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??Abstracts?? Objective To study the T2* magnetic resonance imaging for evaluation of iron deposition of liver?? pancreas and heart in β- thalassemia major ??β-TM?? patients and the relationship of the serum ferritin with iron overload. Methods Measurement of hepatic?? pancreatic and cardiac MRI T2* was performed in 153 patients with β-TM from May 1?? 2010 to December 31?? 2010??The demographics and serum ferritin ??SF?? were collected. The rate of the iron overload in liver?? pancreas and heart was analyzed. The rates of combined pancreatic and cardiac iron overload in different hepatic iron overload groups were compared. Results According to MRI T2*?? there was serious hepatic iron overload in 85 cases?? moderate in 39?? mild in 21?? no iron overload in 8. Similarly?? there was pancreatic iron overload in 134?? no iron overload in 19. In terms of cardiac iron overload?? there was serious cardiac iron overload in 37 cases?? mild in 21?? no iron overload in 95. No correlation was found between hepatic?? pancreatic and cardiac MRI T2* and age or SF?? but hepatic MRI T2* correlated with pancreatic and cardiac MRI T2*??P = 0.000?? r = 0.529?? r = 0.369???? and pancreatic MRI T2* correlated with cardiac MRI T2* well ??P = 0.000?? r = 0.715??. As grade of hepatic iron overload increases?? the patients demonstrated higher rate of combination of pancreatic and cardiac iron overload simultaneously ??χ2 = 20.78??P = 0.000??.     

重症肺炎后闭塞性细支气管炎的危险因素分析

目的 探讨引起感染后闭塞性细支气管炎（postinfectious bronchiolitis obliterans,PIBO）的重症肺炎的临床特征及危险因素。方法 回顾性分析2014年4月—2019年4月在深圳市儿童医院因重症肺炎住院治疗并最终诊断为PIBO的病例为观察组,并随机抽取同期诊断为重症肺炎未发生PIBO的病例为对照组。分析观察组重症肺炎的临床特征,并分析发生PIBO的危险因素。结果 观察组49例,对照组98例。观察组男33例,女16例;发病年龄≤2岁45例（91.8%）,患者发热、咳嗽49例（100%）,热程（12.898±5.818）d,喘息22例（44.9%）、气促19例（38.8%）。出院时肺部仍有啰音28例（57.1%）。胸部影像病初表现为间质性改变11例（78.6%,11/14）,病程中主要表现为实变19例（57.6%,19/33）。病原腺病毒26例（53.1%）,肺炎支原体17例（34.7%）。入住PICU 31例（63.3%）,使用有创呼吸机19例（38.8%）,使用激素25例（51.0%）,使用人免疫球蛋白28例（57.1%）。多因素Logistic回归结...     

肺动态顺应性导向呼气末正压滴定法用于肺保护性通气策略的研究进展

肺保护性通气策略是全麻气管插管管理的重点之一,有助于提高患者术中氧合,减少肺部损伤和并发症的发生,改善患者预后。在肺保护性通气策略中,小潮气量、呼气末正压（PEEP）和肺复张的应用已得到广泛认可,但关于PEEP的具体设置和使用尚无一致意见。近年来肺动态顺应性导向PEEP滴定法已成为该领域的研究热点,此方法能够针对不同个体制定出合适的通气策略,对患者的肺组织起到一定保护作用。本文以肺保护性通气策略为基础,对肺动态顺应性导向PEEP滴定法的研究现状做一综述。     

硬膜外不同输注模式用于分娩镇痛的比较

目的 比较规律间断硬膜外泵注（RIEB）和持续性硬膜外输注（CEI）复合病人自控硬膜外镇痛（PCEA）用于分娩镇痛的效果。方法 自愿接受分娩镇痛的初产妇225例,按照随机数字表法分为A、B、C三组,每组75例。所有产妇给予硬膜外分娩镇痛,选取L2~3间隙行硬膜外穿刺,镇痛液配方为0.08%罗哌卡因＋0.4 μg/mL舒芬太尼。A组产妇予以CEI模式镇痛,8 mL/h持续输注镇痛液。B组与C组产妇予以RIEB模式镇痛,自注射首剂开始,每间断1 h给予8 mL镇痛液,其中B组的注射速度为2 mL/min,C组的注射速度为6 mL/min。记录产妇满意度评分,镇痛前（T1）、镇痛后30 min（T2）、1h（T3）、宫口开大7~8 cm时（T4）、宫口开全时（T5）、分娩时（T6）的平均动脉压（MAP）、心率（HR）、疼痛视觉模拟评分（VAS）和改良Bromage评分,观察病人自控硬膜外镇痛（PCEA）有效按压次数、罗哌卡因用量、舒芬太尼用量、产程、镇痛时间、分娩方式、新生儿Apgar评分、不良反应发生情况、产妇满意度评分。结果 三组产妇T1~T3时点VAS评分无统计学差异（P>0.05）;三组产妇T4~T6时点VAS评分,PCEA追加次数,罗哌卡因用量,舒芬太尼用量方面均显示C组B组>A组（P<0.05）;三组患者的平均动脉压,心率,改良Bromage评分,产程,镇痛时间,分娩方式,不良反应发生率,新生儿Apgar评分无统计学差异（P>0.05）。结论 RIEB复合PCEA用于分娩镇痛的效果显著,且泵注速度为6 mL/min的效果最佳,可有效减少PCEA追加次数,罗哌卡因用量和舒芬太尼用量,提高产妇满意度,而不良反应并没有增加。     

以肺间质疾病为主要表现的免疫缺陷病六例分析

目的探讨以肺间质疾病为主要表现的免疫缺陷病的临床特征,提高对免疫缺陷引起的肺间质疾病的认识。方法回顾性分析2014年1月至2016年12月收治在深圳市儿童医院的6例以肺间质疾病为主要表现就诊且最终诊断为免疫缺陷病患儿(男5例、女1例)病例资料,分析免疫缺陷相关的肺间质疾病的临床特点和诊断线索。结果6例患儿年龄3月龄~5岁9月龄,均表现为咳嗽、气促;3例急性肺部感染和呼吸衰竭;2例慢性缺氧;1例杵状指和趾;3例皮疹;5例营养不良。6例胸部CT均表现为双肺弥漫性磨玻璃密度影,其中2例有囊状影,1例"铺路石征"。5例确诊免疫缺陷前均怀疑肺表面活性物质功能障碍并进行基因检测,结果阴性。通过人类免疫缺陷病毒抗体、免疫功能检查和(或)基因检测,最终诊断1例获得性免疫缺陷综合征、2例高IgM综合征、1例高IgE综合征、1例湿疹-血小板减少伴免疫缺陷综合征、1例STAT3基因功能获得性变异。回顾分析所有病例均有提示免疫缺陷的临床线索。结论免疫缺陷引起的肺间质疾病主要表现为咳嗽、气促或慢性缺氧,合并感染可引起呼吸衰竭,影像主要表现为弥漫性磨玻璃密度影。仔细询问病史和免疫筛查可发现诊断免疫缺陷的线索。肺间质疾病的病因诊断程序中应重视免疫缺陷病的筛查,否则可能导致漏诊或不必要的检查。     

桡骨小头半脱位的超声诊断及其临床意义

目的 探讨超声检查对桡骨小头半脱位（RHS）的诊断价值。方法 回顾性分析34例RHS患儿的临床及超声检查资料。所有患儿均接受常规双侧肘关节多切面、对比超声检查,且X线检查结果均为阴性。结果 RHS的超声表现包括：肱桡间距增宽29例（29/34,85.29%）,关节间隙增宽、回声增强25例（25/34,73.53%）,旋后肌上移并呈“钩”型表现32例（32/34,94.12%）,环状韧带嵌顿33例（33/34,97.06%）。结论 RHS的声像图表现具有一定特征,通过超声连续扫查双侧肘关节,并进行对比,有助于快速、准确地对X线检查阴性的RHS做出诊断。     

注意缺陷多动障碍伴情绪不稳儿童的家庭环境特点

目的:探讨注意缺陷多动障碍(ADHD)伴情绪不稳儿童的家庭环境特点。方法:选取符合DSM-5ADHD诊断标准的儿童183例和正常儿童50例,采用家庭环境量表(FES-CV)、Conners儿童行为问卷分别评定ADHD儿童和正常儿童的家庭环境特点以及情绪是否稳定。将Conners儿童行为问卷中第7、8、33、37情绪相关条目总分大于等于6分定义为伴有情绪不稳。结果:ADHD组情绪不稳的比例高于正.常对照组(41%vs.2%,P<0.05)。ADHD情绪不稳组儿童FES-CV家庭的知识性、娱乐性得分同时低于ADHD情绪稳定组和对照组(P<0.05),矛盾性得分同时高于情绪稳定组和对照组,亲密度、独立性和组织性得分低于对照组(均P<0.05),与情绪稳定组差异无统计学意义(P>0.05)。结论:ADHD儿童伴.情绪不稳的比例高于正常儿童,他们的家庭中文化活动与课外活动较情绪稳定的ADHD儿童更少。     

Antimicrobial resistance of Haemophilus influenzae isolates from pediatric hospitals in Mainland China: Report from the ISPED program, 2017–2019

PurposeThis study set out to determine the antimicrobial resistance trends of Haemophilus influenzae isolates from pediatric hospitals in Mainland China, which would provide basis for clinical treatment.MethodsThe Infectious Disease Surveillance of Pediatrics (ISPED) collaboration group conducted this study. H. influenzae strains isolated from nine pediatric hospitals in Mainland China were included. Disk diffusion method was used for antimicrobial susceptibility test. Cefinase disc was used for detection of β-lactamase.ResultsIn total, 13810 H. influenzae isolates were included during 2017–2019: 93.17% of which were from respiratory tract specimens, 4.63% from vaginal swabs, 1.10% from secretion, and 1.10% from others. Of all strains, 63.32% isolates produced β-lactamase; 8.22% isolates were β-lactamase-negative and ampicillin-resistant (BLNAR). The resistance to sulfamethoxazole-trimethoprim was 70.98%, followed by resistance to ampicillin (69.37%), cefuroxime (51.35%), ampicillin-sulbactam (38.82%), azithromycin (38.21%), amoxicillin-clavulanate (35.28%). More than 90% of H. influenzae isolates were susceptible to ceftriaxone, cefotaxime, meropenem, levofloxacin and chloramphenicol. The resistance rate of ampicillin and azithromycin in H. influenzae showed an increasing trend through the years. Statistically significant differences in antibiotic-resistance rates of all the antibiotics except chloramphenicol were found in different regions. The major Multi-Drug Resistance pattern was resistant to β-lactams, macrolides, and sulfonamides.ConclusionsThere is a rising trend of resistance rate of ampicillin and azithromycin in H. influenzae. Antimicrobial resistance of H. influenzae deserves our ongoing attention. Third-generation cephalosporin could be the preferred treatment option of infections caused by ampicillin-resistant H. influenzae.     

两种术式矫治法洛四联症术后肺动脉和左心室发育的对比研究

目的:对比保留瓣环与跨瓣环补片矫治法洛四联症(TOF)术后肺动脉和左心室发育速度。方法:回顾本院2015年1月至2020年10月收治的TOF患婴临床资料,根据右心室流出道狭窄的解除方式分为：保留瓣环组和跨瓣环组。采用独立样本 t检验或非参数检验比较两组间术前、末次随访时肺动脉和左心室发育指标,术前与术后指标...     

The design and synthesis of dextran-doxorubicin prodrug-based pH-sensitive drug delivery system for improving chemotherapy efficacy

Tumor cells show acidic conditions compared with normal cells, which further inspires scientist to build nanocarrier responsive to tumor microenvironment (TME) for enhancing tumor therapeutic efficacy. Here, we report a pH-sensitive and biocompatible polyprodrug based on dextran-doxorubicin (DOX) prodrug (DOXDT) for enhanced chemotherapy. High-density DOX component was covalently decorated on the nanocarrier and the drug molecules could be effectively released in the acidic tumor tissue/cells, improving chemotherapy efficacy. Specifically, a dextran-based copolymer was preliminarily prepared by one-step atom transfer radical polymerization (ATRP); then DOX was conjugated on the copolymer component via pH-responsive hydrazone bond. The structure of DOXDT can be well-controlled. The resulting DOXDT was able to further self-assemble into nanoscale micelles with a hydration diameter of about 32.4 nm, which presented excellent micellar stability. Compared to lipid-based drug delivery system, the DOXDT prodrug showed higher drug load capacity up to 23.6%. In addition, excellent stability and smaller size of the nanocarrier contributed to better tissue permeability and tumor suppressive effects in vivo. Hence, this amphipathic DOXDT prodrug is promising in the development of translational DOX formulations, which would be widely applied in cancer therapy.