哮喘患儿诱导痰液中NO3^—／No2^—含量的变化及其意义

探讨儿童哮喘诱导痰液中一氧化氮(NO)代谢终产物硝酸盐/亚硝酸盐(NO-3/NO-2)含量的变化及临床意义,采用3%高渗盐水雾化吸入诱导患儿咳痰,0.1%DTT和PBS缓冲液裂解痰液,应用硝酸酶还原法和荧光酶标法分别测定诱导痰液中NO-3/NO-2和嗜酸性粒细胞阳离子蛋白(ECP)含量,便携式肺功能仪测定肺通气功能.结果表明,稳定期、轻度和中、重度发作期患儿诱导痰液中NO-3/NO-2浓度较对照组显著增高,P<0.05;ECP含量较对照组显著增高,P<0.05;不同时期哮喘患儿各组间诱导痰液中NO-3/NO-2含量和ECP均有显著性差异,P<0.05.哮喘患儿诱导痰液中NO-3/NO-2和ECP含量与1秒钟用力呼气容积占预计值百分比(FEV1.0%)呈显著负相关,r=-0.512,P<0.01;而NO-3/NO-2含量与痰液中ECP浓度呈显著正相关r=0.607,P<0.01.提示NO参与了儿童哮喘的发生和发展,诱导痰液中NO-3/NO-2水平可反映气道炎症的变化,可用于儿童哮喘病情监测及指导药物治疗.     

儿童1型糖尿病TH1/TH2免疫应答状况研究

目的研究儿童1型糖尿病T     

Concentrations of LTB4, LTC4, LTD4 and LTE4 in bronchiolitis due to respiratory syncytial virus

Fifty-five infants with bronchiolitis due to respiratory syncytial virus were evaluated for the presence of leukotriene B₄, C₄, D₄ and E₄ in nasopharyngeal secretions. An attempt was made to correlate concentrations of leukotrienes to arterial oxygen tension. Forty participants received conventional therapy consisting primarily of aerosolized albuterol and occasional aminophylline therapy. The other 15 individuals received ribavirin therapy in addition to conventional therapy, and leukotriene concentrations were compared among individuals in these groups. RSV infection was documented by standard methods, and leukotrienes were measured by reverse-phase high pressure liquid chromatography. The leukotriene detected most commonly was LTC₄ (up to 83% of subjects); LTD₄ and LTB₄ were present in approximately 30% of individuals. The mean partial pressure of oxygen was found to be lower in those individuals with detectable LTB₄ than in those without detectable LTB₄ (p < 0.025), and an overall inverse correlation of LTB₄ concentrations with initial pO₂ values was observed (r = 0.318, p < 0.05). The presence and quantity of other leukotrienes did not correlate with the severity of illness. During the first week of illness, the concentration of leukotrienes declined sharply in ribavirin recipients. Individuals receiving conventional therapy during the same time interval exhibited stable or increasing leukotriene concentrations. These observations suggest that LTB₄ may be important in the pathogenesis of bronchiolitis, and that ribavirin therapy may inhibit leukotriene release in the respiratory tract.     

Altered Na+-K+ ATPase activity in uraemic adolescents

The Na⁺-K⁺ ATPase enzyme plays an essential role in the regulation of cell composition and volume. Enzyme activity itself is regulated by substrate availability and several hormones. In adult uraemic patients red blood cell Na⁺-K⁺ ATPase activity is decreased. However, it is unknown if children with uraemia exhibit the same phenomenon. Therefore, in the present study we examined whether endogenous digoxin-like factors (EDLF) and physicochemical membrane properties play a role in the regulation of erythrocyte Na⁺-K⁺ ATPase activity in uraemic children and adolescents. Healthy age-matched children were used as controls. Enzyme activity was measured in detergent-pretreated red blood cells and erythrocyte ghosts. Na⁺-K⁺ ATPase activity (2204 ± 538nmol Pi ml erythrocyte^?1 h^?1 in detergent pretreated erythrocytes; 204 ± 56 nmol Pi mg protein^?1 h^?1 in ghosts) in adolescents with uraemia was lower compared to controls (3245 ± 362 nmol Pi ml erythrocyte ¹ h^?1; 266 ± 37 nmol Pi mg protein^?1 h^?1, p < 0.001, p < 0.05, respectively). Plasma levels of EDLF were elevated in uraemic patients (0.30 ± 0.05 versus 0.21 ±0.04 ng ml^?1, p < 0.01). Furthermore, the membrane lipid component was decreased in patients with uraemia, while the cholesterol/phospholipid ratio and membrane fluidity were similar in both groups. No correlation was found between the decrease in Na⁺-K⁺ ATPase and the increase in EDLF concentration and altered membrane lipid components. Our results demonstrate, that similar to the findings of adults, the activity of Na⁺-K⁺ ATPase is diminished in uraemic adolescent patients, and that uraemia-associated elevation in EDLF and altered membrane components do not play a role in the down-regulation of Na⁺-K⁺ ATPase. Therefore other factors (presence of other inhibitors and/or reduced number of enzyme molecules) should contribute to the lower activity of the Na⁺-K⁺ pump.     

Cytochrome B558 Component of O-2M Generating Oxidase in the Neutrophils From Patients With Chronic Granulomatous Disease

Cytochrome b₅₅₈ is probably a component of an electron transport chain which is called NADPH oxidase. Cytochrome b₅₅₈ from the neutrophils of two male patients with chronic granulomatous disease (CGD) and their parents was studied. One of the CGD patients had decreased amounts of cytochrome b₅₅₈, The α-band of light absorption of cytochrome b₅₅₈ at 558 nm was found as a trace, and the peak of the γ-band was shifted to 420 nm, whereas the normal γ-band is at 426 nm. Intermediate amounts of cytochrome b₅₅₈ were present in his mother, whereas his father had a normal amount. Another patient had normal peaks of α- and γ-bands of cytochrome b₅₅₈. Thus, abnormalities in NADPH oxidase of the two patients were different.     

A1c hemoglobin values in children with overt diabetes maintained in high degree of control

Studies of nine children 4 7/12 to 13 years of age who had rickets are presented. No evidence of renal abnormalities, vitamin D deficiency, or of the inherited varieties of rickets was found. The salient features were their rural origins, mild hypocalcemia with evidence of secondary hyperparathyroidism, and improvement with a normal diet that contained an average of 944 mg calcium/24 hours. It is proposed that the etiology of the rickets is related to low calcium intake with or without a high oxalate concentration in the diet.     

Comparison of glucose/electrolyte and glucose/glycine/electrolyte oral rehydration solutions in hospitalized children with diarrhea in Costa Rica

The experience of Nalin et al. and Patra et al. with a "super oral rehydration solution (ORS)" containing glucose plus glycine to enhance the intestinal absorption of sodium and water prompted us to investigate a similar ORS containing the standard World Health Organization (WHO/ORS) plus either 55 or 110 mmol/L glycine in infants and small children with noncholera diarrhea. We did not find a statistically significant difference between the glycine-fortified ORS and the standard WHO/ORS with respect to the clinical outcome and composition of serum electrolytes.     

Diagnostic accuracy of neuroimaging in pediatric optic chiasm/sellar/suprasellar tumors

Preoperative diagnosis for tumors arising in the optic chiasm/sellar/suprasellar region in children is helpful to determine surgical necessity and approach, given the high operative risk in this area. We evaluated the ability to differentiate tumor type by preoperative neuroimaging. Thirty‐eight of 53 tumors were correctly diagnosed by neuroimaging based on final pathologic diagnosis (prediction accuracy 72%). Prediction accuracies were 87% (20/23) for craniopharyngioma, 79% (11/14) for optic pathway glioma, 64% (7/11) for germ cell tumor, and 0% (0/5) for Langerhans cell histiocytosis. Diagnosis of optic chiasm/sellar/suprasellar tumors in children by imaging alone should be considered when biopsy is considered high risk.     

Effect of PaCO2 and Haemoglobin Concentration on Day to Day Variation of CBF in Preterm Neonates

Pryds, O. and Greisen, G. (Department of Neonatology, Rigshospitalet, Copenhagen, Denmark). Effect of P_aCO₂ and haemoglobin concentration on day to day variation of CBF in preterm neonates. Acta Paediatr Scand, Suppl 360: 33, 1989.
The CBF was measured on the first three days of life in 22 mechanically ventilated, preterm neonates (mean gestational age 29.5 weeks) with simultaneous recordings of arterial carbon dioxide tension (P_aCO₂), arterial oxygen tension (P_aO₂), haemoglobin concentration (Hgb), haemoglobin oxygen saturation and mean arterial blood pressure (MABP). CBF ± tended to increase slightly with age. The intra-individual variation of CBF ± was positively related to changes in P_aCO₂ (p=0.0004) and inversely related to changes in Hgb (p=0.029). Neither P_aO₂ nor MABP achieved a significant relation to changes in CBF ± Thus, the mean CBF ±-CO₂ reactivity was calculated to 22.1 % per kPa whereas CBF increased by a mean of 11.9% per mM decrease of Hgb thereby providing a constant oxygen delivery to the brain. It is concluded that P_aCO₂ and Hgb have the expected effect on CBF ± in preterm neonates even during respiratory distress shortly after birth.     

Comparison of ADVIA Centaur® and Pharmacia UniCAP® tests in the diagnosis of food allergy in children with atopic dermatitis

In a study comprising 63 children diagnosed with atopic dermatitis, the results of the ADVIA Centaur system was compared with the results obtained with the Pharmacia UniCAP100 system, which has been widely considered as a reference method for seric specific IgE (sIgE) measurements. The individual immunization against the most common food allergens [egg (f1), cow milk (f2), cod (f3), wheat (f4), peanut (f13) and soy bean (f14)] was determined by in vitro serum IgE testing and skin prick test (SPT). The comparison of the sIgE titers revealed a good concordance between the Centaur and the UniCAP tests for f1, f3, and f13 (94 %, 91 %, and 96 % respectively). However, the concordance was lower for f2, f4, and f14 (76 %, 77 %, and 77 % respectively) because of discrepancies between the two techniques. When compared with SPT and clinical diagnosis, on the 40 discordant cases found between the Centaur and the UniCAP, the Centaur showed concordance with the patients food reaction and SPT in 34/40 cases, and UniCAP in only 6/40 cases. Accordingly, the Centaur test displayed a statistically significantly better performance on specificity and concordance with SPT for f2, f4, and f14 (concordance/specificity = 70%/71%, 76%/75% and 90%/88% respectively), than the CAP test (49%/54%, 51%/52% and 67%/65% respectively).     

Prospective and parallel assessments of cystic fibrosis newborn screening protocols in the Czech Republic: IRT/DNA/IRT versus IRT/PAP and IRT/PAP/DNA

Cystic fibrosis (CF) is a life-threatening disease for which early diagnosis following newborn screening (NBS) improves the prognosis. We performed a prospective assessment of the immunoreactive trypsinogen (IRT)/DNA/IRT protocol currently in use nationwide, versus the IRT/pancreatitis-associated protein (PAP) and IRT/PAP/DNA CF NBS protocols. Dried blood spots (DBS) from 106,522 Czech newborns were examined for IRT concentrations. In the IRT/DNA/IRT protocol, DNA-testing was performed for IRT?≥?65 ng/mL. Newborns with IRT?≥?200 ng/mL and no detected cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations were recalled for a repeat IRT. In the same group of newborns, for both parallel protocols, PAP was measured in DBS with IRT?≥?50 ng/mL. In PAP-positive newborns (i.e., ≥1.8 if IRT 50-99.9 or ≥1.0 if IRT?≥?100, all in ng/mL), DNA-testing followed as part of the IRT/PAP/DNA protocol. Newborns with at least one CFTR mutation in the IRT/DNA/IRT and IRT/PAP/DNA protocols; a positive PAP in IRT/PAP; or a high repeat IRT in IRT/DNA/IRT were referred for sweat testing. CONCLUSION: the combined results of the utilized protocols led to the detection of 21 CF patients, 19 of which were identified using the IRT/DNA/IRT protocol, 16 using IRT/PAP, and 15 using IRT/PAP/DNA. Decreased cut-offs for PAP within the IRT/PAP protocol would lead to higher sensitivity but would increase false positives. Within the IRT/PAP/DNA protocol, decreased PAP cut-offs would result in high sensitivity, an acceptable number of false positives, and would reduce the number of DNA analyses. Thus, we concluded that the IRT/PAP/DNA protocol would represent the most suitable protocol in our conditions.