背景  功能性消化不良作为临床常见疾病，其指南及共识众多，但质量参差不齐。目的  了解功能性消化不良的临床指南与共识的现状，评价和分析其质量，为今后的临床决策和指南的修订及完善提供参考。方法  检索中国知网、万方数据知识服务平台、维普网、PubMed、Web of Science、OVID、Embase；同时补充检索国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网络、美国国立指南库、医脉通、中华医学会等数据库；检索时间限定自建库至 2024-03-30。由经过培训并对条目理解一致的研究者独立使用 AGREE Ⅱ和 RIGHT 工具对纳入指南进行质量评价。结果  共纳入指南及共识 17 篇。AGREE Ⅱ评价结果表明，6 个领域的平均得分依次为范围和目的（71.49%±2.38%）、参与人员（42.48%±5.03%）、严谨性（36.00%±5.88%）、清晰性（60.29%±5.05%）、应用性（20.47%±2.69%）、独立性 50.00%（0，57.29%）；9 篇推荐等级为 B 级，8 篇推荐等级为 C 级，无 A 级文献。RIGHT 评价结果显示 7 大领域的平均报告率分别为基本信息（70.83%±3.03%）、背景（68.02%±2.98%）、证据 15.00%（10.00%，55.00%）、推荐意见（36.76%±3.21%）、评审和质量保证 0（0，6.25%）、资助与利益冲突声明和管理（25.37%±5.18%）及其他方面 16.67%（0，37.50%）。结论  功能性消化不良的临床实践指南及专家共识方法学及报告质量整体有待提升，建议严格按照 AGREE Ⅱ各领域要求及参考 RIGHT 清单撰写指南。

Background: Childhood obesity is linked to both neuroticism and subjective wellbeing (SWB); however, the causal relations between them remain unclear. Methods: Two-sample Mendelian randomization (MR) analysis was applied to determine the causal effects of childhood BMI ( n = 39,620) on neuroticism ( n = 366,301) and SWB ( n = 298,420) using summary statistics from large scale genome-wide association studies (GWASs). Inverse-variance weighting (IVW), weighted mode, weighted median, and MR-Egger approaches were used to estimate the causal effects. Sensitivity analyses including the Cochran's Q statistics, MR-Egger intercept test, MR-PRESSO global test, and the leave-one-out (LOO) analysis were used to assess potential heterogeneity and horizontal pleiotropy. Two-step MR mediation analysis was employed to explore the potential mediation effects of neuroticism on the causal relationship between childhood BMI and SWB. Results: Our study revealed that genetically predicted higher childhood BMI was causally associated with increased neuroticism (beta = 0.045, 95%CI = 0.013,0.077, p = 6.066e-03) and reduced SWB (beta = -0.059, 95%CI = -0.093,-0.024, p = 9.585e-04). Sensitivity analyses didn't detect any significant heterogeneity and horizontal pleiotropy (all p > 0.05). Additionally, the two-step MR mediation analysis indicated that the causal relationship between childhood BMI and SWB was partially mediated by neuroticism (proportion of mediation effects in total effects: 21.3 %, 95%CI: 5.4 % to 37.2, p = 0.0088). Conclusion: Genetically proxy for higher childhood BMI was associated with increased neuroticism and reduced SWB. Further studies were warranted to investigate the underlying molecular mechanisms and potential use of weight management for improving personality and SWB.

BackgroundThis overview of systematic reviews (SRs) and meta-analysis (MAs) aimed to systematically collate, appraise and synthesize evidence of probiotics for functional constipation (FC) in children.MethodsSRs/MAs of probiotics for FC in children were systematic identified by searching Cochrane Library, PubMed, Embase, and Web of science. Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were unitized by two reviewers independently to assess the methodological quality, reporting quality, and quality of evidence, respectively.ResultsSeven SRs/MAs met the eligibility criteria and were included in this study. According to AMSTAR-2, a very low methodological quality assessment was given to the included SRs/MAs due to the limitations of items 2, 4 and 7. For the PRISMA statement, the overall quality of reporting was unsatisfactory due to the lack of reporting on protocol, risk of bias across studies, synthesis of results, and additional analysis. According to GRADE, the quality of evidence for outcomes was rated as very low to moderate.ConclusionsProbiotics may be beneficial in improving FC in children. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs/MAs are needed to provide robust evidence for definitive conclusions.

成都中医药大学基于新时代创新型人才培养理念要求,结合中医儿科学专业特色,构建了以"班级+协会"联动培养板块、"本硕博融通"朋辈导师培养板块、儿科临床实践培养板块、优秀学子访学培养板块、社会资源助学培养板块为培养途径的"五位一体"第二课堂平台,通过与第一课堂的有机融合,不仅强化了学生的理论和实践结合的能力,提升了学生的专业认识和专业信心,而且促进了高校间、校企间的合作开展,有效提高了中医儿科专业人才培养质量,实现了立体化、多维度的中医儿科人才培养模式.

目的 系统评价中国儿童抽动障碍预后的影响因素.方法 计算机检索PubMed、EM base、T he Cochrane Library、Web of Science、CBM、维普、万方以及中国知网数据库,全面收集中国儿童抽动障碍预后影响因素的观察性研究,检索时限均为从建库至2022年4月.由两名研究员独立进行文献筛选、资料提取,并选用纽卡斯尔-渥太华量表(NOS)进行纳入文献的质量评价.采用RevMan 5.4软件进行Meta分析.结果 检索文献共3572篇,最终纳入10篇,包含2项病例对照研究和8项队列研究,共包含1699例中国抽动障碍患儿.Meta分析结果显示,精神、神经疾病家族史[OR=3.17,95％CI(1.51,6.66)]、共患病[OR=2.55,95％CI(1.68,3.87)]、病情反复频数[OR=3.65,95％CI(2.06,6.48)]、病情严重程度[OR=1.52,95％CI(1.19,1.94)]、反复呼吸道感染[OR=1.33,95％CI(1.22,1.44)]、家庭环境[OR=3.00,95％CI(1.50,5.99)]是影响中国儿童抽动障碍预后的危险因素.结论 精神、神经疾病家族史、共患病、病情反复频数、病情严重程度、反复呼吸道感染、家庭环境与中国儿童抽动障碍预后不佳相关.

"卫气津营血精神"七纲理论由四川省十大名中医吴康衡教授在"卫气营血"理论基础上提出,系统总结了外感温热类疾病各个阶段的诊治方药.过敏性紫癜是儿科常见疾病之一,临床常表现出类似于温病的证候特点.本文探讨了以"卫气津营血精神"七纲理论治疗过敏性紫癜的方法,依据过敏性紫癜各个阶段的临床表现,将过敏性紫癜治法分为解表透卫、清热泻脾、凉润生津、清热透营、清热凉血、滋阴生精、补气养神七类,常用木贼宣痹汤、泻黄散、竹叶石膏汤、清营汤、五草五炭汤、加减复脉汤、清心莲子饮等方剂加减,进一步丰富"卫气津营血精神"七纲理论的临床应用.

在完成文献检索评级、综述总结撰写的基础上,通过专家调查问卷及专家论证会、公开征求意见等步骤形成《儿童鼻鼽中医诊疗指南(修订)》.修订内容主要包含指南适用范围、规范性引用文件、术语定义、诊断、辨证、治疗、预防和调护建议等,旨在突出临床实用性,为合理、规范应用中医药进行儿童鼻鼽防治提供关键的理论与实践指导.

新型冠状病毒(简称"新冠")感染自爆发以来,各国经济发展和社会稳定均受到不同程度的影响.新冠感染患儿少见危重症,无症状感染者比例高,多数患儿临床症状轻、预后好.中医药在新冠疫情中充分发挥整体审查、辨证论治和三因制宜的独特优势,在疫情防控中扮演了重要角色.该文从儿童新冠感染的中医认识、中医治疗及预防3个方面对儿童新冠感染的中医药防治研究进展进行综述.

目的 探究儿童幽门螺旋杆菌(Hp)感染和过敏性紫癜(HSP)的发病是否具有相关性,为探讨HSP的病因病理提供依据.方法 系统检索 CNKI、WanFang Data、MEDLINE、Cochrane Library、EMbase、Web of Science、VIP 等数据库中有关 Hp 感染与儿童HSP相关性的研究文献,检索时限为建库起至2022年12月.使用Endnote整理筛选文献,文献质量评价采用纽卡斯尔渥太华量表.研究基本特征、效应量以及计算效应量所需相关数据由2名独立研究人员进行提取.采用RevMan5.3软件和STATA16.0软件进行Meta分析,使用随机效应模型对数据进行计算.结果 共纳入15项病例对照研究,包括2676例研究对象,纳入研究NOS评分为6～7分.Meta分析显示,儿童HSP组Hp感染阳性率高于健康儿童对照组,差异有统计学意义(OR=4.32,95％CI:3.07～6.10,P＜0.000 01).考虑到不同检测指标、地域对研究的异质性产生影响,进行亚组分析及Meta回归分析,提示这2个因素未被确定为异质性的潜在危险因素.腹型和肾型HSP合并结果均提示腹型和肾型紫癜发病可能与Hp感染有关,但不能明确其相关性是否比其它类型紫瘢更强,HSP儿童中腹型紫癜(OR=5.35,95％CI:2.59～11.05,P=0.000),肾型紫癜(OR=5.30,95％CI:1.05～26.61,P=0.043)可能与Hp感染有关.结论 儿童Hp感染和HSP发病存在一定相关性,其与HSP分型的相关性尚不明确,儿童Hp感染可能是HSP的发病原因之一,甚至可能是病理机制中的重要环节,但以上结论有待更多多中心、大样本、高质量的研究以得出更可靠的结论.

Objective To investigate the safety and efficacy of a traditional Chinese medicine（TCM） treatment of pediatric Henoch-Sch9nlein purpura nephritis（HSPN）（proteinuria below the nephrotic level）.Methods This study was a prospective multicenter stratified randomized controlled trial. In total, 316 children diagnosed with HSPN were divided into the Chinese medicine group（mild: n=132; severe: n=83） and the Western medicine group（mild: n=60; severe: n=41）. Patients in the Chinese medicine group were treated with tripterygium wilfordii multiglucoside + sulfotanshinone sodium injection+Qingre Zhixue Formula, the starting dose of tripterygium wilfordii multiglucoside for the Chinese medicine mild group was 1.5 mg/（kg·d）, while that for the Chinese medicine severe group was 2 mg/（kg·d）. Patients in the Western medicine mild group were treated with low-molecular-weight heparin calcium + benazepril + dipyridamole + a TCM simulator. In addition, patients in the Western medicine severe group received prednisone. The patients were treated for 12 weeks and followed up for 36 weeks. The urinary protein levels and urinary red blood cell（RBC） count were investigated in the 4th week and the 12th week. In addition, the recurrence rate at the end of 48 weeks of follow-up was calculated, and the incidence of adverse events at the end of 12 weeks of treatment was calculated.Results The urinary protein levels in the Chinese medicine group, the Chinese medicine mild group and the Chinese medicine severe group at the 4th week and the 12th week were significantly lower than in the Western medicine group, the Western medicine mild group and the Western medicine severe group（P＜0.01）. The urinary RBC counts in the Chinese medicine group, the Chinese medicine mild group and the Chinese medicine severe group at the 4th week and the 12th week were significantly lower than in the Western medicine group, the Western medicine mild group and the Western medicine severe group（P＜0.01）. No significant difference in recurrence rate was found between the Chinese medicine group and the Western medicine group, between the Chinese medicine mild group and the Western medicine mild group, or between the Chinese medicine severe group and the Western medicine severe group. The incidence of adverse events was lower in the Chinese medicine group than in the Western medicine group, and it was lower in the Chinese medicine severe group than in the Western medicine severe group（P＜0.01）, but there was no significant difference between the Chinese and Western medicine mild groups.Conclusion Chinese medicine alone can be used to reduce urinary protein levels and urinary RBC counts in both mild and severe HSPN. The effect of Chinese medicine on proteinuria was quicker than that of Western medicine, and the incidence of adverse events was significantly lower in the Chinese medicine group than in the Western medicine group. The stepwise Chinese medicine scheme, which is mainly based on tripterygium wilfordii multiglucoside combined with Qingre Zhixue Formula, shows an excellent curative effect and fewer adverse events, indicating it is worthy of clinical promotion.

目的:应用中医传承辅助平台(V2.5)软件,分析常克教授治疗过敏性紫癜的用药规律.方法:收集2018年3月1日-2019年2月28日常克教授在成都中医药大学附属医院门诊治疗过敏性紫癜时的处方,将其录入到中医传承辅助平台软件,通过构建数据库进行数据挖掘,分析常教授治疗过敏性紫癜的用药规律.结果:共收集治疗过敏性紫癜处方219个,发现药性以寒为主,药味苦甘均用,归经多属太阴阳明;频次前5的药物为黄芩、茯苓、炒栀子、知母、连翘,频次前5的药对为茯苓-泽泻、金银花-连翘、连翘-栀子、黄芩-蒲公英、生石膏-炒栀子,根据药物关联规则演化得到3大核心药物群组和13个新处方.结论:常克教授治疗过敏性紫癜常选用苦寒药物进行组方,但亦重视甘温益气;同时善用风药,重视清利手阳明大肠,善以祛痰化瘀治疗紫癜性肾炎.

目的 系统评价匹多莫德辅助治疗传染性单核细胞增多症(IM)的有效性.方法 于PubMed、EMbase、The Cochrane Library、VIP、CNKI、Wanfang Data数据库中检索匹多莫德辅助治疗IM的随机对照试验,两名研究者独立检索筛选数据库中文献时限至2022年2月,纳入研究的文献使用RevMan5.3进行Meta分析.结果 与对照组相比,常规疗法基础上,加用匹多莫德能提高治疗IM的总有效率(OR 5.95,95％CI 3.71～9.55),缩短IM患儿退热时间(MD=-2.01,95％CI-2.28～-1.73),改善咽峡炎(MD=-1.42,95％CI-1.67～-1.18),促使肝脾(MD=-2.21,95％CI-2.74～-1.68)及淋巴结(MD=-2.42,95％CI-2.81～-2.04)由肿大至恢复正常,减少CD8+T细胞(MD=-6.37,95％CI-8.11～-4.62),增加CD4+T细胞(MD=5.35,95％CI 4.48～6.22)及CD4+/CD8+值(MD=0.38,95％CI 0.30～0.47).结论 匹多莫德辅助治疗IM有良好的临床疗效,以上结论仍需更多大规模、高质量研究加以验证.

Abstract Background: Chronic prostatitis (CP) is one of the most common diseases in urology. Longdanxiegan decoction (LDXGD), a classical formula of traditional Chinese medicine (TCM), has been widely used for chronic prostatitis patients with the damp invasion of lower energizer syndrome in China, and the effects were satisfactory. However, there is still no clear understanding of its clinical effects. Purpose: This study aimed to systematically evaluate the efficacy and safety of LDXGD for chronic prostatitis. Methods: Pubmed, EMBASE, Cochrane Library, China Biology Medicine disc (CBMdisc), China national knowledge infrastructure (CNKI), Wanfang, and VIP database were searched from their inceptions to August 11, 2022 to identify RCTs that inspected the efficacy of LDXGD on chronic prostatitis. Results: 12 trials totaling 1314 patients were identified for analysis. Meta-analysis showed that LDXGD treatment was more effective (RR=1.31, 95%CI (1.18, 1.45), P<0.00001) and cure rate (RR=1.79, 95%CI (1.52,2.12), P<0.00001) than western medicine. Meanwhile, LDXGD had reduced NIH-CPS score, such as the total score, pain domain score, urinary domain score, and QoL domain score. Besides, LDXGD was more effective in improving EPS - WBC count. LDXGD safety remained unknown. Conclusions: According to preclinical evidence, LDXGD could be an effective and promising treatment for chronic prostatitis. In addition, more well-designed studies are needed to confirm this conclusion. Trial registration: PROSPERO 2022 CRD42022347076.

在治疗肾病综合征的激素大剂量应用阶段、激素减量撤药阶段、激素小剂量维持阶段以及停用激素后调理阶段四个阶段中,充分发挥中医药优势,辨证论治,能有效缓解激素治疗过程中的毒副反应,提高本病治愈率.但各医家临床治疗思路各成体系,很多治疗经验缺乏全面总结,故以中药分阶段治疗小儿肾病综合征(nephrotie syndrome,NS)为出发点,通过查阅近十年相关文献,总结近年来现代医家治疗原发性NS 的临床经验,大多数医家主要以温阳健脾,利水消肿为主,在激素大剂量运用治疗NS 时,加以滋阴降火,清热利湿;撤减阶段,注意益气温肾;小剂量维持阶段以及停药后,则注重固本培元,预防感染.以此为中药治疗小儿NS 治疗提供新思路.

目的 采用数据挖掘方法分析中医药治疗小儿厌食症用药规律,提供治疗用药参考.方法 计算机检索CNKI、万方、VIP三大数据库中医药治疗小儿厌食症的文献,检索时间自建库起至2021年3月,利用Ex-cel2016进行数据筛选、整理,将数据导入古今医案云平台,建立标准化数据库,利用频次统计、聚类分析、复杂网络分析等数据分析方法,分析中医药治疗小儿厌食症的用药频次、四气、五味、归经、核心处方等用药规律,并进行可视化展示.结果 共纳入处方153首,涉及药物149味,高频使用药物为焦山楂、白术、茯苓、炙甘草等,性味以温、平、甘、辛为主,归经以脾、胃、肺经为主.结论 小儿厌食症的中医辨证以脾胃气虚证最多见,肝旺脾虚证其次,治疗大法为健脾益气,多用健脾益气、消食导滞之药.

目的:基于中医传承辅助平台管理系统(V2.5)分析常克教授治疗遗尿症的用药经验及规律.方法:通过回顾性研究方法,收集常克教授门诊治疗小儿遗尿症处方129首,应用软件构建常克教授治疗遗尿症的数据库,通过药物频次统计、规则分析及熵聚类等数据挖掘算法,分析其治疗遗尿症的用药规律.结果:共纳入129张处方,涉及药物234味,使用频次最高药物为茯苓,其次为麻黄、白术、石菖蒲等;通过药物关联规则显示频次最高为麻黄-黄芩;通过复杂系统煽层次聚类分析,生成新处方10个.结论:通过分析,发现常克教授治疗小儿遗尿疾病,以开窍醒神为要,并重视补益脾胃,亦佐以清热、利水渗湿之品,重视辨证,讲求因人而治.中医传承辅助平台对挖掘名老中医学术经验具有重要价值,可为临床治疗和科研提供新的参考与思路.

目的 基于PRIO-harms量表评价国内外中医药系统评价再评价(overviews)报告的规范性,进行对比分析,为进一步提高中医药overviews的报告质量提供参考依据.方法 计算机检索中国知识资源总库(CNKI)、万方数据知识服务平台(万方数据)、中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library建库至2021年7月中医药相关的overviews.使用PRIO-harms量表对纳入的overviews报告的规范性进行评价,对中、英文文献进行对比.结果 共纳入文献29篇,PRIO-harms评价结果显示,中文文献符合、部分符合、不符合条目数占比分别为8.96％、57.47％、33.57％,英文文献符合、部分符合、不符合条目数占比分别为13.89％、57.87％、28.24％.中、英文文献对于危害性结局指标的报告规范性均较差.结论 国内外开展的中医药overviews研究报告质量尚待提高,尤其对危害性结局指标的报告普遍存在较大不足.英文文献规范性优于中文文献,建议研究者在今后研究中参照PRIO-harms量表,提高报告的质量与规范性.

在完成文献检索、文献评价及文献总结的基础上,通过组内征求专家意见、专家论证会、专家指导组审核、组外专家及网上征求意见,制定《儿童哮喘治未病干预方案》,提出了儿童哮喘治未病干预的术语和定义,明确了流行病学、病因病机、筛查、诊断、分期、辨体质、干预方案和随访监测.该方案的提出,旨在规范儿童哮喘治未病干预措施,为临床医师提供儿科常见治未病标准化处理的策略与方法,提高中医儿科治未病技术规范和科研水平,可作为治未病技术规范和质量评价的重要参考依据,供中医科、儿科、儿童保健科、呼吸科、治未病中心等相关科室临床医师使用.

目的 观察加味桔梗汤治疗肺经伏热型儿童过敏性鼻炎的临床疗效.方法 选取2019年1～12月成都中医药大学附属医院儿科门诊收治过敏性鼻炎患儿101例,随机分为观察组52例和对照组49例.观察组加味桔梗汤治疗,对照组给予开瑞坦治疗,疗程3周.初步评价两组患儿的疗效和安全性.结果 治疗3周后观察组鼻炎有效率为92.3％(48/52),显著高于对照组61.2％(30/49),差异有统计学意义(P<0.05).治疗3周后观察组肺经伏热证候有效率为92.3％(48/52),显著高于对照组79.6％(39/49),差异有统计学意义(P<0.05).观察组喷嚏、鼻塞、流涕、鼻痒、鼻黏膜肿胀、咽干、咽痒及咽红评分均低于对照组,差异有统计学意义(P<0.05).两组患儿治疗过程中均未出现不良反应.结论 加味桔梗汤治疗后患儿病情得到明显改善,临床疗效显著,且较为安全.

原发性遗尿症为儿科临床的常见病、多发病,病程长,复发率高.患儿遗尿若长期不能缓解,则降低其生活质量,是继父母离异、暴力后排名第3位的严重影响儿童心理的生活事件.中医目前大多从肾虚或寒进行论治,多采用补肾固涩之法为主,效者固多,然或有疗效不显,亦或有显效而反复者.笔者认为此病不仅有肾虚或寒之证,风、热、实等证亦有之,从实或热入手,探讨脑、肺、肝胆、脾胃、三焦及督脉其与遗尿的关系,试用风药为主来治疗此病,获得了一定的临床疗效,为治疗遗尿症提供了新方法和新思路.