幽门螺杆菌感染对慢性胃炎患儿胃动力功能的影响

目的探讨幽门螺杆菌(Hp)感染对慢性胃炎患儿胃动力功能的影响。方法通过Hp检测及组织病理检查,将47例慢性胃炎患儿分为Hp阳性和阴性组。对各组进行固体餐放射性核素胃排空检查和胃电图(EGG)检测。Hp阳性患儿予克拉霉素15mg/(kg.d)、阿莫西林50 mg/(kg.d)、奥美拉唑0.8 mg/(kg.d)三联抗Hp治疗2周。其中Hp根除者再行EGG检测。结果Hp阳性组胃半排空时间(GET1/2)明显高于Hp阴性组(t=6.403 P<0.01)。二组EGG参数值比较无明显差异,但Hp阳性组存在餐前振幅不规则现象,且Hp阳性组根除Hp前餐前主功率明显低于根除后(t=2.197 P<0.05)。结论Hp感染影响患儿胃排空及胃肌电活动,导致慢性胃炎患儿胃动力功能低下。     

埃索美拉唑、克拉霉素、甲硝唑三联治疗儿童幽门螺杆菌感染的疗效

目的研究埃索美拉唑、克拉霉素、甲硝唑三联治疗儿童幽门螺杆菌(Hp)感染的疗效及安全性。方法经13C-尿素呼吸试验(13C-UBT)证实为Hp感染反复腹痛儿童98例,随机分为治疗组66例,予埃索美拉唑0.8mg/(kg.d),1次/d,克拉霉素15mg/(kg.d),2次/d,甲硝唑30mg/(kg.d),3次/d,三联治疗;对照组32例,予除奥美拉唑(0.8mg/kg,1次/d)外抗生素与治疗组相同,疗程1周。停药后4周门诊复诊并复查13C-UBT。结果二组儿童腹痛均有缓解,缓解率100%;Hp转阴60例,根除率90.9%。对照组转阴28例,根除率87.5%,二组幽门螺杆菌根除率无显著性差异(P>0.05)。结论埃索美拉唑、克拉霉素、甲硝唑三联治疗儿童Hp感染临床疗效好,Hp根除率高,未见明显不良反应,安全性好。     

三联疗法治疗幽门螺杆菌感染的疗效

目的用克拉霉素加阿莫西林及奥美拉唑与标准三联疗法(阿莫西林 枸橼酸铋 甲硝唑)对照,三种方案、三种疗程治疗Hp感染儿童,评价其疗效。方法经胃镜检查确诊为慢性胃炎或十二指肠溃疡且Hp呈阳性的患儿204例随机分组,A组治疗方案为阿莫西林50 mg/(kg.d),枸橼酸铋7~8 mg/(kg.d),甲硝唑15~20 mg/(kg.d),疗程6周。B组用药与A组相同,疗程为2周。C组为克拉霉素15 mg/(kg.d),奥美拉唑0.8 mg/(kg.d),阿莫西林50 mg/(kg.d),疗程2周。结果A组Hp根除率73.4%,B组Hp根除率75%,C组Hp根除率92%,B组和C组比较有显著性差异(P<0.05)。结论以克拉霉素、奥美拉唑、阿莫西林三联治疗儿童Hp感染,具有疗程短、疗效高、耐药少、依从性好、Hp根除率高等优点。     

对含奥美拉唑三联疗法耐药的幽门螺杆菌感染的治疗

目的　探讨对含奥美拉唑三联疗法耐药的幽门螺杆菌 (Hp)感染的治疗方法。方法　选择 13 5例经13 C尿素呼吸试验 (13 C UBT)及血清Hp IgG证实为Hp感染的腹痛患儿 ;男 73例 ,女 62例 ;平均年龄 6.8± 2 .6岁。接受克拉霉素 15mg/ (kg·d) ,2次 /d ;奥美拉唑 0 .8mg/ (kg·d) ,1次 /d ;阿莫西林 3 0mg/ (kg·d) ,3次 /d ,联合治疗 1周 ,于停药后 4周复查13 C UBT ,了解腹痛治疗效果及Hp根除率 ;如果Hp仍为阳性 ,再改为胶态次枸橼酸铋钾 (CBS) 8mg/ (kg·d) ,2次 /d ,疗程 4周 ;甲硝唑 2 0mg/ (kg·d) ,3次 /d ;奥美拉唑剂量同前 ,疗程 1周。停药后 4周再复查13 C UBT。结果　 13 5例中腹痛完全消失者 56例 ,好转 71例 ,无效 8例 ,总有效率 94.1% ;119例Hp转阴 ,Hp根除率 88.2 % ;16例Hp阳性者改方案后仅 3例Hp转阴。结论　本疗法治疗儿童Hp感染临床效果显著 ,不良反应少 ;一旦Hp对某一治疗方案耐药 ,可能也对其他方案耐药 ,使其很难被根除     

幽门螺杆菌粪便抗原检测在幽门螺杆菌感染的应用

目的　评估幽门螺杆菌粪便抗原 (HpSA)试验在幽门螺杆菌 (Hp)感染治疗前后的准确性。方法　收集 62例 4～ 1 7岁因上消化道症状就诊而接受1 3C 尿素呼气试验 (1 3C UBT)、胃镜检查和 31例根除Hp后停药至少 4周 ,接受1 3C 尿素呼气试验 2d内患儿粪便标本 ,应用酶免疫反应原理进行HpSA试验 ;以1 3C UBT检测和胃镜活检作为诊断标准。结果　以光密度值 (A)≥0 .1 2 1为阳性 ,HpSA检测治疗前诊断Hp感染敏感性为 92 .30 %、特异性 91 .30 %、阳性预测值为 92 .30 %、阴性预测值 87.50 %、准确性 91 .94% ;治疗后诊断Hp感染敏感性为 83 .33 %、特异性 88.0 0 %、阳性预测值为 62 .50 %、阴性预测值 95 .65 %、准确性 87.1 0 %。结论　HpSA检查对治疗前诊断儿童Hp感染准确率较高 ;对治疗后的诊断敏感性和特异性较治疗前低。     

疗程对儿童幽门螺杆菌感染根除率及其疗效影响

目的 研究疗程对儿童幽门螺杆菌(Hp)感染根除率及临床疗效影响。方法 183例经13C-尿素呼吸试验(C-UBT)及血清Hp-lgG证实为Hp感染腹痛患儿,男98例,女85例,年龄(6.7±2.7)岁,随机分为甲组102例,乙组81例;均接受克拉霉素15 mg／(kg·d),2;k／d;奥关拉唑0.8 mg／(kg·d),1;k／d;阿莫西林30 mg／(kg·d),3次／d,联合治疗,2组治疗方案一样,但甲组疗程1周,乙组2周。于停药后4周复查13C-UBT,了解腹痛治疗效果及Hp根除率。结果 甲组腹痛完全消失者65例,好转31例,无效6例,总有效率94.1％;乙组分别为49、30、2例,总有效率97.5％(X2=1.26 P>0.05)。甲组Hp根除率88.2％,乙组为93.8％。两组比较X2=1.68 P>0.05。结论 含奥关拉唑的三联疗法治疗儿童Hp感染,2周与1周疗程相比临床疗效及Hp根除率无明显差异,1周疗程更经济、实用。     

儿童胃息肉与幽门螺杆菌感染的关系

目的探讨儿童胃息肉与幽门螺杆菌(Hp)感染的关系。方法对本院2002-2006年经胃镜活检及病理诊断的36例胃息肉患儿Hp感染情况进行分析。并与同期胃镜检查无异常且病理报告正常的35名对照组儿童Hp感染情况进行比较。结果胃息肉组Hp感染率为16.67%(6/36例),对照组Hp感染率为14.29%(5/35例)。二组比较无显著性差异。6例Hp检查阳性胃息肉患儿经根除Hp治疗,0.5 a后复查胃镜发现4例炎性息肉消失。结论Hp感染与儿童胃息肉无明显相关性。但胃炎性息肉的发生可能与Hp感染有关。根除Hp治疗可使部分炎性息肉消失。     

儿童幽门螺杆菌感染临床检测方法评价

目的探讨适合检测儿童幽门螺杆菌(Hp)抗原的方法。方法对2000年9月-2006年2月儿科消化专科门诊及住院937例患儿行13C尿-素呼气试验(13C-UBT)。其中96例行胃黏膜活检标本检测;557例行Hp粪便抗原(HpSA)检查。2003年4月-2004年4月105例患儿同时进行13C-UBT及HpSA检测,以13C-UBT作为诊断标准。结果1.13C-UBT阳性检出率为41.7%,胃镜取胃黏膜活检的Hp抗原阳性检出率40.6%,HpSA的抗原阳性检出率为38.2%,三者间无统计学差异。2.同时行13C-UBT及HpSA患儿105例,13C-UBT阳性率为41.9%,HpSA阳性率为39.0%,以13C-UBT为诊断标准,HpSA检测Hp感染敏感性为91.8%、特异性为81.8%、一致性Kappa系数为0.743(P=0),13C-UBT与HpSA检测阳性检出率无统计学差异(P=0.388)。结论13C-UBT与HpSA 2种检测方法均可作为临床非侵入性检测Hp抗原有效方法,且HpSA更简便、非侵入、经济,是儿童及家长更易接受的诊断儿童Hp感染的有效方法。     

粪便幽门螺杆菌抗原检测对儿童复发性腹痛病因诊断的价值

目的：慢性胃炎、消化性溃疡是引起儿童复发性腹痛(recurrent abdom inalpain,RAP)的主要原因之一,而幽门螺杆菌(helicobacterpylori,Hp)感染与慢性胃炎、消化性溃疡的相关性尚有待进一步探讨。目前国内儿科临床上缺乏一种简便、安全、经济、有效地非侵入性Hp感染检测方法。故此,该研究探讨RAP与Hp感染的关系及幽门螺杆菌粪便抗原检测(Hpstoolantigen,HpSA)在RAP病因诊断中的价值。方法：对182例RAP患儿进行13C尿素呼气试验(13Cureabreathtest,13CUBT)及HpSA检测,测定其Hp感染率,观察抗Hp治疗后RAP患儿的腹痛缓解率,并对两种检测方法进行比较。结果：RAP儿童Hp感染率为41.2%。男女比例为1∶1.143,差异无显著性。Hp阳性儿童进行抗Hp治疗后,Hp根除和未根除的患儿腹痛缓解率分别为93.4%及28.6%。两者比较差异有显著性(P<0.05)。以13CUBT作为金标准计算,HpSA检测方法的敏感性、特异性、假阳性率、假阴性率、准确率、阳性预测值、阴性预测值分别为90.7%,97.2%,2.8%,9.3%,94.5%,95.8%,93.7%。HpSA试验与13CUBT一致性用Kappa值表示为0.886,U=25.237,P=0,两者有高度一致性。结论：Hp感染与RAP有密切相关性,可能为RAP的主要致病因素;HpSA检测有较高的敏感性和特异性,还具有安全、简便可靠、经济、非侵入性等优点,在RAP病因诊断中具有良好的实用价值。     

儿童免疫性血小板减少症与幽门螺杆菌感染

目的探讨幽门螺杆菌(Hp)感染与儿童免疫性血小板减少症(ITP)发病的关系。方法应用酶联免疫法检测54例ITP患儿粪便Hp抗原,观察Hp抗原阳性与阴性患儿的临床表现、血小板减少程度及对治疗的反应。结果 54例患儿,Hp阳性率19%(10例),不同发病年龄患儿阳性率差异无显著性。47例急性ITP患儿中Hp阳性9例(19%),治疗后血小板恢复正常平均需7.3 d;38例Hp阴性患儿血小板恢复正常平均需5.1 d,两组间差异无显著性(P>0.05)。慢性ITP患儿Hp阳性率14%,与急性ITP差异无显著性。结论未发现ITP患儿Hp感染率高于一般人群;Hp阳性率与患儿年龄无明显相关;Hp感染不影响ITP患儿对治疗的反应。     

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.     

�¶�֢��ϵ�ϰ���ע��ȱ�ݶද�ϰ������ڵ�ת��

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.     

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.