学龄期肥胖儿童心脏自主神经功能分析

目的对学龄期肥胖儿童的心率减速力(DC)、心率加速力(AC)及心率变异性(HRV)进行分析,并观察肥胖儿童体重指数(BMI)与DC、AC及HRV的相关性。方法选取学龄期肥胖儿童108例,其中血脂正常组75例,血脂异常组33例,另选取103例学龄期健康儿童为对照组。对所有受试者行24 h动态心电图检查,分别将肥胖组与对照组、肥胖儿童中血脂异常组与血脂正常组的DC、AC及HRV进行比较,并将肥胖儿童的BMI与DC、AC及HRV进行相关性分析。结果肥胖组的DC、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频功率(LF)、高频功率(HF)均低于对照组,AC高于对照组(P0.05)。肥胖儿童中血脂异常组的DC、SDNN、SDANN、RMSSD、LF、HF均低于血脂正常组,AC、BMI高于血脂正常组(P0.01)。肥胖儿童BMI与DC、SDNN、SDANN、RMSSD、HF呈明显负相关(P0.05);与AC呈明显正相关(P0.05)。结论学龄期肥胖儿童的自主神经功能受损,表现为迷走神经张力减低,其中合并血脂异常者以上表现尤为突出。肥胖程度越高,迷走神经张力越低,发生心血管疾病的危险性可能越大。     

学龄期肥胖儿童胰岛素抵抗与心率变异性及心率减速力的相关性

目的探讨学龄期肥胖儿童胰岛素抵抗(IR)与心率变异性(HRV)、心率减速力(DC)及心率加速力(AC)之间的关系。方法选取学龄期6～10岁肥胖儿童83例,根据空腹血糖及空腹胰岛素值计算胰岛素抵抗指数(IRI),再根据IRI值将实验对象分为IR组45例和非IR组38例。在检测空腹血糖及空腹胰岛素同日行24小时动态心电图检查,计算出DC、AC、HRV各指标。比较IR组与非IR组DC、AC、HRV各指标,并进行相关性分析。结果 IR组DC、正常RR间期标准差(SDNN)、5分钟均值标准差(SDANN)、高频功率(HF)均低于非IR组,AC高于非IR组,差异均有统计学意义(P0.05)。肥胖儿童的IRI与DC、SDNN、SDANN、相邻RR间期差值的均方根(RMSSD)、低频功率(LF)、HF均呈显著负相关(r=-0.475～-0.249,P0.05),与AC呈显著正相关(r=0.488,P0.01)。结论 IR较非IR肥胖儿童的自主神经功能损伤严重,主要表现为迷走神经张力降低,且IRI越高,迷走神经张力越低。     

健康婴儿心率减速力和心率变异性的变化及其相关性

目的观察健康婴儿的心率减速力(DC)、心率加速力(AC)和心率变异性(HRV)的变化及其相关性。方法 82例健康婴儿接受24h动态心电图检查,按月龄不同分为小婴儿组(6个月)和大婴儿组(6~12个月)。计算机自动测定其24 h的DC、AC及HRV时域指标(SDNN、SDANN、RMSSD、PNN50)与频域指标(LF、HF);比较两组婴儿的DC、AC及HRV各项指标,并分析DC、AC与HRV各项指标之间的相关性。结果大婴儿组的DC为(3.96±1.53)ms明显高于小婴儿组的(3.20±1.44)ms,而AC为(-3.84±1.10)ms明显低于小婴儿组的(-3.11±0.95)ms,差异有统计学意义(P均0.05)。24 hDC与心率呈显著负相关(r=-0.56,P=0.000),与SDNN、SDANN、RMSSD、PNN50、LF和HF之间呈显著正相关(r=0.25~0.75,P均0.05);24h的AC值与心率呈显著正相关(r=0.78,P=0.000),与SDNN、SDANN、RMSSD、PNN50、LF和HF之间呈显著负相关(r=-0.88~-0.56,P均0.01)。结论婴儿期的DC与HRV多项指标随月龄增加而增大,AC随月龄增加而减小;DC、AC与心率及HRV各项指标密切相关。     

不明原因心前区不适患儿心率减速力及心率变异性分析

目的探讨心率减速力(DC)、心率加速力(AC)及心率变异性(HRV)在不明原因心前区不适患儿中的变化。方法 56例不明原因心前区不适患儿(患儿组)和63例健康儿童(对照组),年龄6~17岁,行24 h动态心电图检查,并对其DC及HRV各项指标进行对比及相关性分析。结果患儿组的DC值小于对照组,AC值大于对照组,心率(HR)大于对照组,差异有统计学意义(P均0.05);患儿与对照组间HRV指标的差异无统计学意义(P0.05)。患儿组中,DC与HRV多项指标呈显著正相关(r=0.27~0.40,P均0.05),与HR呈显著负相关(r=–0.46,P=0.000);而AC与HRV多项指标呈显著负相关(r=–0.57~–0.34,P均0.05),与HR呈显著正相关(r=0.61,P=0.000)。12岁男性患儿HR大于同龄男性对照儿童、相邻RR间期差值的均方根(RMSSD)小于后者;≥12岁男性患儿DC小于、AC大于同龄男性对照儿童;≥12岁女性患儿DC小于同龄女性对照儿童,差异均有统计学意义(P0.05)。结论不明原因心前区不适患儿的迷走神经张力降低,DC明显低于正常组,且与HRV多项指标有密切相关性。患儿组DC、HRV性别差异不明显。≥12岁患儿组DC明显低于同龄对照组,提示青春期儿童易发生自主神经功能紊乱。     

特发性性早熟女童心脏自主神经功能分析

目的研究特发性性早熟(ICPP)女童的心脏自主神经功能状态。方法选取ICPP女童66例,其中合并肥胖36例,非肥胖30例;另选年龄相匹配的健康女童68例(正常对照)及单纯肥胖女童51例为对照。对所有受试者行24 h动态心电图检查,比较组间的心率减速力(DC)、心率加速力(AC)、心率变异性(HRV)及体重指数(BMI)。结果 ICPP组的DC、RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)和高频功率(HF)均低于正常对照组,AC和BMI高于正常对照组;ICPP组的RMSSD、BMI均低于单纯肥胖组(P0.05)。ICPP女童中合并肥胖组的DC、RMSSD及HF均低于非肥胖组,AC和BMI高于非肥胖组(P0.05)。结论 ICPP女童的心脏自主神经功能紊乱,其中合并肥胖者尤为突出,以迷走神经张力降低为主。     

不明原因心前区不适患儿心率减速力及心率变异性分析北大核心CSCD

目的：探讨心率减速力（DC）、心率加速力（AC）及心率变异性（HRV）在不明原因心前区不适患儿中的变化。方法56例不明原因心前区不适患儿（患儿组）和63例健康儿童（对照组）,年龄6-17岁,行24h动态心电图检查,并对其DC及HRV各项指标进行对比及相关性分析。结果患儿组的DC值小于对照组,AC值大于对照组,心率（HR）大于对照组,差异有统计学意义（P均〈0.05）;患儿与对照组间HRV指标的差异无统计学意义（P〉0.05）。患儿组中,DC与HRV多项指标呈显著正相关（r=0.27-0.40,P均〈0.05）,与HR呈显著负相关（r=–0.46,P=0.000）;而AC与HRV多项指标呈显著负相关（r=–0.57-–0.34,P均〈0.05）,与HR呈显著正相关（r=0.61,P=0.000）。〈12岁男性患儿HR大于同龄男性对照儿童、相邻RR间期差值的均方根（RMSSD）小于后者;≥12岁男性患儿DC小于、AC大于同龄男性对照儿童;≥12岁女性患儿DC小于同龄女性对照儿童,差异均有统计学意义（P〈0.05）。结论不明原因心前区不适患儿的迷走神经张力降低,DC明显低于正常组,且与HRV多项指标有密切相关性。患儿组DC、HRV性别差异不明显。≥12岁患儿组DC明显低于同龄对照组,提示青春期儿童易发生自主神经功能紊乱。     

血管迷走性晕厥患儿无症状期自主神经功能分析

目的分析无症状期心率减速力(DC)对血管迷走性晕厥(VVS)的诊断价值。方法选取2018年1月至2019年12月确诊为VVS的45例患儿作为VVS组,同期在门诊体检的45例健康儿童作为对照组,完善24小时动态心电图检查,比较VVS患儿和健康儿童的基础DC值、连续心率减速力(DRs)及心率变异性(HRV)各指标的变化情况,并按年龄段及性别进行分组比较;同时分析DC与HRV各指标间的相关性及DC对VVS诊断的预测价值。结果 VVS组的DC值、DR8及低频功率与高频功率之比(LF/HF)均明显高于对照组,差异均有统计学意义(P0.05)。在VVS组中,学龄期患儿的DC值、DR4及低频功率(LF)均明显低于青春期患儿,差异均有统计学意义(P0.05),而男女患儿的DC值、DRs、HRV各指标差异均无统计学意义(P0.05)。对照组年龄段及性别组间DC值、DRs、HRV各指标差异均无统计学意义(P0.05)。学龄期VVS组的DC值明显高于对照组,青春期VVS组的DC值、DR4、DR8及LF均明显高于对照组,差异有统计学意义(P0.05)。DC与HRV多项指标呈显著正相关(r=0.31～0.67,P均0.05),与LF/HF呈显著负相关(r=-0.36,P0.05)。行二分类logistic回归分析发现,青春期患儿仅DC与VVS相关(P0.05)。采用受试者工作特征曲线(ROC)分析发现,学龄期DC值以7.72 ms、青春期DC值以8.36 ms为界值时有较好的灵敏度及特异度。结论 VVS患儿无症状期自主神经功能存在异常,随年龄增长,自主神经功能异常更加显著。学龄期及青春期VVS患儿均有迷走神经张力升高,且青春期VVS患儿还有一定程度交感神经张力升高;DC与迷走神经张力间呈明显正相关,对VVS诊断有较好预测价值。     

维生素D缺乏对学龄前期肥胖儿童心脏自主神经功能的影响

目的 研究维生素D缺乏对学龄前期肥胖儿童心脏自主神经功能的影响。方法 242例学龄前期单纯性肥胖儿童,根据血清25-羟基维生素D（VitD）水平分为VitD缺乏组（76例）、VitD不足组（83例）及VitD充足组（83例）,将3组间心率减速力（DC）、心率加速力（AC）及心率变异性（HRV）进行比较;并分别将VitD不足组和缺乏组的VitD水平与DC、AC、HRV进行相关性分析。结果 DC、相邻RR间期差值的均方根（RMSSD）、低频功率（LF）以VitD缺乏组最低（P < 0.05）,AC值以VitD缺乏组最高（P < 0.05）,其中VitD不足组的DC、RMSSD和LF低于充足组,AC值高于充足组（P < 0.05）;VitD缺乏组的RR间期总体标准差（SDNN）、高频功率（HF）低于VitD充足组（P < 0.05）。VitD缺乏组的VitD水平与DC、SDNN、SDANN、RMSSD、LF、HF呈正相关（P < 0.05）,与AC呈负相关（P < 0.05）;VitD不足组的VitD水平与AC呈负相关（r=-0.257,P < 0.05）。结论 VitD不足和缺乏的学龄前期肥胖儿童均存在心脏自主神经功能障碍,且VitD浓度越低,心脏迷走神经张力越弱。     

超重/肥胖儿童自主神经功能综合评价

目的?评估超重/肥胖儿童的自主神经功能情况。方法 通过研究动态心电图的心率变异性（HRV）及心率减速力（DC）指标,平板运动试验的运动当量、达峰值心率(HR_max)的运动时间、运动终止后第一分钟心率恢复（HRR₁）、恢复至静息心率时间、静息期收缩压、运动峰值收缩压及运动恢复期第三分钟收缩压指标来评估肥胖儿童的自主神经功能。结果 肥胖组儿童31例,男23例、女8例,平均年龄（10.4±2.6）岁;超重组69例,男35例、女34例,平均年龄（10.9±2.7）岁;对照组100例,男57例、女43例,平均年龄（10.2±2.7）岁。超重、肥胖与对照组三组儿童之间正常RR间期标准（SDNN）、相邻RR间期差值的均方根（RMSSD）、5 min均值标准差（SDANN）、NN50占所有NN间期个数的百分数(pNN₅₀)、低频功率（LF）/高频功率（HF）、心率减速力（DC）值的差异均有统计学意义（P<0.05）。超重、肥胖与对照组三组儿童之间达HR_max运动时间、运动当量、HRR₁/...     

甲状腺功能亢进症儿童的甲状腺激素与心率减速力及心率变异性的相关性

目的 对甲状腺功能亢进症（简称“甲亢”）儿童的心率减速力（DC）、心率加速力（AC）、心率变异性（HRV）进行分析,并探讨甲亢儿童的血清甲状腺激素水平与DC、AC及HRV的关系。方法 选取甲亢儿童47例,另选取50例健康儿童为对照组,对所有受试者行24 h动态心电图检查,将甲亢组与对照组的DC、AC、心率（HR）及HRV各指标[RR间期总体标准差（SDNN）、RR间期平均值的标准差（SDANN）、相邻RR间期差值的均方根（RMSSD）、低频功率（LF）、高频功率（HF）]进行比较,并将甲亢儿童的甲状腺激素指标[游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）]与DC、AC及HRV各指标进行相关性分析。结果 甲亢组的DC、SDNN、SDANN、RMSSD、LF、HF均低于对照组;AC和HR均高于对照组（P < 0.05）。甲亢儿童的血清FT3、FT4与DC、SDNN、SDANN、RMSSD、LF、HF均呈负相关（P < 0.05）;与AC和HR呈正相关（P < 0.05）。结论 甲亢儿童的心脏自主神经功能受损,表现为迷走神经张力降低。血清甲状腺激素水平越高,迷走神经张力越低,提示发生心血管疾病的危险性越大。     

Caring for children,focusing on children

Two First Nations girls with leukemia received a significant amount of media attention in 2014 and 2015. In both cases, the parents refused to continue chemotherapy, the only proven effective treatment; they opted instead for a combination of traditional Aboriginal healing approaches and alternative therapies offered in a facility outside of the country. One child has died; the other relapsed and required chemotherapy to avoid death.Media reports were polarized, focusing either on the historical legacy of distrust felt by First Nations people when accessing health care, or the need for child protection services to intervene. One article in the Canadian Medical Association Journal focused on the legacy of mistrust and methods of countering it, but did not address the legal and ethical duties of physicians in such situations.The present commentary describes the events, responsibilities of professionals involved and a course of action for physicians when faced with similar circumstances.     

Voice processing abilities in children with autism, children with specific language impairments, and young typically developing children

It is well established that people with autism have impaired face processing, but much less is known about voice processing in autism. Four experiments were therefore carried out to assess (1) familiar voice-face and sound-object matching; (2) familiar voice recognition; (3) unfamiliar voice discrimination; and (4) vocal affect naming and vocal-facial affect matching. In Experiments 1 and 2 language-matched children with specific language impairment (SLI) were the controls. In Experiments 3 and 4 language-matched children with SLI and young mainstream children were the controls. The results were unexpected: the children with autism were not impaired relative to controls on Experiments 1, 2 and 3, and were superior to the children with SLI on both parts of Experiment 4, although impaired on affect matching relative to the mainstream children. These results are interpreted in terms of an unexpected impairment of voice processing in the children with SLI associated partly, but not wholly, with an impairment of cross-modal processing. Performance on the experimental tasks was not associated with verbal or nonverbal ability in either of the clinical groups. The implications of these findings for understanding autism and SLI are discussed.     

Health of homeless children and housed, poor children.

Homeless children in families are increasing in numbers across the country and have been noted to have frequent health problems. The health status of homeless children was assessed on multiple dimensions through parental report in a survey conducted with 196 homeless families in 10 shelters in Los Angeles and 194 housed poor families after March 1987 through January 1988. During the month before the survey, the homeless and housed poor children experienced high rates of illness symptoms, disability, and bed days. Homeless and housed poor children were frequently rated by their parents to be in fair or poor health (17% vs 13%, P = .14). Homeless children, however, were reported to have more behavior problems and school failure [30% vs 18%, P = .06] than housed poor children. Homeless children also had high rates of other health problems such as developmental delay (9%) and overweight (13%). The diets of homeless children were frequently imbalanced, dependent on food from "fast-food" restaurants, and characterized by repeated periods of deprivation. Family problems were more common among homeless families, especially among single-parent homeless families compared with single-parent housed families (spousal abuse, 68% vs 41%, P less than .01; parental drug and alcohol abuse, 60% vs 39%, P less than .01). It is concluded that homeless children have significant child behavior and developmental problems and disorders of nutrition and growth, which are associated with multiple risk factors in their environment.     

Boxing, youth and children

Boxing remains a popular spectator sport, success in which is achieved by the promotion of boxing in the childhood years. Despite the failure to ban boxing generally, there remains the realistic expectation that organised boxing by children below the age of consent (appropriately 16 years) is still achievable. There are two reasons for banning children under the age of 16 years from boxing. The first is that children have little awareness of risk, specifically the risk of chronic encephalopathy, which develops only after a lag period measured in decades or more. The second is that there is no place in contemporary society for a youth sport which has, as its primary goal, the infliction of acute brain damage on an opponent. This paper analyses the medical and ethico-social issues implicit in this subject. Boxing, in historical perspective, has been an altruistic amateur sport for boys and male youths, and has a proud tradition. But in the context of social evolution, and in current perspective to prevent exploitation of underprivileged youths, the time has come for an absolute ban on underage boxing. Such is achievable even if adult boxing remains an Olympic and television sport for some time to come.     

Cholelithiasis in infants, children, and adolescents

During the past two decades, cholelithiasis has been recognized in increasing numbers of pediatric patients. This diagnosis should be considered in the event of upper abdominal complaints, particularly when one or more risk factors are evident. The etiology may be unknown or may be related to risk factors, including hemolytic conditions. In recent years, it has become evident that approximately 80% of gallstones in children are not due to hemolytic disease and that the remaining 20% are related to recurring hemolysis. The diagnosis of gallstones is best confirmed with ultrasonography. Routine ultrasonographic evaluation should be performed at intervals for all children who received TPA for more than 4 weeks, particularly those who have had ileal resection or have had chronic enteritis (Crohn disease). Cholecystectomy is the procedure of choice for symptomatic children with cholelithiasis, regardless of age. Cholecystectomy is recommended for the asymptomatic child younger than 3 years of age when echogenic shadows have been present for at least 12 months following resumption of oral feedings or when the gallstones are radiopaque. Also, cholecystectomy is advised for asymptomatic children who are older than 3 years of age if ultrasonographic studies confirm that echogenic foci with shadowing are true stones and not echogenic sludge. Complications of common bile duct obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis may thus be prevented. Morbidity and mortality following cholecystectomy are expected to be relatively low in the pediatric age group.