无神经节细胞症大鼠结肠上皮离子转运的变化

目的 建立一种适合骨髓间充质干细胞（mesenchymal stemcells，MSCs）移植的实验性无神经节细胞症大鼠模型，并探讨模型大鼠结肠上皮离子转运的变化。方法8～9周龄SD大鼠80只，随机分为二组。氯胺酮麻醉下开腹，实验组用0．1%苯扎氯铵（benzalkonium chloride，BAC）处理大鼠降结肠浆膜40min，温盐水冲洗后关腹，对照组用生理盐水代替苯扎氯铵。分别于术后1、2、3、4、8周进行大体观察、钡灌肠X线检查，结肠测压、取处理段结肠行组织学检查，利用短路电流技术检测结肠上皮离子转运的变化。结果BAC处理后1周，实验组大鼠出现腹胀，处理段结肠狭窄，反射性收缩消失，近端结肠扩张，且随着时问延长症状加重。组织学检查发现BAC处理后1周结肠神经节细胞明显减少、空泡变，3周后完全消失。短路电流检测提示，与对照组比较，实验组大鼠结肠上皮各时间点跨膜电压、基础电流明显降低，而钠离子吸收电流占基础电流的百分比升高。另外，由Forskolin所引起的氯离子分泌电流也明显高于对照组，但二苯胺-2，2’-二羧酸阻断Forskolin所引起的Isc的百分比下降且小于1。而结肠跨膜电阻二组之间无差异。结论①采用0．1％BAC处理降结肠浆膜成功建立了实验性无神经节细胞症大鼠模型，为进一步结肠内MSCs移植分化为神经细胞的研究奠定了基础；②实验性无神经节细胞症大鼠模型结肠黏膜屏障功能未受损伤，结肠上皮离子转运功能紊乱，提示巨结肠大便排空困难除与失神经之后的平滑肌和括约肌功能失调有关外，可能还与结肠离子转运的蛮化有关。     

丹参联合骨髓间充质干细胞移植治疗新生鼠缺氧缺血性脑损伤的实验研究

目的 研究骨髓间充质干细胞(MSCs)植入缺氧缺血性脑损伤(HIBD)新生大鼠脑后,植入MSCs在脑组织中的迁移、神经细胞抗原分化率的变化,探讨丹参联合MSCs移植治疗新生儿HIE的可行性.方法 将36只7日龄新生SD大鼠随机分为正常对照组(8只)、HIE组(8只)、MSCs移植组(10只)、MSCs移植+丹参组(10只).在MSCs移植后18 d取脑组织后做石蜡切片,免疫组织化学法检测并计数进入脑组织的MSCs,观察植入细胞在脑组织中的分布、迁移;免疫荧光双标记法检测植入细胞神经元巢蛋白(Nestin)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)的表达,观察其向神经细胞的分化,并进行组间比较.结果 植入MSCs主要分布于HIBD组左侧大脑皮质区,MSCs移植+丹参组标本中MSCs更多向右侧大脑半球迁移,且分布范围更广,与MSCs移植组比较,不同脑组织层面、两侧大脑半球MSCs计数均有统计学差异(Pa＜0.05);免疫荧光双标记法观察MSCs主要在左侧大脑皮质、海马等部位分化为神经细胞,Nestin、NSE、GFAP均可表达.MSCs移植+丹参组植入MSCs的Nestin、NSE分化率更高,且有统计学意义;MSCs移植组和MSCs移植+丹参组GFAP分化率比较差异无统计学意义.结论 MSCs植入HIBD新生大鼠脑组织后能存活,并在脑组织中移行,植入MSCs主要在HIBD新生鼠左侧脑皮质、海马等部位分化为神经细胞,表达Nestin、NSE及GFAP,加用丹参后可促进植入MSCs表达Nestin及NSE,对GFAP表达无影响.     

脐带间充质干细胞植入脑缺氧缺血模型仔鼠存活、增殖及分化

目的 观察脐带间充质干细胞(UCMSCs)植入HIE大鼠模型仔鼠后存活、增殖及分化情况.方法 取人脐带组织,经胶原酶和胰蛋白酶消化后,分离UCMSCs,采用5-溴脱氧尿苷(BrdU)标记.将孕鼠随机分为实验组(n=6)和对照组(n=1).实验组结扎孕鼠子宫动脉15 min,建立宫内全脑缺氧缺血损伤模型,幼鼠出生20 d(P20)随机分为干细胞组(n=24)和PBS组(n=19).干细胞组仔鼠小脑延髓池穿刺注射UCMSCs,PBS组注射PBS.移植后1、2、3、4周,采用免疫组织化学方法检测其BrdU、巢蛋白(Nestin)、神经元特异性烯醇化酶(NSE)、胶原纤维酸性蛋白(GFAP)表达,以硫堇染色观察其神经元形态.对照组正常分娩,同样检测作同期对照.结果 干细胞组于移植后1周海马齿状回即出现BrdU、Nestin、NSE和GFAP阳性细胞;BrdU和Nestin阳性细胞于移植1～3周逐渐增高,组间两两比较具有统计学意义(Pa<0.01),移植3～4周阳性细胞数目无明显差异(P>0.05);NSE和GFAP阳性细胞于1～4周均渐增加,组间两两比较具有统计学意义(Pa<0.01).硫堇染色观察其海马细胞形态,对照组神经细胞排列整齐,神经元呈多形性,数目多;PBS组神经细胞排列紊乱,神经元数目减少;干细胞组细胞排列较整齐,神经元数目较多.结论 UCMSCs经小脑延髓池移植至HIE大鼠模型能存活,并分化为神经干细胞、神经元及星形胶质细胞.     

先天性巨结肠乳鼠模型的建立和评价

目的 建立接近于人类先天性巨结肠（HD）的乳鼠模型,并进行模型评价。方法 9窝6～7日龄SD乳鼠随机分为实验组、对照组和正常组,每组3窝。实验组以0.1％苯扎氯铵(BAC)、对照组用生理盐水处理降结肠15 min,正常组不做任何处理。各组分别于术后第1、3、5、6和7周行大体解剖结肠形态学观察及组织病理学检查,以SABC法检测各组结肠神经节细胞S-100蛋白和神经细胞特异性烯醇化酶（NSE）表达,c-Kit免疫荧光检测各组结肠Cajal间质细胞（ICC）的分布和表达。结果 ①术后7周,实验组均出现不同程度的排便减少、腹胀、精神萎靡和消瘦,粪便颗粒较对照组和正常组大而干燥,处死后大体解剖可见BAC处理段结肠肠管狭窄、痉挛,无蠕动,病变近端肠管扩张,肠腔内容物潴留。②术后1、3、5和6周,实验组病理学检查可见肌间及黏膜下神经节细胞逐渐减少,术后7周肌间及黏膜下神经节细胞完全消失,肠壁其他结构完整,未发现瘢痕形成及炎症细胞浸润。对照组和正常组均可见正常的肌间和黏膜下神经节细胞。③术后1、3、5和6周,实验组肌间及黏膜下神经节细胞S-100蛋白和NSE的表达逐渐减少;术后7周S-100蛋白和NSE的表达完全消失,对照组及正常组S-100蛋白和NSE表达均未见明显变化。④术后1、3、5、6和7周,实验组结肠c-Kit的表达逐渐减少,ICC分布均较对照组和正常组明显减少,网络状结构受到破坏,ICC形态出现异常,表现为突起变短、变钝。对照组和正常组c-Kit表达无明显变化。结论 本研究成功建立HD乳鼠模型,为进一步研究HD及其相关并发症的病因、病理机制、生理机制及以ICC为靶点治疗HD奠定实验基础。     

不同类型无神经节细胞巨结肠乳鼠模型的建立与鉴定

目的 建立不同类型无神经节细胞巨结肠乳鼠实验动物模型,为进一步研究该病的发病机制及相关分子生物学机制提供可靠模型.方法 将6～8日龄SD大鼠4窝(每窝10只乳鼠)随机分为实验组(包括短段型组、常见型组、长段型组)及对照组.对照组乳鼠经肛门推注9 g/L盐水,实验组分别采用经肛门置入不同长度的导管,推注不同剂量、不同浓度苯扎氯铵(BAC)的方法进行处理.分别于处理后2、4、6、8周行大体观察,取全段结肠及直肠,固定、包埋、切片后行HE染色,通过免疫组织化学染色检测蛋白基因产物9.5(PGP9.5)的表达以鉴定模型建立成功与否,确定病变累及肠管的范围.通过免疫荧光技术观察狭窄肠段与相应部位正常肠段c-kit标记的Cajal间质细胞(ICC)的表达.结果 实验组大鼠处理后4周逐渐出现腹胀,粪便颗粒变小.8周处死后解剖发现肠管出现痉挛狭窄,狭窄近端粪便潴留；组织学检查可见处理段肠管肠神经节细胞基本消失,且不同的实验处理方法造成病变累及的肠段明显不同.对照组无上述改变.与对照组相比,实验组c-kit标志的ICC在狭窄段的表达明显减少.结论 经肛门灌注不同浓度、不同剂量BAC的方法成功建立了短段型、常见型、长段型3种类型无神经节细胞巨结肠的乳鼠实验模型,该方法建立的模型稳定、可重复性好,为深入研究先天性巨结肠的发病机制提供了一个可靠的模型基础.     

人脐带间充质干细胞的生物学特性及向神经样细胞分化的研究

目的 研究人脐带华尔通胶来源的间充质干细胞（MSCs）的特性及向神经细胞分化的可能性,为神经移植寻找新的细胞来源。方法 检测人脐带来源的MSCs的细胞表面标记;丹参和B巯基乙醇诱导人脐带来源的MSCs向神经细胞分化,用免疫细胞化学方法对分化和未分化的细胞进行鉴定;半定量逆转录聚合酶链反应（RT—PCR）检测细胞的神经相关基因表达。结果 从人脐带分离、培养的贴壁细胞,体外生长形态类似于成纤维细胞,可以维持在未分化状态稳定增殖,体外增殖超过10代。这类细胞MSCs的表面标记CD29、CD44、CD59、CD105仿呈现高表达,造血细胞表面标记CD14、CD33、CD34、CD27、CD45、CD117和与移植免疫排斥相关的表面标记CD80（137—1）、CD86（B7-2）、CD40、CD40L不表达或低表达。丹参和β巯基乙醇均可诱导人脐带MSCs向神经样细胞分化,分化的细胞表达神经干细胞的标记巢蛋白（Nestin）,神经元的标记类神经微管（β-TubulinⅢ）和神经微丝（NF）,以及神经胶质细胞的标记胶质纤维酸性蛋白（GFAP）。RT-PCR检测证实,经丹参诱导后的MSCs表达神经干细胞相关基因Nestin,诱导前和诱导后的MSCs均表达神经细胞基因Pleiotrophin,诱导后的表达明显增强。结论 人脐带华尔通胶含有丰富的MSCs,易于培养扩增,其表达MSCs的表面标记。不表达或低表达造血细胞和与移植排斥相关的细胞标记。人脐带来源的MSCs能分化为神经细胞,表达神经细胞的相关标记和基因,这种细胞可能成为中枢神经系统细胞移植的一个干细胞来源。     

脐血间充质干细胞静脉移植治疗新生大鼠缺氧缺血性脑损伤

目的探讨脐血间充质干细胞（MSCs）静脉移植治疗新生鼠缺氧缺血性脑损伤（HIBD）的可行性。方法将脐血MSCs移植前以DAPI标记，移植鼠在HIBD后第2周经鼠尾静脉注入脐血MSCs，于移植后第1、2和4周随机处死，行脑组织病理形态学观察，并取海马回相同部位的缺血脑组织切片，荧光镜下观察DAPI阳性细胞数。结果脐血MSCs经尾静脉移植后4周，各组鼠死亡率无显著差异，移植组脑病变率显著低于HIBD组，且该组脑组织病变仅偶见轻度，大多接近于正常，未见到重度脑组织病变发生；HIBD后1周左侧大脑缺血水肿区仍见神经细胞肿胀，细胞外间隙增宽，移植治疗1周后左侧脑组织水肿已明显减轻，上述病理组织学变化已不明显，大鼠病灶侧脑内，可见大量的DAPI阳性细胞分布，集中分布于病灶区周围，与宿主脑有机整合，没有明显的界限。结论脐血MSCs移植治疗新生鼠HIBD可以减轻脑水肿和脑损伤，在移植过程中MSCs可以透过血脑屏障并分布在损伤的脑组织周围，未见植入反应和其他任何副作用。     

大鼠胚胎肠神经嵴干细胞的分离培养和诱导分化

目的 探索从大鼠胚胎肠组织获取肠神经嵴干细胞（neural crest stem cells，NCSCs）的可能性；与脑神经干细胞（neural stem cells，NScs）比较，了解其生物学性状。方法 用NSCs的培养液同时进行肠NCSCs和脑NSCs的培养；得到的神经细胞球用神经上皮干细胞蛋白（nestin）进行鉴定，计数NCSCs神经细胞球和NSCs神经细胞球中各自的Nestin阳性细胞比例。NCSCs神经细胞球在胎牛血清诱导分化培养7d后，用神经元细胞特异性标记神经纤维丝蛋白（NF68）和星形胶质细胞特异性标记神经胶质酸性蛋白（GFAP）对其进行免疫荧光鉴定。结果从大鼠胚胎肠组织成功得到NCSCs，并且形成神经细胞球，Nestin为阳性；分化后细胞为NF68或者GFAP阳性；与NSCs比较，NCSCs能较快形成神经细胞球，其神经细胞球中的Nestin阳性细胞比例（66．75±12．42）％低于NSCs（91．60±5．62）％（P=0．000）。结论 肠NCSCs可以从大鼠胚胎肠组织分离培养得到，在体外培养环境下能够增殖，并且具有多向分化潜能。     

无神经节细胞动物模型的建立及鉴定

目的建立一种简单、有效的无神经节细胞大鼠模型,为肠神经干细胞移植治疗先天性巨结肠提供可用的动物模型。方法取新生1周龄乳鼠16窝,每窝中随机取4只肛门灌注生理盐水为对照组,4只肛门灌注1%的苯扎氯铵(BAC)作为实验组,灌注后2、4、6、8周观察两组灌注后表现(饮食、活动、腹部及排便等情况)以及直肠形态;HE染色、HuD免疫荧光(IF)染色观察肠神经节形态,并计算各组大鼠肠肌间神经节的数量;qRT-PCR检测胶质细胞源性神经营养因子(GDNF)以及神经型一氧化氮合酶(nNOS)的表达情况。结果灌注后2、4周,两组大鼠无明显异常,6周后实验组出现轻微腹胀,排便减少,至8周时腹胀明显,不排大便,伴精神萎靡,对照组大鼠无异常表现。2周、4周时两组直肠形态无异常,6周时实验组出现轻度狭窄,8周时明显狭窄,对照组未见异常改变。HE染色:术后2、4周两组直肠神经节细胞大小、形状以及数量上无明显异常(P0.05),6周时两组神经节细胞数量的中位数分别为3.0和6.0,两组比较差异有统计学意义(z=-5.82,P0.001),至8周时实验组未见肌间神经节细胞,对照组无变化。免疫荧光染色:HuD在两组大鼠肠肌间神经节中均有表达,2、4周两组无明显区别;6周时,实验组神经节细胞较对照组体积小、形态异常,至8周时,实验组已无荧光表达,对照组无改变。qRT-PCR:2、4周时两组GDNF mRNA、nNOS mRNA均无明显差异(P0.05),6、8周时实验组GDNF mRNA比对照组明显降低(0.06±0.03 vs 1.05±0.32;0.39±0.24 vs 1.02±0.22),经统计学分析差异有意义(P0.001),8周时GDNF mRNA的表达量较6周时明显升高,经统计学分析差异有意义(P0.001);6、8周时实验组nNOS mRNA比对照明显降低(0.54±0.33 vs 1.14±0.50;0.40±0.24 vs 1.03±0.26),经统计学分析差异有意义(P0.001)。结论直肠灌注BAC可以导致大鼠直肠神经节细胞完全缺如,GDNF以及nNOS异常表达可能与HD发生有关。     

黄芩苷对自身免疫性脑脊髓炎大鼠细胞凋亡的影响

目的：观察黄芩苷（BAC）对自身免疫性脑脊髓炎（EAE）大鼠的疗效及其对脊髓炎症细胞凋亡的影响。方法：44 只Wistar大鼠随机分为正常对照组（NC, n=10）、EAE 组(n=12)、地塞米松治疗组（DXM, n=12）、BAC 治疗组(n=10)。 DXM 组和 BAC 组在抗原免疫后1周分别予以DXM (1 mg/kg) 和BAC (200 mg/kg) 治疗7 d;观察各组动物脊髓病理变化及髓鞘碱性蛋白（MBP）表达的情况和脊髓炎症细胞凋亡情况。结果：EAE 组、DXM 组和 BAC 组较NC组体重均下降,BAC 组体重较 EAE 组及DXM组明显上升（P<0.05）。DXM 组和 BAC 组大鼠神经功能评分明显优于EAE组（P<0.05）;DXM 组和 BAC 组脊髓 MBP 阳性数均较 EAE 组显著增多（P<0.05）。DXM 组和 BAC 组脊髓炎症细胞凋亡数均较EAE 组显著增多（P<0.05）。 结论：BAC对EAE大鼠有治疗作用,并且能促进大鼠脊髓炎症细胞凋亡。     

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.