The expression of mTOR and p70S6K in hemangioma vascular endothelial cell in vitro

目的 观察mTOR、p70S6K在体外培养血管瘤血管内皮细胞中的表达,探讨其与血管瘤血管内皮细胞周期分布的关系.方法 用组织块法培养血管瘤内皮细胞,同步化培养血管瘤内皮细胞后,采用Western blot法检测血管瘤内皮细胞mTOR、p70S6K-α的表达水平,同期用流式细胞仪检测血管瘤血管内皮细胞周期的变化;并分析mTOR、p70S6K-α的表达水平与血管瘤血管内皮细胞周期分布的关系.结果 mTOR蛋白表达水平较高0.20±0.01,p70S6K-α蛋白表达水平较低时0.25±0.01,处于G0/G1期的细胞较少(55.95±4.38)％; mTOR蛋白表达水平下降至0.16±0.02,p70S6K-α蛋白表达水平升高至0.29±0.01,处于G0/G1期的细胞明显增多(77.86±8.18)％;二者比较差异有统计学意义(t=- 5.781,P＜0.01).结论 mTOR和p70S6K参与了体外培养的血管瘤血管内皮细胞细胞周期G0/G1阻滞.     

虎杖苷对THP-1细胞增殖及凋亡的影响及其作用机制研究北大核心CSCD

目的探讨虎杖苷对急性单核细胞白血病细胞株THP-1增殖及凋亡的影响及可能的作用机制。方法以不同梯度浓度的虎杖苷处理THP-1细胞24 h、48 h,CCK-8法检测细胞增殖活力,并计算半数抑制浓度。取对数生长期的THP-1细胞,分为虎杖苷处理组(处理浓度为半数抑制浓度)和空白对照组(细胞中未施加虎杖苷溶液处理),培养48 h后,采用流式细胞术检测细胞凋亡及细胞周期;Western blot法检测PI3K、AKT、p-AKT、mTOR、p-mTOR、p70 S6K、p-p70 S6K蛋白的表达。结果虎杖苷可有效抑制THP-1细胞的增殖,48 h的半数抑制浓度为1800μmol/L。经1800μmol/L的虎杖苷溶液作用48 h后,THP-1细胞的凋亡率较空白对照组显著增加(P<0.05);细胞周期出现G0/G1期至S期的阻滞,表现为G0/G1期的细胞比例较空白对照组明显上升,S期的细胞比例较空白对照组显著下降(P<0.05);PI3K、AKT、p-AKT、mTOR、p-mTOR、p70 S6K、p-p70 S6K蛋白表达较空白对照组显著降低(P<0.05)。结论虎杖苷可有效抑制THP-1细胞的增殖,阻滞细胞周期并诱导细胞凋亡,其作用机制可能与PI3K/AKT/mTOR信号通路的抑制表达有关。     

mTOR/p70S6K信号通路在小儿血管瘤演变中的作用

目的 探讨mTOR/p70S6K信号通路在小儿血管瘤的发生、发展及消退过程中的作用.方法 收集未经其他治疗、单纯手术切除并经病理诊断为血管瘤的标本31例,结合Mulliken分类法与增殖细胞核抗原(PCNA)表达对血管瘤进行分类和分期,免疫组织化学检测并比较增生期血管瘤和消退期血管瘤组织中雷帕霉素靶蛋白(mTOR)和p70S6K-a的表达水平.结果 18例增殖期血管瘤mTOR、p70S6K-a的积分光密度分别为6336.47±1655.89,588.72±223.87;13例消退期血管瘤mTOR、p70S6K-a的积分光密度分别为846.22±297.09,3235.64±947.86;血管瘤增殖期p70S6K-a的积分光密度明显低于消退期,差异有统计学意义(P＜0.01).血管瘤增殖期mTOR的积分光密度明显高于消退期,差异有统计学意义(P＜0.01).结论 小儿血管瘤组织中有mTOR、p70S6K-α表达,mTOR/p70S6K信号通路可能在小儿血管瘤的病理演变中发挥作用.     

粒细胞集落刺激因子通过mTOR/p70S6K途径调节新生大鼠缺氧缺血性脑损伤后炎症反应北大核心CSCD

目的观察粒细胞集落刺激因子（G-CSF）对新生大鼠缺氧缺血性脑损伤（HIBD）后炎症反应的影响及哺乳动物雷帕霉素靶蛋白/p70核糖体S6蛋白激酶（mTOR/p70S6K）信号通路在其中发挥的作用。方法7日龄新生SD大鼠90只按随机数字表法随机分为假手术组、缺氧缺血（HI）模型组、G-CSF组、雷帕霉素组及对照组,改良Rice法建立新生大鼠HIBD模型。HI前1 h,雷帕霉素组腹腔注射雷帕霉素250 μg/kg,对照组予等体积乙醇腹腔注射。HI 1 h后,G-CSF组、雷帕霉素组及对照组腹腔注射G-CSF 50 μg/kg,HI模型组及假手术组予等体积9 g/L盐水腹腔注射。HI 48 h后,Western blot检测脑组织中肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-10及mTOR/p70S6K信号通路蛋白水平,尼氏染色评估海马CA1区及皮质神经元损伤情况,2,3,5-氯化三苯基四氮唑染色检测脑梗死面积。结果与HI模型组比较,G-CSF组及对照组脑梗死面积减少[（12.87±1.54）%、（11.90±1.31）%比（24.21±3.28）%],尼氏染色阳性神经元计数增多[海马CA1区：（61.00±4.90）个/视野、（61.67±6.40）个/视野比（42.67±4.46）个/视野;皮质：（92.67±6.68）个/视野、（90.17±4.45）个/视野比（70.83±6.97）个/视野],TNF-α及IL-1β水平降低（TNF-α：0.67±0.07、0.55±0.05比0.86±0.05;IL-1β：0.65±0.06、0.52±0.10比0.86±0.06）,IL-10、p-mTOR/mTOR及p-p70S6K/p70S6K水平升高（IL-10：0.68±0.04、0.62±0.05比0.34±0.02;p-mTOR/mTOR：0.53±0.02、0.51±0.01比0.26±0.01;p-p70S6K/p70S6K：0.89±0.03、0.90±0.03比0.55±0.02）,差异均有统计学意义（均P〈0.05）。与G-CSF组及对照组比较,雷帕霉素组脑梗死面积增加[（25.70±1.50）%],尼氏染色阳性神经元计数减少[海马CA1区：（40.67±3.50）个/视野;皮质：（68.33±8.17）个/视野],TNF-α及IL-1β水平升高（分别为0.97±0.06、0.98±0.10）,IL-10、p-mTOR/mTOR及p-p70S6K/p70S6K水平降低（分别为0.21±0.02、0.30±0.01、0.55±0.01）,差异均有统计学意义（均P〈0.05）。结论G-CSF可能通过上调mTOR/p70S6K信号通路抑制HIBD后的炎症反应。     

卡维地洛对体外柯萨奇病毒B3致心肌细胞凋亡与Bcl-2/Bax蛋白表达的影响

目的探讨卡维地洛对体外柯萨奇病毒B3(CVB3)致心肌细胞凋亡的抑制作用及其机制。方法采用差速贴壁法培养原代Wistar乳鼠心肌细胞。实验分为正常对照组、病毒组、卡维地洛组及美托洛尔组。正常对照组仅加入不含血清的DMEM培养液,后3组于CVB3感染心肌细胞后分别加入不含血清的DMEM培养液、无血清培养基配制的卡维地洛、美托洛尔溶液。72h后在倒置相差显微镜下观察各组心肌细胞的形态、搏动速率;采用黄嘌呤氧化酶法测定其心肌细胞培养液中超氧化物歧化酶(SOD)活性,硫代巴比妥酸法测定其心肌细胞培养液中丙二醛(MDA)水平,流式细胞术检测其心肌细胞凋亡率,免疫细胞化学法检测其心肌细胞内Bcl-2及Bax蛋白表达水平。结果1.与病毒组比较,卡维地洛组心肌细胞搏动速率明显提高(P<0.05)、凋亡率明显降低(P<0.05),心肌细胞培养液中SOD活性显著升高(P<0.05)、MDA水平明显降低(P<0.05);美托洛尔组与病毒组比较,心肌细胞搏动速率、凋亡率、心肌细胞培养液中SOD活性、MDA水平均无统计学差异(Pa>0.05);2.与病毒组及美托洛尔组比较,卡维地洛组心肌细胞内Bcl-2蛋白表达增多,而Bax蛋白表达减...     

儿童重型再生障碍性贫血T细胞内调控因子GAS5和mTOR信号途径分子的表达研究

目的：通过检测再生障碍性贫血（AA）患儿T细胞内mTOR信号途径分子及T细胞内调控因子GAS5的表达水平,初步探讨该信号途径在儿童AA中的改变。方法（1）对16例初治重型AA（SAA）及8例免疫抑制剂治疗（IST）有效的SAA患儿,用流式细胞术（FCM）方法检测外周血CD3＋T细胞内mTOR信号途径分子磷酸化Akt（p-Akt）、磷酸化TSC2（p-TSC2）、磷酸化mTOR （p-mTOR）、磷酸化4EBP1（p-4EBP1）及磷酸化p70S6K（p-p70S6K）的表达水平。（2）用实时荧光定量聚合酶连反应（QRT-PCR）方法检测23例初治SAA及7例IST有效SAA患儿骨髓CD3＋T细胞内调控因子 GAS5的表达水平。结果（1）初治 SAA 组外周血 CD3＋T 淋巴细胞内 p-Akt、p-TSC2、p-mTOR、p-4EBP1及p-p70S6K表达水平均明显高于正常对照组,而低于阳性对照CEM细胞株组;（2）SAA 治疗有效组外周血 CD3＋T 淋巴细胞内 p-Akt、p-TSC2、p-mTOR、p-4EBP1及p-p70S6K的表达水平均均低于初治SAA组;SAA治疗有效组p-Akt、p-TSC2、p-mTORC1、p70S6K的表达水平与正常对照组无明显差异,但p-4EBP1的表达水平高于正常对照组。（3）初治SAA组骨髓CD3＋T淋巴细胞内GAS5的表达量明显低于正常对照组,而显著高于CEM细胞株组。（4）SAA治疗有效组骨髓CD3＋T淋巴细胞内GAS5的表达水平高于初治SAA组,而与正常对照组无明显差异。结论（1）mTOR信号途径的活化程度与疾病状态相关,初治SAA患儿外周血细胞中p-Akt、p-TSC2、p-mTOR、p-4EBP1、p-p70S6K表达升高,说明mTOR信号在SAA患儿中呈活化状态,可能参与AA的T细胞的免疫异常。（2）初治SAA患儿骨髓T细胞内GAS5表达水平明显低于正常儿童而显著高于 CEM细胞,SAA 治疗有效后 GAS5表达水平明显升高,GAS5的表达水平可能与mTOR信号途径的活化存在一定负相关。GAS5可能为负性调控因子。     

CD_(40) Ig融合蛋白阻断共刺激信号通路对病毒性心肌炎小鼠的治疗作用

目的探讨CD40Ig融合蛋白(简称CD40Ig)对柯萨奇B3病毒(CVB3)所致病毒性心肌炎(VMC)小鼠死亡率、心肌病理改变和病毒复制的影响。方法106只4～6周龄健康雄性BALB/c小鼠,体质量12～16 g,随机分为CD40Ig组(16只)、病毒组(40只)、IgG组(40只)及正常对照组(10只)。CD40Ig组、病毒组和IgG组小鼠腹腔注射半数组织细胞感染量(TCID50)为10-3L-1的CVB30.15 mL,正常对照组小鼠接种0.15 mL不含病毒的Eagle液。CD40Ig组、IgG组小鼠于接种病毒后6 h、72 h分别注射CD40Ig(0.1 mg.kg-1)及IgG(0.1 mg.kg-1)。接种病毒后第7天处死所有小鼠。在光镜下观察其心肌病理变化,并计算心肌病理组织学积分;采用实时荧光定量PCR检测其心肌组织中CVB3mRNA的表达;采用免疫组织化学法检测其心肌组织中CD40蛋白表达。结果1.与病毒组比较,CD40Ig组小鼠死亡率降低(80.0%vs50.0%,P<0.05)、心肌病理组织学积分下降[(8.88±2.95)分vs(3.42±1.21)分,P<0.05]、心肌CVB3mR...     

CTLA-4Ig融合蛋白对病毒性心肌炎小鼠Foxp3+调节性T细胞的影响

目的 探讨细胞毒T淋巴细胞相关抗原4免疫球蛋白(CTLA-4Ig)对柯萨奇B3病毒(CVB3)病毒性心肌炎(VMC)小鼠的病死率、心肌病理改变、病毒复制和心肌组织中Foxp3+调节性T细胞(Tregs)的影响.方法 106只4 ～ 6周龄健康雄性Balb/c小鼠,体质量为12 ～ 16 g,随机分为CTLA-4Ig组16只、病毒组40只、IgG组40只及正常对照组10只,CTLA-4Ig组、病毒组和IgG组小鼠腹腔注射半数组织细胞感染量(TCID50)为10-3/L的CVB3 0.15 ml,正常对照组小鼠接种0.15 ml不含病毒的Eagle液.CTLA-4Ig组、IgG组小鼠于接种病毒后6、72 h分别注射CTLA-4Ig(0.1 mg/kg)及IgG(0.1 mg/kg).接种病毒后第7天处死所有小鼠在光镜下观察心肌病理变化并计算心肌组织病理积分;采用实时荧光定量PCR(RQ-PCR)检测心肌组织中CVB3 mRNA的表达;采用免疫组织化学法检测Foxp3分子在心肌组织中的表达,并计算Foxp3+ Tregs所占浸润细胞数的百分率.结果 与病毒对照组相比较,CTLA-4Ig组小鼠病死率降低(80%比50%,P ＜ 0.05),心肌组织病理积分下降(1.78 ± 1.05比1.00 ± 0.72,P ＜ 0.05),心肌CVB3 mRNA表达减少(3.48 ± 2.89比0.81 ± 1.06,P ＜ 0.05);CTLA-4Ig组小鼠心肌组织中Foxp3+ Tregs所占浸润细胞数的百分率较病毒组明显增加(9.22 ± 2.28)% 比(5.42 ± 1.59)%,(P ＜ 0.05).结论 CTLA-4Ig可减轻VMC小鼠心肌炎症,降低心肌病毒复制及病死率,其机制可能与上调Foxp3+ Tregs比、抑制T细胞活化有关.     

哺乳动物雷帕霉素靶蛋白在阿霉素诱导足细胞损伤中的作用

目的 探讨哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)复合体在阿霉素损伤足细胞中的作用.方法 用1 μmol/L的阿霉素(adriamycin,ADM)诱导小鼠足细胞24 h,检测足细胞活力、足细胞凋亡比例、足细胞损伤标志物结蛋白(Desmin)和mTOR相关分子的表达,分析mTOR复合体在ADM损伤足细胞中的作用.结果 (1)1μmol/L的ADM诱导足细胞24h,可使足细胞损伤.与对照组比较,足细胞活性下降(t =28.68,P＜0.001),足细胞早期凋亡比例增加(t=10.24,P=0.09),晚期凋亡比例也增加(t =-4.26,P=0.013);损伤标志分子Desmin表达增多(t=6.16 P＜0.001);(2) ADM诱导组足细胞mTOR蛋白表达下降,与对照组比较,mTOR和磷酸化mTOR表达均下降(t=3.57,P=0.023),mTOR下游分子S6K1和4EBP1 mRNA表达下降(t=18.28,P＜0.001).结论 ADM可诱导足细胞损伤,ADM损伤足细胞的机制可能与mTOR蛋白减少、活性下降有关.     

核因子κB在病毒性心肌炎小鼠发病中的作用

目的 探讨核因子κB(NF-κB)在病毒性心肌炎(VMC)发病机制中的作用.方法 BALB/c小鼠100只,随机分成2组.对照组40只,腹腔注射MEM培养液0.1 ml;病毒组60只,腹腔注射107/ml柯萨奇B3病毒(CVB3)病毒液0.1 ml.两组在接种后第O、4、7、10天取心肌组织用Westem blot法检测心肌细胞核NF-kB的含量,同时测定心肌病毒载量、心肌病理积分.结果 病毒感染后第4、7、10天病毒组心肌细胞核NF-kB的含量明显高于对照组,差异有统计学意义,且与心肌病变积分呈显著正相关(r=0.985、0.965,P＜0.05);第4、7天CVB3载量与心肌病理积分(坏死)呈正相关(r=0.790、0.759,P＜0.05),而第10天无相关性(r=-0.058,P＞0.05).结论 NF-KB在病毒性心肌炎的发病机制中有重要作用;CVB3感染可调节心肌细胞核NF-kB的含量,这种调节作用不依赖于CVB3的复制.     

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.     

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.     

Whole-body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age

Aim: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background.

Methods: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses.

Results: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

Conclusion: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.     

The potential role of rapamycin in pediatric transplantation as observed from adult studies

Although pediatric patient and renal graft survival rates have shown marked improvements during the past decade, the persistent toxicities of immunosuppressive drugs and chronic allograft attrition remain major obstacles in transplant therapy. Results in adult patients suggest that complete steroid withdrawal is possible in the majority of recipients under treatment with a cyclosporin A-rapamycin (CsA RAPA) regimen. Furthermore, preliminary studies suggest that a marked reduction in the dose of CsA may be possible under the umbrella of RAPA coverage. The gain in immunosuppressive efficacy afforded by RAPA has not only been obtained without an increased morbidity owing to infectious or neoplastic causes, but also with the potential for reducing the incidence and/or progression of chronic rejection.     

VARICELLA ZOSTER VIRUS INFECTIONS IN THE PEDIATRIC STEM CELL TRANSPLANT PATIENT

Varicella zoster virus (VZV), a member of the human herpesvirus family, causes the clinical syndromes of chickenpox during primary infection and shingles on later reactivation. In immunocompromised patients, including those undergoing hematopoietic stem cell transplantation, VZV can produce life-threatening infections. The most serious forms of VZV infection involve hematogenous dissemination of the virus to vital organs, such as the lung, brain, and liver. Advances in immunoprophylaxis, antiviral chemotherapy, and vaccine development have provided effective tools to limit the morbidity and mortality previously associated with VZV infection in hematopoietic stem cell transplant patients. In this review, we discuss virologic aspects of VZV, pathogenesis of VZV infection, methods of viral diagnosis, clinical manifestations of infection in both normal and immunocompromised patients, and available preventative and therapeutic measures.     

Génétique des schizophrénies : mise en perspective des schizophrénies à début précoce et autres pathologies du développement

Schizophrenia (SCZ) is a severe brain disorder characterized by hallucinations, delusions, flat and/or inappropriate affect and cognitive impairment. The lifetime risk is about 0.5% with heritability of 65–85%. The prevalence of early-onset schizophrenia (defined here as before 15 years of age) has not been well studied, but is likely to be 5–10% of all cases. The rarity of early-onset SCZ has made it difficult to study. We focus on genetic studies of adults with schizophrenia, highlighting results for early-onset schizophrenia where available. Prior to the past 5 years, studies failed to find replicable association or linkage between SCZ and specific genes when appropriate statistical corrections for multiple testing were used. Many false positive results were probably reported using the candidate gene approach. Recently, the development of single nucleotide polymorphism (SNP) “chips” has permitted large genome-wide association study (GWAS) analyses that suggest that across all age groups, a proportion of genetic risk can be attributed to a large number of common SNP, each with a very small effect on risk (odds ratios of 1.1 or less). The greatest known genetic effect is conferred by the 1.5–3 Mb 22q.11.2 deletions, which occurs in ∼ 1/4000–1/6000 births with SCZ developing in 20–30% of carriers. Large SNP and aCGH microarray studies have now identified associations between SCZ and other rare, large copy number variations (CNV, insertions and deletions) with high odds ratios (5–10), including deletions of 1q21, 2p16.3 (neurexin-1 gene), 3q29 and 15q13.3, and duplications of 16p11.2. Some of these CNV are also associated with autism or other developmental disorders as well as epilepsy or intellectual deficiency, suggesting some overlap in the mechanisms that contribute to risks of these disorders. Based on preliminary data from larger-scale analyses in progress, approximately 1–2% of cases carry a CNV that has been clearly associated with SCZ (ORs 4–12). Whole exome and genome sequencing studies of large adult samples will be the next steps to identify rarer SCZ-associated mutations, including point mutations and smaller as well as rarer CNV. Genetic findings are beginning to contribute to an understanding of biological mechanisms of SCZ risk and may lead to new approaches to treatment.     

INACTIVATION OF PULMONARY SURFACTANT AND THE TREATMENT OF ACUTE LUNG INJURIES

Inactivation of pulmonary surfactant may be important in acute lung injury and acute respiratory distress syndrome. Treatment of surfactant dysfunction by instilling exogenous surfactants may improve gas exchange and pulmonary mechanics. Surfactants used for treatment vary in their attributes and effects, so when various surfactants are considered for therapy, resistance to inactivation is an important consideration. Animal models of acute lung injury exist in which the relative merits of surfactants can be compared. We hypothesize that the surfactants most resistant to inactivation in vitro will be the ones that are most effective in treatment of animal models of acute lung injury. Surfactants with higher concentrations of surfactant proteins (specifically A, B, and C) are more resistant to inactivation. Nonionic polymers mimic surfactant proteins in preventing surfactant inactivation under some conditions. Adding nonionic polymers to surfactant containing minimal amounts of SP-B and SP-C markedly improves lung function of animals with lung injury. Making surfactants more "inactivation-proof" may improve surfactant therapy of acute lung injuries.     

Plasma Proinsulin and C-Peptide Concentrations in Children with Hyperinsulinaemic Hypoglycaemia

ABSTRACT. Plasma concentrations of proinsulin and C-peptide were measured in five children presenting with svere hypoglycaemia associated with elevated plasma levels of immunoreactive insulin (IRI) in order to determine whether the profile of circulating B-cell products related to the underlying pathophysiology of the pancreas. Results were compared with data from 13 normal infants. Four children, three neonates and a nine year old girl, were subjected to partial or total pancreatectomy. The neonates had nesidioblastosis, nesidioblastosis with a microadenoma, and a functional abnormality without histological derangement respectively; the older child had a localised adenoma. The remaining child, a neonate, had transient hypoglycaemia and elevated IRI levels associated with hyperlactataemia and hyperalaninae-mia. All the children had markedly elevated plasma proinsulin concentrations; the highest levels were seen in the child with an isolated adenoma and in the neonate with nesidioblastosis and a microadenoma. Both of these children also had substantially elevated plasma C-peptide concentrations. The remaining three neonates had plasma C-peptide levels, which although in the normal range for normoglycaemia were inappropriately elevated during hypoglycaemia. It is concluded that elevated proinsulin and C-peptide concentrations are seen in children with hypoglycaemia associated with increased plasma IRI levels and that the profile of the concentrations does not provide a reliable marker for the nature of the underlying pancreatic abnormality.     

Growth tracks in early childhood

Aim: Child growth is modulated by numerous factors and, particularly in infancy and early childhood, often tends to follow apparently irregular patterns, with many centiles crossed before the later growth channels are reached. The aim of this study was to visualize the diversity of individual growth. Design: The study investigated 333 girls and 329 boys without chronic illnesses from four paediatric practices in Kiel, Germany. The children were measured on natural     

Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow-up study regarding cardiopulmonary and neurological symptoms

Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hypertension and is increasingly used as rescue treatment in intensive care algorithms aiming at reducing severe hypoxaemia in neonates and children. Although the immediate effects may seem impressive, longterm outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in children after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was performed in four paediatric intensive care units in university hospitals in Sweden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulmonary hypertension, and in whom 6 mo had elapsed since treatment, were included for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examination, echocardiography, chest X-ray and a capillary blood sample. Four patients with congenital heart disease had residual pulmonary hypertension. Nine patients were receiving bronchodilators. Sixteen patients had minor (n = 15) or moderate (n = 1) changes on a chest X-ray. One patient had a possible delay in psychomotor development. Conclusions: In spite of the severity of their primary illness, we found that the overwhelming majority of the surviving children were asymptomatic and doing well. The few residual circulatory and respiratory symptoms could be related to the initial condition.