儿童青少年自杀及相关问题

郑毅 教授 2000年WHO的资料表明，全球每年约有100万人死于自杀，每40s就有1人死于自杀，每3s就有1人自杀未遂，在所有国家中自杀是15～34岁人群死亡的前3位原因之一。以100000人为单位计算自杀率：美国2000年男性17．1，女性4．0；法国1999年男性26．1，女性9．4；日本2000年男性35．2，女性13．4；中国1999年男性13．0．女性14．8；印度1998年男性12．2，女性9．1；俄罗斯2002年男性69．3，女性11．9。     

有氧运动和合理饮食对单纯性肥胖青少年学生体质的影响

目的 探讨有氧运动和合理饮食对肥胖中学生体质的影响.方法 抽取单纯性肥胖中学生60例,采用有氧运动、合理饮食进行为期10个月的减肥活动,有氧运动为每天下午的课外活动,40～60min/次,5～7次/周.参照＜体育测量与评价＞标准对试验对象体质量、腰围、臀围、三头肌皮褶、肩胛下皮褶、安静心率、肺活量、血压等指标进行试验前后比较.结果 男学生体质量由(72.68±8.28)kg减少至(69.01±5.01)kg,女学生体质量由(69.11±3.40)kg降低至(65.3±6.31)kg,男、女学生试验前后比较均有显著性差异(Pa＜0.05),除身高外,体质量指数、腰围、臀围、腰/臀围比、三头肌皮褶、肩胛下皮褶试验后与试验前比较均明显降低(Pa＜0.05).男、女学生肺活量和台阶指数较试验前明显升高,分别由(3300±235.46)mL、(2250±23.25)mL和(55.17±6.43)、(54.27±5.32)升高至试验后(3650±226.01)mL、(2550±218.18)mL和(64.16±3.21)、(63.73±8.13)(Pa＜0.05);心率、心功能指数、收缩压、舒张压试验后与试验前比较明显降低(Pa＜0.05).结论 有氧运动和合理饮食具有明显控制体质量、改善肥胖学生的心肺功能的作用.     

病毒性脑炎后岛盖综合征2例报告

例1.患儿女,4岁.主因发热2d,频繁抽搐1d于2004-11-01第1次入院.患儿于2d前出现发热,体温最高38.5℃,伴流涕、咳嗽.1d前出现频繁抽搐,表现为El角歪斜,双眼向上凝视,四肢强直,持续1～2min缓解,共抽搐8～9次.查体:体温38.2℃,脉搏128/min,呼吸26/min,血压90/60mmHg(1mmHg=0.133kPa).     

危重症患儿低钠血症的相关问题

低钠血症是儿科较常见的电解质紊乱,危重患儿低钠血症的发生涉及摄入不足、丢失过多、血管升压素分泌异常、脑耗盐、自由水代谢异常、输入低张液体等多种因素,严重快速发展的低钠血症可危及生命,治疗不及时可导致中枢神经系统后遗症.临床实践中需密切监测危重患儿血钠,鉴别低钠血症的病因,及时正确处理低钠血症.     

发热 血尿 多浆膜腔积液

患儿,男,7岁,2003-04-12因血尿伴尿痛2个月,发热伴面色苍白20d入院.2个月前无诱因出现肉眼血尿并伴排尿时疼痛,不伴水肿,无头痛头晕.偶有腹痛,食欲减退.当地按"肾炎"治疗半个月,用药不详,肉眼血尿消失,仍有镜下血尿.20d前发热,体温37.5℃左右,伴面色苍白且逐渐加重.时有咳嗽,痰中带血.在当地治疗无好转来我院.查体:体温37.7℃,血压90/60mmHg(1mmHg=0.133kPa),发育中等,贫血貌,眼睑无水肿.     

肺动静脉瘘1例报告

1临床资料患儿,男,9.5岁,因反复咯血8d入院。患儿于8d前无明显诱因阵发性干咳后出现咯血,量不详,无咳痰,无胸痛,无呼吸困难,无发热,次日咯血量增多,约100~200mL,为鲜血及暗红色血凝块,咯血时患儿出冷汗,咯血后面色苍白,全身无力,伴胸闷,呼吸困难、烦躁不安,当地医院住院给止血,     

卵巢病变82例的诊断与治疗

目的 总结分析儿童卵巢病变的发病趋势、临床特点及诊治进展.方法 对本院1992年1月-2007年1月收治的82例卵巢病变息儿年龄、是否急诊、居住地、病理及手术方式等进行回顾性分析.结果 女性患儿82例.年龄1 d～14岁,平均年龄6.7岁.急诊入院31例(37.8%),平诊入院51例(62.2%);乡村患儿27例(32.9%),城镇患儿55例(67.1%);非肿瘤性病变45例(54.8%),良性肿瘤性病变31例(37.8%),恶性肿瘤性病变6例(7.4%).其中1992-1996年发病12例(14.6%),1997-2001年24例(29.5%),2002-2007年46例(55.9%).恶性肿瘤6例转内科化疗,性早熟2例保守观察,余74例均治愈.随访54例均无复发.结论 儿童卵巢病变可发生于任何年龄,以急腹症入院较多,城镇发病多于乡村,有逐年上升趋势,病理类型以良性为主,腹腔镜手术有明显优势.     

孤独症神经心理特征和相关脑机制

1 社会脑和心理理论 孤独症(autism)属于广泛性发育障碍(pervasive developmental disorder, PDD)范畴.该症损害人的最基本社会化功能,导致人际沟通障碍和对他人心理活动的认知缺陷.     

婴儿暴发性紫癜1例

患儿男,5月龄,主因"发热3d,四肢出血性皮疹伴水肿、少尿1d"于2006-10-15入院.患儿入院前3d无明显诱因出现发热,当地医院给予静点林可霉素、病毒唑抗感染治疗.入院前1d患儿双下肢出现紫色皮疹,对称性分布.     

单纯性肥胖男童血清瘦素、性激素水平及其对性发育的影响

目的 探讨单纯性肥胖男性儿童血清瘦素、性激素水平及其对性发育的影响.方法 从8～14岁1 208例小学生中筛选出体质量指数(BMI)≥25 kg/m2的42例男童作为肥胖组,选择BMI 14.1～23.0 kg/m2的健康男童32例作为健康对照组,对所入选儿童用ELISA法测定其血清瘦素,放射免疫分析法测定其血清雌二醇(E2)、睾酮(T)水平,用游标卡尺测量其阴茎长度及睾丸体积.采用SPSS 10.0软件行组间t检验比较二组差异,直线相关分析单纯性肥胖儿童血清瘦素与E2、T的相关性.结果 肥胖组男童血清瘦素为(16.82±11.46)μg/L,较健康对照组(5.43±3.56)μ/L显著增高,二组比较有显著性差异(t=5.419 P<0.01).肥胖组男童血清E2水平为(20.51±16.42)ng/L,较健康对照组[(8.84±4.53)ng/L]显著增高,二组比较有显著性差异(t=3.903 P<0.01).肥胖组男童T水平为(1.64±0.85)μg,/L,低于健康男童[(2.07±0.98)μ/L],二组比较有显著性差异(t=2.018 P<0.05).肥胖组男童阴茎长度为(4.51±1.36)cm,低于健康男童[(5.64±0.99)cm],二组比较有显著性差异(t=3.965 P<0.01).肥胖组男童睾丸体积[(4.21±2.32)cm3]低于健康男童[(7.08±3.76)cm3],二组比较有显著性差异(t=4.043 P<0.01).瘦素与BMI、E2呈正相关(r=0.757,0.266 Pa<0.05),与T呈负相关(r=-0.368 P<0.01).结论 高水平瘦素可能是单纯性肥胖重要的生物学标志之一.单纯性肥胖男童存在性激素代谢紊乱、性发育落后,瘦素可能影响男性肥胖儿童的性发育.     

Breastfeeding perceptions in communities in Mangochi district in Malawi

Aim: To investigate mothers’ perceptions of breastfeeding and influences from their social network. Methods: A cross‐sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi‐urban mother–infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby‐Friendly facility, OR = 5.22; 95% CI (1.92–14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.     

胶原成分在儿童系膜增生性肾小球肾炎中的变化

目的观察系膜增生性肾小球肾炎（ＭｓＰＧＮ）系膜区胶原成分的变化。方法应用链菌素亲生物素过氧化酶连接法观察了３０例轻度ＭｓＰＧＮ肾穿刺活组织标本和正常的肾小球系膜区Ⅳ型胶原及其α链（α１、α３、α５链）、Ⅵ型胶原及Ⅰ型胶原的变化。结果（１）正常肾脏组织中，Ⅳ型胶原及其α１（Ⅳ）链分布于系膜区和基底膜，α３（Ⅳ）、α５（Ⅳ）链分布于基底膜，Ⅵ型胶原分布于系膜区、肾小球基底膜和间质，Ⅰ型胶原仅分布于肾间质。（２）在轻度ＭｓＰＧＮ时，系膜区内Ⅳ型胶原及其α１链、Ⅵ型胶原含量较正常对照明显增多（Ｐ＜０．０１）；当系膜区系膜细胞超过４个时，Ⅰ型胶原开始在肾小球内出现，且在硬化肾小球内Ⅰ型胶原均呈阳性；α３（Ⅳ）、α５（Ⅳ）链与正常对照比较无明显变化，硬化肾小球α３（Ⅳ）、α５（Ⅳ）染色呈阳性。结论系膜区胶原成分增多可先于系膜细胞增生，并随系膜细胞增生而增多，间质胶原成分Ⅰ型胶原，不但出现于硬化肾小球内，而且出现于系膜细胞增生较重时     

Cardiomyopathy in children in Ahmedabad

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2–5 years and 10–16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.     

北京地区2007年儿童A群轮状病毒腹泻的流行病学研究

目的 研究北京地区急性腹泻儿童中A群轮状病毒(RV)感染的流行病学特点.方法 收集2007年4月至12月我院肠道门诊就诊的2039例急性腹泻患儿的粪便标本,采用标记金的A群RV单克隆抗体,以免疫层析双抗体夹心法定性检测A群RV抗原.结果 2039份粪便标本中,621份检测到A群RV,总检出率为30.5%(621/2039),其中男430例(69.2%),女191例(30.8%).RV感染者中,以6个月～2岁年龄段的患儿为最多,共571例(91.9%).检出率以10～12月份最高,均在30%以上,其中高峰出现在11月份,达43.4%.北京地区18个区县的统计数据显示,距市区较近的区县RV抗原检出率较低,边远区县较高.少部分患儿合并肠道细菌感染.结论 A群RV为北京地区2岁以下儿童急性腹泻病的主病原,6个月～2岁婴幼儿是A群RV的易感人群,10～12月份为北京地区的流行高峰.在流行季节对肠道细菌感染患儿常规进行A群RV抗原检测有助于避免漏诊和进行更合理的治疗.     

Achalasia in siblings in infancy

Achalasia is rare in children, more so familial. We report two siblings with familial achalasia who presented in their infancy with vomiting and failure to thrive. Achalasia can be misdiagnosed as upper gastrointestinal obstruction as happened in one of our siblings. Esophageal contrast roentgenography is diagnostic. Both the children were treated successfully by transabdominal esophagomyotomy with fundoplication.     

哮喘大鼠气道重塑中尾加压素-的表达变化

目的：研究哮喘大鼠气道重塑血清和支气管肺泡灌洗液（BALF）中尾加压素 Ⅱ（U-II）含量的变化及其作用。方法：32只雄性Sprague-Dawley大鼠随机分为正常对照组、哮喘2周组、哮喘4周组和哮喘8周组,每组8只。以卵清白蛋白(OVA)致敏与激发建立哮喘大鼠气道重塑模型,图像分析技术测量大鼠支气管壁总面积和平滑肌面积,计算单位基底膜周径(Pbm)的支气管壁厚度(Wat)和平滑肌厚度(Wam),ELISA法测定血清和BALF中U-II的含量。结果：哮喘各组Wat及Wam均明显高于正常对照组（P<0.01）;哮喘组血清和BALF中U-II含量均显著高于正常对照组（P<0.01）,其中哮喘8周组血清和BALF中U-II含量显著高于哮喘4周组和哮喘2周组（P<0.01）,哮喘4周组也显著高于哮喘2周组（P<0.01）。各组大鼠BALF中的U-II含量与Wat及Wam呈正相关,BALF与血清中U-II含量亦呈正相关。结论：哮喘大鼠气道重塑血清和BALF中U-II含量增加;且U-II含量的变化与气道重塑相关。［中国当代儿科杂志,2010,12（4）：287-289］     

Poisoning in children in Japan

The Japan Poison Information Centre (JPIC) received 31510 inquiries about poisoning in children under 6 years old being exposed to poison in the fiscal year 1995. The most frequently implicated products were tobacco (20%) and the peak age for ingestion of household products was 1 year and younger (83.3%). Especially, the inquiries related to children less than 1 year old were 35.7% of the cases. In contrast, the American Association of Poison Control Centers (AAPCC) data showed that the most common poisonings were due to pharmaceutical products and the inquiries related to children less than 1 year old were only 12.1%. The objective of this report was to find out the poison exposure in children in Japan and to compare the data with that of AAPCC.     

转流术治疗小儿精索静脉曲张

目的 采用转流术治疗小儿精索静脉曲张，重新建立精索静脉通道，使静脉回流受阻立即得到改善，消除因睾丸淤血而造成的损害，以利睾丸的正常发育。方法 对28例30侧(左侧26例，双侧2例)精索静脉曲张与腹壁下静脉进行吻合，通过腹壁下静脉，髂静脉转流，手术在放大镜下应用显微外科技术进行，其中28侧用精索静脉主干，2侧结扎一条属支，用另一条静脉进行吻合。结果 通畅率为100％。术后扩张迂曲静脉团消失，阴囊下坠感消失。术后随访24例，时间为3个月-10年。除1例二次手术证实为一条静脉属支漏扎而复发外，另23例全部治愈。结论 精索静脉曲张转流术效果明显优于结扎术，可减少因睾丸淤血对其造成的进一步损害，且术后复发率低。     

Rotavirus infection in children in Japan

Currently, a high morbidity of rotavirus diarrhea has been seen in children in developed and developing countries. Improvement of the vaccines is necessary in order to reduce the burden of diarrhea caused by rotavirus. A survey of rotavirus infection from diarrheal stool specimens in children of seven regions in Japan was conducted from 1984 to 1999. The present study discusses the survey results and reviews the national and international data of more than 23 papers and congress proceedings about rotavirus infection in Japan. We analyze the prevalence of rotavirus infection in acute diarrheal in- and outpatients, the distribution of rotavirus G-serotypes and surveillance data for seasonality and age groups in Japan. The data indicated that rotavirus is the most important cause of diarrhea in Japan among young children, with the prevalence ranging from approximately 9.7 to 88%. The most common rotavirus strains belonged to serotype G1, specifically since 1993. Serotypes G2, G3 and G4 had also been documented to be predominantly based in the area and year before 1992. However, untypeable rotavirus strains had been found each year, with a prevalence up to 56.7% which suggests that rare serotypes (except G1-4) or new serotypes might exist. Unexpectedly, in Tokyo and Sapporo from 1998 to 1999, G9 was found to be the first most prevailing serotype with a high prevalence of 52.9 and 71.4%, respectively. Despite these data from different geographic areas, the year under investigation was relatively clear in respect to seasonality, with a peak of rotavirus activity in late winter (February) through early spring (March). Age distribution had also characterized that the infection was predominant among children aged 1-2 years of age, although it was also common in children of 2-3 years. In addition, mixed infection with bacteria was documented.