Objective:To clarify the clinical characteristics and related fators of children with delayed antibody production of mycoplasma pneumoniae pneumonia(MPP).Methods:Two hundreds and eithty-five cases of children hospitalized at Children′s Hospital of Soochow University with MPP(positive for nucleic acid testing of respiratory secretion)were chosen from January 1st, 2019 to September 31st, 2019.Delayed antibody production group included 36 cases, who were tested for negative IgM antibody meanwhile the titer of IgG antibody changed less than 4 folds within 14 days.Positive group included 249 cases who were tested for positive IgM antibody or the titer of IgG antibody changed over 4 folds within 14 days.The characteristics of clinical manifestation, immunology and radiology were comparatively analyzed.Results:The medium age of delayed antibody production group was 0.75(0.30, 2.78)years old, which was obviously younger than that from positive group[5.50(3.73, 7.20)years old]( P<0.001). Low level of serum immunoglobulin IgG was the independent effect factor of delayed production for Mycoplasma pneumoniae antibody( P=0.037). When the serum immunoglobulin IgG level was lower than 7.155mmol/L, the sensitivity of predicting delayed production for mycoplasma pneumoniae antibody would be 0.819 and the specificity was 0.833.The underlying diseases associated with delayed antibody production were hospitalization history during neonatal period( P=0.007)and congenital heart disease( P=0.001). There were 11.11%(4/36)of children appearing spasmodic cough, 41.67%(15/36)of children showing wheezing and 33.33%(12/36)showing diarrhea in delayed antibody group, which were significantly higher than those in positive group[0.40%(1/249), 24.50%(61/249)and 9.64%(24/249), respectively, P<0.05]. The incidence of fever in delayed antibody group were 63.89%(23/36), which was lower than that in positive group[92.37%(230/249)]( P<0.001), meanwhile, the fever last time was 2.50(0, 4.75)days in delayed antibody group, which was shorter than that in positive group[ 7(5.00, 8.50)days]( P<0.001). In the delayed antibody group, there was 19.44%(7/36)of children sufferring from lobar pneumonia, and no extrapulmonary manifestations occurred, which were significantly lower than those in positive group[75.50%(188/249), 14.86%(37/249)]( P<0.05). Conclusion:Delayed antibody production in children with MPP is more common when serum immunoglobulin IgG level is lower than 7.155 mmol/L, especially in the presence of neonatal hospital history and congenital heart disease.The clinical manifestations of these children are mainly characterized by spasmodic cough and wheezing, with low probability of fever, lobular pneumonia and extrapulmonary manifestations.

目的 报告1例RAF1基因突变致Noonan综合征(NS)的临床特征,增加对RAF1基因突变表型谱的认识.方法 收集患儿的临床资料,包括病史特点、相关实验室检查和家族史等.采用外显子捕获的方法对患儿及其父母进行全外显子高通量测序,并进行生物信息学分析,通过Sanger测序对高通量测序结果进行验证.结果 患儿女,9岁,发育落后,头发稀疏卷曲,前额宽大突出,鼻梁扁平,眼距宽,双侧眼裂向外下略倾斜,上睑下垂.彩色多普勒超声心动图显示房间隔缺损,室间隔与左室肥厚.心电图提示:房性早搏,房性心动过速,测序发现RAF1基因c.770C>T(p.S257L)杂合突变,其父母均未携带,为突变.Sanger法验证了上述测序结果.结论 RAF1基因突变可出现NS表型,而房性心律失常可能是RAF1基因突变型NS的一个新的表型谱.

目的:探讨以问题为基础的学习(problem-based learning,PBL)+多学科协作(multidisciplinary team,MDT)教学模式在小儿心胸外科规培医师教学中的应用效果.方法:以30名在苏州大学附属儿童医院心胸外科进行临床规培的医师为研究对象,分为试验组(PBL联合MDT教学模式)15名和对照组(PBL教学模式)15名,对比分析2组规培学员出科时的基础理论、病例分析和操作考试成绩,以及问卷调查教学满意度.结果:试验组的病例分析及操作考试成绩分别为(77.90±2.583)分和(79.40±2.862)分,显著高于对照组的(64.60±1.875)分和(68.30±1.328)分(P＜0.05).试验组对教学效果的满意度也明显优于对照组(P＜0.05).结论:PBL联合MDT教学模式应用于小儿心胸外科教学中,较单纯PBL教学模式可以显著提升临床规培医师的教学成绩及临床素养,值得在小儿心胸外科进行推广应用,以便更好地培养优秀的临床医师.

神经外科重点学科建设是展现科室及医院临床医疗及科研能力的重要方面,是提升医院核心竞争能力不可缺少的方法.而神经医学图书馆作为神经外科书籍、文献资料的信息中心,担负着为神经外科临床医疗、教学、科研提供信息服务的重要作用.如何将神经医学图书馆的建设融入神经外科重点学科建设中,建立起适应神经外科重点学科建设发展所需要的信息资源体系是神经医学图书馆建设面临的重要工作任务.该文对此进行了专题研究.

问题导向性教学(PBL)模式与传统的教学不同,能否吸收PBL的精髓,并顺利完成从"主导者"到"促进者"的角色转换以及完成学生思维能力的转换,对各个学科教师来说无疑是极大的挑战,尤其是对多学科交叉且病情多变的儿科重症医学来说更是如此.通过探索PBL在儿科重症医学住院医师教育培训实践中的应用,阐述了PBL规范化培训中师生考核的主要内容,讨论了在儿童重症医学中PBL应用的利与弊以及总结了在儿童重症医学中的实践和成效.总之,以PBL为导向的多元化教学模式在儿科重症医学中是可行的且在临床教学中具有一定的优势.

目的:探讨1对1导师制在儿童重症医学科住院医师规范化培训中的作用.方法:本次将48名参加规范化培训的住院医师纳入研究对象,针对48名住院医师进行1对1导师制的培养,导师和学生共同制订学习计划,在教学过程中,除了传统的讲授式教学法,还加入了基于问题的教学模式以及基于病例的教学模式,并通过每周讲座、教学查房、导师“手把手”教学实践操作以及病例讨论等多种形式,系统地对学生进行综合培养、指导.1对1导师制的作用和效果通过学生问卷调查、客观考试,以及住院医生对进入1对1导师制培训体系以来的主观感受等进行评价.结果:48名住院医师在培训前后两次考试结果显示,培训后的正确率较培训前显著提高(p＜0.05).住院医师对1对1导师制的满意程度调查显示,非常满意为90％,满意为10％.住院医师参加江苏省住院医师规范化培训第一阶段考核的成绩,理论合格率98％、实践合格率98％.结论:1对1导师制培养体系是儿童重症医学科住院医师规范化培训体系中的重要内容,能够培养出专业理论与临床实践能力都合格的住院医师.

随着经济全球化的历史进程,高校教育国际化格局已经形成,而来华留学生教育是高校教育国际化的重要组成部分.临床见习是医学生正式接触临床的开始,是从课堂到临床的过渡,是对学生临床思维能力和解决临床实际问题能力培养的开始,为进一步临床实习和成为一名合格的临床医师打下坚实基础.本文探讨多种教学方法 在海外留学生儿科临床见习带教工作中的应用.

在新媒体语境下医院应如何处理公共关系以及应对舆情事件,值得深入研究.该文分析了当前时期医院所面临的新媒体语境的变化,分析了医院处理公共关系的难点,并提出了相应的舆情应对策略,以维护和提升医院的社会形象和品牌影响力,并进一步推动我国医改工作的实施,构建和谐有序的医疗环境.

通识教育是为了改变以就业为导向的专业化教育倾向,培养学生的人文和科学的精神、健全人格的教学.将《生长发育》这门原本在医学专业的课程,通过课程改革面向非医学类专业,将生活方式和常见疾病的预防全面推广,顺应了学生对健康知识的需求,满足了培养全面人才的基本要求.

目的 探讨二维斑点追踪成像(2D-STI)技术在评价急性淋巴细胞白血病患儿柔红霉素化疗对左心功能损害中的应用价值.方法 选取25例经临床诊断为急性淋巴细胞白血病的患儿(病例组)和25例健康体检儿童(正常对照组),应用2D-STI技术测量正常对照组和病例组化疗前及化疗3个月后左室长轴各室壁收缩期总体纵向峰值应变和常规超声心动图参数,包括左室射血分数(LVEF)、E/A值、E’/A’值、E/E’值及左室Tei指数,结果进行对比分析.结果 病例组25例患儿化疗后LVEF、E/A值、E’/A’值及E/E’值与化疗前和正常对照组比较,差异均无统计学意义;左室Tei指数与化疗前和正常对照组比较,差异有统计学意义(P＜0.05).病例组25例患儿化疗后左室各切面室壁收缩期总体纵向峰值应变与化疗前及正常对照组比较,差异均有统计学意义(均P＜0.05).结论 2D-STI技术能早期发现急性淋巴细胞白血病患儿柔红霉素化疗后左室功能的损害,对临床早期诊断和干预有重要指导意义.

Objective:To examine correlations of plasma high-mobility group box 1 (HMGB1) with the severity of surgical stress, surgical approach and postoperative complications in children subjected to surgery, and develop new thinking on the preven-tion and treatment of postoperative complications. Methods: A total of 53 pediatric patients admitted to Children’s Hospital Affiliated to Soochow University between June 2013 and December 2014 were divided into moderate and severe stress groups, general and cardiothoracic surgery groups, and postoperative-complication and non-complication groups, in accordance with their clinical symptoms and laboratory findings. Peripheral blood samples were collected Plasma HMGB1 levels were mea-sured at following time points: pre-operation (PRE), immediately postoperative (POD0), 1 day (POD1), 3 days (POD3), and 7 days(POD7) post-operation. Enzyme-linked immunoabsorbent assay(ELISA) was used to measure the expression of plasma HMGB1 and interleukin 6 (IL-6). Correlations between plasma HMGB1 and surgical stress, surgical approach, and postopera-tive complications were analyzed. Results: HMGB1 was more widely expressed than IL-6. Plasma HMGB1 levels in pediatric patients were affected by surgical stress and surgical approach(P<0.05). The expression of plasma HMGB1 in pediatric pa-tients was correlated with the severity of surgical stress(visceral injuries in particular), surgical approach and gender(P<0.05), but was not correlated with postoperative complications(P>0.05). Conclusion: The severity of surgical stress and surgical ap-proach are key factors leading to the abnormal expression of plasma HMGB1, so reducing the severity of surgical stress or op-timizing surgical approach will contribute to the timely suppression of the overactivity of plasma HMGB1 and thus the reduced occurrence of complications.

儿科医生的职业规划从大学本科时期即已开始，本科生的教育直接影响到他们今后的职业生涯，为了加强儿科学本科学生综合素质，培养具有创新精神、全面发展、高素质的卓越儿科医师，苏州大学儿科临床医学院在临床医学儿科学课程组的学生中推行了临床导师制。该项制度已经推行2年6个月，作为一名本科生的导师，现将制度实施的过程和影响进行总结和分析，为制度的不断完善提供依据。

目的 总结近年来不完全川崎病(IKD)患儿的临床特征及实验室检查特点,为尽早诊治提供理论依据.方法对2007年1月至2013年12月在苏州大学附属儿童医院住院的IKD 173例及典型川崎病(KD)457例的临床资料进行回顾性分析.分别对IKD和典型KD患儿的年龄、性别、发病季节、临床特点、急性期实验室特点、超声心动图等资料进行对比分析.结果 (1)IKD组与典型KD组在发病年龄、性别无统计学差异,但IKD组发病年龄偏小,两组均以春夏季发病为主;(2) IKD组发热持续时间长;IKD组结膜充血、口唇干裂、杨梅舌、指(趾)端脱皮、颈部淋巴结肿大及皮疹发生率低于典型KD组,而卡疤红肿则高于典型KD组;(3)IKD组检测白蛋白及前白蛋白较典型KD组高,差异有统计学意义(P<0.05);IKD组发生冠状动脉损害(CAL)与典型KD无统计学差异;IKD组支原体感染率高于典型KD组.结论 IKD患儿发热时间长,易卡疤红肿,白蛋白及前白蛋白较典型KD高,不明原因肝脏损害、外周血检测炎症指标与典型KD相似.因此,对于发热时间较长的患儿,应尽早完善相关检查,结合临床特点均有助于IKD诊断,可减少CAL的发生.

Objective To investigate the role of the Notch signaling pathway in the pathogenesis of HFMD. Methods 82 children with HFMD were enrolled in this study. The HFMD group was further divided into uncomplicated HFMD group and HFMD with encephalitis group. The control group is 40 children who underwent elective surgery for treatment of inguinal hernias. Results Children with HFMD showed significantly reduced CD3+, CD3+CD4+and CD3+CD8+cell subsets, but significantly enhanced CD3-CD19+cell subset (P<0.05 versus control subjects). The expression of Notch ligands Dll1 and Dll4 in the peripheral blood mononuclear cells of the HFMD group were significantly higher than those in the control group (P<0.05). There were significant differences in CD3+, CD3+CD4+and CD3-CD19+cell subsets, but not in the Notch ligands expression, between the uncomplicated HFMD and HFMD with encephalitis groups. Dll4 expression in HFMD children correlated negatively with the CD3+and CD3+CD8+cell subsets (P<0.05), while positively with the CD3-CD19+cell subset (P<0.05). Furthermore, Dll4 expression in HFMD with encephalitis children correlated positively with total white blood cell (WBC) number and total protein concentration in cerebrospinal fluid (CSF) (P<0.05). Conclusion The Notch ligand Dll4 shows a strong correlation with the CD3+, CD3+CD8+and CD3-CD19+cell subsets in children with HFMD, which indicates that the Notch signaling may be involved in the development of HFMD by affecting the number and status of human peripheral lymphocytes.

Objective To evaluate the immediate and medium-long term effectiveness of percutaneous balloon pulmonary valvuloplasty (PBPV) on the treatment of congenital pulmonary valvular stenosis (PS) in children. Methods Thirty cases with PS treated by PBPV from 2007 to 2013 in the Children's Hospital Affiliated to Soochow University, aged 2~89 months, weighing 4~27 kg, were analyzed retrospectively, to observe and compare the change of pressure of pulmonary and right ventricle before and after PBPV, the size of pulmonary artery valve ring and balloon , and the postoperative therapeutic effect evaluated by echocardiography. Results In 30 cases, there is 1 case which developed to atrial flutter and the PBPV was stopped, and there is no serious complications in remaining cases. The diameter of pulmonary valve ring tested by angiography was (13.01±2.83) mm, the size of the selected balloon was (15.78±3.22) mm, and the ratio of balloon to pulmonary artery annulus was 1.1~1.3. The systolic pressure gradient across the pulmonary valve decreased from (55.76±19.40) mmHg to (19.76±7.46) mmHg (P<0.05) immediately after PBPV, and they further decreased after PBPV in one day, one month, six months and one year which evaluated by echocardiography (P<0.05). Conclusion PBPV is simple, safe and effective, which should be the first choice for children with PS. The key to success and to reduce complications is to measure the annulus diameter accurately, and select the appropriate size of balloons.

随着经济的发展,社会对儿科医疗卫生事业提出了更高的要求.在当前我国儿科医师严重匮乏,儿科医疗资源严重不足的现状下,对医学生加强人文态度、人文知识及人文精神培养,提高儿科专业医学生人文素养至关重要.

1临床资料<br>　　患儿男，45 d，因“呻吟伴精神差11 h”入住苏州大学附属儿童医院心内科。入院查体：T 36.3℃， P 240次／min， R 60次／min， BP 78／46 mm Hg， SpO278％。神志清，精神萎，口唇微绀，营养发育中等，面色苍白，呼吸急促，无脱水貌。全身皮肤花纹，前囟压力高，双侧瞳孔等大等圆，直径约3 mm，对光反射灵敏。咽部无充血，颈软，双肺呼吸音清，未闻及干湿啰音及哮鸣音。心率240次／min，心律齐，心音中等，腹软，未触及包块，肝肋下3 cm，质地中等，脾脏肋下未及。四肢凉，循环差，病理反射未引出。入院心电图提示：室上性心动过速（心率250次／min）、WPW综合征、左心室大；采用Philips IE33彩色多普勒超声诊断仪对患儿进行超声心动图检查，超声心动图示：心动过速，左心收缩功能减低（ EF＝45％，FS＝21％），左、右心室内侧壁高回声团块（左侧大小约18.5 mm ×5.6 mm，右侧大小约11.5 mm ×11.0 mm），二尖瓣中重度反流，三尖瓣轻度反流，肺动脉压偏高（压差约35 mm Hg ）；X线胸片示支气管纹理增粗、心影稍增大。血液检查：B 型钠尿肽（ BNP）35 pg／ml，肌钙蛋白0.028 ng／ml；凝血常规：D-二聚体1096μg／L，活化部分凝血活酶时间42.9 s，抗凝血酶Ⅲ（活性）65.3％，纤维蛋白原1.88 g／L。入院后诊治：予生理盐水扩容，呼吸机辅助，予三磷腺苷弹丸式静脉推注，室上性心动过速可转律；同时以磷酸肌酸、人血丙种球蛋白等治疗。病程初期仍反复出现室上性心动过速，达4～6次／d，以三磷腺苷静脉推注均可转律，入院第4天起加以美托洛尔口服，心率、心律渐稳定，恢复正常，其后心动过速未再反复。但复查超声心动图仍提示存在左右心室内团块影，初步考虑心功能不全合并血栓形成，予低分子肝素溶栓治疗1周，但超声心动图示改变不明显（左心室后下壁约16 mm ×7 mm，右心室侧壁12 mm ×9 mm，室间隔隔瓣侧4.6 mm ×4.5 mm，见图1～3）。复查CT示占位较前减少，左心室腔多发充盈缺损（较大者约14 mm ×8 mm ×9 mm，见图4）；赴外院检查，超声心动图示：心脏肿瘤（左心室侧壁后瓣下方6.3 mm ×5.4 mm，左心室后侧壁处11.4 mm ×4.5 mm，右心室三尖瓣前瓣下方6.8 mm ×5.4 mm，隔瓣下方3.5 mm ×2.8 mm）。因肿瘤位于心腔内，标本病理采集风险较大，且其肿瘤病灶多发，不宜手术，予以门诊随访观察。在病程2个月复查超声心动图示：心脏肿瘤（左心室侧后壁约12.7 mm ×7.9 mm ，右心室三尖瓣前瓣下方12.2 mm ×10.8 mm，隔瓣下方4.6 mm ×4.1 mm ）。多普勒探测右心室流出道内血流速度稍快，Vmax ＝1.8 m／s，EF＝54％，FS＝27％（见图5）。病程4个月后外院复查超声心动图示占位肿瘤均较前缩小。

Objective To provide experimental model for Kawasaki disease.Methods A total of 20 weanling rabbits were randomly divided into 2 groups of 10 rabbits each.Rabbits in model group and control group were intravenously administered with bovine serum albumin or normal saline respectively through ear margnial vein on day 1 and day 12.After 6 weeks,coronary angiography was performed in all rabbits.Coronary arteries were separated in one hour.Histopathological examination was performed by light and transmission electron microscopy.Results Coronary arteriography showed that 3 rabbits in the model group had various degrees of dilation and narrowing in the left coronary arteries.Histological examination showed endothelial thickening,inflammatory cell infiltration and incomplete endothelium in the coronary arteries of the model group.Incomplete endothelium,exfoliation of endothelial cells,swollen mitochondria,endoplasmic reticulum expansion,degeneration of smooth muscle cells and breakage of the internal elastic lamina were observed in rabbits of the model group by transmission electron microscopy.Conclusions The model of immune complex vasculitis in rabbit can be induced with bovine serum albumin,and its histopathological changes of coronary arteritis were similar to those of Kawasaki disease in human.

本科生导师制是目前我国高校探索育人的新模式,是一种亲情化、个性化的培养机制,对于提高学生的综合素质起到了积极的作用.本文结合苏州大学附属儿童医院实施本科生导师制的实践,介绍了本科生导师制的作用及其具体实施办法,同时分析目前条件下存在的一些不足,探讨了进一步优化完善的对策与建议.

Objective To evaluate the clinical value of tanscatheter closure of atrial septal defect(ASD) with occlusion device in pediatric patients by the guiding of echocardiology.Methods In 126 patients with ASD,38 males,88 females,the age ranged from 2.3 to 17.0 years(mean 6.7±3.5 years).9 patients were multiple ASD,1 case associated with pulmonary stenosis(PS) and 3 cases atrial septal aneurysm(ASA).126 ASD patients underwent transthoracic echocardiography(TTE) or transesophageal echocardiography(TEE) before the interventional therapy.The occluder sizes were decided by ASD sizes according to the results of TTE or TEE.TTE was used in all patients for postoperative follow up.Results 124 patients including 7 cases of edge-insufifciency ASD or large ASD had been occluded successfully.The success rate was 98.4%.The diameters measure by TTE or TEE were 3.3 to 26.0mm(mean 16.5±3.4mm).The diameters of devices were 6.0 to 30.0mm(mean 19.0±4.0mm).Among them,7 cases with multiple ASDs have been occluded using one device and one case with multiple ASDs using two devices.One case associated with PS was treated by balloon dilatation simultaneously.Trace residual shunt was found in two cases post-occlusion,but the shunt vanished one month later.Conclusion Echocardiography have high value in selecting patients and guiding in transcatheter occlusion of ASD and postoperative follow-up in pediatric patients with ASD.