硬性透氧性角膜接触镜对单眼屈光参差性弱视儿童的矫治效果观察

目的 研究硬性透氧性角膜接触镜(RGP)对单眼屈光参差性弱视儿童矫治效果。 方法 选取2014年2月至2015年8月西安市中心医院收治的单眼屈光参差性弱视患儿110例。根据治疗方式的不同分为观察组59例,对照组51例。观察组予以RGP矫正视力,对照组则佩戴框架眼镜矫正视力。分别对两组患儿进行为期1年的随访,比较视力矫正情况,临床疗效,并发症发生情况以及患儿满意度。 结果 观察组配镜后1个月、6个月及12个月后矫正视力分别为(4.33±0.31)、(4.52±0.47)、(4.76±0.29),均高于对照组的(4.19±0.30)、(4.33±0.40)、(4.41±0.44),差异有统计学意义(均P＜0.05)。观察组治疗总有效率为67.80%(40/59),高于对照组的43.14%(22/51),差异有统计学意义(P＜0.05)。两组并发症发生率对比不明显,差异无统计学意义(P＞0.05)。观察组病人满意度为100.00%(59/59),高于对照组的90.20%(46/51),差异有统计学意义(P＜0.05)。     

儿童肠道病毒性脑炎的临床特点及脑脊液病毒检测结果分析

目的 探讨肠道病毒性脑炎(EVE)儿童的临床特点及脑脊液病毒检测结果。方法 回顾性分析河南省儿童医院2015年1月至2017年12月收治的216例EVE病儿病例资料。结果 临床特点:发热症状占69.44%,头痛占64.35%,呕吐占75.00%;6[KG-*3]～8月发病占39.35%,9[KG-*3]～11月占31.48%;白细胞(WBC)总数＞10×10⁹/L占68.98%,C反应蛋白(CRP)升高占57.87%;脑电图轻中度异常检出率21.76%。脑脊液病毒检测:肠道病毒(EV)通用核酸检测阳性率55.56%,其中埃柯病毒30(ECHO30)型占79.17%;特异性IgM抗体阳性95例;不同年龄段、不同发病时间段病儿脑脊液EV通用核酸阳性检出率、特异性IgM抗体阳性检出率比较均差异有统计学意义(P均＜0.05)。预后:均治愈出院。结论 儿童EVE主要症状为发热、头痛及呕吐,好发于夏、秋季;脑脊液病毒检测以ECHO30为主且特异性IgM抗体检出率较高,经综合治疗后病儿预后良好。     

3种清热解毒类中药注射剂治疗小儿手足口病的Meta分析

摘 要 目的：评价清热解毒类中药注射剂在手足口病治疗中的临床应用的疗效和安全性。 方法: 计算机检索 PubMed、Cochrane Library、CNKI,VIP和WanFang Data数据库,搜集清热解毒类中药注射剂治疗小儿手足口病的随机对照试验（RCTs）,检索时限均为建库至2019年3月,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。 结果: 共纳入11个RCTs,共 2 071例患儿。Meta分析结果显示,与西药常规疗法组比较,中药注射剂组治疗小儿手足口病可提高总有效率 [OR=2.88,95%CI（1.62,5.10）,P=0.000 3]、缩短退热起效时间 [MD=-8.10,95%CI（-11.77,-4.42）,P＜0.000 1]、缩短体温恢复正常时间 [MD=-16.63,95%CI（-22.68,-10.59）,P＜0.000 01]、缩短手足皮疹消退时间 [MD=-29.57,95%CI（-47.18,-11.95）,P=0.001];在不良反应发生率、重症转化率上,两组的差异无统计学意义（P＞0.05）。 结论: 清热解毒类中药注射剂治疗小儿手足口病具有一定的优势,可在临床推广使用。但现有高质量文献不多,因此本研究最终纳入文献数量较少,未能对3种中药注射剂之间的疗效和安全性进行比较,需要更多设计严谨的高质量、多中心的随机双盲临床研究进一步验证。     

Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children’s functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children’s perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.     

Detection of pronator muscle overactivity in children with unilateral spastic cerebral palsy: Development of a semi-automatic method using EMG data

BackgroundThe pronator teres and pronator quadratus muscles are frequently injected with neuromuscular blocking agents to improve supination in children with spastic cerebral palsy and limited active elbow supination. However, determining by simple clinical examination whether these muscles are overactive during active movement is difficult.ObjectiveThis study aimed to develop a semi-automatic method to detect pronator muscle overactivity by using surface electromyography (EMG) during active supination movements in children with cerebral palsy.MethodsIn total, 25 children with unilateral spastic cerebral palsy (10 males; mean [SD] age 10.6 [3.0] years) and 12 typically developing children (7 males; mean age 11.0 [3.0] years) performed pronation–supination movements at 0.50 Hz. Kinematic parameters and surface EMG signals were recorded for both pronator muscles. Three experts visually assessed muscle overactivity in the EMG signals of the children with cerebral palsy, in comparison with the reference group. The reliability and discrimination ability of the visual assessments were analysed. Overactivity detection thresholds for the semi-automatic method were adjusted by using the visual assessment by the EMG experts. The positive and negative predictive values of the semi-automatic detection method were calculated.ResultsIntra-rater reliability of visual assessment by EMG experts was excellent and inter-rater reliability was moderate. For the 25 children with unilateral spastic cerebral palsy, EMG experts could discriminate different profiles of pronator overactivity during active supination: no pronator overactivity, one overactive pronator, or overactivity of both pronators. The positive and negative predictive values were 96% and 91%, respectively, for this semi-automatic detection method.ConclusionsDetection of pronator overactivity by using surface EMG provides an important complement to the clinical examination. This method can be used clinically, with the condition that clinicians be aware of surface EMG limitations. We believe use of this method can increase the accuracy of treatment for muscle overactivity, resulting in improved motor function and no worsening of paresis.     

家庭照顾者焦虑程度与患儿静脉渗出的相关性研究

目的 调查住院患儿家庭照顾者的焦虑程度,并探讨其与患儿静脉渗出的相关性。方法 采用焦虑自评量表（Self-Rating Anxiety Scale, SAS）,对172名住院患儿家庭照顾者焦虑程度进行测评,同时计算在此期间患儿静脉渗出比率,使用SPSS 20.0软件对数据进行处理和统计分析。结果 0～6岁患儿家庭照顾者主要表现为中重度焦虑,0～3岁患儿家庭照顾者的焦虑程度显著高于3～6岁患儿家庭照顾者（P<0.05）;女性照顾者的焦虑程度显著高于男性（P <0.05）;照顾者焦虑程度年龄大的显著高于年龄低的（P<0.05）;患儿家庭照顾者焦虑程度与患儿静脉渗出比率成正相关,差异均有统计学意义（P<0.05）。结论 家庭照顾者焦虑程度越高,患儿静脉渗出发生率越高,降低住院患儿家庭照顾者的焦虑程度,可以降低患儿静脉渗出的发生率。     

造血干细胞移植患儿口腔黏膜炎风险预测模型的构建及验证

目的 分析造血干细胞移植患儿口腔黏膜炎的危险因素,构建风险预测模型,并验证其预测效果。方法采用便利抽样法,选取2019年1月—2022年6月于重庆市某三级甲等儿童专科医院行异基因造血干细胞移植的286例患儿作为调查对象,回顾性分析相关资料,通过Logistic回归分析筛选其口腔黏膜炎的危险因素,应用R 3.6.1软件绘制列线图,并进行验证。结果 Logistic回归分析结果显示,BMI<16、口腔pH值≤6.5、口腔清洁度评分为2～3分、预处理方案为减低强度或清髓性预处理、使用甲氨蝶呤、中性粒细胞计数<1.5×109/L是造血干细胞移植患儿口腔黏膜炎的危险因素（P<0.05）。Hosmer-Lemeshow检验结果提示,该风险预测模型具有较好的拟合度（χ2=0.969,P=0.998）。模型验证结果显示,该模型的受试者操作特征曲线下面积为0.881,最佳临界值为0.7,准确度为80.36%,灵敏度为83.59%,特异度为74.88%;预测口腔黏膜炎的一致性指数为0.881,校正一致性指数为0.862。结论 该研究构建的风险预测模型具有良好的区分度与准确度,可为临床护理...     

学龄期恶性肿瘤患儿运动康复的最佳证据总结

目的 检索、评价及总结学龄期恶性肿瘤患儿运动康复的相关证据,为医护人员指导患儿及其家庭开展运动康复提供参考。方法 计算机系统检索国内外数据库、相关指南网站及专业学会网站中关于学龄期恶性肿瘤患儿运动康复的临床决策、推荐实践、指南、证据总结、专家共识及系统评价。检索时限为2017年2月—2022年2月。由2名研究者独立进行文献质量评价、证据提取及整合。结果 最终纳入13篇文献,其中指南3篇、证据总结3篇、推荐实践1篇、专家共识1篇、系统评价5篇。从运动目的 、运动对象、运动评估、运动方案和运动管理5个方面共总结21条最佳证据。结论 该研究总结了学龄期恶性肿瘤患儿运动康复的最佳证据,建议医护人员应用证据时充分考虑临床情境,结合患儿及其家庭的需求和偏好,制订更为详细的个性化运动康复方案。