兰州地区婴幼儿轮状病毒和杯状病毒腹泻的研究

目的 研究兰州地区婴幼儿轮状病毒和杯状病毒腹泻的分子流行病学特点。方法 2001年12月～2002年11月在兰州医学院第一附属医院儿科收集婴幼儿病毒性腹泻粪便标本244份,用酶联免疫吸附试验(ELISA)检测轮状病毒抗原,阳性标本用逆转录聚合酶链反应(RT-PCR)、巢式PCR及琼脂糖凝胶电泳方法进行基因分型;阴性标本用ELISA和RT-PCR进行杯状病毒病原检测。结果 224份标本轮状病毒检出率为45．5％(111／244份),G分型中G3为58．6％,G1为18．0％,G2为4．5％,G9为2．7％,混合型为6、3％,11例未能分型。P分型中P[8]为61．0％,P[4]为7．3％,混合型为2．4％,14例未能分型。133份轮状病毒阴性标本杯状病毒检出率为15．8％,其中ELISA检测阳性率为11．3％,RT-PCR检测阳性率为9．0％。结论 轮状病毒是兰州地区婴幼儿病毒性腹泻的主要病原,2002年流行株为G3型,发现了G9型轮状病毒感染;杯状病毒也是引起兰州地区婴幼儿病毒性腹泻的病原之一,应引起重视。     

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目的通过分子流行病学调查研究兰州地区婴幼儿病毒性腹泻的病原学特点。方法采用酶联免疫吸附试验(ELISA)及逆转录聚合酶链反应(RTPCR),对2003年7月至2004年6月兰州地区收集的624例婴幼儿腹泻粪便标本随机抽取271例进行轮状病毒(RV)、杯状病毒(HuCV)及星状病毒(AstV)检测。结果在271例标本中共检出RV感染153例(56.46%),其中G394例(61.44%),G24例(2.61%),G93例(1.96%),未发现G1、G4型和混合感染;在随机抽取的69例G分型阳性标本中,检出P[8]型28例(40.58%);RV的感染对象主要为6～23月龄的婴幼儿,发病高峰在10、11月份(86.27%、73.81%)。在118例RVELISA阴性标本中检出HuCV感染13例(11.02%),其中诺如病毒(NLV)GⅡ型11例,札如病毒(SLV)2例,未检出NLVGⅡ型,发病年龄1～18个月(11.31±4.53个月);同时检出AstV感染7例(5.93%),发病年龄4～12个月(8.27±2.69)个月,其中有1例合并有SLV感染,另有1例为迁延性腹泻。HuCV和AstV感染均未表现出明显的季节性。结论RV是兰州婴幼儿病毒性腹泻的主要病原,其流行的主要血清型为G3型,HuCV和AstV亦是重要病原之一。     

2001-2004年兰州地区婴幼儿杯状病毒腹泻的流行病学调查

目的通过分子流行病学调查研究兰州地区婴幼儿杯状病毒（HuCV）腹泻的特点。方法采用逆转录．聚合酶链反应（RT-PCR）对2001年12月—2004年6月兰州地区婴幼儿腹泻轮状病毒ELISA阴性粪便标本进行HuCV检测。结果251份轮状病毒阴性标本中共检出HuCV感染25例,总阳性率9,96％,其中133份2001—2002年的标本中检出HuCV感染12份,阳性率为9,02％,未进行分型;118份2003-2004年的标本中检出HuCV感染13份,阳性率为11、02％,其中诺瓦克样病毒GⅡ型11例,未检出诺瓦克样病毒GⅠ型,札棍样病毒2例,其中有1例合并星状病毒感染。发病年龄以2岁以下患儿为主,呈散发流行,未表现出明显的季节性。结论HuCV是引起兰州地区婴幼儿病毒件腹泻的丰萼病原之一．其丰要流行型可能为诺瓦青样病毒GⅡ型。     

兰州地区婴幼儿腹泻轮状病毒的分型特点

目的 调查研究兰州地区婴幼儿腹泻轮状病毒的分子流行病学特点。方法 分别用酶联免疫吸附试验（ELISA）、聚丙烯酰胺凝胶电泳（PAGE）、逆转录－聚合酶链反应（RT－PCR）三种方法对2000年1－2月、10－12月，2001年1－3月在兰州医学院第一附属医院儿科门诊及住院部收集的11 婴幼儿腹泻粪便标本进行轮状病毒病原检测，并用核酸杂交方法对轮状病毒阳性标本进行分型。结果 三种方法检测轮状病毒感染的阳性率分别为61％（ELISA）、58％（PAGE）、58.8%（RT－PCR），轮状病毒核酸的电泳型有长、短两种类别，以长型为主（81.8%），偶有长、短型混合感染。流行的G型主要为G3（61％）、其次为G2（25.4%）、G1（13.6%），未见G4型，8例未能分型。P型主要为P1A（77.4%），其次为P1B（22.6%），无P2型。结论 婴幼儿轮状病毒腹泻在兰州地区的流行病学特点与世界各国报道的情况相仿，但2000年1－2月、10－12月，2001年3月期间，其流行的主要基因型为G3型。本次研究结果从分子水平初步揭示了兰州地区轮状病毒的流行情况，为轮状病毒疫苗在该地区的应用提供了流行病学资料。     

2010年郑州地区婴幼儿腹泻A组轮状病毒VP7基因型分型

目的 研究2010年郑州地区秋冬季婴幼儿腹泻A组轮状病毒(RV)VP7基因型分型.方法 收集郑州市第一人民医院儿科2010年9-12月腹泻住院患儿的粪便标本80份.采用TRIzol法抽提粪便中RV RNA,采用聚丙烯凝胶电泳法检测其RV基因组,反转录(RT)-PCR法以及巢式(net)-PCR法进行A组RV的VP7基因型分型.结果 80份粪便标本中,40份检测到A组RV RNA基因,阳性率为50%.男24例,女16例;年龄6～36个月,平均11.7个月.对40份A组RV RNA阳性标本进行VP7基因型分型,其中G3型30例(75.0%),G1型6例(15.0%),G1和G3混合感染型3例(7.5%),G1与G9混合感染型1例(2.5%).40例A组RV RNA阳性患儿中并呼吸道感染7例,其中G3型6例,G1和G3混合型1例.结论 郑州地区秋冬季婴幼儿腹泻A组RV以G3型为主要流行基因型,并发现混合型感染病例及不常见的G9型感染病例.     

马鞍山、苏州地区婴幼儿轮状病毒腹泻临床特征和G血清型研究

目的　研究马鞍山和苏州地区婴幼儿轮状病毒 (RV)腹泻的临床特征和G血清型。方法　收集马鞍山和苏州地区5岁以下儿童急性腹泻粪便标本 1 2 67份 ,采用酶联免疫吸附试验和巢式 聚合酶链反应检测RV感染和血清型。结果　 1 2 67份标本中RV阳性 378份 ,血清型G型是优势株共 2 50株 ,其中G1 1 0 0株 ,G3 1 1 1株 ,G2 8株 ,G4、G9各 3株 ,混合感染 4株 ,未能分型2 1株 (8.40 % )。马鞍山地区以G1型为主 (58.54 % ) ,苏州地区以G3型为优势株 (47.85 % )。结论　RV是导致马鞍山和苏州地区婴幼儿腹泻的主要病原 ,流行的血清型分别为G1和G3型。     

南京儿童医院腹泻患儿轮状病毒感染情况

目的分析南京儿童医院腹泻患儿中轮状病毒(RV)的感染情况。方法收集南京儿童医院2004年1月-2006年12月门诊及住院非细菌性感染性腹泻患儿粪便标本,经聚丙烯酰胺凝胶电泳(PAGE)或酶联免疫吸附试验(ELISA)检测RV。结果3 324例标本中共检出RV阳性1 406例,检出率为42.30%。其中6~11个月、1~2岁和2~3岁3个年龄段RV检出率分别为43.4%、47.1%和51.2%;RV腹泻年龄最高为6~11个月年龄段,达41.2%;全年检出RV比较,秋冬季(9~12月份)为检出高峰,占56.2%;1 035例RNA阳性标本中,RNA长型占819例(79.13%)。结论南京儿童医院RV腹泻中6个月~2岁婴幼儿是RV的易感人群。以秋冬季(9~12月份)为流行高峰,基因组以长型为主。     

5岁以下婴幼儿病毒性腹泻病原学分析和研究

目的 探讨甘肃白银市5岁以下婴幼儿病毒性腹泻感染状况、流行特点及轮状病毒(rotavirus,RV)血清型分型.方法 收集白银市第二人民医院2008年10月至2009年9月腹泻患儿粪便标本519份,其中住院181例,门诊338例,由中国疾病预防控制中心采用酶联免疫法进行RV、杯状病毒(human calicivirus,HuCV)、肠道腺病毒(enteric adenovirus,EADv)、人类星状病毒(human astrovirUS,HAstV)的检测,以及逆转录-聚合酶链反应法对RV检测阳性标本进行血清型分型.结果 检测的519份标本,4种病毒总阳性率为45.09％,其中RV 34.68％、HuCV 7.32％、EADv 2.12％、HAstV0.96％.RV是导致该地区婴幼儿病毒性腹泻的主要病原.180份RV阳性标本,G血清型流行优势菌株为G3型(35％),其次是G1型(20.6％),比例最低是G4型(2.2％).P基因型最常见的毒株类型是P8型(63.3％),其次是P4型(10％),最少的是P10型(0.6％).其发病高峰在每年10月、11月和12月为主,患病年龄以6～23月龄婴幼儿为主.结论 RV是导致白银地区儿童病毒性腹泻的主要病原,其次为HuCV、EADv及HAstV.RV亚型以[P8]G3为主,存在混合感染情况.     

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目的了解婴幼儿急性腹泻的病原构成,为本地区临床合理有效地控制小儿急性腹泻提供病原依据。方法对2009年1-12月福州儿童医院消化专科收治的459例急性腹泻患儿的粪便标本进行细菌培养,采用免疫胶体金法检测轮状病毒(RV)抗原;抽取其中218例,再应用ELISA法检测RV抗原,逆转录聚合酶链式反应(RT-PCR)法检测诺如病毒(NV)核酸。结果 459例患儿细菌感染35例(7.6%),真菌感染5例(1.1%),检出RV阳性117例(25.5%)。218例中RV阳性69例(31.7%),NV阳性61例(28.0%),上述二种病毒混合感染14例(6.4%)。两种病毒感染阳性率男女性别差异无统计学意义(P>0.05),不同年龄组间RV及NV阳性率差异有统计学意义(P<0.05),均以2岁以下患儿为主。RV、NV均有明显的季节特征,RV以10-12月份为发病高峰,NV以7~9月份为发病高峰分布,差异均有统计学意义(P<0.05)。结论小儿感染性腹泻病原类型复杂多样,在临床诊治中应重视病原学检测。     

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目的研究昆明地区2002~2004年轮状病毒肠炎患儿的病毒分子流行特征。方法收集昆明医学院第一附属医院2002、2003、2004年9~12月儿科住院和门诊轮状病毒肠炎患儿的粪便标本计210份。采用聚丙烯酰胺凝胶电泳法检测轮状病毒基因组,用逆转录-聚合酶链反应(RT-PCR)以及巢式-PCR(net-PCR)对5种主要的VP7的血清型(G1、G2、G3、G4和G9)进行分型,并采用RT-PCR对VP7阳性标本进行NSP4(非结构蛋白4)的基因扩增,选取30份标本用net-PCR法扩增出NSP4CDNA500bp送去测序。结果210份标本中轮状病毒基因阳性143份(68·1%),其中长型143份,未发现短型和混合型。143份阳性标本行RT-PCR扩增VP7全基因,134份获得阳性产物,进一步用net-PCR分型显示G3型73例(73/134,54·5%),G1型38例(28·4%),未分型11例(8·2%),混合型8例(6%),G4型4例(3%),未发现G2和G9型。所有VP7阳性标本均可以扩增出NSP4的全长,其中30份标本送去测序显示有变异。结论A组轮状病毒是目前昆明地区婴幼儿腹泻的主要致病原,在不同的3年中,轮状病毒电泳型以长型为主,血清型以G3、G1型为主,G4型少见,未见G2、G9型。3年监测结果显示NSP4存在变异,但未发现轮状病毒肠炎临床症状与NSP4的变异有关。     

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.