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20/08/2026

Celiac Disease with Failure to Thrive, Diagnosis and Dietary Management Dr. Li Zhiguang β€” Xinhua Hospital, Shanghai Jiao Tong University
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Miss Jiang, a 6-year-old girl, was referred for evaluation of chronic diarrhea, abdominal distension, and poor growth since the introduction of complementary foods at age one. She had been investigated at multiple centers without a definitive diagnosis. Height and weight were both below the 5th percentile. Serology revealed markedly elevated anti-tissue transglutaminase IgA (anti-tTG IgA >10Γ— upper limit of normal). Upper GI endoscopy with duodenal biopsy confirmed subtotal villous atrophy with crypt hyperplasia, consistent with celiac disease (Marsh grade 3b).

Dr. Li Zhiguang counseled the family comprehensively on strict gluten-free diet implementation, arranged dietitian support for meal planning in the Chinese dietary context, and established a structured follow-up protocol with serial serology and growth monitoring.

Follow-up: 12 months dietary management.

Anti-tTG IgA normalized by month six on a strict gluten-free diet. Diarrhea resolved within four weeks of dietary change. Miss Jiang demonstrated significant catch-up growth, gaining 3.8cm in height and 2.6kg in weight over twelve months. Repeat duodenal biopsy at one year confirmed mucosal recovery with near-normal villous architecture.

Accurate diagnosis and structured gluten-free dietary management achieved full mucosal recovery and restored growth trajectory in a young child with long-undiagnosed celiac disease.

19/08/2026

Autoimmune Hepatitis in a Child, Immunosuppressive Management Dr. Li Zhiguang β€” Xinhua Hospital, Shanghai Jiao Tong University
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Miss Shen, an 11-year-old girl, presented with a six-week history of progressive jaundice, fatigue, and right upper quadrant discomfort. Liver function tests revealed markedly elevated transaminases (ALT 680 U/L, AST 590 U/L) with hyperbilirubinemia and elevated IgG. ANA and anti-smooth muscle antibody (ASMA) were strongly positive. Liver biopsy confirmed interface hepatitis with plasma cell infiltration and rosette formation, consistent with autoimmune hepatitis type 1.

Dr. Li Zhiguang initiated standard immunosuppressive induction with high-dose prednisolone followed by azathioprine as a steroid-sparing maintenance agent, with serial liver function monitoring and thiopurine metabolite level measurement to guide azathioprine dosing and minimize toxicity.

Treatment course: 8 weeks induction, ongoing maintenance.

Transaminases normalized within six weeks of treatment initiation. Bilirubin resolved by week four. Miss Shen tolerated azathioprine well with no significant adverse effects. At one-year follow-up, she remained in biochemical remission on low-dose prednisolone and azathioprine, with liver ultrasound showing no progression to fibrosis.

Early diagnosis and prompt immunosuppressive therapy achieved sustained biochemical remission in a child with autoimmune hepatitis, preventing progression to cirrhosis during a critical period of liver development.

18/08/2026

Pediatric Crohn's Disease, Biologic Therapy Induction and Remission Dr. Li Zhiguang β€” Xinhua Hospital, Shanghai Jiao Tong University
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Master Fang, a 14-year-old boy, was referred after eight months of recurrent abdominal cramping, bloody diarrhea, significant weight loss, and growth faltering. Colonoscopy revealed deep longitudinal ulcerations and cobblestone mucosa in the terminal ileum and ascending colon. Histopathology confirmed transmural granulomatous inflammation consistent with Crohn's disease. Nutritional assessment demonstrated severe protein-energy malnutrition with a BMI at the 3rd percentile for age.

Dr. Li Zhiguang initiated exclusive enteral nutrition as primary induction therapy alongside infliximab anti-TNF biologic therapy, with close monitoring of inflammatory markers, f***l calprotectin, and therapeutic drug levels to optimize dosing during the induction phase.

Treatment course: 14 weeks induction, followed by maintenance therapy.

Clinical remission was achieved by week six, with CRP normalizing and f***l calprotectin falling below 100 Β΅g/g by week ten. Repeat colonoscopy at week fourteen confirmed mucosal healing. Master Fang gained 4.2kg over the induction period and resumed normal school attendance. At one-year follow-up, he remained in sustained steroid-free remission on maintenance infliximab with continued catch-up growth.

Combination biologic therapy and exclusive enteral nutrition achieved deep mucosal remission and restored growth trajectory in an adolescent with severe Crohn's disease, avoiding the need for surgical intervention.

17/08/2026

Post-Cardiac Surgery Respiratory Failure, Mechanical Ventilation and PICU Care Dr. Zhang Yucai (张育才) β€” Xinhua Hospital, Shanghai Jiao Tong University
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Master Lin, a 14-month-old boy with tetralogy of Fallot, underwent complete intracardiac repair including ventricular septal defect closure and right ventricular outflow tract reconstruction under cardiopulmonary bypass. In the immediate post-operative period, he developed acute respiratory failure with bilateral pulmonary infiltrates, hypoxemia refractory to conventional oxygen therapy, and reduced lung compliance consistent with post-bypass acute lung injury.

Dr. Zhang Yucai assumed management of the post-operative PICU course, implementing lung-protective mechanical ventilation with low tidal volumes, optimized PEEP, and prone positioning sessions to improve ventilation-perfusion matching. Hemodynamic support was carefully titrated to balance right ventricular afterload and systemic perfusion during the recovery phase.

PICU stay: 9 days.

Oxygenation improved progressively over 72 hours with prone positioning. Mechanical ventilation was successfully weaned and Master Lin was extubated on day six. He was transferred to the cardiac ward on day nine and discharged home two weeks post-operatively. At three-month follow-up, echocardiography confirmed excellent surgical repair with normal biventricular function and clear chest X-ray.

Lung-protective ventilation strategy and prone positioning successfully reversed post-bypass acute lung injury in a toddler following complex congenital heart surgery, enabling safe extubation and full cardiac recovery.

16/08/2026

Post-Cardiac Surgery Respiratory Failure, Mechanical Ventilation and PICU Care Dr. Zhang Yucaiβ€” Xinhua Hospital, Shanghai Jiao Tong University
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Master Lin, a 14-month-old boy with tetralogy of Fallot, underwent complete intracardiac repair including ventricular septal defect closure and right ventricular outflow tract reconstruction under cardiopulmonary bypass. In the immediate post-operative period, he developed acute respiratory failure with bilateral pulmonary infiltrates, hypoxemia refractory to conventional oxygen therapy, and reduced lung compliance consistent with post-bypass acute lung injury.

Dr. Zhang Yucai assumed management of the post-operative PICU course, implementing lung-protective mechanical ventilation with low tidal volumes, optimized PEEP, and prone positioning sessions to improve ventilation-perfusion matching. Hemodynamic support was carefully titrated to balance right ventricular afterload and systemic perfusion during the recovery phase.

PICU stay: 9 days.

Oxygenation improved progressively over 72 hours with prone positioning. Mechanical ventilation was successfully weaned and Master Lin was extubated on day six. He was transferred to the cardiac ward on day nine and discharged home two weeks post-operatively. At three-month follow-up, echocardiography confirmed excellent surgical repair with normal biventricular function and clear chest X-ray.

Lung-protective ventilation strategy and prone positioning successfully reversed post-bypass acute lung injury in a toddler following complex congenital heart surgery, enabling safe extubation and full cardiac recovery.

14/08/2026

Pediatric Septic Shock with Multi-Organ Dysfunction, PICU Resuscitation Dr. Zhang Yucai β€” Xinhua Hospital, Shanghai Jiao Tong University
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Master He, a previously healthy 5-year-old boy, was transferred to the PICU after presenting to a district hospital with three days of high fever, rapidly deteriorating consciousness, and hemodynamic instability. On arrival, he was in septic shock with a mean arterial pressure of 42mmHg, lactate of 6.8 mmol/L, and early signs of acute kidney injury and hepatic dysfunction consistent with multi-organ dysfunction syndrome (MODS). Blood cultures subsequently grew Streptococcus pneumoniae.

Dr. Zhang Yucai led the resuscitation team, implementing early goal-directed therapy with aggressive fluid resuscitation, vasopressor support with norepinephrine and vasopressin, broad-spectrum antibiotics, and continuous hemodynamic monitoring via arterial and central venous lines. Continuous renal replacement therapy (CRRT) was initiated on day two for fluid overload and rising creatinine.

PICU stay: 11 days.

Hemodynamic stability was achieved within 24 hours. Renal function recovered fully by day seven, allowing CRRT to be discontinued. Hepatic enzymes normalized by day nine. Master He was stepped down to the general ward on day eleven and discharged home three days later with no neurological sequelae. At three-month follow-up, all organ function parameters were within normal limits.

Rapid bundle-based sepsis resuscitation and timely CRRT support achieved full multi-organ recovery in a critically ill child, preventing irreversible end-organ damage during the most vulnerable window of pediatric septic shock.

13/08/2026

Patent Ductus Arteriosus with Pulmonary Hypertension, Transcatheter Closure Dr. Sun Kun β€” Xinhua Hospital, Shanghai Jiao Tong University
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Master Jiang, a 3-year-old boy, presented with recurrent respiratory infections, poor weight gain, and exercise intolerance. Echocardiography confirmed a large patent ductus arteriosus (PDA) measuring 5mm with significant left-to-right shunting, left ventricular volume overload, and elevated estimated pulmonary artery pressure at 55mmHg. Cardiac catheterization confirmed operability with a pulmonary vascular resistance index within acceptable limits for closure.

Dr. Sun Kun performed transcatheter PDA closure using an Amplatzer Duct Occluder device deployed via femoral arterial access, with hemodynamic assessment confirming favorable response to test occlusion before definitive device deployment.

Procedure: 2 hours.

Complete ductal occlusion was confirmed on post-procedural aortography. Pulmonary artery pressure normalized to 28mmHg at three-month follow-up echocardiography. Master Jiang's weight gain improved significantly and respiratory infections ceased. At one-year follow-up, left ventricular dimensions had normalized and pulmonary pressures remained within normal range.

Transcatheter PDA closure reversed pulmonary hypertension and restored normal cardiac loading conditions in a toddler, avoiding open thoracotomy and enabling full clinical recovery.

12/08/2026

Fetal Pulmonary Stenosis, Prenatal Diagnosis and Postnatal Balloon Valvuloplasty Dr. Sun Kun β€” Xinhua Hospital, Shanghai Jiao Tong University
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A 28-year-old mother was referred at 24 weeks gestation after routine obstetric ultrasound raised concern about fetal cardiac anatomy. Fetal echocardiography performed by Dr. Sun Kun confirmed severe pulmonary valve stenosis with a peak gradient estimated at 60mmHg and mild right ventricular hypoplasia. Multidisciplinary counseling was provided to the family regarding postnatal management planning and delivery at a center with immediate interventional capability.

Following delivery at Xinhua Hospital, the newborn β€” Master Fang β€” was stabilized and Dr. Sun Kun performed balloon pulmonary valvuloplasty via femoral venous access on day three of life, dilating the stenotic pulmonary valve under fluoroscopic guidance.

Procedure: 2 hours.

The peak gradient was reduced from 65mmHg to 18mmHg post-valvuloplasty. Right ventricular pressure normalized progressively over the following months. At six-month follow-up, echocardiography demonstrated normal right ventricular growth and satisfactory valve function without reintervention.

Prenatal diagnosis enabled seamless transition to postnatal intervention, with balloon valvuloplasty successfully relieving critical pulmonary stenosis in a neonate and supporting normal right ventricular development.

11/08/2026

Atrial Septal Defect, Transcatheter Device Closure Dr. Sun Kun (孙锐) β€” Xinhua Hospital, Shanghai Jiao Tong University
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Miss Tang, a 7-year-old girl, was referred after her school health check detected a cardiac murmur. Transthoracic echocardiography confirmed a secundum atrial septal defect (ASD) measuring 18mm with significant left-to-right shunting and mild right ventricular volume overload. Her parents were advised surgical repair at a local hospital but sought a catheter-based alternative to avoid open-heart surgery.

Dr. Sun Kun performed transcatheter ASD device closure under echocardiographic and fluoroscopic guidance, deploying an Amplatzer-type occluder device via femoral venous access without cardiopulmonary bypass.

Procedure: 1.5 hours.

Complete closure was confirmed on post-procedural echocardiography with no residual shunt. Right ventricular dimensions normalized at three-month follow-up. Miss Tang was discharged the following day and returned to school within one week. At one-year follow-up, echocardiography confirmed stable device position and normal biventricular function.

Transcatheter ASD closure provided a definitive, scar-free correction in a school-age child, avoiding open-heart surgery and enabling rapid return to normal childhood activity.

10/08/2026

Kawasaki Disease with Coronary Artery Aneurysm, Medical Management and Surveillance Dr. Huang Guoying (ι»„ε›½θ‹±) β€” Children's Hospital of Fudan University
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Master Wang, a 2-year-old boy, was referred after five days of persistent high fever unresponsive to antibiotics, accompanied by bilateral conjunctival injection, strawberry tongue, diffuse rash, and cervical lymphadenopathy. Kawasaki disease was diagnosed clinically. Echocardiography performed on admission revealed a right coronary artery aneurysm measuring 4.5mm (z-score +3.2), indicating medium-risk coronary involvement.

Dr. Huang Guoying initiated high-dose intravenous immunoglobulin (IVIG) combined with aspirin therapy, with serial echocardiographic monitoring to track coronary artery dimensions and guide anticoagulation decisions throughout the acute and subacute phases.

Treatment duration: 6 weeks of active management.

Fever resolved within 36 hours of IVIG administration. Serial echocardiography demonstrated progressive regression of the coronary aneurysm, with normalization of coronary artery dimensions by week eight. Master Wang remained on low-dose aspirin for six months and was discharged from active surveillance at one year with normal coronary anatomy confirmed on echocardiography.

Early diagnosis and prompt IVIG therapy achieved complete coronary aneurysm regression, preventing long-term cardiovascular sequelae in a toddler with medium-risk Kawasaki disease.

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