2018年 · 第56卷第02期

On September 25, 2015, the 193 member states of the United Nations formally adopted the 17 sustainable development Goals (SDGs), or the 2030 Agenda for sustainable development, at the summit. One of the core goals of development for the next 15 years mentioned in this global programmatic document is to address inequality in order to form a stable and harmonious society. One of the main challenges to achieving this core goal is to ensure the healthy development of every child. Childhood development continues to affect a person's life. From the individual level, from the beginning of mother's conception to childhood, the experiences of all ages will have an important impact on the remodeling of children's brain neural circuits and the improvement of other organs' biological functions; At the national and global level, early childhood development is directly related to national economic development and ultimately affects the development of all human beings. Many developed countries, as well as some developing countries, have been running early childhood development intervention projects for many years, and in some countries have begun to take shape and even become national-level projects. The evidence about the effectiveness of early childhood development intervention programs and their importance to national socio-economic development has been fully verified. However, how to transform these strong academic evidences into application practice in the field of healthy childhood development requires all departments in relevant fields to form a unified goal and cooperate to plan the implementation path, so as to finally achieve healthy childhood development. Moreover, at the national level, policies to close the gap between the rich and the poor need to be prioritized to ensure that the capacity of the next generation is fully developed to build more prosperous societies.

In recent years, the role of early child development (ECD) in promoting the comprehensive quality of the population has been confirmed by more and more studies, and its importance has been highly valued by international organizations and governments. Famous medical journals in recent 10 yearsLancetHe has published three special issues, publishing the global report on early childhood development and core research results. Our government attaches great importance to early childhood development. In recent years, the National Health and Family Planning Commission has set up 30 national early childhood development bases in 21 provinces, and at the same time, a series of pilot projects have been carried out nationwide. However, on the whole, this work is still in the initial and exploratory stage in China. In the work of early childhood development, scientific assessment has always been one of the focus of practice, researchers and policy makers. Because scientific assessment can not only screen out potential problems and intervene early in the early stage of highly plastic brain, reduce the risk of individual stunting, but also understand the current situation and influencing factors of early childhood development in various regions from the group level, and make an important reference for resource allocation and government project work planning, thus truly helping to give full play to the effect of early childhood development with half the effort. By reviewing the traditional clinical neuropsychological development assessment tools suitable for individuals, this paper systematically introduces the child development assessment tools suitable for population which have emerged gradually with the research in the field of early childhood development in recent 10 years. At the same time, combining with the needs of early childhood development in China, it puts forward the application prospect of relevant assessment tools in China.

lupus nephritis is the renal damage of the autoimmune disease systemic lupus erythematosus (SLE). It is the most common and important renal complication of SLE. Its clinical manifestations range from asymptomatic hematuria and/or proteinuria to nephrotic syndrome to rapidly progressing nephritis with renal impairment. In September 2010, the Chinese Journal of Pediatrics published guidelines for the diagnosis and treatment of lupus nephritis^[1]It has played a positive role in standardizing the diagnosis and treatment of the disease. Because new research evidence has been published in recent years^[2,3,4]Therefore, based on the 2010 guidelines, this guideline is revised through comprehensive inquiry, analysis and evaluation of new research evidence, solicitation of opinions from all parties and full discussion to reach consensus, aiming to help clinicians choose the current relatively good diagnosis and treatment methods for children. This guide is mainly applicable to clinical pediatricians who have a certain professional foundation in pediatric nephrology and have received professional training or training in pediatric nephrology, especially to provide clinical reference for pediatric nephrologists. In clinical practice, physicians should refer to the principles of this guideline and carry out individualized treatment according to the specific condition of children.

Radiofrequency ablation was first used in 1991 to treat tachyarrhythmias in children^[1]At present, it has become the first choice method for radical cure of many types of tachyarrhythmia in children. Due to the particularity of children, such as low weight, thin blood vessels, small heart chamber volume, and the need for general anesthesia, the difficulty of radiofrequency ablation for children is higher than that of adults. Therefore, there are fewer hospitals in China that pediatricians independently perform radiofrequency ablation for children, and the number of radiofrequency ablation cases for children is far lower than that of adults. Children: adults are about 1:100. After more than 20 years of efforts by pediatric electrophysiologists in China, radiofrequency ablation surgery has achieved good results with high success rate and low complications in children. Studies have shown that radiofrequency ablation can also achieve high success rate and low complication rate in infants and young children^[2,3,4]。 For complex arrhythmias, with the help of three-dimensional electroanatomical mapping system and new technical equipment, the safety and effectiveness of radiofrequency ablation surgery have also been significantly improved. Cryocatheter ablation is gradually applied in pediatrics as a safe technique for treating tachyarrhythmias of near atrioventricular node origin.

In 2016, the Nephrology Group of the Pediatrics Branch of the Chinese Medical Association issued the "Evidence-based Guidelines for the Diagnosis and Treatment of Common Kidney Diseases in Children in China (Trial) (VI) Diagnosis and Treatment of Lupus Nephritis"^[1](hereinafter referred to as the 2010 edition of the guidelines) has been revised to form the "Evidence-based Guidelines for the Diagnosis and Treatment of Lupus Nephritis (2016)" in pediatrics in China (hereinafter referred to as the 2016 edition of the guidelines). This revision mainly refers to the "Guidelines for the Examination, Treatment and Management of Lupus Nephritis" of the American College of Rheumatology in 2011^[2]2011 International Committee for Improving the Outcome of Nephrology (KDIGO) Guidelines for the Treatment of Lupus Nephritis^[3]Recommendations for the Management of Lupus Nephritis in Adults and Pediatrics by the European Alliance Against Rheumatism and the European Nephrological Society-European Society for Dialysis and Transplantation (EULAR/ERA-EDTA)^[4]Combined with the clinical practice experience introduced in domestic and foreign literatures and the opinions and suggestions put forward by many discussions and communication discussions of children's kidney experts in China, a preliminary interpretation of the relevant issues of the 2016 edition of the guidelines is now made.

Male, born 12 d, was admitted to the Children's Hospital affiliated to Suzhou University in July 2016 due to repeated hematemesis and melena for 4 d. The child was the first birth, with a gestational age of 40 weeks and 2 days, and was born naturally. The maternal pregnancy examination found that the fetal gastric vesicle was small, and the perfect magnetic resonance plain scan showed no abnormality. The child went to the local hospital 4 days before admission due to repeated hematemesis with melena, and the blood routine was examined for platelets 60×10⁹/L, hemoglobin 86 g/L, and was given symptomatic and supportive treatment such as anti-infection, human immunoglobulin, acid suppression, etc. The condition did not improve, so he was transferred to our hospital.

Example 1Male, 10 years old, was admitted to the Affiliated Hospital of Zunyi Medical College in April 2017 due to "developmental delay with paroxysmal regression for 6 years". The parents were normal, the child was the second child and the first child, and there was a 6-year-old sister with the same condition (Case 2). The disease occurred at the age of 4. Before the disease, the mental and motor development was normal. The early manifestations were mental and motor regression after fever, mainly motor regression, accompanied by dystonia, no convulsive attacks, no persistent fever and coma. There were no abnormalities in blood routine and cerebrospinal fluid tests in the acute phase. Blood glucose, blood ammonia and homocysteine were normal, and blood lactate was 2.3 mmol/L (reference value<2.05 mmol/L). The hematuria metabolic screening was normal. Cranial magnetic resonance imaging (MRI): bilateral lenticular nucleus, caudate nucleus head long T1WI, long T2WI, fluid attenuation inversion recovery sequence and diffusion-weighted image hyperintensity (Figure 1）。 Considering hereditary metabolic diseases, the condition can improve after symptomatic treatment, and the intellectual progress is obvious. However, symptoms can worsen when you are sick (fever, diarrhea, etc.). He was suspected of mitochondrial disease in other hospitals, and was negative for mitochondrial DNA hotspot mutations (3243A>G, 8993T>G, 14487T>C, 13513G>A). He took traditional Chinese medicine and rehabilitation treatment at home. This time, due to recurrent aggravation of symptoms, physical examination: height 125 cm, weight 25 kg, basically relevant answers, unstable gait, only able to walk, no hirsutism, negative heart, lung and abdomen, normal muscle volume, obviously increased limb tension, hyperreflexia, positive Pap sign. Reexamination of blood routine showed no abnormalities in biochemistry, and blood ammonia and lactic acid were normal. MRI of the skull showed that the lesions in bilateral basal ganglia were significantly reduced and partially softened. Diffusion weighted (DWI) was isosignal.

transposition of the great arteries (TGA) is a common neonatal cyanotic congenital heart disease (CHD)^[1], accounting for 5% to 7% of all CHD and 0.2% of live births^[2]。 The natural mortality rate of children with TGA is extremely high, and the mortality rate of untreated children under 1 year of age reaches 90%^[3]。 arterial switch operation (ASO) is a standard surgical method for the treatment of neonatal TGA. Although the early success rate of surgery is almost close to 100%, long-term survival is also very good^[4]However, many children develop neurodevelopmental and behavioral abnormalities that require lifelong follow-up^[5]。 The pathogenesis of neurodevelopmental abnormalities in children with perioperative TGA and the neurodevelopmental abnormalities in children with long-term ASO are summarized as follows.

Vaccines have successfully prevented the prevalence of many diseases worldwide, significantly reducing the incidence of infectious diseases. Different vaccines have different immune effects, and the immune effects and protective power of the same vaccine are also different. The immune effect induced by the vaccine is not only related to the dosage form and adjuvant of the vaccine itself, but also related to the immune status, genetic background and environment of the vaccine recipient. At present, there are certain differences in the effect of vaccination among individuals. Some people can't produce protective antibodies or have low antibody levels after vaccination, and the reasons are not very clear. In recent years, with the deepening of research on human intestinal flora, more and more studies have found that human symbiotic flora plays a very important role in the immune response of the body and the immune effect of vaccine^[1]。 Then, whether the unsatisfactory vaccination effect of some populations is related to the composition and abundance of bacterial flora, this review summarizes and discusses the influence of bacterial flora on vaccine effect and its mechanism, in order to provide new ideas for future vaccination strategies.

autosomal recessive polycystic kidney disease (ARPKD) is a serious monogenic fibrocystic disease of liver and kidney. It is also one of the important causes of pediatric end-stage kidney disease. Its incidence is about 1:10 000~1:40 000^[1]。 The clinical presentation of the disease has a high degree of variability, mainly manifested by diffuse fusiform dilatation of bilateral renal collecting ducts and varying degrees of hepatic fibrosis. In addition, the disease can also involve the lungs, pancreas, vascular system, as well as growth retardation and cognitive dysfunction. The onset of the disease is early and severe, and the patient's involvement of multiple organs begins in the intrauterine development phase. About 30% of the children died in the perinatal period due to lung hypoplasia, and most of the surviving postpartum children developed end-stage renal disease before puberty due to space-occupying lesions of renal cysts and severe renal parenchymal fibrosis. At present, there are many good strategies for the clinical treatment of this disease. Therefore, in-depth research and understanding of the pathogenesis of this disease is an urgent need for the majority of clinicians. Combined with the research results of our research group, the current progress of research on the pathogenesis of this disease at home and abroad is summarized.

Whether the subjects meet the needs of the study is the basis for the success of a clinical study. At the same time, the selection of research objects is one of the speed limiting links of the research. How to enroll research objects efficiently is an important guarantee to complete the research on time. In order to ensure the scientific and feasible selection of research objects, researchers should first consider the following key issues when designing research protocols.