不同反应类型血管迷走性晕厥儿童的心率变异性

目的研究血管迷走性晕厥(VVS)儿童的心率变异性(HRV),探讨不同反应类型对VVS儿童HRV的影响。方法2003-01—2007-05在中南大学湘雅二医院晕厥专科诊治的不明原因晕厥(UPS)或接近晕厥儿童87例(晕厥组),其中男34例,女53例;年龄4～17(10.92±2.62)岁。匹配73例健康儿童为对照(对照组)。晕厥组与对照组儿童均行24h动态心电图(Holter)检查,将所记录数据输入TLC 3000A12通道动态心电图分析系统,程序自动分析结合人工干预生成HRV时域指标和频域指标。晕厥组儿童在Holter检查前后1d内行直立倾斜试验(HUTT)检查。用SPSS11.0软件进行数据统计分析。结果(1)晕厥组儿童HUTT阳性率62.1%(54/87);HUTT阳性儿童中男31.5%(17/54),女68.5%(37/54);血管抑制型38例(70.4%),混合型14例(25.9%),心脏抑制型2例(3.7%)。(2)与对照组比较,晕厥组儿童时域指标和频域指标均降低,其中SDNN、VLF(P<0.05)和TP、LF、HF(P<0.01)降低显著。(3)与对照组比较,HUTT阳性组儿童时域指标SDANN降低明显(P<0.05),其余时域指标和频域指标稍降低(P>0.05)。(4)血管抑制型与混合型儿童相比,各项时域指标均降低,以SDNN降低明显(P<0.05);频域指标TP、VLF、LF、HF稍降低(P>0.05)。结论VVS儿童基础自主神经功能异常,血管抑制型是最常见的反应类型,VVS儿童的HRV与反应类型有关。     

小儿扩张型心肌病心率变异性分析

目的分析扩张型心肌病(DCM)儿童的心率变异性(HRV)。方法DCM儿童23例(研究组),匹配健康儿童23例为对照(对照组)。采用康泰TLC3000A12通道动态心电图(EKG)分析系统描记24hEKG,分析心率、HRV的时域指标和频域指标。应用SPSS11.0软件进行统计学处理。结果与对照组比较,研究组最低心率明显增高(P<0.05),最高心率稍增高(P>0.05);HRV时域指标SDNN、SDANN、pNN50明显降低(P<0.05),rMSSD稍降低(P>0.05);HRV频域指标TP、ULF明显降低(P<0.05),VLF、LF、HF、LF/HF稍增高(P>0.05)。结论DCM儿童自主神经功能明显受损。     

儿童血管迷走性晕厥与焦虑的关系研究

目的 探讨儿童血管迷走性晕厥(VVS)与焦虑的关系.方法 2007年6月至2007年11月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的VVS患儿84例,其中男47例,女37例;年龄7～16岁,平均(11.01±2.00)岁.将VVS患儿分为直立倾斜试验(HUTT)阴性组(41例)和HUTT阳性组(43例),再将HUTT阳性组依临床症状分为头晕组与晕厥组.所有受试儿童完成儿童焦虑性情绪障碍筛查表(SCARED),用统计软件SPSS11.0进行数据分析.结果 (1)HUTT阴性组与HUTT阳性组SCARED得分比较:躯体化或惊恐、广泛性焦虑与焦虑量表总分HUTT阴性组高于HUTT阳性组,分离性焦虑、社交恐怖与学校恐怖得分HUTT阴性组低于HUTT阳性组,但差异均无统计学意义(P>0.05).(2)HUTT阳性组、阴性组与全国城市常模组(常模组)SCARED得分比较:躯体化或惊恐、广泛性焦虑、分离性焦虑、社交恐怖、学校恐怖与焦虑量表总分均明显高于常模组(P<0.05).(3)HUTT阳性头晕组与晕厥组SCARED得分比较:躯体化或惊恐、广泛性焦虑、分离性焦虑、社交恐怖及焦虑量表总分头晕组高于晕厥组,但差异无统计学意义(P>0.05);学校恐怖得分头晕组明显高于晕厥组(P<0.05).结论 儿童VVS中焦虑发生率高.儿童VVS躯体化或惊恐、广泛性焦虑、分离性焦虑、社交恐怖与学校恐怖普遍存在,但这些焦虑症状与HUTT结果关联不明显.HUTT阳性患儿中,没有晕厥病史的VVS患儿焦虑评分更高.提示心理因素如焦虑在儿童VVS发生、发展、治疗及预后中可能起重要作用.     

血管迷走性晕厥患儿无症状期间心率变异性分析

目的分析血管迷走性晕厥(VVS)患儿无症状期间的心率变异。方法选择本院45例临床诊断VVS的患儿为研究组,其中直立倾斜试验(HUTT)阳性者38例、阴性7例;匹配20例健康儿童为健康对照组。分析2组24 h心率变异时域及频域指标的变化。结果 1.研究组与健康对照组比较:时域指标SDNN(R-R间期)(121.82±33.0 vs 152.95±31.66,P<0.01)、SDANN(24 h内5 min节段平均心动周期的标准差)(114.42±33.41 vs 134.7±27.43,P<0.05)明显下降;频域指标低频功率/高频功率(LF/HF)(1.67±0.54 vs 1.25±0.20,P<0.01)明显升高。2.HUTT阳性组与阴性组时域及频域指标比较无明显差异(P>0.05)。3.血管抑制型(VD)与心脏抑制型(CI)患儿比较,SDNN(100.61±23.02 vs 150.5±29.46,P<0.01)、SDANN(96.78±28.77 vs 141.25±29.06,P<0.05)、rMSSD(相邻正常R-R间期差值的均值)(29.22±19.56 vs 53.75±23.08,P<0.05)、PNN50(全部NN间期中相邻的NN间期之差>50 ms的心搏数占所有NN间期个数的百分数)(11.29±9.31 vs 23.96±12.54,P<0.05)明显下降;LF(39.61±8.45 vs 19.68±4.17,P<0.01)、LF/HF(2.12±0.55 vs 1.09±0.11,P<0.01)明显升高。与混合型(MX)比较,VD患儿rMSSD(29.22±19.56 vs 52.57±18.54,P<0.05)、PNN50(11.29±9.31 vs 22.96±11.13,P<0.05)明显下降;LF(39.61±8.45 vs 29.72±9.87,P<0.05)、LF/HF(2.12±0.55 vs 1.38±0.30,P<0.01)则明显升高。CI型与MX型比较各指标之间无显著差异(P>0.05)。4.VD患儿与健康对照组比较:rMSSD(29.22±19.56 vs 49.55±14.10,P<0.05)、PNN50(11.29±9.31 vs 21.3±9.82,P<0.05)明显下降,LF(39.61±8.45 vs 25.49±5.03,P<0.05)显著升高。结论 VVS患儿无症状期间自主神经功能存在变化;rMSSD、PNN50及LF对预测VD型VVS可能具有参考价值。     

血管迷走性晕厥患儿无症状期自主神经功能分析

目的分析无症状期心率减速力(DC)对血管迷走性晕厥(VVS)的诊断价值。方法选取2018年1月至2019年12月确诊为VVS的45例患儿作为VVS组,同期在门诊体检的45例健康儿童作为对照组,完善24小时动态心电图检查,比较VVS患儿和健康儿童的基础DC值、连续心率减速力(DRs)及心率变异性(HRV)各指标的变化情况,并按年龄段及性别进行分组比较;同时分析DC与HRV各指标间的相关性及DC对VVS诊断的预测价值。结果 VVS组的DC值、DR8及低频功率与高频功率之比(LF/HF)均明显高于对照组,差异均有统计学意义(P0.05)。在VVS组中,学龄期患儿的DC值、DR4及低频功率(LF)均明显低于青春期患儿,差异均有统计学意义(P0.05),而男女患儿的DC值、DRs、HRV各指标差异均无统计学意义(P0.05)。对照组年龄段及性别组间DC值、DRs、HRV各指标差异均无统计学意义(P0.05)。学龄期VVS组的DC值明显高于对照组,青春期VVS组的DC值、DR4、DR8及LF均明显高于对照组,差异有统计学意义(P0.05)。DC与HRV多项指标呈显著正相关(r=0.31～0.67,P均0.05),与LF/HF呈显著负相关(r=-0.36,P0.05)。行二分类logistic回归分析发现,青春期患儿仅DC与VVS相关(P0.05)。采用受试者工作特征曲线(ROC)分析发现,学龄期DC值以7.72 ms、青春期DC值以8.36 ms为界值时有较好的灵敏度及特异度。结论 VVS患儿无症状期自主神经功能存在异常,随年龄增长,自主神经功能异常更加显著。学龄期及青春期VVS患儿均有迷走神经张力升高,且青春期VVS患儿还有一定程度交感神经张力升高;DC与迷走神经张力间呈明显正相关,对VVS诊断有较好预测价值。     

不同体重指数血管迷走性晕厥心脏抑制型儿童心率变异性的差异

目的探讨不同体重指数(BMI)血管迷走性晕厥心脏抑制型(VVS-CI)儿童心率变异性(HRV)的差异。方法回顾性分析2012年1月至2019年12月因晕厥或晕厥先兆在中南大学湘雅二医院儿童晕厥专科门诊诊断为VVS-CI的34例儿童的临床资料。根据身高、体重计算体重指数(BMI),分为偏瘦组(BMI≤18.4 kg/m²,n=19)和正常组(BMI 18.5-23.9 kg/m²,n=15)。对24 h动态心电图HRV进行分析。HRV分析采用线性分析法,时域指标SDNN、SDANN、rMSSD和pNN50,频域指标总功率(TP)、超低频功率(ULF)、极低频功率(VLF)、低频功率(LF)、高频功率(HF)和LF/HF。结果偏瘦组与正常组比较SDNN、SDANN和rMSSD差异无统计学意义(P>0.05),pNN50升高(P<0.05)。两组间TP、ULF、LF、HF和LF/HF差异无统计学意义(P>0.05),偏瘦组较正常组VLF降低(P<0.05)。偏瘦组、正常组不同性别之间时域指标、频域指标差异无统计学意义(P>0.05)。偏瘦组<12岁较≥12岁SDNN、SDANN、LF升高(P<0.05),rMSSD、pNN50、TP、ULF、VLF、HF和LF/HF差异无统计学意义(P>0.05)。正常组<12岁较≥12岁ULF升高、LF降低(P<0.05),SDNN、SDANN、rMSSD、pNN50、TP、VLF、HF和LF/HF差异无统计学意义(P>0.05)。结论低BMI与正常BMI的VVS-CI儿童自主神经调节功能不同,引起HRV存在差异。相同BMI<12岁与≥12岁儿童之间HRV也存在差异。     

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目的探讨直立倾斜试验(HUTT)对儿童血管迷走性晕厥(VVS)反复发作的预测价值。方法2001-01—2006-08在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥患儿251例,男112例,女139例,年龄418(12.25±3.27)岁。依临床晕厥发生频次分A组(晕厥发作仅1次,n=54)、B组(晕厥发作24次,n=137)与C组(晕厥发作≥5次,n=60)。HUTT在取得知情同意后采用基础直立倾斜试验(BHUT,n=251)及舌下含服硝酸甘油倾斜试验(SNHUT,n=92)。结果(1)HUTT阳性率与晕厥频次关系:BHUT阳性率随晕厥频次增加而递增(χ2=4.285,P>0.05),SNHUT阳性率与晕厥频次不呈线性关系(χ2=1.316,P>0.05),HUTT总阳性率(指BHUT阳性率+SNHUT阳性率)亦随晕厥频次增加而递增(χ2=3.809,P>0.05)。(2)HUTT反应类型与晕厥频次关系:无论是BHUT还是SNHUT,反应类型以血管抑制型为主,BHUT或SNHUT在不同晕厥频次组间比较无明显差异(分别为χ2=3.008,P>0.05;χ2=2.426,P>0.05)。结论HUTT与儿童VVS临床晕厥反复发作频次无明显关系,对儿童VVS临床反复晕厥发作没有预测价值。     

儿童血管迷走性晕厥QT间期离散度及心率变异性分析

目的探讨儿童血管迷走性晕厥（VVS）QT间期离散度（QTd）及心率变异性（HRV）的变化。方法采用日本光电9320K12导联同步心电图机及DeMar-K100动态心电图仪对52例VVS患儿及30例健康儿童的QTd及HRV进行测量。结果VVS患儿QTd、校正QT间期离散度和最长QT间期较对照组显著增大，差异具有显著性；直立倾斜试验（HUTT）阳性组和阴性组间QTd值比较差异无显著性。SDNN、SDANN及RMSSD病例组较对照组减小，且病例组SDNN、RMSSD与对照组相比差异有显著性；HUTT阳性组和阴性组间HRV差异无显著性。结论VVS的发病机制与交感神经和副交感神经调节存在障碍有关。HUTT作为诊断VVS的金标准，其阴性者不能除外VVS。QTd、HRV对于VVS患儿发生心肌缺血、心律失常等心血管事件具有一定的预测价值。     

儿童血管迷走性晕厥的临床特征及血浆和血小板中5-羟色胺的变化

目的 探讨小儿血管迷走性晕厥的临床特征和血浆、血小板中5-羟色胺(5-HT)的变化.方法 2006年10月-2009年2月在首都儿科研究所经直立倾斜试验(head-up tilt test,HUTT)确诊为血管迷走性晕厥(VVS)患儿41例(HUTT阳性组),诊断标准参照基础HUTT对儿童不明原因晕厥的诊断研究,男17名,女24名,年龄6～14岁,平均年龄(10.5 ±1.8)岁.匹配健康儿童(对照组):当地幼儿园和中小学36名健康小儿,男16名,女20名,年龄9～14岁,平均年龄(10.7±1.5)岁.分析晕厥诱因和先兆症状、HUTT反应方式、晕厥发作时间、VVS患儿静息状态各亚型血压和心率变化等临床特点.全体研究对象抽取静脉血3 ml,用双抗体夹心酶标免疫分析(ELISA)法对41例血管迷走性晕厥患儿及36名健康儿童的血浆和血小板中5-HT进行测定.结果 ①41例血管迷走性患儿平均年龄为(10.5±1.8)岁,女童比例高于男童,为1.4:1.②VVS先兆症状:患儿中33例存在晕厥先兆(80.4%),其中头晕发生率高达78.8%.③VVS发生诱因:儿童VVS发作前常存在诱发因素,包括:长久站立、劳累、情绪影响等.其中长久站立比例最高,达90.2%.④HUTT平均反应时间及晕厥持续时间:基础直立倾斜试验(BHUT)阶段平均反应时间为(20.6±8.6)min;舌下含化硝酸甘油激发倾斜试验(SNHUT)阶段平均反应时间(5.0±2.2)min.晕厥持续时间均短于5 min.⑤HUTT不间反应类型的分布:血管抑制型61.0%,混合型24.4%,心脏抑制型14.6%.⑥血压和心率的比较:VVS患儿和正常儿童静息状态下基础心率、收缩压、舒张压相比差异无统计学意义;VVS患儿中血管抑制型、混合型和心脏抑制型静息状态下基础心率、收缩压、舒张压相比差异无统计学意义.⑦VVS患儿基础状态和HUTT阳性时血浆中5-HT较对照组差异无统计学意义[(27.51±1.32)μg/Lvs.(27.28±2.48)μg/L,t=0.518,P=0.606;(27.51±1.32)μg/L vs.(28.05 ±1.40)μg/L,t=2.044,P=0.167],基础状态下血小板5-HT与对照组之间差异无统计学意义[(82.30 ±6.06)10~9ng/L vs.(79.88±5.79)10~9ng/L,t=1.788,P=0.780].⑧VVS患儿基础状态下和HUTT阳性时的血小板5-HT比较差异有统计学意义[(82.30±6.06)10~9ns/L vs.(97.90±6.59)10~9ng/L,t=11.26,P=0.00].结论 VVS患儿具有明显的临床特征;VVS患儿基础状态和晕厥(或晕厥先兆发生时)血浆中5-HT变化不明显;VVS患儿晕厥或晕厥先兆发生时血小板5-HT明显升高,提示中枢5-HT系统可能参与了VVS的发病过程.     

血管迷走性晕厥儿童的心理因素

目的探讨血管迷走性晕厥(VVS)儿童的心理因素。方法选取2007年6-11月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥儿童84例(VVS组)。男47例,女37例;年龄7～16岁[(11.01±2.00)岁]。将VVS儿童分为直立倾斜试验(HUTT)阳性组(n=43)和HUTT阴性组(n=41)。受试儿童均完成儿童抑郁障碍自评量表与儿童焦虑性情绪障碍筛查表,采用SPSS11.0软件进行分析。结果1.儿童抑郁障碍自评量表得分,VVS组儿童睡得很香、吃东西香及爱与家人交谈等项目得分显著低于全国常模组(Pa<0.05,0.01),VVS组患儿总是想哭、肚子痛、感到孤单、感到悲哀、感到烦恼得分及抑郁总分高于全国常模组(Pa<0.05,0.01)。HUTT阳性组患儿盼望美好事物和容易高兴起来得分高于HUTT阴性组(Pa<0.01),HUTT阴性组患儿生活没有意思得分高于HUTT阳性组(P<0.05)。2.儿童焦虑性情绪障碍筛查表得分,躯体化/惊恐、广泛性焦虑、分离性焦虑、社交恐怖、学校恐怖、焦虑量表总分与简明焦虑量表等得分VVS组显著高于全国常模组(Pa<0.01)。HUTT阴性组与HUTT阳...     

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.