Constipation in children is one of the most common clinical symptoms in pediatric outpatient clinic.With a high incidence rate,it can be caused by a variety of causes,and mainly include functional constipation.Children's functional constipation is different from adult at many aspects such as clinical manifestation,diagnostic criteria,treatment,etc.It is because children are in a special condition with growth and development.In the course of the treatment,there are many problems such as children do not coordinate the treatment,symptoms can be difficult to control,recurrence after treatment,and so on,which have adverse effects on the physical and mental health of children.So in recent years,children's functional constipation reports continue to emerge.This review will elaborate the current status and progresses of children's functional constipation treatment.

Objective:To investigate the age of onset of functional constipation in children and to explore its relationship with possible factors.Methods:Four hundred and sixteen children with functional constipation who were admitted to the Digestive Specialist Clinic of Nanjing Children′s Hospital from January 2017 to December 2018 were divided into 4 groups (Q1-Q4) according to the quartiles of the onset age.The gender, duration of symptoms and constipation of their parents of the 4 groups were analyzed.Results:Age of onset of 416 children was (1.58±1.64) years, the age of onset in the Q1 group was (0.27±0.19) years, the age of onset in the Q2 group was (0.82±0.17) years, the age of onset in the Q3 group was (1.64±0.32) years, and the age of onset in the Q4 group was (3.91±1.83) years.The constipation duration in 416 patients was (1.50±1.62) years; the constipation duration of Q1, Q2 and Q4 groups was (2.20±1.95) years, (1.33±1.48) years, (1.11±1.05) years and (1.35±1.66) years, respectively, and the group with the youngest age of onset (Q1) had the longest duration of constipation, which was statistically significant compared with the other three groups ( F=9.644, P<0.05). Of the 416 children, 190 cases (45.7%) were boys, 226 cases (54.3%) were girls; 54 boys (50.9%) and 52 girls (49.1%) in the Q1 group, 47 boys (39.8%) and 71 girls (60.2%) in the Q2 group, 39 boys (40.6%) and 57 girls (59.4%) in the Q3 group; 53 boys (55.2%) and 43 girls (44.8%) in the Q4 group; there were no significant differences in gender ( χ2=7.210, P>0.05). Among 416 children with FC, 196 cases (47.1%) had at least one of their parents with constipation symptoms, including 61 cases (57.5%) in Q1 group, and 66 cases (55.9%) in Q2 group, 34 cases(35.4%) in Q3 group, 35 cases (36.5%) in Q4 group.The 2 groups (Q1-Q2) with younger onset compared with the older onset children (Q3-Q4), their parents were more likely to have constipation symptoms, and the difference was statistically significant ( χ2=17.96, P<0.05). Conclusions:The age of onset of functional constipation in children is young, and younger functional constipation children are less likely to receive formal guidance treatment at an early stage; gender has no significant relationship with the age of onset; children with a younger onset, genetic factors are more meaningful to them.

Objective:To investigate the prevalence of rotavirus infection and susceptibility to Histo-Blood Group Antigens (HBGAs) in children with diarrhea under 5 years of age in Nanjing.Methods:Stool and corresponding saliva samples were collected from 295 children with acute diarrhea and 150 healthy children. Rotaviruses were detected in stool samples by antigen detection method, and rotavirus positive samples were genotyped by RT-PCR method. HBGA phenotype of saliva samples was determined by anti-tissue blood group monoclonal antibody ELISA method. Rotavirus infection and HBGA susceptibility were analyzed by statistical analysis.Results:In the case group, 139 (47.12%) of 295 samples were rotavirus positive, with G9[P8] genotype being the most common genotype (84.17%, 117/139). The proportion of fever ( χ2=34.81, P<0.001), vomiting ( χ2=25.01, P<0.001) and respiratory symptoms ( χ2=4.73, P=0.03) in rotavirus infected children, which were higher than those in non-rotavirus infected group, and the difference was statistically significant. In the ABO blood group system, type AB children were more likely to have diarrhea (95% CI: 1.029~2.622; P= 0.036), and type B children had a higher risk of rotavirus infection ( OR=1.783, 95% CI: 1.027~3.095, P= 0.039). In the secretory system antigens, secretory children were more prone to diarrhea and rotavirus infection, G9[P8] genotype infection was related to secretory phenotype ( OR=2.854, 95% CI: 1.641~4.962), and non-secretory children ( χ2=5.723, P=0.017) were less susceptible to rotavirus and G9[P8] genotype rotavirus infection. Conclusions:G9[P8] genotype was the main rotavirus infection in diarrhea children under 5 years of age in Nanjing, and individuals with secretory phenotype were more likely to be infected with G9[P8], which provided scientific basis for preventing and controlling rotavirus diarrhea in this area.

Objective To observe the value of quality control system based on artificial intelligence(AI)for improving imaging quality of chest CT.Methods Totally 1 726 CT images obtained from 415 patients were retrospectively collected,among which 1 414 images were used for convolutional neural network(CNN)training and the rest 312 images were used for validation.Precision,Recall,F1-Score,mean average precision(mAP)and intersection over union(IOU)of quality control system based on AI for chest CT scanning were calculated.Meanwhile,21 patients with unsatisfactory chest CT who would undergo re-examination were prospectively enrolled,and chest CT scanning with quality control system based on AI were performed.The results of 2 examinations were compared.Results Precision,Recall,F1-Score,mAP and IOU of quality control system based on AI for chest CT were all good.All 21 cases were diagnosed correctly with re-examination CT based on quality control system.Among 21 cases,the first CT misdiagnosed 19 cases,the displaying of the area,volume and display quality of pulmonary nodules were not significantly different,but the morphology,boundaries,spiny protrusions,vacuolar signs,inflatable bronchial signs of nodules as well as the thickened and twisted blood vessels were obviously different between 2 times examination.The first CT missed 1 case while correctly diagnosed 1 case.Conclusion The quality control system based on AI was helpful for improving imaging quality of chest CT and increasing diagnostic efficacy.

Objective:To explore the relevancy between the uridine diphosphate-glucuronylgly-cosyltransferase 1A1 (UGT1A1) gene mutation and the phenotype of indirect hyperbilirubinemia in children.Methods:Sixteen cases with indirect hyperbilirubinemia who visited the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from July 2013 to November 2019 were retrospectively analyzed and were divided into Gilbert syndrome (GS), Crigler-Najjar syndrome type II (CNS-II), and indirect hyperbilirubinemia groups unexplained by UGT1A1 gene mutations. The differences in gene mutation site information and general clinical data were compared. The association between gene mutation spectrum and bilirubin level was explored by t-test analysis.Results:Ten of the sixteen cases with indirect hyperbilirubinemia had GS, three had CNS-II, and three had indirect hyperbilirubinemia unexplained by UGT1A1 gene mutations. A total of six mutation types were detected, of which c.211G?>?A accounted for 37.5% (6/16), c.1456T?>?G accounted for 62.5% (10/16), and TATA accounted for 37.5% (6/16), respectively. Compared with the GS group, the CNS group had early disease onset incidence, high serum total bilirubin ( t ?=?5.539, P ??0.05) and age of onset ( t ?=?0.3611, P ?>?0.05) between the two groups. There was no significant correlation between the number of UGT1A1 gene mutations and serum bilirubin levels. Children with c.1456T?>?G homozygous mutations had the highest serum bilirubin levels. Conclusion:The common pathogenic variants of the UGT1A1 gene sequence are c.1456T?>?G, c.211G?>?A, and TATA, indicating that these site mutations are related to the occurrence of indirect hyperbilirubinemia and have important guiding significance for the etiological analysis of indirect hyperbilirubinemia in children.

Objective: To investigate the clinical and epidemiological characteristics of Coronavirus HKU1 (Human CoV-HKU1) and NL63 (Human CoV-NL63) in children with acute respiratory tract infection in Nanjing. Methods: From August 2009 to July 2011, 1 286 respiratory samples were collected from the outpatient and hospitalized children in the Children′s Hospital of Nanjing Medical University. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect HCoV-HKU1 and NL63 genes, besides, positive samples were used for common respiratory virus screening. The positive amplification products were cloned, sequenced, homologous and phylogenetic analysis was conducted by molecular biological method . Results: The detection rate of HCoV-HKU1 was 1.1% (14/1 286), the positive sequences shared a 98.2%-100% nucleotide identity with the HCoV-HKU1 strains and mixed infection rate was 92.9%. The main clinical diagnoses were bronchitis, bronchopneumonia and bronchiolitis. The clinical manifestations were cough, fever, wheezing. The detection rate of HCoV-NL63 was 1.5% (19/1 286), the positive sequences shared a 95.6%-100% nucleotide identity with the HCoV-NL63 strains and mixed infection rate were 63.2%. The main clinical diagnosis were acute upper respiratory tract infection, bronchitis, bronchopneumonia. The clinical manifestations were fever, cough, expectoration. No deaths were found in both HCoV-HKU1 and NL63 infections. Conclusions From August 2009 to July 2011, HCoV-HKU1 and NL63 were detected in children with respiratory tract infection in Nanjing area. HCoV-HKU1 infected cases were lower respiratory tract infection, epidemic in winter and spring, infected cases were mainly under 1 years of age, HCoV-NL63 infected cases including upper respiratory and lower respiratory tract infection, epidemic in the season of summer and autumn. The infected cases were mainly at the age rank from 1 year to 3 years. The clinical manifestations of children infected with coronavirus HKU1 and NL63 are not specificity.