学习困难儿童的家庭因素和社会适应能力分析

目的 为了解儿童学习困难与家庭因素、社会适应能力的相关影响。方法 应用学习情况家庭因素调查表“婴儿－初中学生社会生活能力量表”、采用多元Ｌｏｇｉｓｔｉｃ回归分析，对５８例学习困难和４２名学习正常儿童的家庭因素及社会适应能力进行了分析。结果学习情况家庭因素中儿童学习态度、家庭经济、父母教育方式和管理方法等有显著性意义。社会量表显示，独立生活能力和自我管理能力具有显著性意义。结论 在进行儿童学习困难     

ZnT-1, ZnT-3, CaMK II,PRG-1 expressions in hippocampus following neonatal seizure-induced cognitive deficit in rats

Epilepsy in children is associated with a broad spectrum of cognitive deficits, which is associated with hippocampal mossy fiber sprouting. The underlying molecular mechanisms involved in mossy fiber sprouting in hippocampus following developmental seizures are not completely known. We studied the timing of cognitive dysfunction following neonatal seizures and the relation of this cognitive impairment to zinc transporter 1 (ZnT-1), 3 (ZnT-3), calcium/calmodulin-dependent protein kinase II (CaMK II), plasticity-related gene 1 (PRG-1) expression in hippocampus. A seizure was induced by inhalant flurothyl daily in neonatal Sprague-Dawley rats from postnatal day 6 (P6). Rats were assigned into the single-seizure group (SS), the recurrent-seizure group (RS, seizures induced in six consecutive days), and the control group. During P41–P46 and P85–P90, the rats were tested for spatial learning and memory abilities with automatic Morris water maze task. At P90, mossy fiber sprouting and gene expression in hippocampus were determined subsequently by Timm staining and RT-PCR methods. The escape latencies from the water maze were significantly longer in rats of RS group than those of the control and SS groups at d4 of the first maze test and at d3, d4 of the second maze test. As far as Spatial Probe Test was concerned, the frequency of passing through the platform quadrant was significantly decreased in RS group than that in control and SS groups in the entire two probe tests. In rats with recurrent seizures (RS group), there was an increased distribution of Timm granules in both the supragranular region of the dentate gyrus and the stratum pyramidale of CA3 subfield in RS group, while remaining barely visible in control and SS groups; the Timm scores in CA3 and dentate gyrus in the RS animals were significantly higher than that in the control and SS groups. RT-PCR densitometry analysis showed that the ratios of hippocampal ZnT-1 to β-actin of SS and RS group were decreased significantly compared with that of control group. Meanwhile, CaMK II to β-actin of RS group was markedly lower compared with those of SS and control groups. Our results suggest that the long-term adverse effects of recurrent neonatal seizures on cognition and mossy fiber sprouting may be associated with the down-regulated expression of ZnT-1 and CaMK II in hippocampus.     

Ilizarov技术结合髓内克氏针治疗先天性胫骨假关节

目的介绍用Ilizarov技术结合髓内克氏针治疗先天性胫骨假关节的临床经验和疗效.方法4例术前均经数次手术,1例为初诊,通过截去假关节和病变骨膜,用克氏针进行力线矫正急性肢体短缩并上伊氏环急性断端加压,4例同时行胫骨近端截骨延长.结果5例均取得骨性愈合,1例出现再骨折,均残留轻度足外翻畸形.结论Ilizarov技术结合髓内克氏针临床疗效可靠,拆除外固定架后仍需长期支具保护.     

Effect of agonist on gamma-aminobutyric acid B receptor subunit expression in the hippocampus of epileptic rats

BACKGROUND： An amino acid imbalance has been considered to be responsible for epilepsy pathogenesis. Gamma-aminobutyric acid-B receptor （GABABR） inhibits voltage-sensitive calcium ion channels and GABA or glutamic acid （Glu） neurotransmitter release, which promotes or inhibits onset and development of epilepsy. OBJECTIVE： To explore the effect of baclofen on GBRla and GBR2 mRNA expression in the hippocampus of epileptic rats following kainic acid （KA） induction, and to study the adaptability of GABABR subunits. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment based on molecular biology was performed at the Laboratory Research Center of Second Hospital Affiliated to Soochow University from November 2005 to March 2006. MATERIALS： KA was provided by Sigma, USA. In situ hybridization detection kit of GBRla and GBR2 was provided by Wuhan Boster Biological Technology, China. GABABR agonist （baclofen） was provided by Sigma, USA. METHODS： Forty-four epileptic rats were randomly allocated to epileptic （n = 28） and drug intervention （n = 16） groups. The epileptic group was further divided into post-epileptic subgroups at different time points： 6, 12 hours, 1, 3, 7, 15, and 30 days （n = 4）. The drug intervention group was further divided into intervention controls subgroups at various time points： 6 hours, 1 day, and 3 days （n = 4）. Four additional rats were considered the normal control group and not modeled, but were injected with saline in the hippocampal CA3 region. MAIN OUTCOME MEASURES： GBRla and GBR mRNA expression was detected in the right hippocampal CA1, CA3, and dentate gyrus （DG） areas of the control, epileptic, and interference groups at various time intervals according to in situ hybridization results. RESULTS： （1） During the early stage of epilepsy （6 and 12 hours）, GBRla and GBR2 mRNA expression was decreased, and expression was less than the control group at one day after KA induction （P 〈 0.05）. mRNA expression was increased in the DG, but was greater than the control group at day 3 （P 〈 0.05）. Expression in the hippocampal CA1 and CA3 regions remained low （P 〈 0.05）, but gradually recovered to control levels. （2） The time points when subunit expression was decreased were prolonged following baclofen intervention, and expression was significantly greater than the epileptic group （P 〈 0.05）. CONCLUSION： Both mRNA expressions of GABABR subunits were up-regulated following decreased expression in the epileptic group, suggesting that the temporal lobe exhibited endogenous antiepileptic mechanisms during the early stages of epilepsy onset. Baclofen promoted mRNA expression of GBRla and GBR2.     

Mounla法在极低体质量儿营养评价中的价值

目的寻找评价极低体质量儿营养状况和生长发育水平的新方法和新途径。方法2002年3月至2007年6月我科收治的36例极低体质量儿，采集其出生体重，最低体重，回复出生体重的日龄，用Mounla提出的方法进行营养评估，探讨营养不良的诊断方法。结果在36例极低体质量儿中，用Mounla法评价营养不良的有21例，总发生率为58.33％，其中轻度营养不良者12例，占57．14％，中度7例，占33．33％，重度2例，占9．52％；适于胎龄儿（AGA）和小于胎龄儿（SGA）的营养不良发生率分别为83．33％和45．83％，两者间差异有统计学意义（P〈0．05）。结论Mounla营养评价法为极低体质量儿的临床营养支持提供一定的参考价值。     

呼吸科住院患儿父母心理需求调查分析

目的:了解呼吸科患儿住院期间其父母的心理需求情况。方法:采用自制问卷形式,对呼吸科住院患儿父母300例进行问卷调查。结果:呼吸科患儿父母在需求方面已不局限于治好疾病,他们也非常需要健康的环境、科学的生活指导及预防保健知识。结论:提示护士在工作中要重视患儿父母的心理支持,加强健康宣教;进一步完善消毒隔离制度,建立合理的陪护制度,促进患儿康复;发挥沟通的主动性,满足患儿父母的信息需求。     

连续性血液净化治疗儿童多脏器功能障碍综合征

目的评价连续性血液净化(CBP)在救治儿童多脏器功能障碍综合征(MODS)时的疗效及安全性。方法采用CBP治疗儿童MODS患者10例,观察治疗前后的血压、心率、血BUN、Cr、电解质和血气变化,对临床资料作回顾分析。结果10例患儿年龄2~10岁,治疗前存在2个以上脏器功能障碍、严重电解质紊乱、代谢性酸中毒同时合并少尿无尿。治疗后患儿生命体征平稳,血压、心率变化无显著差异,血BUN、Cr、电解质和血气变化明显好转。结论CBP治疗过程中,血流动力学稳定,循环衰竭患儿也能进行CBP治疗。CBP能有效纠正氮质血症和水电解质酸碱紊乱,是治疗儿童MODS合并少尿无尿者一种有效和安全的方法。     

骺板软骨细胞的体外培养及鉴定

目的:建立体外培养及鉴定骺板软骨细胞的方法。方法:实验于2005-03/2006-05在苏州大学附属儿童医院骨科实验室完成。选用3只生后14～28d的新西兰幼兔,空气栓塞处死,暴露股骨下端和胫骨上端,分别取2处的骺板组织,将其剪切成1～3mm3的小块,经胰蛋白酶消化,接种于含150g/L牛血清的1640培养基中,饱和湿度培养,传代。①细胞接种后3h在倒置显微镜下观察细胞生长情况,见细胞贴壁后每天观察2次。②第2代细胞达到80%～90%左右汇合时采用常规苏木精-伊红染色,光镜观察细胞爬片情况。③第3代细胞爬片至细胞达到80～90%左右汇合时,采用苏木素染色3min,3%亮绿染色5min,蕃红花“O”染色5min,光镜观察细胞产生蛋白聚糖情况。④采用PCR检测细胞Ⅱ型胶原的表达。⑤采用四唑盐MTT比色法检测细胞活性。结果:①骺软骨细胞刚接种后呈大小不等之圆形悬浮于培养液中,3h后见大部分细胞贴壁,24h后贴壁细胞呈短梭形、圆形、三角形和不规则形,见细胞分裂相。48h后见细胞伸展明显,细胞分裂相每高倍镜视野可见多个。经隔日换液细胞生长至第5天,细胞呈聚集生长,达到汇合状态,将细胞传代。接种后第1代细胞2d后呈梭形,培养4d传至第2代,第2代细胞长满瓶底后,90%呈胞膜较厚的圆形,10%为梭形,第3代、第4代亦如此。传至第5代见肥大细胞增多,细胞松散,折光性减弱,呈凋亡状态。②细胞爬片后观察骺软骨细胞形态以梭形居多,同时也有圆形、三角形和不规则形。可见细胞分裂及细胞中的分泌小泡。③见细胞呈红色,无绿色,证明蕃红花“O”-亮绿染色阳性,显示所培养的细胞可以分泌蛋白聚糖。④PCR检测术所养细胞含有Ⅱ型胶原,电泳带在440bp上。⑤四唑盐MTT比色法检测显示,第3代骺软骨细胞的生长曲线近似倒“S”形,在第4,5,6天细胞呈对数生长,约在7,8,9,10d达平台期,至第12天细胞出现生长抑制。结论:建立了骺板软骨细胞的体外培养方法,并证实所培养出的细胞分泌蛋白聚糖和Ⅱ型胶原,具有软骨细胞的共同特点。     

新生儿重症监护病房的院内感染临床分析

目的:探讨新生儿重症监护室院内感染的危险因素,指导院内感染防控。方法:对入住我科NICU的580份病例进行院内感染调查分析。结果:在580例新生儿中有71例发生了96次院内感染,院内感染率为12.2%,包括36例血流感染,33例肺炎,18例尿路感染,6例结膜炎及3例脐炎。最常见的病原菌是肺炎克雷伯杆菌(38.5%)和凝固酶阴性葡萄球菌(31.3%)。只有3例念珠菌引起的血流感染(8.3%)。结论:院内感染与住院天数、Apgar评分、低出生体重及菌株的耐药等因素有关,应加强管理和防范,降低新生儿院内感染率。     

Effect of Kangshuai Yizhi Formula I (抗衰益智方 I) on learning and memory dysfunction induced by scopolamine in mice

Objective：To evaluate the improvement of Kangshuai Yizhi FormulaⅠ（抗衰益智方Ⅰ,KYFⅠ）on the learning and memory dysfunction in mice,and on the mechanism of the hippocampal cholinergic system and the nervous system of monoamine which are closely related to learning and memory function.Methods：Mice in the low-,middle-,and high-dose KYFⅠgroups were given low-,middle-,and high-dose KYF,respectively, by gastrogavage for 35 successive days.Animals in the control group and the model group were treated with distilled water.The acute learning and memory dysfunction model was established by injection of scopolamine from day 31,and Morris water maze was used to assess the behavior performance of scopolamine-induced model mice for five days.The activities of acetylcholinesterase（AChE）,choline acetyl transferase（ChaT） and the content of monoamine neurotransmitters in hippocampus were measured.The activity of monoamine oxidase（MAO）in hippocampus and serum was also detected.Results：（1）Compared with the control group,the mean escape latency was shortened,and the frequency across the platform and the staying time at the platform area on the 5th day were decreased in the model group by Morris water maze test.The activities of AChE and MAO were increased,and the ChaT activity and monoamine neurotransmitter content were decreased as well.（2） The escape latency for 4 days in the low-,middle-,and high-dose KYFⅠgroups was significantly shortened than that in the model group,with the shortest latency in the high-dose KYFⅠgroup（P〈0.05,P〈0.01）.The frequency across the platform was significantly increased and the staying time at the platform was significantly prolonged in the middle-and high-dose KYFⅠgroups（P〈0.05,P〈0.01）.（3）As compared with the model group,the activity of ChaT and the content of monoamine neurotransmitters in the hippocampus were significantly increased, and the activities of AchE and MAO were significantly decreased in the hippocampus in the high-dose KYFⅠgroup（P〈0.01）.Conclusions：High-dose KYFⅠcan significantly improve the learning and memory dysfunction induced by scopolamine in mice.Its mechanism may be related to improving the central cholinergic system and regulating the hippocampal monoamine neurotransmitters.