微生态制剂对早产儿喂养不耐受及早期生长发育的影响

目的 探讨微生态制剂对早产儿喂养不耐受和早期生长发育的影响.方法 将80例早产儿(胎龄29～36周;出生体质量1 000～2 000 g)随机分成治疗组和对照组,每组40例.二组患儿均予常规护理和治疗,治疗组在此基础上于出生24 h内开始口服(或经胃管)微生态制剂酪酸梭菌-婴儿型双歧杆菌二联活菌散剂,0.5 g/次,2次/d.观察出生28 d二组患儿体质量、头围、身长和体质量恢复至出生时体质量所需时间,监测喂养不耐受的发生率及可能的不良反应.结果 新生儿期治疗组喂养不耐受发生率为27.5%,对照组为52.5%,二组比较有显著差异(X2=5.208 3 P<0.05);过渡到全胃肠喂养所需时间治疗组为(12.1±2.45)d,对照组为(16.8±8.78)d,二组比较有显著差异(t=3.26 P<0.01);治疗组新生儿期头围、身长、体质量增长速度[(0.65±0.1)cm/周、(0.8±0.15)cm/周、(22.3±2.56)g/d]较对照组[(0.6±0.11)cm/周、(0.7±0.16)cm/周、(16.1±1.32)g/d]均明显增快(t=2.12P<0.05;t=2.88 P<0.05;t=13.61 P<0.01),体质量恢复至出生时所需时间[(5.2±1.13)d]亦较对照组[(9.8±3.16)d]明显缩短(t=8.67 P<0.01).治疗过程中无不良反应发生.结论 酪酸梭菌-婴儿型双歧杆菌二联活菌散剂可降低早产儿喂养不耐受的发生率,缩短达到全胃肠喂养的时间,促进早产儿早期生长发育.     

二氧化硫对低氧性肺动脉高压大鼠肺动脉结构的影响

目的 探讨二氧化硫(sulfur dioxide,SO2)对于低氧性肺动脉高压大鼠肺动脉结构的影响.方法 将大鼠分为3组:对照组(n=8)、低氧组(n=8)和低氧+SO2组(n=10,给予Na2SO3/NaHSO3).对低氧组和低氧+SO2组大鼠进行低氧处理21 d.同时对照组置于常氧环境.检测各组大鼠肺动脉平均压.并通过光镜检测肌型小动脉相对中膜厚度(RMT),应用透射电镜观察各组大鼠肺小动脉超微结构的变化,检测血浆SO2含量.结果 低氧组大鼠肺动脉平均压[(5.12±0.51)kPa]较对照组[(2 25±0.50)Ida]高(t=5.091,P＜0.01),低氧组肺动脉RMT测定值(9.66±1.27)较对照组(6.83±1.57)高(t=3.392,P＜0.01),超微结构观察显示低氧组大鼠肺小动脉内皮细胞体积增大变性,内弹力层疏松厚薄不均.平滑肌细胞体积增大,细胞器丰富,细胞间见胶原原纤维增多,同时低氧组血浆SO2含量[(27.01±4.17)tunol/L]较对照组[(33.36±5.62)μmol/L]低(t=3.767,P＜0.05);低氧+SO2组大鼠的肺动脉平均压[(3.94±0.33)kPa]较低氧组[(5.12 ±0.51)kPa]低(t=2.712,P＜0.01),低氧+SO2组RMT测定值(6.97±1.83)较低氧组(9.66±1.27)低(t=3.009,P＜0.01),超微结构观察显示给予SO2干预后上述改变较低氧组明显改善,同时血浆SO2含量[(29.89±4.52)μml/L]较低氧组[(27.01±4.17)μmol/L]高(t=1.263,P＞0.05).结论 SO2对低氧性肺动脉高压大鼠肺小动脉结构具有重要的调节作用.     

儿科乳糜胸及乳糜腹规范化营养治疗15例

目的：回顾分析使用肠外营养支持的乳糜胸/腹的治疗,分析其与国际乳糜胸/腹治疗建议的共同点。方法收集2012、2013年共15例使用PN的乳糜胸/腹的诊疗内容,并对患儿一般资料、治疗方案的制定、预后等进行分析。结果2012、2013年间本院使用PN支持的乳糜胸/腹患儿共15例,其中乳糜胸11例（73．3％）,乳糜腹4例（26．7％）,12例放置胸/腹引的患儿平均引流时间为（23．2±17．8）d。患儿PN时间平均为（19．9±19．1）d。经过积极引流、规范营养支持、奥曲肽、手术结扎胸导管等综合治疗,最终13例乳糜漏患儿治愈出院,1例带腹腔引流管出院后失访,1例住院1周后自动出院。15例患儿平均住院时间为（30．8±17．7）d。结论充分引流、合理营养支持、适时应用生长抑素等保守治疗可治愈大部分乳糜胸/腹,如保守治疗无效,可选择红霉素胸/腹膜粘连和手术治疗等侵入性治疗方式。高MCT饮食较常规低脂饮食更为有效。但仍需进一步探索更规范的治疗方案。     

宫内发育迟缓新生儿脐血心钠素及甲状旁腺素水平的变化及其与电解质的关系

目的 探讨宫内发育迟缓(IUGR)新生儿脐血心钠素(ANP),甲状旁腺素(VrH)水平的变化及其与电解质的关系.方法 选择2006年1月-2007年8月本院出生的IUGR新生儿71例.按胎龄分为2组:足月IUGR组(29例)、早产IUGR组(42例).选择40例健康足月适于胎龄儿为健康对照组.各组均在娩出后水即抽取脐血,采用放射免疫分析法测定其ANP及PTH水平.同时抽取静脉血1.5 mL测定各组血清Na+、Ca2+水平.结果 1.早产IUGR组和足月IUGR组脐血ANP水平[(1.26±0.47) ug/L、(1.09±0.51)ug/L]与健康对照组[(0.78±0.42)ug/L]比较均明显增高(t=5.98,2.76 Pa<0.01);早产IUGR组和足月IUGR组血Na+[(129.33±6.02)mmol/L、(130.27±5.47)mmol/L]与健康对照组[(135.26±4.63)mmol/L]比较均明显降低(t=5.04,4.86 Pa<0.01).2.早产IUGR组脐血PTH水平[(0.97±0.64)ug/L]与健康埘照组[(1.31±0.74)ug/L]比较明显降低(t=2.27 P<0.05).足月IUGR组[(1.21±0.69)ug/L]下降不明显(t=0.57 P>0.05);早产IUGR组血Ca2+[(1.85±0.37)mmol/L]与健康对照组[(2.02±0.44)mmol/L]比较明显降低(t=1.93 P<0.05),足月 IUGR绀[(1.99±0.35)mmol/L]与健康对照组比较无明显差异(t=0.30 P>0.05).3.脐血 ANP水平升高与血清Na+水平下降呈显著负相关(r=-0.93 P<0.01).结论 IUGR患儿脐血ANP增高明显,与低钠血症密切相关,而早产IUGR新生儿对甲状旁腺反应低下,可造成低钙血症,测定脐血ANP和PTH对治疗有指导作用.     

体位引流辅助气管吸引对胎粪吸入综合征的防治效果

目的 评价体位引流辅助气管吸引防治胎粪吸入综合征(MAS)的临床效果.方法 2007年1月至2008年12月我院收治的窒息合并MAS新生儿61例,分为对照组24例,生后气管插管应用胎粪吸引管气管内吸引;观察组37例,插管后体位引流再行气管吸引.主要观察两组气管内吸出胎粪量、MAS并发症及转归.结果 观察组气管内抽出胎粪量(2.16±1.82)ml,较对照组(1. 23±0.97)ml明显增多,差异有显著性(P＜0.05);观察组吸净胎粪所需插管次数为(1.19±0.46)次,较对照组[(1.79±0.83)次]显著减少,差异有显著性(P＜0.01).观察组并发症发生率为8.11%,明显低于对照组29.17%,差异有显著性(P＜0.05).观察组吸氧时间(包括机械通气)为(21.30±22.38)h,较对照组[(52.91±39.20)h]显著缩短,差异有显著性(P＜0.01);观察组住院天数(9.24±3.94)d,对照组为(14.39±6.49)d,差异有显著性(P＜0.01).观察组病死率为0,对照组病死率4.17%,差异无显著性(P＞0.05).观察组1 min Apgar评分与对照组相近,差异无显著性(P＞0.05);观察组5 minApgar评分8～10分者占70.16%,明显高于对照组(58.34%),差异有显著性(P＜0.05).结论 体位引流辅助气管吸引可有效清除气管内胎粪,减少MAS并发症的发生,缩短吸氧时间和住院天数.     

红霉素对新生儿胃肠道功能紊乱的疗效观察

目的 评估口服红霉素对新生儿胃肠道功能紊乱的疗效.方法 采用随机、双盲、安慰剂对照试验,选择2009年1月至2011年12月于深圳市儿童医院新生儿重症监护室住院的90例患儿作为研究对象,随机分为小剂量红霉素组、大剂量红霉素组和对照组,每组30例,分别给予3 mg/(kg·次)、10 mg/(kg·次)红霉素或等量生理盐水口服或鼻饲,每8小时1次,疗程14 d.比较各组患儿达到半量、3/4量及全量肠内营养时间、肠外营养时间及住院时间.结果 与对照组[(8.1±0.4)d,(13.5±1.0)d,(15.7±1.2)d]比较,大剂量红霉素组[(3.0±0.5)d,(6.2±0.7)d,(8.2±1.0)d]和小剂量红霉素组[(6.2±0.5)d,(8.3±0.6)d,(10.6±1.1)d]患儿达到半量、3/4量及全量肠内营养的时间均明显提前(P＜0.05).肠外营养时间[(14.2±1.4)d vs (9.3±1.2)d vs (7.8±1.1)d]及住院时间[(13.0±1.4)d vs (8.1 ±0.8)d vs (6.8±0.7)d],对照组明显长于不同剂量红霉素组,3组间比较差异均有统计学意义(P＜0.05).治疗期间发生肝功能损害、脓毒症的患儿,不同剂最红霉素组两组相似,但是比对照组明显降低.未见口服红霉素治疗的相关不良反应(QT间期延长、心律失常).结论 口服红霉素可以作为肠内营养不足的新生儿胃肠道功能紊乱的治疗方法,并且口服大剂量红霉素较小剂量效果更好.     

左卡尼汀对新生儿窒息致心肌损害的疗效

目的 探讨左卡尼汀治疗新生儿窒息致心肌损害的疗效.方法 窒息致心肌损害新生儿91例随机分为左卡尼汀治疗组(治疗组,48例)和常规治疗组(对照组,43例),二组患儿均予常规治疗,治疗组在常规治疗的基础上加用左卡尼汀针0.1 g/(kg·d)静脉滴注,1次/d,10 d为1个疗程.观察治疗前以及治疗过程中患儿症状体征的变化.在治疗前和治疗1个疗程,抽取患儿静脉血3 mL,分离血清,采用免疫抑制法和酶速率法分别检测其血清CK-MB和AST水平的变化,采用免疫比浊法和溴甲酚绿比色法分别检测血清前清蛋白和清蛋白水平的变化.采用Stata 7.0软件进行t、鳘2检验.结果 治疗组临床有效率(91.67%)明显高于对照组(74.42%)(P<0.05).治疗组心率恢复正常时间[(3.18 ±1.10) d]短于对照组[(4.32±1.43) d](P<0.05);治疗组CK-MB及AST分别为(22.48±4.72) U/L、(42.18±9.27) U/L,均较对照组[(29.06±6.10) U/L、(51.31±11.81) U/L]更接近正常值(Pa<0.05);治疗组前清蛋白[(125.25±30.64) mg/L]较对照组[(110.73±25.46) mg/L]提高更为明显(P<0.05);治疗组清蛋白[(38.58±6.56) g/L]较对照组[(35.79±6.44) g/L]也提高更为明显(P<0.05).结论 左卡尼汀治疗新生儿窒息致心肌损害具有良好疗效.     

大鼠获得性漏斗胸形成过程中肺功能的观察

目的 观察获得性漏斗胸形成过程中肺功能的变化.方法 4周龄SD大鼠40只按数字随机法分为实验组和对照组各20只.实验组行经胸骨旁切断下位三对肋软骨观察漏斗胸形成,对照组不做任何干预,于术后3d和4周测定动物肺功能指标,包括:吸气阻力(Ri)、呼气阻力(Re)、肺的顺应性(Cl)、每分钟通气量(MVV)、用力肺活量(FVC)、第0.2s用力呼气容积(FEV0.2)、FEV0.2/FVC%、呼出50%FVC量时的流速(FEF50%)及用力最大呼气流速(PEF)等,检测结果在组间进行比较分析.结果 造模术后1周内动物呼吸频率增快,其后漏斗胸逐渐形成并稳定.肺功能检测:术后3d测得Ri在实验组和对照组分别为(1.16±0.21)cmH2O·ml-1·s-1和(0.73±0.26)cmH2O·ml-1·s-1 (P=0.00),Re分别为(0.86±0.30)cmH2O·ml-1·s-1和(0.58±0.16)cmH2O·ml-1·s-1 (P=0.01),Cl分别为(0.05±0.01)cmH2O/ml和(0.09±0.02)cmH2O/ml(P=0.00),FVC分别为(3.69±0.10)ml和(3.89±0.19)ml (P=0.00),FEV0.2分别为(3.28±0.40) ml和(3.58±0.15)ml(P=0.02);术后4周测得Ri在实验组和对照组分别为(0.88±0.17) cmH2O·ml-1·s-1和(0.66±0.10)cmH2O·ml-1·s-1 (P=0.00),FVC分别为(5.76±0.52)ml和(5.47±0.20) ml(P=0.05).Ri在术后3d和4周的检测结果在同龄动物组间比较差异均有显著性,造模术后动物的吸气阻力增加(P<0.05);Re、Cl、FEV0.2和FVC等指标在术后3d的测得值组间差异有显著性,实验组Re增加而另3个指标减小(P<0.05),FVC在术后4周时组间比较P=0.05,而MVV 、FEV0.2/FVC%、PEF25%~75%和PEF等指标不论在术后3d还是4周的检测结果组间比较差异均无统计学意义(P>0.05).结论 通过胸骨旁切断下位三对肋软骨造成模型漏斗胸的形成过程中,幼鼠吸气和呼气阻力增加,胸壁和肺的顺应性均降低,随着漏斗胸的形成和稳定,肺功能重新建立适应,但胸廓的顺应性仍较正常降低.     

窒息新生儿激活素A水平与缺氧缺血性脑病相关性研究

目的 研究窄息新生儿内源性激活素A(ACT A)的水平变化及其与新生儿缺氧缺血性脑病(HIE)的发生、严重程度及预后的相关性.方法 应用ELISA方法动态监测58例窒息足月新生儿(轻度窒息39例,重度窒息19例)和30例正常足月新生儿血清ACT A、成纤维细胞生长因子(FGF)、肿瘤坏死因子-α(TNF-α)的血清浓度(脐血、7 d),同时观察意识状态、肌张力、原始反射、有无惊厥及瞳孔改变、呼吸、心率、囟门张力等临床指标,结合颅脑CT进行临床诊断与分度.结果 窒息新生儿脐血清ACT A[(3.64±0.69)ng/ml vs(2.95±0.34)ng/ml、FGF[(77.55±23.18)pg/ml vs(36.43±9.51)pg/ml]和TNF-α[(10.72±1.50)as/ml vs(9.15±0.99)ng/ml]水平较对照组明显升高,P均<0.01;ACT A水平与生后1分钟Apgar评分旱负相关(r=-0.948,P<0.01).生后7 d窒息组患儿血清ACT A[(5.59±1.33)ng/ml vs(2.93±0.25)ng/ml]、FGF水平[(64.21±18.70)pg/ml vs(41.69±9.08)pg/ml]仍高于对照组,P均<0.01;TNF-α水平与对照组比较差异无统计学意义[(9.41±0.87)ng/ml vs(9.03±1.06)ng/ml],P>0.05.相关性分析显示,ACT A水平与HIE的严重程度呈正相关(r=0.962,P<0.01).结论 内源性ACT A参与新生儿HIE的发病过程,动态检测内源性ACT A水平,对判断窒息所致新生儿HIE的严重程度及估计预后,可能具有重要价值.     

毛细支气管炎患儿血清肺表面活性蛋白A测定及其意义

目的 测定毛细支气管炎患儿血清肺表面活性蛋白A (surfactant protein A,SP-A)浓度,探讨毛细支气管炎患儿SP-A在病情严重程度判断方面的临床意义.方法 2011年9月至12月于新乡市中心医院儿科住院治疗的毛细支气管炎患儿62例,根据病情严重程度分为3个亚组,并以15例健康体检儿童为对照组,采用ELISA方法测定其血清SP-A浓度,应用SPSS 14.0统计软件包进行分析.结果 毛细支气管炎患儿血清SP-A浓度[(38.52±10.19) ng/ml]显著高于对照组[(27.66±2.52) ng/ml],差异有统计学意义(t=18.292,P＜0.05).轻度、中度、重度毛细支气管炎患儿血清SP-A浓度分别为(31.35±6.44) ng/ml、(36.43±9.20) ng/ml、(45.27±12.21) ng/ml,各组间差异有统计学意义(F=9.899,P＜0.05).结论 SP-A参与了毛细支气管炎发生与发展过程,对其严重程度有提示作用,有利于指导临床治疗.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.