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摘要： Paediatric hypotrichosis is the clinical feature of paucity of hair arising congenitally or in early life. It is a hallmark finding of a diverse group of genodermatoses and sporadic disorders, presenting as either an isolated symptom or in association with syndromic features. Hypotrichoses are rare, with numerous possible differentials requiring a thorough clinical assessment, additional investigations for hair shaft abnormalities, and occasionally genetic counselling to reach a diagnosis. We propose a clinical algorithm for the investigation and diagnosis of paediatric hypotrichosis, designed to aid the clinician by utilising key clinical findings in conjunction with the forced hair pull test and trichogram to differentiate groups of hair shaft and hair loss disorders. The initial clinical approach aims to identify the patient's history of hair growth and loss and the phenotypical features of hair. Abnormal hair that is sparse, short, brittle, fragile is characteristic of a range of isolated hereditary hair shaft disorders, with variable sparing of non-scalp hair. Presence of systemic features suggests syndromic disorder, for example, abnormalities in the skin, hair, nails and teeth are indicative of an ectodermal dysplasia. Bedside tests such as trichoscopy and a forced hair pull test may yield further valuable diagnostic features and can be followed up with a trichogram or scalp biopsy. Negative findings in the presence of an otherwise systemically well child may suggest an isolated hereditary hypotrichosis (HYPT1-12). Management is generally conservative in nature, with limited but emerging data suggesting a potential role for the use of oral biotin, topical minoxidil and topical retinoids in the treatment of some forms of intractable hypotrichoses.

关键词： adverse motor outcome   cerebral palsy   children   cohort studies   hemiplegia   ischaemic stroke  

摘要： Background Various frequencies of adverse motor outcomes (cerebral palsy and hemiplegia) after paediatric ischaemic stroke have been reported. Few reports on the risks of adverse motor outcomes in nationwide cohorts and contributing risk factors are available. Objectives To assess risk of adverse motor outcome and potential risk factors thereof after paediatric ischaemic stroke in a nationwide cohort. Methods This nationwide matched cohort study identified 877 children <18 years of age diagnosed with ischaemic stroke through the Swedish national health registers from 1997 to 2016. These children, exposed to ischaemic stroke, alive 1 week after stroke, were matched for age, sex and county of residence with 10 unexposed children. Using Cox regression, we estimated the risk of adverse motor outcomes in children with stroke compared to that in unexposed children. Logistic regression was applied to compare the characteristics of children with and without adverse motor outcomes after stroke. Results Out of the 877 children with ischaemic stroke, 280 (31.9%) suffered adverse motor outcomes compared with 21 (0.2%) of the 8770 unexposed: adjusted hazard ratio (aHR) 167.78 (95% confidence interval (CI) 107.58, 261.66). There were no differences between risk estimates of adverse motor outcome according to age at stroke: perinatal stroke (aHR 124.11, 95% CI 30.45, 505.84) and childhood stroke (aHR 182.37, 95% CI 113.65, 292.64). An association between adverse motor outcome and childhood stroke aOR 1.56 (95% CI 1.05, 2.31) was found when analysing only children with ischaemic stroke. No associations were found between adverse motor outcome and sex, gestational age or parental age at birth. Conclusions The risk of adverse motor outcome is substantial after paediatric ischaemic stroke, especially childhood stroke, confirming results of previous smaller studies. This study found no associations between sex, gestational age or parental age and adverse motor outcome after paediatric

关键词： children   COVID-19   prevalence   respiratory virus   SARS-CoV-2  

摘要： Aim To investigate the prevalence of infections by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses among children admitted to paediatric emergency departments (PEDs). Methods From April to July 2020, a prospective, multicentre cohort study was conducted in the PEDs of eight French university hospitals. Regardless of the reason for admission, a nasopharyngeal swab sample from each child was screened using reverse transcription polymerase chain reaction tests for SARS-CoV-2 and other respiratory viruses. We determined the prevalence of SARS-CoV-2 and other respiratory viruses and identified risk factors associated with a positive test. Results Of the 924 included children (median [interquartile range] age: 4 years [1-9];boys: 55%), 908 (98.3%) were tested for SARS-CoV-2. Only three samples were positive (0.3%;95% confidence interval: 0.1-1) and none of these children had symptoms of coronavirus disease 2019. Of the 836 samples (90%) tested for other viruses, 129 (15.4%) were positive (primarily rhinovirus). Respiratory viruses were significantly more common in young children and in children with respiratory tract symptoms and fever. Conclusion The prevalence of SARS-CoV-2 among children admitted to emergency departments was low. In contrast, and despite social distancing and other protective measures, the prevalence of other respiratory viruses detection was high.

关键词： Intra-dialytic hypotension   Haemodialysis   Child   Quality improvement  

摘要： Background Intra-dialytic hypotension (IDH) is the most common serious adverse event in paediatric haemodialysis (HD). Repeated IDH results in chronic multi-organ damage and increased mortality. At the Hospital for Sick Children, Toronto, retrospective data from all in-centre HD sessions revealed frequently occurring IDH events (16.5 +/- 5.6% of HD sessions per week). Based on literature review and clinical expertise, fluid volume management was selected as a potential modifiable risk factor to decrease IDH. Root causes identified as contributing to IDH were incorporated into a Paediatric haemodialysis fluid volume management (PedHDfluid) program using the Model for Improvement methodology including rapid cycles of change. Methods Multiple measures were evaluated including (i) Outcome: IDH events per number of HD sessions per week;(ii) Process: number of changes to estimated dry weight per number of HD sessions per week;(iii) Balancing: time spent on dry weight meeting per week. Data was analysed using statistical process control charts. We aimed to decrease IDH in our dialysis unit to < 10% of HD sessions per week over a 6-month period by implementing a PedHDfluid program, including a multifaceted dry weight assessment protocol, multidisciplinary meetings and electronic health records "Dry Weight Evaluation flow sheet/synopsis". Results The project resulted in a decline in IDH events from 16.5 +/- 5.6% to 8.8 +/- 3.3% of HD sessions per week. More frequent dry weight changes and increased awareness of fluid removal goals were noted. Conclusions A multidisciplinary approach including regular assessment, guidelines and systematic discussion, with an embedded electronic health record assessment and data gathering tool may sustainably reduce IDH events.

关键词： PET   EANM dosage card   PET   MR systems  

摘要： Aim Recent advancements in PET technology have brought with it significant improvements in PET performance and image quality. In particular, the extension of the axial field of view of PET systems, and the introduction of semiconductor technology into the PET detector, initially for PET/MR, and more recently available long-field-of-view PET/CT systems (>= 25 cm) have brought a step change improvement in the sensitivity of PET scanners. Given the requirement to limit paediatric doses, this increase in sensitivity is extremely welcome for the imaging of children and young people. This is even more relevant with PET/MR, where the lack of CT exposures brings further dose reduction benefits to this population. In this short article, we give some details around the benefits around new PET technology including PET/MR and its implications on the EANM paediatric dosage card. Material and methods Reflecting on EANM adult guidance on injected activities, and making reference to bed overlap and the concept of *** bed(-1) kg(-1), we use published data on image quality from PET/MR systems to update the paediatric dosage card for PET/MR and extended axial field of view (>= 25 cm) PET/CT systems. However, this communication does not cover the expansion of paediatric dosing for the half-body and total-body scanners that have recently come to market. Results In analogy to the existing EANM dosage card, new parameters for the EANM paediatric dosage card were developed (class B, baseline value: 10.7 MBq, minimum recommended activity 10 MBq). The recommended administered activities for the systems considered in this communication range from 11 MBq [F-18]FDG for a child with a weight of 3 kg to 149 MBq [F-18]FDG for a paediatric patient weight of 68 kg, assuming a scan of 3 min per bed position. The mean effective dose over all ages (1 year and older) is 2.85 mSv. Conclusion With this, recommendations for paediatric dosing are given for systems that have not been considered previousl

关键词： adverse drug events   medication safety   paediatric critical care   paediatric intensive care   patient safety  

摘要： Aims The aim of this study was to assess the incidence, nature, preventability and severity of adverse drug events (ADEs) across three paediatric intensive care units (PICUs) in England. Methods A prospective observational cohort study was conducted across three PICUs over a three-month period during 2019. Included patients were aged <= 18 years and stayed in PICU for a minimum of 24 hours. Identification of suspected ADEs was performed by trained PICU pharmacists. A multidisciplinary expert panel assessed causality, preventability and severity of events. Results A total of 302 patients were included and 62 ADEs were confirmed (definite/probable causality). One in six patients experienced one or more ADEs. The estimated incidence of ADEs were 20.5 per 100 patients (95% CI 15.3-27.5) and 16.7 per 1000 patient-days (95% CI 9.3-29.9). The majority of ADEs were judged preventable by the expert panel (36/62, 58.1%). ADEs were commonly involved with medicines prescribing (29/62, 46.8%) and caused temporary patient harm (42/62, 67.7%). Medications for the central nervous system (14/62, 22.6%), infections (13/62, 20.9%) and cardiovascular system (12/62, 19.4%) were commonly implicated with ADEs. Multivariable analysis revealed that patients who stayed in PICU for >= 7 days (OR 6.29, 95% CI 2.42-16.32) were more likely to experience an ADE compared to patients with a stay of 1-6 days. Conclusion ADEs are common in English PICUs and most of them may be preventable. There is a strong association between ADE occurrence and duration of PICU stay, which represents a target for remedial interventions. Exploring contributory factors of preventable ADEs is now necessary to inform preventive policies.

关键词： 蒯氏   中医儿科   传承  

摘要： 目的:探索挖掘齐鲁医派潍坊蒯氏中医儿科的形成背景、源流及学术思想特色。方法:采用传统医史文献整理研究方法和现代数据库挖掘技术相结合的研究手段,对蒯氏中医儿科的形成背景、源流及学术思想特色进行系统分析和总结。结果:潍坊蒯氏中医儿科起源于清代,盛于建国前后。蒯氏中医儿科学术思想来源于中医经典,传承于学术交流,创新于融会新知,重视脾胃后天之本,强调“肝常有余,脾常不足,肺脏娇嫩”,提倡疾病的分期、分型施治,特别是急慢惊风、湿疹、疳证、腹痛腹泻等。结论:蒯氏中医儿科的学术思想对现代中医临床仍有较大的指导意义,值得深入研究和借鉴。

关键词： 混合式教学模式   儿科   临床带教   传染病学   呼吸病学  

摘要： 临床实习是医学生从理论学习过渡到实践的重要阶段,是培养未来合格医学人才的重要环节。临床实践带教中,合适的教学模式有助于提高学生的学习主动性和积极性,培养学生的临床思维,提高学习效果。本文从儿科学临床实习生带教实践出发,分析讲授式教学法、以案例为基础的教学法、基于问题的学习法及混合式教学法的优缺点,认为新时代单一的教学模式无法适应教学的发展,混合式教学模式的应用更能满足儿科临床带教的要求,以期不断提高实习生培训的质量。

关键词： 翻转课堂   中医儿科学   理论教学  

摘要： 目的探索翻转课堂教学模式在中医儿科学教学中的应用效果。方法选择长春中医药大学中医学专业大四级开设中医儿科学的1个班级(60名)的学生作为主要研究对象,将中医儿科学专业课程的内容划分为前半段、后半段2门课程。前半段的课程是运用中医药传统的教学模式(对照组)进行教学,后半段的课程是运用中医药翻转课堂的教学模式(实验组)教学,在不同阶段的课程完成时,对2组教学模式下的学生分别进行考核,按照评分标准进行评卷,并将教学情况制作成调查问卷,发放给学生进行调研。结果实验组的理论测试成绩远远优于对照组(P<0.05),且实验组中有98%的学生对该项目的教学方法予以肯定。结论翻转课堂式教学模式可提高学生的学习成绩、学习兴趣,同时还能够充分培养学生的学习思维能力和学生临床教学思考分析能力,实现以学生为主体的教学模式的转化。