前囟闭合早晚与学龄前儿童身高发育轨迹的关联研究

目的 分析前囟闭合时间对学龄前儿童身高发育轨迹的影响。方法 采用回顾性队列研究方法,以140 710例学龄前儿童为研究对象。利用组基轨迹模型对研究对象2～6岁间身高发育轨迹进行拟合,并分为快速增长组（FG）、正常增长组（NG）和缓慢增长组（SG）。利用方差分析或卡方检验对多组连续变量或分类变量进行描述性分析,采用非条件logistic回归分析前囟闭合时间与身高发育轨迹分组间的关联性。结果 FG、NG和SG三组儿童的频数和百分比分别为34 722（24.68%）、81 904（58.21%）和24 084（17.11%）。与NG组和SG组相比,FG组12月龄前囟闭合率更高。男童1岁前囟门闭合的比例较女童更高,至18月龄时男女童的前囟闭合比例趋于一致。非条件logistic回归分析发现,以18月龄前囟闭合的对象为对照,与NG组相比,前囟在18月龄前闭合的儿童FG组可能性更高,如前囟12月龄闭合时FG组校正OR（95%CI）为1.15（1.11～1.20）;而前囟在18月龄后闭合的儿童SG组的可能性更高,如24月龄闭合时SG组校正OR（95%CI）分别1.16（1.12～1.20）。结论 与18月龄前囟闭合的儿童身高发育相比,前囟闭合较早的儿童学龄前期身高发育较快的可能性更大,前囟闭合较晚的儿童学龄前期身高发育较慢的可能性更大。     

经导管房间隔缺损封堵术后心脏形态大小变化的随访研究

目的评价房间隔缺损(ASD)患者经导管ASD封堵术后及随访中心脏形态和大小的变化。方法应用超声心动图分别测量36例ASD患者经导管ASD封堵治疗术前、术后3 d、术后3月和术后6月右室舒张末期前后径(RVEDD)、右房长径(RAD1)右房横径(RADt)、左室舒张末期前后径(LVEDD)、左室舒张末期容积(LVEDV)和左房前后径(LAD)。结果ASD封堵术后3 d及术后3月,RVEDD、RAD1、RAD t逐渐缩小;LVEDD、LVEDV和LAD逐渐增大。术后6月随访时,RVEDD继续缩小,LVEDD和LVEDV继续增大,RAD1、RADt和LAD无进一步变化。结论ASD封堵术治疗既减轻了右心容量负荷,使右房、右室内径缩小,也改善了左心的几何构型,使已经缩小的左房、左室逐渐增大恢复。     

上海市徐汇区121例孤独症儿童确诊年龄回顾性分析

目的 通过总结分析徐汇区2012—2020年开展社区(初级卫生保健机构)早期孤独症(ASD)筛查工作以来,登记确诊的徐汇区ASD儿童的就诊时间、确诊年龄,旨在为更早更快地识别孤独症儿童提供依据。方法 徐汇区妇幼保健所及13家社区卫生服务中心儿保门诊体检的18～24月龄儿童常规筛查阳性者、18～24月龄筛查阴性和非18～24月龄儿童体检时医生怀疑有社交沟通技能问题并结合年龄段筛查量表或丹佛发育筛查Ⅱ(DenverⅡ)异常者,均通过绿色通道定向转诊至复旦大学附属儿科医院儿保科发育行为专科门诊进行确诊,确诊的ASD儿童作为研究对象,将他们分为年龄段筛查阳性确诊、非年龄段筛查阳性确诊、年龄段筛查假阴性确诊3种不同就诊原因进行分析。采用单因素方差分析(ANOVA)进行组间比较、差异有统计学意义时用LSD法进行组间两两比较。结果 确诊的121例ASD儿童,82例为年龄段筛查阳性确诊、18例为非年龄段筛查阳性确诊、21例为年龄段筛查假阴性确诊,平均确诊月龄为(26.34±9.08)个月。年龄段筛查阳性确诊、非年龄段筛查阳性确诊、年龄段筛查假阴性确诊年龄不同,差异有统计学意义(F=21.22,P<...     

Closure of a ventricular septum defect in a 4-year-old boy during percutaneous heart catheterisation

A 4-year-old boy in whom a muscular ventricular septal defect (VSD) had been diagnosed at birth presented with limited exercise tolerance and mild cardiomegaly. The moderately large defect was closed with an umbrella device via percutaneous heart catheterisation. Thereafter, his symptoms disappeared and the dimensions of the left heart returned to normal. A VSD occurs in 1.5-3.5 per 1,000 live births. In symptomatic patients with a medium or large-sized VSD, surgical closure is indicated to prevent the development of a fixed pulmonary resistance hypertension, ventricular dysfunction and the risk of endocarditis. Depending on the size and localisation of the defect, closure with an umbrella device may be chosen. The initial results have been promising in children. The safety and efficacy in the long term are still unknown.     

Urination problems following total hip arthroplasty: insertion or not of an indwelling catheter?]

OBJECTIVE. To assess the frequency of urine retention and of urinary tract infection after total hip replacement in order to: to minimize morbidity due to urine retention and urinary tract infection after total hip replacement; to limit the discomfort to the patient; to decrease the work load of the nursing staff, if possible. SETTING. University Hospital Rotterdam. DESIGN. Prospective, randomized. PATIENTS AND METHODS. In 61 patients after 63 total hip replacements the use of an indwelling catheter for 48 hours (group 1) was compared with catheterisation on indication only (group 2). RESULTS. Urine retention was less in group 1 than in group 2, 12/39 (31%) versus 15/24 (63%). In the subgroup males no difference was found between both groups. Urine retention was more frequent in elderly people. No other risk factors could be demonstrated. The number of patients with bacteriuria greater than 10(5) CFU/ml in group 1, 11/39 (28%) did not differ from group 2, 9/24 (38%). CONCLUSIONS. On the basis of these study results we recommend: In females: to use an indwelling catheter for 48 hours after total hip replacement; In males: to discuss this choice with the patient, because use of an indwelling catheter appears not to decrease the frequency of urine retention. The risk of discomfort caused by catheterisation and urine retention still exists. An indwelling catheter can, without increasing the risk of significant bacteriuria, eliminate this discomfort in the first 48 hours after operation.     

Percutaneous closure of a perimembraneous ventricular septal defect: the first 4 patients in The Netherlands

In four female patients, aged 30, 10, 8 and 2 years and 9 months (the latter with Down's syndrome), all with a perimembranous ventricular septal defect (VSD), percutaneous closure of the VSD was carried out using an Amplatzer endoprosthesis. These were the first 4 patients to undergo this procedure in The Netherlands. In 3 of the patients the procedure was without complications and complete occlusion of the defects was achieved. The last patient developed a left anterior hemiblock after implantation of the device and one week later an intermittent second degree atrioventricular block was detected, for which a pacemaker was implanted. A few days later the atrioventricular conduction time returned to normal. There was complete occlusion of the defect. Percutaneous closure of a perimembranous VSD using an Amplatzer prosthesis is a promising technique with good short-term results. In a selected group of patients this new technique can replace surgical treatment.     

超声心动图在评价房间隔缺损经皮介入封堵术中的应用

目的应用超声心动图系统评价房间隔缺损（ASD）经皮介入封堵术前后右心形态及功能的改变。方法对实施ASD经皮介入封堵术患者术前术后进行超声心动图检查,评价患者手术前后的右心几何形态及血流动力学、三尖瓣环运动速度方面的改变。结果患者手术前后右心几何形态、血流动力学、三尖瓣环运动速度均有明显变化,术后1 d与术前1 d比较及术后3个月与术后1 d和术前1 d各测定值比较,差异均有统计学意义（P〈0.05或P〈0.01）。结论经皮介入封堵为中央型ASD有效的根治方法。     

The effect of Helicobacter pylori eradication on chronic use of acid-suppressant medication by patients in general practice; a randomised, double-blind study

OBJECTIVE: To study the feasibility of tapering long-term acid-suppressant drugs (ASD) use in chronic dyspeptic patients in relation to Helicobacter pylori eradication. DESIGN: Prospective randomised double-blind study. METHOD: Patients from 54 general-practitioner practices in the Amsterdam area were studied in the period 1 April 1997 - 30 September 1999 after selection on the basis of their use of acid suppressants for a period of at least 8 weeks. After gastroscopy the patients with a peptic ulcer (PUD) and H. pylori were treated with eradication therapy and patients without an ulcer but with H. pylori were randomised for eradication or placebo treatment. After a gradual reduction of acid suppressants over a 3-week period following the intervention, the patients kept a diary for 24 weeks of the quantities of acid suppressants and antacids they used. RESULTS: Of the 1083 patients approached, 434 were prepared to undergo the gastroscopy. Data for the follow-up period were available for 186 of the 227 H. pylori-positive patients. Of them 61% stopped ASD use during follow-up. The mean daily ASD dosage per patient decreased by 85% from 1.85 to 0.27 units (p < 0.05), with minimal antacids use. Of the 75 patients with peptic-ulcer disease 86% stopped ASD use. In patients with functional dyspepsia no difference in ASD use was observed after successful H. pylori eradication or placebo. Patients with mild reflux disease (GERD) used more ASD after H. pylori eradication than after placebo (p < 0.05). CONCLUSION. After H. pylori eradication many patients with PUD stopped ADS use, while GERD patients used more ASD than after placebo. A gradual withdrawal of long-term ASD use, supported by antacids and on-demand use of low-dosage ASD, facilitated reduction of ASD use during 6 months.     

Respiratory disease associated with community air pollution and a steel mill, Utah Valley.

This study assessed the association between hospital admissions and fine particulate pollution (PM10) in Utah Valley during the period April 1985-February 1988. This time period included the closure and reopening of the local steel mill, the primary source of PM10. An association between elevated PM10 levels and hospital admissions for pneumonia, pleurisy, bronchitis, and asthma was observed. During months when 24-hour PM10 levels exceeded 150 micrograms/m3, average admissions for children nearly tripled; in adults, the increase in admissions was 44 per cent. During months with mean PM10 levels greater than or equal to 50 micrograms/m3 average admissions for children and adults increased by 89 and 47 per cent, respectively. During the winter months when the steel mill was open, PM10 levels were nearly double the levels experienced during the winter months when the mill was closed. This occurred even though relatively stagnant air was experienced during the winter the mill was closed. Children's admissions were two to three times higher during the winters when the mill was open compared to when it was closed. Regression analysis also revealed that PM10 levels were strongly correlated with hospital admissions. They were more strongly correlated with children's admissions than with adult admissions and were more strongly correlated with admissions for bronchitis and asthma than with admissions for pneumonia and pleurisy.     

儿童社交情绪与孤独症谱系障碍患病风险的相关研究

目的探讨16~30月龄儿童社交情绪问题与孤独症谱系障碍(Autism Spectrum Disorders,ASD)初筛患病风险之间的关系,为基层医院尽早发现儿童ASD高危特征,从而尽早进行ASD的初筛提供参考。方法对2018年1月-2019年11月来北京市房山区妇幼保健院做常规保健的542名儿童进行调查。儿童家长在培训过的医护人员的指导下填写儿童所在月龄组的ASQ-SE问卷。在同一天或相邻时间内,由对ASQ-SE筛查结果不知情的医护人员指导家长完成M-CHAT-R/F。对ASQ-SE与M-CHAT-R分数的相关性进行分析。结果社交情绪异常儿童在M-CHAT-R上的分数高于社交情绪正常儿童,差异具有统计学意义(U18月龄组=5004.00,U24月龄组=5491.50,U30月龄组=409.00,P<0.001)。社交情绪异常儿童中,用M-CHAT-R初筛发现有ASD患病风险的人数比例较高(18月龄组为86.96%,24月龄组为90%,30月龄组为80%);ASQ-SE分数与M-CHAT-R分数呈正相关(r18月龄组=0.724,r24月龄组=0.693,r30月龄组=0.783,P<0.01)。结论社交情绪异常的儿童中大多数具有ASD的患病风险,应引起重视。尤其是小年龄段社交情绪异常的儿童,建议儿童保健科医生根据实际情况,对儿童采用M-CHAT-R/F量表进行ASD初筛。     

彩色多普勒超声心动图诊断新生儿非青紫型先天性心脏病的临床价值

目的:探讨彩色多普勒超声心动图诊断新生儿非青紫型先天性心脏病的临床价值。方法:2005年5月～2007年1月本院出生活产儿9612例,其中临床疑诊为先心病225例行彩色多普勒超声心动图检查,可疑或明确诊断病例出院后继续定期随访观察。结果:发现非青紫型135例,其中室间隔缺损43例(31.9%),继发孔型房间隔缺损54例(18例明确为房间隔缺损,36例为房间隔缺损可疑),动脉导管未闭35例(25.9%)。38例室间隔缺损患儿随访发现缺损自闭及变小12例,无明显变化16例,扩大10例,15例明确为房间隔缺损患儿随访发现缺损自闭或变小2例,31例房间隔缺损可疑患儿随访发现自闭或变小26例。29例动脉导管未闭患儿在3个月内随访发现自闭或变小22例。在随访后确诊为先心病患儿共69例,检出率为7.18‰。结论:彩色多普勒超声心动图可作为诊断新生儿非青紫型先心病的重要手段。     

Autism Spectrum Disorder and Particulate Matter Air Pollution before,during, and after Pregnancy: A Nested Case–Control Analysis within the Nurses’ Health Study II Cohort

Background

Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet has unclear etiology.

Objective

We explored the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child.

Methods

We conducted a nested case–control study of participants in the Nurses’ Health Study II (NHS II), a prospective cohort of 116,430 U.S. female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants’ children born 1990–2002 with ASD (n = 245), and children without ASD (n = 1,522) randomly selected using frequency matching for birth years. Diagnosis of ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤ 2.5 μm (PM_2.5) and 2.5–10 μm (PM_10–2.5) were predicted from a spatiotemporal model for the continental United States and linked to residential addresses.

Results

PM_2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range (IQR) higher PM_2.5 (4.42 μg/m³) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM_2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, whereas the association with the 9 months of pregnancy remained (OR = 1.63; 95% CI: 1.08, 2.47). The association between ASD and PM_2.5 was stronger for exposure during the third trimester (OR = 1.42 per IQR increase in PM_2.5; 95% CI: 1.09, 1.86) than during the first two trimesters (ORs = 1.06 and 1.00) when mutually adjusted. There was little association between PM_10–2.5 and ASD.

Conclusions

Higher maternal exposure to PM_2.5 during pregnancy, particularly the third trimester, was associated with greater odds of a child having ASD.

Citation

Raz R, Roberts AL, Lyall K, Hart JE, Just AC, Laden F, Weisskopf MG. 2015. Autism spectrum disorder and particulate matter air pollution before, during, and after pregnancy: a nested case–control analysis within the Nurses’ Health Study II cohort. Environ Health Perspect 123:264–270; http://dx.doi.org/10.1289/ehp.1408133     

Retrospective application of the performance indicator 'hip fracture: operate within 24 hours' in 217 patients treated at the University Medical Centre Utrecht in 2000-2003: reduction in postoperative pneumonia but not mortality

OBJECTIVE: To evaluate whether patients with hip fracture who undergo surgery within 24 hours--which has been propagated as an indicator of quality care--is associated with a reduced risk of mortality and complications, compared with later surgery. DESIGN: Retrospective status study based on a prospectively designed electronic medical record. METHOD: Data were collected on patients aged > or =60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 12 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration ofhospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. RESULTS: A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. CONCLUSION: Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.     

黑龙江省孤独症谱系障碍儿童就诊康复及养护现状

了解黑龙江省孤独症谱系障碍(autism spectrum disorder,ASD)儿童就诊、康复和养护现状,为完善ASD康复教育体系及政策的制定提供科学依据.方法 分层整群抽取黑龙江省8所孤独症康复教育机构,采用自拟的"ASD儿童康复教育现状及需求调查表"对357名ASD儿童主要照顾者进行现况调查.结果 ASD儿童发现行为异常的平均年龄为(31.08±12.96)月,首次就诊的平均年龄为(35.88±13.20)月,确诊为ASD的平均年龄为(38.64±13.20)月,开始康复的平均年龄为(43.56±16.08)月.3岁前被确诊以及3岁前到康复机构接受训练的儿童分别占39.0%和32.0%.非户口所在地(异地)康复儿童比例为47.3%,每周康复时间20 h及以上的ASD儿童占73.4%.因儿童的康复问题,父、母工作受影响的比例分别为34.5%,67.8%,差异有统计学意义(χ2=226.32,P<0.01).调查对象享受政府惠民项目资金支持的ASD家庭占41.2%.结论 黑龙江省ASD儿童确诊时间有延迟,早期康复的患者占比较低,孤独症儿童康复教育资源分布存在明显的地区差异,政府惠民救助项目支持的覆盖率还有待提高.     

Factors Affecting Spontaneous Closure of Gastrocutaneous Fistulae After Removal of Gastrostomy Tubes in Children With Intestinal Failure

Background: Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long‐term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT. Materials and Methods: Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis. Results: Fifty‐nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months. Conclusions: Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.     

The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

BACKGROUND: Although initial studies of preemptive analgesia showed that preoperative blockade with local anaesthetics or preoperative administration of systemic opioids was more effective in reducing postoperative pain than control conditions involving no treatment, the result of subsequent investigations comparing the effects of preoperative treatment with the same treatment initiated after surgery have produced inconsistent RESULTS. The reasons for the lack of consistency are not clear. Studies about the relationship of preemptive analgesia and both analgesic consumption and surgical stress response are limited. The purpose of this study was to evaluate the effect of preemptive intravenous morphine on both postoperative analgesic consumption and surgical stress response. METHODS: Sixty patients, ASA I or II, aged 20-60, undergoing total abdominal hysterectomy plus bilateral salpingo-oopherectomy and double-blinded were randomly assigned to three groups of 20 patients. Group I (n=20) received 0.15 mg/kg of morphine following induction and placebo saline during peritoneal closure. Group II (n=20) received placebo saline following induction and 0.15 mg/kg of morphine during peritoneal closure. Group III (n=20) received placebo saline both during induction and peritoneal closure. Blood cortisol, glucose levels and leukocyte count were measured in the pre and postoperative period. RESULTS: Postoperative total morphine consumption was significantly lower in group I compared with group III (p<0.001). In all groups, plasma cortisol levels increased significantly within 4 hours of surgery as compared to pre-op values (p<0.001). Plasma glucose also increased to a significantly higher level in all groups in the postoperative 30 min and 8 hours than in the pre-op values (p<0.001). Postoperative leukocytosis was observed in all groups and the leukocyte count was significantly greater during postoperative 24 h than pre-op values (p<0.001). CONCLUSIONS: Preemptive morphine 0.15 mg/kg intravenous has decreased total morphine consumption but has failed to suppress the surgical stress response.     

母亲孕期被动吸烟和补充叶酸与其子女孤独症行为的交互作用

目的 探讨母亲孕期被动吸烟和补充叶酸与儿童孤独症行为的交互作用。方法 以2014年深圳市龙华新区新入园的小班（3岁）儿童为研究对象,由家长填写问卷,询问儿童年龄、性别、早产、低出生体重、父母学历、父母生育年龄、家庭收入等,用孤独症行为量表评估儿童孤独症行为,按筛检界值31分和诊断界值62分将儿童分为正常组（<31分）、亚临床组（31～61分）和疑似临床组（≥62分）。控制混杂因素后,采用多分类logistic回归模型,分析孕期母亲被动吸烟和补充叶酸对儿童孤独症行为的主效应和交互作用。结果 孕期母亲被动吸烟与儿童孤独症行为呈正相关（亚临床组：OR=1.48,P<0.05;疑似临床组：OR=2.85,P<0.05）,孕期母亲补充叶酸与儿童孤独症行为的关联无统计学意义（亚临床组：OR=1.04,P>0.05;疑似临床组：OR=0.75,P>0.05）。分层分析显示,孕期母亲未被动吸烟的儿童中,孕期母亲补充叶酸与儿童孤独症行为呈负关联（疑似临床组：OR=0.30,P<0.05）;孕期母亲补充叶酸的儿童中,孕期母亲被动吸烟与儿童孤独症行为显著正关联（亚临床组：OR=1.52,P<0.05;疑似临床组：OR=4.45,P<0.05）。进一步交互作用分析显示,孕期母亲被动吸烟和补充叶酸对儿童孤独症行为疑似临床组的交互作用明显（OR=5.30,P<0.05）。结论 孕期母亲被动吸烟和补充叶酸与儿童孤独症行为关联,且存在交互作用。