胆道闭锁Kasai术后肝移植患儿不同自体肝生存的临床与病理分析

目的分析和比较胆道闭锁(Biliary Atresia,BA)Kasai术后肝移植患儿不同自体肝生存情况,结合手术时病理及肝功能指标,初步探讨自体肝生存时间较长患儿的肝脏病理特点。方法将43例Kasai术后行肝移植的BA患儿按Kasai术与肝移植术间隔时间分为3组:G1组(n=17),间隔时间6个月;G2组(n=18),间隔时间6个月至2年;G3组(n=8),间隔时间2年。分析各组患儿临床资料包括Kasai手术时年龄、术后胆管炎发生情况、肝移植术前肝功能生化指标,同时对实施Kasai手术时及肝移植手术时的肝组织进行HE、Masson及免疫组化(CK19)染色,观察肝脏纤维化程度、胆管增生程度、淤胆情况以及炎性细胞浸润情况。结果 (1)三组Kasai手术时平均日龄分别为66.65 d、58.39 d、49.63 d,差异有统计学意义(F=3.757,P=0.032);三组患儿术后出现胆管炎的比例分别为12/17(70.6%)、14/18(77.8%)、4/8(50.0%),经统计学分析差异无意义(χ~2=2.035,P0.05);三组出现频发胆管炎的例数分别为7/10(41.2%)、12/18(66.7%)、1/8(12.5%),经统计学分析差异有意义(χ~2=6.679,P=0.032);肝移植手术前三组患儿肝功能指标显示G3组AST、ALT、TBI、DBI、GGT、TBA均低于前两组,但差异无统计学意义(P0.05)。(2)Kasai手术时肝纤维化分级为3(2～3),胆管增生分级为2(1～2.5),胆栓分级为1(1～2.5),汇管区炎细胞浸润程度分级为3(1.5～3);移植时肝脏病理显示三组肝纤维化程度分级分别为4(4～4)、4(4～4)、4(2～4),经统计学分析差异有意义(χ~2=5.978,P=0.047);胆管增生程度分级分别为3(3～3)、2(1～3)、0(0～2),经统计学分析差异有意义(χ~2=19.577,P0.001);胆栓分级分别为3(2.5～3)、1(1～3)、1(1～3),经统计学分析差异有意义(χ~2=13.998,P0.001);炎细胞浸润程度分级分别为2(1～2)、1.5(1～2)、1(1～1),差异具有统计学意义(χ~2=6.221,P=0.044)。(3)Kasai手术日龄越早,术后胆管炎发作次数越少的BA患儿,其肝纤维化进展速度缓慢,胆管增生、淤胆及炎细胞浸润程度轻,自体肝生存时间较长。结论 (1)BA患儿行Kasai手术的日龄及术后胆管炎发作的频次,是影响术后肝脏病理及自体肝生存时间的重要因素。(2)对于自体肝生存时间长的BA患儿,Kasai手术解除了胆道梗阻,降低了炎细胞浸润程度,有助于延缓肝纤维化进程。     

婴儿阻塞性胆管病肝组织与胆管构形的研究

目的：通过病理学方法，作出肝外胆道闭锁的诊断和预后判定。方法：对２３例婴儿阻塞性胆管病和５例对照的肝组织，按病理诊断和年龄分组，进行肝组织的二维病理学研究和肝内胆管三维构形观察。结果：肝外胆道闭锁与狭窄和新生儿肝炎肝组织的病变相似，仅程度不同。不同年龄组间，胆管增生、汇管区面积和肝纤维化及肝硬化有显著性差异。胆道闭锁的大月龄组中胆道病变和胆栓明显，新生儿肝炎时肝细胞坏死更突出。肝内胆管的三维构形表明，胆道闭锁时增生赫令管多数管腔开放，并互相连接成网络状；少数赫令管形成膨大盲端和局部小叶间胆管形成微囊肿。结论：①阻塞性胆管病时，肝纤维化、胆管增生和汇管区面积与患儿月龄有关；②赫令管形成网络状暗示胆道阻塞，结合胆管的病变和胆栓有助于诊断胆道闭锁；③胆管的微囊肿和赫令管膨大盲端提示胆道闭锁预后差     

胆道闭锁与婴儿肝炎综合征肝活检病理对比分析

目的对比分析胆道闭锁、婴儿肝炎综合征患儿肝组织活检病理表现,明确胆道闭锁与婴儿肝炎综合征的相关性及不同病理表现。方法收集2004年1月至2014年1月在本院因黄疸保守治疗效果不佳而疑为胆道畸形并行胆道探查、胆道造影患儿的肝活检标本32例,其中胆道闭锁25例,婴儿肝炎综合征7例,分别就两者肝活检HE染色切片肝细胞淤胆、变性,毛胆管淤胆,汇管区胆管增生,胆管内胆栓,汇管区炎性细胞浸润,肝脏纤维化程度进行比较。结果虽然婴儿肝炎综合征胆道造影存在胆道形态异常,但同年龄段胆道闭锁与婴儿肝炎综合征患儿肝细胞淤胆、变性,毛胆管淤胆,汇管区炎性细胞浸润等情况比较无明显差异;胆道闭锁患儿汇管区胆管增生,肝脏纤维化程度明显高于婴儿肝炎综合征组(P0.05)。结论婴儿肝炎综合征与胆道闭锁病理表现明显不同;汇管区胆管增生、肝纤维化程度是鉴别胆道闭锁与婴儿肝炎综合征的主要病理依据;婴儿肝炎综合征能否最终发展为胆道闭锁尚需进一步随访研究。     

胆道闭锁肝内外胆系组织病理形态学分析

目的 通过胆道闭锁（BA）肝门纤维块、肝脏组织的病理及其超微结构观察，对肝门成纤维细胞分化程度进行评分，并与肝纤维化分级进行相关分析。方法 选取BA患儿作为研究对象，术中取肝门纤维块及肝脏组织标本；研究同期选取疑似BA经术中胆道造影除外BA，诊断为胆汁淤积综合征和先天性胆管扩张症患儿作为对照组，留取肝脏组织标本。在光镜和电镜下观察标本的病理改变，以及肝细胞、毛细胆管和肝门成纤维细胞的超微结构。采用SPSS 14.0软件，半定量比较BA与对照组肝脏纤维化的差异，检验肝门纤维块成纤维细胞活跃程度与肝纤维化分级的相关性。结果 2005年7月至2006年5月复旦大学附属儿科医院收治的21例BA Kasai根治术病例，手术平均年龄（66±20）d；对照组为5例胆汁淤积综合征和10例先天性胆管扩张症患儿。BA组肝组织病理改变主要是肝内门脉区胆管炎症及纤维化形成，肝纤维化程度明显高于同年龄胆汁淤积综合征和先天性胆管扩张症患儿；肝门纤维块毛细胆管增生，部分管腔闭锁、狭窄，腔内炎细胞浸润及部分淤胆，大量间质成分增生；电镜下肝门成纤维细胞活跃、肝脏毛细胆管上皮微绒毛缺失、肝细胞及肝血窦内电子致密物质增多及部分毛细胆管扩张；肝门成纤维细胞分化程度与肝组织纤维化程度相关（P=0.04）。结论 BA肝组织病理改变主要是肝内门脉区胆管炎症及严重纤维化形成；超微结构改变提示肝门部成纤维细胞活跃，其分化程度与肝纤维化程度相关。     

胆小管增生诱导胆道闭锁早期肝纤维化

目的观察门管区胆小管增生与肝纤维化的关系，进而探讨胆小管增生对胆道闭锁病程的作用和意义。方法选取在1997-2003年间经我科治疗的胆道闭锁(17例)和婴儿肝炎综合征(19例)患儿。术中肝活检标本石蜡切片行常规HE染色和免疫组化染色(Cytokeratin-7，Ki67)，观察手术时年龄、肝纤维化、胆管增生、胆管增生活性和术前直接胆红素水平。结果在胆道闭锁组，不同肝纤维化级别的胆小管增生级别有相关关系(rs=0．561，P=0．019)。结论大量的胆管迅速增生，诱导产生大量的基质沉积于门管区，可能就是胆道闭锁患儿肝纤维化迅速进展的主要原因。     

肝外胆道闭锁和胆管板畸形

肝外胆道闭锁(extra-hepatic biliary atresia)即胆道闭锁(biliary atresia, BA),是新生儿梗阻性黄疸的主要病因,其组织病理表现为肝门部及肝外胆道的纤维性炎症改变,肝外胆管闭塞或狭窄,肝脏门管区炎症浸润、部分纤维化及小胆管增生改变~([1]).     

MMP-7、APRI与胆道闭锁肝纤维化的相关性分析北大核心CSCD

目的探讨胆道闭锁(biliary atresia,BA)患儿的术前实验室检查结果与肝纤维化程度的相关性,拟建立更好的评估肝纤维化的无创预测模型。方法回顾性分析2021年4月至2023年4月在浙江大学医学院附属儿童医院新生儿外科就诊的100例BA患儿的临床资料。采用Mann-Whitney U检验或Kruskal-Wallis H检验比较不同Ohkuma's肝纤维化分级和不同胆管增生分级患儿间各术前实验室指标的差异。根据多元logistic回归分析方法建立整合模型,各实验室指标同时绘制受试者操作特征(receiver operating characteristic,ROC)曲线,比较其对肝纤维化程度的预测效能。结果BA患儿Kasai手术年龄、血清基质金属蛋白酶-7(matrix metalloproteinase-7,MMP-7)、丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、直接胆红素(direct bilirubin,DBil)、间接胆红素(indirect bilirubin,IBil)、前白蛋白(prealbumin,PAB)、天冬氨酸转氨酶/血小板比值指数(aspartate aminotransferase to platelet ratio index,APRI)在不同肝纤维化分级及不同胆管增生分级患儿间差异有统计学意义(均P<0.05)。肝纤维化分级越高,胆管增生分级普遍越高(P<0.001)。整合模型的ROC曲线下面积为0.876(95%CI:0.806,0.945),敏感性为68.3%,特异性为93.2%,准确性为83.0%,阳性预测值为87.5%,阴性预测值为80.9%,高于各实验室指标的单独预测效能。结论Kasai手术年龄、MMP-7、APRI与BA患儿肝纤维化分级、胆管增生分级相关。多实验室指标的创新整合模型对于无创预测BA肝纤维化程度具有良好的诊断效能和准确度。     

胆道闭锁Kasai术后肝内胆管囊性扩张的形成特点与病理研究

目的分析胆道闭锁(biliary atresia,BA)患儿Kasai术后肝内胆管囊性扩张(intrahepatic biliary cysts,IBC)的形成特点及病理学表现,探索其与预后之间的关系。方法选取2017年1月至2018年12月天津市儿童医院Kasai术后行肝移植手术的BA患儿179例(男75例,女104例),收集患儿的临床资料和影像学资料,用以判断是否存在IBC,其中36例CT检查结果提示存在肝内胆管扩张,作为IBC(+)组,143例未检测到肝内胆管扩张,作为IBC(-)组,比较两组的自体肝生存状况及肝功能指标。同时收集到上述患儿中50例患儿的肝移植时的病肝组织,其中IBC(+)组18例,IBC(-)组32例,进行HE染色,观察肝脏纤维化程度、胆管增生程度、淤胆以及胆管板畸形的发生情况。结果①IBC(+)组女患儿有27例,占75.0%(27/36),IBC(-)组女患儿有77例,占53.8%(77/143),两组中女患儿占比的差异具有统计学意义(P=0.021),两组患儿在行Kasai术时的日龄及术后胆管炎的发生率的比较中,差异无统计学意义(P>0.05);②IBC(+)组患儿的中位生存期为11.5个月,明显高于IBC(-)组患儿的9.0个月。Log-Rank检测发现,IBC(+)组术后自体肝生存状况优于IBC(-)组患儿,且差异具有统计学意义(P=0.038);③肝功能的比较结果发现IBC(+)组除胆汁酸(total bile acids,TBA)外,均低于IBC(-)组患儿,其中总胆红素(total bilirubin,TBI)、结合胆红素(direct bilirubin,DBI)水平在两组的差异具有统计学意义(P<0.05);④IBC(+)组患儿的肝纤维化程度、胆管增生程度及胆管板畸形发生率均较IBC(-)组略低,差异无统计学意义;但IBC(+)组淤胆程度明显低于IBC(-)组,差异具有统计学意义(P=0.013)。结论BA患儿Kasai术后发生IBC可能是肝脏代偿的积极表现,短期内不会导致胆汁淤积的加重,相反扩张的胆管可以减轻胆汁淤积的程度,改善肝功能及病理分级,从而延长自体肝生存时间。     

胆道闭锁肝胆病理改变与预后的关系研究

目的 通过研究BA患儿术中肝活检和肝门纤维块的病理表现,探讨肝脏和纤维块病理表现与BA预后的关系.方法 2009年4月至2010年9月,61例BA患儿在我院行Kasai手术治疗,术中取肝活检和肝门纤维块.病理切片观察肝小叶结构、纤维化情况,将所有BA患儿根据肝病理诊断是否为胆汁性肝硬化分为肝硬化组和非肝硬化组.根据镜下观察到纤维块中小胆管增生的程度分为少许小胆管增生组和较多小胆管增生组.术后随访3～17个月.结果 病理诊断为肝硬化者术时年龄较大、术中门脉测压较高、术后肝功能恢复情况较差.肝硬化组术后3个月黄疸消退率明显较非肝硬化组低(X2=4.020,P=0.045),术后1年病死率明显较非肝硬化组高(P=0.046).肝硬化者纤维块内小胆管增生程度较重(x2=4.244,P=0.039);纤维块内小胆管增生越严重,术后3个月黄疸消退率越低(P=0.045).结论 肝病理检查是较早的评估BA患儿预后的可靠方法,肝硬化是影响BA预后的重要因素;纤维块小胆管增生程度与BA患儿的短期预后有相关关系,但其是否与BA的远期预后有关系还需要进一步的研究.

Abstract：

Objective To investigate the correlation between the pathologic changes of liver and fibrous portal tissue and prognosis of biliary atresia (BA). Methods Between April 2009 and September 2010, the Kasai's procedures were carried out on 61 patients with BA. Specimens of the liver tissue and fibrous portal tissue were collected in operation. The pathology of the liver tissue and fibrous portal tissue was studied. Based on the severity of hepatic cirrhosis, the patients were grouped into two groups: cirrhosis group and no cirrhosis group. According to whether or not there was obvious bile ductular proliferation in fibrous portal tissue, the hepatic cirrhosis patients were further grouped into 2 groups. All of patients with BA were followed up for 3 to 17 months. Results The patients of hepatic cirrhosis group were older at operation, and had higher portal pressure and poorer prognosis. The 3 months post-operative jaundice clearance rate of cirrhosis patients was significantly lower than that of no cirrhosis patients (39. 5% vs 83. 3%,X2 = 4. 020,P= 0. 045). The 1-year post-operative mortality of the cirrhosis patients was significantly higher than that of no cirrhosis patients (53. 3% vs 0,P= 0. 046). The patients of the cirrhosis group had more bile ductular proliferation (60% vs 0, X2 = 4. 244, P = 0. 039). The more severe bile ductal proliferation in the cirrhosis patients was, the lower jaundice clearance rate they would have (76. 5% vs 38. 5%,P=0. 045). Conclusions The pathologic findings of liver can be used to predict the prognosis of the BA patients after Kasai's procedure. The patients with severe hepatic cirrhosis and bile ductal proliferation have poor prognosis.     

热休克蛋白70 在胆道闭锁肝组织纤维化中作用及对预后影响

目的探讨热休克蛋白70在胆道闭锁(BA)肝组织纤维化中的作用及对预后的影响。方法选取择期行Kasai术治疗的BA患儿46例、胆总管囊肿患儿30例和门静脉海绵样变患儿17例;免疫组化染色检测肝组织中HSP 70蛋白表达,利用天狼星红-饱和苦味酸染色液检测BA患儿肝组织纤维化,双重染色法检测BA患儿不同纤维化肝组织中HSP 70蛋白表达,所有BA患儿术后均获得随访。结果 BA、胆总管囊肿以及静脉海绵样变患儿三组,HSP 70蛋白高表达比例的差异有统计学意义(χ~2=7.99,P=0.018),以BA组的HSP 70蛋白高表达比例为最高。等级相关分析显示,肝组织中HSP70蛋白表达强度与肝纤维化程度呈正相关(r=0.861,P0.001);46例BA患儿中,死亡15例,生存分析显示,轻度BA患儿术后生存率82.4%,中位生存时间(34.6±2.3)月;中重度患儿术后生存率58.6%,中位生存时间(25.5±2.8)月;Log-Rank检验显示,两组生存函数的差异有统计学意义(χ~2=5.27,P=0.012)。BA患儿中,HSP 70蛋白低表达者的生存率85.0%,术后中位生存时间(34.0±2.6)月,HSP70蛋白高表达者生存率53.8%,术后中位生存时间(18.3±2.2)月;Log-Rank检验显示,两组生存函数差异有统计学意义(χ~2=4.77,P=0.029)。结论 BA患儿肝组织中HSP70蛋白呈高表达,且与肝组织纤维化程度呈正相关,推测其可能参与了肝纤维化进程,HSP70表达上调往往预示患儿预后不良。     

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.     

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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     

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.     

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.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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.     

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.     

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.