重症监护条件下新生儿缺氧缺血性脑病疗效评价

目的观察重症监护条件下新生儿缺氧缺血性脑病（HIE）的治疗效果，探索更有效的治疗方法。方法2006年5-12月50例HIE患儿（NICU组）纳入新生儿重症监护病房（NICU）管理治疗，严密监测生命体征、经皮血氧饱和度、血生化等，以血糖和新生儿行为神经评分（NBNA）为指标评价3项支持和3项对症治疗的效果，并与2005年同期42例（对照组）对照。结果二组入院时血糖及3d内NBNA比较均无差异（Pa〉0．05）。治疗后NICU组血糖及NBNA改善情况明显优于对照组（Pa〈0．05）；NICU组总有效率为96％，对照组为76％，二组比较差异极为显著（x^2=9．83P〈0．01）。结论NICU治疗环境对改善HIE疗效和预后有积极意义。     

静脉营养在新生儿颅内出血的应用

目的探讨静脉营养在新生儿颅内出血治疗中的作用及意义。方法将新生儿颅内出血患儿随机分成治疗组和对照组，对照组即是对颅内出血患儿进行常规治疗，而治疗组则在对照组基础上增加了静脉营养治疗，静脉营养于生后第2～4天开始进行，疗程5～6天。结果治疗组44例发生医院感染3例（发生率6．8％），发生硬肿症14例（发生率31．8％），对照组38例发生医院感染10例（发生率26．3％），发生硬肿症26例（发生率68．4％），治疗组医院感染及硬肿症的发生率明显低于对照组（P〈0．01）。且治疗组临床表现改善及硬肿症消失时间较对照组早，两组比较差异有显著统计学意义（P〈0．01）。结论新生儿静脉营养能明显降低新生儿颅内出血患儿医院感染、硬肿症的发生率。     

纳洛酮治疗新生儿缺氧缺血性脑病的疗效

目的探讨纳洛酮辅助治疗新生儿缺氧缺血性脑病（HIE）的疗效。方法HIE患儿56例随机分为治疗组29例，对照组27例。2组均予常规治疗，在此基础上治疗组加用纳洛酮针剂0．1mg／kg，静脉注射，随后0．03～0．05mg／（kg·h）连续4～6h泵入，共3～5d。根据HIE临床分度中7项指标（意识、肌张力、原始反射、惊厥、中枢性呼吸衰竭、瞳孔改变、前囟张力），分别作出轻度（3分）、中度（2分）、重度（1分）的评分；由专业人员，分别于治疗1、2周进行新生儿20项行为神经测定（NBNA）。结果治疗1、2周，治疗组7项临床指标评分及新生儿20项NBNA与对照组比较均无显著性差异（Pa〉0．05）；治疗组死亡2例（6．9％），对照组死亡3例（11．1％），2组病死率亦无显著性差异（P〉0．05）。结论纳洛酮对HIE的治疗效果不确切，临床工作中应严格掌握适应证，不可滥用。     

金振口服液治疗痰热咳嗽（小儿支气管炎）156例临床疗效观察

目的观察金振口服液治疗痰热咳嗽（小儿支气管炎）的疗效。方法对156例痰热咳嗽的患儿随机分成两组，在常规治疗的基础上，治疗组加用金振口服液，对照组加用伤风止咳糖浆，观察用药效果。结果本实验中支气管炎治疗组80例，对照组76例，其有效率分别为91．25％与75．00％。结论金振口服液治疗痰热咳嗽（小儿支气管炎）的疗效好，副作用少。     

机械通气治疗新生儿呼吸衰竭64例

目的比较不同机械通气方式治疗新生儿呼吸衰竭的效果。方法选择2003年10月～2007年4月诊断为新生儿呼吸衰竭并采用机械通气治疗患儿64例，按常规机械通气（CMV）治疗31例为对照组；采用高频震荡通气（HFOV）者33例为治疗组；比较二组疗效。结果对照组治愈率61．30k，治疗组治愈率为87．8％，二组比较有显著差异（P〈0．05）。结论HFOV是治疗新生儿尤其是早产儿呼吸衰竭有效和安全的一种通气方式。     

高压氧治疗新生儿缺氧缺血性脑病疗效观察

目的探讨高压氧治疗新生儿缺氧缺血性脑病（HIE）的疗效。方法将106例中季度HIE患儿确诊后分组收治，对照组50例，给予积极支持和对症治疗；观察组56例，在对照组治疗的基础上应用高压氧治疗，10天为1个疗程。结果治疗后观察组有效率为89．3％，对照组为66．0％；观察组病死率为3．6％，对照组为20．0％。差异有显著性。对两组存活者随访7-16个月，观察组有后遗症8例（14．0％），对照组18例（36．0％）。结论高压氧是治疗HIE有效安全的方法，可降低HIE病死率，提高治疗效果。     

1,6-二磷酸果糖治疗新生儿缺氧后心肌损害

本文应用１，６－二磷酸果糖（ＦＤＰ）治疗新生儿缺氧后心肌损害３０例，收到较好效果。总有效率为９０％，其中显效１５例（５０％），有效１２例（４０％），无效３例（１０％），用药组显效率及总有效率明显高于对照组，提示１．６－ＦＤＰ可作为治疗新生儿缺氧后心肌损害的主要药物之一。     

思连康佐治新生儿黄疸的临床观察

目的观察思连康辅佐苯巴比妥治疗新生儿黄疸的疗效。方法将102例新生儿随机分为治疗组54例，对照组48例。对照组单用苯巴比妥，治疗组在苯巴比妥的基础上加用思连康，观察两组疗效。结果治疗组有效率94．44％，对照组有效率62．5％，两组比较差异有显著统计学意义（P〈0．01）。结论思连康辅佐治疗新生儿黄疸效果显著。     

选择性头部亚低温治疗新生儿缺氧缺血性脑病

目的探讨选择性头部亚低温对新生儿缺氧缺血性脑病（HIE）的疗效。方法50例中、重度HIE新生儿随机分为治疗组和对照组各25例。对照组予对症支持治疗，治疗组在此基础上予选择性头部亚低温，持续72h。观察治疗后二组头颅B超大脑中动脉阻力指数（RI）和生后5—7d及28dNBNA评分。结果治疗组与对照组比较总有效率48％（12／25例）vs28％（7／25例），中度HIE有效率68．75％（11／16例）vs41．18％（7／17例），重度HIE有效率11．11％（1／9例）vs0。生后3—4d头颅B超大脑中动脉RI〈0．55的患儿，治疗组与对照组比较总有效率13．33％（2／15例）vs0，R10．55～0．80的总有效率100％（10／10例）vs58．33％（7／12例）。结论选择性头部亚低温做为一种脑保护治疗可被用来治疗新生儿HIE；亚低温对中度HIE治疗可能有效。     

垂体后叶素在新生儿心肺复苏中的应用

目的探讨垂体后叶素在新生儿心肺复苏中的应用价值。方法收集我院2007年至2011年急诊科、NICU收治的73例心跳呼吸骤停新生儿的临床资料。经常规新生儿复苏流程“ABC”急救后未复苏成功的新生儿分为肾上腺素组47例（对照组）及垂体后叶素联合肾上腺素组26例（治疗组）。结果治疗组患儿的初步复苏成功率（23．1％,6／26）与对照组（34．O％,16／47）比较差异无统计学意义（x。=0．956,P〉0．05）。结论在新生儿复苏中垂体后叶素联合肾上腺素与单独使用肾上腺素的疗效相似。     

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.