遗尿症儿童感觉统合能力的研究

目的：分析原发性夜间遗尿症(PNE)儿童的感觉统合能力,探讨感觉统合失调在原发性遗尿症发生中的作用。方法：采用感觉统合能力发展量表对46例PNE组儿童及46例正常对照组儿童进行感觉统合功能测试,对两组结果采用t检验和χ2检验进行统计分析。结果：PNE组与对照组儿童感觉统合失调的发生率分别为82.6%和43.5%,其中重度失调的发生率分别为36.9%和2.1%,两组间差异有显著性（P﹤0.01）;PNE组所有感觉统合功能因子得分均明显低于对照组,差异有显著性(P﹤0.01)。结论：PNE组儿童存在感觉统合失调现象,感觉统合功能失调在PNE发生中可能有一定作用。     

剖宫产与学龄前儿童感觉统合失调的前瞻性队列研究

目的 采用前瞻性队列研究,评价剖宫产与学龄前儿童感觉统合失调的关联。 方法 依托上海交通大学医学院附属新华医院和附属国际和平妇幼保健院2012年建立的多中心母婴队列,于2017年采用儿童感觉统合能力发展评定量表,从前庭平衡、触觉防御和本体觉3个维度评价392名学龄前儿童感觉统合功能。剖宫产出生为暴露因素,阴道分娩者作为对照组。采用多因素logistic回归分析评估剖宫产与感觉统合各维度失调的关联。 结果 学龄前儿童感觉统合失调率为21.9%（86/392）,前庭平衡、触觉防御和本体觉失调率分别为5.9%（23/392）、5.4%（21/392）和15.1%（59/392）。调整母亲分娩年龄、母亲受教育程度及儿童出生情况等混杂因素后,剖宫产儿童发生本体觉失调的风险性显著增加（RR=4.16,95%CI：1.41~12.30,P<0.05）。按性别分层分析发现,剖宫产男童本体觉失调的发生风险高于阴道分娩男童（RR=5.75,95%CI：1.26~26.40,P<0.05）。 结论 剖宫产能显著增加学龄前儿童本体觉失调的发生风险,尤其是对男童的影响更为明显。     

郑州地区7~12岁儿童血压分布特征

目的：了解郑州地区7~12岁儿童的血压现况。方法按分层整群随机抽样法抽取郑州市3个城区和2个郊区县的5所学校6~13岁在校儿童,测量身高、体质量、腰围、臀围、收缩压(SBP)和舒张压(DBP),对相关数据进行分析。结果调查的7~12岁儿童有效人数为6460人,其中城区3206人(49.63%),郊区县3254人(50.37%);男童3525人(54.57%),女童2935人(45.43%)。男童的SBP(117.86±18.18)mmHg明显高于女童(113.82±13.11) mmHg,差异有统计学意义(t=3.16,P=0.002)。高血压发生率7.52%;其中男童高血压发生率明显高于女童,差异有统计学意义(χ2=9.66, P=0.002);无论男、女童,城区儿童高血压发生率均高于郊区县,差异有统计学意义(χ2=24.15、14.39,P均=0.000)。男童的SBP和DBP,女童SBP均与年龄、身高、体质量、BMI、腰围呈显著正相关(P均<0.01)。结论郑州地区儿童青少年血压的分布特征为男性高于女性,城区高于郊区县,儿童血压与年龄、身高、体质量、BMI、腰围密切相关。     

感觉统合治疗儿童感觉统合失调198例

我院从 2 0 0 0年成立感觉统合治疗中心以来 ,共收治感觉统合失调儿童 198例 ,现将临床资料报告如下。对象与方法一、对象　均为 2 0 0 0年 6月～ 2 0 0 2年 2月来本中心咨询和测试的儿童 ,并符合感觉统合失调评定标准[1] 共 198例 ,男 14 5例 ,女 5 3例 ;年龄 4～ 10岁。二、方法　采用集体训练、个别调整训练和家长配合三种相结合的治疗方法。集体训练依据陈文德教授的感觉统合指导进行训练。按就诊顺序随机编组 ,每组儿童制订循序渐进的训练方案 ,采用滑板、平衡木、触觉球等器材 ,以游戏形式进行形体、触觉、精细动作及记忆、视、听力等…     

原发性遗尿症儿童感觉统合能力的对照研究

目的：探索儿童原发性夜间遗尿症（PNE）与感觉统合能力的关系。方法：采用儿童感觉统合能力发展量表,对70例PNE患儿进行感觉统合功能测试,并与74例正常儿童进行对照研究。结果：PNE组感觉统合失调发生率 (76% vs 35%)、重度感觉统合失调发生率(39% vs 18%) 明显高于对照组,差异有统计学意义（P<0.01）。PNE组儿童所有感觉统合功能因子得分均明显低于对照组,差异有统计学意义（P<0.01）。结论：PNE患儿普遍存在感觉统合失调,并且是多方面的,故对PNE患儿进行感觉统合功能测试,并针对性地对伴发的感觉统合失调问题进行训练很有必要。［中国当代儿科杂志,2010,12（5）：341-343］     

感觉统合训练治疗孤独症的疗效

目的探讨感觉统合训练治疗孤独症的疗效。方法对23例孤独症患儿进行6个月的感觉统合训练,在训练前后,分别采用感觉统合评定量表和孤独症儿童行为检查量表对孤独症患儿的感觉失调状况和临床症状进行评估,并进行对比分析。结果感觉统合训练治疗后,感觉统合能力有明显改善,其中感觉统合失调的改善以前庭平衡失调、触觉过分防御、本体感觉失调的改善为显著,训练6个月的改善率分别为91.3%、95.7%、69.5%,而学习能力改善较差,为60.8%。通过训练,孤独症儿童的语言、交往、感觉和躯体运动能力较治疗前均显著改善(Pa<0.05),生活自理项改善不明显。结论感觉统合训练对治疗孤独症有一定疗效。     

安徽农村留守儿童行为问题的现状

目的 了解农村地区留守儿童与非留守儿童行为问题的发生率及行为问题各因子的差异。方法 整群抽取安徽省庐江县12所中学12～16岁在校初中生5973名（男3168名，女2805名）。其中留守儿童3589名（60．1％），非留守儿童2384名（39．9％），采用Achenhach儿童行为量表（CBCL）进行问卷调查。结果 留守儿童中行为问题发生率为41．3％，非留守儿童行为问题发生率为36．6％（χ^2=13．185P〈0．05）。其中留守男童在分裂样、强迫行为、攻击性行为和多动及行为问题总分方面显著高于非留守男童；留守女童行为问题总分与非留守女童差异显著。结论 农村留守儿童行为问题发生率高，值得社会关注。     

深圳市6～12岁正常儿童超声骨密度测定及分析

目的　了解深圳地区儿童超声骨密度状况 ,建立深圳市儿童超声骨密度正常参考值。方法　选择 6～ 12岁深圳居住的正常儿童 6 97例为检测对象 ,用定量超声骨密度仪测定受检者足跟部骨密度 (BMD)值 ,同时测量受检者体重、身高。结果　 6～ 12岁儿童BMD正常参考值 (g/cm2 )分别为 6岁 :0 4 4 5± 0 16 6、7岁 :0 5 0 9±0 15 1、8岁 :0 5 10± 0 133、9岁 :0 5 19± 0 132、10岁 :0 5 2 0± 0 15 3、11岁 :0 5 30± 0 175、12岁 :0 5 4 5± 0 2 0 6。男童与女童之间BMD存在差别但经体重较正后无显著性差别 (P >0 0 5 )。男童与女童BMD随年龄增加呈线性增长 (男 r=0 72 2 ,P <0 0 0 1;女 r=0 785 ,P <0 0 0 1) ,并与体重显著相关 (r=0 984 ,P <0 0 0 1)。结论　 6～ 12岁儿童足跟部BMD与性别无关 ,而与年龄增加呈线性增长 ,这种增长与体重显著相关。     

儿科基础

051918广东省2002年学龄前儿童生长发育状况及评价/聂少萍…//中国学校卫生.-2005,26(2).-111～113调查结果显示男童生长发育状况优于女童,城市儿童优于农村儿童。肥胖发生率城市高于农村,其中0～1岁女童及4～6岁男童肥胖率较高,分别为7.8%,9.8%;消瘦率、低体重率、生长发育迟缓率农村明显高于城市,其中消瘦率以0～1岁年龄段最高;低体重、生长发育迟缓发生情况相似,男童均以4～6岁年龄段最高,女童均以2～3岁年龄段最高。表2参9(张小冬)051919北京市石景山区入托儿童健康状况分析/武一萍…//中国基层医药.-2004,11(11).-1397     

Relationship Between Low-Level Lead Exposure and Neurobehaviors of Preschool Children

目的　探讨低水平铅暴露对儿童神经行为的影响。方法　整群随机抽取某市幼儿园 4～ 6岁 2 11名儿童为研究对象 ,采指端末梢血 2 0 μl,原子吸收石墨炉法测定血铅 ,以血铅水平 10 0 μg/L为界 ,分为高血铅组(≥ 10 0 μg/L)和低血铅组 (<10 0 μg/L) ,采用Achenbach儿童行为量表 (CBCL)及自拟调查表进行问卷调查 ,其结果运用t ,χ2 检验 ,简相关及多元逐步回归等方法进行统计分析。结果　高血铅组外向行为得分及行为异常率(13.2 8± 6 .2 6 ,18.2 6 % )显著高于低血铅组 (9.98± 5 .4 6 ,7.2 9% ) (t =4 .0 6 77,χ2 =5 .4 70 ,均P <0 .0 5 ) ,血铅值与外向行为中多动、攻击、违纪因子分显著正相关 (r =0 .316 4 ,0 .2 82 8,0 .1886 ,P <0 .0 5 ) ,血铅值≥ 15 0 μg/L时 ,行为异常率显著增加 (χ2 =13.6 95 ,P <0 .0 5 )。结论　低水平铅暴露对儿童外向行为具有负性影响。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

How well are we doing? – Metabolic control in patients with diabetes

OBJECTIVE: To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. METHODOLOGY: Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. RESULTS: Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%). CONCLUSION: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.     

MAINTENANCE OF DIFFERENTIATED FUNCTION OF THE SURFACTANT SYSTEM IN HUMAN FETAL LUNG TYPE II EPITHELIAL CELLS CULTURED ON PLASTIC

We report a simplified culture system for human fetal lung type II cells that maintains surfactant expression. Type II cells isolated from explant cultures of hormone-treated lungs (18-22 wk gestation) by collagenase + trypsin digestion were cultured on plastic for 4 days in serum-free medium containing dexamethasone (Dex, 10 nM) + 8-bromo-cAMP (0.1 mM) + isobutylmethylxanthine (0.1 mM) or were untreated (control). Surfactant protein (SP) mRNAs decreased markedly in control cells between days 1 and 4 of culture, but mRNA levels were high in treated cells on day 4 (SP-A, SP-B, SP-C, SP-D; 600%, 100%, 85%, 130% of day 0 content, respectively) . Dex or cAMP alone increased SP-B, SP-C, and SP-D mRNAs and together had additive effects. The greatest increase in SP-A mRNA occurred with cAMP alone. Treated cells processed pro-SP-B and pro-SP-C proteins to mature forms and had a higher rate of phosphatidylcholine (PC) synthesis (2-fold) and higher saturation of PC (~34% versus 27%) than controls. Only treated cells maintained secretagogue-responsive phospholipid synthesis. By electron microscopy, the treated cells retained lamellar bodies and extensive microvilli. We conclude that Dex and cAMP additively stimulate expression of surfactant components in isolated fetal type II cells, providing a simplified culture system for investigation of surfactant-related, and perhaps other, type II cell functions.