Viral Infections During Pregnancy:The Big Challenge Threatening Maternal and Fetal Health

Viral infections during pregnancy are associated with adverse pregnancy outcomes,including maternal and fetal mortality,pregnancy loss,premature labor,and congenital anomalies.Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens.Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns.Despite this,the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission,which was not fully understood until now.In this review,we summarize diverse aspects of the major viral infections relevant to pregnancy,including the characteristics of pathogenesis,related maternal-fetal complications,and the underlying molecular and cellular mechanisms of vertical transmission.We highlight the fundamental signatures of complex placental defense mechanisms,which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.     

新生儿肠系膜上动脉综合征二例

例1:患儿女,16 d,因呕吐6 d入院.呕吐发生在喂奶1 h后,每日呕吐4～9次,量较多,为奶汁和黄色胆汁样物质,无腹胀、腹泻,呕吐后饥饿感明显.入院查体:生命体征平稳,体重2 950 g(出生体重3 200 g),腹软、肝脾无肿大、肠鸣正常,心肺、神经系统及其他均无异常.     

出血性休克与脑病综合征4例

1 临床资料 例1,男,9个月,因发热40℃,呕吐、腹泻2d,抽搐12h,收住本院内科病房.查体:嗜睡,面色苍白,反复抽搐,呼吸急促,轻度腹胀;血常规无异常,CRP52mg/L大便黄稀.     

胸腺增生致上腔静脉压迫综合征1例

1 临床资料 患儿,女,9个月,因右眼肿胀4 d,右面部肿胀3 d,右胸壁肿胀0.5 d入院.4 d前患儿被玩具撞伤右眼角处,开始出现右眼睑肿胀、淤血,到本院眼科就诊,诊断:右眼外伤.予局部处理,肿胀逐渐消退.     

深圳地区2004-2006年儿童腹泻病病原体分布情况

目的 探讨深圳地区2004-2006年儿童腹泻病病原体分布情况.方法 收集深圳地区2004年1月-2005年4月腹泻病患儿粪便标本,采用ELISA法检测轮状病毒(RV),2005年5月-2006年12月采用胶体金法检测RV.真菌性腹泻以40倍高倍镜下同时可见菌丝和孢子为实验诊断标准.阿米巴性腹泻以见溶组织内活动性阿米巴原虫(滋养体或包囊)为实验诊断标准.细菌性腹泻(菌痢)以40倍高倍镜下WBC( )以上,同时可见RBC为实验诊断标准.不确定性腹泻为排除以上4种腹泻外的腹泻.结果 RV腹泻主要发生在10月至次年2月,但夏季6-7月也有一个小高峰,共占40.49%;真菌性腹泻无明显季节性,占3.59%;细菌性腹泻明显在每年的6-9月高发,占39.67%;阿米巴性腹泻仅检测到10例,除1例是春末检测出来外,余皆在夏季检出,占0.03%;不确定性腹泻主要发生在12月至次年的3月,占16.24%.腹泻最高发年龄为＞1～2岁,占24.83%(8 287/33 382例),≤6个月组为最低发年龄组,占6.65%(2 217/33 382例).结论 婴幼儿腹泻种类出现明显的感染交叉性、季节交叉性的特点,具有一定的复杂多样性.加强饮食与环境卫生,切断传播途径,提高儿童主动免疫水平是预防急性腹泻的重要环节.     

褪黑素对哮喘大鼠CD4+CD25+调节性T细胞的影响及抗感染作用

目的 探讨褪黑素(MT)对哮喘大鼠CD4 CD25 调节性T细胞(CD4 CD25 Tr)的影响及抗感染作用.方法 SPF级SD大鼠32只随机分成4组,每组8只.哮喘组:造模第1、7天,大鼠腹腔注射卵清蛋白(OVA)和氢氧化铝混悬液体,第14天,用10g/L的OVA溶液对大鼠进行雾化激发,1次/d,20min/次,连续7d;MT组:致敏、诱导哮喘方法同哮喘组,在每次激发前30min,腹腔注射MT0.1mg/kg;地塞米松组:致敏、诱导哮喘方法同哮喘组,在每次激发前30min,腹腔无菌注射地塞米松0.5mg/kg;对照组:注射、雾化方法同哮喘组,以9g/L盐水替代OVA和氢氧化铝致敏液及雾化液.各组于最后1次雾化激发后取其外周血涂片染色,计数其外周血嗜酸性粒细胞(EOS)百分比;收集其肺泡灌洗液(BALF),计数其炎性细胞总数;制作肺组织石蜡切片,HE染色计数其呼吸道周围EOS数目;用免疫增强浊度法检测其血清IgE水平;用流式细胞术检测其外周血CD4 CD25 Tr水平.采用SPSS 10.0软件进行统计学分析.结果 哮喘组外周血CD4 CD25 Tr/CD4 T细胞值与呼吸道周围EOS细胞数呈高度负相关(r=-0.73 P<0.05),与BALF细胞总数亦呈高度负相关(r=-0.78 P<0.05),与血清IgE水平未见显著相关.CD4 CD25 Tr/CD4 T细胞值哮喘组显著高于其他各组(Pa<0.01),其他3组比较,差异无统计学意义(Pa>0.05).MT组呼吸道周围EOS计数、外周血EOS比例、BALF细胞总数及IgE水平显著低于哮喘组(Pa<0.01).结论 CD4 CD25 Tr参与哮喘的发病.MT能显著降低哮喘大鼠CD4 CD25 Tr的数目,对哮喘大鼠CD4 CD25 Tr的调节作用与地塞米松相当,可有效减轻哮喘大鼠呼吸道炎性反应和血清IgE上升水平.     

腹腔镜Palomo手术治疗精索静脉曲张的疗效

目的 通过与儿童精索静脉曲张精索内静脉结扎术比较,探讨儿童精索静脉曲张腹腔镜Palomo手术治疗的效果.方法 收集2000年1月-2007年6月本院收治的8～15岁儿童精索静脉曲张64例(65侧,其中1例为双侧),精索静脉曲张的诊断依据为一般检查能摸到静脉曲张团块, Valsalva试验团块增大,外观血管显露.采用精索内静脉结扎术治疗29例(常规手术组,29侧),平均10.8岁, Valsalva平均分度2.6度;腹腔镜Palomo手术治疗35例(腹腔镜组,36侧),平均12.1岁, Valsalva平均分度2.6度,比较二组患儿手术时间、住院时间、复发率、并发症发生率及术后异常率(复发加并发),以评价二组手术疗效.采用SPSS 11.0软件进行t检验和X2检验.结果 腹腔镜组的平均住院时间(2.7d)与常规手术组比较(5.5d)有统计学差异(P<0.05),腹腔镜组并发症发生率(2.8%)与常规手术组比较(17.2%)有统计学差异(P<0.05).手术时间(腹腔镜组平均37min,常规手术组平均33min)、复发率(腹腔镜组2.8%,常规手术组6.9%),二组间比较均无统计学差异(Pа>0.05).患儿术后异常率(复发加并发)腹腔镜组(5.6%)低于常规手术组(24.1%),二组比较有统计学差异(P<0.05).结论 腹腔镜Palomo手术治疗儿童精索静脉曲张的疗效优于精索内静脉结扎术,并且该手术方法简单易掌握.     

婴幼儿进食行为异常的临床评估和干预

目的 对婴幼儿单纯性进食行为异常进行临床评估和有效干预.方法 采用进食行为评估、体格测量、膳食分析、多元回归分析等评估77例上海市6个月～3岁婴幼儿的异常进食行为,分析异常进食行为与婴幼儿膳食能最摄入的相关性;对其中47例婴幼儿完成了为期3个月的综合干预,并对干预前后的婴幼儿膳食及生长状况进行对比分析.采用SPSS 10.0软件进行统计学处理.结果 在评估的婴幼儿中最常见的3位异常进食行为是进餐时间不固定[36/77例(46.8%)]、挑食[34/77例(44.2%)]、进餐位置不固定[34/77例(44.2%)].72.7%进食行为异常婴幼儿的膳食能量摄入不足,少部分婴幼儿有生长落后;而与膳食能量摄入不足相关的异常进食行为依次为:进餐时间不固定、挑食、拒绝新食物、进餐位置不固定.经干预后,婴幼儿的膳食能量摄入有明显增加(P<0.01),体质量和身长增长加快,按年龄体质量和按身长体质量的Z-score均明显较干预前改善(Pа<0.01).结论 上海婴幼儿的异常进食行为有其本身的特点,异常进食行为可造成膳食能量摄入不足而影响体格生长,针对性的综合措施可以进行有效干预.     

儿童结核性脑膜炎的诊断和治疗

结核性脑膜炎是严重威胁儿童生命健康的神经系统感染性疾病.在小儿肺外结核病中结核性脑膜炎是最常见的,尽管目前开展了足量的化疗,结核性脑膜炎仍有高发病率和病死率的特点.虽然近年来研究者从细菌学、分子生物学及免疫学等方面对小儿结核性脑膜炎的诊断进行了研究,但均末获得突破性进展,对小儿结核性脑膜炎的诊断仍依靠综合分析患儿的临床特点以及通过辅助检查的结果判断.早期及时诊断和完善的治疗是降低结核性脑膜炎病死率及后遗症发生率的关键.     

新生儿惊厥的处理

惊厥是新生儿期常见急症之一,是中枢神经系统或全身性多种疾病的一个症状,是提示脑损伤可能恶化的指标.反复惊厥可影响新生儿脑的发育,产生后遗症.对惊厥患儿,应立即给予紧急处理,同时积极查找病因.     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

Outcome of the Treatment of Inborn Errors of Metabolism

The use of specific dietary restrictions, cofactor administration, mobilisation of insoluble substances, environmental modifications, product replacement and selective enzyme inhibition are now established for the treatment of some inborn errors of metabolism. There is no generally accepted application for enzyme administration, cytopharmacology (manipulation of the cytoskeleton) or for cell transplantation except for bone marrow transplantation in disorders where the bone marrow is primarily at fault. The other uses of bone marrow transplantation which have been proposed require further evaluation. Results of recent research suggest that the scope of this approach is gradually being widened. There is also scope for development in the field of organ transplantation taking advantage of recent technical¹ and immunological progress. The treatment of inborn errors of metabolism by genetic modification is not yet on a practical clinical level; more laboratory and animal studies are needed before this can be attempted in man. Adenosine deaminase deficiency appears to be the disease in which this will be first attempted using a retroviral vector to insert the gene into the genome of pluripotential bone marrow cells.     

婴幼儿法乐四联症手术治疗近期疗效的影响因素

目的 探讨影响婴幼儿法乐四联症手术治疗近期疗效的各相关因素.方法 将2003年8月至2011年2月经作者一期手术纠治的117例年龄≤3岁的法乐四联症患儿分为疗效良好、疗效较差两组.分析手术时患儿年龄、体重、术前HCT值、McGoon指数、EDVI、主动脉阻断时间、转流时间、室间隔缺损大小、升主动脉与肺动脉干直径比、...     

术中判断肠活力三种方法的比较

术中准确地评价肠活力是外科医师面临的一个普遍问题。应用兔肠缺血模型，比较静脉荧光素、表面血氧测定和激光多普勒三种技术判断肠活力的精确性。结果：诊断效率静脉荧光素法为７８％，表面血氧测定为６８％，激光多普勒为９５％。后者精确度显著优于前二者，且操作简便、迅速，具有临床应用前景。     

Treatment of retinopathy of prematurity

Retinopathy of prematurity is a potentially blinding disorder of premature infants. Retinal ablation of the avascular retina originally described using cryotherapy but now most commonly undertaken with laser photocoagulation, reduces the unfavourable structural outcomes and improves the functional visual acuity outcome. The CRYO-ROP study showed the long-term benefit of treatment of threshold disease compared with no treatment, however even with cryoablation 44.4% of treated eyes had a visual acuity of 6/60 or worse at 10 year follow-up. The ETROP study of earlier treatment for high-risk pre-threshold disease, rather than treatment at threshold, has shown that pre-threshold treatment of type 1 disease produces a significantly improved outcome. Despite treatment some infants develop retinal detachment for which various surgical treatments have been described, although not always with a good functional outcome. Future treatment modalities may include the use of anti-VEGF therapies.     

Evaluation of the Efficacy of Treatment of Kawasaki Disease before Day 5 of Illness

We evaluated the efficacy of treating Kawasaki disease earlier than Day 5 of illness with a standard dose of immunoglobulin and aspirin. We performed a case–control study of patients with Kawasaki disease admitted to Princess Margaret Hospital from 1994 to 1999. Patients with pretreatment coronary aneurysm or those treated after day 10 of illness were excluded. All patients received immunoglobulin (2 g/kg) and aspirin (80–100 mg/kg/day) until fever subsided for 48 hours. Immunoglobulin retreatment was given for persistent fever 48 hours after the first dose of immunoglobulin or recrudescent fever. The case group consisted of 15 patients who received treatment earlier than day 5 of illness, and the control group consisted of 66 patients who were treated on or after day 5. Patients sex, age, duration of posttreatment fever, need for additional immunoglobulin, and coronary artery status were noted. Treatment efficacy was assessed by the duration of posttreatment fever and the prevalence of coronary artery aneurysms. Eighty-one patients were included in this study. There were 15 patients in the case group and 66 in the control group. No significant difference was noted in age and sex between the case and control groups. Thirty-three percent (5/15) and 8% (5/66) of the case and control groups, respectively, had persistent/ recrudescent fever 48 hours after the first dose of immunoglobulin that required retreatment (p = 0.017). Thirteen percent (2/15) and 5% (3/66) of the case and control groups, respectively, had coronary aneurysms (p = 0.158). Treatment of Kawasaki disease before day 5 of illness was associated with persistent/recrudescent fever that required retreatment. However, there was no significant increase in the prevalence of coronary aneurysm if retreatment was given. Poster presented at the third World Congress of Pediatric Cardiology and Cardiac Surgery, Toronto, Ontario, Canada, 2001     

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目的探讨脑性瘫痪的诊断以利防治。方法对南京市儿童医院早期干预门诊确诊的640例脑患儿[早产儿258例(早产儿组),足月儿382例(足月儿组)]分析其病因、早期临床表现及头颅CT征象,进行体格神经系统检查并智测。结果(1)高危因素,两组在颅内出血、肺部疾病早产儿组明显高于足月儿组,缺氧缺血性脑病组足月儿明显高于早产儿组,P均<0·05外余P均>0·05。(2)6个月以内确诊早产儿、足月儿两组各为28、90例的临床表现,反应差、嗜睡、少吃、少哭、少动,肌张力低下,早产儿组明显高于足月儿组,而不停啼哭,护理困难,肌张力增高,足月儿组明显高于早产儿组,P均<0·01及0·05余P均>0·05。(3)早产儿、足月儿两组的身长、体重、头围、MDI和PDI各为73·24±9·82、73·58±11·64(cm),9·12±2·31、9·23±2·80(kg),44·15±3·47、42·99±4·23(cm),44·42±6·09、41·99±7·28(分),43·81±4·95、40·80±4·51(分)。(4)头颅CT表现。早产儿、足月儿两组CT异常率各为95·4%及89·8%,P<0·05。(5)发育落后早产儿组言语落后明显高于足月儿组外,足月儿组身长<2SD明显高于早产儿组P均<0·05,余P均>0·05。结论当患儿具有高危因素、异常临床表现与神经症状、发育明显落后,应结合头颅CT密切随访可早期诊断脑性瘫痪及早干预。     

Spectrum of clinical presentations of vein of Galen aneurysm

Aneurysm of the vein of Galen is a rare intracranial vascular malformation. It is known to have diverse manifestations and varying severity. Four cases with different modes of presentation and outcome are reported. A mortality of 50 per cent was encountered. Among the survivors, one had neurologic sequelae whereas the other had attained age-appropriate developmental milestones. The former was a rare case of spontaneous thrombosis of the aneurysm while the latter was a boy who underwent therapeutic embolization.     

早产儿脑病研究进展

早产儿脑病是复杂的原发性脑损伤和继发性脑发育异常疾病.过去几年对该病有了较为深刻的认识,该文就最新的有关早产儿脑病概念演变,脑损伤后的细胞分子机制和损伤后发育障碍,尤其是活化小胶质细胞介导的少突胶质细胞损伤机制、神经/髓鞘受损和丘脑、板层下神经元及大脑皮层的受损机制或发育成熟障碍进行综述,以便对该病有更深刻的认识.     

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??Inhaled corticosteroids??ICS?? are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy??fewer side-effects and convenience. Here??we focused on some points which should be paid attention to??including how to choose appropriate patients??how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.