手足口病儿童血浆γ干扰素诱导蛋白10的表达水平及临床意义

目的:探讨γ干扰素诱导蛋白10(interferon-γ inducible protein-10,IP-10)在手足口病(hand-foot-mouth disease,HFMD)儿童血浆中的表达水平及临床意义?方法:选取HFMD患儿74例,根据是否伴有神经系统症状将患儿分为重症组和普通感染组;另选取30例体检儿童作为健康对照组?采用流式液相多重蛋白定量检测技术检测血浆中IP-10的表达量,同时检测分析淋巴细胞亚群比例?免疫球蛋白和血常规相关指标?比较各指标在健康对照组?HFMD普通感染组及重症组中的差异;分析IP-10与皮疹出现天数及淋巴细胞各亚群比例之间的相关性?结果:HFMD普通感染组及重症组患儿白细胞计数均增高,但和健康对照组相比无统计学差异?HFMD普通感染组及重症组患儿IP-10蛋白表达均显著增加(P < 0.001),重症组IP-10蛋白表达略低于普通感染组,差异无统计学意义(P > 0.05)?HFMD普通感染组及重症组患儿T细胞比例显著降低(P < 0.001),其中CD4+ T 淋巴细胞与CD8+ T 淋巴细胞亦显著降低(P < 0.05)?相反,B淋巴细胞比例显著增加(P < 0.001)?HFMD普通感染组?重症组与健康对照组相比,IgA降低,IgG增加,但无统计学差异(P > 0.05)?HFMD普通感染组患儿IP-10蛋白表达量与皮疹天数呈负相关(P < 0.05),而重症组虽IP-10蛋白表达量与皮疹天数呈负相关,但无统计学意义?HFMD重症组IP-10蛋白表达量与T淋巴细胞比例呈正相关,其中与CD4+ T 淋巴细胞的正相关有统计学意义(P < 0.01)?结论:HFMD患儿T淋巴细胞比例降低,B淋巴细胞比例增加,IP-10蛋白表达显著增加,与皮疹天数呈负相关?     

氯胺酮肌肉注射与面罩下吸入七氟醚两种麻醉方式在小儿麻醉手术中的临床效果及安全性比较

目的 将面罩下吸入七氟醚应用于小儿麻醉手术的临床效果及安全性与氯胺酮肌肉注射相比较,探讨其有效性、安全性.方法 选择2013年1-12月该院收治的择期手术的患儿228例,ASAⅠ～Ⅱ级,将所有患儿随机分成二组,其中氯胺酮组100例,给予氯胺酮5mg/kg肌肉注射麻醉,七氟醚组128例,给予4L/min纯氧吸入,经面罩吸入七氟醚,吸入浓度从3％逐渐增加至8％.在手术前后对患儿心率(HR)、平均动脉压(MAP)、动脉血氧 饱和度(SPQ)进行监测,采用数字分级法(NRS)对麻醉效果进行评价,观察二组患儿麻醉诱导时间、苏醒时间、手术时间、麻醉费用及不良反应发生情况.结果二组患儿麻醉效果、手术时间、麻醉费用差异无统计学意义(t=0.38、0.77、0.31,P＞0.05),七氟醚组麻醉诱导时间、苏醒时间显著短于氯胺酮组,二组差异有统计学意义(t=55.43、30.42,P＜0.05);二组患儿在插管前后HR、MAP、SPQ平稳,二组差异无统计学意义(P＞0.05);二组不良反应差异有统计学意义(P＜0.05).结论面罩下吸入七氟醚应用于小儿麻醉手术较氯胺酮肌肉注射效果显著,其具有起效快、苏醒时间短、患儿易于接受、不良反应小等优点,为小儿麻醉诱导的理想药物.     

Risk factors for latent tuberculosis infection in children in South Korea

Objectives: In South Korea, latent tuberculosis infection (LTBI) screening is a critical strategy associated with efforts to reduce the incidence of tuberculosis (TB). Currently, only children with a known history of TB contact are considered as pediatric high-risk groups for LTBI, and consequently, LTBI screening is only provided to these children. However, to reduce the incidence of TB, the high-risk groups that undergo LTBI screening should be expanded. This study aimed to assess the risk factors for LTBI among children living in South Korea with no known history of TB contact for the identification of additional high-risk groups. We investigated the risk factors for LTBI among US visa applicant children, who undergo LTBI screening regardless of their TB contact history.

Methods: We obtained data on demographic characteristics, medical history, Bacillus Calmette–Guerin (BCG) vaccination history, and results of LTBI screening for children aged 2–14 years. A tuberculin skin test was used for the diagnosis of LTBI, and an induration of 10 mm or greater was used to define a positive test. Adjusted odds ratios and 95% confidence intervals were calculated to determine the association between clinical and demographic variables and LTBI.

Results: Of the 1,664 study participants, 91 (5.5%) had LTBI. The binary logistic regression analysis showed that children born in high TB burden foreign countries had the highest odds of LTBI when considering all the risk factors investigated. Increasing age, absence of BCG vaccination, and a previous diagnosis of asthma were also significant risk factors for LTBI.

Conclusion: These results indicate that children born in high TB burden foreign countries should be considered a high-risk group for LTBI in South Korea; the inclusion of these children in LTBI screening should be considered.     

急性髓细胞白血病患儿骨髓单个核细胞中自分泌运动因子受体表达的检测

目的:通过检测自分泌运动因子受体(AMFR)在急性髓细胞白血病(AML)患儿骨髓单个核细胞中的表达情况,探讨其与AML化疗缓解率的关系。方法:采用RT-PCR及Western blot方法检测试验组(63例AML患儿)与对照组(50例非AML患儿)骨髓单个核细胞中AMFR mRNA及蛋白的表达水平,其中试验组包括AML初治患儿35例、完全缓解患儿18例、复发患儿10例,分析AMFR mRNA表达与缓解率的关系。结果:1AMFR mRNA及蛋白表达水平在对照组、缓解组、初治组及复发组中逐渐升高(F=13.105、10.010,P均<0.001),组间两两比较差异均有统计学意义(P均<0.05)。2AMFR mRNA高表达患儿的缓解率为15%,低于AMFR mRNA低表达患儿的缓解率84%(χ2=21.254,P<0.001)。结论:AMFR在儿童AML中存在高表达,AMFR可作为化疗敏感性及预后判断的指标。     

呼出气一氧化氮在儿童哮喘缓解期的应用价值

目的：探讨呼出气一氧化氮检测用于评估临床缓解期哮喘儿童病情的价值。方法选取214例处于临床缓解期哮喘儿童,按照有无进行规范化治疗分为治疗组和对照组。同时记录FeNO及PC20 FEV1数值。结果治疗组与对照组平均FeNO值分别为22．63×10－9 ppb和39．67×10－9 ppb ,差异有统计学意义（ P＜0．01）。治疗组与对照组平均 PC20 FEV1数值分别为（7．43±6．16）和（6．78±5．83）,差异无统计学意义（P＞0．05）。FeNO与PC20 FEV1呈负相关性（r＝－0．372,P＜0．01）,直线回归方程为Y＝35．883－1．074X（X表示PC20 FEV1,Y 表示FeNO）。结论 FeNO数值可以作为哮喘患儿非特异性气道炎症控制状况的可靠指标。呼出气一氧化氮检测与支气管激发试验联合,可显著提高临床缓解期哮喘患儿的诊断率。     

儿童膜周部室间隔缺损介入与开胸治疗疗效比较研究

目的：比较外科开胸修补和介入治疗两种方法治疗儿童膜周部先天性室间隔缺损的疗效。方法收集室间隔缺损(VSD)患儿384例,行外科开胸修补202例(开胸组),行介入封堵182例(介入组)。比较两组的手术时间、成功率、术中及术后输血量、并发症发生率、术后恢复时间、术后 ICU 监护时间、体外循环(CPB)时间、心包引流时间、机械通气时间。结果介入组无需输血、ICU 监护、心包引流、机械通气等。而开胸组输血量为(372.45±200.88)mL,术后 ICU 监护时间为(3.21±2.17)d,CPB 时间为(71.09±34.92)min,心包引流时间为(3.52±1.22)d,机械通气时间为(67.09±43.83)min。两组在手术时间和术后恢复时间上,介入组的时间明显少于开胸组(P <0.05)。介入组术后并发症发生率显著低于开胸组(P <0.05)。结论在相同的适应证情况下,介入治疗更有利于患儿身心健康。     

Ultrasound Appearances of Pediatric Testicular Yolk Sac Tumors: Twenty‐one Cases in a Single Institution

Testicular yolk sac tumors are rare, and analyses of relevant ultrasound (US) findings are limited. We retrospectively reviewed the US features of 21 pathologically verified cases (patients aged 10–64 months). Neoplasms were unilateral and solitary, occupying part (focal) or all (diffuse) of the testis. Focal lesions (14 cases) were usually solid and ovoid, with a homogeneous echo texture or multiple random anechoic spaces, and hypervascular. Diffuse neoplasms had heterogeneous echo textures; most were hypervascular. On spectral Doppler US imaging, 11 cases had a mean peak systolic velocity of 12.9 cm/s and a mean resistive index of 0.54. Ultrasound is a useful tool for imaging pediatric testes when a yolk sac tumor is suspected.