目的:探讨健康教育联合标准化营养支持对造血干细胞移植患儿营养指标及生存质量的影响.方法:将185例急性淋巴细胞白血病患儿随机分为对照组92例和实验组93例,对照组采用基础护理措施,实验组在对照组基础上采用标准化营养支持联合健康教育.比较两组干预前1d、干预后3d营养指标(血清白蛋白、转铁白蛋白及总白蛋白)、生存质量[采用生活质量评估量表(QOL)].结果:干预后3 d,两组血清白蛋白及总白蛋白水平高于干预前1 d(P<0.01,P<0.05)、转铁白蛋白低于干预前1 d(P<0.01),且实验组血清白蛋白、总白蛋白、转铁白蛋白水平优于对照组(P<0.05);干预后3 d,两组QOL评分高于干预前1 d(P<0.01,P<0.05),且实验组高于对照组(P<0.01).结论:健康教育联合标准化营养干预能够有效改善患儿营养指标,提升患儿生存质量.

Objective:To assess the value of conventional sonographic characteristics of thyroid nodules combined with internal coarse calcification in differentiating benign and malignant thyroid nodules.Methods:The ultrasonographic data of 217 patients with 229 thyroid nodules confirmed by pathology at Changzhou First People's Hospital from January 2018 to July 2020 were retrospectively analyzed. Ultrasonography of the included nodules showed that there were coarse calcifications in the nodules. According to the gold standard of pathological results, the nodules were divided into either a benign (n=110) or a malignant (n=119) group. The conventional sonographic characteristics of nodules including maximum diameter, anteroposterior/transverse diameter ratio, echo intensity, growth pattern, composition, margin, and color Doppler flow imaging, and sonographic characteristics of coarse calcification including thickness, calcification interruption, morphology, margin of soft tissue outside the calcification, echo consistency, and location were analyzed retrospectively. Univariate analysis was used to compare the conventional sonographic characteristics of nodules and coarse calcification in nodules between the two groups. Binary logistic regression was used to establish prediction models of conventional nodule characteristics (model 1) and the comprehensive characteristics of nodules and coarse calcification (model 2). The diagnostic performance of each parameter and the combined model was compared by receiver operating characteristic curve (ROC) analysis and Z-test.Results:The maximum diameter of thyroid nodules ≤1.25 cm, anteroposterior/transverse diameter ratio >0.78, being solid, vertical growth, irregular margin or extra-thyroidal extension, as well as irregular thickness, interruption, echo inconsistency, soft tissue edge ,and central type of coarse calcification were significantly more common in the malignant group than in the benign group (P＜0.05). Model 1 included the maximum diameter, anteroposterior/transverse diameter ratio, and margin of the nodule. In model 2, the maximum diameter of nodule, anteroposterior/transverse diameter ratio, and calcification thickness, interruption, and location were included. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of model 2 were 81.85%, 82.73%, 82.29%, 80.18%, and 81.22%, respectively. The area under the curve was 0.877, which was significantly higher than that of model 1 (0.753; Z=4.197, P＜0.001).Conclusion:Sonographic characteristics such as irregular thickness, interruption, and central calcification in nodules are helpful for the diagnosis of malignant nodules. While observing the sonographic characteristics of thyroid nodules, it is important to evaluate the characteristics of internal coarse calcification in order to better distinguish benign and malignant thyroid nodules.

儿科临床教学是将儿科理论与实践有效结合的重要阶段,如何做好儿科临床教学工作,使学生能够更好地掌握儿科临床知识是一项艰巨的任务.文章探索翻转课堂融合TBL这种新颖的教学模式应用于儿科临床教学的可行性,从儿科临床教学的特点,翻转课堂融合TBL教学的实施过程,翻转课堂融合TBL教学的优点、存在的问题及解决的建议等方面进行论述,说明翻转课堂融合TBL教学是其他教学模式的补充、完善和优化,值得尝试.

患儿 女，4.5月龄，以“腹泻2周、咳嗽10 d、发热1 d”就诊，结合既往史、临床表现及外周淋巴细胞绝对计数、淋巴细胞亚群、基因检测，诊断为白细胞介素7受体α（IL7R）基因缺陷导致重症联合免疫缺陷病。患儿IL7R基因存在复合杂合突变， c.169T>C，p.C57R和c.799A>G，p.R267G(NM_002185）既往均未见报道。

目的 探讨苏州地区儿童肠道沙门菌感染的临床特征、分布及耐药情况,为儿童腹泻的临床诊疗提供参考.方法 收集2012年1月—2019年12月因腹泻在苏州大学附属儿童医院住院治疗的9096例患儿的粪培养结果,分析其沙门菌检出情况.回顾性分析沙门菌感染患儿的临床特点、血清型分布及药敏试验结果.结果 9096例患儿沙门菌总检出率为6.2％.2012年—2019年的检出率总体呈现上升趋势.每年6-8月为检出高峰,平均检出率为11.2％(289/2580),与其他月份相比差异具有统计学意义(χ2=155.813,P<0.001).大月龄婴儿及幼儿组(6个月～3岁)沙门菌检出率明显高于小月龄婴儿组(<6个月)、学龄前组(3～6岁)及学龄组(≥6岁),差异有统计学意义(χ2=110.704、12.768、92.086,均P<0.001).沙门菌血清型以鼠伤寒沙门菌(292株,51.9％)最多见,其次为肠炎沙门菌(101株,17.9％).<3岁儿童(婴幼儿组)和≥3岁儿童(学龄前及学龄组)相比,鼠伤寒沙门菌和肠炎沙门菌构成比的差异具有统计学意义(χ2=41.284,P<0.001).不同血清型沙门菌的耐药性存在差异,鼠伤寒沙门菌和肠炎沙门菌对氨苄西林、哌拉西林的耐药率均明显高于其他血清型,对环丙沙星的耐药率低于其他血清型;肠炎沙门菌对头孢哌酮的耐药率高于其他沙门菌,对复方新诺明耐药率低于其他沙门菌.鼠伤寒沙门菌多重耐药(MRD)率最高,为56.2％(164/292),与其他血清型相比差异具有统计学意义(χ2=11.764,P<0.01).结论 苏州地区儿童肠道沙门菌感染总体呈现上升趋势,血清型以鼠伤寒沙门菌为主,不同血清型沙门菌的耐药性存在差异,鼠伤寒沙门菌MRD率最高,值得临床重视.

目的 研究肠外营养时大鼠肠道紧密连接蛋白、NOD2及相关信号分子的表达变化及意义.方法 选择12只SPF级雄性SD大鼠随机分为生理盐水组(NS组)和肠外营养组(PN组),检测两组大鼠小肠组织中紧密连接蛋白ZO-1、occludin及NOD2、NF-κB p65、p-p65、p38、p-p38的表达水平.结果 PN组肠道紧密连接蛋白ZO-1、occludin表达水平下降(P<0.01,P<0.01).PN组NOD2的表达水平上升(P=0.003),NF-κB p65活化水平(p-p65:p65)升高(P=0.01),p38活化水平(p-p38:p38)升高(P=0.046).结论 肠外营养时大鼠小肠黏膜紧密连接受损,小肠组织NOD2表达水平升高,NF-κB p65、p38活化水平升高.

Objective To investigate the clinical features of complications of Meckel diverticulum (MD) in children.Methods A total of 92 cases of children with MD who were admitted to the Children's Hospital of Soochow University from February 2012 to February 2017 were selected as study subjects.Their age ranged from 2 months to 13 years and 7 months.According to different complications of children with MD,they were divided into intestinal obstruction group (n =33),painless hematochezia group (n=44) and diverticulitis group (n=15).The general clinical data such as age and gender of three groups were collected by retrospective analysis method,as well as complications,diverticulum height-to-diameter ratio (HDR),the distance from MD to ileocecal valve,and the ectopic rate of gastric mucosa.The diverticulum HDR and the distance from MD to ileocecal valve were statistically analyzed by one-way ANOVA,and SNK-q method was used to further compare among different groups.The age among 3 groups was statistically compared by Kruskal-Wallis H rank sum test.Constituent ratio of gender and ectopic rate of gastric mucosa among 3 groups were statistically analyzed by chi-square test.This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.Results ①Among 92 MD children,44 cases (47.8％) of them had painless hematochezia,33 cases (35.9％) of them had intestinal obstruction,15 cases (16.3 ％) of them had diverticulitis.②There were no significant differences among 3 groups in the general clinical data,such as age and constituent ratio of gender (P ＞ 0.05).③ The diverticulum HDR of intestinal obstruction group,hematochezia group and diverticulitis group were (1.8±0.9),(2.7± 1.3),and (1.9±1.4),respectively,and there was statistical difference among 3 groups in the diverticulum HDR (F 5.391,P =0.006).Further comparisons showed that diverticulum HDR in hematochezia group was higher than that in intestinal obstruction group and diverticulitis group,respectively,and both the differences were statistically significant (P＜ 0.05),but there was no significant difference between intestinal obstruction group and diverticulitis group in diverticulum HDR (P＞0.05).The distances from MD to ileocecal valve of intestinal obstruction group,hematochezia group and diverticulitis group were (44.2± 15.1) cm,(52.6± 13.8) cm,and (39.7±16.9) cm,respectively,and the overall comparison of distances from MD to ileocecal valve among 3 groups was statistically significant (F =5.464,P =0.006).The results of further comparisons showed that the distance from MD to ileocecal valve in hematochezia group was much greater than that in intestinal obstruction group and diverticulitis group,respectively,and there were statistically significant differences (P ＜ 0.05),but there was no significant difference between intestinal obstruction group and diverticulitis group (P＞0.05).④The ectopic rate of gastric mucosa in intestinal obstruction group,hematochezia group and diverticulitis group were 12.1％ (4/33),86.4％ (38/44),and 20.0％ (3/15),respectively,and there was statistically significant difference among 3 groups in the ectopic rate of gastric mucosa of MD children (x2 =47.590,P＜0.001).⑤Among the 92 children with MD,only 1 child (1.1 ％) died.Conclusions Painless hematochezia and intestinal obstruction are the main complications of children with MD,and diverticulum HDR and clinical location of diverticulum are associated with complications of MD.The diverticulum HDR is higher and the distance from MD to ileocolic valve is longer in children with MD who complicated with painless hematochezia.

Objective To analyze the common pathogens and prevalence characteristics of viral diarrhea of the children in hospital that under 5 years in Suzhou, in order to prevent and treat the children with viral diarrhea. Methods 1 735 fecal specimens were collected from the children under 5 years with viral diarrhea who were hospitalized in the digestive department of Children's Hospital Affiliated to Soochow University from January 2013 to December 2017, rotavirus (RV) was detected by ELISA, strain characterization was carried out by nested PCR, norovirus (NoV), spavirus (SaV), enteric adenoviruses (EAdV) and astrovirus (AstV) were detected by RT-PCR or PCR. Results A total of 1 735 fecal specimens were collected and tested. The positive rate of RV, NoV, SaV, EAdV and AstV was 31.6%, 16.9%, 2.3%, 2.6% and 1.9%. Co-infection with multiple enteric viruses were present in 9.0% of all samples. (1)RV G9 was the most serotype (83.6%), and P[8] (94.5%) was the most common genotype. The most common G-P combination was G9P[8]. Among the 549 RV positive specimens, the virus detection rate of 12～23 month age group was the highest, the peak of virus detection was concentrated in October to next February. (2)In 293 NoV positive specimens, the detection rate of 12～23 months and 36～60 months was the highest. The peak of virus detection was concentrated in October. (3)40 cases positive specimens of SaV, the virus detection rate of 12～60 month age group was high; 45 cases of EAdV positive specimens, of which ＜2 years old accounted for 73.3%, 33 cases of AstV positive specimens, of which ＜2 years old accounted for 81.8%. Conclusion Group A RV was the most important pathogen of viral diarrhea in children under 5 years in Suzhou, the second was NoV. The epidemic strains of group A RV was G9P[8], and the epidemiological characteristics of different kinds of viruses were different.

Objective:To study the relationship between Characteristic of Pathohistology,Helicobater Pylori and Degree of inflammation in Chronic Gastritis.Methods:467 cases of chronic gastritis children in our hospital from January 2010 to February 2016 for gastroscopy diagnosis were selected.The histological features of gastric antrum mucosa were examined,and the positive rate of HP was detected,and the relationship between HP infection and pathological features of chronic gastritis and the degree of chronic inflammation was analyzed.Results:In the pathological examination,the HP infection rate in children with mild,moderate and severe inflammatory reaction (7.7％,41.2％,51.1％) was increased,and the difference was statistically significant (P＜0.05).The positive rate of HP in children with inflammatory activity of 76.3％ was significantly higher than that in children with no inflammatory activity for 23.7％ (P＜0.05).The positive rate of Hp was significantly increased with the increase of the grade of intestinal metaplasia,the formation of lymphoid follicles and the degree of atrophy.The incidence of lymph follicle formation,intestinal metaplasia and gastric atrophy in three groups of mild,moderate and severe inflammation was significantly increased,Hp positive rate was significantly increased,and the difference was significant (P＜0.05).Conclusion:HP infection is important factor in the pathogenesis of chronic gastritis,is closely related with gastric mucosal inflammation,activity,lymph follicle formation,intestinal mucosal atrophy atrophy grading and other pathological changes.

目的：探讨常规高频超声联合弹性成像技术在闭合性跟腱撕裂的诊断价值。方法对近年来骨科手术确诊的48例闭合性跟腱撕裂伤患者行高频超声和弹性成像检查，详细观察总结其影像学特征。结果48例患者的高频超声和弹性成像检查结果与手术结果对照，除一例漏诊外其余都做出了准确诊断，准确率大于98％。结论常规超声结合弹性成像技术能显著提高闭合性跟腱撕裂伤的诊断率。

目的：探究儿童造血干细胞移植后口腔并发症的护理方法及其效果。方法：选取我院2014年5月到2015年10月间接收并治疗的儿童造血干细胞移植患儿68例，随机分为观察组和对照组，对对照组进行常规护理，对观察组进行并发症的预防以及护理措施，对两组患儿的护理结果进行比较。结果：观察组满意率94.1％高于对照组79.4％，并发症发生率64.7％低于对照组76.4％，P＜0.05，差异具有统计学意义。结论：进行全方位的护理能够有效减少患儿并发症的发生率，提高病患和家属的满意率，利于患儿治疗的恢复。

Objective To evaluate the effect of low osmolarity ORS and smecta in children with diarrhea. Methods 153 diarrhea patients were recruited in this research, who were randomly selected from diarrhea outpatient clinics in our department. They were divided into 3 groups:Group A of 50 cases were treated with low osmolarity ORS, Group B of 53 cases were treated with ORSⅡand smecta, Group C of 50 cases were treated with low osmolarity ORS and smecta, then character and frequency of the stools, vomiting times were recorded on the 3rd and 5th day after treatment, and significant efficiency in 72 hours were compared. Results There were no significant differences among these 3 groups in age, sex and clinical manifestations (vomiting times, diarrhea frequency, dehydration and mental state). 2 days after treatment, character and frequency of the stools, vomiting times in Group C were significantly better than Group A and B (P<0.05), there were no significant difference in frequency of stools and vomiting between Group A and B. 4 days after treatment, all patients in three groups turned better, there were no difference among character and frequency of the stools, vomiting times (P>0.05), but Group C had a higher significant efficiency in 72 hours than Group A and B. Conclusion Low osmolarity ORS,together with smecta, can relieve vomiting, and decrease stool frequency, have a higher significant efficiency.

目的 探讨隆突性皮肤纤维肉瘤的特征的超声表现.方法 回顾性分析25例经手术病理证实为隆突性皮肤纤维肉瘤的分布、超声图像特征及彩色多普勒血流成像特点.结果 25例隆突性皮肤纤维肉瘤患者团块均位于皮肤或皮下组织,大小约1.6 cm×0.5 cm～6.5 cm×4.5 cm;分布在躯干21(占84％)例、四肢近端2例(占8％)、头颈部2例(占8％).25例肿瘤肿块内部为较均质低回声或以低回声为主的混合回声,内部无液化或钙化且不伴有局部淋巴结转移.10例(占40％)肿瘤边界清楚,形态规则；15例(占60％)边界不清楚；13例(占52％)肿块内部彩色多普勒显示有丰富血流信号.所有患者均未见淋巴结转移.结论 隆突性皮肤纤维肉瘤有一定特征性超声表现,超声检查对协助诊断有重要的临床价值.

<正>克罗恩病(Crohn disease,CD)是一种病因尚不十分清楚的胃肠道慢性炎性肉芽肿性疾病,其发病率近年来上升,克罗恩病为慢性疾病,影响着儿童的生长发育,心理健康,治疗的目的在于减轻该病的临床症状、改善营养状况、促进生长发育、预防并发症及减轻慢性病的心理影响。本文就近年来克罗恩病