Accurate segmentation of pediatric echocardiograms is a challenging task, because significant heart-size changes with age and faster heart rate lead to more blurred boundaries on cardiac ultrasound images compared with adults. To address these problems, a dual decoder network model combining channel attention and scale attention is proposed in this paper. Firstly, an attention-guided decoder with deep supervision strategy is used to obtain attention maps for the ventricular regions. Then, the generated ventricular attention is fed back to multiple layers of the network through skip connections to adjust the feature weights generated by the encoder and highlight the left and right ventricular areas. Finally, a scale attention module and a channel attention module are utilized to enhance the edge features of the left and right ventricles. The experimental results demonstrate that the proposed method in this paper achieves an average Dice coefficient of 90.63% in acquired bilateral ventricular segmentation dataset, which is better than some conventional and state-of-the-art methods in the field of medical image segmentation. More importantly, the method has a more accurate effect in segmenting the edge of the ventricle. The results of this paper can provide a new solution for pediatric echocardiographic bilateral ventricular segmentation and subsequent auxiliary diagnosis of congenital heart disease.
As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.
【摘要】 目的 探讨系统规范的健康教育指导对哮喘患儿护理效果的影响。 方法 记录并分析2002年1月-2009年5月门诊或住院诊治的873例哮喘患儿的情况。将患儿分为健康教育组和对照组；健康教育组采用个体化管理的治疗护理方案进行系统的健康教育，对照组采用常规治疗和护理。 结果 对照组和健康教育组的总体有效率分别为77.3%和96.6%。健康教育组在临床控制率、显效率和总体有效率方面均明显优于对照组（Plt;0.05）。健康教育组在发作次数和缺课天数方面明显少于对照组（Plt;0.01）。 结论 健康教育对小儿哮喘的护理有重要意义。【Abstract】 Objective To investigate the effects of health education on nursing pediatric asthma. Methods A total of 873 asthma children got treatment from January 2002 to May 2009 were registered and analyzed. The children were divided into health education group and control group. The health education group was given education about asthma while the control group was given traditional nursing. Results The overall efficacy rate of the control group and health education group were 77.3% and 96.6%. The clinical control rate, show efficiency rate and overall efficiency rate in the health education group were higher than those in the control group (Plt;0.05).The attack frequency and absent days in the health education group were less than those in the control group (Plt;0.01). Conclusion The health education is important for nursing pediatric asthma.
ObjectiveTo investigate the situation of hospital infection with bacteria producing extended-spectrum β-lactamases (ESBLs), find the source of infection and analyze its transmission route, and take effective prevention and control measures to reduce the incidence of nosocomial infection. MethodsA hospital neonatal ward had six cases of ESBL-producing bacteria infections on February 16 to 26, 2012. According to the processing procedure for hospital infection outbreak, we carried out epidemiological investigation on the patient with suspected hospital infection, including checking the medical records, asking the doctor in charge about the patients'clinical symptoms, collecting sputum samples of the patients and environmental microbiology examination, etc. ResultsFour cases of infection were community-acquired, and two were nosocomial infection. Infection onsets were concentrated (between February 16 and February 26, 2012). Patients had similar clinical symptoms, including fever, cough, cough sputum, and lung wet rales, which showed a lower respiratory infection. Six strains of ESBL-producing Escherichia coli were isolated from the infected children, and their susceptibility reports were not entirely consistent, indicating that they did not belong to the same species and were not homologous pathogens. Through bedside survey, we also isolated from the environmental samples 6 ESBL-producing bacteria, and these bacteria were acquired from the milk countertops, kettle, ventilator tube, two doctors'nasal cavity, and the cleaners'nasal cavity in corresponding wards of those infected children. ConclusionThe infection does not belong to an outbreak of nosocomial infection, and it is only an aggregation event of ESBL-producing Escherichia coli. The symptoms of infection were mainly because of lower immunity of children themselves, plus not so good aseptic technique and management in the department of neonatology. Therefore, strengthening hand hygiene management of medical staffs, and regular environmental sanitation and disinfection can reduce the incidence of neonatal hospital infection.
ObjectiveTo review the characteristics of registered industry-sponsored clinical trials of pediatric drugs and vaccines in China and to provide references for promoting the development of new pediatric drugs. MethodsWe searched ClinicalTrials.gov and the Chinese Clinical Trial Registry for completed registered industry-sponsored clinical trials of pediatric drugs and vaccines from the database inception to September 11, 2022. Data including the date the trial was first posted, product type (drug or vaccine), sample size, and other information to describe the general characteristics of pediatric clinical trials were collected. The studies were divided into 2 phases based on the trial posted date, 2005―2010 and 2011―2022, reflecting the enactment of pediatric drug clinical trial policies in recent years. The quality of trial registration and the main characteristics of interventional trials in the 2 phases were then compared. Exploring the results attached to industry and non-industry sponsored clinical trials. ResultsData for 145 trials were collected, and the largest proportion (63.4%) involved vaccines. Randomized control trial (RCT) was the study type with the highest percentage (68.3%). The average report completion rate for registered interventional trials was 81.0%. Compared with 2005―2010, the percentage of average report completions, pediatric drug clinical studies, multicenter, RCTs, and double-blinded registered trials increased in 2011―2022. The proportion of positive outcomes in pediatric clinical trials sponsored by industries was higher than those sponsored by non-industry. ConclusionThe majority of completed pediatric clinical trials sponsored by industries are for vaccines, in line with the promotion of pediatric policies. The quality of trial registration has improved, but not significantly, and some characteristics of trial design have changed. The proportion of positive outcomes in pediatric clinical trials sponsored by industries is higher. And further promotion of pediatric clinical trials is needed.
Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.
Lumbar puncture for children is a difficult technique and is an important aspect of clinical teaching for residents and interns in the neurological department of pediatrics. In this article, we summarized techniques and experiences of clinical teaching in pediatric lumbar puncture, and discussed difficulty, variability and remedial strategy for lumbar puncture in children. Narrow intervertebral space, poor compliance and resistance of children are the main difficulty for pediatric lumbar puncture. The causes of failure for medical students include different sensations of breakthrough when using different needles, choice of un-preferable intervertebral space, excessive vertical angle for needling performance, deviation from the longitudinal midline of the body, incorrect anesthesia, and exceeding resistance of children patients. Corresponding remedial strategy for failure of puncture includes informing students of the technique and variability of puncture, training experienced staff for second- and third-line substitutes, and reinforcing nursing after surgery. This summary of techniques for pediatric lumbar puncture and experiences of clinical teaching will benefit pediatricians and their clinical training.