小儿慢性咽喉炎与胃食管反流的关系

目的探讨小儿慢性咽喉炎与胃食管反流（GER）的关系。方法对37例慢性咽喉炎患儿进行24h食管pH监测,30例无症状儿作为对照。结果病例组各项食管酸反流指标如酸反流次数、反流≥5min次数、最长反流时间、酸性反流指数及Boix-Ochoa综合评分均高于对照组,差异有统计学意义（Z=2.673～4.144,P均〈0.01）。病例组GER检出率（40.5%,15/37例）高于对照组（3.3%,1/30例）,差异有统计学意义（χ^2=12.617,P〈0.01）。结论GER与小儿慢性咽喉炎关系密切;对常规治疗效果差的慢性咽喉炎患儿要考虑到GER的可能,及时进行有关检测。     

近端食管胃酸反流与胃食管反流患儿呼吸道症状的关系

目的了解胃食管反流(GER)患儿近端食管胃酸反流与呼吸道症状发生的关系。方法采用食管双pH动态监测法，对31例单纯性呕吐、23例伴有反复呼吸道症状的GER患儿同时监测食管近端和远端pH值的变化，以35例健康儿作为对照组。结果单纯呕吐组远端食管各项酸反流指标、近端食管酸反流指标除最长反流时间外均大于对照组，差异有显著性；呼吸道症状组远端食管、近端食管各项酸反流指标均大于对照组，差异有显著性；但单纯呕吐组与呼吸道症状组相比较，无论在近端食管还是在远端食管，各项指标的差异无显著性；病例组远端食管各项酸反流指标均大于近端食管，差异有显著性。结论近端食管酸反流并不是GER患儿发生呼吸道症状的主要因素，而远端食管酸反流是小儿GER的主要反流形式。     

儿童重症肺炎与胃食管反流关系的临床研究

目的 了解重症肺炎患儿胃食管反流(gastroesophageal reflux,GER)的发生及其影响因素.方法 对2009年2月至2011年2月于我科PICU就诊的确诊为重症肺炎患儿25例(肺炎组)和正常儿童10例(对照组)进行连续食管pH监测,监测时间包括鼻饲前1h和餐后3h.结果 肺炎组GER发生率为60.0％(15/25),对照组GER发生率为20.0％(2/10),两组比较差异有统计学意义(x2 =4.58,P＜0.05).肺炎组GER 84.5％出现于咳嗽/吸痰和腹部压力增加时.肺炎组与对照组各项反流指标比较差异均有统计学意义(P均＜0.05).重症肺炎患儿中伴GER者高血糖、腹胀、脓毒症、使用糖皮质激素的发生率明显高于不伴GER者(P均＜0.05).结论 重症肺炎儿童GER发病率高,表现为酸反流次数增加,酸清除能力降低.GER发生与疾病的严重程度相关.     

健康儿童及病理性胃食管反流患儿食管动力功能研究

目的了解小儿食管运动的生理学,探讨小儿病理性胃食管反流(GER)发生的食管动力学基础。方法对60例健康儿童和62例经食管pH监测诊断为病理性GER的患儿用低顺应性毛细管灌注系统进行食管测压研究,并对健康儿童组不同年龄段之间,两组同一年龄段之间进行食管动力功能比较。结果健康儿童组下食管括约肌长度(LESL)随着年龄的增加而增长,胸内段和腹内段也相应增加(P＜0.01),下食管括约肌压力(LESP)以～1岁组为高(P＜0.05);上食管括约肌长度(UESL)随年龄的增加而增长(P＜0.01),上食管括约肌压力(UESP)以～1岁组和～3岁组为低(P＜0.01)。病理性反流患儿的食管动力功能,除～7岁组食管蠕动传导速度低于同一年龄段健康儿童外(P＜0.05),其余指标两组同一年龄段间的差异均无显著性。结论LESP的抗反流功能与年龄关系不大,LESL、UESL和UESP的功能3岁以后逐渐成熟,小儿病理性GER的发生与LESP、LESL关系不大。     

婴幼儿胃食管反流与呼吸道感染的关系探讨

目的探讨婴幼儿阶段胃食管反流与呼吸道感染的关系。方法用便携式24h食管pH监测仪记录食管下端pH值变化。观察组89例,平均年龄(10.5±0.9)个月,系因下呼吸道感染在呼吸科病房住院患儿,符合下述3条件之一①3个月内有下呼吸道感染史≥1次;②咳嗽喘息经过治疗≥半个月仍不愈;③溢乳史。对照组为26例健康儿,平均年龄(13.7±2.1)个月。结果观察组5项反流指标均高于对照组,差异有显著性(P均<0.001)。观察组病理性GER的检出率为79.8%(71/89例),显著高于对照组(χ2=49.554,P<0.01)。呼吸道感染合并GER的患儿在总反流次数、反流时间≥5min的次数和最长反流时间上婴儿高于幼儿,差异有显著性(P<0.01或<0.05);总pH<4时间百分比和综合评分也是婴儿较幼儿高(P<0.01)。呼吸道感染合并GER的患儿体重偏重眼体重大于第80百分位(P80)演占40.8%(29/71例)。婴儿GER患儿中体重偏重者占一半,与幼儿GER相比,差异有显著性。结论在婴儿期胃食管反流症状较幼儿期常见,溢乳和体重偏重有关;婴幼儿时期胃食管反流病与反复呼吸道感染、呼吸道炎症不愈以及部分哮喘有关。     

酸和胆汁反流在胃食管反流病中的作用

目的探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的作用及这两种反流的临床意义。方法应用便携式pH监测仪及胆汁监测仪同步监测12例GERD患儿及11例健康儿童的食管内24 h pH变化和胆汁反流情况。结果GERD组食管酸暴露时间(pH<4)较对照组显著增加(P<0.05);食管胆汁反流采用胆红素吸收值≥0.14的时间百分比表示,GERD组较对照组明显增高(P<0.05),且85%GERD患儿存在酸和胆汁混合反流。结论胆汁反流和酸反流同样常见于GERD患儿,在小儿GERD发病中起重要作用,同步监测食管内pH及胆汁变化对小儿GERD的诊断具有重要意义。     

24h食管pH监测在婴儿喘息性疾病中的应用

目的探讨24 h食管pH监测在婴儿喘息性疾病中的应用。方法对74例喘息性疾病婴儿进行24 h食管pH监测,监测指标包括食管pH<4.00的次数、反流时间≥5 min的次数、最长反流时间、卧位pH<4.00的时间占总监测时间的百分比以及Biox-Ochoa评分;对所有喘息患儿按照病情分为持续性喘息组和一般喘息组,比较2组24 h食管pH监测情况;将其中有病理性胃食管反流(GER)的40例患儿随机分为治疗组和对照组。对照组给予常规抗炎、平喘治疗,治疗组在抗炎、平喘治疗基础上加用抗GER治疗。比较2组患儿住院时间和肺部啰音消失时间?峁?4例喘息性疾病患儿病理性GER发生率为54.0%。其中持续性喘息组病理性GER发生率(69.4%),显著高于一般喘息组(39.5%);持续性喘息组各项反流指标均高于一般喘息组(Pa<0.01)。治疗组患儿住院时间、肺部啰音消失时间均较对照组明显缩短,差异均有统计学意义(Pa<0.01)。所有患儿在24 h食管pH监测中未出现严重不良反应,无终止监测的发生。结论喘息性疾病患儿病理性GER发生率高,持续性喘息患儿发生率更高。伴有病理性GER的喘息患儿经抗GER治疗后效果明显。24 h食...     

儿童非糜烂性反流病与反流性食管炎症状及酸反流比较

目的比较非糜烂性反流病（NERD）与反流性食管炎（RE）临床症状及食管酸暴露特点。方法将127例胃食管反流病（GERD）患儿根据内镜检查结果分为NERD组和RE组,分别对两组的临床症状及食管24hpH值监测结果进行比较。结果127例中NERD79例（62.2%）,RE48例（37.8%）,RE组Ⅰ、Ⅱ、Ⅲ级分别为34、10和4例。NERD组和RE组pH监测阳性者分别为51例（64.6%）和30例（62.5%）,两组阳性率差异无统计学意义（χ^2=0.05,P〉0.05）。NERD组呕吐/反食、腹痛及食管外症状的发生率较RE组高,差异有统计学意义（P〈0.05）,而反酸、烧心/胸骨后痛的发生率两组差异无统计学意义（P〉0.05）。RE组总反流次数及pH值〈4的百分比显著高于NERD组（P〈0.05）;pH值监测阳性的RE组各项酸反流指标均大于pH监测阳性的NERD组,差异均有统计学意义（P〈0.05）;Ⅰ级、Ⅱ级和Ⅲ级RE患儿之间的各项pH监测指标差异无统计学意义（P〉0.05）。结论儿童NERD患者的不典型反流症状和食管外症状发生率更高。GERD的发生与胃酸反流密切相关,酸暴露持续时间延长及反流频率增加可能是导致RE的重要因素,酸反流量与RE的严重程度无明确关系。     

24小时食管动态pH-阻抗联合监测评估小儿胃食管反流性咳嗽的临床特征

目的 探讨24 h食管动态pH-阻抗联合监测对以慢性咳嗽为主要表现的胃食管反流病（GERD）患儿的临床表现及反流特征的评估价值。方法 对2012年2月至2013年7月40例南京医科大学附属南京儿童医院门诊及住院的可疑胃食管反流性咳嗽（RERC）患儿,利用24 h食管pH-阻抗联合监测GERD患者的各项指标。结果 40例慢性咳嗽患儿中,单纯用24 h食管pH监测符合GERD的患儿有23例（57.5%）,利用24 h食管动态pH-阻抗联合监测符合GERD的患儿有34例（85.0%）,明显高于单纯用24 h食管pH监测的结果。且在小儿慢性咳嗽中主要是在直立时弱酸反流和酸反流为主（P＜0.05）,同时发生频率最高的在直立状态下的混合反流（P＜0.05）,而食团清除时间在直立与仰卧时差异无统计学意义（P＞0.05）,近端反流是以仰卧位为主（P＜0.05）。总反流次数与症状指数（SI）呈正相关（r = 0.818,P＜0.05）。结论 利用24 h食管动态pH-阻抗联合监测技术可以检出酸反流、弱酸反流和非酸反流,使GERD的诊断更精确,对以慢性咳嗽为主要表现的GERD有着重要的诊断价值,具有较好的临床应用前景。     

小儿胃酸反流与反流性食管炎的关系

目的探讨胃酸反流与小儿反流性食管炎（RE）发病的关系。方法对180例以呕吐为主要临床表现的患儿进行食管动态pH监测和胃镜检查,观察本组病例中RE、非食管炎（NE）、非糜烂性反流病（NERD）及其反流情况。RE分级参照《全国反流性食管炎研讨会》制定的内镜分级标准。结果180例息儿中诊断为RE的有65例（36．1％）,其中Ⅰ、Ⅱ、Ⅲ级分别有37例、19例和9例;诊断为NE的有115例。RE组病理性胃食管反流（GER）检出率为58．5％（38／65）,NE组为42．6％（49／115）,差异有统计学意义（r=4．179,P〈0．05）。RE组各项酸反流指标均大于NE组,除反流次数和反流〉5min的次数外,差异均有统计学意义（P〈0．05）。Ⅰ、Ⅱ级RE患儿之间各项酸反流指标的差异均无统计学意义;Ⅲ级RE患儿的各项酸反流指标均大于Ⅰ级和Ⅱ级,但除Boix-Ochoa综合评分外差异均无统计学意义。180例患儿中病理性GER有87例（占48．3％）,其中38例为Iu巳。49例为非糜烂性反流病（NERD）,两组间各项酸反流指标的差异无统计学意义（P均〉0．05）。结论胃酸反流在小儿RE的发病中起着重要的作用,但并不是惟一的致病因素;酸反流的程度与RE的严重性之间并无严格的对应关系;酸反流并不都会引起RE。要加强对有反流症状患儿的内镜检杏。     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.