene for CNDI. Two variants found in the both patients were not reported. Hydrochlorothiazide and indomethacin can relieve clinical symptom.

Renal cystic disease caused by hypokalemia: report of two cases and review of the literature

SU Baige, ZHANG Hongwen, Xu ke, et al

Journal of Clinical Pediatrics. 2020, 38(2): 94. doi:10.3969/j.issn.1000-3606.2020.02.004

Abstract ( 562 )

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　Objective　To explore the clinical features and pathogenesis of acquired renal cystic disease caused by chronic hypokalemia. Methods　Clinical data of two patients with childhood renal cystic disease were collected and analyzed, and related literatures were reviewed. Results　Male patient 1 aged 16 years old was diagnosed with Dent disease (type 1) and male patient 2 aged 14 years old, was diagnosed with renal tubular acidosis (type 1). They both presented with renal cystic diseases and chronic hypokalemia without regular treatment and follow-up. Patient 1 also presented with abnormal renal function and patient 2 presented with nephrocalcinosis. There was no evidence on other heredity renal cystic diseases. Conclusions　Renal cystic diseases can be caused by chronic hypokalemia in some conditions, which should be diagnosed in early stage, treated timely and followed-up regularly. Key

Alport syndrome in a family caused by an insertion mutation in COL4A5 gene

YE Qing, ZHANG Yingying, WANG Jingjing, et al

Journal of Clinical Pediatrics. 2020, 38(2): 97. doi:10.3969/j.issn.1000-3606.2020.02.005

Abstract ( 474 )

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Objective　To investigate the clinical characteristics and related pathogenic genes of Alport syndrome. Methods　The clinical data of an Alport syndrome family were retrospectively analysed. Results　A TTCT insertion mutation (c.41_42 dup TCTT) lead to reading frame disturbance was identified in the COL4A5 gene of the proband, an 11 years and 8 months old male. Integrative Genomics Viewer software found that the frameshift mutation lead to the preterm stop codon at 40th amino acid residue and termination of protein translation. The proband's mother (II5) and grandmother (I2) both carried the mutant gene and had end-stage renal disease at the age of 35 and 34, respectively. Both of them had hearing impairment with no ocular abnormalities, which showed a co-segregation association with the affected members of the families. Conclusions　This study provides evidence of molecular genetics for the clinical diagnosis of this family and expands the mutation spectrum of COL4A5 gene.

Analysis of a novel mutation of COL4A5 gene in a child with Alport syndrome

JIA Shilei, GAO Xiaojie, MA Yijiao, et al

Journal of Clinical Pediatrics. 2020, 38(2): 101. doi:10.3969/j.issn.1000-3606.2020.02.006

Abstract ( 1362 )

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Objective　To analyze the genotype and clinical characteristics of Alport syndrome in children. Methods Clinical manifestation and genetic test results of 1 Chinese boy with Alport syndrome were retrospectively analyzed. Results The 11-year-old male patient presented with unexplained hematuria and proteinuria with mild renal dysfunction 4 years ago and progressed to the uremia stage of chronic kidney disease due to poor treatment compliance. There was no high-frequency hearing impairment and ocular fundus pathology. Renal biopsy showed chronic sclerosing glomerular disease and diffuse tubular atrophy (atrophy area over 80%). Immunofluorescence staining of basement membrane of alpha 3 and alpha 5 (IV) were positive. Gene sequencing identified a hemizygous mutation of c.2631dupA (insertion) in COL4A5 gene, resulted in amino acid changes of p.G878Rfs*20 (prematurely termination of protein translation after 20 amino acids). It was identified as a de novo mutation. According to ACMG guidelines. This variant is classified as pathogenic. It has not been reported in the HGMDpro database. Conclusion　Gene sequencing is helpful for the diagnosis of Alport syndrome and the discovery of novel variant of COL4A5 gene.

Risk factors of neonatal purulent meningitis complicated with white matter damage

WANG Hairu，QIN Zijian，WANG Bin, et al

Journal of Clinical Pediatrics. 2020, 38(2): 104. doi:10.3969/j.issn.1000-3606.2020.02.007

Abstract ( 405 )

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Objective　To investigate the clinical features and risk factors of white matter damage (WMD) in neonatal purulent meningitis. Methods　A total of 170 cased of full-term neonates with purulent meningitis hospitalized in the NICU between January 2008 to January 2018 were retrospectively enrolled in the study. Clinical data were retrospectively analyzed by univariate and logistic multivariate regression analysis. Results　Of the 170 full-term neonates enrolled, 32 cases were combined with WMD (case group), and the remaining 138 cases were concurrent with no WMD (control group). There were 17 cases of WMD had a confirmed bacterial etiology, and the most common of which are Group B beta-hemolytic streptococcus (GBS) (n=6) and Escherichia coli (n=4). There was no significant difference between Gram positive cocci and Gram negative bacilli in concurrent WMD (P < 0.05). There were significant differences between GBS and Burkholderia cepacia in concurrent WMD (P < 0.05). A total of 8 cases (25%) had EEG abnormalities in neonates with WMD, and 16 cases (50%) had hearing impairment. The incidence of EEG abnormalities and hearing impairment increased significantly (P<0.01). The univariate analysis showed the factors related with WMD were as follows: convulsion, altered level of consciousness, bulging fontanel, CRP＞100 mg/L, Cerebrospinal fluid composition change (CSF-WBC＞ 500×106/L、CSF-LDH＞300 U/L、CSF-Pro＞2.0 g/L，CSF-Glu＜1.1 mmol/L) and positive bacterial culture (all P<0.05). According to the logistic multivariate regression analysis, convulsion (OR=5.284), CSF-WBC (OR=4.218) ), CSF-LDH (OR=3.634), positive bacterial culture (OR=3.123) were high risk factors for WMD in neonatal purulent meningitis. ROC curve analysis showed that CSF-WBC, CSF-LDH were effective predictors for WMD, with the area under ROC curve were 0.707, 0.672, respectively. Conclusion　Neonatal purulent meningitis complicated with severe manifestations, and prematurity and abnormal laboratory indicators were high risk factors for WMD, which should be highly vigilant in clinical practice, and active treatment should be given.

Clinical features of HPRT-related neurological dysfunction and genetic analysis

ZHAO Peiwei, BI Bo, TAN Li, et al

Journal of Clinical Pediatrics. 2020, 38(2): 110. doi:10.3969/j.issn.1000-3606.2020.02.008

Abstract ( 381 )

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　Objective　To investigate the clinical features and gene mutation of a patient diagnosed with HPRT-related neurological dysfunction (HRND). Method　Genetic analysis of this patient was performed using whole exome sequencing, Sanger sequencing was used to verify the results, and literatures about clinical features of HRND with similar genotype were reviewed. Effect of mutation on RNA splicing was investigated. Results　The patient was a 3 years 4 months old boy with global developmental delay, presented with limited extremities, low muscle strength, partially weighed legs and valgus feet. Hypermyotonia and frequent involuntary movements were observed in the patient during activity and emotional stress. Uric acid increased significantly (1404.7 μmol/L), and Y trace protein also increased (1.64 mg/L). The level of lactate dehydrogenase was 539U/L and its isozyme (LD1) 84U/L (15-65 U/L). EEG, EMG and CT/MRI results were normal. We found a c.319-2A>T hemizygous mutation in HPRT1 gene inherited from his mother. This mutation affects RNA processing by producing a transcript with exon3 skipping. Conclusion　The splice site mutation (c.319-2A>T) of HPRT1 is the genetic cause of HRND in this patient, and WES technology can assist clinical diagnosis.

Clinical and genotypic analysis of a patient with limb-girdle muscular dystrophy type 2D

XU Min, GUO Hu, GAO Xiucheng, et al

Journal of Clinical Pediatrics. 2020, 38(2): 113. doi:10.3969/j.issn.1000-3606.2020.02.009

Abstract ( 394 )

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Objective　To improve the understanding of the clinical and genotypic characteristics of limb-girdle muscular dystrophy type 2D (LGMD2D). Methods　The clinical manifestations, laboratory tests, electromyography, muscle MRI and genetic test results of a patient with LGMD2D were retrospectively analyzed, and the related literature were reviewed. Results The patient was a 5 years and 7 months old male, who presented with progressive muscle weakness, gastrocnemius hypertrophy, Gower sign positive, phosphocreatine kinase 20602 U/L, electromyography showed myogenic damage, muscle MRI showed a high signal of double lower limb subcutaneous fat layer and the muscles on the fat suppressed sequence, and the muscles were more obvious. The MLPA result of Duchenne muscular dystrophy (DMD) gene test was negative, and the whole exom sequencing showed a homozygous c.234-235AC>GA mutation in exon 3 of SGCA gene which has not been reported. According to ACMG rating, this variant was pathogenic, and his parents were all heterozygous carriers. The patient was diagnosed as LGMD2D. Conclusion　SGCA c.234-235AC>GA variation may be a novel pathogenic mutation in LGMD2D. For children with clinically suspected muscular dystrophy and significantly increased muscle enzyme, in addition to DMD, we should also pay attention to the LGMD2D.

Clinical and genetic analysis of a patient with Joubert syndrome caused by MKS1 gene mutation

ZHANG Guangyu, LI Sansong, Yang Lei, et al

Journal of Clinical Pediatrics. 2020, 38(2): 116. doi:10.3969/j.issn.1000-3606.2020.02.010

Abstract ( 457 )

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　Objective　To investigate the clinical and genetic data of a pedigree clinically diagnosed as Joubert syndrome. Method　Clinical data of a patient diagnosed as Joubert syndrome in 2017 was retrospectively analyzed. Whole exome sequencing and sanger sequencing were used to find the causative genes. Results　The 3 months old boy displayed eye movement abnormalities, developmental delay and hypotonia in the four limbs. Cranial MRI showed “molar tooth sign”. The gene sequencing identified a frameshift mutation of c.1411_c.1412insG inherited from his father and a novel missense mutation of c.44A>G in MKS1 gene inherited from his mother. Conclusion　The child has typical clinical features of Joubert syndrome. With Combination of clinical features and gene sequencing, the child was diagnosed as Joubert syndrome.

Clinical and genetic analysis of two patients with pyruvate kinase deficiency caused by PKLR gene 　mutation

Qiu Ju, Cheng Shouchao

Journal of Clinical Pediatrics. 2020, 38(2): 120. doi:10.3969/j.issn.1000-3606.2020.02.011

Abstract ( 358 )

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　Objective　To investigate the clinical features of two patients diagnosed with pyruvate kinase deficiency caused by PKLR gene mutation. Method　Clinical data of the patients was retrospectively analyzed. Genetic test was performed using the whole exome sequencing (WES), and Sanger sequencing was used to verify the results. Related literatures on clinical and genetic features of pyruvate kinase deficiency were reviewed. Results　Two female patients with three years and eight months old respectively, suffered from a sallow complexion for three years were recruited in this study. The clinical manifestations of the children were moderate anemia, yellow sclera and low hemoglobin levels (all below 60g/L) as indicated by routine blood tests. Compound heterozygous mutations of c.106G>T inherited from her mother and c.817C>T inherited from her father in PKLR gene were found by the whole exome sequence, and two heterozygous mutations of c.1279G>T inherited from her mother and IVS6-1G>T inherited from her father IVS6-1G>Tin PKLR gene were found in patient 2. In silico analysis showed that mutation may affect protein function, and IVS6-1G>T mutation may affect splicing. Conclusion　The mutations of PKLR gene is the pathogenesis of two PKD families. Genetic test could help diagnosis in patients with PKD.

Long-term follow-up of different treatment on complete left bundle branch block after closure of perimembranous ventricular septal defect in children

CHEN Yiwei, ZHAO Wenchuo, WANG Shunmin, et al

Journal of Clinical Pediatrics. 2020, 38(2): 123. doi:10.3969/j.issn.1000-3606.2020.02.012

Abstract ( 436 )

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Objectives　To investigate different treatments and prognosis on complete left bundle branch block (CLBBB) in children after closure of perimembranous ventricular septal defect (VSD). Method　Eighteen cases with CLBBB after perimembranous VSD intervention diagnosed from February 2009 to June 2019 were enrolled in this study. The patients were divided into 4 groups according to different treatments such as close follow-up, glucocorticoid treatment, removing closure device and CRT treatment. The follow-up results including clinical signs and symptoms, chest radiography, electrocardiogram (ECG), echocardiography (ECHO) and type B natriuretic peptide (BNP) were analyzed. Results　A total of 8 patients accept close follow-up for 5 to 10 years without any symptoms or signs, showed normal cardiac function (NYHA I) and normal left ventricular ejection fraction (LVEF) by ECHO. The left ventricular end-diastolic diameter (LVDD) were larger according to references. There were 4 cases suffered CLBBB on 1 to 4 days after intervention. They recovered after accepting glucocorticoid treatment for 1 week. The ECG, ECHO and BNP tests were normal after 6 month. There were 2 cases admitted to remove the closure device and accepted surgical repair. The first case accepted surgery after 6 months of intervention. The ECG after postoperative 1 week showed complete right bundle branch block until now. The other observation target including ECHO and BNP were normal after one-year follow-up. Another case accepted surgery 7 years after intervention, but complete atrioventricular block occurred after surgery and not recovered 1 week later. The patient accepted double chamber pacemaker implantation and showed normal cardiac function excepting the enlarged LVDD after 1 year follow up. There were 4 cases with heart failure accepted standard medicine therapy for at least six months and had no obvious improvement. Three (3) of them accepted CRT implantation, another case accepted permanent pacemaker implantation (left atrial sensing, left ventricular pacing) for personal reasons. The QRS wave was shorter than 150 millisecond after surgery. One (1) patient accepted CRT implantation died after 3 days because of acute heart failure. The cardiac function was significantly improved and LVEF were increased at least 45% in other 3 patients after one- or two-years medicinal therapy, and The LVDD and BNP were decreased significantly compared with the data before implantation. Conclusions　CLBBB would be occur after VSD intervention which will lead to desynchronization of ventricular contractions and heart failure. For the patients suffered CLBBB early after intervention, the glucocorticoid treatment may be useful. Another choice is to remove the device, but it would lead to complete atrioventricular block. CRT implantation is an alternative treatment for patients with heart failure.

Ultrasonographic diagnosis of 42 children with congenital heart disease complicated with infectious 　endocarditis

FU Xingpeng, YE Jingjing, YU Jin, et al

Journal of Clinical Pediatrics. 2020, 38(2): 129. doi:10.3969/j.issn.1000-3606.2020.02.013

Abstract ( 282 )

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Objective To evaluate the value of echocardiography in the diagnosis of congenital heart disease (CHD) complicated with infective endocarditis (IE). Methods　The clinical data of CHD children with IE diagnosed in hospital from January 2009 to July 2018 were retrospectively analyzed. Results　A total of 42 CHD children (20 males and 22 females) complicated with IE were enrolled. The median age of the children was 7 years and 1 month. Among them 17 (40.5%) were the school-age children, followed by 15 infants (35.7%). Twenty-seven (27) cases were preoperative, CHD including 19 cases of leftto-right high-speed shunt CHD (70.4%) and 15 cases of post-operative CHD. The main types of CHD were ventricular septal defect in 19 cases (45.2%) and complex CHD in 10 cases (23.8%). The clinical manifestations were fever in 37 cases (88.1%) and positive blood culture in 18 cases (43.9%). Ultrasound showed that there were 24 cases of vegetations, 16 cases (38.1%) before operation, 8 cases (19.0%) after operation, and 1 case of left endocardial thickening with echo enhancement before operation. The total positive rate was 59.5%. A total of 38 vegetations were found, most commonly located at the valve 22. In the preoperative group, 11 patients received surgical treatment, and 10 patients were confirmed with vegetations (another 1 patient was examined with vegetations continuously shrinking before surgery), 5 cases (45.5%) of valve-related injuries were found during operation. The remaining 3 cases were transferred to another hospital for further treatment, but 2 cases did not recover. In postoperative group, 5 cases were found to have reduced or disappeared vegetations, 2 cases were transferred to another hospital for further treatment and 1 case was not cured. Among the complications associated with ultrasound, 3 patients had pericardial effusion and 1 patient had peripheral vascular embolization, before operation. 16 children with clinical vegetation were treated effectively, and 15 children with no vegetation were treated effectively, the total effective treatment rate was 73.8%. Conclusion　Ultrasound can provide an effective basis for the diagnosis of children with CHD complicated with IE. It can also provide great clinical value in assessing the development of the disease and prognosis.

Analysis of clinical characteristics of children with severe pertussis in Chongqing

Zhang Guangli, Tian Xiaoyin, Gu Ruixue, et al

Journal of Clinical Pediatrics. 2020, 38(2): 134. doi:10.3969/j.issn.1000-3606.2020.02.014

Abstract ( 382 )

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Objective　To investigate the clinical features of children with severe pertussis in Chongqing. Methods Clinical characteristics of 72 cases of severe pertussis admitted to the Children's Hospital of Chongqing Medical University from January 2013 to June 2018 were retrospectively analyzed. Results　Children under 6 months old had a higher incidence. Severe pertussis was distributed throughout the year and more common in winter and spring. Sixty-two cases (86.1%) were not vaccinated with DTP. Thirty-three cases (45.8%) with underlying diseases were more common with malnutrition (51.5%) and congenital heart disease (39.4%). There were 65 cases (87.5%) of leukocytosis. Respiratory complications were more common in respiratory failure (93.1%) and severe pneumonia (84.7%). Extrapulmonary complications were mainly cardiac insufficiency (18.1%) and pertussis encephalopathy (18.1%). Sixty-three cases (87.5%) had leukocytosis. Common respiratory complications were respiratory failure (93.1%) and severe pneumonia (84.7%). Extrapulmonary complications were cardiac insufficiency (18.1%) and pertussis encephalopathy (18.1%). Fifty-two (72.2%) children were infected with pathogens, and 39 (75.0%) were in winter and spring. The virus of community acquired infection was mainly RSV (72.4%); the first bacterial pathogen was Klebsiella pneumoniae (23.9%), and the major nosocomial bacterial pathogen was Klebsiella pneumoniae pneumonia and Acinetobacter baumannii. Twenty-nine cases (40.3%) had viral infection and the predominant virus was RSV. Fourty-six cases (63.9%) had bacteria infection. The main bacteria infection was Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. With anti-infection, respiration, circulatory support and symptomatic treatment, 20 cases (27.7%) died. Comparative analysis showed that the WBC peak and incidence of hypoglycemia were significantly higher in the death group than that in the survival group (56.13±36.97 vs 31.56±22.16, P<0.05; 5.8% vs 30%, P<0.05, respectively). The ROC curves of peak WBC for predicting death of severe pertussis was drawn. It was found that peak WBC>36.58×109/L was of high value in predicting death of severe pertussis. The predicted sensitivity and specificity were 0.700 and 0.712, respectively, and the corresponding AUC=0.701. Conclusions　Severe pertussis in Chongqing mostly attacked infants without DTP vaccination. They were always combined with Klebsiella pneumoniae infection, nosocomial Acinetobacter baumannii infection or community RSV infection. Moreover, the cases which have hypoglycemia and those WBC peak > 36.58 × 109/L are prone to death.

Clinical value of different assessment tools in disease assessment of juvenile dermatomyositis

XUE Ru, LU Yanming

Journal of Clinical Pediatrics. 2020, 38(2): 140. doi:10.3969/j.issn.1000-3606.2020.02.015

Abstract ( 354 )

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　Objective　To investigate clinical application values of different assessment tools in evaluating the activity and severity of juvenile dermatomyositis (JDM). Methods: Clinical data of children diagnosed with JDM in Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2008 and September 2018 were collected, MDAAT (myositis disease activity assessment tool)/DAS (disease activity score)/CMAS (childhood myositis assessment scale) were performed to assess disease activity of JDM patients on the first day and after 24 - 48 h when they were in hospital. Results　Of these 35 JDM children, 2 with JPM, 4 with CADM, 29 with JDM, 15 children were male, and 20 were female, the female to male ratio was 1.33:1, and the average age at disease onset was 3.16±1.45 years, the elevation of serum levels of muscle enzymes at the disease onset was 50%～95.5%, the proportion of first symptoms onset with rash, muscle weakness, and both were 60%, 37%, 3%, respectively. Cronbach α values were all ＞0.8 for MDAAT, DAS, and CMAS, internal correlation coefficient for MDAAT, DAS, and CMAS was 0.940, 0.957, 0.942 (＞0.75), respectively；Construct validity was assessed by exploratory factor analysis according to the original questionnaires., which showed significant difference for scores between pre-therapy and post-therapy by MDAAT, DAS, and CMAS assessment (P<0.05). Conclusions　The assessment tools, including MDAAT, DAS, CMAS, have a good reliability, validity and responsiveness. The DAS is the shortest to get answers, which has great value in clinical practice.

Single-center drug epidemiological study of warfarin in children

XU jinghan, GU zhichun, LI Hao, et al

Journal of Clinical Pediatrics. 2020, 38(2): 146. doi:10.3969/j.issn.1000-3606.2020.02.016

Abstract ( 403 )

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Objective　To summarize the application of warfarin in children. Methods　Clinical data of 362 children who used warfarin from January 2014 to December 2018 were collected and retrospectively analyzed. Results　Among the 362 patients treated with warfarin, 210 (58.0%) were male patients and 152 (42.0%) were female patients. Of them 194 (53.6%) came from department of cardiothoracic surgery and 125 (34.5%) came from Department of Cardiology. Diseases needed warfarin therapy were mainly congenital heart disease (242 cases, 66.9%) and Kawasaki disease (74 cases, 20.4%). Pediatric patients treated with warfarin were mainly from East China (262 cases, 72.4%). Conclusion　The use of warfarin in children is very different from that in adults. Children's anticoagulant therapy and research require special attention.

Prospective applications of small-molecule inhibitors and biological agents in pediatric atopic dermatitis

WU Chenglong

Journal of Clinical Pediatrics. 2020, 38(2): 149. doi:10.3969/j.issn.1000-3606.2020.02.017

Abstract ( 518 )

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　Atopic dermatitis (AD) is a chronic, pruritus skin disease, which can affect both adults and children. It is more common in children and is difficult to cure in a short time. Due to limitations of drug selection in infants and children, there are great challenges in the treatment of pediatric AD. In addition to traditional treatments such as topical corticosteroids and calcineurin inhibitors, small-molecule inhibitors and biological agents targeting specific inflammatory pathway in the pathogenesis of AD have been gradually in clinical use. This paper reviews therapies currently available to pediatric AD.

Progress in diagnosis and treatment of cystinosis

LI Xiaoqiao, GONG Chunxiu

Journal of Clinical Pediatrics. 2020, 38(2): 156. doi:10.3969/j.issn.1000-3606.2020.02.018

Abstract ( 196 )

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