2015年 · 第53卷第09期

The emergence of evidence-based medicine has made the medical model develop from empirical medicine to evidence-based medicine, which has made great changes in the research and practice of clinical medicine, and has become the development direction of clinical medicine in the 21st century. Evidence-based medicine requires that any medical decision should not be based solely on clinical experience, but must be based on the best current research evidence combined with clinical expertise and patient value.

Kidney transplantation is the most effective alternative treatment for uremia, and it is also the most mature and stable organ transplantation technology at present. Compared with dialysis patients, the survival time and quality of life of renal transplantation patients were significantly prolonged and improved^[1]。 The longest postoperative survival time of kidney transplant patients in the world has exceeded 50 years so far, and the longest survival in China has reached 35 years. According to the United States Kidney Disease Data System (USRDS), the incidence of end-stage kidney disease (ESRD) in children has been increasing over the past few decades, reaching 14/1 million children, accounting for about 1.3% of all ESRD patients^[2]。 For uremic children, the advantages of kidney transplantation compared with dialysis treatment are more prominent. The recipient can not only get a longer life expectancy, but also obviously improve its growth, development and cognitive ability, which ensures the normal learning and life of the children to the greatest extent. Therefore, kidney transplantation should be the first choice for children with ESRD.

At present, the safety of children's medication in China has aroused widespread attention in the society. There are problems such as lack of kinds, fewer dosage forms, unknown usage and lagging research and development in children's drugs. About 70% of the cases of off-label medication in hospitalized children, and the proportion of neonatal patients is as high as 80% ~97%^[1]。 Expressions such as "dose reduction for children" and "follow doctor's advice" are commonly found in the drug instructions. Children's growth and development are in a continuous and dynamic process of developmental changes. Due to physiological changes, there are significant differences in pharmacokinetics and pharmacodynamics between adults and children^[2]。 The efficacy and safety data of drugs are often only confirmed in adult clinical trials, while the lack of validation in pediatric clinical trials, the lack of scientific data support and evidence-based evidence directly leads to the randomness and uncertainty of drug treatment in pediatric clinical practice. Children's doses are often estimated based on body weight or body surface area based on the physician's personal experience and adult doses. These empirical prediction methods have been proved to have systematic errors, and the younger the child, the greater the prediction error. Obviously, empirical treatment increases the risk of treatment failure or adverse drug reactions in children.

therapeutic drug monitoring (TDM) refers to the application of modern analytical techniques to quantitatively determine the concentration of drugs and their metabolites in the body fluids of patients after treatment and medication under the guidance of pharmacokinetics (PK) principles, so as to design or adjust the dosing regimen to achieve individualized treatment, improve the curative effect, and avoid or reduce drug toxic and side effects. TDM is one of the major advances in pharmacotherapeutics in the 20th century. It is an effective way for physicians to use drugs rationally and improve the quality of medical services. Children are the key population of TDM. Children's TDM in China has been carried out for more than 30 years, and so far there is no corresponding norm to guide the implementation of TDM. Therefore, the Pediatric Clinical Pharmacology Group of the Pediatric Society of Chinese Medical Association organized clinicians and clinical pharmacists in pediatric neurology, respiratory, neonatal, digestive, kidney, immune, tumor, blood, cardiovascular, infection and other specialties nationwide to form a "Children's TDM Expert Consensus" formulation team. Referring to domestic and foreign TDM research, expert consensus and guidelines, the "Children's TDM Expert Consensus" was formulated, aiming at providing reference for children's TDM, promoting children's rational drug use and ensuring the safety of pediatric drug use.

The 11-year-old and 4-month-old child was admitted to the hospital for "edema with abnormal urine test for 15 d". The child developed edema of both eyelids without obvious trigger 15 days before admission, and the edema gradually spread to both lower limbs. There was no frequent urination, urgency, painful urination, no macroscopic hematuria, and no obvious decrease in urine output. No rash, fever, joint discomfort, hair loss and oral ulcer, dizziness, palpitation, chest tightness and other discomfort, so I went to the local county people's hospital for treatment. Urinary routine examination: urine protein (+ +), urine occult blood (+ +), 24-h urine protein quantitation 1.75 g, liver function: albumin 19.9 g/L, globulin 19.3 g/L, total cholesterol 6.83 mmol/L, diagnosed as "nephrotic syndrome", given "penicillin G, ceftazidime injection, hydrochlorothiazide tablets, spironolactone tablets, captopril tablets" and other treatments, and started oral prednisone tablets (15 mg/time, 3 times/d) 13 days before admission. The edema was reduced compared with before, but the urine protein did not turn negative, so I was transferred to our hospital.

tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare subtype of acute interstitial nephritis. First reported in 1975 by Dobrin et al.^[1]。 Approximately 250 cases were reported worldwide by 2014^[2,3]。 The majority of patients with TINU syndrome were adolescents and young women with a median age of 15 years^[4]At present, the cases are mainly reported in ophthalmology and adult nephrology, and there is no large-scale epidemiological investigation. In particular, there are few pediatric reports. As of 2014, searching the CNKI, Wanfang, and VIP databases showed that only 3 pediatric cases under 16 years old were reported in China^[5]。 The lower diagnosis rate of children and adolescents is related to the characteristics of the disease, and also to the insufficient understanding of this disease by clinical nephrology (children and adults) and ophthalmologists. In order to improve the understanding of this disease and avoid missed diagnosis and delayed diagnosis, the clinical characteristics, diagnosis, treatment and related progress of TINU syndrome are reviewed.

In premature infants, the ductus arteriosus cannot be closed in time due to dysplasia of the ductus arteriosus wall and abnormal secretion of prostaglandins, and then left-to-right shunt occurs. Premature infants are prone to heart failure and pulmonary edema due to poor left ventricular systolic capacity, and develop haemodynamically significant patent ductus arteriosus (hsPDA) or symptomatic patent ductus arteriosus (sPDA)^[1,2]。 In recent years, it has been found that B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) Not only has high sensitivity and specificity in diagnosing heart failure^[3,4,5]It is also helpful to accurately judge the severity of PDA and cardiac function in premature infants^[6]and contributes to the early screening of PDA in premature infants requiring intervention^[6,7]Predict and judge the effect of the intervention^[7]。 The application of BNP and NT-proBNP in PDA of premature infants in recent years is reviewed as follows.

According to the three-stage model of clinical research, clinical research can be divided into exploratory clinical research, nurturing clinical research and confirmatory clinical research.