Attention Deficits in Children Exposed to Alcohol Prenatally

Twenty children with fetal alcohol syndrome or fetal alcohol effect (FAS/FAE) were compared with 20 attention deficit disorder (ADD) children and 20 normal controls on three experimental tasks designed to isolate four different components of attention. Parents completed three questionnaires regarding their child's activity level and overall functioning, and the children completed a short form of an IQ test. The children in each group ranged from 5 to 12 years. Results indicate that although the children with FAS/FAE are significantly more impaired intellectually, their attentional deficits and behavioral problems are similar to those of children with ADD. These findings imply that the treatments known to facilitate learning in children with ADD may also benefit children with FAS/FAE.     

Specific Impairments in Self-Regulation in Children Exposed to Alcohol Prenatally

The present study utilizes a conceptual framework derived from theories of cognition to explain the pattern of behavioral and learning problems observed in subjects with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Based on a modern interpretation of Luria's theory of self-regulation, this study used a neuropsychological test battery to compare 10 subjects (mean age = 13 years) having FAS/FAE with 10 control subjects (mean age = 12 years and 9 months). Subjects with FAS/FAE were relatively high functioning and did not significantly differ from controls with respect to receptive vocabulary. However, those with FAS/FAE exhibited greater difficulty than controls on tasks that involved the manipulation of information and goal management in working memory (e.g., Planning, Controlled Oral Word Association, etc). Both groups performed equally well on some tasks that demanded rule learning (Delayed Response) and response inhibition (Go-No-Go). The above impairments were interpreted to be reflective of selective rather than generalized disruptions of neural networks that subserve working memory.     

Abnormalities of the Corpus Callosum in Children Prenatally Exposed to Alcohol

For 20 years, it has been known that fetal alcohol syndrome (FAS) is associated with abnormal brain development. Early autopsy studies point to the corpus callosum as one area affected by heavy alcohol exposure. Little is known, however, about the integrity of the brain in alcohol-exposed children who survive the perinatal period. This study was designed to assess the corpus callosum in living children exposed to high doses of alcohol prenatally. Thirteen children with histories of significant prenatal alcohol exposure and 12 normal control children were evaluated using magnetic resonance imaging. Using the midsagittal section, images were measured for the area of the corpus callosum using a computer-assisted measurement technique. In addition to the overall area, five equiangular regions were determined for each corpus callosum. Of the 13 alcohol-exposed children assessed, two had agenesis of the corpus callosum. The remaining alcohol-exposed children had significantly smaller overall callosal areas, as well as smaller regional areas of four of the five callosal regions, when compared with the normal control children. Importantly, when corrected for brain size, three of the five callosal regions were still smaller in the alcohol-exposed children, although overall area of the corpus callosum was no longer significantly different. These results suggest that prenatal exposure to high levels of alcohol is associated with abnormalities of the corpus callosum. They verify callosal agenesis in children with FAS, which previously had only been noted in autopsy reports. The current findings further document selective reductions in the area of certain regions of the corpus callosum after in utero alcohol exposure, extending our current understanding of alcohol's teratogenic effects on brain development. There is also some indication that the selective reduction in the area of the corpus callosum is similar to that reported in attention deficit disorder.     

Clinical Features of the Complete Closure of the Ductus Arteriosus Prenatally

Objective. Prenatal constriction of the ductus arteriosus associated with maternal drug ingestion was reported several decades ago. There are fewer reports of the complete closure of the ductus arteriosus; therefore, the clinical features of the latter are poorly understood. The aim of this study is to clarify the clinical features of complete ductal closure and postnatal pulmonary hypertension by performing echocardiography of the fetus. Patients. We diagnosed four fetuses with complete ductal closure by performing fetal echocardiography and reviewed the prenatal and postnatal medical records of the mother and fetus. Results. One mother each had bronchial asthma, ulcerative colitis, and idiopathic thrombocytopenic purpura, and they had received nonsteroidal anti‐inflammatory drugs and/or corticosteroids during pregnancy. The fourth mother did not have basal disease and had not ingested any drugs. Fetal diagnosis was performed at 32–38 weeks of gestation. All fetuses had right heart dilatation with tricuspid regurgitation in the absence of any cardiac defects, and Doppler echocardiography indicated that the right ventricular pressure was elevated. Two of the fetuses had fetal hydrops, which suggested severe right heart dysfunction. All fetuses were delivered by emergent cesarean delivery. After birth, all the infants developed persistent pulmonary hypertension and required oxygen inhalation. Of these, three required mechanical ventilation, and two, nitric oxide inhalation. All infants improved within 2 weeks, and they had no neurological and cardiac complications after discharge. Conclusion. Right heart dilatation and severe tricuspid regurgitation in the absence of a cardiac defect in the fetus strongly suggested ductal dysfunction. Careful evaluation of ductal patency and right ventricular function can lead to precise early diagnosis and good prognosis.     

Prevalence and Molecular Characterization of Human Bocavirus Detected in Croatian Children with Respiratory Infection

Human bocavirus (HBoV) 1 is considered an important respiratory pathogen, while the role of HBoV2-4 in clinical disease remains somewhat controversial. Since, they are characterized by a rapid evolution, worldwide surveillance of HBoVs’ genetics is necessary. This study explored the prevalence of HBoV genotypes in pediatric patients with respiratory tract infection in Croatia and studied their phylogeny. Using multiplex PCR for 15 respiratory viruses, we investigated 957 respiratory samples of children up to 18 years of age with respiratory tract infection obtained from May 2017 to March 2021 at two different hospitals in Croatia. Amplification of HBoV near-complete genome or three overlapping fragments was performed, sequenced, and their phylogenetic inferences constructed. HBoV was detected in 7.6% children with a median age of 1.36 years. Co-infection was observed in 82.2% samples. Sequencing was successfully performed on 29 HBoV positive samples, and all belonged to HBoV1. Croatian HBoV1 sequences are closely related to strains isolated worldwide, and no phylogenetic grouping based on mono- or co-infection cases or year of isolation was observed. Calculated rates of evolution for HBoV1 were 10⁻⁴ and 10⁻⁵ substitutions per site and year. Recombination was not detected among sequences from this study.     

厌食患儿外周血淋巴细胞凋亡过程及临床意义

目的;检测厌食患儿免疫功能,探讨外周血淋巴细胞凋亡（PCD）过程。方法：检测58例厌食患儿外周血凋亡淋巴细胞和免疫功能,并与28例健康儿童对照。T淋巴细胞亚群采用间接免疫荧光法,免疫球蛋白采用免疫比浊法,细胞凋亡用吖啶橙－溴化乙锭染色法。结果：该组患者免疫功能低下,主要表现为IgG,CD4^ ,CD4^ /CD8^ 明显降低,IgM,CD8^ 明显升高。PCD率明显升高。结论：PCD过度是该组患者免疫功能低下的一个重要原因。     

High Prevalence of Rheumatic Heart Disease Detected by Echocardiography in School Children

Objectives: It is fairly easy to detect advanced valve lesions of established rheumatic heart disease by echocardiography in the clinically identified cases of rheumatic heart disease. However, to diagnose a subclinical case of rheumatic heart disease, no uniform set of echocardiographic criteria exist. Moderate thickening of valve leaflets is considered an indicator of established rheumatic heart disease. World Health Organization criteria for diagnosing probable rheumatic heart disease are more sensitive and are based on the detection of significant regurgitation of mitral and/or aortic valves by color Doppler. We attempted diagnosing RHD in school children in Bikaner city by cardiac ultrasound. Methods: The stratified cluster sampling technique was employed to identify 31 random clusters in the coeducational schools of Bikaner city. We selected 1059 school children aged 6–15 years from these schools. An experienced operator did careful cardiac auscultation and echocardiographic study. A second expert confirmed the echocardiographic findings. Findings: The prevalence of lesions suggestive of rheumatic heart disease by echocardiography was 51 per 1,000 (denominator = 1059; 95% CI: 38–64 per 1,000). We were able to clinically diagnose RHD in one child. None of these children or their parents having echocardiographic evidence of RHD could provide a positive history of acute rheumatic fever. Conclusions: By echocardiographic screening, we found a high prevalence of rheumatic heart disease in the surveyed population. Clinical auscultation had much lower diagnostic efficacy. (Echocardiography 2010;27:448‐453)     

An Analysis of Errors Detected in the Course of Large Scale ABO Grouping

Les causes d'erreur du groupage en série dans le système ABO des donnenrs et des femmes enceintes sont analysées. Au cours de la détermination des antigènes des hématies on a observé respective-ment 2 et 5 erreurs sur 1000 groupages. Les réactions sont plus souvent faussement positives que faussement négatives. C'est au cours de la détermination des anticorps sériques que les erreurs sont le plus souvent commises.

Zusammenfassung

Die Fehlerquellen der ABO-Blutgruppenbestimmungen in großen Serien bei Blutspendern einerseits und bei Schwangeren andererseits werden analysiert. 2 bzw. 5 Fehler fallen auf 1000 Bestimmungen, wenn nur die Erythrocyten-Eigenschaften geprüft werden. Falsche positive Ergebnisse sind häufiger als falsche negative. Bei der Prüfung der Serum-Antikörper gegen bekannte Erythrocyten werden die meisten Fehler beobachtet.     

Tocilizumab-induced Leukoencephalopathy with a Reversible Clinical Course

Tocilizumab (TCZ; Actemra/RoActemra) is an anti-interleukin (IL)-6 receptor antibody for the treatment of rheumatoid arthritis (RA) and other autoimmune diseases and cytokine storms. The present case is a 63-year-old female well-controlled RA patient, who presented with a progressive cognitive impairment after 34 months of TCZ administration. Brain magnetic resonance imaging (MRI) showed leukencephalopathy with a lactic acid peak in magnetic resonance spectroscopy (MRS), a decreased blood flow in single photon emission computed tomography (SPECT), and a decreased accumulation in fluorodeoxyglucose positron emission tomography (FDG-PET). The discontinuation of TCZ improved her cognitive function and brain MRI findings at 3 months after drug cessation. The present case suggests that TCZ may sometimes cause leukoencephalopathy after long-term administration, and thus the early discontinuation of TCZ is recommended to achieve a good prognosis.     

A New Circular Single-Stranded DNA Virus Related with Howler Monkey Associated Porprismacovirus 1 Detected in Children with Acute Gastroenteritis

Putative replication-associated protein (REP) and capsid-like (CAP) proteins are encoded by circular single-stranded DNA viruses (CRESS DNA), which have been found in samples from most eukaryotic groups. However, the details of these viruses’ life cycles and their significance in diseases have yet to be established. We presented and analyzed two full-length CRESS DNA genomes acquired from two children diagnosed with acute gastroenteritis (GI) in the northeast state of Tocantins, Brazil, using next-generation sequencing and a virus-like filtration approach. Both sequences (named SmaCV3BR08 and SmaCV3BR291) are closely similar to a prior CRESS DNA sequence discovered in the feces of a new world monkey (Alouatta caraya) from the United States in 2009 and termed Howler monkey-associated porprismacovirus 1 (Genbank ID: NC 026317). According to our comparative study, these porprismacovirus genomes deviate by 10% at the nucleotide level. For comparative reasons, the divergence between our sequences (SmaCV3BR08 and SmaCV3BR291) and a porprismacovirus recently identified in a human fecal sample from Peru is 37%. These data suggest that there is a great diversity of porprismacoviruses in South America, perhaps more than two species. In addition, the finding of closely related sequences of porprismacoviruses in humans and native monkeys highlights the zoonotic potential of these viruses.     

儿泻暖脐膏治疗婴幼儿急性腹泻的临床研究

为了观察中药治疗婴幼儿急性腹泻的临床效果，应用儿泻暖脐膏敷脐配合西药常规疗法（简称治疗Ⅰ组）治疗婴幼儿急性腹泻，并与十香暖脐膏敷脐配合西药常规疗法（简称治疗Ⅱ组）及西药常规疗法（简称对照组）对照。结果治疗Ⅰ组102例，治愈61例（59．8％），显效24例（23．5％），有效11例（10．8％），无效6例（5．9％），显效率83．3％，总有效率94．1％；治疗Ⅱ组54例，治愈25例（46．3％），显效15例（27．8％），有效11例（20．4％），无效3例（5．6％），显效率74．1％，总有效率94．4％；对照组55例，治愈22例（40．0％），显效12例（21．8％），有效9例（16．4％），无效12例（21．8％），显效率61．8％，总有效率78．2％。治疗Ⅰ组的治愈率、显效率和总有效率均高于对照组（P＜0．05或P＜0．01）；治疗Ⅱ组总有效率显著高于对照组（P＜0．05）。提示儿泻暖脐膏敷脐配合西药常规疗法能提高临床疗效。     

Clinical Characteristics of Dysphagia in Children with Down Syndrome

Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study reports characterizes oral and pharyngeal phase dysphagia and diet modifications on videofluoroscopic swallow studies (VFSS) in a large cohort of children with Down syndrome. A total of 158 pediatric patients (male = 95; female = 63; mean age 2.10 years, SD 3.17 years) received an initial VFSS at a pediatric teaching hospital as part of their medical care. A total of 56.3 % (n = 89) children had pharyngeal phase dysphagia with aspiration and deep laryngeal penetration occurring most frequently. Of the 61 patients who aspirated, 90.2 % (n = 55) did so silently with no cough or overt clinical symptoms. In 76.7 % of cases of pharyngeal phase dysphagia, a functional feeding plan, with use of thickened liquids or change in feeding system to control flow rate and/or bolus size, was able to be established, which allowed children to continue eating by mouth. Thickened liquids (76.7 %, n = 46) were the most effective adaptation, with change in feeding system alone effective in only 8.3 % (n = 5) cases. Oral phase dysphagia was reported in the majority of patients (63.8 %, n = 88/138); however, this was not predictive of pharyngeal phase dysphagia. Age, sex, and reason for referral, including prior clinical symptoms, did not have a statistically significant impact on the presence of dysphagia. This comprehensive review has application to clinical understanding and management of dysphagia in children with Down syndrome.     

212例儿童脑囊虫病患者的临床及影像学分析

目的探讨儿童脑囊虫病的临床特点及CT特征.方法对212例儿童脑囊虫病患者的临床表现和CT资料进行统计分析.结果儿童脑囊虫病患者主要通过使用被绦虫卵污染的饮食而感染.发病年龄集中在8～11岁,农村高于城镇.临床上以癫痫发作和头痛为主.CT异常率为82.5%,主要表现为片状和圆形的低密度影和少量的高密度影.经2～4个疗程的抗囊治疗后,212例患儿疗效均达到治愈标准.有128例患者复查了头颅CT,其中126例(98.4%)患者的低密度影消失,2例(1.6%)转化为点状钙化.结论儿童脑囊虫病患者以异体感染为主,癫痫发作和头痛是其主要临床表现,抗囊治愈率为100%.CT 检查对儿童脑囊虫病人的诊断和疗效考核具有重要的使用价值.     

Neonatal Development in Prenatally Zika Virus-Exposed Infant Macaques with Dengue Immunity

Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits, or remain asymptomatic. It is unclear why some infants are more affected than others, although enhancement of maternal ZIKV infection via immunity to an antigenically similar virus, dengue virus (DENV), may play a role. We hypothesized that DENV immunity may worsen prenatal ZIKV infection and developmental deficits in offspring. We utilized a translational macaque model to examine how maternal DENV immunity influences ZIKV-exposed infant macaque neurodevelopment in the first month of life. We inoculated eight macaques with prior DENV infection with ZIKV, five macaques with ZIKV, and four macaques with saline. DENV/ZIKV-exposed infants had significantly worse visual orientation skills than ZIKV-exposed infants whose mothers were DENV-naive, with no differences in motor, sensory or state control development. ZIKV infection characteristics and pregnancy outcomes did not individually differ between dams with and without DENV immunity, but when multiple factors were combined in a multivariate model, maternal DENV immunity combined with ZIKV infection characteristics and pregnancy parameters predicted select developmental outcomes. We demonstrate that maternal DENV immunity exacerbates visual orientation and tracking deficits in ZIKV-exposed infant macaques, suggesting that human studies should evaluate how maternal DENV immunity impacts long-term neurodevelopment.     

Abnormal Development of the Cerebellar Vermis in Children Prenatally Exposed to Alcohol: Size Reduction in Lobules I–V

Abnormalities of the cerebellar vermis have been well documented in animal models of fetal alcohol syndrome. At this point, it is not known if the same brain region is affected in humans prenatally exposed to alcohol. In this study, the area of the cerebellar vermis was measured from brain magnetic resonance images of 9 children and young adults with prenatal alcohol exposure and 24 control subjects in the same age range. Six of the exposed children met standard criteria for fetal alcohol syndrome. The remaining three subjects had significant histories of prenatal exposure to alcohol, but did not have enough of the classic facial features for the diagnosis. For each subject with a suitable midsagittal section, three vermal areas were circumscribed: anterior vermis (vermal lobules I–V), posterior vermis (vermal lobules VI and VII), and the remaining vermal area (including lobules VIII–X). Statistical analyses revealed that the anterior region of the vermis was significantly smaller in subjects with prenatal alcohol exposure, whereas the posterior region and the remaining vermal area did not differ between groups. Previous findings from an animal model of neonatal alcohol exposure have documented Purkinje cell loss in vermal lobules I–V and IX–X, with notable sparing in lobules VI–VII. Thus, the results of both studies indicate similar patterns of abnormal brain development in the anterior vermal region, with apparent sparing in the posterior vermal region. Our findings, for the first time, suggest that regionally specific Purkinje cell death may also occur in humans prenatally exposed to alcohol.     

X综合征女性患者电子束CT测定冠状动脉钙化的临床特点

为探讨X综合征女性患者冠状动脉钙化及临床情况 ,利用电子束CT对 2 6例X综合征女性患者和 2 2例冠状动脉造影及运动试验均正常的女性胸痛者冠状动脉进行检测 ,同时对其冠心病危险因子进行评估 ,测定血脂和血浆氧化型低密度脂蛋白水平 ,对比不同病例的冠状动脉钙化积分及病变血管支数。结果发现 ,有 19例(73% )X综合征女性患者存在冠状动脉钙化 ,而正常组中仅 4例 (18% )存在冠状动脉钙化 ;有冠状动脉钙化的X综合征女性患者冠心病危险因子明显高于正常组 (1.8± 1.3比 1.1± 0 .9,P <0 .0 5 ) ,前者的血浆氧化型低密度脂蛋白浓度也明显高于后者 (5 2 .38± 6 .89比 39.92± 7.87,P <0 .0 5 ) ;其中 13例为绝经期患者。绝经后X综合征患者冠状动脉钙化积分和有冠状动脉钙化的血管支数与非绝经期者相比无明显差异 ,但这两组均较正常组明显增高 (P<0 .0 5 )。结果提示 ,有相当数量的X综合征女性患者存在冠状动脉钙化 ,这种钙化似乎与绝经与否无关 ,有必要对这类患者的临床资料进行评估并作相应治疗