sIL—4和细胞间粘附分子及总IgE在呼吸道炎症中的表达

目的探讨可溶性白细胞介素－4（solubleinterleukin－4,sIL－4）、细胞间粘附分子－1（in-tercellaradhesionmolecule－1,ICAM－1）在过敏性鼻炎（allergicrhinitis,AR）、咳嗽变异性哮喘（coughvariableasthma,CVA）、哮喘和慢性支气管炎发病中的作用。方法采用酶标法测定12例AR、21例CVA、29例哮喘缓解期、27例哮喘发作期、11例慢性支气管炎患者和10例正常健康人血标本。结果（1）sIL－4：CVA、哮喘发作期和慢支组高于正常组（P＜0．05）。AR、哮喘缓解期与正常组比较无显著性差异。（2）ICAM－1：各组均高于正常组（P＜0．05）。哮喘发作组又高于AR组和哮喘缓解组（P＜0．05）。（3）总IgE：除慢支组外其余各组均高于正常组（P＜0．05）。结论sIL－4、ICAM－1参与气道炎症的形成过程,且其含量的高低与咳嗽的发生呈平行发展关系。     

Creative versus repetitive dance therapies to reduce the impact of fibromyalgia and pain: A systematic review and meta-analysis

Background and purposePhysical exercise is one of the most effective interventions to reduce fibromyalgia symptoms. Previous studies have reported benefits of dance-based intervention on the fibromyalgia impact, health-related quality of life and pain, regardless the interventions were based on creative- or repetitive dance. This study aimed to compare the effectiveness of creative and repetitive dance interventions.MethodsPRISMA guidelines were followed in this systematic review. The Cochrane Library, PubMed, Trip, Google Scholar, Web of Science (WOS), Embase and Scopus databases were selected to identify potential articles. Studies were included if they met the following inclusion criteria: to be a clinical trial or a randomized controlled trial, include people with fibromyalgia, have a comparison group and evaluate the impact of the disease, pain or quality of life. Fifteen articles fulfilled the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Collaboration's tool.ResultsDance-based interventions significantly reduced fibromyalgia impact (standardized mean difference = −0.69), pain (standardized mean difference = −0.70 and increased quality of life (standardized mean difference = 0.43) of people with fibromyalgia. The effectiveness of dance interventions is increased when a creative component is added, since it can lead to higher improvements in pain, impact of the disease and improving quality of life.ConclusionDance-based interventions are significantly effective in reducing the impact of fibromyalgia, pain as well as increasing health-related quality of life. Subgroup analyses suggest that creative dance-based interventions could be more effective than repetitive dance-based interventions to reduce pain and fibromyalgia impact. However, results must be taken with caution due to the large heterogeneity and the small number of articles.     

Prospective feasibility study of a mindfulness-based program for breast cancer patients in the southeastern US

BackgroundMindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL.MethodsThis study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2–5 patients.ResultsThe sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL.ConclusionsFeasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.     

Pediatric intestinal transplantation

Advancements in donor management, organ preservation and operative techniques, as well as immunosuppressive therapies, have provided children with intestinal failure and its complications a chance not only for enteral autonomy but also long-term survival through intestinal transplantation (ITx). First described in the 1960’s, experience has grown in managing these complex patients both pre- and post-transplant. The goals of this review are to provide a brief history of intestinal transplantation and intestinal rehabilitation in pediatric patients, followed by focused discussions of the indications for ITx, induction and maintenance immunosuppression therapies, common post-operative complications, and outcomes/quality of life post-transplant.     

Paediatric intestinal transplantation: where are we now?

Intestinal transplantation (ITx) is the only curative treatment option for children with irreversible intestinal failure (IF) and complications of parenteral nutrition (PN). ITx is an immunologically difficult transplant due to the immune load of the donor gut; therefore, main causes of death and graft loss are immunological complications like sepsis or acute and chronic rejection. This article aims to help paediatricians in training understand when children should be referred for ITx, the different types of ITx, the complications these children might present with, and to learn about the journey a candidate for ITx must take with the support of the IF and ITx multidisciplinary teams (MDT).     

Infective endocarditis in paediatrics

Infective endocarditis is a result of infection of the endocardium, particularly of the heart valves (native or prosthetic valves). The most common causative organisms in the paediatric population are: Streptococci, Staphylococci and Enterococci. The classical signs of infective endocarditis like Roth spots, Janeway lesions, splinter haemorrhages and Osler's nodes are relatively rare in children. A high index of suspicion in a febrile child with a new murmur, detailed history, meticulous examination, repeated blood cultures, and echocardiography are essential in establishing the diagnosis. Management of infective endocarditis involves a prolonged course of antibiotics, at least for 4–6 weeks depending upon the causative organism and underlying heart condition. Complications of infective endocarditis include congestive heart failure resulting from valvular damage/regurgitation, infective emboli leading to abscesses in other organs and abnormal host immunological responses. Prophylactic antibiotics for dental and other medical procedures like genitourinary tract procedures are no longer recommended in the UK. The emphasis should be on educating children and their parents in early recognition of infective endocarditis. Children at high risk of developing endocarditis should be assessed urgently after clinical suspicion.     

The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

ObjectivesNecrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.MethodsRetrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0–19.5) months.ConclusionNEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.Level of evidenceLevel IV.     

Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective

The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980’s, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990’s early indomethacin administration was associated with a reduction of severe hemorrhage.