Adipose tissue and liver lipid metabolism in obese children: role of the body mass index and the presence of acanthosis nigricans.

AIMS: The aims of our study were to determine if insulin resistance is associated with increased plasma levels of non-esterified fatty acids (NEFA), glycerol, 3-hydroxybutyrate and triglycerides in obese children. We also studied whether the presence of acanthosis nigricans (AN) led to further alterations in the above parameters. METHODS: A total of 101 children were studied on their first visit to the paediatric endocrine clinic. Seventy-four were obese, 30 of them with AN. The remaining 27 were non-obese healthy children (control group). NEFAs, glycerol, triglycerides, 3-hydroxybutyrate, insulin, leptin, adiponectin and glucose were determined in blood samples obtained after overnight fasting. The insulin resistance index (IRI) was calculated following the homeostasis model assessment (HOMA). Data from the three groups were compared using appropriate statistical tests. RESULTS: No differences in age, sex ratio and pubertal stage were observed among the three groups. The group of children with the highest body mass index (BMI) showed higher plasma levels of insulin and leptin, higher IRI and lower plasma levels of adiponectin. As insulin and IRI increased, NEFA and 3-hydroxybutyrate decreased and triglycerides increased. When obese children were categorized by BMI, the presence of AN further exacerbated these differences. CONCLUSIONS: In obese children, insulin resistance is associated with plasma lipid alterations suggestive of both decreased adipose tissue lipolysis and hepatic beta-oxidation and increased hepatic synthesis of triglycerides. Such a metabolic condition may facilitate fat storage and hinder weight loss.     

CD34+细胞自身移植治疗儿童难治型系统性红斑狼疮

目的探讨治疗儿童难治型系统性红斑狼疮(SLE)积极、有效的方法.方法对2例病程分别为5年和7年,狼疮肾Ⅲ级和Ⅳ级,主要表现为持续性血小板减少、蛋白尿和浆膜炎的患儿进行CD34+细胞分选的自身干细胞移植.首先经惠尔血动员、CS-3000血细胞分离机获取单个核细胞,通过CliniMACS CD34+细胞分选仪分别得到了1.7×106/kg及1.0×106/kg CD34+细胞,采集物中分别尚存2×105/kg和1×104/kg的CD3+细胞.用CTX 50 mg/kg·d×4 d+ATG(Fresennius S 5 mg/kg·d×3 d)预处理.结果两患者分别于+9 d和+7 d获粒细胞重建,自+15 d起血小板维持于正常水平.现已分别随访13月和6月,原发病症状完全消失,自身免疫相关抗体全部转阴,但细胞免疫功能仍未恢复,CD4细胞仍处于低水平.结论CD34+细胞分选的自身干细胞移植治疗儿童难治型红斑狼疮近期疗效满意.     

慢性鼻窦炎患儿家长疾病知识认知度调查

目的了解鼻窦炎患儿家长对儿童鼻窦炎相关知识的认知情况,为进一步加强卫生宣教、预防儿童鼻窦炎提供理论依据。方法对65名鼻窦炎患儿家长进行关于儿童鼻窦炎发病因素、临床表现、并发症以及对儿童生长发育影响等问题的问卷调查。结果调查显示95.4%的家长对儿童鼻窦炎知识缺乏了解,且知识获得途径单一。结论应通过各种途径加强儿童鼻窦炎知识的宣教,积极预防儿童鼻窦炎。     

A Decision Rule for Predicting Bacterial Meningitis in Children with Cerebrospinal Fluid Pleocytosis When Gram Stain Is Negative or Unavailable

Objectives:  Among children with cerebrospinal fluid (CSF) pleocytosis, the task of separating aseptic from bacterial meningitis is hampered when the CSF Gram stain result is unavailable, delayed, or negative. In this study, the authors derive and validate a clinical decision rule for use in this setting.
Methods:  This was a review of peripheral blood and CSF test results from 78 children (<19 years) presenting to Children's Hospital Columbus from 1998 to 2002. For those with a CSF leukocyte count of >7/μL, a rule was created for separating bacterial from viral meningitis that was based on routine laboratory tests, but excluded Gram stain. The rule was validated in 158 subjects seen at the same site (Columbus, 2002–2004) and in 871 subjects selected from a separate site (Boston, 1993–1999).
Results:  One point each (maximum, 6 points) was assigned for leukocytes >597/μL, neutrophils >74%, glucose <38 mg/dL, and protein >97 mg/dL in CSF and for leukocytes >17,000/mL and bands to neutrophils >11% in peripheral blood. Areas under receiver-operator-characteristic curves (AROCs) for the resultant score were 0.98 for the derivation set and 0.90 and 0.97, respectively, for validation sets from Columbus and Boston. Sensitivity and specificity pairs for the Boston data set were 100 and 44%, respectively, at a score of 0 and 97 and 81% at a score of 1. Likelihood ratios (LRs) increased from 0 at a score of 0 to 40 at a score of ≥4.
Conclusions:  Among children with CSF pleocytosis, a prediction score based on common tests of CSF and peripheral blood and intended for children with unavailable, negative, or delayed CSF Gram stain results has value for diagnosing bacterial meningitis.     

中国人手腕骨发育标准——中华05.IV.中国儿童手腕骨发育特征

目的:观察中国儿童手腕骨发育特征,为应用国外研究成果提供参考。方法:受试者为2005年骨发育调查样本2~18岁的16035名儿童。使用TW3方法评价手腕骨成熟度,与文献中的日本、欧美儿童的数据相比较。结果:中国和日本儿童的手腕骨发育特征相似。在儿童期,中国男儿童TW3-RUS和TW-腕骨成熟度延迟于欧美儿童0.3~0.6岁,女儿童在5~10岁TW3-RUS骨发育与欧美儿童非常接近;但在男12岁、女10岁以后,中国男女儿童TW-RUS骨成熟度加速而分别提前1.1~1.6岁和1.2岁。与欧美儿童相比,中国男儿童在3~10岁、女儿童在2~5岁,TW-腕骨成熟度分别延迟0.3~0.6岁和0.2~0.4岁;在男10岁和女5岁后,中国儿童TW-腕骨成熟度加速而提前,腕骨发育成熟的年龄均提前1.4岁。结论:与1970s~1990s的欧美儿童相比,中国儿童骨发育的延迟已不明显,但是青春期TW3-RUS骨发育加速提前的程度以及腕骨发育成熟年龄的提前则更加显著。     

Learning to Observe Relationships and Coping

Milieu relationships provide the critical background presence to staff's attempts to motivate, regulate, and teach patients how to cope with stress. Forging a connection with hospitalized children and adolescents demands attention to how they respond to adults and engage with staff around milieu expectations. Assessment guides that deal with these issues are presented. Important aspects of children's relatedness are presented in the context of their working models of adults and the influence of these representations on their response to staff. Coping skills are explained with particular emphasis on behavioral coping strategies. Tied to the assessment process are interventions that emphasize staff's role in helping patients manage strong affects and avoid the use of nonproductive behavior regulation strategies.     

玻璃体切除术治疗儿童外伤性眼内炎

①目的 观察玻璃体切除联合玻璃体内注药治疗儿童外伤性眼内炎的效果。②方法 对18例18眼儿童外伤性眼内炎采取玻璃体切除术治疗，同时玻璃体腔内给药。③结果 随访6～60个月，平均27．2个月。视力0．50者1眼，0．10～0．30者3眼，0．02～0．09者7眼，光感～手动3眼，无光感2眼，2眼眼球萎缩。1l眼视力改善(66％)。④结论 玻璃体切除术联合玻璃体腔内注药是治疗儿童外伤性眼内炎的有效方法，早期诊治是挽救眼球和视功能的关键。     

炎琥宁与阿奇霉素联合治疗小儿支原体肺炎

目的:探讨炎琥宁辅助治疗小儿支原体肺炎的疗效.方法:将141例临床确诊的支原体肺炎患儿随机分为两组,治疗组71例,应用阿奇霉素加炎琥宁静点.对照组70例,单纯使用阿奇霉素治疗.结果:治疗组有效率96%,对照组有效率87%,两组统计学差异显著(P＜0.05),治疗组疗效优于对照组.结论:炎琥宁辅助治疗小儿支原体肺炎,临床症状消失快,疗效显著,无明显不良反应,值得推广.     

癫痫儿童认知学习能力的研究

目的:探讨癫痫儿童的认知学习状况。方法:采用学习障碍筛查量表(PRS)测量60例癫痫儿童和60例健康对照,并用丹麦维迪Keypoint诱发电位仪检测其事件相关电位P300。结果:①癫痫儿童PRS量表总分、言语得分及非言语得分均较正常儿童降低,差异有显著性(P<0.01);②癫痫儿童P300潜伏期较正常儿童延长,差异有显著性(P<0.01);③全面性发作组与部分性发作组比较,P300与PRS量表均未见显著性差异(P>0.05)。结论:本研究表明癫痫儿童存在学习障碍,PRS量表与P300可从不同角度反映癫痫儿童的认知学习状况。