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功能性构音障碍(functional articulation disorder,FAD)是最常见的语言障碍[1],患儿常因语音不清造成人际交往困难和一系列情绪及行为问题。目前国内有关FAD的研究较少,对FAD儿童感觉统合能力的研究尚未见报道。为探讨FAD儿童的感觉统合能力发展水平及其在FAD发生中的作用,我们对FAD患儿和正常儿童进行了感觉统合能力的对照研究,现将结果报告如下。1对象和方法1.1对象病例组:以2005-01—2006-06来我院发育儿科就诊的以吐字不清为主诉的6~12岁儿童为研究对象,符合FAD诊断标准者共38例,其中男35例,女3例。FAD的诊断依据日本听力言…     

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目的探讨弥散加权成像(DWI)、常规磁共振成像(MRI)在新生儿低血糖性脑损伤不同阶段的动态变化。方法回顾分析了2005年9月至2008年9月,中国医科大学附属盛京医院新生儿科收治的经MRI确诊的20例低血糖性脑损伤患儿(病例组)的临床资料,并随机选取同期住院MRI正常的20例单纯性低血糖患儿为对照组。结果病例组平均最低血糖值低于对照组(P<0.01),低血糖持续时间长于对照组(P<0.01)。病例组于低血糖发生后3.8(1～11)d完成首次MRI检查,受累部位主要为枕叶11例、枕顶叶8例,顶叶1例,受累部位在DWI均表现为高信号,常规MRI相应部位12例表现为T1加权成像(T1WI)、T2加权成像(T2WI)正常信号,仅6例表现为T1WI低信号、T2WI高信号;11例于首次检查后11.4(8～15)d完成第2次MRI检查,首次检查受累部位DWI7例转为正常信号,4例低信号,常规MRI均表现为T1WI低信号、T2WI高信号。3例于6个月随访,提示枕叶DWI正常信号,T1WI低信号、T2WI高信号。结论新生儿低血糖性脑损伤早期DWI表现为异常高信号的部位,与晚期常规MRI表现为T1WI低信号、T2WI高信号的部...     

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目的探讨氨溴特罗口服液改善毛细支气管炎患儿气道功能的疗效影响。方法将2009年11月至2010年9月广州市妇女儿童医疗中心93例毛细支气管炎患儿随机分为治疗组(氨溴特罗口服液组)和对照组。观察两组患儿治疗前后潮气呼吸流速-容量环(TBFV)的形态改变以及肺功能各项指标的变化。结果两组患儿治疗前TBFV环均变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷;治疗后明显好转。两组患儿治疗前各项主要参数比较,差异无统计学意义(P>0.05)。两组患儿治疗前后比较:呼吸频率(RR)、呼气峰流速(PEF)、呼吸系统阻力(Rrs)、每千克体重功能残气量(FRC/kg)均降低(P<0.05或P<0.01);每千克体重潮气量(VT/kg)、吸呼比(TI/TE)、呼气达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、呼气达峰容积(VPTEF)、达峰容积比(PFV)、呼出75%潮气量时的呼气流速/呼气峰流速(25/PF)、潮气呼气中期流速/潮气吸气中期流速(ME/MI)、每千克体重顺应性(Crs/kg)均增加(P<0.05或P<0.01)。其中治疗组与对照组比较,反映大小气道阻塞主要指标PFV、25/PF、ME/MI及肺顺...     

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??Abstract??Objective??To investigate alterations of circulating levels of the inflammatory markers— reflecting brain and adipose tissue inflammation—in the fetal growth restriction??FGR??fetuses and newborns??and explore its possible relation ship with adverse intrauterine development. Methods??Sixty parturients??hospitalized in Shengjing hospital of China Medical University??giving consecutively birth either to 30 appropriate for gestational-age??AGA?? singleton infants ??AGA group ?? or 30 FGR full-term singleton infants ??FGR group????were recruited.Plasm hs-CRP??PAI-1??S100B and leptin levels were determined by enzyme link immune assay??ELISA??in the umbilical cords blood ??UC ?? and venous blood from neonates on postnatal day 1 ??D1?? and day 4??D4??. Results??The birth weight??body length and the body mass index ??BMI?? of the FGR neonates were significantly lower compared with those of AGA group ??P < 0.05??.The leptin levels of UC in the FGR neonates were lower than that in the AGA groups??P < 0.05????and correlated positively with the birth weights and the BMI??P < 0.05??.Plasma hs-CRP levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05??.hs-CRP levels in Umbilical cords blood were significantly decreased when compared with D1 hs-CRP in both AGA and FGR groups ??P < 0.05????and D1 hs-CRP was significantly increasedwhen compared with respective D4 hs-CRP??P < 0.05??.Plasma PAI-1 and S100B levels did not differ significantly at all time points between AGA and FGR groups??P > 0.05????and did not correlated with the birth weights and the BMI. Conclusion??Despite the lower birth weight??BMI and leptin levels in FGRs?? there was no difference for the levels of inflammatory markers hs-CRP and PAI-1 between IUGR and AGA fetuses/neonates.The CRP level in both studied groups fluctuated from fetus to neonate stage might attribute to parturition stress and adaptation recovery.     

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??Objective??To explore the clinical characteristics of coinfections in children with pertussis. Methods??From February 2016 to September 2017??198 cases with pertussis-like symptom were tested for PCR??bacterial culture??respiratory virus antigen and serum mycoplasma pneumoniae antibody in Children’s Hospital of Soochow University. Results??Totally 198 patients were enrolled and 105 patients were B.Pertussis positive. Single infection was in 37 cases??35.2%??. Coinfections were observed in 68??64.8%?? children with pertussis??including co-infection with one pathogen in 51 cases??75.0%??. The most frequent co-infection pathogen was rhinovirus??50.9%??26 cases????followed by Mycoplasma pneumoniae??13.7%??7 cases?? and Streptococcus pneumoniae??11.8%??6 cases??. There was no statistical difference in the coinfection rate among different age groups??P = 0.08??. Pertussis coinfection with MP was increased with age. Coinfections patients were older than those with single infections???11.77±2.32?? months vs. ??6.74±8.07?? months??P = 0.017??. Fever??dyspnea??and positive signs of lung in chest imang were more common in children with mixed infections??0 vs. 10.3%??20.6% vs. 5.4%??76.5% vs. 36.4%??P??0.05??. Chest imaging showed pathy shadow in most cases. There was no significant difference in lab tests??such as white blood cell counts??neutrophil counts??C-reactive protein??CRP????course of disease prior to admission or hospital stay between patients with pertussis only and those with mixed-pathogen infections??P??0.05??. Patients older than 3 months??OR??3.0??95%CI 1.1-8.5??P??0.03?? and fever??OR??2.5??95%CI 1.1-6.7??P??0.03?? were the independent risk factors for mixed infections. Conclusion??There is a higher proportion of coinfection in hospitalized children with pertussis??most commonly co-infected with rhinovirus??followed by Mycoplasma pneumoniae and Streptococcus pneumoniae. Coinfections are found to aggravate pertussis. Fever and being older than 3 months are risk factors of mixed infection.     

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??Abstract?? Objective To investigate if there is an association between caesarean section and allergic rhinitis as well as asthma in Suzhou children and whether the association is affected by family history of allergies. Methods This study was based on the epidemiological investigation of asthma among children aged 0-14 years from Pingjiang area of Suzhou city in 2010. From 540 asthmatic children we selected 427 children aged 5 to 14 years?? 290 males and 137 females ?? the average age being ??8.46±2.3??years. Another 427 non-asthmatic children were chosen by 1:1 matching by the same sex and age with the asthma children ?? A total of 854 cases were chosen as the study population??Then analyze the survey data by using Chi-square test and Logistic regression analysis. Results Of the 854 children?? 388 were delivered by cesarean section??allergic rhinitis 158 cases??asthma 191 cases?? and 466 by vaginal??allergic rhinitis 146 cases??asthma 236 cases????After adjusting for potential confounders??caesarean section was associated with an increased risk of allergic rhinitis??OR=1.66??95%CI 1.21??2.29????Specifically??while approximately 2.6-fold higher odds of allergic rhinitis was observed in children with a family history of allergies??OR=2.58??95%CI 1.46??4.56????no association was observed in children without a family history of allergies??OR=1.42??95%CI 0.95??2.13????Children born by cesarean section had no higher risk of asthma than those delivered vaginally??OR=0.91??95%CI 0.68??1.22??. Conclusion The association of caesarean section and allergic rhinitis appears more remarkable in children with family history of allergies??However??caesarean section is not associated with asthma in childhood.     

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????Objective To observe and evaluate the clinical effect and adverse effects of the infliximab and etanercept in treating patients with juvenile idiopathic arthritis ??JIA??.Methods There were 26 patients of JIA treated with anti-TNF therapy from June 2008 to December 2011.All patients were divided into two groups?? including those treated with in?iximab??11 patients?? and those with etanercept??15 patients??.We assessed clinical effects by DAS28??inactive disease standards and clinical remission??CRM/CR???? evaluating adverse reactions of two drugs as well.Results After a follow up of 3 to 31 months??the clinical symptoms and laboratory indexes of two groups were all improved.We have found statistical differences in CRP of infliximab at the beginning of therapy and after 3 months??in ESR of etanercept at the beginning of therapy and after 6 months??in swollen joint counts of etanercept at the beginning of therapy and after 3??12months??P??0.05????in the numbers of tender joints ??or pain with activity?? of etanercept at the beginning of therapy and after 3??6 months.Our study also showed statistically signi?cant differences in DAS28 values at the beginning of therapy and after 3??6 months in etanercept??and at the beginning of therapy and after 3 months in infliximab.There was obvious decrease of DAS28 values in etanercept compared with infliximab in the treatment of 3??6 months??but infliximab group much lower than etanercept one in 12 months.We found no signi?cant differences in short term clinical effect between the two drugs??P??0.05??.Except rushes and pain caused by injection??there were no other side effects in the two groups.Conclusion Both in?iximab and etanercept can reduce DAS28 values and improve joint function in patients with JIA.We find no signi?cant differences in the responses??remissions or adverse effects between both drugs in the short term.There are no serious adverse reactions in both groups.     

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??Abstract?? Objective??To investigate the effects of early therapeutic intervention with nerve growth factor??NGF?? on brain damage following severe asphyxia in neonates. Methods??From Jan.2007 to Oct.2009??fifty-two cases of perinatal severe asphyxia in Guangzhou Children’s Hospital were randomly assigned to two groups?? the control group ??26 cases?? received routine treatment??including cerebrolysin and citicoline???? the study group ??26 cases?? was given NGF on the basis of routine treatment as early as possible ??within twenty-four hours after birth??. The incidence of the mortality were observed?? the degree of hypoxic-ischemic encephalopathy ??HIE?? was evaluated?? and the Neonatal Behavioral Neurological Assessment ??NBNA?? was done in both groups. Myelin basic protein??MBP?? and S-100 protein were measured dynamically by ELISA in serum from all patients. Results??There was no significant difference of the incidence of severe HIE and the mortality between the study group and the control group??23.08% vs 38.46%??χ2 = 1.4444??P > 0.05?? 3.85% vs 7.69%??χ2 = 0.0000??P > 0.05??. The level of blood serum MBP or S-100 protein in the asphyxiated newborns was higher than that of the normal term newborns. At 3d and 7??8d after birth??the level of blood serum MBP or S-100 protein in the study group was much lower than that in the control group. The percentage of the cases whose NBNA marks were less than 35 at 7??8 d and 14??16 d after birth in the study group was much lower than that in the control group??40.00% vs 70.83%??χ2 = 4.7055??P < 0.05??20.00% vs 50.00%??χ2 = 4.8640??P < 0.05??. Conclusion??Using NGF on the basis of the routine treatment as early as possible after resuscitation can reduce markedly the severity of asphyxia-induced brain damage in neonates.     

Clonidine poisoning in children: a recent experience

OBJECTIVES: To identify cases of clonidine poisoning presenting to a tertiary paediatric hospital and to investigate trends in presentation, outcome and prevention. Furthermore, any public health implications of the use of clonidine in children are to be explored. METHODS: Cases of clonidine poisoning presenting to Royal Children's Hospital were reviewed over the period from 1997 to 2001 (inclusive), with significant data obtained from coded medical records. RESULTS: Twenty-four cases of clonidine poisoning were identified over the 5-year period. Nine patients ingested their own medication, which was prescribed for attention-deficit hyperactivity disorder. Clonidine was prescribed for a child in 16 cases (67%). Impaired conscious state and bradycardia were the most common presenting features. Activated charcoal was given in 14 cases and volume expansion in six. There were 12 children (50%) who required admission to intensive care for monitoring, including three who received mechanical ventilation. The average length of stay was 25.7 h with no long-term complications. CONCLUSIONS: This is the largest series of clonidine poisoning in children recorded in Australia, with morbidity considerable. Emphasis needs to be placed on educating parents of clonidine's dangers in overdose to their own children as well as others.     

Which better predicts conduct problems? The relationship of trajectories of conduct problems with ODD and ADHD symptoms from childhood into adolescence

BACKGROUND: To assess the co-occurrence in deviant trajectories of parent-rated symptoms of conduct disorder (CD), oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) from age 4 to 18 years old in a general population sample of Dutch children. METHODS: Developmental trajectories of CD, ODD, and ADHD were estimated in a sample of 1,016 males and 1,060 females. Children's disruptive problem behaviors were rated at 5 time-points. The co-occurrence patterns between the deviant CD trajectory, and the high ODD and high ADHD trajectory were studied for males and females separately. RESULTS: Four percent of males and 2% of females followed a deviant CD trajectory. Six percent of the sample followed a high ODD trajectory, and 5% a high ADHD trajectory. Engagement in the deviant CD trajectory was predicted by ODD and ADHD in females, but only by ODD in males. CONCLUSIONS: Although ADHD co-occurs with CD, the association between ADHD and CD is largely accounted for by accompanying ODD. Gender differences should be taken into account in understanding the onset of CD.     

注意力缺陷多动障碍儿童定量脑电图研究

目的探讨注意力缺陷多动障碍(ADHD)汉族男童的脑电图特征。方法对70例ADHD汉族男童(包括混合型64例,注意缺陷为主型6例)及30例年龄匹配的健康汉族男童进行定量脑电图功率谱分析。记录安静闭目状态下的脑电图,经傅里叶转换得到总功率,α、β、θ、δ频段绝对及相对功率,以及θ/α、θ/β等。结果 ADHD组较正常对照组δ活动增多,β活动减少,前脑区的总功率及θ/β升高。两亚型相比,混合型较注意缺陷为主型θ、δ活动增多,β活动减少,总功率、θ/α、θ/β升高。不同程度注意力缺陷患儿相比,重度组较轻中度组α活动减少,δ活动增多,θ/α升高。结论 ADHD汉族男童的脑电图与正常对照组显著不同。定量脑电图功率谱分析对ADHD诊断、亚型区分及病情评估具有一定的鉴别作用,在ADHD研究与临床领域具有良好的应用前景。     

癫癎儿童健康相关生活质量研究

为探讨癫痫儿童的健康相关生活质量（HRQOL）及其影响因素,采用澳大利亚癫痫儿童生活质量父母问卷（QOLCE）对101例癫痫儿童进行生活质量的评估,以探讨影响因素并与正常儿童进行比较。结果表明,癫痫儿童的生活质量明显低于正常儿童,年龄、起病年龄、发作频率、发作类型、病程,抗癫痫药物及智力等均影响患儿的生活质量。提示对癫痫儿童应采取综合治疗措施,重视患儿的心理健康,才能提高其生活质量。     

Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND: In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner. METHOD: By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence. RESULTS: ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found. CONCLUSIONS: ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.     

临床下电活动癫痫患儿的健康生活质量

目的探讨临床下电活动癫患儿的健康相关生活质量(HRQOL)。方法门诊随访的癫患儿临床下电活动30例、有临床发作50例、无临床发作也无电活动28例和非癫对照儿童30例为研究对象,采用癫患儿生活质量父母问卷(QOLCE),由上述观察对象的父母或其他监护人完成问卷填写,按量表评分标准进行评分,得分高者生活质量好。结果临床下电活动组的多个分量表得分较对照组低;总的健康和自评生活质量量表得分高于有临床发作组。结论临床下电活动患儿生活质量虽好于有临床发作的癫患儿,但它仍明显影响患儿认知功能、行为,限制患儿日常生活,影响患儿的社会功能,使患儿的生活质量低于正常儿童。     

临床下电活动癫患儿的健康生活质量

目的 探讨临床下电活动癫患儿的健康相关生活质量（HRQOL）。 方法 门诊随访的癫患儿临床下电活动30例、有临床发作50例、无临床发作也无电活动28例和非癫对照儿童30例为研究对象,采用癫患儿生活质量父母问卷（QOLCE）,由上述观察对象的父母或其他监护人完成问卷填写,按量表评分标准进行评分,得分高者生活质量好。 结果 临床下电活动组的多个分量表得分较对照组低;总的健康和自评生活质量量表得分高于有临床发作组。 结论 临床下电活动患儿生活质量虽好于有临床发作的癫患儿,但它仍明显影响患儿认知功能、行为,限制患儿日常生活,影响患儿的社会功能,使患儿的生活质量低于正常儿童。     

提高癫(癎)儿童的生活质量是治疗的最终目的

在控制癫(癎)发作的同时关注生活质量,表达了21世纪癫(癎)治疗及相关服务中的一种值得注意的趋势.癫(癎)对患者生活质量影响的因素包括癫(癎)的类型、癫(癎)灶的部位、起病年龄、发作频率、持续时间和病程,特别是抗癫(癎)药物本身对儿童生活质量的影响.在癫(癎)治疗中,对于选择药物种类要权衡利弊,既要达到较好的治疗效果,又要尽可能地减少药物对患儿智力影响程度,并提倡单药治疗.癫(癎)治疗的目的 已不再是以控制发作为终点,而以在控制发作的同时提高患者的生活质量为治疗的终点.癫(癎)的治疗应该是在控制发作及提高生活质量间找到最佳结合点.