Living donor liver transplantation in 43 children with biliary atresia: a single-center experience from the mainland of China

BACKGROUND: There is no large-cohort report on living donor liver transplantation (LDLT) for biliary atresia (BA) patients from the mainland of China. This single-center study describes our initial experience with 43 LDLTs for BA patients aged two years or younger. METHODS: In this study, the eligibility criteria were BA as the primary diagnosis and two years of age or younger. From October 2006 to December 2010, the clinical data of 43 LDLTs, including pre-operative evaluations, surgical techniques, postoperative complications and outcomes of donors and recipients, were retrospectively analyzed. RESULTS: Donor graft type was the left lateral segment with compatible ABO blood groups. Forty-three recipients were selected in this study. The median patient age at operation was 9 months (range 6-24), and the median body weight was 8 kg (range 5.7-12.5). Fourteen (32.6%) recipients received Kasai operations before liver transplantation. The overall one- and two-year cumulative survival rates for grafts and recipients were 81%, 81% and 76%, 76%, respectively. No donor mortality was encountered, with a minimal morbidity and no long- term sequelae. Nine out of 43 recipients died. Postoperative complications of recipients were biliary leakage and refluxing cholangitis (11/43, 25.6%), hepatic artery thrombosis (4, 9.3%), pulmonary infections (4, 9.3%), portal vein thrombosis (3, 7.0%), wound disruption (3, 7.0%), acute rejection (3, 7.0%), cytomegalovirus infection (2, 4.7%), and intra-abdominal bleeding (1, 2.3%).CONCLUSION: Despite the relatively low survival rates due to lack of experience initially, LDLT still provides encouraging outcomes for pediatric recipients with BA, even small children under two years old.

Forty-four living donor liver transplantations for children with biliary atresia

Objective To observe the outcomes of living donor liver transplantation ( LDLT) for children with biliary atresia ( BA) and to summarize clinical experiences. Methods Forty - four BA patients ( 26 boys and 18 girls) underwent LDLT between October 2006 and December 2010. Mean ( SD) and median ( range) age

Outcomes in children with biliary atresia following liver transplantation

BACKGROUND: Congenital biliary atresia is a rare condition characterized by idiopathic dysgenesis of the bile ducts. If untreated, congenital biliary atresia leads to liver cirrhosis, liver failure and premature death. The present study aimed to evaluate the outcomes of orthotopic liver transplantation in children with biliary atresia. METHOD: We retrospectively analyzed 45 patients with biliary atresia who had undergone orthotopic liver transplantation from September 2006 to August 2012. RESULTS: The median age of the patients was 11.0 months (5-102). Of the 45 patients, 41 were younger than 3 years old. Their median weight was 9.0 kg (4.5-29.0), 34 of the 45 patients were less than 10 kg. Thirty-one patients had undergone Kasai portoenterostomy prior to orthotopic liver transplantation. We performed 30 living donor liver transplants and 15 split liver transplants. Six patients died during a follow-up. The median follow-up time of surviving patients was 11.4 months (1.4-73.7). The overall 1-, 2- and 3-year survival rates were 88.9%, 84.4% and 84.4%, respectively. CONCLUSION: With advances in surgical techniques and management, children with biliary atresia after liver transplantation can achieve satisfactory survival in China, although there remains a high risk of complications in the early postoperative period.

Prevalence and Years Lived with Disability for Dental Caries among Children Aged 0-14 Years in China, 1990-2016

The estimate of dental caries among Chinese children at the microscale level using standard methodology remains unclear. In this study, we assessed and analyzed the disease burden of childhood dental caries in China by extracting data from the Global Burden of Disease, Injuries, and Risk Factors Study 2016 （GBD 2016）. In 2016, the number of cases, prevalence, years lived with disability （YLD）, and age-standardized YLD rate of dental caries was 93.0 million, 43.0%, 32,200 person years, and 14.8 per 100,000, respectively. Across 33 provincial units, the disease burden was highest in Hubei （YLD rate 28.6 per 100,000）, lowest in Macao （9.1 per 100,000）, while geographical clustering was not observed. Compared with 1990, the prevalence in 2016 decreased from 46.8% to 43.0%, and the YLD rate decreased from 16.5 per 100,000 to 14.8 per 100,000. Given the slight decrease in dental caries burden, the prevalence and disease burden remained high among Chinese children. Strategies for addressing the spatial inequity of childhood dental caries require geographical targeting.

Live Fibular Graft for the Treatment of Long Bone Tumors in Children

Purposes: We would like to inform the characteristics of recurred osteo-fibrous dysplasia (OFD), and also the possible use of vascularized composite autograft and allografts (VCA) combined with live fibular graft (LFG) for the treatment of aggressive benign bone tumor and osteogenic sarcomas in children. Materials and Methods: We reviewed one boy with recurred OFD after LFG, and other four children with osteogenic sarcoma in long bone which was treated with LFG and VCA, and followed them for average 9 years (3 - 14 years). Survival of the LFG and VCA was estimated by the ISOLS Functional Radiologic Scoring System, but not with Kaplans-Meier’s scoring system because of a small series of case reports. Results: All succeed after surgeries initially, but the cause of recurrence of OFD was still unclear, and one girl with osteogenic sarcoma on distal femur died with skip and lung metastasis, 4 years after surgeries. Conclusions: The causes of recurred OFD are not found thru pathologic studies of our patient, but we believe the multifocal origin of tumor cells even on the adjacent soft tissues in OFD is one of the causes. The excised long bone tumor is recycled by pasteurization or autoclaving, or allograft, then LFG, and neo-adjuvant chemotherapy would be one of elective surgery for the treatment of malignant long bone tumors in children. The LFG into recycled autograft or allograft bone is difficult to perform simultaneously, but very effective to increase more earlier regenerative vascularities and also the stabilities of the dead bones in children.

Lived Experience of Thalassaemic Children in Bangladesh

Background: Worldwide thalassemia poses a serious public health problem due to the high prevalence. Globally, 15 million people are suffering from clinically thalassemic disorders. Objective: To describe the lived experience of thalassaemic children in Bangladesh. Methods: This study was conducted following a descriptive qualitative research approach. Twenty thalassemic children were recruited purposively in the present study. Semi-structured individual’s interview guidelines were used to collect in depth information. In addition, digital recorder was used to capture the children’s voice. Data were analyzed using the process of content analysis. This study was approved by the Institutional Review Board (IRB), NIANER. Results: The mean age of the thalassemic children was (16.05) SD = 1.877. Most of the children were Muslim (95.0%) and they study at school (70.0%). Most of their mothers were (90.0%) housewife. This study revealed four major themes and eleven subthemes based on the experience of thalassemic children: 1) understanding of children meaning of thalassaemia: perception of children, unable to perform daily activities, and educational impact, 2) feeling frustrating experience and disease management: feelings about long term treatment, coping and altered body image, 3) family relationship: differences from siblings, parental attention and feeling burden, and 4) social interactions: sharing with peer, inability to social interaction. Conclusion: This study indicated that thalassaemia has affected negatively on several areas of health of these children including physical, emotional, social financial and educational areas. Reducing these problems requires comprehensive constant support and surveying health and medical status of these children to promote care and decrease the suffering of thalassaemic children. The findings of the present study are grounds for further research in a wider range to describe the different areas of the experience of thalassaemic children.

Quality of life,depression and anxiety in potential living liver donors for pediatric recipients:A retrospective single center experience

BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list.Donor evaluation goes beyond physical variables to include social,emotional,and ethical aspects.The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment.Success implies recovery from the operation and pro-mpt engagement in pre-transplant professional and social activities,without leading to psychological or physical distress.Psychological profiling of potential living liver donors(PLLD)and evaluation of quality of life(QOL)can influence outcomes.AIM To evaluate the socio-demographics and psychological aspects(QOL,depression,and anxiety)of PLLD for pediatric liver transplantation in a cohort of 250 patients.METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019.All the recipients were children.The Beck anxiety inventory,Beck depression inventory,and 36-item short-form health survey(SF-36)scores were used to evaluate anxiety(Beck anxiety inventory),depression(Beck depression inventory),and QOL,respectively.RESULTS A total of 250 PLLD were evaluated.Most of them were women(54.4%),and the mean age was 29.2±7.2 years.A total of 120(48.8%)PLLD were employed at the time of evaluation for donation;however,most had low income(57%earned<2 times the minimum wage).A total of 110 patients(44%)did not finish the donation process,and 247 PLLD answered a questionnaire to evaluate depression,anxiety,and QOL(SF-36).Prevalence of depression was of 5.2%and anxiety 3.6%.Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor,some traces of ambivalence were observed:46%of the respondents said they would feel relieved if a deceased donor became available.CONCLUSION PLLD had a low prevalence of anxiety and depression.The foundation for effective and satisfactory results can be found in the pre-transplantation process,during which evaluations must follow rigorous criteria to mitigate potential harm in the future.Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues.The impact of such findings on the donation process and outcomes needs to be further investigated.

Different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children

Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were treated in this hospital between September 2015 and February 2018 were selected and randomly divided into the living high - training low group (n=109) and living low - training low group (n=109). Living high - training low group received living high- training low intervention, living low - training low group received living low - training low intervention, and the intervention of both groups lasted for 4 weeks. The differences in serum levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines were compared between the two groups of children before intervention and after 4 weeks of intervention. Results: Before intervention, the levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines in serum were not significantly different between the two groups of obese children. After 4 weeks of intervention, serum insulin sensitivity-related indexes ISI, FPIR and GDR levels of living high-training low group were higher than those of living low - training low group;appetite-related hormones CCK and PYY3-36 contents were higher than those of living low - training low group whereas Ghrelin content was lower than that of living low - training low group;adipocytokines omentin-1 and APN contents were higher than those of living low - training low group whereas chemerin and LEP contents were lower than those of living low - training low group. Conclusion: Compared with traditional living low - training low intervention, living high - training low intervention is more effective in improving the insulin sensitivity and balance the secretion of appetite-related hormones and adipocytokines in obese children.

恒前牙外伤冠折露髓患儿术后预后不良的危险因素分析及模型构建

目的探究断冠再接术联合活髓切断术治疗儿童恒前牙外伤冠折露髓不良预后的危险因素,同时基于筛选出的危险因素构建风险列线图模型,并对构建的模型进行验证。方法选取98例儿童恒前牙外伤冠折露髓患儿为研究对象,均为2020年1月至2023年12月间在本院行断冠在接术联合活髓切断术治疗者。将受试者根据预后结果分为预后良好组和预后不良组,收集两组患儿临床资料,筛选患儿术后预后不良的危险因素。基于危险因素构建预后不良风险列线图模型,并对构建的模型进行验证。结果98例患儿中有18例发生预后不良,预后不良率为18.37%(18/98)。预后不良组牙髓暴露时间>24 h、牙龈炎、露髓孔直径>1 mm、口腔溃疡、牙周炎、牙根发育程度(根尖接近形成)占比高于预后良好组(P<0.05)。牙髓暴露时间>24 h、牙龈炎、牙周炎、牙根发育程度(根尖接近形成)均是影响恒前牙外伤冠折露髓患儿术后预后不良的危险因素(P<0.05)。列线图风险模型预测恒前牙外伤冠折露髓患儿术后预后不良受试者工作特征(ROC)曲线下面积(AUC)、95%CI、灵敏度、特异度分别为0.868、0.633~0.992、95.10%、79.30%(P<0.001)。列线图预测模型C指数为0.842(95%CI:0.789~0.994),预测值与实际预测值均在理想曲线附近,且Hosmer-Lemeshow拟合优度曲线检验χ^(2)=2.743,P=0.671。结论本研究综合牙髓暴露时间、牙龈炎、牙周炎、牙根发育程度等4个危险因素构建的风险列线图模型对患儿预后不良具有较高的预测价值。

儿童成长家庭客厅家具产品创新设计研究与实践

通过若干设计实践案例,探讨亲子家庭客厅家具创新设计的方法。定位儿童成长家庭,通过开展市场调研,合理构建QDF质量屋;以“形式追随生活”的理念开展概念设计;严格执行《儿童家具通用技术条件》,深化产品设计。通过一系列儿童成长家庭客厅家具的创新设计尝试,提出若干儿童成长家庭客厅的创新家具产品设计解决方案。探析出儿童成长家庭的客厅家具可以从儿童的学习和运动能力的需求方面寻找设计创新点。在产品创新设计过程中需要注意:结合家庭消费观念,选择适合的解决方案;注重功能的可识别性与安全可靠;遵循尽可能简约的设计原则;选择色彩应用时,应综合考虑家庭成员的需求;产品设计风格要与全屋定制趋势相匹配。

针刺丘墟透照海联合运动发育推拿法治疗小儿痉挛性脑瘫临床研究

目的:观察针刺丘墟透照海联合运动发育推拿法对小儿痉挛性脑瘫患者运动发育及肌张力的影响。方法:选取痉挛性脑瘫患儿90例作为研究对象,采用随机数字表法分为对照组和观察组各45例。2组均采用运动发育推拿法,观察组加用针刺丘墟透照海治疗。评价2组临床疗效,比较2组治疗前后运动发育、肌张力、运动功能、日常生活活动能力、F波波幅、刺激阈值。结果:观察组总有效率为88.89%,高于对照组71.11%,差异有统计学意义(P<0.05)。治疗后,2组Peabody运动发育量表(PDMS-2)评分、粗大运动功能(GMFM88)量表评分、日常生活活动能力评分均高于治疗前(P<0.05),且观察组各项评分均高于对照组(P<0.05)。治疗后,2组改良Ashworth痉挛量表评分均低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。治疗后,2组F波波幅低于治疗前,刺激阈值高于治疗前(P<0.05);且观察组F波波幅低于对照组,刺激阈值高于对照组(P<0.05)。结论:针刺丘墟透照海联合运动发育推拿法治疗小儿痉挛性脑瘫效果明显,可有效改善运动发育,降低肌张力,提高日常生活活动能力。

真实世界12岁以下儿童接种麻腮风联合减毒活疫苗后30天内单纯性热性惊厥发生风险分析

目的分析甘肃省12岁以下儿童接种麻腮风联合减毒活疫苗(MMR)后30 d内发生单纯性热性惊厥(SFS)特征。方法筛选甘肃省2021年1月1日至2023年12月31日电子病历库中诊断为“热性惊厥”个案,利用病例身份信息匹配甘肃省免疫规划信息系统中该病例的接种信息,采用观察性流行病学方法分析12岁以下儿童出现SFS的流行特征及接种MMR 30 d内SFS发生风险。结果共纳入10614例SFS儿童患者,12岁以下儿童SFS总体发生率为92.42/10万,其中12~24月龄儿童发生率最高,为297.67/10万,男性儿童发生SFS风险高于女性儿童(RR值为1.61,P<0.001)。接种MMR后30 d内发生SFS风险较未接种该疫苗的高(RR值为2.66,P<0.001)。接种第1剂次的发生率(27.98/10万)较第2剂次(18.48/10万)高,12~24月龄儿童在接种第1剂次MMR 6~14 d SFS发生风险较<12月、25月~6岁组高(RR值分别为4.06和2.64,P<0.001)。结论12~24月龄儿童在接种MMR后6~14 d SFS发生风险增加,以12~24月龄儿童最为常见,应高度关注高风险人群并加强对SFS监测。

让Living Library走进少年儿童

Living Library是近年来图书馆界一种全新的服务理念和服务方式,通过一本本"真人书"的出借,让读者获得更加真实可感的阅读体验。Living Library不仅在少儿阅读中有着独特的优势和魅力,而且对少年儿童的健康成长有着深刻的现实意义。公共图书馆,尤其是少儿图书馆要广泛开展基于少年儿童的Living Library活动,让少年儿童在借阅真实的人生中成长。

儿童功能性消化不良患者使用四磨汤联合双歧杆菌三联活菌的治疗效果

目的观察功能性消化不良患儿在使用四磨汤联合双歧杆菌三联活菌后的治疗效果。方法随机选取2021年1月—2022年12月福建医科大学附属厦门弘爱医院儿科80例功能性消化不良患儿为研究对象。按照随机数表法分为对照组(n=40)和观察组(n=40)。对照组给予四磨汤治疗,观察组以四磨汤联合双歧杆菌三联活菌进行治疗。以多项症状积分为疗效分析切入点,比较胃肠功能指标,评价治疗的有效性及安全性。结果治疗后,观察组症状积分比对照组更低,差异有统计学意义(P<0.05);治疗后,观察组胃肠功能指标均显著优于对照组,差异有统计学意义(P<0.05);观察组经治疗后的总有效率(95.00%)高于对照组的77.50%,观察组的不良反应发生率(5.00%)明显低于对照组,差异有统计学意义(χ^(2)=5.165、4.114,P均<0.05)。结论以四磨汤联合双歧杆菌三联活菌片治疗儿童功能性消化不良的有效性、安全性非常高,在改善症状、恢复肠道功能等方面的优势更显著。

“活教师”何以养成?——“学以成童”理念下学前教育本科实践教学体系构建

高质量学前教育体系建构的核心是“活教师”,师范教育应孵育适宜高质量教育工作的“活教师”,依循“发现儿童、了解儿童、解放儿童、信仰儿童、变成儿童”的“学以成童”幼儿教师养成规律,建构具有“园校整合”“理实印证”“早开始、分阶段、多层次”特征的学前教育专业本科人才实践教学体系。

“生生不已”的幼儿园环境创设探析——基于生命美学的视角

幼儿作为独特的生命存在,其生长离不开环境,生命美学以“人的生命需要”为逻辑起点,深度契合幼儿园环境创设的内在要求。从生命美学的视角来看,幼儿园环境是幼儿生命成长的关键场域,其创设应紧紧围绕幼儿的生命来展开。“生生不已”既符合中国传统生命美学的意蕴,又是当代生命美学回归生命本体的凝练表达。“生生不已”的幼儿园环境,关键在于遵循幼儿生命完整性、幼儿生命体验性、幼儿生命审美性的三重原则,在运动变化、持续向上中彰显幼儿生命之美。“生生不已”的幼儿园环境创设路径在于:在自然环境下,丰富幼儿生命的感性认知;在虚拟和真实环境的相互结合中,赋能幼儿生命的多重体验;在物质美和精神美的美美与共里,呵护幼儿生命的自由表达。这三条创设路径之间互生互动,共同指向幼儿生命的美好发展。

酪酸梭菌活菌散与醒脾养儿颗粒联合治疗小儿消化不良性腹泻的效果

目的探讨在酪酸梭菌活菌散的基础上联合醒脾养儿颗粒治疗小儿消化不良性腹泻(ID)取得的效果。方法选取2021年9月至2023年8月于本院接受治疗的98例ID患儿,按照随机数字表分组。两组患儿均接受常规对症治疗,对照组49例患儿采用酪酸梭菌活菌散治疗,研究组49例患儿在对照组的基础上使用醒脾养儿颗粒治疗。针对两组患儿的疗效、大便次数与症状好转时间、胃肠激素指标、免疫功能指标[T淋巴细胞分化簇4^(+)(CD4^(+))、分化簇8^(+)(CD8^(+))、CD4^(+)/CD8^(+)]、不良反应(ADR)情况进行比较。结果两组患儿总有效率评价显示,研究组结果较对照组高(P<0.05)。治疗后研究组大便次数较对照组少(P<0.05)。研究组腹胀、大便性状、腹泻症状好转时间较对照组短(P<0.05)。治疗后研究组胃动素、胃泌素指标较对照组低(P<0.05),生长抑素指标较对照组高(P<0.05),CD4^(+)/CD8^(+)、CD4^(+)水平较对照组高(P<0.05),CD8^(+)水平较对照组低(P<0.05)。ADR评价显示中,两组未见差异(P>0.05)。结论在酪酸梭菌活菌散的基础上联合应用醒脾养儿颗粒治疗小儿ID效果较佳,可以快速改善相关症状,调节胃肠激素指标,增强机体免疫功能,安全可靠。

留守儿童适当生活水准权实现的法治路径——以习近平民生思想为指引

习近平民生思想的核心就是“以人民为中心”。站在新的发展阶段,民生领域中的问题,既有新的挑战,也有老生常谈的问题,如留守儿童的权益保障等。儿童享有的适当生活水准权应包括衣着权、食物权、健康权、住房权、受教育权等方面。我国通过法律法规及相关政策的贯彻落实,在留守儿童的权益保障工作方面取得了一定的成果,但也存在不少问题,如立法层级低、政出多门等。在未来,应建立健全留守儿童适当生活水准权的法律保障体系,将适当生活水准权的具体内容法定化,明确留守儿童适当生活水准权实现的国家义务,建立专门的儿童权益保障行政管理机构,设立留守儿童权益保障工作的专项财政资金,并建立留守儿童社会工作的职业化人才队伍。

双歧杆菌三联活菌散联合蒙脱石散治疗小儿腹泻的临床效果

目的:探讨双歧杆菌三联活菌散联合蒙脱石散治疗小儿腹泻的临床效果。方法:选择2020年10月—2021年12月如皋市第三人民医院收治的腹泻患儿85例进行研究,对患儿进行随机分组,分为对照组和观察组。对照组给予蒙脱石散治疗,观察组在对照组基础上联合双歧杆菌三联活菌散治疗。对比两组治疗效果、症状缓解时间、炎性因子水平。结果:观察组治疗总有效率高于对照组(P=0.021)。观察组发热、呕吐、腹泻缓解时间均短于对照组,大便性状恢复时间早于对照组(P<0.001)。治疗前,两组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平比较,差异无统计学意义(P>0.05);治疗后,两组TNF-α、IL-6、IL-10水平均低于治疗前,且观察组低于对照组(P<0.05)。结论:双歧杆菌三联活菌散联合蒙脱石散治疗小儿腹泻的临床效果显著,能够缓解患儿临床症状,降低炎性因子水平,促进患儿康复。

穴位敷贴联合醒脾养儿颗粒治疗小儿消化不良性腹泻的效果及对胃肠激素的影响

[目的]探讨穴位敷贴联合醒脾养儿颗粒治疗小儿消化不良性腹泻的临床疗效及对胃肠激素的影响。[方法]选取2022年6月至2023年6月在衡水市妇幼保健院儿科就诊的小儿消化不良性腹泻患儿110例,随机分为对照组(55例)和观察组(55例)。对照组服用酪酸梭菌活菌散,观察组给药醒脾养儿颗粒同时进行穴位敷贴,连续治疗9 d。比较两组患儿中医症候积分,临床疗效,症状改善时间,胃肠指标包括胃泌素(gastrin,GAS)、胃动力素(motilin,MTL)、生长抑素(somatostatin,SS)水平,以及不良反应。[结果]治疗后两组患者中医症候积分的主症、次症及总分较治疗前降低,观察组更低(P<0.05)。与对照组比较,观察组临床总有效率更高(P<0.05),治疗后体温恢复正常时间、腹胀消失时间、大便次数及性状恢复正常时间更短(P<0.05)。与治疗前比较,治疗后两组患者GAS、MTL水平上升,SS水平下降(P<0.05)。与对照组比较,观察组GAS、MTL更高,SS水平则更低(P<0.05)。两组不良反应总发生率差异无统计学意义(P>0.05)。[结论]穴位敷贴联合醒脾养儿颗粒治疗小儿消化不良性腹泻疗效显著,可明显改善临床症状,缩短恢复进程,调节胃肠激素水平,而且安全性好。