婴幼儿轮状病毒无症状感染的研究

目的     

婴幼儿体外循环术中自体血液回收对血液成分及凝血功能的影响

目的：观察体外循环中采用自体血液回收输注后对婴幼儿血液成分及凝血功能的影响。方法：随机将80例患儿分为观察组和对照组各40例。观察组使用血液回收机,将术中及体外循环机器余血全部回收处理,并于术后6小时内回输至患儿体内。对照组不使用血液回收机,术中及体外循环机器余血弃用。收集两组患儿性别,年龄,体重,术中体外循环时间,主动脉阻断时间;术前、术后15min、24h、第5天的血色素(Hb)、红细胞压积(Hct)、血小板(PLT);术前、术后15min、24h、72h凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-D二聚体(D-D)、纤维蛋白原降解产物(FDP);术后24h引流量,围术期异体血使用率、围术期红细胞使用量、术后凝血酶原复合物(PCC)使用率。结果：两组患儿性别、年龄、体重、术中体外循环时间及主动脉阻断时间比较差异无统计学意义(P＞0.05)。两组患儿术前Hb、Hct、PLT、PT、INR、APTT、FIB、TT、D-D、FDP比较差异无统计学意义(P＞0.05)。两组患儿各时点两组患儿术后15minPT、INR、APTT、TT、D-D、FDP与术前比较差异有统计学意义(P＜0.05);两组患儿术后不同时点PT、INR、APTT、FIB 、TT、D-D、FDP组间比较差异无统计学意义(P＞0.05)。两组患儿术后15min的Hb、Hct组间比较差异有统计学意义(P＜0.05);两组患儿术后24h、术后第5天的Hb、Hct、PLT与术前比较差异无统计学意义(P＞0.05),组间比较差异无统计学意义(P＞0.05)。两组患儿库血使用率与库血使用量比较差异有统计学意义(P＜0.05);两组患儿术后24h引流量和PCC使用率组间比较差异无统计学意义(P＞0.05)。结论：小儿心脏体外循环手术后使用自体血液回收在不同时点的凝血功能指标与不使用自体血液回收相比较无明显差异。使用自体血液回收可明显减少异体血使用率和使用量,且不增加并发症,可在小儿心脏手术中积极应用。     

Safety and utility of capsule endoscopy for infants and young children

AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.     

Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation

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Dietary treatment of colic caused by excess gas in infants: biochemical evidence

AIM:To evaluate the impact of feeding colicky infants with an adapted formula on the hydrogen breath test and clinical symptoms.METHODS:Hydrogen expiration was measured by SC MicroLyzer gas chromatography at inclusion and 15 d after treatment with an adapted low-lactose formula in 20 colicky infants.RESULTS:All babies were symptomatic:85% with excess gas,75% with abnormal feeding pattern,and 85% with excessive crying.The hydrogen breath test at inclusion was abnormal:35 ± 3.1 ppm.After 15 d feeding with an ...     

老年常见慢性病凝血功能的改变与临床意义

目的 探讨老年常见慢性疾病凝血机制和纤溶功能改变的临床意义.方法 对于2010年1月至2012年12月在复旦大学附属华东医院住院检查及治疗的86例老年患者,按原发性高血压、冠心病、慢性阻塞性肺疾病（CDPD）和/或慢性炎症、Ⅱ型糖尿病、血栓性疾病、恶性肿瘤等6种老年常见病分组,分别比较各组凝血功能及凝血因子方面的差异.结果 健康的老年人与患有常见病的老年患者相比,其凝血功能PT：（13.85±1.55）s、APTT：（37.38±6.41）s、活性度：（95.12±15.67）％、INR：（1.04±0.10）、FIB：（4.38±1.33） g/L、FDP：（0.49±0.94）、D-二聚体：（0.53±1.23）mg/L）两者差异均无统计学意义.但患有慢性阻塞性肺疾病、慢性炎症的老年患者其凝血因子Ⅴ（141.3±27.90）高于患有其他疾病的老年患者（P＜0.05）;患有冠心病的老年患者其凝血因子Ⅶ（117.77±14.17）高于其他疾病组;患有Ⅱ型糖尿病、血栓性疾病的老年患者凝血因子Ⅷ（171.21±14.90,172.64±8.44）高于其他疾病组（P＜0.05）;患有恶性肿瘤的老年患者FIB（6.00±1.29 g/L）水平高于其他疾病（P＜0.05）,差异均有统计学意义.结论 老年常见慢性疾病存在凝血功能异常.     

糖尿病肾病患者凝血与纤溶平衡变化的研究

目的　探讨糖尿病肾病患者的凝血、纤溶状态。方法　 35例 2型糖尿病、糖尿病肾病 (DN)患者和慢性肾小球肾炎 (CGN)患者 2 9例 ,按是否合并肾病综合征 (NS)分为 :DN- NNS组 19例 ,DN- NS组 16例 ,CGN- NNS组 16例 ,CGN- NS组 13例。酶联免疫吸附法系统检测各项凝血和纤溶指标。结果　无论是否合并 NS,DN患者较 CGN组血中TM、PF1 2 、TAT、FPA及 PAI-水平明显增加。结论　DN患者较慢性肾小球肾炎患者合并更强的血液高凝状态     

The importance of hematocrit in the interpretation of coagulation tests in the full-term newborn infant

BACKGROUND: Hematocrit (HCT) is significantly higher in newborns than in adults, but this fact is not usually considered when performing coagulation tests in newborns. We studied 71 healthy full-term newborns and compared them to 100 healthy adults to test the hypothesis that correcting the anticoagulant-to-blood ratio for neonatal HCT would reduce the differences among the two populations. METHODS: PT, PTT, fibrinogen, platelets and factors II, VII, IX, X, V, VIII were measured in 71 healthy full-term newborns and 100 healthy adults. An anticoagulant-blood ratio corrected for HCT was used. In 16 newborns, a non corrected value was also used and results were compared with the corrected ratio. RESULTS: A significant difference was observed between newborns and adults in all tests with the exceptions of fibrinogen and factor V. In the 16 newborns from whom blood was collected without correcting in the anticoagulant, a significant difference was also found in all parameters but fibrinogen. A weak correlation linked the different variables. CONCLUSIONS: After correction for HCT, neonatal PT and factors V, VII, VIII and IX were much closer to adult values; neonatal PTT and factors II and X were still definitely lower.     

Eosinophilia and first-line coagulation testing

Although eosinophilia (eosinophil count >0.60 × 10⁹/l), is a prothrombotic condition, little is known on the association between eosinophil count in blood and first-line coagulations tests, including fibrinogen, activated partial thromboplastin time (APTT), prothrombin time (PT) and platelet count. Cumulative results of APTT, PT, fibrinogen, platelet and eosinophil counts were retrieved from 6,944 outpatients >15 years old referred to our laboratory for routine blood testing over the previous 3 years. The median value and the percentage of patients with abnormal values of platelet count and fibrinogen but not APTT and PT, were significantly higher in patients with eosinophilia. This epidemiological association in a large subset of patients provides an additional potential mechanism to explain the link between eosinophilia and thrombosis and is consistent with the hypothesis that platelet count and fibrinogen might be worthwhile assessing in the presence of an abnormal eosinophil count.     

上海地区血清ALT测定标准化和参考范围调查

目的　探索上海地区血清丙氨酸氨基转移酶 (ALT)的检测标准化 ,并进行测定条件下人群ALT参考范围调查。方法　将cfas中含IFCC推荐要求的ALT值传递给一份新鲜混合人血清样品 ,以此作为临时校准品 ,校准后测定不同浓度的血清样品。 19所医院检验科共进行 7次实验 ,并在测定条件下检测 2 0岁以下到 71岁以上 75 98人的ALT。结果　ALT在 3 0 0U /L以下时 ,各参加医院检验科之间的平均测定值具有良好的可比性 ,CV <5 .0 % (1.80 %～ 4.60 % )。两次实验之间测定值的CV <3 .4% (3 .3 4%～ 3 .3 9% )。 75 98例ALT测定值男性或女性的第 97.5百分位点分别为 66U /L和 5 5U/L ,约相当于 3 5或 2 9赖氏法测定单位 ;第 99百分位点分别为 74U/L和 64U/L ,约相当于 3 9或 3 4赖氏单位。结论　采用统一校准血清 ,可使不同单位 (不同方法 )间ALT测定值差异明显减小 ,可比性显著增加     

Enteroenteroanastomosis near adjacent ileocecal valve in infants

AIM: To investigate the feasibility and the effectiveness of ileoileostomy in the region adjacent to the ileocecal valve, which can retain the ileocecal valve in infants.METHODS: This is a retrospective review of 48 patients who underwent ileoileostomy in the region adjacent to the ileocecal valve (group 1) and 34 patients who underwent ileocecal resections and ileotransversanastomosis (group 2). Patients were monitored for the time to flatus, resumption of eating, length of hospital stay after surgery, serum total bile acid, vitamin B12 and postoperative complications.RESULTS: The time to flatus, time until resumption of eating and post-operative length of hospital stay showed no statistically significant differences between the two groups. Serum total bile acid and vitamin B12 were not significantly different between the two groups at post-operative day 1 and day 3, but were significantly decreased at 1 wk after operation in group 2. None of the patients died or suffered from stomal leak in these two groups. However, the incidence of diarrhea, intestinal infection, disturbance of acid-base balance and water-electrolytes in group 1 was lower than in group 2.CONCLUSION: Ileoileostomy in the region adjacent to the ileocecal valve is safe and results in fewer complications than ileotransversanastomosis in infants.