微生态调节剂干预母乳性黄疸临床观察和机制探讨

观察微生态调节剂(妈咪爱)干预母乳性黄疸疗效,并探讨其机制,检测"妈咪爱"治疗前后血清和十二指肠液胆红素值、胆汁和粪便β-葡萄糖醛酸苷酶(β-GD)活性.结果显示"妈咪爱"制剂干预组血清总胆红素值从130.60±20.06μmol/L下降到61.20±16.04μmol/L(P＜0.05),十二指肠液β-GD从1859.91±908.60U/100ml下降到858.26±260.90U/100ml,粪便中β-GD从4053±983.0U/100ml下降到2110.9±1541U/100ml(P＜0.05);而对照组十二指肠液胆红素值则无明显变化(P＞0.05).可以结论,"妈咪爱"调节剂能降低血清总胆红素值和肠道及胆汁中β-GD活性.     

微生态调节剂干预母乳性黄疸临床观察和机制探讨

观察微生态调节剂（妈咪爱）干预母乳性黄疸疗效,并探讨疗其机制,检测“妈咪爱”治疗前后血清和十二指肠液胆红素值、胆汁和粪便β-葡萄糖醛酸苷酶（β-GD）活性。结果显示:“妈咪爱”制剂干预组血清总胆红素值从130.60±20.06μmol/L下降到61.20±16.04μmol/L（P<0.05）,十二指肠液β-GD从1859.91±908.60U/100ml下降到858.26±260.90U/100ml,粪便中β-GD从4053±983.0U/100ml下降到2110.9±1541U/100ml（P<0.05）;而对照组十二指肠液胆红素值则无明显变化（P>0.05）。可以结论,“妈咪爱”调节剂能降低血清总胆红素值和肠道及胆汁中β-GD活性。     

β—葡萄糖醛酸苷酸在母乳性黄疸发病中的作用

探讨β－葡萄糖醛酸苷在母乳性黄疸发病中的作用。方法采用酶学比色法对４７例母乳性黄疸患儿及６０例正常新生儿粪便,血清及其母乳中β－ＧＤ活性浓度进行测定,并分析母乳性黄疸患儿β－ＧＤ活性浓度与血胆红素浓度的相关性。     

双歧杆菌活菌制剂治疗新生儿母乳性黄疽的疗效

目的观察双歧杆菌活菌制剂治疗新生儿母乳性黄疸的疗效.方法对63例新生儿母乳性黄疸患儿随机分为双歧杆菌治疗组和常规治疗组,常规治疗组采用输液、清蛋白静滴,重者采用蓝光治疗;双歧杆菌治疗组在常规治疗方法基础上加用双歧杆菌活菌制剂,并观察两组患儿黄疸消褪时间及血清总胆红素水平的变化.结果双歧杆菌治疗组和常规治疗组黄疸消褪时间分别为(4.0±2.1)、(5.5±2.5)d,两组比较有显著差异(P＜0.05),治疗d5血清总胆红素值分别为(45.6±17.3)、(82.5±32.6)μmol/L,两组比较有极显著差异(P＜0.01).结论双歧杆菌活菌制剂治疗新生儿母乳性黄疸有显著疗效.     

β-葡萄糖醛酸苷酶在母乳性黄疸发病中的作用

目的探讨β葡萄糖醛酸苷酶（βＧＤ）在母乳性黄疸发病中的作用。方法采用酶学比色法对４７例母乳性黄疸患儿及６０例正常新生儿粪便、血清及其母乳中βＧＤ活性浓度进行测定，并分析母乳性黄疸患儿βＧＤ活性浓度与血胆红素浓度的相关性。结果母乳性黄疸患儿母乳及粪便βＧＤ活性浓度分别为（１３６±０３０）Ｕ／Ｌ及（１０７±０３０）Ｕ／Ｌ，较正常新生儿［（０７５±０３３）Ｕ／Ｌ及（０５０±０２８）Ｕ／Ｌ］明显增高，二者之间差异有非常显著意义。患儿母乳及粪便βＧＤ活性浓度与血胆红素浓度呈明显正相关。黄疸消退期母乳及粪便βＧＤ活性浓度［（１１１±０３２）Ｕ／Ｌ及（０７２±０２６）Ｕ／Ｌ］较高峰期［（１３６±０３０）Ｕ／Ｌ及（１０７±０１０）Ｕ／Ｌ］明显降低，二者之间差异有非常显著意义。结论母乳及粪便βＧＤ活性浓度增高不仅与母乳性黄疸的发生有关，而且与其严重程度及病程经过密切相关。     

母乳β-葡萄糖醛酸苷酶与母乳性黄疸的关系

目的探讨母乳β-葡萄糖醛酸苷酶(-βGD)活性在母乳性黄疸(BMJ)发病机制中的作用。方法对14例BMJ患儿停母乳,改配方乳喂养3 d,后继续哺煮沸后母乳(灭活乳)3 d。于哺配方奶前、哺配方奶3 d末、哺灭活乳3 d末,分别采集不同乳类和粪便,测定-βGD活性,同时测定血清胆红素浓度。结果1.母乳-βGD活性为(87.60±44.67)U/mL,配方乳为(2.99±2.67)U/mL,灭活乳为(2.76±2.03)U/mL;母乳-βGD活性与配方乳和灭活乳比较均有非常显著差异(P均<0.001);配方乳β-GD活性与灭活乳比较无显著差异(P>0.05)。2.于哺配方乳前、哺配方乳3 d末、哺灭活乳3 d末,测定粪便-βGD活性分别为(310.12±131.98)、(326.86±138.26)和(337.91±143.21)U/g,组间无显著差异(F=0.033 P>0.05)。3.继续哺灭活乳患儿血清胆红素浓度持续下降,无1例出现反弹。结论1.母乳-βGD不是肠道内-βGD的主要来源,可能与BMJ发生关系不大。2.母乳中的一些加热可灭活因子可能与BMJ发生有关。     

晚发型母乳性黄疸患儿停母乳前后表皮生长因子的变化研究

目的 观察晚发型母乳性黄疸患儿停母乳前后患儿血清及母乳中表皮生长因子（epidermal growth factor,EGF）的变化。方法 选取30例足月晚发型母乳性黄疸患儿为研究对象,收集停母乳72 h前后两次的患儿血清及母乳,分别检测患儿血清中的总胆红素值、EGF浓度及母乳中的EGF浓度。结果 停母乳72 h后患儿血清总胆红素值及EGF浓度较停母乳前显著下降（均P<0.05）;而母乳中EGF浓度在停母乳前后差异无统计学意义（P >0.05）。结论 晚发型母乳性黄疸患儿停母乳前后母乳中EGF浓度无明显变化,而患儿血清中EGF浓度显著下降,其在晚发型母乳性黄疸中的作用及机制有待进一步研究。     

高胆红素血症新生儿肠道菌群特点及与β-葡萄糖醛酸苷酶活性的相关性

目的 探讨高胆红素血症新生儿肠道菌群特点及与β-葡萄糖醛酸苷酶（β-glucuronidase,β-GD）活性的关系。方法 选取2018年1~12月入院治疗的高胆红素血症新生儿50例为高胆红素血症组,选取非高胆红素血症新生儿30例为对照组。通过16S rRNA高通量测序方法分析两组新生儿肠道菌群的差异。通过酚酞-葡萄糖醛酸底物法测定高胆红素血症新生儿治疗前后肠道内的β-GD活性。结果 对治疗前高胆红素血症组和对照组肠道菌群分布属水平进行比较,发现两组间有52种细菌的丰度差异有统计学意义（P < 0.05）。对治疗后第3天高胆红素血症组和对照组入组3 d后肠道菌群分布属水平进行比较,发现两组间有42种细菌的丰度差异有统计学意义（P < 0.05）。高胆红素血症组新生儿治疗后,埃希氏菌属和葡萄球菌属在肠道内的含量明显低于治疗前（P < 0.05）,粪便中β-GD活性较治疗前明显降低（P < 0.05）。高胆红素血症新生儿治疗前后粪便β-GD活性与葡萄球菌属和埃希氏菌属丰度均呈正相关（r_s=0.5948~0.7245,均P < 0.01）。结论 高胆红素血症新生儿和非高胆红素血症新生儿肠道菌群存在差异。高胆红素血症新生儿粪便中β-GD活性与差异菌葡萄球菌属和埃希氏菌属丰度呈正相关。肠道菌群可能通过调节β-GD活性影响新生儿高胆红素血症的发生,通过对新生儿肠道菌群和β-GD活性进行测定和分析,可能对早期评估新生儿高胆红素血症的发生有一定的临床意义。     

早发型母乳性黄疸的血清酶学观察

早发型母乳性黄疸是母乳喂养的新生儿在生后3-4天出现皮肤黄疸，血清胆红素的峰值超过生理性黄疸的平均值，临床表现除黄疸外无其它特殊症状和体征。血清胆红素以间接胆红素(unconjugated bilirubin，简称UCB)增高为特征。近年来国内外对UCB造     

茵陈颗粒治疗新生儿高胆红素血症效果分析

目的 探讨茵陈颗粒治疗新生儿高胆红素血症的临床疗效及退黄机理.方法 选择2012年8月至2013年7月我院新生儿科收治的高胆红素血症新生儿,抽签分为观察组和对照组,均给予原发病治疗、光疗及口服微生态制剂,观察组加服茵陈配方颗粒（2g/包）每次1/3包,3次/天,共6天.两组患儿治疗前、治疗第4天、第7天分别检测血清总胆红素水平,收集每日尿液、粪便,测定并比较两组粪便中总胆红素、直接胆红素、尿胆原及尿液中胆红素、尿胆原含量.结果 研究期间共入选67例新生儿高胆红素血症患儿,其中观察组28例,对照组39例.两组患儿治疗前血清总胆红素值差异无统计学意义（P＞0.05）,治疗后观察组血清总胆红素下降值明显高于对照组[第4天：（107.3＆#177;49.4） μmol/L比（87.6＆#177;43.4） μmol/L,第7天：（178.4＆#177;53.3） μmol/L比（144.5＆#177;48.8） μmol/L,P＜0.05].观察组每日粪便有形成分总量与对照组比较差异无统计学意义（P＞0.05）;观察组每日粪便中总胆红素及直接胆红素含量均高于对照组[第1天：总胆红素（3.44＆#177;1.17） μmol比（2.26＆#177;1.02） μmol,直接胆红素（2.42＆#177;0.86） μmol比（1.76＆#177;0.92）μmol,第4天：总胆红素（1.96＆#177;1.33） μmol比（1.32＆#177;1.28） μmol,直接胆红素（1.62＆#177;1.13） μmol比（0.98＆#177;0.65）μmol,P＜0.05];两组粪便中尿胆原及尿液中尿胆红素、尿胆原均阴性.结论 中药制剂茵陈颗粒通过减少胆红素肠肝循环,增加粪便中胆红素排出,从而加快黄疸消退,可作为治疗新生儿高胆红素血症的辅助药物.     

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.