血小板质控初探

血小板质控初探袁光孚，张玉芳，保菊英，秦振庭西宁市第一人民医院ＣＡＭＰＡＲＩＳＩＯＮＯＦＤＩＦＦＥＲＥＮＴＭＥＴＨＯＤＳＦＯＲＰＬＡＴＥＬＥＴＣＯＵＮＴＩＮＧＡＴＨＩＧＨＡＬＴＩＴＵＤＥＱＩＮＧＨＡＩ￥Ｋｕａｎｇ－ＦｕＹｕａｎ．ｅｔａｌ（Ｘｉ－Ｎｉｎ...     

小儿白血病形态学、免疫学分型研究

小儿白血病形态学、免疫学分型研究程岩，田根全，袁文菊，杨小红青海省儿童医院ＴＨＥＲＥＳＥＡＲＣＨＯＦＭＯＲＰＨＯＬＯＧＩＣＡＮＤＩＭＭＵＮＯＬＯＧＩＣＡＬＣＬＡＳＳＩＦＩＣＡＴＩＯＮＯＦＴＨＥＰＥＤＩＡＴＲＩＣＬＥＵＫＥＭＩＡ￥ＹａｎＣｈｅｎｇｅｔａ...     

不同日龄、不同病情新生儿血小板数量的观察

不同日龄、不同病情新生儿血小板数量的观察秦振庭，王广方北京医科大学第一临床医学院妇儿医院ＰＬＡＴＥＬＥＴＣＯＵＮＴＳＡＴＤＩＦＦＥＲＥＮＴＡＧＥＧＲＯＵＰＳＯＦＮＥＷＢＯＲＮＳ￥Ｃｈｅｎ－ＴｉｎｇＣｈｉｎｅｔａｌ（Ｗｏｍｅｎ＆Ｃｈｉｌｄｒｅｎｈｏｓｐ...     

小儿急性白血病患者血浆纤维结合蛋白测定的临床意义

小儿急性白血病患者血浆纤维结合蛋白测定的临床意义张宝玺，郭稳捷河北医学院附属二院儿科ＴＨＥＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮＣＥＯＦＰＬＡＳＭＡＦＩＢＲＯＮＥＣＴＩＯＮＤＥＴＥＣＴＩＯＮＩＮＣＨＩＤＨＯＯＤＡＣＵＴＥＬＥＵＫＥＭＩＡ￥ＺｈａｎｇＢａ...     

小儿特发性血小板减少性紫瘢T细胞亚群的观察

小儿特发性血小板减少性紫瘢Ｔ细胞亚群的观察田根全，袁文菊，程岩青海省儿童医院ＴＨＥＴ－ＣＥＬＬＳＵＢ－ＧＲＯＵＰＭＥＡＳＵＲＥＭＥＮＴＯＦＩＤＩＯＰＡＴＨＩＣＴＨＲＯＭＢＯＣＹＴＯＰＥＮＩＣＰＵＲＰＵＲＡ（ＩＴＰ）ＩＮＰＥＤＩＡＴＲＩＣＰＡＴＩＥＮＴ...     

重组人集落刺激因子在白血病中的临床应用

重组人集落刺激因子在白血病中的临床应用顾立达，艾孜买提，孔佩艳，严媚，赵勒新疆医学院一附院儿科血液组ＣＬＩＮＩＣＡＬＡＰＰＬＩＣＡＴＩＯＮＯＦＲＥＣＯＭＢＩＮＡＮＴＨＵＭＡＮＧＲＡＮＮＬＯＣＹＴＥＣＯＬＯＮＹＳＴＩＭＵＬＡＴＩＮＧＦＡＣＴＯＲＯＮＬＥ...     

蚕豆病复发因素的探讨(附257例随访病例报告)

蚕豆病复发因素的探讨（附２５７例随访病例报告）陈茂余，卓慧琼，衡德芳，罗运贵，肖彦勋四川省遂宁市人民医院ＥＸＰＬＯＲＡＴＩＯＮＴＯＲＥＣＵＲＲＥＮＴＦＡＣＴＯＲＳＯＦＦＡＶＩＳＭ－ＷＩＴＨＦＯＬＬＯＷＩＮＧＵＰＲＥＰＯＲＴＯＦ２５７ＣＡＳＥＳ￥Ｃｈｅ...     

小儿血液病骨髓活检的临床意义

小儿血液病骨髓活检的临床意义屠立明，沈亦逵，王若洁广东省人民医院儿科ＣＬＩＮＩＣＳＩＧＮＩＦＩＣＡＮＣＥＯＦＢＯＮＥＭＡＲＲＯＷＢＩＯＰＳＹＩＮＣＨＬＬＤＲＥＮＨＥＭＡＴＯＬＯＧＩＣＤＩＳＥＡＳＥＳ￥ＴｕＬｉｍｉｎｇ，ｅｔａｌ．（ＧｕａｎｇｄｏｎｇＰ...     

小儿恶性组织细胞增生症血象及骨髓象分析

小儿恶性组织细胞增生症血象及骨髓象分析郭艺杰，王令仪武汉同济医科大学同济医院儿科ＡＮＡＬＹＳＩＳＯＦＨＥＭＯＧＲＡＭＡＮＤＢＯＮＥＭＡＲＲＯＷＰＩＣＴＵＲＥＳＩＮＭＡＬＩＧＮＡＮＴＨＩＳＴＯＣＹＴＯＳＩＳ￥ＧｕｏＹｉＪｉｅ，ｅｔａｌ（Ｄｅｐａｒｔｍｅ...     

血管内溶血性贫血多指标联合诊断优化方案的探讨

血管内溶血性贫血多指标联合诊断优化方案的探讨卢桂森，张华，陈琼俊广西玉林地区红十字会医院ＣＯＭＢＩＮＥＤＤＩＡＧＮＯＳＴＩＣＯＰＴＩＭＩＺＩＮＧＳＨＥＭＥＷＩＴＨＭＵＬＴＩＰＬＥＩＮＤＥＸＥＳＦＯＲＩＮＴＲＡＶＡＳＣＵＬＡＲＨＥＭＯＬＹＴＩＣＡＮＥＭ...     

Favorable preliminary results using TLI/ATG‐based immunomodulatory conditioning for matched unrelated donor allogeneic hematopoietic stem cell transplantation in pediatric severe aplastic anemia

Pillai A, Hartford C, Wang C, Pei D, Yang J, Srinivasan A, Triplett B, Dallas M, Leung W. Favorable preliminary results using TLI/ATG‐based immunomodulatory conditioning for matched unrelated donor allogeneic hematopoietic stem cell transplantation in pediatric severe aplastic anemia.
Pediatr Transplantation 2011: 15: 628–634. © 2011 John Wiley & Sons A/S. Abstract: To assess whether a tolerance‐induction regimen could be applied for unrelated (MUD) HCT in SAA, we retrospectively reviewed our HCT experience using unmanipulated 10/10 HLA‐matched bone marrow grafts from MSD vs. MUD donors. Conditioning was CTX 200 mg/kg (CTX) + rabbit ATG 10 mg/kg (ATG) for MSD (n = 9) and TLI (800 cGy) + CTX/ATG for MUD HCT (n = 5). Immunoprophylaxis was CSA and short‐course MTX. Median patient age was 14.7 yr, median time to HCT 1.5 yr, and median follow‐up 3 yr. Outcome measures included EFS, time to engraftment, and cumulative incidence of GVHD (CIN of GVHD) for MSD and MUD cohorts. EFS and stable engraftment rate were 100%. CIN of acute GVHD was: MSD, Grade I–II: 1 (11%), Grade III–IV: 0%; MUD, Grade I–II: 1 (20%), Grade III–IV: 1 (20%). CIN of chronic GVHD was: MSD, limited: 1 (11%), extensive: 0%; MUD, limited: 0%, extensive: 0%. All immunosuppressive‐compliant patients successfully weaned immunosuppression. Although in limited patients, our results suggest that immunomodulatory TLI added to backbone CTX/ATG conditioning is a promising option for MUD HCT in SAA patients, which we will examine in a prospective clinical trial.     

Transient renal enlargement in pediatric hematopoietic cell transplant recipients

Age‐dependent renal length tables are routinely used when interpreting pediatric ultrasound. Standard renal length tables may not be accurate for HCT patients due to treatment effects on kidney size. The purpose of this study was to determine whether renal size changes from expected lengths based on age after HCT in the absence of other markers of renal disease. Four hundred and fifty renal measurements were made on 101 patients who underwent HCT between 2006 and 2010. Renal length was measured at 1–90 days pre‐HCT and at 0–30, 31–90, 91–180, and 181+ days post‐HCT. Values were compared with normal renal length tables. Average post‐HCT renal lengths were greater than established normative renal length data within every age group. Age‐adjusted average renal lengths measured at 0–30 and 31–90 days post‐transplantation were significantly larger than pre‐HCT renal lengths, with relative increases of 6.9% (4.5, 9.4; p < 0.001) and 3.9% (1.4, 6.4; p = 0.003), respectively. Average renal length did not differ significantly after 90 days post‐transplantation. HCT patients may have larger kidneys in the absence of renal disease. Awareness of the potential phenomenon of transient renal enlargement following HCT can prevent misdiagnosis and eliminate unnecessary diagnostic evaluations, interventions, anxiety, resource allocation, and financial costs.     

Promoting Early Literacy Using Digital Devices: A Pilot Randomized Controlled Trial

ObjectiveTo determine feasibility and explore effects of literacy promotion using e-books versus board books on the home reading environment, book reading, television use, and child development.MethodsRandomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6 and 12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development-3rd Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis.ResultsA total of 104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in sociodemographic characteristics between groups at baseline. Children in the DLP group initially had lower StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs 23%, P < .001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs SLP 89.7; P = .10) at the 6-month follow-up.Conclusions/DiscussionLiteracy promotion using e-books was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.     

新生儿不同日龄电子计数法血常规检查结果分析

鉴于近年来应用电子计数法，进行血常规检验日益增多，的确较准确、快速、实用。本文对１９９３年９月～１９９４年８月住院新生儿无明显因素影响血常规的前提下，对资料较完整的３７７例做了重点分析。结果表明，Ｒｂｃ、Ｈｂ、ＨＣＴ、ＭＣＶ、ＭＣＨ五项均在出生２４小进后，逐渐下降到晚期新生儿最低，按新生儿早、中、晚期比较，有统计学显著性差异，无性别差异、男女规律性近似；未成熟儿与足月儿则略有不同，前者略高于后者，随日龄增加其差别逐渐减小；ＭＣＨＣ变化不大。白细胞变化无新线索。血小板的变化与红细胞略有不同，血小板是随日龄增加而升高，到新生儿中期达高峰，以后逐渐稍降，但仍比早期新生儿为高；未成熟几例数偏少，尚待探讨。     

Pericardial effusion after pediatric hematopoietic cell transplant

PE can occur following HCT. However, the incidence, etiology, risk factors, and treatment remain unclear. We performed a retrospective study evaluating 355 pediatric recipients of HCT treated at a single institution between January 2005 and August 2010. No cases of PE were identified in the autologous HCT (auto‐HCT) recipients (0/43), while 19% (57/296) of allogeneic HCT (allo‐HCT) developed PE. Among the 57 PE patients, 40 (70%) were males; the median age at transplantation was 6.6 yr (0.1–17.3 yr). Thirty‐six patients (63%) had significant PE with 23 patients (40%) treated by pericardiocentesis, and 19 (33%) experiencing recurrent PE. OS rates for patients who developed PE were 84% at 100 days and 65% at three yr after HCT. Risk factors associated with PE on multivariate analysis included myeloablative conditioning (p = 0.01), delayed neutrophil engraftment (p < 0.01), and CMV + serostatus of the recipient (p = 0.03). Recipients with non‐malignant diseases were significantly less likely to die after development of PE (p = 0.02 and 0.004 when comparing with standard and high‐risk diseases, respectively). In summary, PE is a common and significant complication of pediatric allo‐HCT. Prospective studies are needed to better determine the etiology and optimal method of PE treatment after HCT.     

Frequency of asymptomatic and symptomatic respiratory virus detection in pediatric hematopoietic cell transplant patients

Respiratory viral infections are common and can cause significant morbidity and mortality in pediatric patients undergoing hematopoietic cell transplantation (HCT). The prevalence of disease has been primarily identified from retrospective studies using standard‐of‐care specimens. The incidence of both asymptomatic respiratory viral detection and symptomatic respiratory viral detection in this high‐risk population is not well described. We performed longitudinal, active, prospective surveillance in pediatric HCT patients. Subjects underwent weekly midturbinate swabs (MTSs) for the detection of 18 respiratory viruses and subtypes peri‐HCT and 100 days post‐HCT. Clinical data were obtained from the medical record. From September 2015 to February 2017, 24 children underwent 29 HCT, and 284 MTSs were collected. Forty‐two (15%) specimens were virus‐positive from 10 (42%) subjects. Specimens from children undergoing allogeneic HCT were more likely to have a virus detected (17% vs 8%, P = .04) compared with specimens from children undergoing autologous HCT. Sixteen (38%) detections were not associated with symptoms. Almost half (8/17) of the unique viral infections occurred during the HCT hospitalization after a negative specimen, suggesting nosocomial acquisition, and preceded detection from a clinical specimen. Rhinovirus, the most common virus detected, was the only virus detected in 33 (81%) virus‐positive specimens; only 11 (33%) rhinovirus detections were asymptomatic. Asymptomatic detection of coronavirus and bocavirus occurred. Asymptomatic respiratory virus detection occurred in more than one‐third of the children undergoing HCT. The acquisition of respiratory viruses during HCT hospitalization suggests nosocomial acquisition. Early detection of respiratory viruses during asymptomatic periods could have infection prevention and treatment implications.     

The effect of maturation and sedation on amplitude-integrated electroencephalogram of the preterm neonate: results of a prospective study

Background and aim: Amplitude-integrated electroencephalogram (aEEG) is becoming more common in NICUs for monitoring infants after perinatal asphyxia. We used aEEGs for preterm infants, and analysed the influence of sedation and maturation on their aEEG, focusing on continuous activity. Methods: Weekly or biweekly aEEGs were performed in preterm infants and evaluated by visual analysis. Results: We analysed 92 aEEGs of 56 preterm infants (gestational age (GA) 24 + 6 to 34 + 0 wk, median 30 + 0 wk). In their first week of life, children with higher GA had a higher percentage of continuous activity: with a GA ≤ 28 + 0 wk it was 8.1%, 33.5% with a GA from 28 + 1 to 30 + 0 wk (p=0.02), 85.9% with a GA from 30 + 1 to 32 + 0 wk (p=0.005), and 89.1% with a GA from 32 + 1 to 34 + 0 wk. Continuous activity increased with growing postnatal age. With a GA ≤ 28 + 0 wk, it rose from 8.1% (first week) to 55.3% (second week) and reached 96.8% (week 6/7) (p=0.017). With GA from 28 + 1 to 30 + 0 wk, continuous activity was 33.5% (first week) and 86.6% (second week) (p=0.03).

Conclusion: The aEEG of preterm infants appears to be a good tool for monitoring cerebral activity. Continuous activity seems to indicate maturation in the neonatal brain. Further investigations of aEEGs in preterm infants should be performed.     

股骨锁定加压钢板（LCP）在儿童股骨转子下骨折中的应用

目的：探讨股骨锁定加压钢板（LCP）对儿童股骨转子下骨折的临床疗效。方法回顾性分析本院2010年2月至2012年12月收治的22例股骨转子下骨折患儿临床资料,其中男16例,女6例,平均年龄8．5岁。结果22例均获得随访,随访时间6～48个月,平均27个月,22例均骨性愈合,无断钉、脱钉、钢板松动、断板及髋内翻、关节活动障碍等并发症发生。结论股骨锁定加压钢板（LCP）对于儿童股骨转子下骨折可以有效改善传统保守牵引、克式针、弹性髓内钉固定及其他治疗方法的不足,可早期进行功能锻炼,减少关节僵直,效果良好。     

Neonatal polycythaemia: Effect of partial dilutional exchange transfusion with human albumin on whole blood viscosity

Haematocrit (HCT) and viscosity of whole blood were measured in ten polycythaemic hyperviscous newborn infants both before and after dilutional partial exchange transfusion with 5% albumin. This was performed in order to evaluate the effect on the lowering of HCT and whole blood viscosity. Mean umbilical HCT values decreased from 68.7% before, to 54.4% post transfusion. This decrease in HCT and viscosity was highly significant (P<0.001). Safety and lack of complications make human albumin solution superior to human plasma for exchange transfusion in neonatal polycythaemia.     

Low serum albumin levels prior to pediatric allogeneic HCT are associated with increased need for critical care interventions and increased 6‐month mortality

Poor nutritional status in HCT patients is a negative prognostic factor. There are no pediatric studies evaluating albumin levels prior to HCT and need for critical care interventions. We hypothesized that pediatric patients with low albumin levels, routinely measured 30 days (±10 days) prior to allogeneic HCT, have a higher risk of critical care interventions in the post‐transplant period. We performed a 5‐year retrospective study of pediatric patients who underwent allogeneic HCT for any indication. Patients were categorized based on albumin level. Hypoalbuminemia was defined as <3.1 g/dL. A total of 73 patients were included, with a median age of 7.4 years (IQR 3.3, 13.2). Patients with hypoalbuminemia had higher needs for critical care interventions including non‐invasive ventilation (44% vs 8%, P=.01), mechanical ventilation (67% vs 17%, P<.01), and vasoactive therapy (56% vs 16%, P=.01). Patients with hypoalbuminemia also had a higher 6‐month mortality (56% vs 17%, P=.02). Our data demonstrate that children undergoing allogeneic HCT with hypoalbuminemia in the pretransplant period are more likely to require critical care interventions and have higher 6‐month mortality. These findings identify an at‐risk population in which nutritional improvements may be instituted prior to HCT in hopes of improving outcomes.