2014年 · 第52卷第09期

acute lymphoblastic leukemia (ALL) is the most common malignant tumor in childhood. In the past 30 years, with the improvement of diagnosis, classification and treatment, the disease-free survival and cure rate have been greatly improved. Domestic hospitals have kept up with international progress, continuously improved and optimized treatment plans according to the specific domestic conditions, and achieved good treatment results. The long-term event-free survival (EFS) rate of three domestic multi-center studies "Chinese Children's Leukemia Group (CCLG)"-ALL 2008 program, Shanghai Children's Medical Center (SCMC) -ALL-2005 program and Guangzhou (GZ) -2002 program reached 70% ~80%, which is close to the international advanced level [1,2,3,4,5]。 In order to standardize the diagnosis and treatment of ALL in children, absorb the new diagnosis and treatment concepts and methods of foreign advanced treatment research groups, and refer to the useful experience of domestic hospitals in recent years, the hematology group of Pediatrics Branch of Chinese Medical Association and the editorial committee of Chinese Journal of Pediatrics revised the recommendations for the diagnosis and treatment of ALL in children (the third revision) formulated in 2006.

In order to further standardize the diagnosis and treatment of acute lymphoblastic leukemia (ALL) in children, the Hematology Group of the Pediatrics Branch of the Chinese Medical Association held two seminars in September 2012 and March 2013. The original diagnosis and treatment recommendations (the third revised draft)^[1]Based on the research progress of advanced treatment groups at home and abroad in recent years, a new fourth revised scheme (hereinafter referred to as the recommendation) was proposed. The treatment of ALL in children is a long-term process. There are certain individual differences in the age, gender and basic health conditions of children. There may also be certain uncertainties in the tolerance of each child to intense chemotherapy at each treatment stage. Medical facilities and testing conditions in various places need to be further improved. Therefore, it is necessary to closely combine the children's general condition and local objective conditions, and on the premise of ensuring medical safety, refer to and implement the new version of children's ALL diagnosis and treatment recommendations. The characteristics of this suggestion and related problems in clinical application are interpreted, so as to provide reference for clinicians to understand and apply this suggestion.

The child, 10 months old, was seen in our hospital in April 2014 due to unsteady sitting since birth. After the child was born, the parents found that his body was soft and his motor development was backward: his head stood up for 4 months, he turned over for 7 months, and he was unable to sit steadily so far; Intellectual development is also backward: 4 months can laugh, now can't identify the mother, can't clearly answer the name, and occasionally babble. There were no abnormalities in diet, urine, and sleep, and no history of convulsions. There were no abnormalities in maternal pregnancy, birth history and neonatal period. No family history of genetic disease, healthy parents, non-consanguineous marriage.

Early Childhood Warning Score^[1]pediatric early warning score (PEWS) is a scoring method that is used to evaluate children's respiratory, circulatory and conscious states in a simple way on the basis of summarizing adult early warning scores and combining children's characteristics. It is used to predict the risk of disease, identify children with possible cardiopulmonary failure early, and admit them to intensive care units or transfer them to higher medical institutions as soon as possible, so as to effectively reduce the mortality rate of children. PEWS is suitable for disease risk assessment of hospitalized children in general wards, triage of children in emergency rooms and pre-examination triage; Modified Transport PEWS^[2](transport pediatric early warning score, TPEWS) It is suitable for inter-hospital transport of critically ill children. With the gradual establishment of China's transit network system^[3]The number of referrals for critically ill children is increasing, and the uncontrollable factors in the transfer process are increasing. It is urgent to assess the transfer risk, guide the transfer of critically ill children and carry out quality control methods in the transfer process. The simple scoring method of PEWS and its good correlation with the development direction of disease have laid a good foundation for its popularization and application. It has application value in general ward, emergency room and inter-hospital transportation of critically ill children. Now, the research on the development and application of PEWS abroad is reviewed.

Due to the continuous development of urbanization and globalization, changes in human lifestyle and serious environmental pollution, the incidence of allergic diseases in the world has increased rapidly in recent years, and the prevalence rate has reached 22%, mainly including allergic rhinitis, allergic asthma and allergic dermatitis, which have seriously affected the quality of life and health of people, especially children^[1,2]。

off-label drug use means that the age, dosage, route of administration, indications and contraindications of the drug use are not included in the drug instructions provided by the manufacturer. In pediatric clinical practice, the phenomenon of off-label medication is very common. This phenomenon not only brings hidden dangers to pediatric clinical medication, but also brings risks to children and doctors, and it is also a social problem involving pharmaceutical companies and national policies. Only by facing and analyzing this problem can we solve this problem reasonably. The 4th National Conference on Pediatric Clinical Pharmacology and the Symposium on the Current Situation and Countermeasures of Off-label Medication for Children in China were held in Shenzhen from October 25 to 27, 2013. This is another nationwide large-scale academic activity of the Clinical Pharmacology Group of Pediatrics Branch of Chinese Medical Association since its establishment in August 2011. This conference mainly focuses on this hot issue as the theme of the conference. The main contents of the meeting include: