Food allergy(FA) seems to be increasing world wide which is roughly divided into IgE mediated or non-IgE mediated FA(NFA).NFA primarily affects the gastrointestinal mucosa which is far less understanding the immunological mechanisms than IgE-mediated FA.Clinicians sometimes experienced confusion due to delayed onset of symptoms and subsequent difficulty in making the clinical association between offending food and clinical symptoms.The lack of easily accessible diagnostic measures also contributes to the problem.The diagnosis of NFA usually is established in the eliminated of food allergen and food challenge test.In this paper,the diagnosis and treatment of NFA is introduced combined with our clinical practice experience.

Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Most ca-ses are asymptomatic,while it can be symptomatic when complications happened,its complications often expressed as hematochezia,abdominal pain,vomit,fever,and so on. When signs or symptoms arise from a Meckel′s diverticulum, morbidity and mortality will increase. So make a definite diagnosis of the diverticulum play an important role in the treatment of Meckel′s diverticulum. In this essay,now illustrate the meaning of imaging examination about the diagnosis of Meckel′s diverticulum,wish to make a diagnosis as soon as possible.

Objective To analyze the main clinical manifestations,laboratory features and prognosis of neonatal intrahepatic cholestasis caused by Citrin defiency (NICCD).Methods Twenty-nine NICCD infants were diagnosed by blood tandem mass spectrometry (MS-MS)analysis and/or SLC25A13 mutation analysis from July 2012 to February 2015 in Children's Hospital of Chongqing Medical University.Clinical data of 29 cases were analyzed retrospectively which included manifestations,laboratory features and prognosis.The general situation,feeding,liver function,growth were followed up.Results Twenty-nine infants suffering from NICCD presented jaundice in an early time,and some clinical manifestations were investigated such as hepatomegaly (20/29 cases),splenomegaly (3/29 cases),anemia (14/29 cases),and failure to thrive (9/29 cases).Laboratory data suggested that all of 29 patients had increased conjugated bilirubin,total bile acid,γ-glutamyl transferase and alkaline phosphatase.Some patients also showed abnormal coagulation function (20/22 cases),dyslipidemia (9/20 cases),increased blood lactic acid (22/26 cases) and alpha-fetoprotein (14/14 cases),decreased albumin (24/29 cases),blood glucose (17/22 cases) and ceruloplasmin (4/4 cases).The pathological analysis of one patient's liver indicated the edema and degeneration of liver cells,intrahepatic cholestasis and a small amount of fibrous tissue hyperplasia in portal area.MS-MS analysis of blood samples revealed distinctive increase in methionine,tyrosine,threonine,citrulline,arginine and free carnitine,long chain acyl-carnitine in most patients.Gas chromatography-mass spectrometer (GC-MS) analysis of urine samples mainly showed elevated 4-hydroxyphenyllactic acid and 4-hydroxyphenylpyruvic acid.Prognosis showed that most of the NICCD patients (8/29 cases) could recover in one-year old with a lactose-free,medium chain triglyceride-enriched formula,and one patient died of liver cirrhosis.Three patients at over one-year old had the preference of a high protein and low carbohydrate diet.Conclusions Infants might be considered to have NICCD if they have jaundice in an early time,with the clinical characteristics of hepatomegaly,splenomegaly,abnormal coagulation function,anemia,failure to thrive,dyslipidemia,decresed albumin and blood glucose,increased blood lactic acid and alpha-fetoprotein.After that further tests of MS-MS,GC-MS and gene analysis of this disease are needed to confirm diagnosis.

Food allergy is a common illness in children,which is divided into IgE-mediated,non-IgE mediated and mixed-mediated food allergy.Gastrointestinal tract is the mainly affected organ,mostly mediated by non-IgE mechanism.Gastrointestinal food allergy are lack of unified diagnostic criteria currently,whose mechanism is also elusive.Moreover,the double-blind placebo-controlled food challenge is the gold standard for the diagnosis of food allergy.This review focuses on the procedure for the oral food challenge and its application in the diagnosis of gastrointestinal food allergy.

Chronic intestinal pseudo-obstruction(CIPO)is an intestinal motility dysfunction caused by intestinal myopathies or neuropathies or mesenchymopathies.The clinical manifestation is almost the same with mechanical intestinal obstruction,but in the absence of any obstruction in the gastrointestinal tract.According to etiology,it can be divided into primary and secondary.While according to gastrointestinal neuromuscular disorders,it can be categorized as myopathy,neuropathy and mesenchymopathy,which have different pathogenesis.The disease with the clinical manifestation,imaging examination or histopathology was diagnosed,but mechanical intestinal obstruction must be excluded.Presently,the therapies of CIPO mainly are stimulating the motility of intestine and ensuring the necessary nutrition of the children.The review is mainly focused on the research progress of the pathogenesis,clinical manifestation,diagnosis,therapy of pediatric CIPO in recent years.

Drug induced liver injury(DILI) is one of the most common factors causing liver damage and liver failure in children.And in most cases,patients' manifestations lack characteristic features.Thus,patients will develop gastrointestinal symptoms such as jaundice,nausea,vomiting and abdominal abstention until serious hepatic dysfunction.Futhermore,some patients are likely to develop acute liver failure,even death,without drug discontinuation and timely intervening measures.Early diagnosis and effective therapies considerably make sense.This review aims to illustrate the mechanism,manifestations,diagnosis and treatment of DILI in children,in order to promote the early treatment of the disease,reduce the serious complications and improve survival rate in clinical work.

Objective]To investigate the effect of acupuncture-assisted anesthesia on cerebral state index(CSI) under the steady-state anesthesia of sevoflurane. [Methods] Fifty patients scheduled for elective knee arthroscopy operation were randomly divided into two groups with 25 in each. All patients were induced with sevoflurane, the end-tidal concentrations of sevoflurane in two groups were adjusted to 1.0 MAC and maintained for 15 min after tracheal intubation, acupuncture-assisted anesthesia was used on the affected side in group A, Yanglingquan(GB34) and Zusanli(ST36) were selected as the acupoints. The positive and negative electrodes of the electropuncture apparatus(G8650) were respectively connected with Yanglingquan(GB34) and Zusanli(ST36). People reccived transcutaneous electrical acupoint stimulation with condensation-rarefaction wave(2/15 Hz, 8~12mA) untill the end of operation, patiant's body types SBP, SDP, MAP, HR and CSI were recorded at lying still for 5 min(T1), steady state of sevoflurane(T2), acupuncture-assisted anesthesia after 20 and 30 min(T3, T4). [Results] SBP, DBP, MBP, HR and CSI at T3~T4 were significantly lower in group A than those in group B and T2(P<0.05). [Conclusion]Acupuncture-assisted anesthesia can reduce the CSI under the steady-state anesthesia of sevoflurane and lower blood pressure and heart rate at the same time.

OBJECTIVE:To study the bioequiavailability of both the domestic and the imported azithromycin tablets in healthy human body.METHODS:The serum concentrations in 12 healthy volunteers was determined by HPLC-UV after administration of a single oral dose of 500mg azithromycin tablets by a cross-over design.The compartment model was discriminated by F-test and AIC method and the pharmacokinetic parameters were calculated by DAS program.RESULTS:The optimal compartment model fitted to two-compartment model.The main pharmacokinetics parameters of the domestic azithromycin tablets vs.the imported ones were the following:Cmax was(437.4 670? 51.5 670),(442.9 670? 61.5 030)? g/L;t1/2? was(44.7 450? 13.1 750),(49.2 670? 15.1 740)h;tmax was(2.5 830? 0.5 150),(2.5 830? 0.5 150)h;AUC0～ 144 was(13.2 799? 2.9 827),(12.1 953? 2.9 140)(mg? h)/L.The relative bioavailability of the domestic azithromycin tablets was(101.7? 0.1)%.CONCLUSION:The domestic azithromycin tablets and the imported ones were bioequivalent.

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, and is also a common cause of recurrent abdominal pain in children.The pathogenesis of IBS has not been completely clarified, and it is currently believed to be related to factors such as gastrointestinal dysmotility, visceral hypersensitivity, and brain-gut axis dysfunction.Pediatric IBS often shows abdominal pain, bloating, accompanied by altered bowel habits, while its clinical manifestations are not specific.The diagnosis of IBS is usually made based on the Rome Ⅳ criteria.The ultimate goal of treatment is to improve the quality of life of children, including alleviating the abdominal pain of children and restoring normal bowel habits.The treatment mainly includes adjusting diet and lifestyle, medicine etc.This review is to investigate the progress of the pathogenesis, diagnosis and treatment of IBS in recent years.

OBJECTIVE To explore kinetic features and its underlying mechanism of the positive inotropic effect of liguzinediol(LZDO)in rats. METHODS ①An In vivo study was made to record the effect of LZDO 20 mg · kg-1 injected for 30 consecutive min from the left external jugular vein on pressure-volume relationships. ②Ex vivo study was used to record the antagonistic effect of LZDO on reduced contractility induced by caffeine. Caffeine and LZDO were perfused as follows:normal perfusion solution, caffeine 0.5 mmol · L-1,and then caffeine 0.5 mmol · L-1+LZDO 100 μmol · L-1. ③ Ca2+ transient from cardiomyocyte sarcoplasmic reticulum (SR) was measured to analyze the effect of LZDO on Ca2 +release blocked by thapsigargin. Thapsigargin and LZDO were perfused as follows:normal perfusion solution,thapsigargin 2 μmol · L-1,and then thapsigargin 2 μmol · L-1+LZDO 100 μmol · L-1.④The SR vesicles were prepared and the effect of LZDO(1,10 and 100μmol·L-1)on sarcoplasmic reticulum Ca2+ATPase(SERCA2a)activity was determined according to the ultramicro-Ca2+-ATP enzyme kit. RESULTS ① LZDO 20 mg · kg- 1 significantly reduced the end-systolic volume (Ves) and enhanced the end-systolic pressure (Pes),stroke volume (SV),ejection fraction (EF),cardiac output(CO),peak rate of rise of left ventricular pressure(+dp/dtmax)and stroke work(SW)(P<0.05). However,LZDO 20 mg · kg-1 did not significantly change the heart rate(HR )or the end-diastolic volume (Ved). ② Caffeine 0.5 mmol · L- 1 significantly enhanced HR,left ventricular developed pressure (LVDP ),and+dp∶dtmax at 5 min after caffeine and decreased at 30 min. However,LZDO 100μmol·L-1 restored the reduced HR,LVDP,and+dp/dtmax induced by caffeine at 30 min(P<0.05).③Thapsigargin 2μmol·L-1 significantly reduced the SR Ca2+transient from perfusion solution group(100±5)%to(51± 5)%(P<0.05) and LZDO 100 μmol · L-1 failed to restore the decreased Ca2+ transient〔(49 ± 4)%〕. Normalized Ca2+transients were reduced by thapsigargin 2μmol·L-1 and thapsigargin 2μmol·L-1+LZDO 100 μmol · L-1. ④ LZDO(10 and 100 μmol · L-1)significantly increased the activities of SERCA2a in perfusion solution group 0.98±0.10 to 1.17±0.20 and (1.43±0.09)μmol Pi·g-1·h-1,respectively(P<0.05). CONCLUSION LZDO can enhance SR Ca2+ gradient by activating the SERCA2a and might be developed to serve as a potential positive inotropic agent in clinical settings.