BACKGROUND & AIMS: :This report describes a case of diabetes insipidus associated with acute myelogenous leukemia. An 11-year-old boy presented with fatigue, polydipsia and polyuria. His evaluation revealed a diagnosis of acute myelogenous leukemia FAB-M2, and a water deprivation test confirmed the diagnosis of central diabetes insipidus. His brain magnetic resonance imaging (MRI) showed a thickened, enhancing pituitary stalk with absence of the normal hyperintense signal in the posterior pituitary. He was treated with systemic chemotherapy, intensive intrathecal therapy, and 1,000 cGy to the pituitary. The patient achieved a remission but continued to need desmopressin therapy to control his diabetes insipidus. Diabetes insipidus is a rare complication of acute myelogenous leukemia that can be caused by leukemic infiltration of the pituitary. The diabetes insipidus is irreversible despite intensive systemic and central nervous system chemotherapy and radiation.

背景与目标： : 本报告描述了一例与急性骨髓性白血病相关的尿崩症。一个11岁的男孩出现乏力，多饮和多尿。他的评估显示诊断为急性骨髓性白血病FAB-M2，缺水试验证实了中枢性尿崩症的诊断。他的脑磁共振成像 (MRI) 显示垂体柄增厚，增强，垂体后叶没有正常的高信号。他接受了全身化疗，强化鞘内治疗，并向垂体1,000 cGy。患者获得缓解，但继续需要去莫加压素治疗以控制其尿崩症。尿崩症是急性骨髓性白血病的罕见并发症，可由垂体的白血病浸润引起。尽管进行了大量的全身和中枢神经系统化疗和放疗，但尿崩症是不可逆的。

BACKGROUND & AIMS: :Currently available data indicate a clear and probably causal relationship between long-lasting gastroesophageal reflux disease, the development of long segments with specialized intestinal metaplasia in the distal esophagus and subsequent progression to adenocarcinoma. To a lesser degree, this also appears to be the case for short segments of specialized intestinal metaplasia in the distal esophagus. In contrast, epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia at the gastric cardia. Despite its high prevalence and malignant potential, many questions about the prevention and management of intestinal metaplasia in the distal esophagus remain unsolved. In patients with chronic gastroesophageal reflux, current modes of medical therapy do not appear to prevent the development of intestinal metaplasia, while effective anti-reflux surgery seems to have a protective effect. Formal studies with adequate follow-up are, however, still lacking. Neither acid-suppression therapy nor anti-reflux surgery, with or without mucosal ablation, can reliably prevent the malignant degeneration of established intestinal metaplasia of the esophagus. Close endoscopic surveillance with extensive biopsies, therefore, remains mandatory in such patients, irrespective of the treatment modality.

背景与目标： : 目前可用的数据表明，长期持续的胃食管反流病，远端食管中长节段的特殊肠上皮化生的发展以及随后发展为腺癌之间存在明确的因果关系。在较小的程度上，远端食道中特异肠化生的短节段似乎也是这种情况。相比之下，用于诊断胃食管反流疾病的流行病学数据和经典参数目前不支持胃食管反流在胃card门特殊肠化生的发病机理中的因果作用。尽管其高患病率和恶性潜能，但有关远端食管肠化生的预防和管理的许多问题仍未解决。在慢性胃食管反流患者中，目前的药物治疗模式似乎无法阻止肠上皮化生的发展，而有效的抗反流手术似乎具有保护作用。然而，仍然缺乏足够随访的正式研究。无论有无粘膜消融，抑酸疗法还是抗反流手术都不能可靠地预防已建立的食管肠化生的恶性变性。因此，对于此类患者，无论治疗方式如何，都必须进行密切的内窥镜检查和广泛的活检。

BACKGROUND & AIMS: Aims:To focus asthma care on those patients most in need whilst providing annual audit data. Methods:An observational questionnaire study. Patients on the asthma register received a postal invitation to the asthma clinic plus a questionnaire which enquired about both symptoms and the process of care. Medical records were searched for data on non-responders. Results:Of the 1241 people sent the invitation and questionnaire 682 (57%) returned it and 99 attended the clinic. Follow-up of responders with high morbidity resulted in a further 32 people attending. The 99 attenders had a higher morbidity than non-attenders on the criteria of a course of oral steroids in the last six months(15% v 29%)and a mean symptom score of 3 or more ( 12% v 31%). Conclusions:Whilst the process did focus care on those in need, and resulted in a manageable number of people attending the asthma clinic, many individuals with high morbidity or risk factors did not attend.

背景与目标：

BACKGROUND & AIMS: The objective of this study was to develop an indigenous measure of common mental disorders (CMD) in the Shona language in Zimbabwe. Ethnographic and qualitative studies elicited idioms of distress of mental disorder leading to the preliminary Shona Symptom Questionnaire (SSQ), and items from the Self-Report Questionnaire (SRQ) were added to it. The 56-item Preliminary Shona Symptom Questionnaire (PSSQ) was administered to 302 randomly selected primary care attenders, of whom 100 were classified as cases on the basis of agreement between care provider assessment and a psychiatric interview. Discriminant analysis identified 14 items that were the strongest predictors of mental disorder. The 14-item SSQ has a high level of internal consistency (Cronbach's alpha = 0.85). The items are a mixture of emic and etic phenomena. The total score correlates strongly with patients' self-assessment of the emotional nature of their illness. Satisfactory specificity and sensitivity occurred at a cut-off point of 7/8. The SSQ is the first indigenous measure of mental disorder developed in sub-Saharan Africa to have included idioms or distress of primary care attenders and involved patients consulting traditional medical practitioners. It promises to be a useful instrument for epidemiological and clinical research. The methodology used is an innovative way of combining etic and emic methods in the evaluation of CMD.

背景与目标： 这项研究的目的是开发一种针对津巴布韦Shona语言的常见精神障碍 (CMD) 的本地测量方法。人种学和定性研究引起了精神障碍困扰的成语，导致了初步的Shona症状问卷 (SSQ)，并在其中添加了自我报告问卷 (SRQ) 中的项目。对302随机选择的初级护理人员进行了56个项目的初步Shona症状问卷 (PSSQ)，其中100人根据护理提供者评估和精神病学访谈之间的协议被归类为病例。判别分析确定了14个项目是精神障碍的最强预测指标。14项SSQ具有高水平的内部一致性 (Cronbach's alpha = 0.85)。这些项目是emic和etic现象的混合物。总分与患者对疾病情感性质的自我评估密切相关。在7/8的临界点出现令人满意的特异性和敏感性。SSQ是撒哈拉以南非洲开发的第一个本地精神障碍措施，其中包括初级保健服务人员的成语或困扰，并涉及患者咨询传统医疗从业人员。它有望成为流行病学和临床研究的有用工具。所使用的方法是在CMD评估中结合etic和emic方法的一种创新方法。

BACKGROUND & AIMS: :Fatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex- and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.

背景与目标： 乏力是慢性肾脏疾病患者的常见症状，但移植后很少进行研究。我们确定了肾移植受者 (KTRs) 严重乏力的患病率，影响和相关因素。使用病历和问卷来评估肾功能，供体特征，乏力 (个人力量清单)，功能障碍 (疾病影响特征)，工作状态，体重指数 (BMI)，疼痛，抑郁症状，社会支持和睡眠问题参加KTRs的180。将KTRs与性别和年龄匹配的基于人群的对照进行比较。与匹配的对照组 (22%; P = 0.001) 相比，ktr明显更经常严重疲劳 (39%)。严重疲劳的KTRs比非严重疲劳的接受者具有明显更多的功能障碍 (效应大小 ≥ 0.7) P <0.001，并且很少有报酬的工作 (27% 对48%，P = 0.005)。单变量分析显示，严重疲劳的KTRs更经常从已故捐赠者那里获得肾脏，BMI更高，疼痛更多，社会支持差异，抑郁症状和睡眠问题。在多变量分析 (n = 151) 中，后两种关联仍然显著。严重乏力是KTRs中非常普遍的致残症状。此外，与特定的移植相关因素相比，肾移植后的严重乏力与行为和社会心理因素的关系更为密切。研究结果对乏力管理有影响。

BACKGROUND & AIMS: Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.

背景与目标： 健康调查，身体症状报告研究和身体不适的医疗登记发现，症状报告中的性别差异一致，女性的比率更高。总的来说，这种女性过度的身体症状与症状度量，反应格式和使用的时间范围以及所研究的人群无关。由于大多数研究都涉及健康个体，因此性别差异不能简单地归因于女性的身体发病率更高。在本文中，我们基于症状感知的生物心理社会观点，对这种现象提出了许多解释。我们讨论了一种症状感知模型，该模型将现有文献中的因素和过程汇集在一起，这些因素和过程被认为会影响症状报告，例如躯体信息，通过注意力和分心选择信息，躯体感觉的归因以及人格因素躯体化和负面情感。最后，我们讨论了模型引起的身体症状性别差异的解释。

BACKGROUND & AIMS: BACKGROUND:No studies have evaluated associations between patterns of diet-related practices as determined by latent class analysis (LCA) and gastro-esophageal reflux disease (GERD). We aimed to assess this relationship in a large sample of Iranian adults. METHODS:In a cross-sectional study in 4763 adults, diet-related practices were assessed in four domains, 'meal pattern', 'eating rate', 'intra-meal fluid intake', and 'meal-to-sleep interval', using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. We defined GERD as the presence of heartburn sometimes, often or always. KEY RESULTS:The prevalence of GERD in the study population was 23.5% (n = 1120). We identified two distinct classes of meal patterns: 'regular' and 'irregular', three classes of eating rates: 'moderate', 'moderate-to-slow', and 'moderate-to-fast', two major classes of fluid ingestion with meals: 'moderate' and 'much intra-meal drinking', and two classes regarding the interval between meals and sleeping: 'short' and 'long meal-to-sleep' interval. After adjustment for potential confounders, subjects with 'irregular meal pattern' had higher odds of GERD compared with subjects with 'regular meal pattern' (OR: 1.21; 1.00-1.46). However, when taking into account BMI, the association disappeared. 'Long meal-to-sleep interval' was inversely associated with GERD compared with 'short meal-to-sleep interval' (OR: 0.73; 95% CI: 0.57-0.95). 'Eating rate' and 'intra-meal fluid intake' were not significantly associated with GERD. CONCLUSIONS & INFERENCES:Our data suggest certain associations between dietary patterns and GERD. These findings warrant evaluation in prospective studies to establish the potential value of modifications in dietary behaviors for the management of GERD.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:European studies have shown that itch is a widespread symptom, yet little is known about its frequency in the United States. OBJECTIVE:We sought to describe ambulatory care visits to clinicians in the United States for which itch was coded as a patient symptom. METHODS:This study uses retrospective data from the National Ambulatory Medical Care Survey from 1999 through 2009. RESULTS:Itch was coded as a symptom for an average of 7 million visits per year or approximately 1% of all outpatient visits, which was nearly 40% of the number of visits for the symptom of low back pain. Patients seen in visits for itch were more likely to be black or Asian than other patients (20% vs 14%). They were also more likely than other patients to receive a new medication (68% vs 36%) and were over twice as likely to receive 2 or more new medications (31% vs 14%). LIMITATIONS:Secondary data sets may not optimally capture patient reports and some of the procedures or medications may have been ordered for reasons other than itch. CONCLUSION:Visits to clinicians for itch represent a sizeable proportion of ambulatory care visits in the United States, and research on the epidemiology, treatments, and causes of itch should be a priority.

背景与目标：

BACKGROUND & AIMS: :Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance-using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self-medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.

背景与目标： : 探索PTSD和酒精滥用与妇女使用亲密伴侣暴力 (IPV) 之间的关系，对于发展我们对为什么某些妇女可能参与IPV的理解至关重要，这可以最大程度地为妇女提供干预。这项研究调查了创伤后应激障碍 (PTSD) 症状群通过涉及酒精滥用的途径与女性使用IPV直接和间接相关的程度，同时控制了女性IPV受害的严重程度。样本由目前正在遭受IPV受害的物质使用，低社会经济地位的社区妇女 (N = 143) 组成。大多数样本是非裔美国人 (n = 115，80.42%)。该样本的平均家庭年收入为 $14,368.68 (SD = $12,800.68)，相当于高中教育 (11.94年，SD = 1.32)。路径分析表明，妇女使用IPV与妇女IPV受害之间存在最强烈的统计关系。PTSD的再体验和麻木症状的严重程度与女性使用心理，轻微身体和严重身体IPV有关; 但是，这些关系是通过酒精滥用间接的。研究结果为自我用药假说在PTSD，酒精滥用和IPV研究中的应用提供了初步支持。

BACKGROUND & AIMS: BACKGROUND & AIMS:Heartburn and gastroesophageal reflux disease (GERD) during pregnancy are accepted as an innocent condition. The effect of heartburn during pregnancy on the initiation or progress of GERD is not known. We aimed to determine the predisposition effect of heartburn during pregnancy for presenting with GERD in the future. METHODS:A validated reflux questionnaire was applied to 1180 randomly selected women aged between 18-49 years who had given birth to at least one delivery. Frequent symptoms were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. Occasional symptoms were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. RESULTS:The mean live delivery rate was 2 +/- 1 (range, 1-10). The prevalence of GERD was 7.4%. Whereas the prevalence of GERD for women with a history of just 1 delivery was 1.5%, more than 2 deliveries were accompanied with risk of 15.1% (P < .001). In the group with no heartburn during pregnancy only 5.5% had GERD (P < .00001). If there was heartburn during any of the pregnancies, the risk was 17.7%; and more than 2 pregnancies with a history of heartburn accompanied 36.1% risk of having GERD. Logistic regression analysis showed that the risk is independent from obesity and age. CONCLUSIONS:The risk of GERD is increased by the presence of heartburn during pregnancy. This association is independent of obesity and age. Heartburn during pregnancy might not be accepted as an innocent and temporary condition.

背景与目标：

BACKGROUND & AIMS: :Studies comparing voiding urosonography (VUS) with voiding cystourethrography (VCUG) and direct radionuclide cystography (DRNC) were analyzed and detailed tables demonstrating the diagnostic values and grading of vesicoureteric reflux (VUR) are presented. Comparative studies of DRNC were too few and did not allow definite conclusions. Using VCUG as the reference, the results of VUS were as follows: sensitivity 57-100%, specificity 85-100%, positive/negative predictive values 58-100%/87-100%, respectively, and diagnostic accuracy 78-96%. With the exception of two studies the diagnostic accuracy reported was 90% and above. In 19% of pelviureteric units (PUUs) the diagnosis was made only by VUS and in 10% only by VCUG. Thus in 9% of PUUs more refluxes were detected using VUS. In 73.6% the reflux grades were concordant in VUS and VCUG. Reflux grade was found to be higher with VUS than with VCUG in 19.6% of PUUs. In 71.2% of PUUs with grade I reflux on VCUG, the reflux was found to be grade II and higher on VUS. The common selection criteria for VUS as the primary examination for VUR currently include (a) follow-up studies, (b) first examination for VUR in girls, and (c) screening high-risk patients.

背景与目标： : 分析了排尿超声检查 (VUS) 与排尿膀胱尿道造影 (VCUG) 和直接放射性核素膀胱造影 (DRNC) 的比较研究，并给出了详细的表格，证明了膀胱输尿管反流 (VUR) 的诊断价值和分级。DRNC的比较研究太少，无法得出明确的结论。以VCUG为参照，VUS的结果如下: 敏感性57-100%，特异性85-100%，阳性/阴性预测值58-100%/87-100%，诊断准确性78-96%。除两项研究外，报告的诊断准确性90% 以上。在骨盆单位 (PUUs) 的19% 中，仅由VUS进行诊断，10% 仅由VCUG进行诊断。因此，在PUUs 9% 中，使用VUS检测到更多的回流。在73.6% 中，回流等级在VUS和VCUG中一致。发现19.6% PUUs时，VUS的回流等级高于VCUG。在VCUG上具有I级回流的PUUs 71.2% 中，发现回流为II级且在VUS上更高。VUS作为VUR主要检查的通用选择标准目前包括 (a) 随访研究，(b) 对女孩进行VUR的首次检查以及 (c) 筛查高危患者。

BACKGROUND & AIMS: INTRODUCTION:Transureteroureterostomy (TUU) provides urinary drainage of both renal systems to the bladder via a single ureter and is useful in selected situations of complex urological reconstructions. Herein we discuss its use, advantages and complications in children with neurogenic bladders and high-grade (4/5) reflux who have undergone augmentation cystoplasty. PATIENTS AND METHODS:Children with neurogenic bladder complicated by unilateral or bilateral high-grade vesicoureteric reflux (VUR), who underwent TUU along with augmentation cystoplasty (BA), were selected from two institutions. Eighteen children with an average age of 5 years at presentation were identified from a retrospective chart review. RESULTS:All had bilateral hydroureteronephrosis (HUN) of which there were 30 refluxing megaureters. While BA reduced bladder pressure, VUR was managed by refluxing to non-refluxing TUU in six cases with unilateral VUR and unilateral reimplantation with TUU to the reimplanted ureter in 12 cases of bilateral VUR, thus minimizing reimplantation to 12 of 30 ureters. The average time of follow-up was 51 months. Follow-up cystograms showed complete resolution of VUR in all. HUN improved/stabilized in all but one child. Serum creatinine remained normal in all but two cases. Other advantages of TUU include the use of the distal ureter as a catheterizable channel and ease of undiversion when the ureter has been diverted as a ureterostomy. An unusual complication of a TUU site stricture is discussed and the innovative technique of using a cecal patch to salvage the anastomosis is detailed. CONCLUSION:We conclude that a TUU is a safe and useful adjunctive procedure in children undergoing BA for neurogenic bladder with high-grade VUR, minimizing the need for ureteric reimplant in an unhealthy bladder.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Cognitive impairment is one of the fundamental features among patients with schizophrenia. The relationship between schizophrenia symptoms, insight and cognitive domains remains controversial. We aimed to study these relations in a sample of Egyptian patients with schizophrenia. METHODS:A total of 109 patients with schizophrenia were assessed using Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders (4th ed.)) Axis I diagnosis (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Scale to Assess Unawareness of Medical Disorder (SUMD). Cognitive functions were assessed using the Wechsler Adult Intelligence Scale (WAIS), the Wisconsin Card Sorting Test (WCST) and the Wechsler Memory Scale (WMS). The cognitive functions would be distributed to cover six cognitive domains: attention/vigilance speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. RESULTS:There was a significant correlation between all cognitive domains (except attention) and PANSS subscales. PANSS negative and general psychopathology subscales were significantly correlated with five cognitive domains: speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. PANSS negative subscale was significantly correlated with verbal learning (verbal paired association 1) and visual learning (visual paired association 1). There was a significant correlation between all cognitive domains and SUMD, except verbal and visual learning domains assessed by verbal and visual paired association 1 subtests, as well as attention assessed by failure to maintain set subtest. Only visual learning (trials administered), working memory (percentage error), and processing speed (perseverative responses, and trials to complete first category) were significantly negatively correlated to SUMD. CONCLUSION:Cognitive impairment in patients with schizophrenia is most likely to underlie negative symptoms, general psychopathology symptoms and poor insight, suggesting that treatment strategies minimizing these symptoms would improve cognitive impairment.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To characterize a scale for the measurement of fibromyalgia (FM)-like symptoms; to investigate whether FM is a discrete disorder; to understand the significance of FM-like symptoms; and to investigate causal and noncausal factors in the development of such symptoms. METHODS:We evaluated 25,417 patients with rheumatic disease using the Symptom Intensity (SI) Scale, a self-report scale that combines a count of pain in 19 nonarticular regions with a visual analog scale for fatigue. We studied this scale in relation to demographics, clinical symptoms, and serious outcomes, including serious medical illnesses, hospitalization, work disability, and death. RESULTS:Compared with other rheumatic disease assessments, the SI scale was the best identifier of symptoms associated with FM content, including an increase in general medical symptoms. SI scale elevations were associated with increases in cardiovascular disorders, hospitalization, work disability, and death. Persons with socioeconomic disadvantage by reason of sex, ethnicity, household income, marital status, smoking, and body mass had increased SI scores. For almost all clinical variables studied, the prevalence and/or severity of the variable increased linearly with SI scores. CONCLUSION:We identified a clinical marker for general symptom intensification that applies in all patients and is independent of a diagnosis of FM. We found no clinical basis by which FM may be identified as a separate entity. Higher scores on the SI scale were associated with more severe medical illness, greater mortality, and sociodemographic disadvantage, and these factors appear to play a role in the development of FM-like symptoms and symptom intensification.

背景与目标：

BACKGROUND & AIMS: :The aim of this study is to describe the prevalence of gastroesophageal reflux disease (GERD) in infants under 3 months old with a history of cyanotic episodes, who were examined at the emergency room of a university hospital. This descriptive study reviews reports of esophageal pH monitoring from a pediatric gastroenterology service over a period of 5 years. The following data were collected: age, sex, pediatric as well as other specialists' evaluations, and the esophageal pH monitoring reports. This study included 67 infants with a history of cyanotic episodes, with no primary cause determined by pediatrician and pediatric specialists' evaluations, who underwent esophageal pH monitoring. The infants were 6-90 days old, 41 (61.2%) of them male. Fifty infants (74.6%) had at least one esophageal pH monitoring parameter above the normal limit. ZMD index was abnormal in 32 cases (48%) and reflux index was abnormal in 31 cases (46%). When other common causes of cyanosis have been ruled out, a significant proportion of infants presenting cyanosis have abnormal pH study, suggesting the role of GERD in cyanosis. The authors highlight that reflux index is not enough to conclude whether a pH study is normal or not. The ZMD index and the presence of episodes longer than 20 minutes are also important parameters for GERD diagnosis.

背景与目标： : 这项研究的目的是描述在大学医院急诊室检查的3个月以下有发绀发作史的婴儿中胃食管反流病 (GERD) 的患病率。这项描述性研究回顾了儿科胃肠病服务机构在5年内进行的食管pH监测报告。收集了以下数据: 年龄，性别，儿科以及其他专家的评估以及食管pH监测报告。这项研究包括67名有发绀发作史的婴儿，这些婴儿没有由儿科医生和儿科专家评估确定的主要原因，他们接受了食道pH监测。婴儿为6-90天，其中男性41 (61.2%)。50名婴儿 (74.6%) 至少有一个食管pH监测参数高于正常限值。ZMD指数异常32例 (48%)，反流指数异常31例 (46%)。如果排除了其他常见的发绀原因，则有相当一部分出现发绀的婴儿进行了异常pH研究，这表明GERD在发绀中的作用。作者强调，反流指数不足以得出pH研究是否正常的结论。ZMD指数和发作时间超过20分钟也是GERD诊断的重要参数。