The Pre-Diagnosis History of Gynecologic Tumors in Children

Introduction: Gynecologic tumors represent less than 5% of all solid tumors in children. Patients and Method: Through a prospective and descriptive study over 4-years, we included girls aged less than 15 years admitted for a gynecologic tumor. We collected and analyzed the medical data, and paid particular attention to the pre-diagnosis history. Results: Eleven girls met our criteria with a mean age of 8.5 years (2 - 13 years). Abdominal pain, abdominal distension or protrusion of a vaginal mass was the main symptoms. The patients were seen at least by one doctor outside the surgical structure [1] [2] [3]. Four of eleven were received by two different doctors before carrying out the evocative radiological assessment. The average consultation delay was 7-months (24 hours to 18 months). There were nine ovarian tumors and two vaginal tumors. The histological study revealed five of eleven (45%) malignant tumors. Conclusion: Gynecological tumors in children are rare. However, there is a significant proportion of malignant tumors. All doctors can be confronted with it and should not delay the radiological assessment.

Early rehabilitation improves neurofunctional outcome after surgery in children with spinal tumors

To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in chil- dren with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients （1-17 years old） who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4 （range, 2-7） days after surgery for 10 （range, 7-23） days. Results from the Modified McCormick Scale, Functional Independence Measure for Chil- dren, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pedi- atric children who received early rehabilitation were significantly improved. Results also showed that tumor setting and level localization as well as patients＇s clinical symptoms have no influences on neurofunctional outcomes.

Robotic-assisted resection of ovarian tumors in children: A case report and review of literature

BACKGROUND Ovarian tumors are common gynecological diseases in children, and the most commonly seen ovarian tumors are germ cell tumors. Robotic surgery is the new access for children ovarian tumors.CASE SUMMARY From June to October 2017, 4 children with ovarian tumors were admitted and treated in the Department of Pediatric Surgery of People’s Liberation Army General Hospital. The mean age, height, and weight of these patients were 7.5(1-13) years old, 123.75(71-164) cm, and 36.8(8.5-69.5) kg, respectively. Roboticassisted resection of ovarian tumors was performed for all 4 patients. The 3-port approach was used for robotic manipulation. The surgical procedures were as follows. After creation of the pneumoperitoneum, the robotic scope was placed to explore and find the left ovarian tumor. The trocars for robotic arms 1 and 2 were placed at the sites to the lower right and left of the port of the scope. The tumor capsule in the fallopian tube was incised, and the tumor was completely stripped by an electric hook along the junction of the tumor and the capsule. The resected tumor was completely removed using an endobag. The average docking time of the robotic system was 18.5 min, the average operative time was 120 min, and the average blood loss was 20 m L. No drainage tube was placed except in one patient with a mucinous tumor of the ovary. No fever, pelvic fluid, or intestinal obstruction was reported after surgery. No antibiotics were used during the perioperative period, and the average length of hospital stay after surgery was 3 d.CONCLUSION Robotic-assisted resection of ovarian tumors is a simple, safe, and effective surgical procedure for selected patients.

A Qualitative Study on the Negative Emotions of Mothers during Chemotherapy of Their Children with Malignant Brain Tumors

Objective: To explore the negative emotions of mothers during chemotherapy of their children with malignant brain tumors. Methods: The phenomenological method for qualitative studies was adopted;convenience sampling was used to conduct semi-structured interviews to the mothers of 9 children with malignant brain tumors who received chemotherapy from June 2019 to December 2019;the Colaizzi 7-step analytical method was implemented to collate and analyze the original data. Results: The results were summarized into six subjects: stressed, exhausted because of trying to control everything in home care, prone to excessive care, financially burdened, desperate for knowledge of patient care, and desperate for psychosocial support. Conclusions: Understanding the real experiences and inner feelings of mothers during chemotherapy of their children with malignant brain tumors is helpful for medical staff to learn about the psychological distress and needs of mothers of children with malignant brain tumors, so as to give them psychological support and even social support, and help the mothers and the families of children with malignant brain tumors get through a special period.

The clinical characteristics and treatment outcomeof 57 children and adolescents with primary central nervoussystem germ cell tumors

Primary central nervous system germ cell tumors(CNS-GCTs) in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrolled. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years(range, 2.7 to 18.0 years) at diagnosis; 43(75.4%) had non-germinomatous germ cell tumors(NGGCTs) and 14(24.6%) had germinomas; 44(77.2%) had localized disease and 13(22.8%) had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB(cisplatin, etoposide, and bleomycin) protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months(range, 1.2 to 139 months). Fourteen patients died of relapse or disease progression. The 3-year event-free survival(EFS) and overall survival rates for all patients were 72.2% and 73.8%, respectively. The 3-year EFS was 92.9% for germinomas and 64.8% for NGGCTs(P = 0.064). The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively(P = 0.042). Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.

Appendicular Neuroendocrine Tumors in Children

Appendicular Neuroendocrine Tumors (ANETs) in pediatric age group are infrequent. Though children may present like symptoms of acute appendicitis, these tumors are incidentally picked up during routine histological examination of resected appendix. We report our experience with ANETs in children from a tertiary care hospital in Arabian Peninsula. During 6-year period, there were 700 appendectomies performed in children (≤14 years) and we collected only 3 cases of ANETs diagnosed from histological examination of resected appendix. Appendectomy alone has been sufficient in all cases and they are disease free at follow-up till 3 years after surgery. We have reviewed the clinical presentation, diagnosis and management of these cases. With no typical clinical picture, ANET is usually an incidental finding hence we propose that the review of the histology of resected appendix is mandatory to identify the prevalence of ANETs in pediatric population. For most patients, appendectomy is the appropriate treatment and the outcome is excellent after appendectomy.

Analysis of Present Situation and Influencing Factors of Coping Methods by Parents of Children with Central Nervous System Tumors

Background: Central nervous system (CNS) tumors are the most common solid tumors among children. Due to the severity of the tumors and the complexity of therapeutic regimes, it is very important to examine whether parents of the children with CNS tumors have positive coping methods against the disease. This study aims to analyze the coping methods of the parents and the factors influencing the methods. Methods: A total of 108 parents of brain cancer children admitted from January 2019 to September 2020 were selected as subjects. After collecting the general information of the parents, they were studied using the Coping Health Inventory for Parents (CHIP, Chinese version). Additionally, their coping pattern and the influencing factors were analyzed. Results: The average scores of the three subscales of the CHIP were (4.25 ± 0.939), (3.11 ± 1.205) and (3.60 ± 1.187), respectively. Univariate analysis showed that parents’ education, medical payment methods, places of residence and economic concerns were the main factors influencing the coping methods (all P < 0.05). Conclusions: Healthcare staff should fully evaluate the coping methods adopted by the parents having children with CNS tumors, take targeted nursing measures accordingly, and assist the parents in seeking social support and learning disease-related knowledge. In addition, public education on disease is equally important.

Relationship of Tumor Necrosis Factor-α and Nitrogen Oxide with Treatment of Frequent Relapse Nephrotic Syndrome by Shenkangling(肾康灵)Granule in Children

Objective: To observe the relationship of tumor necrosis factor-o (TNF-a) and nitrogen oxide (NO) with the treatment of frequent relapse nephrotic syndrome (FRNS) and to explore the patho-genesis of FRNS and the therapeutic mechanism of Shenkangling (肾康灵,SKL) Granule in children. Methods: Sixty children suffering from FRNS were randomly divided into the treated group and control group, 30 in each, and the other 30 healthy children were taken as healthy group. The patients were treated with prednisone for a long-term course, and those with no effect or partial effect shown were treated with additional Tripterygium or Cytoxan in the control group, while in the treated group patients were treated with prednisone and additional SKL. The two groups were compared as to their changes of TNF-a, NO before and after treatment, and the relapses after treatment. Results: The levels of TNF-a and NO in the sick children before treatment were markedly higher than those after treatment and normal group (P< 0. 01). The positive correlation between TNF-o of FRNS cases and relapse risk displayed more significance than that between the relapse of FRNS and NO. The difference between treated group and control group was significant (P<0. 01). Conclusion: TNF-a can be regarded as the monitoring parameter of the active phase in FRNS, and the higher the level, the more possible the relapse would occur. SKL could markedly reduce the relapse rate of FRNS in children.

家庭功能在恶性肿瘤患儿应对方式与疾病获益感间的调节作用

目的:了解恶性肿瘤患儿家庭功能现状及其与疾病获益感的关系,并分析家庭功能在应对方式与疾病获益感间的调节作用,为进一步改善恶性肿瘤患儿疾病获益感提供支持。方法:采用便利抽样法,于2022年2月—10月使用家庭关怀度量表、中文版癌症患儿疾病获益感量表、癌症患儿应对方式量表等,调查北京、河北、河南共3家儿童医院的284例恶性肿瘤患儿;使用多元线性回归分析家庭功能在恶性肿瘤患儿应对方式与疾病获益感间的调节作用。结果:恶性肿瘤患儿的家庭功能得分为(7.81±2.38)分,不同状况的家庭功能对于以问题为导向应对方式与疾病获益感之间的关系,以及防御应对方式与疾病获益感之间的关系均起到了调节作用。结论:在日常诊疗和护理中,应重点关注家庭功能存在障碍的患儿,发现家庭在合作度、成长度等方面的潜在问题,给予切实指导以促进家庭功能的调适,帮助患儿获得良好的疾病获益感。

右美托咪定联合丙泊酚静脉麻醉在儿童肿瘤患者放射治疗中的安全性研究

目的评价右美托咪定联合丙泊酚在儿童肿瘤静脉麻醉放射治疗中的安全性。方法选取2016年10月~2022年5月在郑州市第三人民医院行静脉麻醉下放疗的82例儿童肿瘤患者,非插管静脉麻醉共1256次,采用随机数字表法分为丙泊酚麻醉组(P组)41例,静脉麻醉628次;右美托咪定联合丙泊酚麻醉组(D+P组)41例,静脉麻醉628次。观察比较两组患儿在不同麻醉方式下放疗前(麻醉前)、放疗后(麻醉后)呼吸频率、心率、氧饱和度的变化,计算丙泊酚给药次数、丙泊酚用量,计算患儿麻醉后入睡至放疗结束后清醒的时间间隔,并统计两组不良反应发生情况。结果P组与D+P组患儿放疗前后的心率、呼吸频率、氧饱和度差异无统计学意义(均P>0.05);两组患儿放疗前后心率和呼吸频率差异均无统计学意义(均P>0.05),两组患儿放疗前后氧饱和度差异有统计学意义(P<0.05)。两组麻醉苏醒时间差异无统计学意义(P>0.05),D+P组丙泊酚给药次数减少、用药剂量减少。P组不良反应发生率为63.41%,D+P组不良反应发生率为12.19%,两组比较差异有统计学意义(P<0.05)。结论丙泊酚及右美托咪定联合丙泊酚在儿童肿瘤静脉麻醉放疗过程中,安全性均较好,其中右美托咪定联合丙泊酚组麻醉苏醒时间未见明显延长,丙泊酚给药次数减少,用药剂量减少,不良反应小,值得临床推广应用。

肿瘤患儿化疗相关性口腔黏膜炎护理的最佳证据总结

目的:检索、评价并总结肿瘤患儿化疗相关性口腔黏膜炎护理的最佳证据总结,为医护人员临床工作提供借鉴。方法:依据“6S”证据模型自上而下系统检索相关指南网站、专业学会网站及国内外数据库中关于肿瘤患儿化疗相关性口腔黏膜炎护理的临床决策、指南、专家共识、系统评价、证据总结、原始文献。检索时限为2013年6月—2023年6月。由2名研究者独立进行文献质量评价、证据提取及整合。结果:最终纳入11篇文献,其中指南6篇、专家共识1篇、系统评价2篇、随机对照试验2篇。汇总了包括评估、健康教育、基础口腔护理、冷冻疗法、光生物调节疗法、药物及其他方法6个方面共23条最佳证据。结论:本研究总结了肿瘤患儿化疗相关性口腔黏膜炎护理的最佳证据,建议医护人员应用证据时结合临床情境及实际情况,选择性应用证据。

儿童声带颗粒细胞瘤2例临床特征分析

目的:分析儿童声带颗粒细胞瘤(GCT)的临床特征。方法:回顾性分析2013年1月至2023年12月西安交通大学第二附属医院收治的2例儿童声带GCT患者的临床资料。结果:病例1,女,6岁,因“发声无力3月余”入院,喉镜提示声门下弥漫性膨隆,颈部增强CT提示前联合下方低密度结节并渐进性强化;患儿在全麻下行支撑喉镜CO_(2)激光切除术,术后病理确诊GCT;术后1个月至术后2年复查,肿物无复发,术区局部瘢痕形成,但无明显黏连,声门闭合可。病例2,女,11岁,因“声嘶半年余”入院,喉镜提示前联合光滑肿物,颈部增强CT及喉部增强MRI提示前联合强化结节;患儿在全麻下行支撑喉镜CO_(2)激光切除术,术后病理确诊GCT,术后2周至术后1年复查,肿物无复发,声门下瘢痕形成,声门闭合良好。结论:儿童声带GCT常表现为发音异常,需依靠病理确诊;手术切除为其主要治疗方法,术后应密切随访。

增强MRI全域直方图鉴别儿童星形细胞瘤和室管膜瘤的价值

目的深入探究T_(1)全域灰度直方图分析在儿童后颅窝星形细胞瘤与室管膜瘤鉴别诊断中的实用价值。方法本研究对我院数据库中记录的51例经MRI检查及病理确诊的儿童后颅窝肿瘤病例进行了详尽的回顾性剖析。在这51例病例中,星形细胞瘤占26例(男性12例,女性14例),室管膜细胞瘤占25例(男性13例,女性12例)。患者年龄分布在1至12岁之间,平均年龄为(5.5±2.3)岁。我们运用Mazda软件,在两组MR增强T_(1)矢状位图像的每一层肿瘤层面上,精确地勾画出感兴趣区域,并进行全面的灰度全域直方图分析。接着,我们对这两组直方图参数特征进行了详尽的统计学对比,旨在深入剖析各参数在鉴别诊断中的统计意义,以期为儿童后颅窝肿瘤的精确诊断提供更为有效的辅助手段。结果在深入分析通过增强T_(1)全域灰度直方图所提取的九个参数时,我们发现其中四个参数——变异度(Variance)、偏度(Skewness)、第一百分位数(Perc.01%)以及第10百分位数(Perc.10%)在统计学上具有显著差异(P均<0.05),这一发现为我们的研究提供了强有力的数据支撑。特别是Variance这一参数,其灵敏度高达73.3%,特异度也达到了61.9%,且其曲线下面积(AUC)为0.731,展现出优秀的鉴别效能。进一步地,我们确定了Variance的最佳临界值为740.71,这一具体数值为我们的诊断提供了明确的参考标准。结论增强的T_(1)全域灰度直方图分析在儿童后颅窝星形细胞瘤和室管膜瘤的鉴别诊断中,展现出了不容忽视的价值。这一方法不仅能够为医生提供新的诊断视角,而且有望成为一种针对这两种儿童后颅窝肿瘤的有效辅助诊断工具,为我们的医疗实践带来积极的影响。

头颈部恶性肿瘤患儿放化疗所致口腔黏膜炎的护理策略

目的通过有效的护理对策降低头颈部肿瘤患儿放化疗所致口腔黏膜炎(OM)的严重程度。方法选取2020年1月—2022年12月北京同仁医院儿科收治头颈部恶性肿瘤放化疗OM患儿,儿童口腔评估指南量表评分为9-16分的中度OM患儿100例,随机分为对照组和干预组,每组各50例,对照组根据医嘱用药,干预组在医嘱用药基础上加用(0-4)℃的0.9%生理盐水指导患儿在进食后、睡前、呕吐后、口腔黏膜炎用药前10分钟,利用双侧颊部运动形成水压涡流含漱,每次含漱口液10-15 mL,漱口≥30 s。干预3天后应用儿童口腔评估指南量表进行比较两组患儿口腔黏膜的严重程度及愈合时间、痛苦程度对比。结果干预组较对照组OM的严重程度明显减轻(χ^(2)=12.398,P=0.00);OM导致的痛苦程度干预组较对照组明显减轻(χ^(2)=5.263,P=0.02);OM愈合时间干预组较对照组明显短(χ^(2)=8.752,P=0.01)。结论儿童头颈部恶性肿瘤放化疗后口腔炎用生理盐水清洁口腔能明显降低OM的严重程度;减轻OM导致的痛苦;提高药物的治疗效果缩短OM的病程,具有临床推广价值。

数字医学3D成像技术与传统2D成像技术在儿童腹部实体肿瘤术前医患沟通中的应用价值

目的比较数字医学3D成像技术与传统2D成像技术在儿童腹部实体肿瘤术前医患沟通中的应用价值。方法选取2018年1月至2022年1月广西壮族自治区贵港市人民医院小儿外科收治的80例腹部实体肿瘤患儿为研究对象,随机将其分为试验组和对照组,各40例。试验组使用数字医学3D成像技术进行术前医患沟通,对照组使用传统2D成像技术进行术前医患沟通。比较两组患儿家属的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及满意度。结果沟通后,两组患儿家属的SAS和SDS评分均降低,且试验组低于对照组,差异具有统计学意义(P<0.05)。试验组患儿家属的满意度明显高于对照组,差异具有统计学意义(P<0.05)。结论数字医学3D成像技术在儿童腹部实体肿瘤术前医患沟通中发挥了积极作用,可减轻患儿家属术前焦虑及抑郁情绪,提高了对医疗服务的满意度,增强了患儿家属对医疗过程的依从性,值得在临床中推广。

Endoscopic Third Ventriculostomy for Non-Tumor Obstructive Hydrocephalus in Children under Two Years of Age

The goal of this work is to report on the efficacy of endoscopic third ventriculostomy (ETV) for non-tumor obstructive hydrocephalus in children aged two years and below. In the period between June 2007 and December 2014, we had performed ETV in 30 patients with hydrocephalus from diverse etiologies. Among them were eight children aged two years or below. Clinical, radiological and outcome data of these children were retrospectively reviewed to assess ETV efficiency in this age group. Eight children (6 boys, 2 girls) with age range from 6 to 24 months (mean 12.5 months, median 15 months) suffering from non-tumor obstructive hydrocephalus underwent ETV as primary treatment. Seven patients (87.5%) were under two years and 3 had less than one year of age at the time of surgery. Macro crania, suture diastasis, scalp vein bulging and sunset gaze were the most common findings on physical examination. Computed tomography scanning was done in all patients but none had magnetic resonance imaging. Hydrocephalus was due to primary (congenital) aqueductal stenosis in all cases and was associated with myelomeningocele in one. ETV was successful in 7 (87.50%) cases but failed in one. Operation time varied from 28 to 35 minutes (mean 31.12 minutes, median 31.5 minutes). No intraoperative complication occurred. The child in whom ETV failed had postoperative CSF leak. No death related to procedure occurred. Hospital stay ranged from 2 to 4 days (mean, 2.87 days, median, 3 days). Follow up range was 5.5 to 86 months (0.46 to 7.16 years);mean, 59.14 months (4.92 years);median, 45.75 months (3.81 years).

儿童非横纹肌肉瘤类软组织肉瘤的临床特点及预后

目的 分析儿童非横纹肌肉瘤类软组织肉瘤(NRSTS)的临床特点、治疗及预后影响因素。方法 回顾性分析2012年8月—2022年8月确诊并在我院接受规范治疗的NRSTS患儿的临床资料,通过Kaplan-Meier法分析患儿的预后及影响因素。结果 共纳入49例患儿,男27例,女22例,中位诊断年龄52.7 (0.8~149.6)个月。病理亚型有14种,包括婴儿型纤维肉瘤9例(18.4%)、肾外横纹肌样瘤8例(16.3%)、炎性肌纤维母细胞瘤7例(14.3%)、肝未分化胚胎性肉瘤7例(14.3%)、其他病理亚型18例(36.7%)。在多学科综合治疗下,初治完全缓解43例,部分缓解1例,有效率89.8%。复发15例(30.6%),中位复发时间14 (3~40)个月,复发后中位生存时间16个月。中位随访时间37(4~125个月),3年OS为(74.9±6.6)%,3年EFS为(59.4±7.3)%。Ⅰ+Ⅱ期、Ⅲ+Ⅳ期的3年OS分别为(94.4±5.4)%vs(56.9±10.4)%(P=0.003),3年EFS分别为(72.9±9.6)%vs(46.2±10.3)%(P=0.042)。COG危险度分组低危组和中高危组3年OS分别为100%vs(62.0±9.2)%(P=0.009)。结论 儿童NRSTS治疗以多学科综合治疗为主,完全手术切除是预后良好的关键,COG中高危组预后不佳,复发患儿预后较差。

PTEN基因致病性突变患儿51例病例系列报告

背景PTEN基因突变可引起多种综合征表型,目前在成人中的表型谱研究较多,在儿童中相关研究较少。目的总结PTEN基因突变患儿的基因型和临床表型及二者的相关性。设计病例系列报告。方法纳入2016年1月1日至2023年1月31日复旦大学附属儿科医院分子医学中心经高通量测序发现有PTEN基因突变,且致病性评级为致病/可能致病的患儿,采集其临床特征和基因检测结果。主要结局指标临床表型与PTEN基因突变的关联。结果纳入51例确诊为PTEN基因致病性突变的患儿,男33例,基因检测时中位年龄为2岁(1天至13岁),中位随访年龄为5.2(3.6,6.5)岁,主诉以“发育落后”或“沟通障碍”为主(24例,47.0%)。共检出PTEN基因的41个致病/可疑致病突变,包括错义突变28个(68.3%),无义突变5个,移码突变4个,经典剪切位点突变3个,起始密码子突变1个;位于磷酸酶结构域28个(68.3%),位于C2结构域11个(24.4%),位于PIP2结合模体(PBD)和C-tail(C端尾)结构域各1个。c.388C>T(p.R130X)(5例)和c.302T>C(p.I101T)(3例)为热点突变位点。12个突变位点未见报道。22例患儿验证了突变来源,17例(77.3%)为新发突变。48例(94.1%)有巨头畸形。42例(82.3%)诊断为神经发育障碍,其中语言发育迟缓36例(70%),大运动发育迟缓25例(49.0%),精细运动迟缓2例,平衡能力差3例,ASD 14例(27.4%),智力障碍13例(25.5%),注意力缺陷及多动障碍、学习困难各1例,3例(5.8%)有癫癎发作。11例(21.6%)发现肿瘤性疾病,发现时中位年龄为4.0(1.0~5.0)岁。8例(15.7%)有皮肤表现,包括阴茎雀斑、牛奶咖啡斑、黑痣、毛囊角化等。39例行头颅MR,35例(89.7%)发现异常,主要表现为脑血管周围间隙增宽(18例)、脑白质异常(6例)和脑室扩大(4例)。临床表型与PTEN基因的突变类型、突变位点的结构域分布均无明显关联。结论PTEN基因突变患儿以巨头畸形伴神经发育障碍(如发育迟缓、智力障碍和ASD)为主要表现,可有肿瘤发生、皮肤学表现、头颅MR异常等。

小剂量重组人白细胞介素-2维持治疗对肿瘤患儿免疫细胞亚群的影响

目的:探讨小剂量重组人白介素-2(r IL-2)维持治疗对恶性实体肿瘤患儿免疫细胞亚群的影响及相关副反应。方法:选取2012年12月-2017年11月在本科治疗的22例肿瘤患儿,男女各11例,开始IL-2治疗的中位年龄9(3-16)岁,给予小剂量r IL-2免疫治疗前均完成全部手术及放化疗,其中完全缓解17例,部分缓解5例。化疗结束1个月后开始使用rIL-2小剂量维持治疗:4×10^(5)IU/(m^(2)·d),隔日皮下注射,每周3次,共1年。每3个月行免疫细胞亚群检测至治疗终止,同时随访患儿病情转归及治疗相关副反应。结果:22例患儿经r IL-2治疗后外周血T淋巴细胞(CD3^(+))、自然杀伤细胞(CD3-CD56^(+))、辅助性T细胞(CD3^(+)CD4^(+))、杀伤性T细胞(CD3^(+)CD8^(+))的绝对值及辅助T细胞/抑制T细胞比例均显著升高(均P<0.05),而调节性T细胞(CD4^(+)CD25^(+)CD127^(-))治疗前后的绝对值及比例无显著性差异(P>0.05)。在治疗前获得完全缓解的17例患儿中,14例在治疗后继续保持完全缓解,3例复发,其中2例放弃治疗后死亡;治疗前获得部分缓解的5例患儿经治疗后行PET/CT扫描后评估为完全缓解。在小剂量r IL-2免疫治疗初期,出现注射部位皮疹1例,注射后低至中度一过性发热2例,均给予对症处理后消失,未见治疗相关器官功能损害。结论:小剂量r IL-2维持治疗耐受性良好,可显著改善肿瘤患儿外周血部分抗肿瘤免疫细胞亚群的分布,且不会导致调节性T细胞绝对值及比例的升高。

肿瘤患儿父母共享决策体验的Meta整合

目的分析肿瘤患儿父母共享决策的体验,为医护人员制订干预方案提供参考并促进共享决策。方法检索Cochrane Library、CINAHL、PubMed、Embase、Web of Science、PsycINFO、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库中关于肿瘤患儿父母共享决策体验的文献,检索时限为建库至2023年10月25日。为了保证文献的质量,采用澳大利亚JBI循证卫生保健中心的质性研究质量评价标准(2020版)对文献进行评价,运用汇集性整合法整合最终的结果。结果共纳入6篇文献,提取25个主题,分为13个类别并将其分组合并为4个整合结果:共享决策的主要方式、共享决策困扰、共享决策过程中积极寻求帮助、共享决策相关情感体验。结论医护人员应及时关注肿瘤患儿父母的共享决策体验,并给予充分的心理支持,从而帮助父母选择最佳治疗方案,改善患儿的生活质量。