极低/超低出生体重儿甲状腺功能减退的临床分析

目的 分析极低/超低出生体重（VLBW/ELBW）患儿甲状腺功能减退的危险因素和治疗情况。方法 选择2018年9月至2019年12月诊断为甲状腺功能减退的VLBW/ELBW患儿为病例组（n=29），按照1：3比例匹配甲状腺功能正常的VLBW/ELBW患儿作为对照组（n=87），比较两组患儿的临床特征，分析甲状腺功能与出生胎龄、出生体重的相关性及甲状腺功能减退的危险因素。结果 符合纳入标准的VLBW/ELBW患儿共162例，其中病例组29例，甲状腺功能减退发生率为17.9%。出生体重越低，甲状腺功能减退发生率越高（P < 0.05）；三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）与出生胎龄呈正相关（P < 0.05），T3、游离甲状腺素（FT4）与出生体重呈正相关（P < 0.05）。小于胎龄儿、多胎、孕母≥35岁、使用多巴胺是发生甲状腺功能减退的独立危险因素（P < 0.05）。病例组中16例患儿给予左旋甲状腺素（每日5~10 μg/kg）治疗，甲状腺功能在治疗2周后恢复正常。结论 VLBW/ELBW患儿甲状腺功能减退的发生率较高，小于胎龄儿、多胎、孕母高龄、应用多巴胺是其发生甲状腺功能减退的危险因素，应用左旋甲状腺素治疗的患儿需定期随访，以保证用药剂量适宜。     

中药栀子本草考证

栀子临床应用广泛,且历史悠久,为更好地利用栀子资源,通过梳理历代文献与现代研究,对栀子名称、品种、产地、炮制、功效等方面进行考证,发现栀子命名主要以形态、色泽为依据,一定程度上反映了栀子的特征,并且存在与水栀子混用"黄栀"之名的情况。古代文献中记载的栀子产地最早为南阳,但产量不高,受人口迁移以及生产力发展的影响,栀子的产地主要转移到南方,且以南方产者为佳。在历代本草文献中记载入药用的栀子为山栀子,水栀子不堪入药,但在《伤寒论》等古代方书中有"肥栀子""大栀子"入药用的记载,通过后世对相应方剂的记载,确定二者应为水栀子,为水栀子的临床应用提供了有力依据。之所以与本草文献记载有所差异,应与《雷公炮炙论》和《伤寒论》的年代不同,栀子的产量及采收能力有所差距,且本草书重规范,择优入药,方书注重实用等特点有关,并且根据现代实验研究表明山栀子与水栀子化学成分组成、含量相似,具有相同的利胆作用。此外,系统整理了历代本草与方书中栀子的炮制方法和功效,并进行了分析,为栀子属资源的进一步研究与利用提供了参考和借鉴。     

血管紧张素转换酶2对儿童2019冠状病毒病的作用研究进展

随着严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在全球的肆虐，儿童感染者人数也越来越多。血管紧张素转换酶2（ACE2）是SARS-CoV-2感染人体的结合位点之一，可以与病毒尖峰蛋白结合，使得跨膜丝氨酸蛋白酶（TMPRSS2）启动S蛋白触发感染，引起白细胞介素-1、干扰素-γ、肿瘤坏死因子等多种炎性因子的产生。与成人相比，儿童的ACE2及TMPRSS2的表达水平较低，推测儿童症状较成人轻，发病人数较成人少均与此有关。该综述对SARS-CoV-2感染过程中ACE2的作用研究进展进行总结，有助于了解SARS-CoV-2的致病机制，为更好地开发药物及疫苗，防治儿童2019冠状病毒病提供参考。     

Determinants of Tobacco Use among Children of a Rural Village in India: An Exploratory Qualitative Study

Background: Tobacco is one of the leading causes of preventable deaths. It is both a major social and health problem. According to National Sample Survey Organization of Government of India about 20 million children of ages 10-14 are estimated to be tobacco-addicted. There are grave consequences of tobacco both socially and also on health thus it is of utmost importance to understand the factors leading to its use and to plan strategies to reduce its intake. However, the health implications of this social issue in a rural context have not been explored. Aims and Objective: this study makes an attempt to explore the health and social implications of tobacco usage by the children below the age of 14 years in hamlet. Materials and Methods:  The present study employed a qualitative study design. Data was collected using focus group discussion and in-depth interview of key informants. Thematic analysis for exploring the explicit and implicit meanings within the data was done. The themes which emerged were knowledge about tobacco and the various products available, children and parents’ tobacco use and habits, the health and social implication of tobacco use, reasons for tobacco use by the children. Results: It was found tobacco use by the children was very common in the community. Parent, peer pressure, sibling pressure were found to be playing important role in the initiation of tobacco habit by the child. Further illiteracy and lack of awareness was also lead to tobacco use among children. Conclusion: The study identifies education and awareness of parents about the ill-effects of tobacco play an important role as parents act as role model for their children, thus equal stress should be laid in improving the parental habits. Even raising the prices of tobacco products can help in controlling this habit.     

The ‘space’ of friendship: young children's understandings and expressions of friendship in a reception class

The purpose of this study has been to explore young children's understandings and experiences of friendship as these manifested in children's behaviours, in a reception class setting. Drawing on an evolutionary, ecological framework, friendship is seen as not only the expression and further development of social understandings and cognitive advances; more than that, making and maintaining friends is seen as an evolutionary trait and a ‘drive’ to relate to similarly minded others. Through ‘niche picking’, children select the environments and opportunities that suit them in order to develop their dispositions and individual traits. The research employed a participatory design in order to capture the children's views and experiences. It took place in a reception class setting, where children's everyday experiences were observed and discussed with them. The study identified six themes of analysis and offered some suggestions about creating enabling educational environments that allow the ‘space’ for niche construction.     

Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology

Introduction

The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice.

Epidemiology of gout and hyperuricemia in New Caledonia

ObjectivesNew Caledonia is a Pacific island of 270,000 inhabitants with mixed ethnicities, including Polynesians (10.2%), people from European ancestry (27.2%), and Melanesians (39.1%),. This study aimed at determining the prevalence of gout and hyperuricemia in the general population and the various ethnicities of New Caledonia.MethodsA 3-degree random sample of the population aged 18 to 60 years was adjusted according to the 2014 New Caledonia census. Face-to-face planned interviews and physical measurements were performed by trained nurses. All consenting participants underwent capillary measurement of creatinine; all consenting men and only women older than 40 years underwent point-of-care uricemia testing. Gout was defined by a validated algorithm. Two definitions of hyperuricemia were used: capillary level equivalent to plasma uric acid level > 360 μmol/l (6 mg/dl) and > 420 μmol/l (7 mg/dl) and/or urate-lowering drug treatment for both thresholds.ResultsWe included 1144 participants (adjusted mean age 37.7 ± 12.0 years; adjusted sex ratio 50.4% men). The adjusted prevalence of gout was 3.3% (95% confidence interval 2.2–4.9). Prevalence was 6.7% (2.5–16.8), 4.1% (1.8–8.9), and 2.6% (1.4–4.7) for Polynesians, Europeans and Melanesians, respectively, and 1.9% (0.5–6.6) for other ethnicities. Prevalence of hyperuricemia, determined in 658 participants, was 67.0% (61.9–71.6) and 37.0% (32.3–42.0) for the 360- and 420-μmol/l thresholds, respectively, and was significantly greater for Polynesians and Melanesians than Europeans for both thresholds.ConclusionsThe prevalence of gout and hyperuricemia in New Caledonia was high, including in patients of European descent.     

OSAHS患儿扁桃体和腺样体术后免疫功能的变化

目的 阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是耳鼻咽喉科的一种常见病，儿童发病率呈上升趋势，调查显示儿童OSAHS发生率为4%~5%，2~6岁是发病的高峰期。OSAHS不仅严重影响儿童的睡眠质量，还会引起儿童生长发育迟缓、智力缺陷等一系列不良反应，OSAHS患儿的主要病因是扁桃体和/或腺样体肥大，因此最有效的治疗方法是扁桃体切除术和腺样体切除术。而扁桃体和腺样体是儿童淋巴组织系统的重要组成部分，在机体的防御和保护功能中发挥着重要作用。手术治疗OSAHS是否影响儿童的免疫功能目前存在争议。一些学者认为扁桃体切除和腺样体切除后儿童的免疫力降低，而另一些学者认为OSAHS儿童的免疫力在手术后保持不变，甚至比手术前有所提高。本文就儿童OSAHS手术前后免疫指标的变化作一综述。