中药敷脐治疗小儿腹泻临床研究

目的:观察中药敷脐治疗小儿腹泻的临床疗效。方法:将本院356例患儿随机分为对照组与治疗组各178例,对照组调理患儿的饮食,给予补液疗法纠正脱水,电解质紊乱,酸碱失衡等一般常规治疗,治疗组在对照组治疗的基础上给予中药敷脐治疗,两组均治疗7 d,观察两组患儿临床疗效及对血C-反应蛋白的影响。结果:治疗组有效率为96.6%,对照组有效率为85.3%,两组有效率比较有统计学差异(P0.05);治疗7 d后,治疗组中细菌感染的患儿血C-反应蛋白下降为(9±2.4)mg·L~(-10),显著低于治疗前(P0.05)。结论:中药敷脐结合西医疗法治疗小儿腹泻疗效确切。     

运用穴位埋线从肺、脾、肾论治小儿反复呼吸道感染

目的:观察运用穴位埋线从肺、脾、肾论治小儿反复呼吸道感染的临床疗效。方法:将78例患儿随机分为埋线组与西药组。埋线组取穴大椎、风门、肺俞、脾俞、肾俞、足三里。纳差者加中脘、胃俞;多汗者加曲池、心俞;鸡胸龟背者加命门;便秘者加支沟;腹泻者加天枢。西药组口服匹多莫德400 mg治疗。两组均治疗3个月,分别于治疗后3个月、6个月、12个月随访,观察其疾病疗效、治疗前后呼吸道感染次数、中医证候疗效。结果:观察中埋线组脱落3例,西药组脱落2例。治疗后埋线组临床痊愈率为64.86%,西药组临床痊愈率为47.22%,两组比较,差异有统计学意义(P0.05)。治疗后6个月、12个月随访其发生上下呼吸道感染次数埋线组均低于西药组(P0.05)。中医证候疗效埋线组有效率为86.49%,西药组有效率为75.00%,两组比较,差异有统计学意义(P0.05)。结论:运用穴位埋线从肺脾肾论治小儿反复呼吸道感染临床疗效确切。     

微生态制剂与肠道菌群平衡观在小儿腹泻中的应用

根据中医基础理论与肠道菌群在平衡观方面的研究,结合阴阳平衡理论及中医脾胃学说,采用微生态调节剂疗法,纠正肠道菌群失衡,调节肠道微生态的平衡,从而缓解腹泻患儿的临床症状,缩短病程,提高小儿腹泻临床治愈率。     

麻杏石甘汤联合西药治疗小儿肺炎的系统综述和meta分析

目的：系统评价麻杏石甘汤联合西药治疗小儿肺炎的临床研究。 方法：采用Cochrane系统综述方法,检索1994-2008年重庆维普数据库、中文期刊全文数据库、万方数据库和中国生物医学文献数据库等电子资料库,同时手工检索相关杂志、专业资料和网络上的信息。由两名评价者共同评价所纳入研究的质量,对同质研究进行meta分析。采用Cochrane协作网提供的RevMan 4.2.7软件进行meta分析。 结果：共检索出146篇文献,符合纳入标准的只有8篇文献,采用Jadad评分标准对纳入研究的每篇文献的方法学质量进行评价。8篇文献均未描述具体的随机方法和分配隐藏的方法,均未提及是否采用盲法,属于低质量文献。Meta分析结果显示麻杏石甘汤联合西药试验组与西药对照组有效率的比值比为4.06,95%可信区间［2.63,6.27］,治疗组有效率优于对照组,差异有统计学意义（P〈0.000 01）。 结论：现有临床证据表明,麻杏石甘汤联合西药治疗小儿肺炎较单用西药组有效,可改善患者的临床症状,提高患者的治愈率。但本系统综述纳入的随机对照试验多属低质量文献,进一步证实其临床疗效尚须开展大规模的设计严谨、方法可靠的多中心临床研究以获得更高强度的证据。     

氯胺酮复合麻醉合并硬膜外阻滞在小儿腹部手术的应用

目的　比较氯胺酮复合麻醉合并硬膜外阻滞和单纯氯胺酮复合麻醉在小儿腹部手术中的应用效果。方法　对 40例随机分为复合组 (A组 ) 2 0例 ,单纯氯胺酮复合麻醉组 (B组 ) 2 0例。观察术中麻醉效果及并发症 ,并记录氯胺酮用量 ,术毕作清醒程度的判断。结果　麻醉效果满意率A组明显优于B组 (P <0 .0 5 )。术中氯胺酮用量A组 (80± 15 )mg比B组 (15 0± 10 )mg显著少 (P <0 .0 1)。与B组比较 ,A组术毕未醒例数极显著减少 ,完全清醒例数大大增多 (P <0 .0 1)。A组无呼吸抑制、恶心、呕吐 ,而B组肌颤 2例、呕吐 3例。结论　氯胺酮复合麻醉合并硬膜外阻滞 ,镇痛完善 ,肌肉松驰 ,用药量明显减少 ,术后并发症少 ,清醒快     

SENSITIVE SKIN AND MOISTURIZATION

A 2-month-old female patient presented an extensive bilateral parotid hemangioma (PH) focally ulcerated. Additionally, hepatic ultrasonography revealed a hemangioendothelioma located at right lobe. She was treated with oral prednisolone (3?mg/kg/day) during 10 months with clinical improvement of PH, despite failure to thrive and arterial hypertension. However, regrowth of the lesion occurred after discontinuation of oral steroid. Propranolol hydrochloride (2?mg/kg/day divided into two doses) was then started and maintained for 16 months, with marked involution of the hemangioma and with no systemic side effects during treatment course. Curiously, also the liver hemangioendothelioma completely resolved after starting propranolol.

PH is a threatening cervicofacial segmental hemangioma that frequently proliferates after the year of age and needs long-term treatment. On the other hand, hepatic hemangioendotheliomas may be associated with cutaneous hemangiomas in some patients and their natural history is similar to these, although patients may die of associated conditions. As for other infantile hemangiomas, propranolol proved to be an effective, safe, and well-tolerated treatment for PH. Its role in liver hemangiomas and hemangioendotheliomas should also be taken into account.     

Inhibition of quisqualate-induced seizures by glutamic acid diethyl ester and anti-epileptic drugs

Summary Glutamic acid diethyl ester (GDEE) is a glutamate antagonist which acts preferentially at the quisqualate-sensitive receptor and has been shown to be an effective anticonvulsant in alcohol withdrawal and homocysteine-induced seizures but ineffective in other seizure models. To better characterize the role of the quisqualate-sensitive receptor in the generation of seizures, quisqualate was administered to mice by intracerebroventricular (ICV) route and immediate onset generalized seizures were observed. The anticonvulsant properties of GDEE and commonly used antiepileptic drugs (AEDs) were investigated with this seizure model. GDEE given by intraperitoneal blocked quisqualate-induced seizures dose-dependently. Diphenylhydantoin (50 mg/kg IP), carbamazepine (50 mg/kg IP), diazepam (1; 4 mg/ kg IP), phenobarbital (40; 80 mg/kg IP), and valproic acid (250; 340 mg/kg IP) were also administered prior to quisqualate-seizure induction. Only valproic acid blocked seizures at nonsedating doses. The GABA transaminase inhibitor aminooxyacetic acid (20 mg/kg IP) was ineffective, suggesting that here valproic acid is active at excitatory receptors rather than by potentiating GABA post-synaptic inhibition. These data are consistent with the hypothesis that the quisqualate-sensitive receptor is involved in some forms of clinically observed seizures, particularly those which are controlled by valproic acid.     

Anticonvulsant action of 1,3-dimethyl-5-aminoadamantane

Summary The anticonvulsant actions of memantine (1,3-dimethyl-5-aminoadamantane) have been evaluated in mice (seizures induced by maximal electroshock, pentylenetetrazol, bicuculline, picrotoxin, 3-mercaptopropionic acid and N-methyl-d,l-aspartic acid) and in photosensitive baboons, Papio Papio (clonic responses to intermittent photic stimulation). Memantine, 5–20 mg/kg, raised the threshold for electroconvulsions and protected mice against the tonic hind limb extension in pentylenetetrazol-, bicuculline-, picrotoxin-and 3-mercaptopropionic acid-induced seizures, but was ineffective against the clonic phase of chemically-induced seizures. In the baboons, no protection against photomyoclonic responses was observed within 5 h after the intravenous administration of memantine, 1–9 mg/kg. Amantadine, 100 mg/kg, reduced the protective effect of memantine against electroconvulsions. Apomorphine, haloperidol, pimozide, spiroperidol and bicuculline did not modify the anticonvulsant activity of memantine in electroconvulsions. These studies demonstrate an anticonvulsant action of memantine in rodents and suggest that dopaminergic mechanisms do not contribute to its mechanism of action.     

Inhalation treatment: Errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.     

Serum levels of Th2 chemokines,CCL17, CCL22, and CCL27, were the important markers of severity in infantile atopic dermatitis

Atopic dermatitis (AD) is considered to be Th2 cell‐mediated disorder. In most infants with AD, AD may be induced by food allergy. In the early stage of infantile AD, it is unclear whether there are changes in serum Th2 chemokines or in Th2 chemokine production by peripheral blood mononuclear cells (PBMC). Thirty‐four patients with AD were examined (mean age, 4.5 months; female:male, 18:16). Ten age‐matched infants with no history of allergic disease were used as controls. Thirty of these 34 patients were sensitized with ovalbumin (OVA; radioallergrosolvent score of >2). Serum levels of CCL17, CCL22, and CCL27 were measured with enzyme‐linked immunosolvent assay (ELISA) kits and their correlation with the severity of skin lesions, defined by the scoring atopic dermatitis (SCORAD) index, was analyzed. The amounts of TNF‐α, CCL17, CCL22, and CCL27 in the culture supernatants of PBMC from OVA‐sensitized AD infants after stimulation with OVA were estimated with ELISA kits. Elevated serum CCL17, CCL22, and CCL27 levels significantly correlated with SCORAD index (r = 0.7181, p < 0.001; r = 0.5354, p < 0.005; r = 0.8312, p < 0.0001, respectively). CCL22 levels produced by PBMC from OVA‐sensitized infants with AD reflected serum CCL22 levels. Only six of 30 OVA‐sensitized patients in whom the skin signs increased immediately after OVA intake showed markedly high titers of TNF‐α produced by PBMC after stimulation with OVA. These high TNF‐α titers correlated significantly with serum CCL27 levels (r = 0.7181, p < 0.001). Serum concentrations of CCL17, CCL22, and CCL27 correlate well with the extent and intensity of AD in infants. Of the three Th2 chemokines examined, serum CCL27 correlated most significantly with the severity of AD. Thus, the peripheral immune responses of infantile AD patients are skewed to a Th2 dominant bias.