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关键词： 乡村资源   幼儿科学   实践活动   方法   分析   探究  

摘要： 随着我国教育的发展,我国愈发注重幼儿科学教育,城市的幼儿教育资源丰富,幼儿能够得到很好的科学启蒙教育。但是与城市相比,乡村受到地理因素、资源条件因素、教学设施等诸多因素的影响,导致乡村的幼儿科学教育阻碍重重。在此情况下,为了加强乡村幼儿的科学教育,有效开展幼儿科学实践活动,我们十分有必要利用乡村本地资源开展幼儿科学教育活动。本文就是探究如何利用乡村资源有效开展幼儿科学实践活动。

关键词： 胃炎   幽门螺旋杆菌   中医药疗法   中医儿科学  

摘要： 目的研究中医辨证治疗在儿童幽门螺旋杆菌感染相关胃炎(Hp胃炎)中的临床效果。方法选择儿科2017年6月—2019年2月收治的90例儿童Hp胃炎的患者资料作为研究对象,分为研究组和对照组,每组45例。其中研究组给予中医辨证治疗,对照组给予常规的西医西药治疗,疗程均为2周。在治疗前后分别检测患者的幽门螺杆菌水平,观察2组患者的临床治疗效果和临床症状的变化。结果 2组患者经过治疗,研究组患者的总有效率为88. 89%,高于对照组患者的总有效率66. 67%,差异有统计学意义(P <0. 05)。治疗前2组患者的泛酸、胃痛、嗳气以及饱胀等临床症状情况相比,差异没有统计学意义(P> 0. 05);治疗后2组患者的泛酸、胃痛、嗳气以及饱胀等临床症状情况相比,研究组明显优于对照组,差异有统计学意义(P <0. 05)。结论中医治疗儿童幽门螺杆菌感染中的临床效果确切,对缓解患者的临床症状方面明显好于常规的西医西药治疗,在临床上值得进一步推广。

关键词： Candida infection   candidaemia   candiduria   paediatric intensive care unit   vitamin D  

摘要： Background The prevalence of Candida infections in paediatric intensive care units (PICUs) has dramatically increased as a result of resistance to conventional anti-fungal treatments. Because vitamin D has been shown to exhibit fungicidal activity against Candida infection in an in vitro antimicrobial screening, we aimed to investigate the effect of vitamin D on Candida infections in the PICU. Methods Four hundred sixteen eligible children aged between 12 months to 5 years old admitted to the PICU, who were on broad-spectrum antibiotic therapy, participated in the study. Patients were randomly assigned to two study groups, receiving a plain yogurt drink (placebo group) or supplemented with 300 IU day(-1) vitamin D (VD group). Primary outcome was defined as the incidences of Candida colonisation (Candida isolated from rectal swab) 14 days after enrollment. Secondary outcome measures were Candida growth in blood (candidaemia) and urine (candiduria). Results The prevalence of candiduria as well as candidaemia was significantly lower in the VD-treated group (26 cases) than in the placebo group (62 cases). The mean (SD) length of PICU stay was obviously lowered in the VD group [11.8 (1.2) days] compared to the placebo group [15.2 (2.3 days)], whereas cases of patient death were similar between the two groups. Conclusions Supplementation of vitamin D effectively reduces infections of Candida in children who were critically ill and on broad-spectrum antibiotic treatment.

关键词： Paediatric   Malignant melanoma   Oncology   Sentinel node biopsy  

摘要： Introduction: Malignant melanoma is increasing in frequency worldwide;however, this disease is rare in children. As large-scale studies on paediatric melanoma are lacking, management is currently often based upon the understanding of the disease process in adults. The aim of this study was to characterise cases of paediatric melanoma diagnosed in the Republic of Ireland over a 21-year period. Methods: This was a retrospective, multicentre study using national data provided by the National Cancer Registry of Ireland and individual practitioners. Results: Twenty-four cases of melanoma treated in 11 different centres were included in the study. The median patient age at diagnosis was 15 years. The majority of cases arose on the limbs. The median Breslow thickness in patients of the pre-pubertal age group was 8.25 mm, while in children more than 13 years, it was 1.65 mm. Eight patients had disease recurrence and five patients died. Conclusion: The diagnosis of melanoma remains rare in children. This study contributes to our current understanding of malignant melanoma in paediatric patients;however, further investigation of the disease characteristics in this group is necessary to achieve optimal management of these cases and therefore improve outcomes. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

关键词： intestinal transplantation   open abdomen   procurement procedure   tissue (non-vascularized) transplantation   wound healing  

摘要： Primary abdominal wall closure after intestinal and multivisceral transplantation may not be possible because of loss of abdominal domain and/or graft size/abdominal cavity mismatch. Traditional closure techniques for the open abdomen may not be valid in these circumstances because of severe scarring of the abdominal wall from multiple previous surgeries in this particular group of patients. We present our initial experience with the use of non-vascularized abdominal rectus muscle fascia in two patients who underwent deceased donation and living-related combined liver and small bowel transplantation, respectively, and who could not be closed primarily. The donor fascia was attached to the recipient fascia in both patients. In either case, there was not enough skin cover for closure, the wound was left open, and a negative pressure dressing was applied. In both cases, over a period of 6 months after placement of the non-vascularized abdominal rectus muscle fascia, the wound contracted, granulation tissue gradually covered the wound, and healing occurred, giving an intact abdominal wall. The abdominal rectus muscle fascia from a deceased donor can be used in a definite procedure for closure of the abdominal wall either at the time of transplant or later when a suitable rectus muscle fascia graft becomes available.

关键词： Acute lymphoblastic leukaemia   Children   Microarray   High hyperdiploid BCP-ALL  

摘要： The aim of our study was to characterize genetic alterations in a cohort of paediatric patients with B-cell progenitors (BCP-ALL) and a hyperdiploid karyotype. In our study, we analysed 55 childhood hyperdiploid BCP-ALL patients using single nucleotide polymorphism (SNP) microarray testing. The group consisted mostly of patients with the modal number of chromosomes between 54 and 58 (34 cases). Within this group, Trisomy 4 and Trisomy 10 (30 cases) were the most frequent cases. Additionally, a total of 93 structural abnormalities mainly affecting chromosomes 1, 6, 9, 12, and 17 as well as 68 copy number alterations (CNAs) were identified. The microarray testing revealed a loss of ETV6, IKZF1, CDKN2A/CDKN2B, PAX5, and RB1. Moreover, chromosomal abnormalities resulting in the loss of heterozygosity (LOH) were also observed. Currently, patients with hyperdiploidy constitute a genetically heterogeneous group, and therefore, it is insufficient to rely only on banding cytogenetic analysis for the identification of hyperdiploid karyotype. Microarray testing has been proven an effective and satisfactory tool for the analysis of molecular karyotypes and to redefine the prognostic criteria in hyperdiploid patients.

关键词： acute kidney injury   children   dialysis   mortality   sub-Saharan Africa  

摘要： Background. Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods. Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post-admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results. Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9-9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7-5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8-8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions. AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.

摘要： Background: Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change. Methods: We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children- aged 6 months to 4 years- were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes. Results: In total, 201 procedures in 90 children aged 19 +/- 8 months were completed. The median maximum pain was FLACC 0 in all groups (p =0.141). The feasibility was better for groups K-6 (p= 0.049) and K-8 (p =0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36+22min) compared with groups K-4 (25+15min;p=0.003) and K-6 (27+20min;p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p <0.0001) and K-6 (p =0.023). One child in group K-8 had a study drug-related serious adverse event - laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6. Conclusions: A rectally administered mixture of racemic ketamine (6mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.