后生素：微生态疗法新理念以及应用前景

<正>肠道菌群与宿主经过长期共同进化,宿主为肠道菌群提供了稳定的环境,而肠道菌群为宿主提供巨大的功能,如消化复杂的膳食营养物质、合成营养素和维生素、防御病原体和维护适宜的免疫系统等。因此,肠道菌群是维护宿主内外环境稳态的调控平台,对宿主的健康和疾病起着重要的作用~([1-3])。益生菌作为活的微生物,当给予足够数量时可对宿主健康产生有益     

Regulatory T cells and their role in rheumatic diseases: a potential target for novel therapeutic development

Regulatory T cells have an important role in limiting immune reactions and are essential regulators of self-tolerance. Among them, CD4+CD25^high regulatory T cells are the best-described subset. In this article, we summarize current knowledge on the phenotype, function, and development of CD4+CD25^high regulatory T cells. We also review the literature on the role of these T cells in rheumatic diseases and discuss the potential for their use in immunotherapy.     

Early breastfeeding cessation: validation of a prognostic breastfeeding score

Aim: To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth.
Methods: Two independent cohorts of Danish mothers in 1999 and 2004 with 4 months of follow-up on breastfeeding duration were used. The breastfeeding score was developed from 471 mothers' responses to a questionnaire in 1999 and based on duration of schooling, previous breastfeeding experience, self-efficacy, and mother's confidence in ability to produce milk. The 2004 cohort consisting of 723 mothers was used to validate the score.
Results: A breastfeeding score of 7 or higher classified 45% of the mothers in the 2004 cohort as being at risk of breastfeeding cessation. With this cut-point the sensitivity was 70% and the specificity 71%. Among primipara the cut-point gave a sensitivity of 76% and a specificity of 54% and classified 60% to be in the risk group. Among multipara the corresponding figures were 66%, 81% and 34%, respectively. The area under the ROC curve was 0.78.
Conclusion: The breastfeeding score based on a simple scoring system derived from four risk factors was capable of predicting the breastfeeding duration in an independent sample. It may help health professionals to identify mothers at risk of breastfeeding cessation before 4 months.     

The etiology of enamel hypoplasia: a unifying concept

In a study of children with chronic disorders of calcium and phosphate homeostasis, enamel hypoplasia was found in hereditary vitamin D-dependency rickets and in hypoparathyroidism, conditions characterized by hypocalcemia, and was not found in X-linked hypophosphatemic rickets, a condition in which the plasma calcium concentration is normal. The occurrence of enamel hypoplasia bore no relation to the plasma phosphate concentration. Enamel hypoplasia has also been reported in other pediatric disorders in which hypocalcemia is a major sign (for example, vitamin D deficiency, prematurity, and neonatal tetany). The existence of enamel hypoplasia in a hypoparathyroid or rachitic patient, when correlated with the chronology of enamel mineralization, helps to establish the time of onset of hypocalcemia. The observations led us to the hypothesis that a low serum calcium concentration during enamel formation is a specific determinant of enamel hypoplasia. This hypothesis may be relevant to the etiology of linear enamel hypoplasia, an endemic lesion of primary teeth in children of many Third World countries that predisposes the teeth to dental caries. The hypothesis may therefore be relevant also in explaining the prevalence of caries in the primary teeth of children in many underdeveloped countries.     

Surgical management of anorectal malformations: a unified concept

Posterior sagittal anorectoplasty (PSARP) is a new approach for the treatment of anorectal malformations. It has allowed direct exposure of the anatomy of these defects, enabling the author to describe the spectrum of this malformation. It also permits patients to be grouped on the basis of their potential for continence and the correlation of operative findings with clinical results. Traditional anatomic concepts have proved very inaccurate. The new approach allows separation of rectum from genitourinary tract without damaging important structures. The rectum is located within the limits of the striated muscle structures in a precise manner. This approach has important implications for therapy, evaluation of results, classification, and terminology. All defects can be treated with PSARP. The size of the incision will vary according to the complexity of the malformation, from minimal PSARP in low malformations to full PSARP in higher defects. In addition, approximately 10% of all cases will require a laparotomy. Colostomy is recommended in most patients except for those with low malformations. A new classification is proposed based on practical therapeutic purposes. Patients are also grouped according to their common potential for continence, which is important for the evaluation and comparison of results. The decision to create a protective colostomy is based on clinical facts in 80%–90% of cases and on invertograms and other diagnostic tests in the remaining 10%–20%.     

Fetal bone age revisited: Proposal of a new radiographic score

In order to establish a fetal bone age score, the post-mortem skeletal radiographs of 85 selected normal fetuses aged from 15 to 41 weeks of gestation (WG) were analysed. Twenty-eight skeletal areas were selected for which quantitative and/or qualitative criteria were defined. Each new aspect was graded and tatistically tested by the stepwise linear regression method. Two modalities of scores of decreasing complexity were then designed. The use of these two scores permitted the assessment of the fetal age withr ² values of 0.97 and 0.96 (standard error of estimation of 1.19 and 1.36 WG). Applied to 15 intrauterine growth retardation (IUGR) fetuses, the age estimated by these scores was well correlated with the age obtained by extraosseous criteria of maturation. This method is proposed as a tool for determining the fetal age during necropsy and could also be useful in US prenatal evaluation.Presented at the Joint Meeting of Pediatric Pathology Societies, Barcelona, 14–16 October 1992 and at the 30th Congress of the European Society of Radiology, London 9–11 June 1993     

Disialoganglioside GD2 and a novel tumor antigen: potential targets for immunotherapy of desmoplastic small round cell tumor

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is an aggressive and often misdiagnosed neoplasm of children and young adults. It is chemotherapy-sensitive, yet patients often relapse off therapy because of residual microscopic disease at distant sites: peritoneum, liver, lymph node, and lung. Strategies directed at minimal residual disease (MRD) may be necessary for cure. Monoclonal antibodies selective for cell surface tumor-associated antigens may have utility for diagnosis and therapy of MRD, as recently demonstrated in advanced-stage neuroblastoma (JCO 16: 3053, 1998). We examined DSRCT samples for the expression of two tumor antigens that could serve as possible targets for antibody-based immunotherapeutic approaches. PROCEDURES: Using immunohistochemistry, we studied the expression of two antigens: (1) G(D2) using antibody 3F8 and (2) a novel antigen using antibody 8H9 in a panel of 46 freshly frozen DSRCT. G(D2) is a disialoganglioside, which is widely expressed among neuroectodermal tumors as well as adult sarcomas. 8H9 recognizes a 58 kDa surface antigen expressed among neuroectodermal, mesenchymal, and epithelial tumors with restricted expression on normal tissues. RESULTS: Thirty-two of 46 (70%) tumors were reactive with 3F8, and 44 of 46 (96%) with 8H9. Both G(D2) and the 58 kDa antigen were localized to tumor cell membrane and stroma. In general, immunoreactivity was stronger and more homogeneous with 8H9 than with 3F8. There was no correlation between expression of either antigen or clinical outcome. CONCLUSIONS: G(D2) and the novel tumor antigen recognized by 8H9 are potential targets for immunodiagnosis and antibody-based therapy of DSRCT. Med Pediatr Oncol 2002;39:547-551.     

Canalisation in human growth: a widely accepted concept reconsidered

According to the concept of canalisation, infants and children stay within one or two growth channels, and therefore, any crossing of height centiles always warrants further evaluation. In view of evidence against this concept we re-investigated the variability of individual growth in the First Zürich Longitudinal Growth Study. The investigation is based on height measurements of 232 children (112 females, 120 males) measured at annual intervals during childhood and half-yearly during adolescence. Height data were transformed into height standard deviation scores (SDS) and canalisation defined by the width of an individual's growth channel, i.e., by the differences between maximum and minimum height SDS, in the individual series of measurements. Many subjects of the First Zürich Longitudinal Growth Study crossed numerous centiles with patterns that often seemed to show characteristic features. For approximately two thirds of the subjects, the SDS channel during the whole growth process covers more than one SDS. In childhood, between the age of two and age of minimal height velocity, only about one fourth of the subjects have an SDS channel below 0.5, indicating acceptable canalisation. During childhood, growth in boys appeared slightly more canalised than in girls (P=0.02). Conclusion The present investigation does not support the concept of strict canalisation of individual growth. We suggest to consider crossing of centiles a normal event in child development, though in a clinical setting crossing centiles should still be taken seriously, at least at first until a medical cause for this has been excluded. Received: 25 July 2000 / Accepted: 11 October 2000     

Validation of a modified pediatric early warning system score: a retrospective case-control study

The Pediatric Early Warning System (PEWS) score may be useful for detection of deterioration in clinical condition. In this retrospective study, the cases were patients transferred to the pediatric intensive care unit (PICU), and controls were those not transferred to the PICU. The maximum PEWS score in both groups were analyzed using Mann-Whitney U test and receiver operating characteristic curve (ROC). The study population included 100 cases and 250 controls. There was no difference in the age of cases and controls (6.3 vs 6.3 years). The length of hospital stay (18.09 ± 32 vs 3.93 ± 2.9 days; P < .001) and the maximum PEWS score (2.95 ± 1.5 vs 1.4 ± 0.8) were significantly higher for the cases (P < .0001). The PEWS score area under the ROC was 0.81 (95% confidence interval = 0.75-0.86). The sensitivity and specificity for a score 2.5 were 62% and 89%, respectively. The use of the modified PEWS score can help identify patients on wards who are at risk for deterioration.     

Comparison of mortality risk: a score for very low birthweight infants

AIM—To develop and evaluate a score which quantifies mortality risk in very low birthweight (VLBW) infants (birthweight below 1500 g) at admission to the neonatal intensive care unit.
METHODS—Five hundred and seventy two VLBW infants admitted from 1978 to 1987 were randomly assigned to a cohort (n = 396) for score development and a cohort (n = 176) for score validation. Two hundred and ninety four VLBW infants admitted from 1988 to 1991 were used to compare risk adjusted mortality between the two eras.
RESULTS—Using multiple regression analysis, birthweight, Apgar score at 5 minutes, base excess at admission, severity of respiratory distress syndrome, and artificial ventilation were predictive of death in the development cohort. According to regression coefficients, a score ranging from 3 to 40 was developed. At a cutoff of 21, it predicted death in the validation cohort with a sensitivity of 0.85, a specificity of 0.73, and a correct classification rate of 0.76. The area under the receiver operating characteristic curve was 0.86. There was no significant difference in risk severity and in risk adjusted mortality between the eras 1978-87 and 1988-91.
CONCLUSION—The present score is robust, easily obtainable at admission, and permits early randomisation based on mortality risk.

     

Single kidney and ureteral atresia in a newborn girl: a treatment concept

Objective

To demonstrate a rare case of urological pathology, we report a combination of a single kidney and ureteral atresia. The treatment concept and outcome are outlined.

Patient and method

Antenatal ultrasound had revealed urinary ascites which lead to caesarean section in the 34th gestational week. Persisting anuria was confirmed postnatally and peritoneal dialysis started on the second day of life. Subsequent laparotomy revealed ureteral atresia after 3 cm of patent ureter. We created an ileum conduit after discussing various other therapeutic options.

Result and conclusion

A follow up of 12 months has shown steady function of the stoma with stable renal parameters. An ileal conduit represents a good option if high drainage is necessary in early childhood.