小儿包皮Fournier坏疽一例诊治并文献复习

目的通过小儿包皮Fournier坏疽的病例及文献复习，加强小儿外科医生对该疾病的再认识，强调快速诊断及治疗的重要性。方法回顾性分析1例小儿包皮Fournier坏疽的临床资料，并检索PubMed、Springer Link、Embase、中国知网（CNKI）、万方数据库中的相关文献资料，结合分析该疾病的发病诱因、临床表现、诊断及治疗、预后情况。结果本例术前快速明确诊断，应用广谱抗生素治疗的同时急诊行手术治疗。完全清创坏死组织，一期行包皮环切手术。术后未再出现坏死病灶，预后良好。检索文献至2015年12月，总共报道8例小儿包皮（或阴茎皮肤）Fournier坏疽病例。发病年龄14 d至14岁（中位年龄14个月），7例有原发基础疾病，其中3例脐炎，3例白血病，1例腹泻，且伴发其他部位的坏疽。1例无原发疾病，伴发阴囊坏疽。平均坏死进展时间为39 h （12～48 h），进行相应部位的清创及对症手术治疗，无死亡病例。结论小儿包皮Fournier坏疽罕见，需要小儿外科医生充分认识、快速诊断、联合治疗，才能减轻患儿痛苦并提高预后。

Clinical observation of treatment of infantile diarrhea due to spleen deficiency using five-step pediatric tuina of Huxiang school

Objective:To observe the clinical efficacy of treating infantile diarrhea due to spleen deficiency with five-step pediatric tuina of Huxiang school.Methods:Using a randomized controlled trial design,sixty eligible kids with diarrhea due to spleen deficiency were randomized into an observation group and a control group,with 30 cases in each group.The observation group was intervened by the five-step pediatric tuina method of Huxiang school,and the control group received conventional tuina treatment.The intervention was conducted once a day,consecutive 5-day treatment as 1 course,at a 2-day interval between courses,successively for a total of 4 courses.Changes in the primary and secondary symptoms of diarrhea due to spleen deficiency were observed,and the clinical efficacy was evaluated.Results:After treatment,the scores of primary and secondary symptoms and the general score of diarrhea due to spleen deficiency were improved;the improvements in fecal form and frequency,decreased appetite,bloating after meals and fatigue and sluggishness were more significant in the observation group than in the control group.Conclusion:The five-step pediatric tuina method of Huxiang school and conventional tuina both can improve the primary and secondary symptoms in infantile diarrhea due to spleen deficiency,while the former one can produce more significant efficacy.

Clinical efficacy observation on pediatric massage for chronic cough in children

Objective To observe the clinical efficacy of pediatric massage(tuina)for chronic cough in children.Methods A total of 96 cases were randomized into a control group and an observation group,with 48 cases in each group.Cases in the control group received routine pediatric massage manipulations.Cases in the observation group received additional Mo-rubbing abdomen manipulation.The treatment was done 3 times a week and 12 times made up a treatment session.The cough symptom scores were evaluated before treatment and after 3,6,9 and 12 treatments respectively.Results There were 8 dropouts in the observation group and 5 dropouts in the control group.Before treatment,there was no statistical difference in coughing score between the two groups(P>0.05).After 9 times of treatment,the total coughing scores were significantly reduced in both groups(both P<0.05);however,there were no statistical differences between the two groups in the score differences between before treatment and after 3,6 and 9 times of treatment(all P>0.05).After 12 times of treatment,the total coughing scores were significantly reduced in both groups(both P<0.05),along with a statistical difference between the two groups in the score difference between before treatment and after 12 times of treatment(P<0.05).There was a statistical difference between the two groups in overall response(P<0.05).The total effective rate in the observation group was 92.5%,versus 86.0%in the control group,showing a statistical difference(P<0.05).Conclusion The routine pediatric massage manipulations alone or in combination with Mo-rubbing abdomen manipulation both can significantly improve chronic cough in children;however,the combination obtains a better effect.

Therapeutic observation of Tui-pushing Wujing plus Chinese patent medicine for infantile diarrhea due to spleen deficiency

Objective:To observe the therapeutic efficacy of pediatric tuina plus Chinese patent medicine for preschool kids with diarrhea due to spleen deficiency.Methods:Ninety-two eligible kids were divided into a tuina plus Chinese patent medicine and a Chinese patent medicine group by the random number table,with 46 cases in each group.The Chinese patent medicine group was intervened by oral administration of Qi Wei Bai Zhu San(Seven-ingredient Atractylodes Macrocepholo Powder);the tuina plus Chinese patent medicine group was additionally given pediatric tuina therapy once a day,20 min each time.Efficacy and safety were evaluated after 7-day treatment in both groups,and a 14-day follow-up was conducted.Results:After treatment,the symptom scores all changed significantly in the two groups(all P<0.05).After intervention,the symptom scores in the tuina plus Chinese patent medicine group were significantly different from those in the Chinese patent medicine group(all P<0.05).The total effective rate was 78.3%in the Chinese patent medicine group,versus 89.1%in the tuina plus Chinese patent medicine group,and the between-group difference was statistically significant(P<0.05).Three cases got a relapse in the Chinese patent medicine group,versus one case in the tuina plus Chinese patent medicine group,and the between-group difference was statistically insignificant(P>0.05).The two groups each had one case of vomiting,which were treated properly and turned better.No other adverse reactions occurred.Conclusion:Tuina plus Chinese patent medicine and Chinese patent medicine alone both are effective for diarrhea due to spleen deficiency in kids,but the combined therapy can produce more significant efficacy.

Clinical experience of Xiangxi Liu's infantile tuina for exogenous fever in children

Xiangxi (the western part of Hunan province) Liu's infantile tuina,as one main school of current infantile tuina in China,highlights the compatibility of the specific points of Wujing in children,the idea of treatment by syndrome differentiation,and produces unique efficacy in the treatment of common diseases in children.Exogenous fever in children can be treated with this method with excellent efficacy.Based on the clinical experience and effective cases treated by this tuina school,the authors elaborated the clinical thought and experience from the perspective view of tuina,for the promotion of Xiangxi Liu's infantile tuina in clinic.

Clinical observation of Tiao Shen Tong Du Tuina in promoting neuropsychological development of premature infants

Objective To observe the impact of Tiao Shen Tong Du(regulating the mind and unblocking the Governor Vessel)Tuina(Chinese therapeutic massage)on neuropsychological development of premature infants,discover effective early-stage intervention techniques,and improve the prognosis of premature infants.Methods A total of 115 eligible premature infants were recruited and divided into a control group of 59 cases and an observation group of 56 cases based on different interventions.The control group received three-month physical therapy(PT)and conventional early-stage intervention,and the observation group received additional Tiao Shen Tong Du Tuina treatment.Before and after treatment and at the one-year follow-up,the Gesell developmental schedule was adopted to evaluate neuropsychological development.Results After treatment,the gross motor development quotient(DQ)was higher in the observation group than in the control group,and the difference was statistically significant(P<0.05);there were no significant differences in the other four domains between the two groups(P>0.05).At the one-year follow-up,the observation group showed more notable improvements in all five domains’DQs than the control group,and the between-group differences were statistically significant(P<0.05 or P<0.01).Conclusion Based on conventional intervention,Tiao Shen Tong Du Tuina can significantly improve the gross motor function of premature infants in the short term,alongside valid long-term efficacy for gross motor function,fine motor function,adaptive behaviors,language,and personal-social behaviors.

Manipulation parameter optimization in Liu's back tuina therapy for kids'cough variant asthma in remission stage

Objective:To determine the optimal manipulation parameters in Liu's back tuina therapy for remission-stage cough variant asthma(CVA)in kids.Methods:A 5-factor 3-level L18(37)orthogonal design was adopted.The experimental factors and levels were selected:A,the number of times of Rou-kneading Feishu(BL 13);B,the frequency of Rou-kneading Feishu(BL 13);C,the number of times of Tui-pushing in a'介'-like pattern;D,the frequency of Tui-pushing in a'介'-like pattern;E,the intensity of red color after Ca-scrubbing Feishu(BL 13)with salt.A1,A2 and A3 stood for 10 times,20 times and 30 times,respectively;B1,B2 and B3 stood for 200 times/min,240 times/min and 280 times/min,respectively;C1,C2 and C3 stood for 50 times,75 times and 100 times,respectively;D1,D2 and D3 stood for 150 times/min,175 times/min and 200 times/min,respectively;E1,E2 and E3 stood for pinkish,bright red and dark red,respectively.A total of 108 kids with CVA in remission stage were divided into 18 groups using the random number table method,with 6 cases in each group.Changes in the cough score and fractional exhaled nitric oxide(FENO)level were observed after 15-day treatment.Results:The cough score and FENO level changed significantly in every group after treatment(all P<0.01).By the effect in improving cough score,the factors were listed as D,B,A,C and E in descending order;the most optimal manipulation parameter combination was group 17(A3B2C1D3E1);the second optimal parameter combinations were group 7(A3B1C2D1E3),group 13(A2B1C2D3E1)and group 14(A2B2C3D1E2).Regarding the effect in down-regulating the level of FENO,the factors were listed as C,A,E,B and D in descending order;the most optimal manipulation parameter combination was group 13(A2B1C2D3E1);the second optimal parameter combinations were group 18(A3B3C2D1E2),group 16(A3B1C3D2E3)and group 14(A2B2C3D1E2).Conclusion:Two most effective manipulation parameter combinations were selected out of 18 different parameter combinations in Liu's back tuina therapy for remission-stage CVA in kids.Doctors can choose an appropriate manipulation based on the symptom features of the disease.