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1.
Are stable postoperative biliary atresia patients really stable? 总被引:5,自引:0,他引:5
Kobayashi H Horikoshi K Yamataka A Lane GJ Furuhata A Sueyoshi N Miyano T 《Pediatric surgery international》2001,17(2-3):104-107
Transforming growth factor-beta 1 (TGF β-1) is an important mediator of liver-cell proliferation and replication that is
implicated in hepatic fibrosis (HF). Hepatic stellate cells (HSC) are activated by TGF β-1 and are the main precursor cells
involved in fibrogenesis. The correlation between serum TGF β-1, activated HSC in liver-biopsy specimens, and liver biochemistry
was investigated to determine the value of TGF β-1 as an indicator of clinical status in postoperative biliary atresia (BA)
patients. Thirty-two postoperative BA patients (mean age 11.2 ± 2.8 years) and 13 normal controls (mean age 10.3 ± 3.7 years)
were studied. Based on average liver function test (LFT) results over a 3-month period immediately prior to this study, the
BA patients were divided into group I (anicteric, normal LFT; n = 10); group II (anicteric, elevated liver transaminases; n = 12), and group III (jaundiced end-stage liver fibrosis awaiting liver transplantation; n = 10). Serum TGF β-1 was determined using ELISA. Liver-biopsy specimens were examined with antibody against TGF β-1 and α-smooth
muscle actin (SMA) antibody for detection of activated HSC. Serum TGF β-1 was significantly higher in groups I (11.4 ± 3.7 ng/ml;
P < 0.01) and II (23.3 ± 11.3 ng/ml; P < 0.001) than in group III (3.0 ± 1.5 ng/ml) and controls (4.5 ± 2.5 ng/ml) despite normal LFT in group I. The 3 subjects
with the highest serum TGF β-1 in group II had bile lakes. Biopsies from groups I and II were strongly positive for TGF β-1
in hepatocytes and Kupffer cells and for activated HSC detected by SMA compared with group III and controls. Because serum
TGF β-1 and activated HSC are only present during active fibrosis, we conclude that there is progressive fibrogenesis even
in seemingly normal postoperative BA patients. In particular, bile lakes should be regarded as a key sign of progressive HF,
the presence of which should be regarded with extreme caution. We suggest that serum TGF β-1 could be used as an accurate
indicator of progressive fibrogenesis in postoperative BA patients.
Accepted: 14 April 2000 相似文献
2.
Kobayashi H Horikoshi K Yamataka A Lane GJ Watanabe S Futagawa S Miyano T 《Pediatric surgery international》2000,16(4):302-305
Early identification of patients likely to deteriorate post-hepatic portoenterostomy for biliary atresia (BA) would be beneficial.
α-Glutathione-s-transferase (α-GST) is a serologic marker of reactive hepatocellular damage because of its low molecular weight,
uniform hepatic distribution, high cytosol concentration, and short half-life. We evaluated whether serum α-GST in post-surgical
BA patients correlates with liver function (LF) and investigated its potential as a medium- to long-term marker of prognosis.
Postoperative BA patients (n = 30; mean age: 11.8 ± 3.7 years) were divided into three groups based on average LF over the
3 months prior to this study. Group I (n = 8) were jaundice-free and had normal LF. Group II (n = 12) had moderate liver dysfunction,
and group III (n = 10) had severe liver dysfunction. Serum α-GST was determined using a specific ELISA. Tissue α-GST was determined
immunohistochemically, using liver needle-biopsy specimens. Bile lakes were found in 5 group II patients and 5 group III patients.
Serum α-GST was significantly higher in group II (20.7 ± 8.4 ng/ml) than in groups I (4.7 ± 1.3 ng/ml) and III (8.0 ± 1.2 ng/ml)
(P < 0.0001) and was highest in group II subjects with bile lakes. In control liver specimens α-GST distribution was weak but
uniform throughout normal liver lobule hepatocytes. In group II there was strong staining in centrilobular hepatocytes, and
in group III α-GST was only found in regenerative nodules. We conclude that α-GST may be a more sensitive indicator of hepatocellular
damage in BA because its distribution is correlated to the proportion of functioning liver tissue present. This is the first
report of this relationship, which has great implications for group II subjects because a sudden shift in concentration of
α-GST may be a better predictor of impending hepatic dysfunction than conventional LF tests. 相似文献
3.
H. Kobayashi T. Miyano K. Horikoshi K. Orihata S. Watanabe S. Futagawa 《Pediatric surgery international》1998,13(7):491-493
Biliary atresia (BA) is the end-result of a destructive inflammatory process that affects intra- and extrahepatic bile ducts,
leading to fibrosis and obliteration of the biliary tracts with the development of biliary cirrhosis and portal hypertension
(PH). Endothelins (ET) are 21-amino-acid peptides of endothelial origin with potent vasoconstrictor activity that bind to
various cells of the liver. Nothing is presently known about plasma ET levels in BA. The aim of this study was to determine
the clinical significance of plasma ET levels in patients with BA after hepatic portoenterostomy (Kasai's procedure) and to
correlate these with liver function tests (LFT) and PH. We measured plasma concentrations of ET in 19 patients with BA (5
boys and 14 girls; mean age 11.6 ± 5.5 years) after portoenterostomy and 10 age-matched controls. Patients were grouped according
to outcome based on LFT: group A consisted of 9 patients with an ‘‘unfavorable outcome” and Group B 10 patients with a “favorable
outcome”. The plasma ET levels were measured using a highly sensitive and specific enzyme immunometeric assay (EIA). No patient
had ascites or hepatorenal syndrome. Plasma ET levels were significantly higher in patients with BA than in controls (3.42 ± 0.42 vs
1.75 ± 0.39 pg/ml, respectively; P < 0.01) and in patients in group A than in group B. (3.75 ± 0.25 vs 3.06 ± 0.23 pg/ml, respectively; P < 0.01). In group A, plasma ET levels were higher in patients with PH (n = 4) than in those without PH (n = 5) (3.99 ± 0.06 vs 3.64 ± 0.22 pg/ml, respectively; P < 0.05). We conclude that plasma ET levels are high in patients with BA, especially those with severe biliary cirrhosis,
and that ET may partially contribute to development of PH in BA. The results of the present study also suggest that plasma
ET concentrations may be a useful marker in the follow-up of patients with BA.
Accepted: 12 September 1997 相似文献
4.
Elevated serum nitric oxide metabolites in biliary atresia 总被引:1,自引:0,他引:1
Vejchapipat P Chongsrisawat V Theamboonlers A Chittmittrapap S Poovorawan Y 《Pediatric surgery international》2006,22(1):106-109
Biliary atresia (BA) remains one of the most intractable liver diseases in children. The aim of this study was to investigate
the possible roles of nitric oxide (NO) in BA. Serum levels of nitrite and nitrate (NO production) were determined using a
colorimetric method from 65 post-operative BA patients and 12 healthy children. The patients were categorized into two groups
according to their jaundice status, and serum alanine aminotransferase (ALT, a marker for liver injury). Unpaired t tests were used. Data are expressed as mean and SD in terms of μmol/l. Age and gender between BA patients and controls were
comparable. Serum NO metabolites of BA patients was higher than the controls (79.77±21.22 vs. 65.75±9.44, P=0.001). Subgroup analysis revealed that there was no difference in serum nitrate/nitrite levels of BA patients without jaundice
compared to those with jaundice (78.85±23.23 vs. 80.90±18.76, P=0.70). However, patients with serum ALT≥100 IU/l had higher levels of serum NO metabolites compared to those with serum ALT<100 IU/l.
In conclusion, NO production was elevated in BA patients compared to normal controls. Serum NO was associated with serum ALT
levels, but not with jaundice status, in BA patients. These suggest that NO plays a role in the pathophysiology of liver injury
in post-operative BA. 相似文献
5.
6.
Beneficial effect of a traditional herbal medicine (inchin-ko-to) in postoperative biliary atresia patients 总被引:3,自引:0,他引:3
Hiroyuki Kobayashi Kentaro Horikoshi Atsuyuki Yamataka Geoffrey J. Lane Masahiro Yamamoto Takeshi Miyano 《Pediatric surgery international》2001,17(5-6):386-389
Inchin-ko-to (ICKT) prevents Fas-mediated liver injury. This study evaluates the effect of ICKT on conventional markers of
liver function (LF) and liver fibrosis in 18 postoperative biliary atresia (BA) patients aged 3 to 23 years with elevated
glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), γ-glutamyl transpeptidase (γGTP) but normal
serum total bilirubin (T-Bil) levels. ICKT (0.15 g/kg per day) was administered orally for 1 year. Serum GOT, GPT, γGTP, total
bile acids (TBA), and T-Bil as markers of LF and hyaluronic acid (HA), prolyl hydroxylase (PH), procollagen III peptide (PIIIP),
and type IV collagen as markers of liver fibrosis were measured before and after treatment in each patient and compared statistically.
All patients tolerated ICKT well, and there were no side effects. The percentage of subjects who improved after ICKT was 45%
for serum GOT, 72% for GPT, 72% for γGTP, 72% for TBA, 67% for HA, 40% for PH, 50% for PIIIP, and 23% for type IV collagen.
Changes in the mean values of all serum markers were statistically significant (P < 0.01). It is concluded that long-term administration of ICKT in postoperative BA patients improves liver status as assessed
by markers of LF and fibrosis.
Accepted: 22 September 2000 相似文献
7.
Circulating soluble adhesion molecule levels in children with acute lymphoblastic leukaemia 总被引:3,自引:0,他引:3
M. Hatzistilianou F. Athanassiadou C. Agguridaki D. Catriu 《European journal of pediatrics》1997,156(7):537-540
The aim of this study was to evaluate levels of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular
cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) as parameters of disease activity and to monitor the
response to treatment in children with acute lymphoblastic leukaemia (ALL). The above soluble adhesion molecules were determined
in the serum of 35 children with ALL and 30 healthy children (control group) of the same age range. The samples were obtained
before treatment, 6 months after the beginning of the treatment (remission of the disease), 6 months after the end of the
treatment and during relapse of the disease. The mean levels of sICAM-1, sVCAM-1 and sE-selectin at the onset of the disease
were 646.6 ± 80.9 ng/ml, 1786 ± 151.8 ng/ml and 140.5 ± 17.3 ng/ml, respectively. These values were significantly higher (P < 0.001) than those of the control group, which were, 245.8 ± 25.7 ng/ml, 798.6 ± 78.9 ng/ml and 44.7 ± 18.2 ng/ml respectively.
During remission, the mean levels did not differ significantly from those of the control group. After the end of the treatment
the mean levels again did not show any significant differences compared to the control group. During relapse the soluble adhesion
molecule mean levels (923.9 ± 110.1 ng/ml, 2945.7 ± 349.9 ng/ml and 258.2 ± 5.1 ng/ml) were significantly higher (P < 0.001) than those of the control group and also than those obtained during remission and after the end of the treatment
(P < 0.001). Pearson's correlation coefficient r was computed in order to detect possible linear correlations between: (1) sICAM-1 and sVCAM-1 (r = 0.632); (2) sICAM-1 and sE-selectin (r = 0.788) and (3) sVCAM-1 and sE-selectin (r = 0.752). All three cases correspond to P < 0.001, thus indicating strong linear correlations.
Conclusion The levels of soluble circulating adhesion molecule levels can be utilized for monitoring disease activity of ALL and its
response to treatment, as well as for early detection of relapse. Strong linear correlations between the three soluble adhesion
molecules tested suggest that each of them may be sufficient as an indicator.
Received: 5 August 1996 / Accepted: 13 February 1997 相似文献
8.
D. Abrahamov E. Erez M. Tamariz O. Dagan E. Pearl Y. Abrahamov B. Gendel N. Desai J. Kats B. Vidne V. Barak 《Pediatric surgery international》2002,18(1):54-59
Capillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a
serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular
endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older
children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative
CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width
index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly
more prominent in the neonatal patients. Low plasma VEFG levels (>35 pg/ml) were found in 3 neonatal control patients and
all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4 ± 559.1 pg/ml,
P = 0.02), which decreased during the operation to levels below 35 pg/ml and increased again 24 h postoperatively to levels
significantly higher than in the older patients (484 ± 270.3 pg/ml, P = 0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented
by CSTWI (P < 0.01, r = 0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates
than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS.
Accepted: 1 March 2000 相似文献
9.
Serum alkaline phosphatase (AP), the bone fraction of which is secreted by osteoblasts, is elevated in rickets. Both normal
and elevated levels of serum osteocalcin (OC), a bone-specific marker secreted by osteoblasts, have been reported in rickets.
Expression of the OC gene is enhanced by 1,25-dihydroxyvitamin D (1,25(OH)2D) in experimental models. This study assessed serum OC levels in 14 controls and 41 patients with active rickets divided
into a phosphopenic (n=20) and a calciopenic (n=21) group. Phosphopenic subjects were older (9.5 versus 5.7 years, P=0.03) with higher median serum calcium level (2.35 versus 2.16 mmol/l, P=0.0002) and serum 25-hydroxyvitamin D level (15.4 versus 10.4 ng/l, P=0.003); and lower serum phosphate (0.80 versus 1.51 mmol/l, P=0.0001), serum 1,25(OH)2D (43.0 versus 95.6 pg/ml, P=0.0001) and intact serum parathyroid hormone level (45.0 versus 141.5 ng/l, P=0.01) than calciopenic subjects. There were no differences in median serum AP (774 versus 1430 IU/l, P=0.17) and OC (14.5 versus 13.4 ng/ml, P=0.6) between the two groups. The mean OC value for the 41 rickets subjects was 15.1 ± 6.2 ng/ml and 17.4 ± 7.8 ng/ml for
the 14 control subjects. In the face of markedly elevated serum AP levels in the rickets subjects, all of the serum OC values
in the study fell within two standard deviations of the mean for normals. There was no association between serum OC and 1,25-(OH)2D in either the phosphopenic or the calciopenic group.
Conclusion These results show that serum osteocalcin levels are not elevated in all forms of active rickets and that, unlike serum alkaline
phosphatase, serum osteocalcin cannot be used in the diagnosis of rickets.
Received: 24 September 1999 / Accepted: 23 March 2000 相似文献
10.
Abul Faiz Kabir Uddin Ahmed Masaki Nio Haruo Ohtani Hiroshi Nagura Ryoji Ohi 《Pediatric surgery international》2001,17(8):601-603
The aim of the present study was to examine the clinical significance of c-kit expression in biliary atresia (BA) using formalin-fixed, paraffin-embedded sections from 21 patients with BA. Patients were
divided into group I (n = 8) with good liver function; group II (n = 8) with moderate liver dysfunction; and group III (n = 5) with severe liver dysfunction. Choledochal cysts (CDC, n = 5) and normal liver samples (NL, n = 4) served as controls. The results were analyzed and compared among the groups. Most c-kit
+ cells were present in the portal tracts, and their numbers in BA were significantly higher than in the controls (11.12 ±
1.64 vs 2.15 ± 0.15 [mean ± standard error], P = 0.02, BA vs CDC; 11.12 ± 1.64 vs 1.66 ± 0.52, P = 0.03, BA vs NL). Clinical correlation revealed a significantly higher number of c-kit
+ cells in group III versus group I (18.10 ± 3.62 vs 8.86 ± 2.51, P = 0.02). These results suggest that c-kit overexpression is associated with an adverse clinical outcome in BA.
Accepted: 1 November 2000 相似文献
11.
L. Sirota R. Straussberg N. Gurary D. Aloni H. Bessler 《European journal of pediatrics》1999,158(11):910-913
The capacity of peripheral blood mononuclear cells (PBMC) to produce interleukin (IL) IL-1β, IL-2, IL-3, IL-6, IL-10 and
tumor necrosis factor-α (TNFα) was examined in term newborns with hyperbilirubinemia after 24 hours' exposure to phototherapy
(wave length 425–475 nm). The results were compared with those from untreated neonates. Fifty newborns spontaneously delivered
at term were included in the study. Blood samples were collected from 20 newborns before and 24 h after phototherapy. The
control group consisted of 30 neonates examined on two consecutive days. PBMC isolated from blood samples were incubated in
vitro for cytokine production. The concentration of cytokines in the supernatants was tested using ELISA kits (for IL-1β,
IL-6, IL-10 and TNFα), or by bioassays (for IL-2 and IL-3). Phototherapy caused a 70% increase in IL-2 secretion (123 ± 27
vs 208 ± 30 units/ml, P < 0.01) and 56% in IL-10 production (1.07 ± 0.19 vs 1.67 ± 0.33 ng/ml, P < 0.03), whereas the spontaneous secretion of IL-1β was reduced by 43% (13.7 ± 2.3 vs 7.3 ± 1.7 ng/ml, P < 0.02). In the control group the secretion of these cytokines was similar on the two consecutive days and did not differ
significantly from secretion in the other group before phototherapy. On the other hand, lipopolysaccharide induced TNFα production
was higher on the second day in the two groups of newborns irrespective of phototherapy (388 ± 58 vs 683 ± 88 pg/ml, P < 0.001, in the control group and 384 ± 75 vs 588 ± 91, P < 0.05, before and after phototherapy). The synthesis of IL-3 and IL-6 did not change significantly between the two days
of the study. The results demonstrate that in addition to the well-known positive effect of phototherapy on the neonate serum
bilirubin level, this treatment affects the function of the immune system in newborns via alterations in cytokine production.
Received: 4 September 1997 / Accepted: 14 February 1998 相似文献
12.
Soluble Intercellular adhesion molecule-1 in newborn infants 总被引:7,自引:0,他引:7
I. Phocas A. Sarandakou G. Giannaki A. Malamitsi-Puchner D. Rizos P. A. Zourlas 《European journal of pediatrics》1998,157(2):153-156
The aim of this study was to evaluate the effect of increasing postnatal age on soluble intercellular adhesion molecule-1
(sICAM-1), a very early and sensitive marker of immune activation and response in the serum of newborn infants. Serum sICAM-1
was measured by EIA (T Cell Diagnostics) in 20 healthy adults (controls) and in 43 (24 females/19 males) healthy neonates,
of whom 28 were full term, and 15 were born at a gestational age between 35 and 38 weeks of pregnancy, on the 1st, 5th and
30th day of life. Neonatal serum sICAM-1 values showed a very significant increase (P<0.01) from the 1st day (137.3 ± 62.0 ng/ml) to the 5th day (259.3 ± 124.0 ng/ml) and then to the 30th day of life (415.0 ± 114.0 ng/ml),
being significantly lower on the 1st day (P<0.01), whereas significantly higher on the 30th day of life (P<0.05), than those in healthy adults (305 ± 195 ng/ml). Serum sICAM-1 values on the 1st day of life depended on both the mode
of delivery (significantly higher in neonates born vaginally) and the gestational age at birth (significantly lower in those
born at a gestational age over 38 weeks). A significant strong correlation was found in sICAM-1 values between the 1st and
the 5th day following delivery (r
P
=0.77, P<0.009).
Conclusion The results of this study demonstrate a significant rise of serum sICAM-1 during the 1st month of life in healthy neonates
suggesting a progressively increased activation of the neonatal immune system.
Received: 20 June 1996 and in revised form: 24 March 1997 / Accepted: 24 April 1997 相似文献
13.
A comparison of intratracheal and intravenous administration of gentamicin during liquid ventilation
M. A. Zelinka M. R. Wolfson I. Calligaro S. D. Rubenstein J. S. Greenspan T. H. Shaffer 《European journal of pediatrics》1997,156(5):401-404
Pulmonary absorption of aminoglycosides is poor with intravenous administration, but may be enhanced by direct intratracheal
administration of these drugs using perfluorochemical liquid ventilation (LV). To test this hypothesis, gentamicin sulfate
was administered to two groups of newborn lambs during LV. Serum and lung tissue levels of gentamicin were compared after
either pulmonary intratracheal (IT) or intravenous (IV) routes of administration. Serial serum levels of gentamicin were obtained
every 15 min for the 1st h, every 30 min for the 2nd h, and then hourly until sacrifice (maximum 6 h). At sacrifice, representative
samples of each lung lobe were homogenized and analyzed for tissue gentamicin content. At 1 h, serum gentamicin levels were
similar in both groups: IT administration levels were 3.7 ± 0.55 SE μg/ml and IV levels were 3.5 ± 0.85 SE μg/ml. The peak
serum gentamicin level of 4.8 ± 0.8 SE μg/ml for the pulmonary administration group occurred 1.5 h after administration. Lung
tissue levels of gentamicin for IT administration (4.04 ± 0.62 SE μg/g) were significantly greater than for IV administration
(1.75 ± 0.33 SE μg/g; P < 0.05). There were no significant differences in interlobar gentamicin distribution for either mode of administration.
Conclusion Perfluorochemical can be used as a vehicle for intratracheal delivery of antimicrobials. This route provides equivalent serum
levels at 1 h, higher lung tissue levels, and uniform interlobar distribution relative to intravenous administration of gentamicin.
We speculate that pulmonary administered gentamicin during LV may provide an effective alternative treatment modality in the
management of severe neonatal pneumonia.
Received: 12 April 1996 and in revised form: 24 July 1996 / Accepted 28 July 1996 相似文献
14.
Effect of elective antibiotic therapy on resting energy expenditure and inflammation in cystic fibrosis 总被引:1,自引:0,他引:1
L. Burdet O. Hugli J. D. Aubert Y. Schutz M. Roulet J. W. Fitting 《European journal of pediatrics》1999,158(9):711-716
Cystic fibrosis (CF) patients often present with malnutrition which may partly be due to increased resting energy expenditure
(REE) secondary to inflammation. Both REE and tumour necrosis factor-alpha (TNF-α), as other markers of inflammation, are
elevated during respiratory exacerbations and decrease after antibiotic treatment. However, the effect of antibiotic therapy
on REE and inflammation in patients without respiratory exacerbation is not known. The aim of our study was to determine the
effect of such an elective antibiotic therapy on REE, TNF-α, and other serum markers of inflammation. Twelve CF patients 5F/7M,
age 15.9 ± 6.1 years, weight for height ratio 89 ± 8% without clinically obvious exacerbation and treated by intravenous antibiotics
were studied. Both before (D0) and after (D14) treatment, pulmonary function tests were performed. REE was measured by indirect
calorimetry and blood taken to measure inflammation parameters. Body weight increased by 1.1 kg from D0 to D14 (P < 0.001), composed of 0.3 kg fat mass and 0.8 kg fat-free mass (FFM). The forced expiratory volume at 1 s increased from
43 ± 15% of predicted at D0 to 51 ± 15% of predicted at D14 (P < 0.01). Mean REE was 41.1 ± 7.6 kcal/kg FFM per day at D0 and did not change significantly at D14 (40.6 ± 8.5 kcal/kg FFM
per day). Serum markers of inflammation decreased from D0 to D14: C-reactive protein 17 ± 17 mg/l to 4 ± 7 mg/l (P < 0.05), elastase 62 ± 29 μg/l to 45 ± 18 μg/l (P < 0.02), orosomucoid acid 1.25 ± 0.11 g/l to 0.80 ± 0.15 g/l (P < 0.001), and TNF-α 37 ± 14 pg/ml to 29 ± 6 pg/ml (P = 0.05). Individual values showed a correlation between changes in REE and in TNF-α (P < 0.02).
Conclusion The contribution of inflammation to energy expenditure is possible but appears to be minimal in cystic fibrosis patients
treated by antibiotics on a regular basis in the absence of clinically obvious exacerbation.
Received: 6 August 1998 and in revised form: 23 November 1998 / Accepted: 23 November 1998 相似文献
15.
The efficacy of biphasic waveform cardioversion of atrial flutter in pediatric patients has not previously been demonstrated.
Cardioversion outcomes were compared in two sequential groups of patients with atrial flutter undergoing transthoracic cardioversion
using monophasic and biphasic waveforms at a single pediatric institution. The mean energy required for procedural success
was 1.7 ± 1.2 J/kg in the monophasic group compared to 0.9 ± 0.6 J/kg in the biphasic group (p = 0.002). The mean number of attempts before achieving procedural success was 1.9 ± 1.2 for the monophasic group and 1.3 ± 1.0
for the biphasic group (p = 0.019). Procedure success rate was 89.5% (33/38) in the monophasic group compared to 100% (27/27) in the biphasic group
(p = 0.13). Success rate for biphasic waveform cardioversion was 83% (5/6) when using energy less than 0.5 J/kg. These findings
provide the impetus for lower starting energies and more widespread use of devices utilizing biphasic waveforms in pediatric
patients. 相似文献
16.
Ming-Guo Xu Li-Na Men Chun-Yu Zhao Xia Zhao Yuan-Xiang Wang Xiang-Chun Meng Ding-Rong Shen Bao-Ying Meng Qing Zhang Tao Wang 《European journal of pediatrics》2010,169(3):289-296
Kawasaki disease (KD) is associated with coronary artery injury. Studies have shown that the endothelial progenitor cell (EPC)
participates in the process of arterial repair. Data have been reported that the number of EPC increased significantly in
the subacute phase of KD. However, until now, there are no data about the functions of EPC in KD patients. The present study
was designed to further investigate the number and functions of EPC in KD. Ten KD patients in the acute phase and ten healthy
volunteers were recruited and attributed to the KD group and control group, respectively. The circulating CD34/kinase insert
domain-containing receptor double positive cells were evaluated in the two groups using flow cytometry. In vitro assays were
used to measure the functions of EPC, including proliferation, adhesion, and migration activities. The plasma levels of nitric
oxide (NO), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP) were also assessed in both groups.
The number of EPC in the KD group was significantly higher than that of the control group (0.021 ± 0.007% vs. 0.014 ± 0.003%,
P < 0.05). The migratory response of EPC was significantly decreased in the KD group, compared with that of the control group
(5.50 ± 1.78 vs. 3.40 ± 1.35 cells/high power field, P < 0.01). Similarly, the proliferative and adhesive activities of EPC in the KD group were also decreased (0.47 ± 0.08 vs.
0.66 ± 0.07, P < 0.01; 6.5 ± 2.12 vs. 11.2 ± 2.04 cells/high power field, P < 0.01). The plasma NO, TNF-α, and hs-CRP levels in the KD group were higher than those of the control group (54.10 ± 11.78
vs. 38.80 ± 11.10 μmol/l, P < 0.01; 48.20 ± 7.42 vs. 37.00 ± 11.12 pg/ml, P < 0.05; 87.10 ± 30.18 vs. 5.30 ± 3.37 mg/l, P < 0.01). The number of circulating EPC positively correlated with the level of NO (r = 0.92, P < 0.001), and the functions of EPC negatively correlated with the levels of TNF-α and hs-CRP, respectively. In Kawasaki disease,
the number of EPC was enhanced and the functions of EPC were attenuated. The two-way regulation of circulating EPC in KD patients
may be associated with the disorders of cytokines or messengers in KD patients. 相似文献
17.
Voranush Chongsrisawat Panjachat Ruttanamongkol Tawatchai Chaiwatanarat Bidhya Chandrakamol Yong Poovorawan 《Pediatric surgery international》2001,17(8):604-608
Biliary atresia (BA) represents a common cholestatic affliction of the gastrointestinal tract affecting infants and children.
The objective of the present study was to evaluate 42 patients (20 with and 22 without jaundice) diagnosed with extrahepatic
BA for bone mineral content and serum 25-hydroxyvitamin D (HVD) levels. Physical examination and anthropometric nutritional
assessment were performed. The investigation included liver function tests and serum calcium (Ca), phosphate (P), magnesium
(Mg), and 25-HVD levels. Dual-energy X-ray absorptiometry was used to measure the bone mineral density (BMD) of the lumbar
spine (L1–L4). Our results showed that 16 jaundiced␣patients (80%) and only 3 nonjaundiced patients (13.6%) showed osteoporosis (P< 0.05). All patients had normal serum Ca and P levels. Only 1 nonjaundiced patient had a low serum Mg level. Serum 25-HVD
levels (mean ± SD) were 20.71 ± 8.24, 16.12 ± 4.3, and 9.18 ± 5.84 ng/ml, respectively, in subjects with normal bone density
(n=7), osteopenia (n=3), and osteoporosis (n=11). Bone disease represents a well-known complication among long-term survivors
of BA. To date, the pathogenesis has remained unexplained. Since, as demonstrated in the present study, jaundiced patients
develop osteoporosis more frequently than nonjaundiced patients, hyperbilirubinemia may have an influence. Bone-mineral deficiency
can be detected earlier by means of BMD measurement (non-invasive method) than by measuring serum Ca, P, and Mg levels in
these patients.
Accepted: 27 November 2000 相似文献
18.
Engin Günel Fatma Çağlayan Osman Çağlayan Aydan Canbilen Murat Tosun 《Pediatric surgery international》2002,18(1):24-27
To investigate the efficacy of antioxidant therapy on collagen synthesis in corrosive esophageal burns, 110 Sprague-Dawley
rats were divided into five groups of 22 animals each. A standard esophageal caustic burn was produced by 1 ml of 10% sodium
hydroxide solution for the rats in groups B to E; group A was instilled only with 0.9% saline after preparation of the distal
esophageal segment. Group A animals (controls) were uninjured and untreated. Group B had untreated esophageal burns. Esophageal
burns were treated in group C with vitamin E (10 mg/kg IM), in group D with vitamin C (10 mg/kg IP), and in group E with methylprednisolone
(30 mg/kg IM) on each of 5 days. Eight rats from each group were killed 4 days after initiation of the study and the abdominal
esophagus was studied for tissue malondialdehyde (MDA; μmol/g protein) levels. The other rats were killed 28 days after initiation
of the study and determination of hydroxyproline (HP) (μg/g tissue) levels in esophageal tissue was performed for 8 rats in
each group. Histopathologic evaluation was also performed in the other 6 rats from each group. MDA levels in esophageal tissue
were significantly lower in groups C (9.24 ± 2.62, P < 0.01) and group E (6.26 ± 2.22, P < 0.001) than in group B (12.35 ± 1.80). HP levels were significantly lower in groups A (0.75 ± 0.21, P < 0.001), C (1.11 ± 0.15, P < 0.01), and E (0.96 ± 0.15, P < 0.001) than in group B (1.40 ± 0.20). Histopathologically, collagen deposition in the submucosa and tunica muscularis was
lower in groups C and E than in group B (P < 0.05, and 0.01, respectively). Our results demonstrate that treatment with antioxidant drugs such as vitamin E and methylprednisolone
decreased tissue HP levels, and thus inhibited new collagen synthesis and stricture formation in rats with alkali-induced
caustic esophageal burns.
Accepted: 16 February 2001 相似文献
19.
Contribution of the blood glucose level in perinatal asphyxia 总被引:3,自引:0,他引:3
This is a comparative study between 60 asphyxiated newborns (cases) and 60 normal neonates (controls) in respect of their
plasma glucose and uric acid levels and also their clinical and neurological status. The mean plasma glucose level was significantly
lower (35.1 ± 11.4 mg/dl vs. 56.9 ± 5.5 mg/dl; P < 0.001) and the mean serum uric acid level was higher (8.0 ± 1.2 mg/dl vs. 4.5 ± 0.83 mg/dl; P < 0.001) in the asphyxiated group when compared to the controls. Within the perinatal asphyxia group, the plasma glucose
level and Apgar scores showed a significant positive linear correlation (r = 0.740, P < 0.001), whereas a significant negative linear correlation was observed between the glucose level and different stages of
hypoxic ischemic encephalopathy (HIE) (r = −0.875, P < 0.001). Although a strong positive linear correlation was found between uric acid and HIE stages (r = 0.734, P ≤ 0.001), the linear correlation between uric acid and Apgar scores (r = −0.885, P < 0.001) and uric acid and the plasma glucose level (r = −0.725, P < 0.001) were found to be significantly negative among the cases. Conclusion: The severity of encephalopathy and cellular
damage varies with the severity of hypoglycemia. 相似文献
20.
The aim of this study was to assess the effects of parenteral alanyl-glutamine dipeptide (Ala-Gln) on TPN-associated liver
injury. Forty-three New Zealand rabbits (6–8 days old) were divided into three groups: 12 in the control group (maternal fed);
18 in the TPN group (TPN for 10 days); 13 in the Gln-PN group (TPN+Ala-Gln 400 mg kg−1 day−1 for 10 days). At the end of the experiment, liver function and histology were evaluated; MDA content of liver tissues and
hepatocyte apoptosis by TUNEL assay were also determined. The serum concentration of direct bilirubin and bile acid in the
Gln-PN group was significantly lower than TPN group (P < 0.05), but showed no difference compared with the control group. AST level of the Gln-PN group was lower than the other
two groups. The light microscopy (LM) features in the TPN group included cholestasis or diffuse steatosis, while in the Gln-PN
group, inflammatory infiltration and mild hydropic degenerative changes were mainly found without obvious cholestasis or proliferation
of bile ducts. The electron microscopy appearances corresponded with LM findings. The liver MDA content in the Gln-PN group
was clearly lower than the TPN group (P < 0.05), and was lower without statistical significance compared with control group. TUNEL assays showed the ratio of apoptotic
hepatocytes in the TPN group was the highest among all the groups (44.59 ± 6.68 vs. 0.92 ± 0.85 in the control group, P < 0.01; 44.59 ± 6.68 vs. 4.14 ± 2.76 in the Gln-PN group, P < 0.01). There were significantly fewer apoptotic hepatocytes in the Gln-PN group. From this study, we found that glutamine
dipeptide supplementation could attenuate TPN-associated liver injury in infant rabbits, and could also decrease liver MDA
production and hepatocyte apoptosis during total parenteral nutrition.
This study was supported in part by the National Key Program Grant (No.2004BA709B09). 相似文献