Despite the availability of specific　serology and point-of-care tests, the symptoms fluctuation as well as the "open-window" existing amongst the late and silent forms, often delays　the diagnosis of celiac disease　(CD). High mobility group box 1 (HMGB1), an important chromatin protein, mediates inflammation and gastrointestinal barrier failure. In this study involving 49 children with CD　and 44 healthy　children, antitissue transglutaminase type 2 and antideaminated form of gliadin antibodies, serum HMGB1 levels, and duodenal mucosal histopathology were performed. Serum HMGB1 levels were significantly higher in those with CD than those in the healthy control group (P　<0.001). Significant differences in serum HMGB1 levels were detected in　children　with typical CD form compared to both　children　with atypical CD form (P　<0.001) and　children　with silent CD form (P　<0.001). By using the Marsh classification, significant differences were also found between subjects with grade 3 B-B1 and 3 C-B2 and villous atrophy, respectively (P　<0.05). On the contrary, no significant differences were detected in serum HMGB1 levels in subgroups of　children　with grade 3 A compared to grade 3 B-B1. It was thus postulated that the HMGB1 is upregulated at diagnosis in all CD　children, especially in typical form, and reflects the histologic severity of　disease.

Does rotavirus vaccination increase the risk of celiac disease or type 1 diabetes in children? (Pediatr Infect Dis J.　2017. April 10. doi: 10.1097/INF.0000000000001600)

Rotavirus infection has been suggested as a trigger of type 1 diabetes (T1D) and　celiac disease　(CD) related autoimmunity in some studies. In this population-based cohort study in Finland, rotavirus vaccination records were collected from healthcare databases during 2009-2011 and validated for a sample of 495　children. Incident diagnoses of CD and TID during 2009-2014 in the cohort were identified in the National Care register. The adjusted relative risks (95% CI) were 0·91 (0·69, 1·20) for T1D and 0·87 (0·65, 1·17) for CD in vaccinated children compared to unvaccinated, suggesting that oral rotavirus vaccination did not alter the risk of CD or T1D during four to six years follow-up after vaccination. Therefore, it appears that oral rotavirus vaccination is safe in the individuals at risk of CD and T1D.

Serum biomarkers as predictors of complicated appendicitis in children (Pediatr Surg Int.　2017 Apr 29. doi: 10.1007/s00383-017-4088-1)

Choosing conservative mode of management of acute uncomplicated appendicitis without appendicolith over appendectomy is now an established treatment option. In this study, the authors evaluated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis. Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analyzed by ROC curve, and Kruskal-Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)]. Of 1197 children　(NA=186, SA=685, CA=326), 7% were <5　years, 55% 5-12, and 38% 13-17. CA patients had higher CRP and WBC levels than NA and SA (P　<0.0001). NEU levels were lower in NA compared to SA or CA (P　<0.0001), but were similar between SA and CA (P　=　0.6). CA patients had higher CRP and WBC levels than SA patients in 5-12- (P　<0.0001) and 13-17-year groups (P　=　0.0075, P　=0.005), but not in <5-year group. CRP levels >40　mg/L were found in 58% CA and 37% SA (P　<0.0001), and WBC count >15　×　10⁹/L in 58% CA and 43% SA (P　<0.0001). Authors concluded that simple markers like CRP and WBC count may help the clinician predict complicated appendicitis in children older than 5 years age and guide decision-making as to the therapeutic modality.