A survey of basic resuscitation knowledge among resident paediatricians

A telephone questionnaire was undertaken to evaluate the knowledge of resident paediatricians on the subject of the basic resuscitation of the acutely sick child. The questionnaire was targeted at 88 resident paediatricians in hospitals accepting paediatric emergencies in four health regions. Outcome was measured as a correct response to questions based on several emergency scenarios and on the confidence expressed of basic resuscitation knowledge. The subject of emergency management of the child with a compromised upper airway was poorly answered with 40/73 (55%) resident paediatricians suggesting an incorrect endotracheal tube size for an 8 year old child. Fluid management was also deemed unsatisfactory with only 36/73 (49%) providing adequate transfusion secondary to haemorrhagic shock. In addition only 19/73 (26%) mentioned the intraosseous route as a means of obtaining vascular access in a child in extremis. Confidence of the knowledge of basic resuscitation of children was low among resident paediatricians with only 30/73 (41%) expressing confidence and 69/73 (94%) expressing a desire for more formal training in paediatric resuscitation. Resident paediatricians are usually the key personnel in the management of very sick children. This survey demonstrates a low level of basic resuscitation knowledge among resident paediatricians of all grades that must be remedied at a local and national level.     

Psychological response to growth hormone treatment in short normal children

Indian childhood cirrhosis (ICC) is an almost uniformly fatal disease whose outcome may be modified with penicillamine if given at a sufficiently early stage. Twenty nine children with ICC seen in Pune, India, in 1980-7, who had survived at least five years from onset of penicillamine treatment, were reviewed aged 6.3 to 13 years. They were assessed clinically, biochemically, histologically, and by duplex Doppler ultrasound examination. None had symptoms suggestive of liver disease. There were no toxic effects of penicillamine other than asymptomatic proteinuria. Hepatosplenomegaly reduced significantly and liver function tests returned to normal in all. In four children, significant hepatosplenomegaly was associated with an abnormal duplex Doppler hepatic vein flow pattern and micronodular cirrhosis on biopsy. Clinical findings, growth and development, and ultrasound examination were normal in the remainder. Review of serial liver biopsy specimens showed a sequence of recovery from ICC through inactive micronodular cirrhosis to virtually normal histological appearances. The four children who still have micronodular cirrhosis beyond four years from onset remain on penicillamine treatment. In the others penicillamine was stopped after 1-7 (mean 3.5) years without relapse, strong evidence that ICC is not due to an inborn error of copper metabolism.     

Re-evaluating currently available data and suggestions for planning randomised controlled studies regarding the use of hydroxyethyl starch in critically ill patients - a multidisciplinary statement

Introduction

Hydroxyethyl starch (HES) is a commonly used colloid in critically ill patients. However, its safety has been questioned in recent studies and meta-analyses.

Methods

We re-evaluated prospective randomised controlled trials (RCT) from four meta-analyses published in 2013 that compared the effect of HES with crystalloids in critically ill patients, focusing on the adherence to ''presumably correct indication''. Regarding the definition of ''presumably correct indication'', studies were checked for the following six criteria (maximum six points): short time interval from shock to randomisation (<6 h), restricted use for initial volume resuscitation, use of any consistent algorithm for haemodynamic stabilisation, reproducible indicators of hypovolaemia, maximum dose of HES, and exclusion of patients with pre-existing renal failure or renal replacement therapy.

Results

Duration of fluid administration ranged from 90 min up to a maximum of 90 days. Four studies considered follow-up until 90-day mortality, three studies 28-/30-day mortality, whereas four studies reported only early mortality. Included studies showed a large heterogeneity of the indication score ranging between 1 and 4 points with a median (25%; 75% quartile) of 4 (2; 4).

Conclusions

The most important question, whether or not HES may be harmful when it is limited to immediate haemodynamic stabilisation, cannot be answered yet in the absence of any study sufficiently addressing this question. In order to overcome the limitations of most of the previous studies, we now suggest an algorithm emphasising the strict indication of HES. Additionally, we give a list of suggestions that should be adequately considered in any prospective RCT in the field of acute volume resuscitation in critically ill patients.     

贫困县小学生睡眠状况调查

目的:了解贫困地区小学生睡眠状况,探讨提高农村儿童睡眠质量的有效措施。方法:于2005-10在吉林省的国家级贫困县应用澳大利亚悉尼大学儿童睡眠中心临床问卷的中国修订版(内容涉及儿童个人情况、睡眠状况、家庭居住环境,父母睡眠状况、吸烟状况,以及父母职业及受教育程度、家庭成员之间的关系等),采用二阶段整群随机抽样法,对750名小学生的睡眠状况进行调查分析,统计分析近1年内儿童在未患重大疾病时的睡眠状况,包括全天睡眠时间分布状况、睡眠障碍发病率及其相关影响因素,根据美国精神障碍诊断统计手册中儿童睡眠障碍的诊断标准,将每周出现1～3次单一或几种睡眠障碍相关症状,定为存在睡眠问题。结果:共发放问卷750份,回收有效问卷691份,回收率为92.1%。6岁和13岁组人数较少予以去除,实际纳入分析者669名。其中男生300名,女生369名;汉族361名,朝鲜族288名,其他民族20名;7岁组96名,8岁组93名,9岁组94名,10岁组122名,11岁组128名,12岁组136名。①贫困县小学生全天睡眠时间均值为(9.62±1.12)h,汉族小学生全天平均睡眠时间比朝鲜族学生长[(9.75±1.23),(9.48±0.90)h,P<0.01]。各年龄组学生全天睡眠时间差异无统计学意义(F=0.169,P>0.05)。②睡眠障碍总时点发病率为27.40%。低年级组小学生(一～四年级)睡眠障碍发病率高于高年级组(五～六年级)(31.80%,24.15%,P<0.05),男生睡眠障碍发病率高于女生(35.35%,20.95%,P<0.01)。③睡眠障碍症状发病率前5位依次为:睡眠不安(8.4%),睡眠姿势异常(8.3%)、张口呼吸(6.1%),梦呓(5.2%);打鼾(4.3%)。④调查结果经单因素相关分析及多重逐步回归分析显示抚养人睡眠习惯、儿童睡眠姿势异常、母亲管教孩子态度和父亲学历等是影响睡眠时间的主要因素。⑤Logistic回归分析显示,孩子患呼吸系统疾病、父母教育孩子方法、母亲有无睡眠障碍、父母之间关系、儿童体弱多病等是睡眠障碍的主要危险因素。结论:贫困地区儿童睡眠障碍是多因素共同作用的结果;孩子的抚养人应改掉不良的睡眠习惯,为儿童提供良好的生活、睡眠环境;增强儿童身体素质,积极防治呼吸系统疾病,应作为近期降低贫困县小学生睡眠障碍的有效措施。     

Influence of HLA-A2 on the effectiveness of platelet transfusions in alloimmunized thrombocytopenic patients

Platelet transfusions from donors selectively mismatched for cross- reactive and certain non-cross-reactive HLA antigens were found to be more effective in HLA-A2 negative than in HLA-A2 positive, alloimmunized thrombocytopenic patients. The two groups of patients responded equally well to platelets matched for antigens of the HLA-A and B loci. Certain alloimmunized patients negative for HLA-A2 continued to respond satisfactorily to platelets selectively mismatched for non-cross-reactive HLA antigens as long as platelets containing HLA- A2 were avoided. The data indicate that platelet transfusion support can be provided within a broader range of donor-recipient HLA antigenic disparity to HLA-A2 negative alloimmunized patients than to those who are positive for this antigen.     

From adolescence to parenthood: a multi-decade study of preconception mental health problems and postpartum parent–infant bonds

Purpose

To examine associations between anxiety and depressive symptoms across adolescence and young adulthood with subsequent maternal- and paternal–infant bonding at 1 year postpartum.

Methods

The data were from a prospective, intergenerational cohort study. Participants (381 mothers of 648 infants; 277 fathers of 421 infants) self-reported depression and anxiety at three adolescent waves (ages 13, 15 and 17 years) and three young adult waves (ages 19, 23 and 27 years). Subsequent parent–infant bonds with infants were reported at 1 year postpartum (parent age 29–35 years). Generalised estimating equations (GEE) separately assessed associations for mothers and fathers.

Results

Mean postpartum bonding scores were approximately half a standard deviation lower in parents with a history of persistent adolescent and young adult depressive symptoms (maternal β_adj = − 0.45, 95% CI − 0.69, − 0.21; paternal β_adj = − 0.55, 95% CI − 0.90, 0.20) or anxiety (maternal β_adj = − 0.42, 95% CI − 0.66, − 0.18; paternal β_adj = − 0.49, 95% CI − 0.95, 0.03). Associations were still mostly evident, but attenuated after further adjustment for postpartum mental health concurrent with measurement of bonding.

Conclusions

Persistent symptoms of depression or anxiety spanning adolescence and young adulthood predict poorer emotional bonding with infants 1-year postbirth for both mothers and fathers.

     

美国国家骨髓库无关供者造血干细胞移植20年回顾

自美国国家骨髓库(NMDP)开展第一例无关供者移植以来,至今已有20年.NMDP目前的库容量已逾700万,已为6大洲提供了30 000多份无关供者造血干细胞.这一辉煌成就是美国国家骨髓库600多名工作人员共同努力的结果,同时也得益于广泛的国际合作,包括171个移植中心,73个供者中心,24个脐血库,97个骨髓采集中心,91个血液净化中心,26个HLA分型实验室和26个合作供者登记处.本文回顾了美国国家骨髓库的历史,阐述了20年来移植病人、移植物来源和预处理方案几方面的主要变化趋势.     

Recombinant adeno-associated virus-mediated gene transfer into hematopoietic progenitor cells [published erratum appears in Blood 1995 Feb 1;85(3):862]

Recombinant adeno-associated viruses (rAAV) containing only the inverted terminal repeats (ITR) from the wild-type virus are capable of stable integration into the host cell genome, and expression of inserted genes in cultured cells. We have now defined the ability of rAAV to introduce genes into primary hematopoietic progenitors. A vector was constructed containing the coding sequences for beta- galactosidase (beta-gal), including a nuclear localization signal, under the control of a strong viral promotor. Infectious vector particles were prepared by cotransfection of the vector plasmid with a second plasmid that contained the coding sequences for AAV proteins into adenovirus-infected human embryonic kidney cells. These vector preparations transferred and expressed the beta-gal gene in human K562 erythroleukemia and Detroit 6 cells. Positive immunoselection yielded a population of enriched CD34+ cells that were transduced with the rAAV beta-gal vector. Nuclear localized enzyme expression was documented in 60% to 70% of infected cells. Progenitor-derived colonies that developed after 2 weeks in clonogenic cultures were shown to have viral- associated DNA at an estimated copy number of 1 to 2 per cell using a semiquantitative polymerase chain reaction (PCR) method. Integration of AAV into hematopoietic progenitors was documented using wild-type virus, as its genome may integrate at a preferred site on chromosome 19. Our data suggest that rAAV will transfer and express genes in primitive hematopoietic progenitors with high frequency, and support the development of this vector system for therapeutic gene transfer.