OBJECTIVES To evaluate the effectiveness of induction therapy with exclusive enteral nutrition (EEN) in pediatric Crohn's disease (CD). METHODS A retrospective analysis was performed on the medical data of 62 children with CD who received EEN in Children's Hospital, Zhejiang University School of Medicine, from March 2013 to August 2021. The medical data included general information and height, weight, Pediatric Crohn's Disease Activity Index (PCDAI), Crohn's Disease Endoscopic Index of Severity, C-reactive protein, erythrocyte sedimentation rate, and serum albumin level before treatment and after 8 weeks of treatment. The changes in the above indicators were compared before and after treatment. RESULTS Among the 62 children with CD, there were 39 boys (63%) and 23 girls (37%), with a mean age of (11.9±3.0) years at diagnosis. Among the 55 children who completed EEN treatment for at least 8 weeks, 48 (87%) achieved clinical remission at week 8. PCDAI at week 8 was significantly lower than that before treatment (P<0.001). Except for 17 children with involvement of the small intestine alone and 3 children with involvement of the colon who did not receive colonoscopy reexamination, the remaining 35 children with involvement of the colon received colonoscopy reexamination after the 8-week EEN treatment. Of the 35 children, 29 (83%) achieved mucosal healing. As for the 48 children who achieved clinical remission at week 8, there were significant improvements in height-for-age Z-score and body mass index-for-age Z-score at week 8 (P<0.01). As for the 7 children who did not achieve clinical remission at week 8, there were no significant changes in height-for-age Z-score and body mass index-for-age Z-score at week 8 (P>0.05). CONCLUSIONS The 8-week EEN treatment has a good effect on clinical remission and mucosal healing in children with CD. For the children with CD achieving clinical remission, EEN can improve their height and body mass index.

目的:探讨同伴互助教学(Peer-Assisted Learning,PAL)在儿科见习临床技能中的效果.方法:选择浙江大学医学院2015级本科见习生146名作为研究对象,实验组(n=73)采用PAL法,对照组(n=73)采用传统教学法,比较两组的教学效果.结果:临床技能操作成绩两组间无差异(P>0.05),但实验组教师授课时间明显减少;问卷调查显示学生普遍认可PAL法.结论:在儿科见习临床技能中实施PAL,即能保证学习效果又能减轻临床教师的工作负担,值得推广应用.

Background: Team-based learning (TBL) is widely used in health profession education. However, the use of TBL in paediatric clerkships is rare. In this study, we explore the efficacy and feasibility of TBL in paediatric clerkships. Methods: We retrospectively reviewed the TBL course for paediatric clerkships from August to October 2019 at the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. The TBL group (with 107 students) was compared to the students from the prior year who learned via case-based discussion (control group with 222 students). The learning outcomes were measured using theoretical exams when the paediatric clerkships ended. The satisfaction with TBL was evaluated by an anonymous questionnaire administered to the TBL group. Results: The grade point averages before paediatric clerkships in the TBL group (3.58, 3.04-3.96) were similar to those in the control group (3.62, 3.16-4.00) ( p =0.839). However, the theoretical exam scores in the TBL group (76, 67-82) were significantly higher than those in the control group (72, 64-78) ( p =0.002). In addition, 92.5% of the students in the TBL group rated their level of satisfaction higher than 90%. Conclusions: Our study demonstrated that TBL in paediatric clerkships was effective and feasible and that it led to better learning outcomes.

目的:探讨TBL+ PAL在儿科见习应用.方法:选择本校2016级临床医学214名学生为研究对象,对照组107名采用原有模式教学,实验组107名采用TBL+ PAL教学,比较两组教学效果.结果:实验组理论、体格测量、操作得分高于对照组(P＜0.05),临床思维无显著差异(P＞0.05),问卷显示多数学生认可TBL+ PAL教学法.结论:TBL+ PAL教学法可改善儿科见习学习效果.

Rationale: Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation enteritis in children. Early diagnosis is essential, and nutrition management plays an important role in pediatric chronic radiation enteritis management. Patient concerns: A Chinese 3-year-10-month-old boy was admitted with vomiting, weight loss (1-2 kg) after radiotherapy for a neuroblastoma. Diagnoses: The patient was diagnosed as neuroblastoma (primary site: left adrenal grand; site of metastasis: multiple bone metastasis, bone marrow invasion, intraperitoneal lymph node metastasis) in 2015. Five months after radiotherapy, he showed vomiting and weight loss with stricture in intestine and thickening intestinal wall in imaging finding. His daily intake was not sufficient and extra supplements were needed by intravenous infusion. He had a weight-for-agezscore of -5.04, a weight-for-height z score of -6.19, a height-for-agezscore of -2.22, and a body mass index-for-agezscore of -5.87. The highest level of alanine aminotransferase was 1433 U/L. Those findings established a diagnosis of chronic radiation enteritis with intestinal failure, intestinal stenosis, severe malnutrition, and hepatic dysfunction. Interventions: This patient was treated by parenteral nutrition with minimal enteral feeding. Other treatments were aiming at complications during hospitalization. Outcomes: The patient weaned off parenteral nutrition finally with nutrition status and quality of life improved. There were no signs of tumor recurrence during the 4-year follow-up. Lessons: Pediatric radiation enteritis is rare. Our study highlights the characteristics of pediatric chronic radiation enteritis. Nutrition therapy is an important part of the whole therapy strategy in pediatric chronic radiation enteritis.

Background Early-onset chronic diarrhoea often indicates a congenital disorder. Mutation in diacylglycerol o-acyltransferase 1 ( DGAT1 ) has recently been linked to early-onset chronic diarrhoea. To date, only a few cases of DGAT1 deficiency have been reported. Diarrhoea in those cases was severe and developed in the neonatal period or within 2 months after birth. Case presentation Here, we report a female patient with DGAT1 mutations with delayed-onset chronic diarrhoea. The patient had vomiting, hypoalbuminemia, hypertriglyceridemia, and failure to thrive at early infancy. Her intractable chronic diarrhoea occurred until she was 8 months of age. A compound heterozygous DGAT1 mutation was found in the patient, which was first found in the Chinese population. Her symptoms and nutrition status improved after nutritional therapy, including a fat restriction diet. Conclusions This case expanded our knowledge of the clinical features of patients with DGAT1 mutations. Intractable diarrhoea with delayed onset could also be a congenital disorder.

Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation enteritis in children. Early diagnosis is essential, and nutrition management plays an important role in pediatric chronic radiation enteritis management.A Chinese 3-year-10-month-old boy was admitted with vomiting, weight loss (1-2 kg) after radiotherapy for a neuroblastoma.The patient was diagnosed as neuroblastoma (primary site: left adrenal grand; site of metastasis: multiple bone metastasis, bone marrow invasion, intraperitoneal lymph node metastasis) in 2015. Five months after radiotherapy, he showed vomiting and weight loss with stricture in intestine and thickening intestinal wall in imaging finding. His daily intake was not sufficient and extra supplements were needed by intravenous infusion. He had a weight-for-age z score of -5.04, a weight-for-height z score of -6.19, a height-for-age z score of -2.22, and a body mass index-for-age z score of -5.87. The highest level of alanine aminotransferase was 1433 U/L. Those findings established a diagnosis of chronic radiation enteritis with intestinal failure, intestinal stenosis, severe malnutrition, and hepatic dysfunction.This patient was treated by parenteral nutrition with minimal enteral feeding. Other treatments were aiming at complications during hospitalization.The patient weaned off parenteral nutrition finally with nutrition status and quality of life improved. There were no signs of tumor recurrence during the 4-year follow-up.Pediatric radiation enteritis is rare. Our study highlights the characteristics of pediatric chronic radiation enteritis. Nutrition therapy is an important part of the whole therapy strategy in pediatric chronic radiation enteritis.

OBJECTIVE:To investigate the efficacy of nutrition support therapy in children with chronic diarrhea. METHODS:A retrospective analysis was performed for the clinical data of 48 children with chronic diarrhea who were hospitalized between July 2012 and July 2014. These children were divided into <1 year group (27 children) and ≤1 year group (21 children). Twenty-seven of these patients, who had malnutrition, were divided into enteral nutrition (EN) group (10 children), partial parenteral nutrition (PPN)+EN group (16 children), and total parenteral nutrition (TPN) group (1 child). The therapeutic process and outcome were compared between different age groups and children receiving different treatments. RESULTS:Among the 48 children, short bowel syndrome, viral enteritis, a history of intestinal surgery, and malabsorption syndrome were common causes of chronic diarrhea, and 24 children (50%) had unknown causes. In the aspect of nutritional assessment on admission, the <1 year group had a significantly higher proportion of children with moderate underweight than the ≤1 year group (P<0.05). In the EN group, the BMI-for-age Z-score (BAZ) increased from -2.2±1.5 before treatment to -1.8±1.0 (P=0.040), and the energy supplied increased from 46±17 kcal/kg per day before treatment to 83±32 kcal/kg per day (P=0.012). In the PPN+EN group, the weight-for-age Z-score (WAZ) increased from -3.3±2.0 before treatment to -2.8±1.8 (P=0.044), and BAZ increased from -2.8±1.4 before treatment to -2.0±1.4 (P=0.012). There was only 1 child in the TPN group, whose symptoms of diarrhea were relieved after treatment. Among 27 children receiving nutritional therapy, 4 were not improved, and the other children achieved remission of symptoms and improvements in nutritional status. CONCLUSIONS:Besides etiological treatment, nutrition support therapy can be applied as part of multimodality therapy in children with chronic diarrhea. This can effectively improve nutritional status and relieve the symptoms of diarrhea.