Endothelin-1 Antagonist in the Management of Refractory Systemic Hypertension in Children with End Stage Kidney Disease: A Case Series

Uncontrolled hypertension is a significant problem in children with end stage kidney disease. We studied 10 children on chronic hemodialysis who received the endothelin-1 receptor antagonist, bosentan as adjunctive therapy in refractory systemic hypertension. Data were retrospectively analyzed on systolic (SBP) and diastolic blood pressure (DBP), antihypertensive medications and hospitalization days per patient per year, at baseline and 3 months after initiation of bosentan. The standard deviation (Z) score of BP for age, height and gender was calculated. Mean age and weight of these children were 11.4 ± 4.8 years (range 1 - 17.5 years) and 32.9 ± 14.4 kg (range 7.4 - 57 kg) respectively and 90% were African American. Seven were on hemodialysis ≥4 times weekly. The average inter-dialytic weight gain was 4.7% ± 1.8%. The pre-dialysis SBP and DBP Z scores were 4.9 ± 1.8 and 4.0 ± 1.0 at baseline and decreased to 1.3 ± 0.4 and 1.3 ± 0.8, 3 months after initiation of bosentan (p < 0.0001). Similarly, anti-hypertensive medications were decreased from 5 ± 1.5 to 2.1 ± 2.6 (p < 0.01). Hospitalization days decreased from 35.6 ± 52.4 days to 1.5 ± 3.3 days (p < 0.0001). This preliminary report indicates bosentan may be beneficial in the management of children with severe refractory hypertension.

Effect of intervention treatment from different stages on prognosis in children with central coordination disturbance

BACKGROUND： Central coordination disturbance is regarded as the early-stage symptom of brain injury-induced cerebral palsy. This disease manifests itself as motor disorder, abnormal attitudinal reflex and muscular tension. Early intervention may improve its prognosis. OBJECTIVE： To observe the effects of intervention treatment from different stages on the prognosis of central coordination disturbance following brain injury in children patients. DESIGN： A contrast observation experiment SETTING： Department of Neurology and Rehabilitation, Urumqi Children＇s Hospital PARTICIPANTS ： Totally 151 children who were diagnosed as central coordination disturbance from January 2002 to December 2003 in the Department of Neurology and Rehabilitation of Urumqi Children＇s Hospital were recruited. All the children patients, including 101 male and 50 female, aged from 3 months to 1 year old, met the diagnosis criteria of central coordination disturbance from Vojta. They were divided into slight, moderate and severe abnormity according to Vojta attitudinal reflex. All 151 patients were divided into 2 groups according to their age at diagnosis： 3-6 months old group （n=74）, 62 severe, 10 moderate and 2 slight; 7-12 months old group （n=77）, 66 severe, 7 moderate and 4 slight. All the relatives of children patients were informed of the experiment. METHODS： ① Both groups received physical training （PT） as the main treatment; Hand training was given if necessary. All of the patients received additional hyperbaric oxygen therapy, bioelectric therapy, scalp acupuncture, drug treatment and family training. The importance of integration of hospital and family based rehabilitation was stressed. Those who did not catch up with the normal development or had abnormal reflexes continued to receive treatment. ② Around the age of 2 years old, all children did a final evaluation using Bayley Scales of Infant Development （BSID）. Mental development index （MDI） and physical development index （PDI） were taken as evaluative criteria. Children with scores 80 and above on MDI and PDI were considered to have normal motor and mental development; 79 and below were considered delayers. The Diagnostic Criteria of Cerebral Palsy and Infantecondary School Social Adaptation Scale were used in the final evaluation[scores ≤5 was extremely severe （extremely severe cerebral palsy）, 6 was severe（severe cerebral palsy）, 7 was moderate（moderate cerebral palsy）, 8 was slight（slight cerebral palsy）, 9 was borderline（slight cerebral palsy）, 10 was normal, 11 was above average, 12 was excellent and ≥13 was extremely excellent]. ③ Final evaluative results of 2 groups were compared. And u test was used for the comparison of Bayley development index and Chi-square test for the comparison of normalization rate. MAIN OUTCOME MEASURES： BSID MDI and PDI as well as the normalization rate of motor function and mental behavior of children patients at 2 years old. RESULTS： Totally 151 children patients entered the stage of result analysis. ①Two groups of children patients were given integrated rehabilitation therapy , and evaluated at 2 years old . The 3-6 months old group had higher MDI and PDI than the 7-12 months old group （91.81＋19.99 vs 71.93＋18.98;91.55＋23.61 vs 68.95＋23.51, u=6.265,5.894,P 〈 0.01 ）.②After being given integrated rehabilitation therapy, children patients of 3-6 months old group had significantly higher normalization rate of motor function and mental behavior than 7-12 months old group （73% ,27%,X2=29.723 9,P 〈 0.01 ）. ③Six slight and 17 moderate central coordination disturbance children of 2 groups all completely recovered; After intervention treatment, among 128 severe central coordination disturbance children, 52 recovered and 76 were still abnormal, in which, 43 slight cerebral palsy, 18 moderate cerebral palsy, 5 severe cerebral palsy and 10 extremely severe cerebral palsy. CONCLUSION： To perform integrated intervention treatment before 6 months old can better improve and promote mental and physical development levels of children patients with central coordination disturbance after brain injury than 6 months later.

Children's Rights Protection Enters New Stage in China

The State Council of China is- sued the National Program on the Development of Children （2011-2020） on July 30,2011,outlining new targets and new measures by the government in promoting under- takings concerning children. The new program marks the start of a new era of children＇s rights protection in China.

中医药防治儿童变应性鼻炎策略

变应性鼻炎是儿童常见过敏性疾病,其发病机制复杂,难以实现根治或有效且稳定的远期治疗目标。中医药防治儿童变应性鼻炎靶点广泛、作用持久且不良反应少,优势明显。提出变应性鼻炎发病多由肺脾肾三脏功能失调,外风引动伏风,两风相合而致。应采取发作期疏外风、抑伏风、宣肺利窍治其标,缓解期防外风、平伏风,调补肺脾肾治其本的中医药分期论治策略;同时应注重未病先防,包括避免先天禀赋因素的不良影响、避免后天环境因素的诱导发病、扶正御邪避其贼风,既病防变以及瘥后防复的全阶段预防。

小肠CT造影对儿童克罗恩病临床活动分期的评价

目的 探讨小肠CT造影(CTE)对儿童克罗恩病临床活动分期的应用。资料与方法 回顾性收集2019年1月—2022年10月首都儿科研究所附属儿童医院收治的83例临床确诊儿童克罗恩病的临床及CTE影像学资料,依据儿童克罗恩病活动指数分为4组(缓解期11例、轻度活动期47例、中度活动期14例、重度活动期11例),收集CTE的各项参数指标,并分析CTE评估与儿童克罗恩病活动度分期的相关性。结果 4组CTE影像表现中,病变肠管范围(χ^(2)=49.934)、肠壁强化方式(χ^(2)=56.561)、肠管狭窄程度(χ^(2)=31.932)、肠壁厚度(χ^(2)=46.535)、肠周淋巴结肿大(χ^(2)=17.330)差异有统计学意义(P<0.05)。儿童克罗恩病活动指数活动期病变(轻-重度活动期)CTE影像表现为受累肠管范围大(>50 mm)(31例,37.3%)、肠壁分层强化多见(27例,32.5%)、肠腔狭窄(<5 mm)(19例,22.9%)及肠壁明显增厚(>5.0 mm)(54例,65.1%)、肠周淋巴结肿大(>7 mm)(16例,19.3%)出现比例高。其中病变肠管范围(r=0.500)、病变肠壁强化方式(r=0.574)、肠腔狭窄(r=0.316)、肠壁增厚(r=0.533)与儿童克罗恩病临床活动分期呈正相关(P均<0.01)。结论 随着病变肠管范围增加、病变肠壁强化方式(均匀-分层)、肠腔狭窄及肠壁增厚程度加重,临床活动分期也逐渐加重,以上4项指标可作为反映儿童克罗恩病活动分期的特征性指标。

基于STEAM理论的学龄前儿童益智类玩具设计研究

本文以设计出一套切合STEAM理论的益智玩具为目的,同时能够提升学龄前儿童的各项智力能力。通过文献查阅对STEAM理论进行深入分析,归纳出STEAM理论的4项特点,STEAM益智玩具应满足的5个方面。根据皮亚杰理论对儿童的分析,选择前运算阶段儿童为目标群体,归纳出该阶段儿童的4项益智需求。通过上述分析设计出一款STEAM益智玩具套装,为后续STEAM益智玩具设计提供了参考。

FEV_(1)%pred、FEV_(1)/VC_(max)%在不同年龄哮喘患儿临床诊断中的应用价值

目的:研究FEV_(1)%pred(第1秒用力呼气容积占预测值的百分比)、FEV_(1)/VC_(max)%(第1秒用力呼气体积与最大肺活量的百分比)在不同年龄哮喘患儿临床诊断中的应用价值。方法:选取佛山市妇幼保健院2022年5月—2023年5月就诊的哮喘患儿,并按照年龄阶段不同分为学龄前组(5~6岁)、早学龄组(7~8岁)、中学龄组(9~10岁)、晚学龄组(11~12岁)、青春初期组(13~14岁),各30例,另外选取同期在医院进行体检的健康儿童90例作为学龄前对照组、早学龄对照组、中学龄对照组、晚学龄对照组、青春初期对照组,各18例。检测不同组别患儿的FEV_(1)%pred、FEV_(1)/FVC_(max)%,同时用受试者操作特征(ROC)曲线界定出不同组患儿诊断哮喘的FEV_(1)%pred、FEV_(1)/VC_(max)%的最佳界值,比较不同组FEV_(1)%pred、FEV_(1)/VC_(max)%切点值的敏感度及特异度。结果:五组哮喘患儿FEV_(1)%pred、FEV_(1)/VC_(max)%均低于对照组,差异均有统计学意义(P<0.05);以85.67%、84.11%为界点鉴别诊断在早学龄组患儿FEV_(1)%pred、FEV_(1)/VC_(max)%的AUC值最大,敏感度和特异度分别为83.3%、94.4%及76.7%、94.4%。结论:FEV_(1)%pred和FEV_(1)/VC_(max)%作为哮喘诊断指标,在不同年龄段哮喘患儿中显示出差异化的敏感度和特异度,其最佳切点值能有效指导临床诊断,对早期识别和治疗哮喘具有重要应用价值。

从“内虚外损”理论辨治儿童反复呼吸道感染

总结尚莉丽教授基于“内虚外损”理论辨治儿童反复呼吸道感染(RRTIs)的经验,认为儿童处于生长发育期,脏腑娇嫩、正气不足,谓之“内虚”;外邪反复侵袭,寒热兼夹,损伤气、血、精、神,谓之“外损”;“内虚外损”导致患儿反复感邪,身心受累,影响生长发育。“内虚外损”理论突出内、外因素对儿童RRTIs的影响,反映了病机演变规律,从而有利于指导临床分期治疗,急性感染期风热证治以辛凉清散,风寒证治以辛温开闭,虚实夹杂证活用攻、补、和、托诸法,辨证论治,随症加减;感染间歇期以扶助正气为目的,兼顾上、中、下三焦,采取益肺、健脾、补肾等治则,为儿童RRTIs的治疗提供有益的思路和方法。

贾六金三期四法辨治儿童鼻窦炎经验介绍

总结贾六金教授治疗儿童鼻窦炎的临证经验。根据儿童鼻窦炎的病程、证候特点等,将鼻窦炎分为三期辨治,即急性发作期、反复迁延期、慢性复发期,相应治法予以散邪气、清肺热、补脾气、通鼻窍,称之谓四法。急性发作期的主要病机为外邪犯肺、肺热熏蒸,治宜散邪气、清肺热;反复迁延期以外邪留恋、余热未清、肺脾气虚为主,治宜散余邪、清肺热、补脾气;慢性复发期则为脾气亏虚、清阳不升、湿浊蒙窍,治宜补脾气为主。同时,通鼻窍治疗应贯穿整个病程的始末。

辨证分期使用中药辅助治疗儿童肱骨外髁骨折临床研究

目的观察辨证分期使用中药配合克氏针内固定术治疗儿童肱骨外髁骨折的效果。方法采用回顾性研究,根据治疗方案的差异将68例Jakob分型Ⅲ型儿童肱骨外髁骨折患儿分为观察组(35例)和对照组(33例)。对照组患儿采用闭合复位克氏针内固定术治疗,术后3天内予小儿伤科一号方,观察组在对照组治疗基础上于术后中后期(术后3天~5周)加用双龙接骨丸口服治疗。采用儿童疼痛行为评估量表(FLACC)对患儿术后第3天和第7天疼痛情况进行评价,采用Femadez-esteve骨痂X线评分对2组患儿术后第3、6周骨痂形成情况评价,采用Flynn肘关节评分标准对2组患儿术后3个月肘关节功能情况进行评价。结果术后第3天,2组FLACC评分比较差异无统计学意义(P>0.05);术后第7天2组FLACC评分均较本组术后第3天降低(P<0.05),且观察组低于对照组(P<0.05)。术后第6周,2组骨痂评分均较本组术后第3周升高(P<0.05);术后第3、6周,观察组骨痂评分均高于对照组同期(P<0.05)。术后3个月,观察组肘关节功能优良率为91.4%(32/35),对照组为66.7%(22/35),观察组肘关节功能优良率高于对照组(P<0.05)。结论辨证分期使用中药配合克氏针内固定术可有效促进儿童肱骨外髁骨折术后骨折愈合,缓解术后疼痛,提高肘关节功能恢复优良率。

杨昆教授分期论治小儿功能性便秘经验

杨昆教授根据小儿生理病理特点,将临床上小儿功能性便秘常见中医证型阴虚肠燥证的治疗分为三期,早期宜清虚热,润肠道为主,兼通腑导滞,中期宜行气导滞为主,后期宜滋阴润肠兼健运脾胃。标本兼治,注重患儿脾胃,强调远期预后,临床疗效甚佳。附案例1则,以资验证。

益气化痰膏联合益气贴治疗小儿肺炎恢复期的临床效果

目的 探讨益气化痰膏联合益气贴治疗小儿肺炎恢复期的临床效果。方法 选取2022年1月至2023年10月北海市中医医院收治的200例肺炎恢复期患儿作为研究对象,按照随机数字表法分为对照组与治疗组,每组各100例。对照组采用西医对症治疗,治疗组在对照组基础上采用益气化痰膏联合益气贴治疗。比较两组症状体征中医积分及临床疗效。结果 治疗后,治疗组症状体征中医积分低于对照组(P<0.05)。治疗组总有效率高于对照组(P<0.05)。结论 益气化痰膏联合益气贴治疗小儿肺炎恢复期的临床效果确切,可有效改善临床症状,值得临床推广。

中医药治疗小儿哮喘缓解期的研究进展

小儿哮喘是儿童期常见的呼吸道疾病,其发病率不断升高,如不及时控制,将严重影响儿童的身心健康。中医药治疗小儿哮喘缓解期具有独特的优势,本文将从中医内治法、中医外治法方面对近年来中医药治疗小儿哮喘缓解期的临床研究进行综述。

海氏三角入路腹腔镜Fowler-Stephens分期手术对小儿高位隐睾的疗效

目的 分析海氏三角入路腹腔镜Fowler-Stephens分期手术治疗小儿高位隐睾的效果。方法 回顾性分析我院116例高位隐睾患儿的临床资料,其中43例行海氏三角入路腹腔镜睾丸引降固定术的患儿作为对照组,73例行海氏三角入路腹腔镜Fowler-Stephens分期手术的患儿作为研究组。比较2组患儿手术前后性激素水平及睾丸功能变化。术后随访6个月,复查睾丸体积,记录并发症发生情况。结果 手术前后2组患儿睾丸体积比较差异无统计学意义(P>0.05),2组患儿术后并发症总发生率比较差异无统计学意义(P>0.05);术后2组患儿血清促卵泡生成素(FSH)、雌二醇(E2)、黄体生成素(LH)水平均较术前明显降低(P<0.05),血清睾酮(T)、抗苗勒管激素(AMH)、抑制素B(INHB)水平及INHB/FSH均较术前升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论 Fowler-Stephens分期手术治疗高位隐睾疗效较好,术中离断精索血管和睾丸引带可建立良好侧支循环,睾丸可下降至阴囊满意位置。

First Language Acquisition:How Children Learn Language

All normal children,with their body development and the influence of environment,could naturally use their mother tongue to interact with other language-users at about 6 years old.During this time,they need no formal instruction to acquire the first language,and it seems that there is some'innate'predisposition in the human infant to acquire language.This paper attempts to explore the com mon features that children share when they are in the process of developing language with the support of data from CHILDES(Child Lan guage Data Exchange System),and explain how child learn language.

Histological outcome of chronic hepatitis B in children treated with interferon alpha

AIM: To evaluate the effect of interferon alpha (IFN-α)treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histology in this group of patients.METHODS: Fibrosis stage and inflammation grade were assessed according to Batts and Ludwig, Ishak et al., and METAVIR (only fibrosis stage) before and 12 mo after IFN-α treatment termination in 93 children aged 2-16years with chronic hepatitis B.RESULTS: None of the three numerical scoring systems for liverfibrosis showed statistically significant differences in liver fibrosis, while evolution of inflammatory activity revealed statistically significant improvement in the whole group of children with chronic hepatitis B treated with IFN-α and in responders. Significantly positive correlations were found between fibrosis stage and inflammation grade in the respective scoring systems.CONCLUSION: Treatment with IFN-α did not improve histological fibrosis but decreased inflammatory activity in children with chronic hepatitis B. The three semiquantitative scoring systems seem to be comparable in the estimation of the inflammation grade and fibrosis stage in this group of children.

王力宁教授分期辨治小儿反复呼吸道感染的临证经验

反复呼吸道感染具有反复患病、病程较长、缠绵难愈等特点,是儿童时期的常见病、多发病。该病是儿童时期发育不成熟所面临的健康问题,不仅影响小儿身心健康,而且对家庭和社会造成一定的负担。中医学在小儿反复呼吸道感染的认识和治疗上有着独特的优势,在整体观念及辨证论治原则指导下,中医学对本病的防治积累了丰富的经验。本文依据王力宁教授长期在儿科临床中对小儿反复呼吸道感染各阶段不同的临床特征、辨治要点及临证经验,总结其分期辨治小儿反复呼吸道感染的学术思想及证治规律。

《幼幼集成》哮喘证治探微

清代医家陈复正所著《幼幼集成》中对小儿哮喘的阐述系统全面。他认为哮喘分虚实,分别从病因病机论治哮喘,从病程分期论治哮喘,认为哮喘病位在肺,与五脏有密切的关系,病因病机以痰火内郁,风寒外束为主,且注重哮喘的预防,提出哮喘预防方剂。也详细记载了哮喘的危急重症,其发作时的临床症状、用药与预后。《幼幼集成》对小儿哮喘的病因病机认识、治则方药,对当今临床仍具有宝贵的指导意义。

补肺防感合剂联合穴位贴敷与丙酸氟替卡松治疗儿童肺脾气虚型哮喘缓解期的效果观察

目的:观察补肺防感合剂联合穴位贴敷与丙酸氟替卡松治疗儿童肺脾气虚型哮喘缓解期的效果。方法:选取2019年3月—2021年3月常州市武进中医医院儿科收治的102例肺脾气虚型哮喘缓解期患儿作为研究对象,采用随机数表法将患儿分为对照组(n=51)与联合组(n=51)。对照组给予丙酸氟替卡松吸入气雾剂与中药穴位贴敷治疗,联合组在对照组的基础上给予补肺防感合剂治疗。比较两组临床疗效、中医症候积分、血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白M(immunoglobulin M,IgM)水平与不良反应发生情况。结果:联合组治疗总有效率为88.24%,高于对照组的70.59%,差异有统计学意义(P<0.05)。治疗后,两组中医症候积分、血清IL-6、TNF-α水平较治疗前均降低,且联合组均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清IgA、IgM水平较治疗前均升高,且联合组高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:补肺防感合剂联合穴位贴敷与丙酸氟替卡松治疗儿童肺脾气虚型哮喘缓解期,可缓解哮喘发作次数,改善临床症状,提高免疫力。