孙丽平教授运用对药辨治小儿咳嗽临证荟萃

阐述了孙丽平教授治疗小儿咳嗽临床常用的8组对药,即前胡与白前、紫菀与款冬花、苦杏仁与桃仁、橘红与桔梗、瓜蒌与冬瓜子、地龙与僵蚕、川贝母与浙贝母、沙参与麦冬的配伍特点及临床应用心得,并列举其临证经典医案,结合中药学理论和现代药理学研究,总结分析孙教授运用对药治疗小儿咳嗽的学术经验及用药思路。孙教授认为小儿体属稚阳,其咳多起肺虚实之热,主以清热护肺,次以运脾滋阴,主次同疗,则阴阳平矣,强调小儿咳嗽用药,应以辨别个体体质差异为基础,提倡对药组方"肺脾同治、气血通调、阴阳平补"的用药理念。附案例1则,以资验证。     

Metastatic adult-type non-rhabdomyosarcoma soft tissue sarcomas in children and adolescents: A cohort study from the European paediatric Soft tissue sarcoma Study Group

Background

Limited data exist on the clinical behavior of pediatric non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) with distant metastases at onset, and a clear standard of care has not yet been defined.

Methods

This cohort study reports on pediatric adult-type metastatic NRSTS enrolled in two concurrent prospective European studies, i.e., the randomized BERNIE study and the single-arm MTS 2008 study developed by the European paediatric Soft tissue sarcoma Study Group. Treatment programs were originally designed for patients with metastatic rhabdomyosarcoma, i.e., nine courses of multidrug chemotherapy (with or without bevacizumab in the BERNIE study), followed by 12 cycles of maintenance therapy, whereas radiotherapy and/or surgery (on primary tumor and/or metastases) were delayed until after seven courses of chemotherapy had been administered.

Results

The study included 61 patients <21 years old treated from July 2008 to December 2016. The lung was the site of metastases in 75% of the cases. All patients received multi-agent chemotherapy, 44% had local therapy to primary tumor, and 18% had treatment of metastases. Median time to progression/relapse was 6 months. A high rate of tumor progression was observed during the initial part of the chemotherapy program. With a median follow-up of 41.5 months (range, 2–111 months), 3-year event-free survival and overall survival were 15.4% (95% confidence interval [CI], 7.6–25.7) and 34.9% (95% CI, 22.7–47.5), respectively. There were no statistically significant differences in outcome depending on the type of treatment administered.

Conclusions

The study confirmed the overall poor outcome for patients with metastatic NRSTS, whose treatment remains a challenge.

Plain Language Summary

• Pediatric non-rhabdomyosarcoma soft tissue sarcomas form a heterogeneous group of rare tumors.
• Although recent international studies have defined the standard of care for patients with localized disease, limited data are available on the clinical behavior of patients with distant metastases.
• This study on 61 metastatic cases treated on two prospective European protocols confirms that the chances of survival of such patients are often dismal and a standard treatment is still lacking.

     

小儿弱视采用多媒体训练与传统遮盖治疗的效果对比

目的分析小儿弱视采用多媒体训练与传统遮盖治疗的效果。方法 100例小儿弱视患儿,采用计算机随机法分为传统组和多媒体组,每组50例。传统组患儿采用传统遮盖治疗,多媒体组患儿采用多媒体训练。比较两组患儿治疗前后立体视觉情况、视力水平及治疗效果。结果多媒体组患儿治疗总有效率为94.00%(47/50),高于传统组的80.00%(40/50),差异具有统计学意义(P<0.05)。治疗后,多媒体组患儿立体视觉正常率为90.00%(45/50),高于传统组的74.00%(37/50),差异具有统计学意义(P<0.05)。治疗后,两组患儿视力水平均高于本组治疗前,且多媒体组患儿视力水平(0.93±0.12)高于传统组的(0.84±0.12),差异具有统计学意义(P<0.05)。结论小儿弱视采用多媒体训练与传统遮盖治疗的效果存在差异,多媒体训练可更好地改善患儿视力,值得推广和应用。     

Exploitation sexuelle des mineurs et traumatisme : revue narrative de littérature

ObjectiveThe sexual exploitation of minors is a multifaced phenomenon with deleterious consequences on the mental health of the children and adolescents who are victims. The traumatic dimension infiltrates this problem, both concerning the antecedents and the situations of sexual exploitation themselves and their psychological sequelae. This article aims to gather and discuss the current literature about the trauma in the sexual exploitation of minors.MethodA keyword and date (between 2010 and 2020) search was made on the search engine Summon 2.0 for articles on commercial sexual exploitation of children and trauma.ResultsTwenty-one articles were studied according to three lines of research, namely: (1) profiles of sexually exploited minors; (2) the traumatic consequences of sexual exploitation; (3) cares and treatments: from identification to therapy.DiscussionThese studies have some limitations. Validity, recruitment and representativeness biases, inherent in this specific population, are discussed. Recommendations for further research and practice were made.ConclusionThis narrative literature review highlights the difficulty of studying this population and insists on the need to carry out further national research with the aim to improve the understanding of commercial sexual exploitation of children in France and to experiment trauma-informed support and care devices, particularly those designed for the needs of these young people in great difficulty.     

A commitment to marginalized children in the European Union: The hope and challenges of the EU Child Guarantee

While children in general are usually seen as a societal priority, many children are disadvantaged by marginalization, with adverse effects on health and development. Following feasibility studies, the European Commission has now adopted a formal Child Guarantee of service access. This paper links the Feasibility Studies to other reports on the need to address marginalized and institutionalized children. The problems in identifying and quantifying such children are outlined, as are the challenges of planning for these groups of children and the difficulty of finding universal definitions and data. This European Union initiative is timely, given that around a quarter of European children are marginalized, while the effects of Covid-19 will add to this marginalization.     

Valuing height: diagnosis,valuation and the case of idiopathic short stature

This paper proposes a ‘valuographic’ approach to diagnosis, exploring how values and valuation practices are implicated in the contested diagnostic category of idiopathic short stature (ISS). ISS describes children who are ‘abnormally’ short but do not have any other detectable pathology. In the USA growth‐promoting hormone therapy has been approved for ISS children, since 2003. However, no other jurisdiction has approved this treatment and the value of ISS as a diagnostic category remains disputed among healthcare professionals. Drawing on qualitative interviews with paediatric endocrinologists in the UK and the US, this study presents a historical snapshot illustrating how the problematisation of ISS as a diagnosis involved multiple registers of value including epistemic, economic and moral calculations of worth. Contestation of the diagnosis was not just about what counts but about what ought to be counted, as respondents’ accounts of ISS gave differential weight to a range of types of evidence and methods of assessment. Ultimately what was at stake was not just the value of increased height for short patients, but what it meant to properly practice paediatric endocrinology. Consideration is then given to how a valuographic approach can be applied to sociological studies of diagnosis more broadly.     

Child and parent perspectives of life quality of children with physical impairments compared with non-disabled peers

Background: Life quality has become a widely used concept within rehabilitation and occupational therapy practice.

Aim: This study explored child and parent perspectives of life quality of children with physical impairments compared with a group of non-disabled children.

Method: Data were collected with the Icelandic self- and proxy-reported versions of the KIDSCREEN-27. For children with physical impairments, reports from 34 children and 40 parents were included in the analyses, and in control group reports from 429 children and 450 parents were included.

Results: Children with physical impairments evaluated their life quality within the average range on four out of five life quality dimensions. The lowest scores were within the physical well-being dimension. Self-reported scores of children with physical impairments were higher than those of their parents on all dimensions except autonomy and parent relations. Thus, the parents considered more environmental and personal factors to negatively influence their child’s life quality than children did themselves.

Conclusion: Children with physical impairments experience their life quality similarly to non-disabled children.

Significance: Focus on life quality can help occupational therapists to identify what circumstances positively or negatively influence client well-being and to focus more on contextual factors that contribute to disablement.     

唐方教授脏腑辨证治疗小儿急性咳嗽经验

小儿急性咳嗽作为儿科常见病,因小儿脏腑娇嫩、形气未充,具有发病急骤、传变迅速的病理特点,故易出现各种变证,建立完善的小儿急性咳嗽诊治体系就显得尤为重要。因咳嗽病程不同,病邪部位有异,辨证论治之法亦有不同,唐方教授通过多年临床实践归纳和总结出小儿咳嗽从"肺胃肝三脏"治疗理论。该理论以脏腑辨证为基础,具有紧抓主症、用药考究、灵活加减的特点。临床用药加减则依据肺主宣发肃降,故多予炙麻黄、桔梗开宣肺气,予桑白皮、葶苈子降气止咳,且小儿生理特点为"脾常不足",故而过量进食之后,损伤脾胃,造成肺胃热盛同病,胃多气多血之腑,故予红景天、地龙、牡丹皮活血凉血清热。通过对临床医案的分析,进一步阐释从"肺胃肝三脏"治疗理论,从而为小儿咳嗽的临床诊治工作提供有益借鉴。