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Yeh PJ, Chen CC, Chao HC, Lai JY, Ming YC, Chen MC, Lai MW. The trends of pediatric duodenal ulcer and predictors of recurrence. J Formos Med Assoc 2024:S0929-6646(24)00211-0. [PMID: 38644127 DOI: 10.1016/j.jfma.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/27/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Duodenal ulcer (DU) causes various symptoms in children. The prevalence of Helicobacter pylori (Hp)-associated DU has been reducing in some regions, yet the updated trend in Taiwan is unknown. Risk factors of DU recurrence have not been comprehensively investigated in children. METHODS This retrospective study included children diagnosed with DU to evaluate the demographics, symptoms, diagnostics, treatment, and outcomes. Specific populations (infant, surgery required) were sorted for subgroup analysis. Predictors of DU recurrence was analyzed in patients who received endoscopic follow-ups. RESULTS A total of 488 children were included. Most patients were male (72.5%), school-aged (11.3 ± 4.8 years old), and with varied underlying diseases in one-fifth. The annual incidences were around 3-5%, with a declining trend of case numbers and the Hp-positive proportion. Hp infection, concurrent gastric ulcer, perforation, and mortality were noted in 32.7%, 16%, 1.6%, and 1% of patients. Patients with or without Hp infection showed different clinical features but similar outcomes. The characteristics of subpopulations were depicted respectively. Male sex, lower Hb level, and perforation were independent risk factors associated with recurrence. CONCLUSIONS Hp-positive DU seems to wane. Patients with male sex, lower Hb level, or perforation at diagnosis carried a higher risk of recurrence, which may warrant active surveillance and endoscopic follow-up.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mi-Chi Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
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Chao HC. Reply to Verma et al. Comment on "Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093". Nutrients 2023; 16:136. [PMID: 38201965 PMCID: PMC10781039 DOI: 10.3390/nu16010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Your comment [...].
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Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan; ; Tel.: +886-3-3281200; Fax: +886-3-3288957
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
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Wang YW, Chao HC, Wang HS, Lin JL, Chang CC, Huang SF. Primary biliary cholangitis with features of autoimmune hepatitis in a 19-year-old adolescent with 14q24.1q24.2 deletion: a case report. Front Pediatr 2023; 11:1280409. [PMID: 38152650 PMCID: PMC10751923 DOI: 10.3389/fped.2023.1280409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Primary biliary cholangitis (PBC) is a rare and chronic autoimmune liver disease characterized by the progressive destruction of small intrahepatic bile ducts that may eventually lead to cirrhosis. PBC with features of autoimmune hepatitis (AIH) has rarely been reported in pediatric patients with genetic defects. We present the case of an adolescent with chromosome 14q24.1q24.2 deletion who was given the diagnosis of stage IV PBC with features of AIH. Case presentation A 19-year-old male adolescent with multiple congenital abnormalities and an intellectual disability presented with abnormal liver enzymes levels and pruritus for more than 5 years. Laboratory examinations revealed elevated levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase. After the exclusion of viral hepatitis, alpha-1 antitrypsin deficiency, Wilson's disease, and other genetic cholestatic liver diseases by laboratory tests and whole exome sequencing, a liver biopsy was performed and stage IV PBC was diagnosed. Notably, features of AIH were also noted in the histopathological report, indicating the presence of PBC with AIH features. The patient responded well to a combination therapy of ursodeoxycholic acid and steroids. Array comparative genomic hybridization analysis performed to study the congenital abnormalities revealed a 3.89 Mb 14q24.1q24.2 deletion. Conclusion PBC with AIH features has rarely been reported in an adolescent with a chromosomal abnormality. The present case can increase awareness for early-onset PBC and its possible correlation with chromosomal defects.
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Affiliation(s)
- Yi-Wei Wang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ju-Li Lin
- Division of Endocrine & Medical Genetics, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Chen Chang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shiu-Feng Huang
- Division of Molecular and Genomic Medicine, Department of Pathology, National Health Research Institute, Miaoli, Taiwan
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Hsieh CS, Lai MW, Chen CC, Chao HC, Wang CY, Wan YL, Zhou Z, Tsui PH. Quantitative ultrasound envelope statistics imaging as a screening approach for pediatric hepatic steatosis and liver fibrosis: using biomarker and transient elastography as reference standards. Heliyon 2023; 9:e22743. [PMID: 38213577 PMCID: PMC10782159 DOI: 10.1016/j.heliyon.2023.e22743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Quantitative ultrasound (QUS) envelope statistics imaging is an emerging technique for the assessment of hepatic steatosis in adults. Blood tests are currently recommended as the screening tool for pediatric hepatic steatosis, a condition that can lead to liver fibrosis in children. This study examined the utility of QUS envelope statistics imaging in grading biomarker-diagnosed hepatic steatosis and detecting liver fibrosis in a pediatric population. A total of 173 subjects was enrolled (Group A) for QUS envelope statistics imaging using two statistical distributions, Nakagami and homodyned K (HK) models, and information entropy. QUS parameter values were compared with the hepatic steatosis index (HSI) and steatosis grade (G0: HSI <30; G1: 30 ≤ HSI <36; G2: 36 ≤ HSI <41.6; G3: ≥41.6). An additional cohort of 63 subjects (Group B) was recruited to undergo both QUS envelope statistics imaging and liver stiffness measurements (LSM) obtained from the transient elastography (Fibroscan), with a cutoff value set at 5 kPa to indicate liver fibrosis. The diagnostic performances were evaluated using the area under the receiver operating characteristic curve (AUROC). QUS envelope statistics imaging generated the AUROC values for steatosis grading at levels ≥ G1, ≥ G2, and ≥ G3 ranged from 0.94 to 0.97, 0.91 to 0.93, and 0.83 to 0.87, respectively, and produced an AUROC range of between 0.82 and 0.84 for identifying liver fibrosis. QUS envelope statistics imaging integrates the benefits of both biomarkers and elastography, enabling the screening of hepatic steatosis and detection of liver fibrosis in a pediatric population.
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Affiliation(s)
- Chiao-Shan Hsieh
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Zhuhuang Zhou
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Po-Hsiang Tsui
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chao HC. Associations among body mass index, abdominal adiposity, and nonalcoholic fatty liver disease in children. Pediatr Neonatol 2023; 64:629-630. [PMID: 37839937 DOI: 10.1016/j.pedneo.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City 33302, Taiwan.
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Chang ES, Lai JY, Chen CC, Chao HC, Ting SY, Yeh PJ, Chen MC, Tseng WY, Lai MW. A rare emergent complication Following Roux-en-Y Hepatico(porto)jejunostomy in children with biliary tract anomalies. Pediatr Neonatol 2023; 64:681-685. [PMID: 37777363 DOI: 10.1016/j.pedneo.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/07/2023] [Accepted: 06/07/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- En-Shuo Chang
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Ya Ting
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pai-Jui Yeh
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mi-Chi Chen
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Yu Tseng
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Pediatrics, Jen Ai Hospital, Dali Branch, No. 483, Dongrong Rd., Dali Dist., Taichung City 412, Taiwan
| | - Ming-Wei Lai
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Chao HC. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023; 15:4093. [PMID: 37836377 PMCID: PMC10574543 DOI: 10.3390/nu15194093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
The benefits of zinc in treating certain gastrointestinal (GI) diseases have been recognized for over two decades. This review aims to explore zinc deficiency (ZD) and the potential therapeutic value and safety of zinc supplementation in pediatric GI diseases. A systematic review of published articles on ZD and zinc as adjuvant treatments for GI diseases was conducted using various databases. Children with inflammatory bowel disease (IBD), celiac disease, and those receiving long-term proton pump inhibitor treatments are particularly susceptible to ZD. ZD in children with celiac disease and IBD is attributed to insufficient intake, reduced absorption, and increased intestinal loss as a result of the inflammatory process. Zinc plays a crucial role in maintaining the integrity of the gastric mucosa and exerts a gastroprotective action against gastric lesions. Although considerable evidence supports the use of zinc as adjuvant therapy for certain GI diseases in adults, its use is unspecified in children except for infectious diarrhea. Current evidence suggests that zinc supplementation with well-documented dosages helps reduce the duration of diarrhea in children with acute or persistent diarrhea, while there are no specific guidelines for zinc supplementation in children with IBD and celiac disease. Zinc supplementation appears to be beneficial in peptic ulcer disease or gastroesophageal reflux disease. The available evidence highlights the need for intervention programs to enhance zinc status and reduce the morbidity of certain GI diseases in children.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan; ; Tel.: +886-3-3281200; Fax: +886-3-3288957
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
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Chang ES, Yeh PJ, Chen CC, Lai MW, Chao HC, Wu HK. Effect of the coronavirus disease 2019 pandemic on pediatric emergency department visits for acute gastroenteritis evaluated using a validated clinical severity score. Pediatr Neonatol 2023; 64:381-387. [PMID: 36581524 PMCID: PMC9758062 DOI: 10.1016/j.pedneo.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/26/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak that began in late 2019 has significantly affected quality of life and healthcare. Approaches to prevent the spread of COVID-19 have also affected the prevalence of other diseases. This retrospective review evaluated pediatric emergency department (PED) volume, in terms of children with acute gastroenteritis (AGE), and changes in AGE severity before versus during the COVID-19 pandemic in a tertiary medical center in Taiwan. METHODS Patients who visited the PED and were diagnosed with AGE during the 70-day COVID-19 lockdown in 2021, or the identical period in 2020, were compared using a clinically validated AGE severity score, the modified Vesikari score (MVS), and additional parameters. RESULTS During the COVID-19 outbreak, there was a 61.4% reduction in the number of children with AGE visiting the PED. In that period, the AGE severity score was similar compared to the pre-pandemic period (9.00 vs. 8.57, p = 0.273). The mean C-reactive protein (CRP) level (55.7 vs. 40.6 mg/L, p < 0.001) and rate of antibiotics use (48% vs. 23.5%, p < 0.001) were higher during the outbreak than the pre-pandemic period. CONCLUSION The number of children with AGE visiting the PED decreased during the COVID-19 outbreak, while disease severity was unchanged compared to the pre-pandemic period. The use of antibiotics during the COVID-19 pandemic warrants further investigation.
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Affiliation(s)
- En-Shuo Chang
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pai-Jui Yeh
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Kuan Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan.
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Tseng WY, Chao HC, Chen CC, Lai MW, Chang YJ. Adenovirus infection is a risk factor for recurrent intussusception in pediatric patients. Pediatr Neonatol 2023; 64:428-434. [PMID: 36641360 DOI: 10.1016/j.pedneo.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/24/2022] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Human adenoviruses are the most common pathogens to be isolated from cases of pediatric intussusception. However, the specific clinical characteristics of pediatric intussusception associated with adenovirus infection are poorly known. METHODS We reviewed the medical records of pediatric patients (≤18 years of age) with intussusception treated between January 2014 and December 2020. We enrolled patients with febrile episodes, 27 with and 29 without adenovirus infections (the latter serving as control group). The demographic data, clinical characteristics, and the diagnoses and management strategies were evaluated. RESULTS The adenovirus group exhibited a significantly longer febrile duration (4.3 ± 1.9 vs. 3.3 ± 1.1 days, p = 0.020) than the control group, with an odds ratio (OR) of 5.098 (95% confidence interval [CI] 1.223-21.254, p = 0.025). The recurrence rates were 48.1% and 13.8% in the two groups (OR 5.804; 95% CI: 1.585-21.245, p = 0.008). Most adenoviruses were non-enteric (85.2%). CONCLUSION Adenovirus-related intussusception is associated with a longer febrile period and a higher rate of intussusception recurrence. It is recommended that patients suspected of adenovirus-related intussusception should be observed for longer than others prior to discharge.
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Affiliation(s)
- Wen-Yu Tseng
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Yi-Jung Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
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Affiliation(s)
- Wan-Ju Yu
- Department of Pediatrics, Saint Paul's Hospital, 123, Jianxin Street, Taoyuan Dist., Taoyuan City, 33069, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
| | - Chuen Hsueh
- Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan; Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan
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Chen JC, Chao HC. Salvage for a child with concurrent tension pneumomediastinum and bilateral pneumothoraces. Pediatr Neonatol 2022; 63:206-208. [PMID: 34922850 DOI: 10.1016/j.pedneo.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/23/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Jeng-Chang Chen
- Department of Surgery, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
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Chao HC. Feeding difficulties and their treatment strategies in children with autism spectrum disorder. Pediatr Neonatol 2022; 63:1-2. [PMID: 34920964 DOI: 10.1016/j.pedneo.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan District, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
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Yeh PJ, Le PH, Chen CC, Chao HC, Lai MW. Application of Argon Plasma Coagulation for Gastrointestinal Angiodysplasia in Children- Experience From a Tertiary Center. Front Pediatr 2022; 10:867632. [PMID: 35450101 PMCID: PMC9016155 DOI: 10.3389/fped.2022.867632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Argon plasma coagulation (APC) has been applied in adults to treat various diseases, including vascular lesions in the gastrointestinal (GI) tract. However, angiodysplasia (AD) is an uncommon cause of pediatric GI bleeding, while the experience of treating AD with APC was rarely reported. METHODS Five children with AD in the GI tract successfully treated with APC were reviewed. RESULTS Three of the five patients were girls, and the age at diagnosis ranged from 1.5 months to 10.5 years of age. One patient with gastric AD manifested with tarry stool, and the rest had colonic AD, which caused various degrees of bloody stool. Three patients had evident anemia. All patients received an endoscopic diagnosis, and two had compatible findings in radiographic exams. Each patient underwent one APC treatment session, and none encountered procedure-related complications or re-bleeding. CONCLUSION AD can be an etiology of GI bleeding even in neonates. APC is an effective and safe therapy for symptomatic AD in children.
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Affiliation(s)
- Pai-Jui Yeh
- Linkou Branch, Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Puo-Hsien Le
- Linkou Branch, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan.,Linkou Branch, Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Linkou Branch, Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Linkou Branch, Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Linkou Branch, Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan.,Linkou Branch, Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chao HC, Lu JJ, Yang CY, Yeh PJ, Chu SM. Serum Trace Element Levels and Their Correlation with Picky Eating Behavior, Development, and Physical Activity in Early Childhood. Nutrients 2021; 13:nu13072295. [PMID: 34371805 PMCID: PMC8308333 DOI: 10.3390/nu13072295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Trace elements are vital components for healthy growth, development, and physical activity. The aim of this study was to investigate the relationship between trace element (iron, zinc, copper) deficiencies and picky eating behavior, development level, and physical activity level. This cross-sectional study involved 203 children aged 4-7 years; picky eating behavior, development level, and physical activity level were assessed through questionnaires. Zinc deficiency has the highest prevalence (37.4%); 67.5% of the children were assessed as picky eaters. Children with picky eating behaviors, poor development level, or poor physical activity level have significantly lower zinc levels, and higher prevalence of zinc deficiency. Pearson's correlation coefficient indicated a positive correlation between serum zinc level and development scores (r = 0.221, p = 0.002) and physical activity scores (r = 0.469, p < 0.001). In multivariate analysis, zinc deficiency independently related to picky eating (OR = 2.124, p = 0.037, CI = 1.042-4.312), developmental level (OR = 0.893, p = 0.022, CI = 0.810-0.984), and physical activity level (OR = 0.785, p < 0.001, CI = 0.700-0.879). In conclusion, the prevalence of zinc deficiency in children aged 4-7 was high, especially in picky eaters. Zinc deficiency was significantly associated with low development and poor physical activity in early childhood.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (J.-J.L.); (C.-Y.Y.); (S.-M.C.)
- Correspondence: ; Tel.: +886-3-3281200; Fax: +886-3-3288957
| | - Jang-Jih Lu
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (J.-J.L.); (C.-Y.Y.); (S.-M.C.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Chang-Yo Yang
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (J.-J.L.); (C.-Y.Y.); (S.-M.C.)
- Division of Neonatology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan;
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (J.-J.L.); (C.-Y.Y.); (S.-M.C.)
- Division of Neonatology, Department of Pediatrics, Chang Gung Children’s Medical Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
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15
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Chen MC, Chao HC, Yeh PJ, Lai MW, Chen CC. Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition. Front Pediatr 2021; 9:646395. [PMID: 33816405 PMCID: PMC8012528 DOI: 10.3389/fped.2021.646395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions. Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded. Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0-1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed. Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.
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Affiliation(s)
- Mi-Chi Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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16
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Yeh PJ, Chao HC, Chen CC, Lai JY, Lai MW. Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web-A 20-Year Experience of a Referral Center. Front Pediatr 2021; 9:753076. [PMID: 34970514 PMCID: PMC8712651 DOI: 10.3389/fped.2021.753076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antral web is a rare cause of gastric outlet obstruction in children. The presentation is diverse, depending on the degree of obstruction. Unfortunately, the guidance of management is still lacking. Methods: This study retrospectively evaluated the presentations, management, and outcomes of the pediatric antral web based on a 20-year experience in a referral center. Results: A total of 23 cases were included. The median age of diagnosis was 10 months (interquartile range, IQR, 0.8-23 months). Main presentations comprised vomiting (83%) and upper gastrointestinal (UGI) bleeding (48%). Concurrent gastric ulcers were common (68%). A total of 13 cases (57%) underwent interventional treatment. The median duration from diagnosis to intervention (DtI) was 10 days, but five with longer DtI, ranged from 30 to 755 days. Among the 15 cases with concurrent gastric ulcers, 10 patients received intervention, immediately in six but delayed in four. Surgical treatments (N = 12) achieved a cure in 11, with one rescued by endoscopic treatment. Conclusions: Children who suffer from early gastric ulcers with outlet obstruction shall raise the suspicion of the antral web. Complete obstruction madates early intervention. Around half of the cases with adequate feeding and growth need no intervention. Recurrent obstructive symptoms or adjacent ulcers justify a switch from observation to intervention to avoid complications or growth faltering.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
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17
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Chao HC, Lin HY. Comparison of Body Mass Index and Fat Indices in Predicting the Severity of Nonalcoholic Fatty Liver Disease Among Children Who Are Overweight and Obese. Front Pediatr 2021; 9:724426. [PMID: 34513769 PMCID: PMC8432615 DOI: 10.3389/fped.2021.724426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Information of the relationships between body mass parameters and the severity of fatty liver is deficient in pediatric nonalcoholic fatty liver disease (NAFLD). Methods: The relationships between body mass parameters (waist circumference [WC], body mass index [BMI], and abdominal subcutaneous fat thickness [ASFT]) and the severity of fatty liver were prospectively evaluated in pediatric patients who are overweight or obese, suffering from NAFLD. Ultrasonography was performed to assess fatty liver and its severity on a three-grade scale (low-grade fatty liver [LGFL], grade 1 or 2; high-grade fatty liver [HGFL], grade 3). Results: A total of 110 subjects (55 LGFL and 55 HGFL) aged 6.2-17.9 years were included. The WC, BMI, and ASFT values were significantly higher in the HGFL group compared to those in the LGFL group (p = 0.00004, 0.01, and 0.04, respectively). WC had the greatest power to predict HGFL under receiver-operating characteristic curve analyses and was positively correlated with the severity of fatty liver in subjects aged 6-12-year old and 13-17-year old (p = 0.007, and 0.0039, respectively). ASFT showed a positive correlation with the severity of fatty liver in subjects aged 13-17-year old (p = 0.04). Conclusions: WC, BMI, and ASFT are predictive of severe NAFLD among children who are overweight and obese; particularly, WC has the most predictive accuracy. Among the parameters, WC and ASFT are predictive in specific age groups.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hsin-Yeh Lin
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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18
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Yeh PJ, Chen CC, Chao HC, Lai JY, Hsueh C, Wang CJ, Lai MW. High initial bowel resection rate and very-early-onset inflammatory bowel disease - A challenge in a low-prevalence area. J Formos Med Assoc 2020; 120:720-727. [PMID: 32819795 DOI: 10.1016/j.jfma.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/15/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD). The incidence in children and adolescents has risen since the 21st century globally, including Taiwan. The study aimed to disclose the characteristics and outcome of pediatric IBD (pIBD) patients in a tertiary center for the past two decades. METHODS We retrospectively reviewed the charts of pIBD children from 2000 to 2018 in a tertiary center in Northern Taiwan. Demographics, presentations, diagnostic modalities, treatment, and outcomes were analyzed. RESULTS A total of 38 cases were enrolled, including 27 CD and 11 UC patients. An almost 3-folds increase in incidence after 2010 was observed. Twelve cases (32%) were early-onset, and six of them (16%) were very-early-onset; four of them were detected with single-gene mutations [XIAP, TTC7A (2 siblings), and ZAP70]. Eleven CD patients (40.7%) received bowel resection at the onset, and another two (7.4%) had bowel resection years after the diagnosis. Initial bowel resection was associated with fibrostenotic/penetrating behavior, early-onset disease, and growth failure. CONCLUSION This study demonstrated an increased incidence of pIBD in the past two decades in Taiwan, a low-prevalence region. The initial high bowel resection rate in CD was related to the fibrostenotic and/or penetrating behavior, younger age at diagnosis, and growth failure.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
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19
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Yeh PJ, Chen SH, Lai JY, Lai MW, Chiu CH, Chao HC, Chen SH, Wu RC, Wang CJ, Chen CC. Rare Cases of Pediatric Vasoactive Intestinal Peptide Secreting Tumor With Literature Review: A Challenging Etiology of Chronic Diarrhea. Front Pediatr 2020; 8:430. [PMID: 32850544 PMCID: PMC7419468 DOI: 10.3389/fped.2020.00430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022] Open
Abstract
Vasoactive intestinal peptide (VIP) secreting tumor (VIPoma) is a rare disease, presenting with profuse diarrhea, electrolyte imbalance, and possibly fatal outcome. The diagnosis and treatment are challenging, and no consensus guideline of management is available. The pediatric incidence remains unclear. This study comprises two pediatric case reports from a tertiary center and a literature-based case series investigating the characteristics among children. The two reported cases both presented with severe diarrhea and laboratory abnormalities, including electrolyte imbalance and elevated plasma VIP level. Case 1 received several imaging investigations, partial pancreatectomy, octreotide, and everolimus, reflecting her complicated and refractory course. Case 2 underwent total excision of suprarenal ganglioneuroblastoma, and the clinical response was significant. In both cases, varied degrees of symptomatic control, reduced plasma VIP level, and correction of electrolyte imbalance were achieved. A literature review-based case series analyzed 45 pediatric cases retrieved from the PubMed database until December 31, 2019. Demographics, clinical features, diagnostic modalities, treatments, and outcomes were presented.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hsin Chen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Yeh PJ, Chen CC, Lai MW, Yeh HY, Chao HC. Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center. Front Pediatr 2020; 8:111. [PMID: 32266189 PMCID: PMC7105830 DOI: 10.3389/fped.2020.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Liver abscess is an important but relatively rare disease in children. This study investigated the clinical characteristics of eligible patients at a referral tertiary center over the past two decades. Method: A 20-year retrospective study (January 2000-December 2019) enrolled 38 children diagnosed with liver abscess. Demographic data; clinical features; laboratory, imaging, and microbiological findings; management strategy; and outcomes were reviewed from the patients' medical records. Results: Thirty-eight cases of pyogenic liver abscess were identified without a culture-proven amebic or fungal abscess. The mean age of diagnosis was 9.6 ± 6.2 years, and the male-to-female ratio was 1.92: 1. Hemato-oncological (28.9%) and predisposing hepatobiliary diseases (23.7%) were the two most common predisposing factors. Fever (94.7%) was the most common presentation followed by right upper quadrant abdominal pain (42.1%) and pleural effusion (34.2%). Among the laboratory parameters, leukocytosis was common (70.3%), and all patients had elevated serum C-reactive protein levels. Increased serum levels of alanine aminotransferase, aspartate aminotransferase, direct bilirubin, and total bilirubin were found in 40.5, 48.6, 23.1, and 42.9% of the cases, respectively. The most common pathogen in blood and pus cultures was Klebsiella pneumoniae. The mean durations of intravenous antibiotic and total antibiotic use were 29.0 ± 15.7 and 45.1 ± 22.1 days, respectively. Twelve patients (31.6%) were treated with antibiotics alone, while percutaneous needle aspiration, percutaneous pigtail drainage, and surgical intervention were performed in 12 (31.6%), 10 (26.3%), and 5 (13.2%) patients, respectively. No mortality was documented in this series. Conclusion: The present study reflects a relatively declining incidence of liver abscess compared with prior studies in Taiwan. K. pneumoniae remains the most prevalent pathogen in both blood and abscess cultures in Taiwan. Proper antimicrobial therapy with timely drainage generally yielded an adequate treatment response without any mortality.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hung-Yu Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
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21
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Ming YC, Chao HC, Chu SM, Luo CC. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) protected intestinal ischemia-reperfusion injury through JNK and p38/MAPK-dependent pathway for anti-apoptosis. Pediatr Neonatol 2019; 60:332-336. [PMID: 30455099 DOI: 10.1016/j.pedneo.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Heparin-Binding Epidermal Growth Factor-Like Growth Factor (HB-EGF) is a potent cytoprotective factor in various body systems, including gastrointestinal tract. In this study, we intended to examine whether HB-EGF exerts its protective effects through MAPK dependent anti-apoptosis after intestinal I/R injury. METHODS We randomly divided 30 laboratory 30 rats into 5 groups: (A) normal control group, (B) ischemia group with normal saline, (C) I/R group with normal saline, (D) ischemia group with HB-EGF (400 ug/kg), and (E) I/R group with HB-EGF (400 ug/kg). With Western blotting study, we determined JNK and p38/MAPK pathway and caspase-3 activity protein levels using Western analyses. RESULTS The JNK phosphorylation protein levels increased after intestinal ischemia or intestinal reperfusion phase, and HB-EGF pre-treatment was significantly decreased in JNK phosphorylation protein levels (p < 0.01). We found that p38 protein levels was increased after intestinal reperfusion phase, and that HB-EGF pre-treatment significantly decreased p38 protein levels (p < 0.01). The expression protein level of caspase 3 was increased after intestinal ischemia or intestinal reperfusion phase. HB-EGF pre-treatment significantly decreased Caspase 3 proteins. (p < 0.01). CONCLUSION Our study revealed that pre-treatment of HB-EGF decreased the amount of activity of JNK and p38/MAPK pathway and caspase-3 protein after intestinal I/R injury. These results may further support that the cytoprotective of HB-EGF after I/R injury could be through anti-apoptotic effect of activity of JNK and p38/MAPK pathway.
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Affiliation(s)
- Yung-Ching Ming
- Division of Pediatric Surgery, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Cheng Luo
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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22
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Chang CH, Chao HC, Kong MS, Chen SY, Chen CC, Lai MW. Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation. Pediatr Neonatol 2019; 60:141-148. [PMID: 29793843 DOI: 10.1016/j.pedneo.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/18/2018] [Accepted: 04/30/2018] [Indexed: 11/15/2022] Open
Abstract
AIM The present study evaluates the long-term clinical and nutritional effect to endoscopic balloon dilatation (EBD) in pediatric esophageal stricture. METHODS This was a 15-year retrospective study involving pediatric patients with esophageal stricture treated with EBD. Outcome parameters included the number of dilatations, procedural success rates, nutritional status, and complications. EBD was performed in patients with a dysphagia score greater than 2. The nutritional status was assessed by weight-for-age z-score. Clinical success was defined as no requirement for EBD for at least 1 year and/or increasing interval between dilatation and the numbers of EBD was fewer than 4 times per year. RESULTS A total of 50 cases (mean age, 4.41 ± 4.9 years) were enrolled. During a mean follow-up of 3.2 ± 1.9 years, a total of 268 EBD sessions were performed, with an average of 5.36 sessions per patient (range, 1-33). Patients who had short segment stricture (<2 cm) were prone to achieve clinical success after EBD (p = 0.0094). Procedural perforation rate is 2.6% (7/268); subsequent tracheoesophageal fistula occurred in two patients. The clinical success rate of EBD therapy was 72% (36/50). All had increments of weight-for-age z-score after EBD therapy, and the increment was significantly greater in those patients with short segment stricture or stricture in the middle esophagus at 12 months (p = 0.01 and 0.008, respectively). CONCLUSIONS EBD has good long-term clinical success and nutritional promotion in pediatric patients with esophageal stricture, especially in short segment stricture or stricture in the middle esophagus.
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Affiliation(s)
- Chun-Hsiang Chang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
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Lin CC, Ni YH, Lin LH, Lau BH, Chao HC, Lee HC. Effectiveness of the IMFeD tool for the Identification and Management of Feeding Difficulties in Taiwanese children. Pediatr Neonatol 2018; 59:507-514. [PMID: 29422246 DOI: 10.1016/j.pedneo.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/14/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The Identification and Management of Feeding Difficulties (IMFeD™) tool was introduced in 2011 for management of children with feeding difficulties and has been used in various countries around the world. This study aimed to assess its acceptance and effectiveness in clinical practice in Taiwan. METHODS This was a prospective, observational, multicenter study where subjects were followed over 3 months. Outpatients identified as picky eaters, having poor appetite, poor weight gain, or weight loss were enrolled. The acceptance and effectiveness of IMFeD tool were evaluated by caregivers and pediatricians. RESULTS Among 423 children who completed the study (235 boys, 188 girls; 78.8% aged <5 years, 21.3% aged 6-10 years), the most common feeding difficulties were poor appetite in a fundamentally vigorous child (85.3%) and highly selective intake (70.2%). Mean percentiles for height and weight were 34.6 ± 25.3 and 20.3 ± 21.3 at enrolment, and increased by 5.4 and 5.9 (p < 0.0001) at the last visit, respectively. Most caregivers (86.5%) thought that the IMFeD tool helped them to understand and better identify picky eating behaviors. Pediatricians reported that the IMFeD tool was effective in 99.3% of patients for managing picky eaters in clinical practice. CONCLUSIONS The IMFeD tool was effective in addressing differences in needs according to type of feeding difficulty by providing a systematic approach to manage feeding difficulty in Taiwanese children. It is applicable to the clinical practice and well-accepted by pediatricians and caregivers.
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Affiliation(s)
- Chieh-Chung Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Lung-Huang Lin
- Department of Pediatrics, Cathay General Hospital, Taiwan; School of Medicine, Fu Jen Catholic University, Taiwan
| | - Beng-Huat Lau
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Hsun-Chin Chao
- Department of Pediatrics, Chang Gung Memorial Hospital, Taiwan
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children's Hospital, Taiwan.
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Chao HC, Chang CH, Chan OW. Multiple magnets trapped at the esophagogastric junction of a child. Pediatr Neonatol 2018; 59:205-207. [PMID: 28802629 DOI: 10.1016/j.pedneo.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/04/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan.
| | - Chun-Hsiang Chang
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan
| | - Oi-Wa Chan
- Division of Critical Care Medicine, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan
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Chao HC, Chang YJ, Huang WL. Cut-off Serum Zinc Concentration Affecting the Appetite, Growth, and Nutrition Status of Undernourished Children Supplemented With Zinc. Nutr Clin Pract 2018; 33:701-710. [DOI: 10.1002/ncp.10079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hsun-Chin Chao
- Division of Pediatric Gastroenterology; Department of Pediatrics; Chang Gung Children's Medical Center; Chang Gung Memorial Hospital; Taoyuan City Taiwan
- Chang Gung University College of Medicine; 5 Fu-Hsing Street, Gueishan District Taoyuan City Taiwan
| | - Yi-Jung Chang
- Chang Gung University College of Medicine; 5 Fu-Hsing Street, Gueishan District Taoyuan City Taiwan
- Division of Pediatric General Medicine; Department of Pediatrics; Chang Gung Children's Medical Center; Chang Gung Memorial Hospital; Taoyuan City Taiwan
| | - Wan-Ling Huang
- Chang Gung University College of Medicine; 5 Fu-Hsing Street, Gueishan District Taoyuan City Taiwan
- Department of Nutritional Therapy; Chang Gung Memorial Hospital; Taoyuan City Taiwan
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Yeh HY, Chao HC, Chen SY, Chen CC, Lai MW. Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study. Front Pediatr 2018; 6:172. [PMID: 29946536 PMCID: PMC6006757 DOI: 10.3389/fped.2018.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time. Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time. Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively. Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.
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Affiliation(s)
- Hung-Yu Yeh
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yen Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chao HC. Association of Picky Eating with Growth, Nutritional Status, Development, Physical Activity, and Health in Preschool Children. Front Pediatr 2018; 6:22. [PMID: 29484290 PMCID: PMC5816267 DOI: 10.3389/fped.2018.00022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the prevalence of picky eating among preschool children and to evaluate the association between eating behavior and growth, physical activity, development, and health status. METHODS A structured questionnaire was used to conduct a cross-sectional descriptive study of 300 primary caregivers of children aged 2-4 years in Taiwan. Data collected included: demographics, food preferences, eating behavior, body weight, and height, development, physical activity, and records of medical illness. Data from children defined as picky or non-picky eaters based on parental' questionnaire responses were analyzed and compared using standard statistical tests. RESULTS The mean age of the children was 2.95 years; 162 (54%) were picky eaters. Compared with non-picky eaters, z-score of weight-for-age, height-for-age, and body mass index (BMI)-for-age in picky eaters was 0.91, 0.73, and 0.44 SD lower, respectively. There were significant differences of rates in the weight-for-age, height-for-age, and BMI-for-age percentiles <15, between picky and non-picky eaters (P = 0.04, 0.023, and 0.005, respectively). Fear of unfamiliar places, poor physical activity, constipation, and high frequency (>2 times in the past 3 months) of medical illness were significantly higher in picky eaters (P = 0.01, 0.001, 0.044, and <0.001, respectively). CONCLUSION The prevalence of picky eaters in preschool children was high, resulting in significant detrimental impacts on growth, nutritional status, development, physical activity, and health status.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Lu YA, Chiu CH, Kong MS, Wang HI, Chao HC, Chen CC. Risk factors for poor outcomes of children with acute acalculous cholecystitis. Pediatr Neonatol 2017; 58:497-503. [PMID: 28499592 DOI: 10.1016/j.pedneo.2016.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/13/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is generally considered to be a mild disease in children; however, if left untreated or treated without caution, AAC can lead to severe outcomes, such as death. The objectives of this study were to present the clinical features and identify the predictors of mortality in pediatric AAC. METHODS Patients diagnosed with AAC between 2005 and 2012 were enrolled. AAC was defined by the presence of fever and an echo-proven thickened gallbladder wall exceeding 4 mm. A poor health outcome was defined as death. Further information related to the demographics, clinical manifestations, laboratory results, ultrasound findings, and pathogens present in the AAC patients was also collected. Predictors of mortality were identified by association analyses and confirmed by multivariate logistic regression. RESULTS A total of 147 pediatric AAC patients (male/female = 1.01, mean age = 5.2 years) were included in this retrospective study. The most common clinical presentation was an elevated C-reactive protein level (84%) followed by hepatomegaly (80%) and anorexia (78%). AAC in children was associated with various diseases, including infectious diseases (70%), systemic diseases (13%), and malignancy (11%). Fourteen of the 147 (9.25%) patients died during the study period. The presences of thrombocytopenia, anemia, gallbladder sludge, hepatitis, and/or sepsis plus hepatitis were found to be the important predictors of AAC mortality. CONCLUSIONS The factors associated with AAC mortality were anemia, thrombocytopenia, gallbladder sludge, hepatitis, and sepsis plus hepatitis. These predictors are likely to help clinicians identify patients who are at a high risk of poor prognoses and make appropriate clinical decisions.
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Affiliation(s)
- Yi-An Lu
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Disease, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-I Wang
- Department of Health Sciences, University of York, York, England, UK
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Luo CC, Chien WK, Huang CS, Lo HC, Wu SM, Huang HC, Chen RJ, Chao HC. Trends in diagnostic approaches for pediatric appendicitis: nationwide population-based study. BMC Pediatr 2017; 17:188. [PMID: 29100501 PMCID: PMC5670701 DOI: 10.1186/s12887-017-0940-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/30/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To define the benefits of different methods for diagnosis of pediatric appendicitis in Taiwan, a nationwide cohort study was used for analysis. METHODS We identified 44,529 patients under 18 years old who had been hospitalized with a diagnosis of acute appendicitis between 2003 and 2012. We analyzed the percentages of cases in which ultrasound (US) and/or computed tomography (CT) were performed and non-perforated and perforated appendicitis were diagnosed for each year. Multivariate logistic regression analyses were performed to evaluate risk factors for perforated appendicitis. RESULTS There were more cases of non-perforated appendicitis (N = 32,491) than perforated appendicitis (N = 12,038). The rate of non-perforated cases decreased from 0.068% in 2003 to 0.049% in 2012; perforated cases remained relatively stable at 0.024%~0.023% from 2003 to 2012. The percentage of CT evaluation increased from 3% in 2003 to 20% in 2012; the rates of US or both US and CT evaluations were similar annually. The percentage of neither CT nor US evaluation gradually decreased from 97% in 2003, to 79% in 2012. The odds ratios of a perforated appendix for those patients diagnosed by US, CT, or both US and CT were 1.227 (95% confidence interval (CI) 0.91, 1.65; p = 0.173), 2.744 (95% CI 2.55, 2.95; p < 0.001), and 5.062 (95% CI = 3.14, 8.17; p < 0.001), respectively, compared to patients who did not receive US or CT. The odd ratios of a perforated appendix for those patients 7-12 and ≤6 years old were 1.756 (95% CI 1.67, 1.84; p < 0.001) and 3.094 (95% CI 2.87, 3.34; p < 0.001), respectively, compared to those 13-18 years old. CONCLUSIONS Our study demonstrated that using CT scan as a diagnostic tool for acute appendicitis increased annually; most patients especially those ≤6 years old who received CT evaluation had a greater risk of having perforated appendicitis. We recommend a prompt appendectomy in those pediatric patients with typical clinical symptoms and physical findings for non-complicated appendicitis to avoid the risk of appendiceal perforation.
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Affiliation(s)
- Chih-Cheng Luo
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei City, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Wen-Kuei Chien
- Biostatistics Center, Taipei Medical University, Taipei City, Taiwan
| | - Chen-Sheng Huang
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei City, Taiwan
| | - Hung-Chieh Lo
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Department of Traumatology, Wan Fang Hospital, Taipei City, Taiwan
| | - Sheng-Mao Wu
- Department of Traumatology, Wan Fang Hospital, Taipei City, Taiwan
| | - Hung-Chang Huang
- Department of Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan.
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Tsai HY, Chao HC, Yu WJ. Early appendectomy shortens antibiotic course and hospital stay in children with early perforated appendicitis. Pediatr Neonatol 2017; 58:406-414. [PMID: 28254405 DOI: 10.1016/j.pedneo.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/10/2016] [Accepted: 09/20/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The optimal management of perforated appendicitis in the pediatric population has been controversial. This study aimed to compare the therapeutic efficacy between conservative treatment (CS) and early appendectomy (EA) in pediatric perforated appendicitis, and to determine whether surgical intervention is an optimal treatment modality for early perforated appendicitis in children. METHODS Patients treated between January 2012 and April 2014, aged 0-18 years, with an imaging-based diagnosis of perforated appendicitis were retrospectively reviewed. Patients were classified into nonabscess and abscess groups by image findings, and were further categorized into CS and EA groups by treatment modality. Early perforated appendicitis was defined as having duration of symptoms≤7 days, C-reactive protein level≤200 mg/L, maximum abscess diameter≤5 cm, and absence of general peritonitis, and unstable vital signs. The clinical features and therapeutic outcomes were compared between CS and EA in each group. RESULTS A total of 326 patients had confirmed appendicitis, including 116 patients with an image diagnosis of perforation. The CS group had a significantly longer duration of symptoms, larger abscesses, and higher serum C-reactive protein levels at presentation (all p<0.05). Patients in the EA group had a shorter antibiotic course and length of hospitalization, and a lower rate of antibiotic escalation than those in the CS group (p<0.001, p<0.001, and p<0.05, respectively). In patients with early perforated appendicitis, the CS and EA groups showed no difference in baseline disease severity. Patients in the EA group also had a shorter antibiotic course and length of hospitalization than those in the CS group (p<0.001 and p<0.001, respectively). CONCLUSION Compared with CS, EA shortens the antibiotic course and hospital stay in pediatric early perforated appendicitis, even in the presence of small abscesses.
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Affiliation(s)
- Hsin-Yu Tsai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
| | - Wan-Ju Yu
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
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Chang YJ, Yan DC, Lai JY, Chao HC, Chen CL, Chen SY, Tsai MH. Strangulated small bowel obstruction in children. J Pediatr Surg 2017; 52:1313-1317. [PMID: 28318600 DOI: 10.1016/j.jpedsurg.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Diagnosing intestinal strangulation as a complication of small bowel obstruction (SBO) remains a considerable challenge in children. We evaluated the clinicoradiological parameters for predicting the presence of a strangulated intestine. METHODS We reviewed the medical records of 69 pediatric patients who underwent operation for acute SBO. Regression analysis was used to identify the parameters for predicting strangulated SBO. RESULTS Of the 69 patients with SBO, 27 patients had intestinal strangulation and were awarded one point each towards the overall clinical score: intractable continuous abdominal pain, tachycardia, white blood cell count >13,600/mm3, and abdominal distention. Patients with a clinical score ≥2 combined with the presence of ascites in ultrasound (US) results or with wall thickness and reduced wall contrast enhancement in abdominal computed tomography (CT) scans showed strong evidence for intestinal strangulation. CONCLUSION The combination of two or more clinical parameters, including intractable continuous abdominal pain, tachycardia, leukocytosis, and abdominal distention with the presence of ascites in US or wall thickness and reduced wall contrast enhancement in, is useful for the identification of strangulated SBO. THE TYPE OF STUDY AND LEVEL OF EVIDENCE Prognosis study; Level III.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Dah-Chin Yan
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Pediatric Surgery, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Yen Chen
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Han Tsai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.
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Chen CL, Chao HC, Kong MS, Chen SY. Risk Factors for Prolonged Hospitalization in Pediatric Appendicitis Patients with Medical Treatment. Pediatr Neonatol 2017; 58:223-228. [PMID: 27477876 DOI: 10.1016/j.pedneo.2016.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND With effective antibiotics against enteric flora and computed tomography-guided drainage for abscesses, the initial use of nonoperative therapy for children with appendicitis has increased both in recent reports and at our hospital. However, it has been reported that these patients have a relatively longer hospital stay and that their treatment is more expensive than those who undergo aggressive surgical intervention. METHODS This was a retrospective cohort study based in a single medical center. A systemic chart review was conducted to identify risk factors for prolonged hospitalization in pediatric appendicitis patients not initially undergoing surgical treatment. Patient demographics, clinical symptoms, duration of symptoms, laboratory findings, imaging findings, complications, and length of hospital stay were analyzed. Logistic regression analysis was used to identify significant predictors of prolonged hospitalization (≥15 days) and readmission. RESULTS One hundred and twenty-five patients were recruited in this study, of whom 53 (42.4%) had prolonged hospitalization. The values of serum C-reactive protein (CRP) were significantly higher in patients with prolonged hospitalization compared with those without prolonged hospitalization (203 ± 108.6 mg/L vs. 140 ± 93.0 mg/L, p = 0.001). Risk factors of prolonged hospitalization were serum CRP >150 mg/L (35/53 vs. 28/72, p = 0.001), abscess formation (38/53 vs. 35/72, p = 0.008), and multiple abscesses (10/53 vs. 1/72, p = 0.001). Under multivariate analysis, CRP >150 mg/L (odds ratio=1.004, p = 0.0334) and multiple abscesses (odds ratio = 8.788, p = 0.044) were two independent predictors for prolonged hospitalization. CONCLUSION Marked elevation of serum CRP (>150 mg/L) and multiple abscesses are two independent risk factors for prolonged hospitalization in children with appendicitis who are initially treated nonoperatively.
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Affiliation(s)
- Ching-Lun Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
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Chao HC, Chang HL. Picky Eating Behaviors Linked to Inappropriate Caregiver-Child Interaction, Caregiver Intervention, and Impaired General Development in Children. Pediatr Neonatol 2017; 58:22-28. [PMID: 27215475 DOI: 10.1016/j.pedneo.2015.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/15/2015] [Accepted: 11/25/2015] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To investigate the differences in eating behaviors between picky and nonpicky eaters, and to correlate parental management of children's eating problems with qualities of general development in children. METHODS This was a cross-sectional analysis of parental observations on their children's eating behavior, sampled from three major cities in Taiwan. We used a structured questionnaire during face-to-face interviews to collect information on each child's picky eating habits and behaviors, caregiver-child interaction and intervention during feeding, and the child's qualities of general development. Analysis of variance was used to determine significant differences between picky and nonpicky eaters. RESULTS Sixty-two percent of the children were considered to be picky eaters. Lack of appropriate caregiver-child interactions (e.g., repeated food attempt, persuasion, and encouragement) and the presence of inappropriate parental interactions (e.g., threatening, snacking, and nutrient supplementation) were significantly more common in picky eaters. Picky eaters also tended to exhibit low development quality in the domains of learning ability, interpersonal relationships, and physical performance, particularly in their attention span and uncooperativeness. CONCLUSION There is a relationship between inappropriate parental interaction and interventions in children's eating problems and the low quality of general development in picky eaters.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Hsueh-Ling Chang
- Division of Pediatric Psychiatry, Department of Psychiatry, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Chao HC. Update on endoscopic management of gastric outlet obstruction in children. World J Gastrointest Endosc 2016; 8:635-645. [PMID: 27803770 PMCID: PMC5067470 DOI: 10.4253/wjge.v8.i18.635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/18/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.
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Yang W, Lai JY, Chao HC, Hsueh C. Gallbladder teratoma and a review of the literature. Pediatr Neonatol 2015; 56:134-5. [PMID: 25458641 DOI: 10.1016/j.pedneo.2014.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/02/2014] [Accepted: 06/30/2014] [Indexed: 01/15/2023] Open
Affiliation(s)
- Wendy Yang
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan.
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan
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Chen SY, Feng Y, Chao HC, Lai MW, Huang WL, Lin CY, Tsai CN, Chen CL, Chiu CH. Emergence in Taiwan of novel norovirus GII.4 variants causing acute gastroenteritis and intestinal haemorrhage in children. J Med Microbiol 2015; 64:544-550. [PMID: 25752853 DOI: 10.1099/jmm.0.000046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
Norovirus is the leading cause of viral gastroenteritis globally. Norovirus genotype GII.4 is responsible for the majority of outbreaks, but new variants are continuously emerging. The objective of the study was to delineate the clinical manifestations and complications associated with these new norovirus GII.4 variants in children. We investigated norovirus infections from the community outbreak in October 2011-September 2012 and an earlier outbreak in 2006-2007, in northern Taiwan. Norovirus genotypes and their variants were validated using molecular methods. A norovirus outbreak started in mid-2011 and continued through 2012 in northern Taiwan. Hospitalized children infected by norovirus in 2012 showed a significantly higher incidence of intestinal haemorrhage, as indicated by grossly bloody faeces (P=0.012) and occult blood in faeces (P < 0.001), and also presented with more high fever >39 °C (P < 0.001), fever >38.5 °C (P < 0.001) and fever of any temperature >38 °C (P < 0.001), compared with children hospitalized in 2006-2007. Analysis of 20 near-full-length genome sequences indicated an emergence of GII.4 2012 variants in 2011-2012. Circulating noroviruses can be divided into two clusters: GII.4 2012a, which is identical to the newly reported strain GII.4 Sydney 2012, and GII.4 2012b, which is close to GII.4 2006b, the earlier predominant strain. The emerging new variants of norovirus GII.4 caused a distinct clinical syndrome of acute gastroenteritis with severe fever and a high rate of intestinal haemorrhage in children. The genetic diversity associated with changing clinical manifestations poses major obstacles to norovirus control.
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Affiliation(s)
- Shih-Yen Chen
- Division of Pediatric Gastroenterology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Ye Feng
- Institute for Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Wen-Ling Huang
- Division of Pediatric Gastroenterology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Chun-Yuan Lin
- Department of Computer Science and Information Engineering, Chang Gung University College of Engineering, Taoyuan, Taiwan, ROC
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.,Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
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Abstract
BACKGROUND Intussusception is the common acute abdomen in children with difficult clinical diagnosis. The routine ultrasound has recently been proposed as the initial diagnostic modality with high accuracy, but is not available for 24 h by gastroenterologists. We aimed to evaluate the validation of bedside ultrasound for intussusceptions performed by pediatric emergency physicians with ultrasound training during the night or holiday. METHODS A retrospective study was conducted in children with suspected intussusceptions when routine ultrasounds by gastroenterologists were not available over the period from July 2004 to July 2008. Patients were divided into two groups: those diagnosed by emergency physicians with ultrasound training and without training. The clinical characteristics and course for all patients were reviewed and compared for seeking the difference. RESULTS A total of 186 children were included. One hundred and thirteen (61%) children were diagnosed by pediatric emergency physician with ultrasound training. The clinical symptoms were not statistically different between the two groups. The diagnostic sensitivity of the ultrasound training group was significantly higher (90% vs. 79%, p = 0.034). Children of the training group also had significantly shorter hospital stay duration at emergency departments before reduction (2.41 ± 2.01 vs. 4.58 ± 4.80 h, p = 0.002). CONCLUSION Bedside ultrasound performed by pediatric emergency physicians with ultrasound training is a sensitive test for detecting intussusceptions. Knowledge and use of bedside ultrasound can aid the emergency physician in the diagnosis of pediatric intussusceptions with less delay in treatment.
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Affiliation(s)
- Yi-Jung Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tauyuan, Taiwan
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Chao HC, Chen CC, Chen SY, Chiu CH. Bacterial enteric infections in children: etiology, clinical manifestations and antimicrobial therapy. Expert Rev Anti Infect Ther 2014; 4:629-38. [PMID: 17009942 DOI: 10.1586/14787210.4.4.629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bacterial enteric infections have a huge impact on human health, particularly among the pediatric population. Despite the explosion of knowledge of the pathogenesis of bacterial enteric infections experienced in the past decade, the number of diarrheal episodes and childhood deaths reported continues to increase in many areas of the world. Specific antimicrobial therapy is indicated for certain confirmed infections, notably shigellosis, enterotoxigenic and enteroinvasive Escherichia coli infections, typhoid fever and cholera. Antimicrobial therapy may have a role in severe and prolonged gastrointestinal illness caused by nontyphoid Salmonella and Campylobacter. However, the use of antimicrobial agents may increase the risk of hemolytic uremic syndrome in children with E. coli O157:H7 infection. Bacterial genome sequencing and better understanding of the pathogenic mechanisms involved in the onset of diarrhea are leading to new preventive interventions, such as enteric vaccines, which may have a significant impact on the magnitude of this human plague.
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Affiliation(s)
- Hsun-Chin Chao
- Chang Gung Children's Hospital, Division of Pediatric Infectious Diseases, Department of Pediatrics, 5 Fu-Hsin Street, Kweishan 333, Taoyuan, Taiwan
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Chang YJ, Chao HC, Wang CJ, Lo WC, Yan DC. Evaluating pediatric intussusception using 24-hour ultrasound. Pediatr Neonatol 2013; 54:235-8. [PMID: 23597532 DOI: 10.1016/j.pedneo.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/21/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Although ultrasound is often the preferred pediatric imaging modality for the evaluation of intussusception in children, many institutions lack access to ultrasound at night. This study characterized the day- and nighttime use of radiographic imaging for evaluation of intussusception. METHODS The charts of pediatric patients evaluated for intussusception between January 2010 and December 2010 were reviewed retrospectively to evaluate the day- and nighttime use of radiographic imaging. Patients were stratified into day and night groups according to when the imaging studies were performed, and differences in the clinical characteristics, imaging studies, cost, and final diagnosis were compared. RESULTS Pediatric consultations were performed for 86 suspected intussusceptions: 40 (46.5%) during the day [38 (95%) ultrasounds and 33 (82.5%) plain abdominal X-rays] and 46 at night [3 (6.5%) computed tomography and 39 (84.7%) plain abdominal X-rays]. The rate of positive enemas was significantly higher during the day than at night (97.5% vs. 52.2%, p < 0.001). The radiation dose during the initial survey was significantly lower during the day than at night (0.63 ± 0.48 vs. 2.06 ± 1.48 mSv, p < 0.001). CONCLUSION Radiographic imaging at night results in higher radiation exposure and negative enema findings. Twenty-four-hour ultrasound availability would decrease the radiation exposure and unnecessary enemas for intussusceptions suspected clinically.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Tauyuan, Taiwan
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Hua MC, Chao HC, Yao TC, Lai MW, Huang JL. Investigation of interleukin-10 promoter polymorphisms and interleukin-10 levels in children with irritable bowel syndrome. Gut Liver 2013; 7:430-6. [PMID: 23898383 PMCID: PMC3724031 DOI: 10.5009/gnl.2013.7.4.430] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/30/2012] [Accepted: 10/31/2012] [Indexed: 12/15/2022] Open
Abstract
Background/Aims The aim of this study was to investigate whether genetic variations at positions -1082, -819, and -592 in the interleukin (IL)-10 promoter affect IL-10 production in children with irritable bowel syndrome (IBS). Methods Ninety-four children with IBS and 102 children as healthy controls (HCs) were enrolled. Genomic DNA was extracted, and IL-10 -1082, -819, and -592 polymorphisms were detected by direct sequencing from all participants. Peripheral blood mononuclear cells (PBMCs) from 46 IBS children and 38 HCs were isolated and cultured with and without 5 ng/mL Escherichia coli lipopolysaccharide (LPS). IL-10 levels in the culture supernatants were measured by enzyme-linked immunosorbent assay. Results There were no significant differences in the distribution of IL-10 -1082, -819, and -592 polymorphisms or in the allele and haplotype frequencies between IBS children and HCs. PBMCs from children with IBS had significantly lower IL-10 levels after LPS stimulation than PBMCs from HCs (p=0.011); however, LPS-induced IL-10 levels in PBMCs with different genotypes of -819 and -592 polymorphisms were not significantly different between IBS patients and HCs. Conclusions Although significantly lower LPS-induced IL-10 production by PBMCs was noted, it is unlikely that IL-10 production was fully genetically determined in our IBS children. ClinicalTrials.gov identifier: NCT01131442.
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Affiliation(s)
- Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan. ; Department of Pediatrics, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Lee SY, Ng KY, Liu H, Chao HC. Evolution of beam distribution in crossing a Walkinshaw resonance. Phys Rev Lett 2013; 110:094801. [PMID: 23496717 DOI: 10.1103/physrevlett.110.094801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Indexed: 06/01/2023]
Abstract
The third-integer coupling resonance at ν(x)-2ν(z)=ℓ, known as the Walkinshaw resonance, is important in high-power accelerators. We find that, when the betatron tunes ramp through a Walkinshaw resonance the fractional emittance growth (FEG) is a universal function of the effective resonance strength: G(1,-2,ℓ)√[ε(xi)]|Δ(ν(x)-2ν(z))/Δn|(-1/2), where G(1,-2,ℓ) is the resonance strength; ε(xi) and ε(zi) are the initial horizontal and vertical emittances, respectively; and |Δ(ν(x)-2ν(z))/Δn| is the resonance crossing rate per revolution. At large effective resonance strengths, the FEG reaches an asymptotic maximum value (FEG)(max)~2ε(xi)/ε(zi) for ε(xi)>>1/2ε(zi) or ε(zi)/(2ε(xi)) for ε(xi)<<1/2ε(zi). There is little emittance exchange at ε(xi)=1/2ε(z), which can be used to minimize emittance growth in crossing a Walkinshaw resonance.
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Affiliation(s)
- S Y Lee
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
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Chao HC, Chang KW, Wang CJ. Intestinal obstruction caused by potato bezoar in infancy: a report of three cases. Pediatr Neonatol 2012; 53:151-3. [PMID: 22503265 DOI: 10.1016/j.pedneo.2012.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/29/2011] [Accepted: 03/30/2011] [Indexed: 11/30/2022] Open
Abstract
We present a report of three young infants with unusual intestinal obstruction caused by potato bezoar. They presented with vomiting, irritable crying, and abdominal distention. Barium gastrointestinal series clearly revealed intraluminal filling defect in the duodenum in two cases and ileum in one. Those bezoars in the pylorus and duodenal bulb were all successfully retrieved endoscopically. The patient's abdominal symptoms subsided after the bezoars were eliminated; no subsequent gastrointestinal events occurred in the following months. The authors believe that the occurrence of these cases suggest that feeding mashed potato to young infants (≤4 months) should be prohibited because it can result in bezoar formation.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Yu TH, Tsai CN, Lai MW, Chen CC, Chao HC, Lin CW, Chiu CH, Chen SY. Antigenemia and cytokine expression in rotavirus gastroenteritis in children. J Microbiol Immunol Infect 2011; 45:265-70. [PMID: 22169122 DOI: 10.1016/j.jmii.2011.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/06/2011] [Accepted: 08/10/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antigenemia is commonly found in children with rotavirus infection, although its clinical significance is undetermined. The aim of this study was to evaluate the association of antigenemia with clinical manifestations and cytokine profiles in children infected by rotavirus. METHODS In total, 68 children hospitalized with rotavirus gastroenteritis were enrolled. Serum samples were collected for detection of antigenemia and viremia. Clinical, laboratory and demographic data were analyzed. Proinflammatory, Th1 and Th2 cytokines were evaluated by bead-based flow cytometry. RESULTS Antigenemia and viremia were found in 45.6% (n = 31) and 5.9% (n = 4) of the 68 rotavirus-infected children, respectively. The mean age of the antigenemia group was significantly greater than that of the non-antigenemia group (43.5 vs. 27.3 months; p = 0.034). The antigenemia group had a significantly shorter length of hospitalization (4.8 vs. 5.8 days; p = 0.0354) in comparison with the non-antigenemia group, and antigenemia was inversely associated with the length of hospitalization (β = 0.31, p = 0.021). A significantly higher tumor necrosis factor (TNF)-β level was found in the patients with antigenemia than those without (236.7 vs. 29.2 pg/mL, p = 0.026). The severity of disease and the rate of extra-intestinal manifestations did not differ between the groups. Viremia was associated with a higher fever (p = 0.012). CONCLUSIONS Antigenemia was positively correlated with shorter hospital stay in children with rotavirus infection. Enhanced innate and T-cell-mediated immunity evidenced by up-regulation of TNF-β was found in patients with antigenemia.
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Affiliation(s)
- Tsung-Han Yu
- Divisions of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Chao HC. Magnetic resonance cholangiopancreatography in the evaluation of pediatric pancreaticobiliary diseases. Pediatr Neonatol 2011; 52:305-6. [PMID: 22192255 DOI: 10.1016/j.pedneo.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Chen CC, Chang CJ, Lin TY, Lai MW, Chao HC, Kong MS. Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea. World J Gastroenterol 2011; 17:4218-24. [PMID: 22072854 PMCID: PMC3208367 DOI: 10.3748/wjg.v17.i37.4218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the value of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea.
METHODS: Patients with acute infectious diarrhea ranging from 3 mo to 10 years in age were enrolled, and one to three stool samples from each subject were collected. Certain parameters, including white blood cells /differential count, C-reactive protein, fecal mucus, fecal pus cells, duration of fever, vomiting, diarrhea and severity (indicated by Clark and Vesikari scores), were recorded and analyzed. Fecal lactoferrin was determined by enzyme-linked immunosorbent assay and compared in different pathogen and disease activity. Generalized estimating equations (GEE) were also used for analysis.
RESULTS: Data included 226 evaluations for 117 individuals across three different time points. Fecal lactoferrin was higher in patients with Salmonella (11.17 μg/g ± 2.73 μg/g) or Campylobacter (10.32 μg/g ± 2.94 μg/g) infections and lower in patients with rotavirus (2.82 μg/g ± 1.27 μg/g) or norovirus (3.16 μg/g ± 1.18 μg/g) infections. Concentrations of fecal lactoferrin were significantly elevated in patients with severe (11.32 μg/g ± 3.29 μg/g) or moderate (3.77 μg/g ± 2.08 μg/g) disease activity compared with subjects with mild (1.51 μg/g ± 1.36 μg/g) disease activity (P < 0.05). GEE analysis suggests that this marker could be used to monitor the severity and course of gastrointestinal infections and may provide information for disease management.
CONCLUSION: Fecal lactoferrin increased during bacterial infection and with greater disease severity and may be a good marker for predicting and monitoring intestinal inflammation in children with infectious diarrhea.
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Abstract
AIM To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children. METHODS This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis. RESULTS There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis. CONCLUSIONS Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan
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Chao HC, Luo CC, Wang CJ. Elimination of postoperative pyloric stricture by endoscopic electrocauterization and balloon dilatation in an infant with congenital antral web. Pediatr Neonatol 2011; 52:106-9. [PMID: 21524632 DOI: 10.1016/j.pedneo.2011.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/07/2010] [Accepted: 05/21/2010] [Indexed: 02/07/2023] Open
Abstract
We, herein, report a male infant who presented with recurrent pyloric stricture after two surgeries (web excision and antropyloroplasty), which were done, respectively, at 5 days of age for congenital antral web and 6 months of age for the subsequent pyloric stricture. The patient suffered from anorexia, progressed vomiting, and weight loss gradually after the first and second surgeries, and then, endoscopy revealed severe pyloric deformity and stricture. Poor inflation was noted during endoscopic balloon dilatation because of tight pylorus; a subsequent electrocauterization and balloon dilatation were done, and the patient's clinical symptoms improved significantly 2 weeks later. A follow-up endoscopy was performed 1 month and 12 months after endoscopic therapy, showing steady regression of pyloric stricture. The patient had adequate diet intake and growth in the later 12 months.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Luo CC, Ming YC, Chao HC, Chu SM, Pang ST. Heparin-binding epidermal growth factor-like growth factor downregulates expression of activator protein-1 transcription factor after intestinal ischemia-reperfusion injury. Neonatology 2011; 99:241-6. [PMID: 21063128 DOI: 10.1159/000318142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/25/2010] [Indexed: 11/19/2022]
Abstract
The pathogenesis of necrotizing enterocolitis (NEC) is unknown. Ischemia and reperfusion (I/R) injury have been considered to be major contributing factors. More recent reports have noted that apoptosis is a significant and perhaps the principal contributor to cell death after I/R injury. Recent studies have revealed that activator protein 1 (AP-1) family proteins including c-Fos and c-Jun potentially induce either the proliferation or apoptosis of the cells in the brain, heart, kidney, and liver. c-Fos and c-Jun expression has also been reported to be upregulated in postischemic intestinal epithelial cells (IECs). Heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) is a potent cytoprotective factor in various pathologic conditions and plays a pivotal role in mediating the earliest cellular responses to injury. This study aims to examine whether HB-EGF, a proven intestinal cytoprotective molecule, exerts its protective effects through modulation of AP-1 transcription factor after intestinal I/R injury. Thirty rats were randomly divided into the following 5 groups: (1) normal control group; (2) ischemia group; (3) I/R group; (4) ischemia group with HB-EGF (400 μg/kg), and (5) I/R group with HG-EGF (400 μg/kg). c-Fos and c-Jun messenger RNAs and protein levels were determined by real-time quantitative polymerase chain reaction (PCR) and Western analyses, respectively. Statistical analysis was performed using ANOVA with Dunn's test. The messenger RNA levels of the c-Fos and c-Jun increased after intestinal ischemia or the intestinal reperfusion phase. HB-EGF pretreatment significantly decreased c-Fos and c-Jun messenger RNAs. The expression of protein levels of c-Fos and c-Jun were correlation with the expression of messenger RNA level. HB-EGF intestinal cytoprotection is mediated, in part, by downregulation of the expression of AP-1 transcription factor after intestinal I/R injury.
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Affiliation(s)
- Chih-Cheng Luo
- Department of Pediatric Surgery, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Shiu JR, Chao HC, Chen CC, Chi CY. Rare concurrent ileoileal and ileocolic intussusceptions in a child presenting with painless hematochezia. Pediatr Neonatol 2010; 51:359-62. [PMID: 21146803 DOI: 10.1016/s1875-9572(10)60070-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/30/2009] [Accepted: 01/22/2010] [Indexed: 11/24/2022] Open
Abstract
Double-site intussusceptions are very rare in children, and only a few have been reported. Here, we report a 17-month-old boy with double intussusceptions, whose clinical manifestations were painless hematochezia and anemia. Ultrasonography demonstrated an edematous, dilated bowel and two target lesions, suggesting multiple sites of intussusception. At surgery, intussusceptions were found in the ileoileal and ileocolic segments of the intestine. The cecum and proximal ascending colon were resected because of a gangrenous ileocolic intussusception. The ileoileal intussusception was reduced manually. Postoperatively, the patient was stable with no subsequent intestinal obstruction or hemorrhage.
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Affiliation(s)
- Jr-Rung Shiu
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Luo CC, Ming YC, Chao HC, Chu SM. Duodenal derotation and extent tapering jejunoplasty as primary repair for neonates with high jejunal atresia. Pediatr Neonatol 2010; 51:269-72. [PMID: 20951356 DOI: 10.1016/s1875-9572(10)60052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/15/2010] [Accepted: 02/09/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The dilated bowel segment usually involves the entire jejunum, as well as the duodenum in patients with high jejunal atresia. Classical approaches with a limited tapering enteroplasty and anastomosis frequently fail to restore intestinal function. A novel technique using duodenal derotation and extent tapering jejunoplasty (DDETJ) is reported here. METHODS Infants with high jejunal atresia within 10 cm of the ligament of Treitz treated with DDETJ over a 3-year period were reviewed. The entire dilated duodenum and jejunum were visualized after duodenal derotation. A longitudinal extensive tapering resection of dilated bowel with Endo GIA stapler was performed to fashion as a tube and anastomosed to the distal jejunum. RESULTS Five female infants underwent this procedure over a 3-year period. Four infants underwent primary DDETJ, while one with associated multiple atresias had previously undergone limited tapering jejunoplasty, but was unable to tolerate oral feeding. DDETJ was performed 4 weeks later. There were no postoperative complications, and all patients tolerated feeding within 14 days. Follow-up lasted from 2 to 18 months. CONCLUSION In very proximal high atresia, the extent of tapering is limited by the proximity of the ligament of Treitz. Duodenal derotation provides better access to the high atresia. The results of this limited experience suggest that the DDETJ procedure could provide an alternative therapy in patients with high jejunal atresia.
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Affiliation(s)
- Chih-Cheng Luo
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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