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关键词： Epidemiology   Registries   Renal biopsy   Nephrotic syndrome  

摘要： Background: Information about renal diseases in children is available from national registries of renal biopsies. Aim of the study was to compare the clinical presentation of glomerular diseases and tubulointerstitial space diseases with pathohistological diagnosis of indicated renal biopsies from pediatric population in the Croatian region of Dalmatia. Methods: Out of 231 pediatric patients with suspected glomerular and tubulointerstitial diseases, 54 underwent ultrasound-guided renal biopsy at University Hospital of Split. Kidney allograft biopsy, and re-biopsy were excluded. The biopsy sections were examined under light microscopy, immunofluorescence and electron microscopy. The data was reviewed to determine the pathohistological spectrum and clinicopathologic correlations. We retrospectively analyzed kidney biopsy data from 2008 to 2017 and compared them to that between 1995 and 2005. Results: The mean age of patients was 9.84 +/- 5.4 years. Male:female ratio was 1.2:1. The main indications for biopsy were pure nephrotic syndrome without hematuria (25.9%), non-nephrotic proteinuria with haematuria (22.2%), nephritic syndrome with nephrotic proteinuria (18.5%), and isolated hematuria (16.7%). The most common pathohistological findings were IgA nephropathy (IgAN, 24.1%), minimal change disease (MCD, 16.7%), Henoch-Schonlein purpura glomerulonephritis (HSPN, 14.8%), Alport syndrome and focal segmental glomerulosclerosis (AS and FSGS, 11.1% each), tubulointerstitial nephritis and membranous glomerulopathy (TIN and MGN, 3.7% each), while other cases were diagnosed rarely. Conclusions: Changes in epidemiology of renal diseases in children between the analyzed periods showed an increasing trend of IgAN, MCD, HSPN, AS and FSGS, while mesangioproliferative glomerulonephritis (MesPGN) and endoproliferative glomerulonephritis (EDGN) showed a decreasing trend that can be explained with the new pathohistological classification.

关键词： Neonate   Children   Ultrasound   Point of care ultrasound (POCUS)   Paediatric intensive care unit (PICU)   Neonatal intensive care unit (NICU)  

摘要： BackgroundPoint-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and *** of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this *** agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C).ConclusionsEvidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

关键词： 幼儿园   科学教育   有效途径   学习环境  

摘要： 科学教育是教育领域崭新提出的幼儿园五大领域教育理念中的重要组成部分,科学教育的目标要求教师在幼儿教育工作中重点培养幼儿的认识兴趣和探究欲望,并将科学教育成果应用到生活问题的实际解决中,这要求教师要贴合幼儿的学习兴趣帮助幼儿进行知识理解,贴合幼儿的生活实际提高幼儿对教育内容的应用程度。为了达到科学教育的教学目标,教师应做好课程的教学设计合理的在幼儿班级中开展科学教育。

关键词： 中医儿科学   教学   案例教学法  

摘要： 探讨中医儿科学教学中案例教学法的应用效果。方法:随机选取本校中医药系130例中医学专业在校学生作为研究对象,采用随机数字表法进行分组,分为常规组与观察组。常规组65例,实施传统教学法;观察组65例,实施案例教学法。观察两组学生的课间实习质量评分、案例分析成绩以及综合成绩。结果:两组基础知识题成绩无显著差异(P>0.05);与常规组相比,观察组的课间实习质量评分、案例分析成绩以及综合成绩较高(P<0.05)。结论:中医儿科学教学中应用案例教学法,学生成绩得到明显提升,值得推广。

关键词： Alveolar soft part sarcoma   Orbital tumour   Tumour recurrence   Histopathology   Differential diagnosis  

摘要： Background Alveolar soft part sarcoma (ASPS) is a clinically and morphologically distinct malignant soft tissue tumour. It occurs mostly in the lower extremities in adults. The purpose of our study was to describe the related clinicopathologic factors, treatment and prognosis of recurrent orbital ASPS in children. Case presentation Three children aged from 1 to 12 years presented with unilateral proptosis, restricted ocular motility and impaired visual acuity of the affected eye. Periodic acid Schiff (PAS) -positive diastase-resistant crystalline granules were found in all cases. Immunostaining of TFE-3, INL1 and Ki67 was positive in the tumour cells of two patients. The time until local recurrence of primary tumor in patient 2 and patient 3, who only underwent tumour resection, was shorter than that of patient 1, who underwent tumour excision and postoperative radiotherapy. The recurrent masses were successfully treated with complete tumour excision followed by adjuvant radiotherapy. Patient 1 presented metastasis at 11 years after radiotherapy. Conclusions Orbital ASPS in children is easily misdiagnosed due to its rare occurrence and atypical clinical findings. Early diagnosis with multidisciplinary, complete surgical resection combined with adjuvant radiotherapy is essential for achieving long-term disease-free survival in orbital ASPS patients.

关键词： 儿科学   临床教育   人文学教育  

摘要： 医学既是一门科学,又是一门人文学。医学中所蕴含的人文精神是每一名医疗工作者在职业生涯中所必须理解与践行的。随着我国医疗卫生水平的逐渐提升,医疗行业迎来蓬勃发展的态势。在新时期的儿科学临床教育教学工作中,必须高度重视对专业学生人文素养的培育,落实人文学教育,确保每一名而科学临床教育专业的学生都能以严谨负责的职业态度和为病患服务人文关怀投入到工作实践中,促进我国医疗卫生事业的发展。

关键词： Meningitis   cytokines   bacteria   cerebrospinal fluid   helper T subsets  

摘要： Purpose: Given the challenge in the diagnosis of bacterial meningitis (BM), we assessed different cytokines in the cerebrospinal fluid (CSF) of antibiotics pre-treated patients. Materials and methods: Laboratory tests and polymerase chain reaction (PCR) were performed for 480 CSF samples from children (2 m to 14 y), suspicious to meningitis and pre-treated with antibiotics, to detect bacterial and viral aetiologies. Sixty-one CSF were included and the levels of 13 cytokines such as IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17F, IL-21, IL-22, IFN-gamma and TNF-alpha were measured using flow-cytometry. Results: All bacterial cultures were negative, but 29 and eight CSF were positive for bacterial and viral agents by PCR. IL-6, IL-10 and IFN-gamma were significantly up-regulated in BM. T helper (Th) subset cytokines showed significant upregulation of Th1, Th2, Th17, Th22 and Tfh cytokines in BM. Common Th subsets cytokines (IL-6, IL-10 and TNF-alpha) were significantly different between the study groups. ROC curve analysis revealed good AUC for common Th related cytokines in discriminating BM. Conclusions: In pre-treated BM patients with negative bacterial cultures, cytokines IL-6, IL-10 and IFN-gamma can predict BM which could be beneficial for rapid diagnosis and treatment to decrease the sequela of the disease.

关键词： Vaccine safety   Vaccine effectiveness   Post-marketing surveillance   Rotavirus   RotaTeq (R)   Intussusception  

摘要： Background: Rotavirus results in a significant burden of hospitalisations and deaths globally. Rotavirus vaccine has been used in New Zealand since July 2014. The aim of this study was to assess the safety and effectiveness of RotaTeq (R) vaccine in New Zealand between 2006 and 2016. Methods: A national cohort study of 723,695 children aged less than 6 years was carried out using linked administrative datasets. Study outcomes were hospitalisation for intussusception, rotavirus, and all-cause gastroenteritis. Intussusception hospitalisation rates were calculated from 2006 to 2016, and rotavirus and all-cause gastroenteritis hospitalisation rates from 2011 to 2016. We examined the effect of RotaTeq (R) vaccination on rotavirus and all-cause gastroenteritis hospitalisation rates using Poisson regression. Adjusted incidence rate ratios controlled for sex, year of birth, ethnicity, socioeconomic deprivation, and district health board area. Results: Significant reductions in the incidence of rotavirus hospitalisation were seen in all age groups, ethnicities, and deprivation following the introduction of RotaTeq (R). There was a 92.6% reduction in hospitalisation incidence in the vaccinated cohort (p < 0.0001). There was also a 48% reduction in all-cause gastroenteritis hospitalisation incidence in the vaccinated cohort (p < 0.0001). The average annual intussusception rate in children aged less than 3 years was 26.2 per 100,000, with no significant change over time (p = 0.847). Conclusions: In New Zealand the introduction of RotaTeq (R) resulted in a significant reduction in rotavirus hospitalisation, and a halving in all-cause gastroenteritis hospitalisation. There has been no change in the overall incidence of intussusception or clear change in patterns of cases, although intussusception cases did occur within risk period immediately post vaccine. (C) 2019 Elsevier Ltd. All rights reserved.

关键词： Burnout   Burn out   Work stress   Pediatric nurses   Pediatrics   Pediatrics   Nurses  

摘要： Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

关键词： Streptococcus pneumoniae   PCV7   PCV13   Japan   Serotype replacement   12F  

摘要： Streptococcus pneumoniae is still one of the major causes of morbidity and mortality worldwide. In Japan, pneumococcal conjugate vaccine (PCV)7 and PCV13 were licensed in 2010 and 2013, respectively. We conducted a nationwide paediatric invasive pneumococcal disease (IPD) and non-IPD surveillance study in Japan between 2015 and 2017. We collected 498 IPD isolates and 231 non-IPD isolates from a total of 187 medical institutions in japan. We performed serotyping, antimicrobial susceptibility testing and multi-locus sequencing typing (MLST) for the collected isolates. Among the 498 1PD isolates, the most prevalent serotype was 24F, followed by 12F, 15A and 15B/C. However, 12F increased and 24F significantly decreased during the study period (p < 0.001), resulting in 12F becoming the most prevalent serotype in 2017. Among the IPD isolates, the PCV7 and PCV13 coverage rates were 0.8% and 9.2%, respectively. The most prevalent serotype among the non-IPD isolates was 15A, followed by 35B, 15B/C and 19A. The overall resistance rates to penicillin (PG), cefotaxime (CTX), meropenem (MEM), erythromycin (EM) and levofloxacin (LFX) were 40.5%, 12.2%, 19.4%, 91.8% and 0.5%, respectively. PG, CTX and MEM resistance rates were significantly higher in non-IPD isolates than in IPD isolates (p < 0.001). Serotype 15A-CC63 and serotype 35B-CC558 tended to be multi-drug resistant. In conclusion, the PCV13 coverage rate was significantly lower than that in a previous surveillance study in Japan between 2012 and 2014, and IPD cases attributable to serotype 19A also decreased. We should note the rapid increase in the prevalence of serotype 12F in IPD cases and the spread of the multi-drug resistant serotype 15A-CC63 and 35B-CC558 lineages. (C) 2019 Elsevier Ltd. All rights reserved.