我国分娩镇痛现状和亟待解决的问题

好的产科镇痛管理模式应为：医院可以随时提供完成全身或区域阻滞麻醉的合格人员和设备。分娩镇痛的有效完成是产科与麻醉科通力合作的结果,双方都应该认识到有必要为所有患者提供高品质的服务,共同创建分娩镇痛医疗服务体系。     

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??Objective??To study the clinical features of childhood acute lymphoblastic leukemia??ALL?? with secondary myelofibrosis. Methods??The clinical data of 208 cases of newly diagnosed childhood ALL were analyzed retrospectively??who had difficulty in sucking the bone marrow fluid and underwent bone marrow biopsy from November 2001 to September 2012 in Hematology Hospital of Chinese Academy of Medical Sciences. The clinical characteristics and prognosis of childhood ALL patients with and without myelofibrosis were compared. Results??All the cases were separated into two groups??group A included 33 cases??who were diagnosed with ALL combined with bone marrow fibrosis confirmed by pathology??175 patients diagnosed with ALL without bone marrow fibrosis were enrolled into group B. From November 2001 to December 2007??we treated patients using CAMSBDH-ALL regimen??and from January 2008 to September 2012 we used CCLG-ALL 2008 regimen. In group A??42.4% of patients showed pancytopenia of peripheral blood. The 5-year overall survival rate??OS?? was 64.3%. The 5-year OS was 58.3% in the patients treated with CAMSBDH-ALL regimen. In group B??15.6% of patients showed pancytopenia of peripheral blood??lower than that of group A. The 5-year OS was 85.0%??which was significantly higher than that of group A ??P??0.010??. The 5-year OS was 68.8% in the patients treated with CAMSBDH-ALL regimen??which was significantly lower than that of patients treated with CCLG-ALL2008 regimen ??5-year OS being 87.2%?? in group B ??P??0.044??. Conclusion??Pancytopenia in childhood ALL with myelofibrosis are more common and with poorer prognosis than those without myelofibrosis. The overall survival of ALL patients without bone marrow fibrosis can be improved by modifying the treatment strategies??but the prognosis can’t be improved for those ALL patients with myelofibrosis.     

重症腺病毒肺炎临床特点及并发闭塞性细支气管炎危险因素分析

目的　总结重症腺病毒肺炎（severe adenovirus pneumonia,SAP）的临床特点,分析其并发闭塞性细支气管炎（bronchiolitis obliterans,BO）的危险因素。方法　对南京医科大学附属儿童医院呼吸科2017年1月至2019年12月住院的125例SAP患儿进行回顾分析,总结其临床特点。根据是否发展为BO将患儿分为BO组和非BO组,并对临床资料进行分析。结果　发病年龄≤24月龄80例（64%）;热峰≥39℃者115例（94.3％）,热程≥10 d者89例（72.9％）;气喘82例（65.6%）;单纯腺病毒感染35例（28%）,72%的患儿合并其他病原体感染［肺炎支原体（MP）40.8%,细菌35.2%］;并发呼吸衰竭32例（25.6%）,肺外并发症以循环系统（36%）和消化系统并发症（22.4%）多见。实访122例SAP患儿,53例（43.4%）最终发展为BO。多因素Logistic回归分析显示呼吸衰竭和合并MP感染是SAP后BO的独立危险因素（P＜0. 05）。结论　SAP主要发生于2岁以下的婴幼儿,多为高热且持续时间长,多数患儿存在喘息,混合感染率高;最常见的并发症是呼吸衰竭、 心功能不全、 肝功能损害和中毒性脑病。呼吸衰竭和合并MP感染是SAP后BO的独立危险因素。     

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??Objective To analyze thecauses ofinfantsalt losing syndrome and theapplication value of gene detection inthe diagnosis of the cause. Methods Four cases ofsalt losingsyndrome withlow sodium and highpotassium admitted from 2010 to 2014in Shanghai Children’s Medical Center?? Affiliated to Shanghai Jiaotong University School of Medicine wereincluded and clinicaldata??therapy and follow-up were collected. DNA of childrenandtheir parentsin thefour cases were detected. Results There were different degrees ofsalt losingsituation in the fourcases. It found that the patients had different gene mutations through genetic testing??mutations of splicing site??c.293-13A??G??heterozygous???? andsmallduplication??c.923dupT?? p.Leu308Phefs*6??heterozygous???? were detected in CYP21A2?? mutation of small deletion??c.1334delC?? p.Ala445Valfs*17??hemizygous???? was detected in DAX1?? mutation of splicing site??c.del1311G?? p.Arg438Glyfs*43??heterozygous???? and point mutation??c.1439+1G??C??heterozygous???? were detected in SCNN1A and mutation of splicing site??c.240-1G??A??heterozygous???? and nonsensemutation??c.1009C??T??p.Gln337*??heterozygous???? were detected in CYP11B2?? respectively. The four cases werediagnosed asfour differentdiseases??congenitaladrenal hyperplasia??21-hydroxylase deficiency????congenital adrenal hypoplasia??pseudohypoaldosteronismtype I and hypoaldosteronism. Conclusion The cause of infant salt losing syndrome is complex and is misdiagnosed easily. Gene analysismay be helpful for early diagnosis and treatment.     

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??Objective To explore the epidemiological features of NV and RV infection and to investigate the clinical features and prognosis of NV infection. Methods Stool specimens??without pus??mucus or blood?? were collected from children less than 3 years old with acute diarrhea within 7 days admitted from November 2012 to October 2013 in Beijing Children’s Hospital??Capital Medical University. Stool specimens were screened for NV and RV using immunochromatographic test??ICG??. History was investigated and the severity was evaluated by Vesikari scale. Follow-ups were conducted via phone calls. The epidemiological features?? clinical manifestations and prognosis of children infected with NV were analyzed and compared with those infected with RV. Results Among the total 942 samples??RV was detected in 329??34.9%?? samples??while NV was detected in 137??14.5%?? samples. Rate of co-infection was 9.7%??91/942??. The seasonal distribution of RV detection showed a peak of incidence from September to February the following year??but NV detection showed sporadic distribution. The times and duration of diarrhea and vomiting were similar in two kinds of infection??but fever??vomiting??severe diarrhea??with fatigue??sleepiness or lethargy?? were significantly more common in RV infection??P??0.05??. NV infection had a higher incidence of respiratory symptoms??such as cough and rhinorrhea. Mean Vesikari severity score was ??8.98±2.94?? in NV infection??remarkably lower than??10.45±3.04??in RV infection??P??0.05??. Most patients recovered in??7 days??but NV infection was likely to have longer duration. Conclusion RV is still the leading cause of acute viral diarrhea??and NV is also a significant cause. NV infection occurs year-round??while RV infection shows a peak in autumn and winter. Fever??vomiting and severe diarrhea with dehydration are more common in RV infection. NV infection has a higher rate of respiratory symptoms and longer recovery period.     

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??Objective??To investigate the clinical features??diagnosis??treatment and prognosis of eosinophilic cystitis in pediatric population. Methods??The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results??All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition??odynuria??dysuria??suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms??peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years??two cases had are recurrence and one case had two recurrences. Conclusion??Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.     

白三烯D4对白细胞介素4诱导嗜酸性粒细胞趋化因子-3在支气管上皮细胞表达的影响

目的研究白三烯D4是否参与调节支气管上皮细胞表达嗜酸性粒细胞趋化因子-3(eotaxin-3，Eot-3)，探讨白三烯和支气管上皮细胞在气道变态 反应性炎症中的作用。 方法用白三烯D4预处理支气管上皮细胞1h，然后用白细胞介素-4(IL-4)刺激细胞24h，RT-PCR法检测Eot-3在mRNA水平的表达；ELISA法检测细胞 培养上清液中Eot-3蛋白的表达。 结果未经处理的支气管上皮细胞仅表达微量的Eot-3，用IL-4刺激细胞并培养24h后，在mRAN和蛋白水平的Eot-3表达明显增强，白三烯D4预处理 细胞1h，可以使IL-4的这种诱导作用加强。 结论支气管上皮细胞不仅是一种屏障细胞，也是一种效应细胞，在炎症介质的刺激下能表达Eot-3，参与支气管炎症的产生。白三烯D4通过上调 IL-4诱导Eot-3在上皮细胞的表达可能是其参与支气管哮喘嗜酸性粒细胞炎症的机制之一。     

Assays for assessment of sperm DNA integrity: relationships with fertility and conceptus quality

Several assays are available for testing nuclear quality of spermatozoa, many of them allowing to define a DNA fragmentation index (DFI). Numerous recent studies on this subject agree on several points: negative correlations are observed between DFI and sperm characteristics. Concerning the relationships between DFI and artificial reproductive technologies, there are some disagreements about correlations between DFI and fertilization rates; conversely, in case of high DFI, both blastocyst formation rate and pregnancy rate are significantly reduced. Several authors have defined a threshold value for DFI, corresponding to an absence of pregnancy, or a very low pregnancy rate, for samples above this value. Unfortunately, there are no data available concerning the relationships between sperm DNA quality and abnormalities at birth.