Objective To investigate the musculoskeletal ultrasound (MSUS) findings in Chinese knee osteoarthritis (OA) patients.Methods All the MSUS data were from the outpatients with knee OA who visited Department of Rheumatology and Clinical Immunology,Peking University First Hospital from February 2013 to August 2014.MSUS findings included number and position of osteophyte,synovitis,thickness of cartilage,and so on.Comparisons between groups were made using t test,Chi-square tests.Results Six hundreds and seventy-four patients were included.Almost all the patients (96.1％) had osteophytes,most patients had both knees osteophytes.The most common osteophyte location was femoral (85.2％),followed by tibia and the upper edge of patella.The number of osteophytes differed from none to ten,and the distribution of bilateral knee osteophytes was symmetrical in most patients.There was no significant difference in the number of osteophytes between male and female,and patients over 60 years old had more osteophytes than the patients aged 60 or below.In all bursae lesions,the suprapatellar bursa were the most commonly affected [effusion,279 (41.4％),synovial hyperplasia,189(28.0％),synovitis 24 (3.6％)].There was no significant difference in the cartilage thickness between bilateral knees.But the cartilage thickness of female patients was significantly thinner than that of men [left:(2.0±0.5) mm vs (2.5:1:0.8) mm,t=3.859,P＜0.05;right:(2.0:1:0.5) mm vs (2.5±0.8) mam,t=4.109,P＜0.05],and the patients over 60 years old had thinner cartilage than patients younger than 60 years old [left:(2.0±0.6) mm vs (2.2±0.6) mm,t=2.108,P＜0.05;right:(2.0±0.6) mm vs (2.2±0.6) mm,t=2.507,P＜ 0.05].None patient had Calcium pyrophosphate dehydrate (CPPD) deposition in the cartilage.Conclusion In the ultrasonographic findings of knee OA in China,osteophyte could be found in 96％ patients,the most common location of osteophyte is the femur area.The distribution of bilateral knee osteophytes is symmetrical in most patients.Patients over 60 years old have more osteophytes.Nearly haff patients have joint effusion,one third patients have synovial hyperplasia or synovitis.Bilateral knee cartilage degeneration is symmetrical.Women and patients over 60 years old have thinner cartilage.

Objective To evaluate the validity of assessing synovitis and tenosynovitis by using musculoskeletal ultrasound scoring systems after standardized training in Chinese doctors.Methods All participants received a 30 minutes' training for the ultrasound scoring systems of synovitis and tenosynovitis.Ten static images were applied to evaluate the changes before and after training,respectively.Each parameter was assessed by a four scale semi-quantitative system recommended by outcomes measures in rheumatoid arthritis clinical trials (OMERACT).Paired t-test was used to assess the differences before and after training.Results Thirteen rheumatologists and two ultrasonographers completed the entire procedure.Significant differences were found before and after training when assessing the severity of gray-scale of synovitis (0.61± 0.30 vs 0.45±0.23;t=2.230,P＜0.05) and power Doppler of synovitis (0.57±0.26 vs 0.31±0.18;t=2.928,P＜0.05) and tenosynotis (0.56±0.15 vs 0.31±0.16;t=5.286,P＜0.05),while no significant difference was found when assessing the gray scale of tenosynovitis (t=-1.679,P＞0.05).Conclusion Standardized training is helpful to improve the validity of ultrasound scoring systems of synovitis and tenosynovitis in Chinese rheumatologists and ultrasonographers.The validity of assessing gray-scale of tenosynovits needs improvement.

Objective To investigate the clinical value of endoscopy for chronic diarrhea in infants and safety of gastroscopy replacing colonoscopy.Methods According to the Nelson chronic diarrhea definition,data of 52 hospitalized infants under 1 year from March 2006 to April 2014,who underwent colonoscopy because of diarrhea lasting for more than 2 weeks and achieving no improvement after series of treatments,or diarrhea suspected with severe milk protein allergy were collected.Endoscopy and mucosal biopsy were performed under intravenous anesthesia.Results A total of 49 cases (94.2%)were found abnormal under endoscopy.Lymphocytes,plasma cells and a little eosinophils were found in lamina propria in 26 cases,20-100 eosinophils/HPF were found in lamina propria in 21 patients,who were diagnosed as eosinophilic colitis.The 21 patients came back for open food challenge test 4 weeks later,16 cases were positive,who were diagnosed as milk protein allergy.Two infants with Crohn disease and ulcerative colitis respectively were treated with mesalazine and prednisone,but symptoms repeated.No complication was observed during endoscopy.Conclusion The etiology of infant chronic diarrhea is complex,except for peptic infections and lactose intolerance ,eosinophilic colitis may be the major cause.Ulcerative colitis and Crohn disease are rare in infants,but cannot be ignored .Endoscopy and mucosal biopsy are important in di-agnosis and treatment.Gastroscopy instead of colonoscopy is safe and effective.

Objective To study the clinical features of congenital glucose-galactose malabsorption (CGGM),and to improve the understanding of CGGM.Method Clinical manifestations and treatment process of one patient with CGGM in our hospital were retrospectively analyzed.From 1966 to 2016 May,Chinese medical database and PUBMED were searched using Malabsorption syndrome,dehydration,hypernatremia , diarrhea , newborn , carbohydrate metabolism ,andglucose/galactose malabsorption as key words.The clinical features of CGGM reported in literatures were summarized.Result The patient in our hospital was a full-term female infant naturally delivered.The onset of the disease was on the 9th day after birth,and the clinical manifestations included severe diarrhea,severe dehydration,hypernatremia,metabolic acidosis and malnutrition.After intravenous infusion and symptomatic treatment,dehydration,hypernatremia and metabolic acidosis were corrected.However,there was no improvement of diarrhea characterized with watery and acidic stools,and neither was weight gain.Glucose loading test was negative,and fructose loading test was positive.Diarrhea was improved markedly using diagnostic carbohydrate-free formula,so CGGM was diagnosed clinically.SLC5A1 homozygous IVS7-2 A ＞ G mutation was detected which confirmed the diagnosis of CGGM.With carbohydrate-free formula feeding,the body weight of the infant was increased.Followed up for 2 months now,her body length and body weight were at P25 and P22 on growth curve respectively,and no obvious neurological sequela was observed.Our literature review revealed 7 reports including 48 cases of CGGM children.Literature review showed that:most children with CGGM (79.2％) had the onset within 7 days of life;main clinical features included diarrhea (100％),dehydration (100％),and malnutrition (54.2％);22.9％ of patients with carbohydrate-free formula and 27.1％ with fructose matrix formula were fed well;no death was detected,77.1％ had normal weight gain,and 91.7％ had normal development of the nervous system.Conclusion CGGM is rare.The symptoms include severe watery and acidic stools with onset during neonatal period.CGGM is associated with severe complications such as hypertonic dehydration and hypernatremia.The diagnosis is established based upon typical clinical manifestations,sugar loading test and SLC5A1 gene detection.Carbohydrate-free formula feeding is effective.

Objective:To discover the epidemiological characteristics and clinical manifestations of Nontyphoidal Salmonella(NTS) infection in children suffering from diarrhea in Guangzhou, and to provide references for the prevention and treatment of salmonella infection. Methods:A total of 570 diarrhea children and 296 non-diarrhea controls were collected with stratified sampling from three districts of Guangzhou Women and Children′s Medical Center from January 2019 to December 2019. Through bacterial culture, corresponding colonies were selected and Salmonella diagnostic serum was applied for preliminary serum diagnosis, and then systemic biochemical method was adopted for diagnosis. A structured questionnaire was conducted to record the demographic information and clinical symptoms from each subject. Results:The detection rate of NTS was 6.67% (38/570 cases, 95% CI: 4.90%-9.02%) in children with diarrhea, and 1.01% (3/296 cases, 95% CI: 0.34%-2.93%) in children without diarrhea. There were statistically differences in NTS detection rate between children with diarrhea and the control ( χ2=13.805, P<0.05, OR=6.976, 95% CI: 2.135-22.796). There were no significant differences in NTS detection rate between male and female children with diarrhea ( χ2=0.395, P>0.05, OR=1.254, 95% CI: 0.619-2.541). The detection rate of NTS was 5.30% (22/416 cases, 95% CI: 3.52%-7.88%) in children younger than 2 years old, and was 10.40% (16/154 cases, 95% CI: 6.50%-15.21%) in children over 2 years old. There were statistically differences ( χ2=4.700, P<0.05, OR=2.076, 95% CI: 1.060-4.068) between the younger and the older groups.The detection rate of NTS was 5.40% (25/460 cases, 95% CI: 3.70%-7.89%) for children with diarrhea in outpatient department and 11.80% (13/110 cases, 95% CI: 7.04 %-19.18%) for children with diarrhea in inpatient department, with statistically significant differences ( χ2=5.813, P<0.05, OR=2.332, 95% CI: 1.152-4.721). The detection rate of NTS diarrhea in children was 4.60% (10/217 cases, 95% CI: 2.52%-8.28%) in spring, 8.50% (12/141 cases, 95% CI: 4.93%-14.29%) in summer, 9.60% (15/144 cases, 95% CI: 6.41%-16.48%) in autumn and 1.50% (1/168 cases, 95% CI: 0.11%-3.30%) in winter, respectively, with statistically differences among the four seasons( χ2=9.404, P<0.05). There were significant differences in most common clinical symptoms of fever, vomiting, abdominal pain, bloody stool and pasty stool between NTS positive and negative children(all P<0.05). Salmonella enteritis is the main type, and Salmonella typhimurium is the second type. Conclusions:NTS is one of the most important bacterial pathogens and leads to diarrhea in children in Guangzhou city, without differences in gender.Children over 2 years old are more likely to suffer from NTS infection.High incidence is in autumn.The most common clinical symptoms include fever, vomiting, abdominal pain, bloody stool and pasty stool. Salmonella enteritis is the main type, and Salmonella typhimurium is the second type.Laboratory tests can provide references for the diagnosis and treatment of NTS-related diarrhea.

Objective To investigate the expression and the possible clinical significance of serum Golgi protein(GP73)in infantile hepatitis syndrome(IHS)by different causes.Methods Totally 79 patients with IHS in Guangzhou Women and Children's Medical Center from February 2012 to December 2012 were enrolled in this study,including 15 cases with biliary atresia(BA)group,29 cases with infection(infection group),5 cases with neonatal intrahepatic cholestasis caused by citrin deficiency(NICCD group),and 30 cases with unknown etiology(idiopathic infantile hepatitis group).At the same time,30 healthy infants were enrolled as healthy control group.The serum levels of GP73 were determined by quantitative enzyme-linked immunosorbent assay(ELISA),and the children's liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),alkaline phosphatase(ALP),γ-glutamyl trans-peptidase(γ-GT),total bile acid(TBA)and albumin(ALB)] were measured by turbidimetric inhibition immuno assay.Then,the corresponding data were statistically analyzed.Results Serum GP73 in BA group,infection group,NICCD group,idiopathic infantile hepatitis group and the healthy control group were(296.6±67.5)μg/L,(185.1±66.4)μg/L,(199.2±87.1)μg/L,(181.7±74.2)μg/L and(65.3±17.0)μg/L,respectively.Serum γ-GT levels in BA group,infection group,NICCD group,idiopathic infantile hepatitis group and healthy control group were(764.7±775.8)U/L,(448.2±352.7)U/L,(239.4±88.7)U/L,(283.3±377.2)U/L and(54.0±72.6)U/L,respectively.The levels of GP73 and γ-GT were significantly higher in infants with IHS,and the levels of GP73 and γ-GT in infants with BA were the highest(F=46.775,9.238,all P<0.05).There was a positive correlation between serum levels of GP73 and γ-GT(r=0.280,P<0.05),and there was no correlation between GP73 and ALT,AST,TBIL,DBIL,ALP,TBA,ALB(r=-0.061,-0.071,0.164,0.123,0.137,0.008,-0.047,respectively,all P>0.05).The receiver operating characteristic curve(ROC)constructed with GP73 showed a sensitivity of 80.0％and specificity of 82.8％with an area under the receiver(AUC)of 0.872 for diagnosis of BA,comparatively,a sensitivity of 66.7％and specificity of 71.9％were showed with a AUC of 0.731 when performed with γ-GT.Conclusions Serum GP73 concentration significantly increased in all liver disease groups,regardless of the etiology.Serum GP73 expression is significantly higher in infants with BA.Serum GP73 shows a superior sensitivity and specificity to γ-GT for diagnosis of BA,which might be useful for early diagnosis of BA and IHS with different causes.

Objective To analyze the clinical, endoscopic and histopathological features of eosinophilic gastroenteritis ( EG) in children. Methods A retrospective study of 76 children with EG was performed to analyze clinical symptoms, laboratory and imaging results, endoscopic and pathological features, status of Helicobacter pylori ( H. pylori) infection, treatment and outcomes. Results The main clinical symptoms were abdominal pain in 55. 3%(42/76) cases, vomiting in 39. 5% (30/76) cases and hematochezia in 38. 2% cases( 29/76) . The hemoglobin level decreased significantly in 34 cases ( 44. 7%, 34/76). Peripheral blood eosinophil (EOS) count increased significantly in 9 cases (11. 8%,9/76) and EOS percentage increased significantly in 13 cases(17. 1%,13/76). Total serum IgE elevated in 32 cases ( 54. 2%, 32/59 ) . There were also 18 cases ( 36. 7%, 18/49 ) positive in serum allergen?specific immunoglobulin E ( sIgE) test and 25 cases ( 32. 9%,25/76) positive in fecal occult blood test. Among 51 cases of abdominal ultrasound examination, there were 7 cases of ascites, 4 cases of pelvis fluid and 3 cases of intestinal wall change. Endoscopic examination in 76 cases showed 63 cases ( 82. 9%) of mucosal hyperemia/edema,20 cases ( 26. 3%) of ulceration, 17 cases ( 22. 4%) of erosion, 11 cases ( 14. 5%) of nodularity or hyperplasia and 9 cases ( 11. 8%) of normal mucosa. The pathological examination showed mucosal inflammation with a large number of EOS infiltration(≥20 per HPF).There were 12 cases(15. 8%, 12/76) of H. pylori infection. Among the 76 cases, clinical symptoms improved significantly in 74 patients after treatment with dietary allergen avoidance, anti?allergy medications, antacids, montelukast and corticosteroid, and the total efficacy was 97. 4%. The efficacy of dietary allergen avoidance, anti?allergy medications, antacids and montelukast was 93. 8%( 61/65 ) . The efficacy of corticosteroid was 86. 7%(13/15). Conclusion The clinical manifestations and endoscopic characteristics of EG in children lack specificity. In terms of diagnosis, the elevated total serum IgE and the positive sIgE test may be taken as reference for the diagnosis of EG. The definite diagnosis is based on pathological examination ( EOS infiltration≥20 per HPF).While in terms of treatment, dietary allergen exclusion, anti?allergy medications, antacids and montelukast are highly effective, which can be taken as the first option. There is no need of corticosteroid as routine therapy.

Objective To assess the effect of Marzulene as an adjuvant therapy for peptic ulcer disease in children and the safety of Marzulene.Methods From Dec.2011 to Feb.2013,138 cases of peptic ulcer disease in children from Chongqing,Guiyang,Guangzhou,Chengdu and Xinjiang were randomly divided into trial group (n =75) and control group (n =63).The treatment protocls of the trial group was Marzulene combined with Omeprazole,and the control group gave Omeprazole only,all the cases with Helicobacter pylori (Hp) infection were treated by antibiotics,then clinical manifestations,gastroscopy and laboratory examinations were followed up after 8 weeks.Results The remission rates of clinical manifestations in the trial group were abdominal pain 91.8％ (56/61 cases),vomiting 90.2％(37/41 cases),melena 92.9％ (26/28 cases),nausea 93.1％ (27/29 cases),hematemesis 89.5％ (17/19 cases),abdominal discomfort 100.0％ (19/19 cases),abdominal distension 100.0％ (11/11 cases),sour regurgitation 100.0％ (9/9 cases),ozostomia 90.0％ (9/10 cases),eructaion 88.9 ％ (8/9 cases),bloody stools 100.0％ (4/4 cases),poor appetite 50.0％ (1/2 case),and abdominal tenderness 89.3 ％ (50/56 cases) ;the remission rates of clinical manifestations in the control group were abdominal pain 90.4％ (47/52 cases),vomiting 89.7％ (26/29 cases),melena 96.4％(27/28 cases),nausea 87.5 ％ (21/24 cases),hematemesis 92.9 ％ (13/14 cases),abdominal discomfort 58.3 ％ (7/12 cases),abdominal distension 85.7％ (12/14 cases),sour regurgitation 100.0％ (13/13 cases),ozostomia 80.0％(8/10 cases),eructaion 100.0％ (8/8 cases),bloody stools 100.0％ (4/4 cases),poor appetite 33.3％ (1/3 case),and abdominal tenderness 90.0％ (45/50 cases).Abdominal discomfort,abdominal distension,ozostomia,eructaion and poor appetite had significant statistical disparity between control group and trial group (P ＜ 0.05).One hundred and thirty-one cases reviewed gastroscopy,in the control group their ulcer clearance rate was 65.1％ (41/63 cases) ;the remission rates of gastroscopic manifestations were edema 54.8％ (34/62 cases),hyperemia 51.7％ (31/60 cases),areola 76.0％ (19/25 cases),atrophy 0％ (0/1 case),and hemorrhage 85.7％ (12/14 cases),the Hp clearance rate in the control group was 67.9％ (19/28 cases).In the trial group the ulcer clearance rate was 66.2％ (45/68 cases),and the remission rates of gastroscopic manifestation were edema 63.0％ (46/73 cases),hyperemia 64.7 ％ (44/68 cases),areola 86.1％ (31/36 cases),atrophy 50.0％ (1/2 case),and hemorrhage 100.0％ (19/19 cases) ;the Hp clearance rate in the trial group was 72.7％ (24/33 cases),and the remission rates of atrophy and hemorrhage had significant disparity between the control group and the trial group.The clinical effective rates of the trial and the control groups were 98.7％ (74/75 cases) and 98.4％ (62/63 cases),and the gastoscopic detection rates were 98.5％ (67/68 cases) and 96.8％ (61/63 cases).There was no adverse reaction in the trial group due to using marzulene for 8 weeks and 4 weeks' follow-up after its withdrawal.Conclusions Marzulene is helpful for improving the clinical and gastroscopic manifestations of peptic ulcer disease in children,and is effective and safe as an adjuvant therapy in children.

Enteral nutrition (EN) is the preferred method of clinical nutrition treatment for children.Different EN preparations and feeding methods were chosen according to the age and condition of the children.Breast milk is the best food for infants.For infants with intractable diarrhea after infection,using breast milk as enteral nutrition preparation can promote the recovery of the disease.Total enteral nutrition can be used as the preferred induction therapy for children with Crohn's disease.Individualized diets simulating the nutritional components of enteral nutrition preparations are also being studied.Early EN is not only safe for children with acute pancreatitis,but also can better reduce pain and shorten the average length of hospital stay.Gastrostomy can be considered in children with neurological impairment who need long-term EN.Early EN has been shown to reduce complications,hospital stay and improve prognosis in critically ill children.

Nutritional therapy is very important for critically ill children. Most children need to put nasogastric tube for enteral nutrition. Severe esophageal stricture, gastric compression, gastric retention and gastric outlet obstruction may require endoscopic catheterization; dysphagia caused by various reasons, or children who need long￣term catheterization for enteral nutrition,need percutaneous endoscopic gastrointesti￣nal stoma catheterization. Gastroscopy￣guided intubation is divided into nasal intubation of gastric tube,nasal intubation of jejunum tube and nasal intubation of three￣chamber gastrointestinal tube. Percutaneous endoscopic gastrointestinal stoma catheterization can be performed through gastrostomy,jejunostomy and duodenostomy. Choosing suitable catheterization method can help all kinds of critically ill children to establish enteral nutri￣tion pathway as soon as possible and promote recovery of illness.