Diagnostic criteria for coeliac disease(CD) from the European Society for Paediatric Gastroenterology,Hepatology,and Nutrition were published in 1990.Since then,the autoantigen in CD,tissue transglutaminase had been identified;CD-specific antibody tests had improved.The perception of CD had changed greatly.A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process in 2012.The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CDspecific antibody testing.In group of children with symptoms suggestive of CD,the diagnosis of CD is based on symptoms,positive serology,and histology that is consistent with CD.If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (＞ 10 times the upper limit of normal),then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests.In group of asymptomatic children at increased risk for CD,the diagnosis of CD is based on positive serology and histology.Human leukocyte antigen-DQ2 and human leukocyte antigen-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative.The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families.

Objective To observe the clinical effects of short-term intermittent ganeiclovir treatment on infants with cytomegalovirus (CMV) hepatitis. Methods The clinical data of infants with CMV hepatitis were analyzed retrospectively. The liver functions including total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltransferase (γ-GT) of the patients in treatment group (85 cases) and control group (37 cases) were collected before and after treatment. Meanwhile, the side effects of ganciclovir during treatment were observed. The measurement data were compared by analysis of variance and numeration data were compared by chi-square test. Results After short-term intermittent ganciclovir treatment in treatment group, TBil level was decreased from (109.1±677.8)μmol/L to (62.9±68.1)μmol/L (F=15.34,P<0.01); ALT level was decreased from (160.2±395.3) U/L to (68.1±56.0) U/L (F=4.73, P<0.05). In control group, TBil level was decreased from (94.9±647.4)μmol/L to (49.2±631.5) μmol/L (F=14.80, P<0.01) ; while ALT level was decreased from (131.6±206.2) U/L to (55.3±631.2) U/L (F=3.50, P=0.067). The readmission rate in control group was significantly higher than that in treatment group (21.6% vs 10.6%). Only one case (0.8%) received three times of intermittent ganciclovir treatment. The longest hospitalization time was six weeks. Conclusions Short-term intermittent ganciclovir treatment may be more suitable for infants with CMV hepatitis. There is no obvious side effect observed during the treatment and the hospitalization time can be shortened.

Objective To investigate the incidence of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD)in neonates with idiopathic neonatal cholestasis (INC)in Nanjing,China,SLC25A13 gene mutations in these neonates,and clinical features.Methods A total of 152 neonates with INC,who were admitted to the Affiliated Nanjing Children's Hospital of Nanjing Medical University from Sep-tember 2009 to August 2013,underwent gene analysis for detecting SLC25A13 gene mutations.The neonates were divided into NICCD group,who had been diagnosed definitely,and INC group at a ratio of 1∶2,considering the age and gender.Several biochemical indices were compared between the two groups.Comparison of continuous data between the two groups was made by Mann-Whitney U test after Bonferroni correction.Results There were 21 confirmed cases of NICCD (21/152,13.82%)among the 152 neonates with INC;five types of SLC25A13 mutations were identified in the 21 neonates with NICCD,including 851_854del (27/42,64.29%),IVS6+5 G→A (7/42, 16.67%),1638ins23 (5/42,11.90%),IVS11 +1 G→A (2/42,4.76%),and Q259X (1/42,2.38%).The alanine aminotransferase (ALT)level,aspartate aminotransferase (AST)level,bile acid concentration,albumin level,fasting blood glucose,blood ammonia,and prothrombin time for the NICCD group were 39.42 ±23.40 U/L,124.85 ±92.65 U/L,142.43 ±24.34μmol/L,30.66 ±2.70 g/L,2.79 ± 0.54 mmol/L,117.57 ±27.88 μmol/L,and 14.03 ±2.79 s,respectively,versus 136.02 ±113.67 U/L,226.12 ±129.26 U/L,80.47 ± 31.53 μmol/L,36.87 ±4.96 g/L,3.14 ±0.45 mmol/L,76.43 ±20.80 μmol/L,and 11.40 ±1.55 s for the INC group.The NICCD group had significantly lower ALT and AST levels than the INC group (Z=-5.02,P=0.000;Z=-3.66,P=0.000);the NICCD group had a significantly higher bile acid concentration than the INC group (Z=-5.58,P=0.000);the NICCD group had significantly lower albumin level and fasting blood glucose than the INC group (Z=-4.52,P=0.000;Z=-2.56,P=0.010);the NICCD group had a significantly higher blood ammonia level than the INC group (Z=-4.75,P=0.000);the NICCD group had a significantly longer prothrombin time than the INC group (Z=-4.10,P=0.000).Conclusion Citrin deficiency due to SLC25A13 gene mutations is an im-portant cause of INC in Nanjing.The three most common mutations are 851_854del,IVS6+5 G>A,and 1638_1660dup23,which account for 92.86% of the SLC25A13 gene mutations.More attention should be paid to clinical analysis and detection of SLC25A13 gene mutations to confirm the diagnosis of NICCD.

Objective To carry out the detection of JAGI gene in children with chronic cholestasis and to im-prove the diagnostic level and understanding of Alagille syndrome. Methods Two cases of chronic cholestasis with multiple organ involvement were selected as the research subjects and their clinical data,laboratory test results were col-lected. Two milliliter peripheral intravenous heparin anticoagulan blood was drawn from each patient. All fragments of 26 exons of the JAGI gene were amplified by polymerase chain reaction - sequence based on typing method. Results One patient with chronic cholestasis,heart murmur and dysmorphic face showed bile duct paucity in liver biopsy and a novel heterozygous mutation c. 809 809delG(p. G270Dfs*142)in 6 exon. Abnormal amino acid replaced JAG1 protein and resulted in truncation of the JAG1 protein. The part of epidermal growth factor(EGF)like repeats region loss and the cysteine rich region completely lost. One case with typical chronic cholestasis and dysmorphic face showed a known IVS20 - 2 5delTAAG heterozygous mutation which resulted in splice site changes. Conclusion A novel JAGI gene mutation c. 809 809delG(p. G270Dfs*142)is helpful to screen JAGI gene of Notch signal transduction pathway for chronic cholestasis with multiple organs involvement in children.

Objective To research the effects of different titers of bacteriophage D29 on growth and function of airway epithelial cell 9HTE.Methods Cell viability rates was analyzed after applying high(109 PFU/mL)and low(107 PFU/mL)titers of bacteriophage D29 and phage buffer respectively by MTT colorimetry.Additionally,the secretion levels of IL-6,IL-8 in cell culture supernatant were detected by ELISA.RT-PCR was performed to detect the expression of ICAM-1 mRNA.Cell apoptosis rate was analyzed by flow cytometry.Results There was no difference in cell growth,secretion levels of IL-6,IL-8,ICAM-1 mRNA and cell apoptosis rate between cells treated with high and low titers of D29 and phage buffer(P>0.05).Conclusion Neither high nor low titer of bacteriophage D29 exerts effect on growth and function of airway epithelial cell 9HTE in vitro.

OBJECTIVE:To study the preparation technology of Fanhuncao sustained-release dropping pills. METHODS:The preparation technology of Fanhuncao sustained-release dropping pills was optimized by orthogonal design and single factor test with PEG4000,PEG6000 and glycerol monostearate(GM)as carrier materials,using sphericity,pill weight difference and appearance quality as index,GM-PEG weight ratio,liquid temperature,nozzle temperature,dipping speed,dropping distance,diameter of emitter as factors and the verification test was conducted. RESULTS:The optimal technology was that the ratio of GM-PEG was 3∶7;the temperature of drug mixture was 85 ℃;the dropping speed was 40 drop/min;dropping distance was 4 cm;and the conden-sate temperature was 15 ℃;diameter of emitter was 4 mm. RSD of each index of 3 batches of dripping pills were all ≤0.58%(n=3)in verification test;the average content of chlorogenic acid was 0.14 mg/g;the average pill weight difference was 3.21%;the average sphericity was 9.43;and the average appearance quality was 4.33. Q1 h were 23.4%,24.4% and 23.3% in average(n=6),and Q12 h were 89.6%,91.2% and 91.5%(n=6). CONCLUSIONS:The optimal preparation technology is stable and simple, and can be used for industrial production of Fanhuncao sustained-release dropping pills.

Objective To explore the relationship between expressions of C-type lectin receptors on natural killer(NK) cells and infant human cytomegalovirus (HCMV) infection. Methods Seventynine cases of HCMV infection infants and 39 cases of HCMV non-infection control infants admitted during January 2006 to June 2008 were recruited in this study. According to HCMV pp65 antigenemia levels in the peripheral blood, 79 cases of HCMV infection infants were divided into two groups: 48cases of active HCMV infection and 31 cases of inactive HCMV infection. The 48 cases of infants with active HCMV infection were treated with ganciclovir for 2 weeks. The expressions of NKG2A,NKG2C, and NKG2D receptors on NK cells in the peripheral blood were examined by flow cytometry.Data analysis was done using SPSS 17.0 software. Comparisons among 3 groups were performed by Kruskal-Wallis nonparametric test for independent samples and comparisons between groups were done by Mann-Whiteney nonparametric test for paired samples. Results There was no difference of the inhibitory receptor NKG2A expression on NK cells among groups of active HCMV infection, inactive HCMV infection and HCMV non-infection controls (x2 = 3. 95, P＞0. 05). However, there was obvious difference of activating receptors of NKG2C and NKG2D expressions on NK cells among the three groups (x2 =24.91 and x2 =47. 80, respectively; both P＜0.01). The expressions of NKG2C and NKG2D on NK cells in the HCMV infection group were both higher than the control group (Z=-4.72 and Z=-5.15, respectively; both P＜0.01). The expression of NKG2D on NK cells in the active HCMV infection group was higher than that in the inactive HCMV infection group (Z= -5.08,P＜0.01). The expression of NKG2D on NK cells decreased after ganciclovir treatment (Z= - 1.34,P=0. 07). Conclusion Expressions of NKG2C and NKG2D on NK cells might play a significant role in regulating NK cell function and anti-HCMV immunity in infants.

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Objective To observe and compare the different forces between doctors and nurses used visible laryngoscope endotracheal intubation applied to the oropharyngeal organization. Methods 10 nurses (to carry on laryngoscope intubation theory, and had certain study period practice) were chosen in group A and 10 clinical anaesthetize doctors (to be possible correctly used visible laryngoscopes) were chosen in group B, two groups used the visible laryngoscope on the same model person body inserted the tube, computer monitor software recorded results. Results The impulse force was (25.57±3.37) N·s and insert tube time was (25.3±3.3) s in group A which were higher than (16.47±2.99) N·s and (16.2±3.0) s in group B (t=2.550 and 2.207, P<0.05). The average forces in group A and group B were (0.87±0.62) N and (0.64±0.30) N, and peak forces were (3.05±0.95) N and (2.06±0.48) N, there was no remarkable difference between the two groups (P>0.05). Conclusions There is no statistics difference forces applied to the oropharyngeal organization between nurses and anaesthesiologists using visible laryngoscope intubation, and visible laryngoscope intubation technique is easy to learn and it is feasible by the nurse to master the technology and applied to anesthesia intubation care and emergency care.