决策树在儿童先天性心脏病体外循环术后预测低体温发生风险中的应用北大核心CSCD

目的应用决策树模型分析先天性心脏病(先心病)体外循环复温后发生低体温的影响因素, 为临床医护人员提供理论依据。方法采用回顾性分析。选取2019年1月1日至4月30日上海儿童医学中心先心病手术患儿共711例为研究对象, 建立决策树模型预测先心病体外循环术后低体温发生的危险因素。结果决策树模型显示:体外循环方案、术前营养评分、患儿体表面积均为先心病体外循环复温后患儿发生低体温的高危因素。决策树模型在验证集上的准确性为86.45%, 敏感性为77.14%, 特异性为90.97%, 受试者工作特征曲线下面积为0.851(95%CI:0.798~0.904)。结论决策树模型在先心病体外循环术后预测低体温的发生有较高的价值, 可从不同层面发现低体温发生的高危因素, 并为临床医护人员对高危患儿采取预防性治疗和护理措施提供切实可行的参考。     

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目的探讨小儿先天性心脏病体外循环术后发生毛细血管渗漏综合征(capillary leak syndrome,CLS)的相关影响因素,为预防和控制CLS的发生提供依据。方法收集2004-01—2005-12重庆医科大学附属儿童医院310例先天性心脏病体外循环(CPB)术后患儿的临床资料,对可能引起CLS发生的因素进行单因素分析和多元Logistic逐步回归分析,确定出与CLS发病相关的独立影响因素。结果体外循环术后CLS的发生率为16·78%,病死率为19·23%。多元Logistic回归分析显示体外循环时间、心脏畸形的种类(单纯型/复杂型)、CPB术中最低温度、年龄是CLS发生的独立影响因素。结论患儿的体外循环时间、心脏畸形的种类、术中最低温度、年龄是CLS发生的独立影响因素。     

先天性心脏病术后脓毒症患儿列线图预后模型的构建与验证

目的 探讨先天性心脏病术后脓毒症患儿死亡的预测因素,并建立列线图预测模型。方法 收集2012年1月至2021年12月广东省人民医院开胸手术的先天性心脏病术后脓毒症患儿临床数据。采用单因素、多因素Logistic回归分析,筛选出先天性心脏病术后脓毒症患儿死亡危险因素,根据筛选结果建立列线图预测模型,使用Bootstrap重抽样法进行内部验证。结果 共纳入157例,存活组135例患儿,死亡组22例。经单因素分析和多因素Logistics回归分析发现,术后发热总时间（OR=1.084,95%CI:1.022～1.151）、术后第3天血管活性-正性肌力评分（OR=1.162,95%CI:1.070～1.263）、二次开胸（OR=6.033,95%CI:1.906～19.098）是先天性心脏病术后脓毒症患儿死亡的独立危险因素（P<0.05）。以上述3项危险因素建立列线图预测模型,受试者工作特征曲线下面积为0.909(95%CI:0.852～0.966),重复抽样法验证的区分度C指数：0.9139(95%CI:0.9100～0.9178);HosmerLemeshow拟合优度检验显示,该模型...     

预测极早产儿坏死性小肠结肠炎发生风险列线图模型的建立北大核心CSCD

目的探讨极早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)发生的危险因素,并构建预测NEC发生风险的列线图模型。方法选取2015年1月至2021年12月住院的752例极早产儿为研究对象,包括2015~2020年极早产儿(建模集)654例和2021年极早产儿98例(验证集)。建模集根据有无发生NEC分为NEC组(n=77)和非NEC组(n=577),通过多因素logistic回归分析确定极早产儿NEC发生的独立危险因素,采用R软件绘制列线图模型。利用验证集的数据对列线图模型加以检验。采用受试者工作特征(receiver operator characteristic,ROC)曲线、Hosmer-Lemeshow拟合优度检验及校正曲线评估模型的效能,采用临床决策曲线评估模型的临床实用价值。结果多因素logistic回归分析显示,新生儿窒息、败血症、休克、低白蛋白血症、严重贫血及配方奶喂养为极早产儿NEC发生的独立危险因素(P<0.05)。建模集ROC曲线的曲线下面积(area under the curve,AUC)为0.833(95%CI:0.715~0.952),验证集ROC曲线的AUC值为0.826(95%CI:0.797~0.862),表明该模型具有良好的区分度和判别能力。校正曲线和Hosmer-Lemeshow拟合优度检验显示该模型在预测值和真实值之间的准确性和一致性较好。结论新生儿窒息、败血症、休克、低白蛋白血症、严重贫血及配方奶喂养是极早产儿NEC发生的独立危险因素;基于多因素logistic回归分析结果建立的列线图模型可为临床早期评估极早产儿NEC的发生提供定量、简便、直观的工具。     

湖北恩施土家族苗族自治州新生儿窒息危险因素分析及列线图预测模型的构建：一项多中心研究

目的 探讨湖北恩施土家族苗族自治州新生儿窒息发生的危险因素,并构建预测新生儿窒息发生风险的列线图模型。方法 回顾性纳入湖北恩施土家族苗族自治州20家协作医院2019年1—12月收治的613例新生儿窒息患儿作为窒息组,随机抽取同期在这些协作医院出生并入住新生儿科的988例非窒息患儿作为对照组。对新生儿窒息的危险因素进行单因素及多因素分析。采用R软件(4.2.2)构建预测新生儿窒息发生风险的列线图模型,采用受试者操作特征曲线、校正曲线和决策曲线分析分别评估模型的区分度、校准度和临床实用价值。结果 多因素logistic回归分析显示:新生儿为土家族、男婴、早产儿、先天畸形、胎位异常、宫内窘迫、母亲职业为农民、母亲高中以下文化程度、产前检查<9次、先兆流产、脐带异常、羊水异常、前置胎盘、胎盘早剥、急诊剖宫产、助产是新生儿窒息发生的独立危险因素(P<0.05)。基于这些危险因素建立的列线图模型预测新生儿窒息发生的曲线下面积为0.748 (95%CI:0.723～0.772);校正曲线提示该模型预测新生儿窒息发生的准确性较高;决策曲线分析显示,使用该模型预测新生儿窒息发生风险可使患儿获...     

儿童肾外伤外科干预影响因素分析及列线图预测模型的建立

目的探讨儿童单侧肾外伤后外科干预的独立危险因素并构建列线图预测儿童单侧肾外伤后外科干预的风险。方法分析2011年9月至2021年9月温州医科大学附属第二医院收治的儿童单侧肾外伤的临床资料和影像学数据包括人口统计学、损伤特征、治疗和预后的数据。采用单因素分析筛选出儿童单侧肾外伤后外科干预的独立危险因素, 多因素logistic回归模型分析危险因素并用R软件建立预测外科干预的列线图, 根据曲线下面积和拟合度检验模型效果。结果共有114例患儿纳入研究, 开放性损伤3例, 钝性损伤111例;其中17例患儿接受了外科干预, 包括5例肾切除术, 5例血管栓塞术及7例其他手术。多因素分析结果显示血肿大小/肾脏厚度比值、开放性损伤、入院4 h内出现休克、造影剂外渗及合并其他腹部器官损伤是儿童单侧肾外伤后外科干预的独立影响因素(均P<0.05)。将这些因素纳入并成功构建列线图, 列线图一致性指数为0.985, 模型的校正曲线显示通过该列线图得出的外科干预预测值与实际观测值之间具有良好的一致性。结论列线图模型拟合度好, 能够为儿童单侧肾外伤的管理决策提供参考。     

小儿急性阑尾炎腹腔镜手术后切口感染危险因素分析及列线图预测模型的构建

目的探讨影响小儿急性阑尾炎腹腔镜手术后切口感染的危险因素, 构建预测术后切口感染的列线图模型, 并评估模型的区分度和一致性。方法选取2016年1月至2021年3月在安徽医科大学附属亳州医院小儿外科行腹腔镜下阑尾切除术的480例患儿作为研究对象, 其中手术后发生切口感染65例(65/480, 13.54%), 未发生切口感染415例(415/480, 86.46%)。收集所有患儿年龄、病理、手术时间、术前体温、阑尾穿孔以及是否留置腹腔引流等临床资料, 采用单因素及多因素Logistic回归分析筛选影响小儿腹腔镜急性阑尾炎术后切口感染的危险因素;采用R软件构建预测术后切口感染的列线图模型, 并使用受试者操作特性曲线(receiver operating characteristic curve, ROC)及校准曲线验证列线图模型的区分度和一致性。结果小儿腹腔镜急性阑尾炎术后切口感染发生率为13.54%(65/480)。单因素分析显示, 年龄、病程、手术操作时间、术前发热、阑尾穿孔、留置腹腔引流是小儿腹腔镜急性阑尾炎术后切口感染的影响因素(P<0.05);多因素Logistic回归分析...     

低白蛋白血症对心脏手术后患儿急性肾损伤发生的影响

目的 探讨小儿心脏病体外循环（CPB）手术后的低白蛋白血症对术后急性肾损伤（AKI）发生的影响。方法 回顾性分析2012~2016年行心脏病CPB手术患儿1 110例临床资料,按术后48 h内最低白蛋白浓度分为低白蛋白组（≤35 g/L）和正常白蛋白组（> 35 g/L）,比较两组患儿的围手术期资料和AKI发生率。对不均衡的围手术期各因素进行倾向评分匹配后再次比较AKI发生率。采用logistic回归分析术后AKI发生的围手术期危险因素。结果 术后AKI发生率为13.78%（153/1 110）,病死率为2.52%（28/1 110）,AKI患儿病死率为13.1%（20/153）,术后白蛋白≤35 g/L 的患儿占44.50%（494/1 110）。匹配前后低白蛋白组AKI发生率均比正常白蛋白组要高（P < 0.05）;匹配前后AKI患儿术后白蛋白浓度均低于非AKI患儿（P < 0.05）;Logistic多因素回归分析结果显示术后白蛋白≤35 g/L是术后AKI发生的独立危险因素之一。结论 术后48 h内白蛋白≤35 g/L是心脏CPB术后患儿AKI发生的独立危险因素,术后加强对白蛋白的检测和补充对控制术后AKI的发生有积极作用。     

10kg以下婴幼儿先天性心脏病手术体外循环管理

目的 总结10 kg以下婴幼儿先天性心脏病手术体外循环(cardiopulmonary bypass,CPB)中和术后的管理资料,探讨低体重患儿CPB管理经验.方法 回顾性分析我院2010年1月至2011年4月收治的122例年龄1.5个月～2岁、体重3～10kg的婴幼儿在浅低温或中低温CPB下行先天性心脏病手术治疗的临床资料.结果 122例患儿,转流时间13 ～118 min,平均(62.69 ±21.48) min;主动脉阻断时间0 ～ 86 min,平均(35.47±19.51) min;心脏全部自动复跳,转流过程平稳,停机顺利,未发现与CPB相关的严重并发症.3例患儿术后死亡(2.46％,3/122).结论 对10 kg以下的低体重先天性心脏病患儿行CPB时,应使用预充量尽可能少的膜式氧合器、管道及微栓过滤器,转流过程保持较高灌注流量,保证血流动力学稳定,维持合理的红细胞压积和胶体渗透压,提供良好的心肌保护,并且应用超滤技术减轻术后水肿的发生.     

先天性心脏病患儿体外循环术后肾上腺皮质功能不全的影响因素

目的 研究小儿体外循环（CPB）术后血皮质醇的变化规律，探讨可能导致术后肾上腺皮质功能不全（A1）的危险因素。方法 收集2006年3～10月本院行心内直视手术治疗的先天性心脏病患儿80例。记录术前及术中可能的相关危险因素，放射免疫分析法测定围术期血浆皮质醇水平，化学发光法测定围术期血浆ACTH质量浓度。结果 术后即刻及术后6h血浆皮质醇浓度较术前明显升高（P〈0．05）。术后24、48、72h血浆皮质醇水平明显回落，较术前略降低，但无统计学差异。本组Al发生率为41％。A1患儿年龄、经皮氧饱和度[Sp（O2）]、CPB时间和主动脉阻断时间与其他患儿比较有显著差异（P〈0.05）。年龄、CPB时间为独立因素。结论 先天性心脏病小儿CPB术后血浆皮质醇水平术后早期升高，术后24h即明显回落，部分患儿术后出现Al。年龄、CPB时间是导致Al的高危因素。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.