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.     

儿童先天性主动脉瓣畸形32例病理组织学特征

目的 探讨儿童先天性主动脉瓣畸形的病理组织学特征，为诊断提供依据。方法 对2003年1月至2005年12月因先天性主动脉瓣畸形、主动脉瓣功能障碍行外科手术切除的32例儿童主动脉瓣标本进行大体观察和组织学检查，复习病史并摘录相关资料，分析其病理组织学特征。诊断依据临床表现、术前超声心动图、术中所见及术后病理组织学检查，除外风湿性或退行性主动脉瓣病变、感染性心内膜炎及原发性结缔组织病变如Marfan综合征。结果 32例儿童先天性主动脉瓣畸形中，男性27例，女性5例，男：女=5.4：1，年龄6~18岁，平均年龄14.9岁。二叶型占37.5％（12例），三叶型59.4％（19例），四叶型3.1％（1例）。主动脉瓣狭窄（aortic stenosis，AS）5例（15.62%），主动脉瓣关闭不全（aortic insufficiency，AI）25例（78.13%），AS-AI 2例（6.25%），均不伴其他心脏瓣膜病变。20例伴其他先天性心脏病：室间隔缺损19例，动脉导管未闭2例，右室双腔心1例，主动脉右冠窦瘤3例。病理组织学改变为瓣叶增厚、大小不等、不规则（卷曲或脱垂）及坚度增加，部分伴钙化，光镜下示纤维组织增生，粘液样变性，胶原纤维溶解、断裂，弹性纤维破坏，偶见胶原纤维玻璃样变性、灶性钙化，无小血管增生及炎性细胞浸润。少数可见心内膜面局部破溃，内皮下毛细血管增生，纤维素性渗出，炎性细胞浸润，继发性钙质、脂质沉着和纤维化。结论 儿童先天性主动脉瓣畸形以男性为多见，二叶型、三叶型主动脉瓣常见，常伴有其他先天性心脏病，瓣膜功能障碍以AI为主，病理组织学改变主要为为瓣叶增厚、大小不等、不规则（卷曲或脱垂），光镜下示纤维组织增生，粘液样变性，胶原纤维溶解、断裂，弹性纤维破坏，无小血管增生及炎性细胞浸润，而纤维化、钙化少见。     

Determinants of Participation in Leisure Activities in Children and Youth with Cerebral Palsy: Systematic Review

Children and youth with cerebral palsy (CP) experience difficulties in their ability to move, problem solve, socialize, and communicate, associated with limitations in activities in all environments. They are at risk for lower participation in social and leisure activities critical in fostering friendships, developing interests, and promoting well-being. Little is known about involvement in leisure activities and their determinants. This systematic review aims to describe participation in leisure activities by children with CP and identify personal and environmental factors that influence participation. The following databases were reviewed—CINAHL, Medline, Cochrane, Web of Science, OTseeker, and REHABDATA—using the keywords participation, cerebral palsy, leisure, and recreation. The literature to date suggests that children with physical disabilities are less involved in leisure activities than their peers; activities are more passive, home based, and lack variety. Several factors influence participation in leisure activities, including age, gender, activity limitations, family preferences and coping, motivation, and environmental resources and supports.     

Quantitative measurements of the urinary excretion of creatinine,uric acid,hypoxanthine and xanthine,uracil, cyclic AMP,and cyclic GMP in healthy newborn infants

Serum creatinine, uric acid, and hypoxanthine and xanthine concentrations were determined in 17 mother-infant pairs at the time of delivery. Creatinine and uric acid levels were nearly similar, but hypoxanthine and xanthine were more than twice as high in the blood of the infants than in the blood of their mothers. In the same newborns the urinary excretion of creatinine, uric acid, hypoxanthine and xanthine, uracil, cAMP, and cGMP was measured on the first and fourth day of life. Creatinine, uracil, and cAMP increased, hypoxanthine and xanthine, and cGMP decreased, whereas the output of uric acid was nearly the same on both days. Correlations of the excreted substances to each other were calculated.Dedicated to Prof. Dr. H.-R. Wiedemann on the occasion of his 65th birthdaySupported by Deutsche Forschungsgemeinschaft     

Long‐term outcome of pediatric renal transplantation: A single center study in Japan

Little is known about the risk factors for long‐term poor outcome in pediatric renal transplantation. Between 1973 and 2010, 111 renal transplants (92 living donations) were performed in 104 children (56 males, mean age, 12.5 yr) at the Social Insurance Chukyo Hospital, and followed‐up for a mean period of 13.6 yr. The patient survival at 1, 5, 10, 15, 20 (living‐ and deceased‐donor transplants), and 30 yr (living‐donor transplants only) was 98.1%, 92.8%, 87.8%, 84.9%, 82.6%, and 79.3%. The graft survival at 1, 5, 10, 15, 20, and 30 yr was 92.0%, 77.3%, 58.4%, 50.8%, 38.5%, and 33.3%. The most common cause of graft loss was CAI, AR, death with functioning, recurrent primary disease, ATN, and malignancy. Donor gender, ATN, malignancy/cardiovascular events, and eras affected patient survival. AR and CAI were the risk factors for graft loss. The evolved immunosuppression protocols improved the outcome by reducing AR episodes and ATN but not CAI, suggesting CAI as the major risk factor for graft loss. CAI was correlated with AR episodes, CMV infection, and post‐transplant hypertension. Strategies for preventing the risk factors for malignancy/cardiovascular events and CAI, including hypertension/infection, are crucial for better outcomes.     

Untersuchungen über Enzymaktivitäten im Liquor cerebrospinalis bei Kindern mit Encephalitis,seröser Meningitis und Hydrocephalus

Zusammenfassung Im Liquor cerebrospinalis von 293 Kindern mit cerebro-meningealen Erkrankungen wurden elf Enzyme untersucht (LDH, MDH, HBDH, GOT, GPT, IDH, CPK, Ald, SDH, LAP, GlDH) mit der Frage, ob besonders bei der Encephalitis Enzymaktivitätsänderungen auftreten, durch die man die Diagnose erhärten kann. Ein Vergleichskollektiv mit 32 Liquores gesunder Kinder wurde dem ersten gegenübergestellt. Signifikante Erhöhungen bei Encephalitis (und beim rasch wachsenden Hydrocephalus) wurden für LDH, MDH, HBDH, GOT, CPK, Ald, LAP und SDH gemessen, nicht dagegen für die anderen Enzyme, deren Aktivität aber ebenfalls angestiegen war. Die möglichen, bis heute noch nicht geklärten Ursachen des Enzymanstieges im Liquor werden ausführlich diskutiert.Mit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft (Si 98/5).Auszugsweise vorgetragen auf der 6. Tagung der österreichischen Gesellschaft für Kinderheilkunde in Wien 11.–13. 10. 1968.     

儿童解没食子酸链球菌脑膜炎系统评价

背景：国内外儿童解没食子酸链球菌（SG）所致脑膜炎报道较少，临床特点尚不明确。 目的：系统评价儿童SG脑膜炎的临床特点。 设计：系统评价。 方法：系统检索PubMed、Embase、Web of Science、中国知网、万方和维普数据库中儿童SG脑膜炎的相关文献，检索时间均为建库至2022年11月9日。纳入报道儿童SG感染且致细菌性脑膜炎的病例报告文献；排除综述、会议论文、仅有摘要不能获取全文的文献、全文非中文和英文的文献。由2位评价员独立筛选文献、提取资料，按照病例报告及病例系列报告质量评价工具表对纳入的文献进行质量评价，提取文献特征、病例临床特征、实验室指标和SG药敏结果。 主要结局指标：存活率和并发症。 结果：17篇文献中的21例SG婴幼儿纳入本文分析，男16例，女4例，1例未报告性别；3例早产儿，16例足月儿，2例未报告胎龄；发病日龄 (14.5±16.6)d；发热14例；神经系统异常17例，有消化道症状9例，有呼吸系统症状9例，心动过速3例。11例报告了CRP检测结果均升高；9例外周血WBC<4×109·L-1，6例＞10×109·L-1。CSF中的WBC计数均升高；18例报告了CSF糖水平，14例<2.2 mmol·L-1；17例报告了CSF蛋白水平，15例＞1 700 mg·L-1。21例CSF培养中20例阳性，18例血培养中16例阳性，5例尿培养中1例阳性，1例粪培养阳性；SG巴氏亚种17例，SG解没食子酸亚种2例，SG 2例。12例单用1种抗生素（11例SG菌株对青霉素/氨苄西林均敏感，1例未报告），9例联用2种抗生素（8例SG菌株对青霉素/氨苄西林敏感，1例耐药），最短抗生素使用时间14 d。6例描述有并发症，其中并发脑室出血和脑室炎各2例，1例合并脑积水、脑室扩张、神经运动迟缓、自主运动不良和肌张力增高，1例同时并发双侧视觉诱发电位下降、硬膜下积液、癫。 结论：SG脑膜炎的发病人群主要为2月龄以下小婴儿，可选择青霉素类药物或头孢噻肟治疗，临床转归大多良好。     

Idiopathic colitis following cardiac transplantation: three pediatric cases

Colitis can cause significant morbidity in pediatric solid organ transplant recipients. In many cases, despite intensive evaluation, a specific infectious, inflammatory, or immunologic etiology is not identified, and idiopathic colitis may be the ultimate diagnosis. We defined idiopathic colitis as the presence of gastrointestinal symptoms (vomiting, diarrhea, abdominal pain) with inflammatory changes seen on intestinal biopsy in the absence of identifiable bowel disease. We describe three cases of idiopathic colitis following cardiac transplantation. In each case, the post-transplant course was complicated by persistent abdominal pain, diarrhea, and in two cases, vomiting. All three patients' post-transplant courses were marked by multiple graft rejection episodes, and all received intensified immune therapy in addition to usual maintenance immunosuppression. Differential diagnosis of the patients' gastrointestinal symptoms included drug side effect, indolent opportunistic infections, inflammatory bowel disease, post-transplant lymphoproliferative disease, and microvascular ischemic colitis. Continued symptoms led these patients to extensive evaluation including imaging studies, endoscopy and tissue biopsy, and stool, blood and tissue cultures for viral, bacterial and parasitic pathogens. Definitive differentiation presented significant diagnostic challenge, and once identifiable etiologies were excluded, the diagnosis of idiopathic colitis was assigned. We conclude that idiopathic colitis following pediatric cardiac transplantation can be a cause of significant morbidity. Endoscopic evaluation of patients who present with gastrointestinal symptoms after transplant is warranted to identify the presence of idiopathic colitis once common causes are ruled out. Further study is needed to identify its incidence, etiology, therapeutic options and prognosis.     

Brain basis of early parent-infant interactions: psychology, physiology, and in vivo functional neuroimaging studies

Parenting behavior critically shapes human infants' current and future behavior. The parent-infant relationship provides infants with their first social experiences, forming templates of what they can expect from others and how to best meet others' expectations. In this review, we focus on the neurobiology of parenting behavior, including our own functional magnetic resonance imaging (fMRI) brain imaging experiments of parents. We begin with a discussion of background, perspectives and caveats for considering the neurobiology of parent-infant relationships. Then, we discuss aspects of the psychology of parenting that are significantly motivating some of the more basic neuroscience research. Following that, we discuss some of the neurohormones that are important for the regulation of social bonding, and the dysregulation of parenting with cocaine abuse. Then, we review the brain circuitry underlying parenting, proceeding from relevant rodent and nonhuman primate research to human work. Finally, we focus on a study-by-study review of functional neuroimaging studies in humans. Taken together, this research suggests that networks of highly conserved hypothalamic-midbrain-limbic-paralimbic-cortical circuits act in concert to support aspects of parent response to infants, including the emotion, attention, motivation, empathy, decision-making and other thinking that are required to navigate the complexities of parenting. Specifically, infant stimuli activate basal forebrain regions, which regulate brain circuits that handle specific nurturing and caregiving responses and activate the brain's more general circuitry for handling emotions, motivation, attention, and empathy--all of which are crucial for effective parenting. We argue that an integrated understanding of the brain basis of parenting has profound implications for mental health.     

The evolution of pregnancy

Although viviparity has evolved many times in the animal kingdom, it remains relatively uncommon—scorpions and therian mammals being rare examples of entirely viviparous major taxa. Viviparity is a specialised form of intra-species parasitism which biases parental investment towards fertilised eggs, temporally spreads that investment, and also temporarily protects offspring from many selection pressures. Importantly, the mammalian viviparity appeared at a relatively late stage in the process of vertebrate evolution. Because of this, viviparity was ‘superimposed’ on complex pre-existing cardiovascular, respiratory, metabolic and immune systems, and has altered them dramatically. Also, pregnancy has exerted pervasive effects on gene expression in mammals, including genetic imprinting, X inactivation, sex determination, and the ectopic expression in the extra-embryonic membranes of many genes previously expressed in the gonads, brain, pituitary and immune system. Finally, although lactation probably pre-dated viviparity in mammalian evolution, the two have co-evolved as alternative strategies of offspring nutrition ever since.     

Common environmental allergens causing respiratory allergy in India

Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that,Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album,Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens,Altemaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mitesD. farinae,D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.     

Book Reviews

Books Reviewed:
W. Damon, N. Eisenberg, Handbook of Child Psychology: Fifth Edition, Vol. Three: Social, Emotional and Personality Development
W. Damon, I. E. Sigel and K. A. Renninger, Handbook of Child Psychology, Fifth Edition, Vol. Four: Child Psychology in Practice
M. Eminson and R. J. Postlethwaite, Munchausen Syndrome by Proxy Abuse: A Practical Approach
E. Dowling and G. G. Barnes, Working with Children and Parents through Separation and Divorce. The Changing Lives of Children
Clare Sainsbury, Martian in the Playground: Understanding the Schoolchild with Asperger's Syndrome
R. Dallos and R. Draper, Introduction to Family Therapy
T. E. Brown, Attention-deficit Disorders and Comorbidities in Children, Adolescents and Adults     

Vitamin E concentration in human milk and associated factors: a literature review

ObjectiveTo systematize information about vitamin E concentration in human milk and the variables associated with this composition in order to find possible causes of deficiency, supporting strategies to prevent it in postpartum women and infants.SourceStudies published between 2004 and 2014 that assayed alpha-tocopherol in human milk of healthy women by high performance liquid chromatography were evaluated. The keywords used were “vitamin E”, “alpha-tocopherol”, “milk, human”, “lactation”, and equivalents in Portuguese, in the BIREME, CAPES, PubMed, SciELO, ISI Web of Knowledge, HighWire Press, Ingenta, and Brazilian Digital Library of Theses and Dissertations databases.Summary of the findingsOf the 41 publications found on the subject, 25 whose full text was available and met the inclusion criteria were selected. The alpha-tocopherol concentrations found in milk were similar in most populations studied. The variable phase of lactation was shown to influence vitamin E content in milk, which is reduced until the mature milk appears. Maternal variables parity, anthropometric nutritional status, socioeconomic status, and habitual dietary intake did not appear to affect the alpha-tocopherol levels in milk. However, the influence of the variables maternal age, gestational age, biochemical nutritional status in alpha-tocopherol, and maternal supplementation with vitamin E had conflicting results in the literature.ConclusionAlpha-tocopherol concentration in milk decreases during lactation, until the mature milk appears. To confirm the influence of some maternal and child variables on milk vitamin E content, further studies with adequate design are needed.     

Incentive-related modulation of cognitive control in healthy, anxious, and depressed adolescents: development and psychopathology related differences

BACKGROUND: Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts. METHODS: Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses. RESULTS: Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity. CONCLUSIONS: Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms.     

Where are we now? Further thoughts on Ways of Seeing

John Berger, the influential art critic, essayist and novelist died in January 2017. His friend the theatre director and actor, Simon McBurney, said, ‘Listener, grinder of lenses, poet, painter, seer. My Guide. Philosopher. Friend. John Berger left us this morning. Now you are everywhere.’ Berger insisted that observation was key to the project of ‘seeing’ truly. Are we there now? Are these ideas indeed ‘everywhere’? The author examines this view in the light of current developments in observation, in the psychoanalytic field, while reaching out to other disciplines to make closer links. She uses observations from students, comments they have made about the process of observation, and a moving observation of an old lady with dementia. John Berger prided himself on being a ‘listener’ as well as an observer, listening with an ear for everything in the other, not only what was spoken, and I hope that we may indeed listen to one another in the service of moving forward across disciplinary lines.     

A PROSPECTIVE STUDY OF URINARY PROTEINS IN EARLY INFANCY

ABSTRACT. Karlsson, F. A., Hardell, L.-I., and Hellsing, K. (Departments of Clinical Research, Internal Medicine, Paediatrics and Clinical Chemistry, University Hospital, Uppsala, Sweden). A prospective study of urinary proteins in early infancy. Acta Paediatr Scand, 68: 663, 1979.—Urinary concentrations of protein, albumin, β₂-microglobulin, α-amino nitrogen, and creatinine were determined in forty-one full-term infants on seven occasions up to six months of age. Except for β₂-microglobulin the concentrations were highest on the first day, followed by a rapid decrease to a constant level within two weeks. Protein diminished approximately seven-fold, albumin twenty-fold, α-amino nitrogen three-fold and creatinine five-fold. By contrast, β₂-microglobulin, a low molecular weight protein, first increased three-fold between day 1 and day 5, thereafter decreasing slowly 17-fold during the first three months of age. The data indicate that different kidney functions mature asynchronously.     

De certains aléas de la transmission. Entre histoire et destinée

By way of this round table's introduction about “transmission and genetics” and before the conference of professor J.-M. Mandel, we propose some thoughts round fundamentals questions of innate and acquired, risks of predetermination, dangers of some predictions. A clinical illustration supports our questioning about stakes of prenatal diagnosis, hazards of genetics’ diagnosis and effects of a predictive diagnosis. In fact, our experience as consultation-liaison child psychiatrist in paediatrics allows us to observe the different viewpoints applied to children: those of science, of genetics, those of neonatology, of paediatrics, of psychoanalysis. If tendency has long been to pit the science's child against the psychoanalysis one, it appears to us that this opposition is becoming obsolete; clinical medicine itself imposes such a correction. The matter is no more to pit but to make up. Besides, it is probably no accident that psychoanalysis is more than ever topical. The more science progresses, the more the question of singularity is obvious. Neurosciences and genetics seek universal mechanisms that finally produce something singular, making still relevant what is peculiar to psychoanalysis. But the confusion is frequent between history and destiny of the child, between anamnesis and destiny, between prevention and prediction, between knowledge and certitude. We insist on the trap of causalities and determinisms (genetic, epidemiological, paediatric, sociologic and even child psychiatric determinisms) specifying that “future is not written”. Always, there is a radical hiatus between a state of the brain and the subject, which is going to deduct (brain plasticity and unconscious), a distance between IRM and the subject, between the disease and the subject who suffers, between genotype and phenotype… And it is in this distance that it's possible to offer a space of freedom, to leave opened the question of the subject, including in the extreme situations. In this debate about the transmission and the predictive diagnosis, the child psychiatrist's has a place. We discuss this place, specifying why the child psychiatrist's is a practitioner of the unexpected, an artisan of the meeting.     

CEREBRAL BLOOD FLOW AND EXCHANGE OF OXYGEN, GLUCOSE KETONE BODIES, LACTATE, PYRUVATE AND AMINO ACIDS IN ANESTHETIZED CHILDREN

Abstract. Settergren, G., Lindblad, B. S. and Persson, B. (Department of Paediatrics, Karolinska Institutet and the Unit of Paediatric Anesthesiology, St. Göran's Hospital, Stockholm, Sweden). Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate and amino acids in anesthetized children. Acta Paediatr Scand, 69: 457, 1980.—Cerebral blood flow (CBF) and cerebral av differences of oxygen, glucose, 3-hydroxybutyrate, acetoacetate, lactate, pyruvate and amino acids were measured in anaesthetized children before elective surgery in order to study possible age-dependent variations. CBF was measured in 70 children, aged 11 days to 15 years. Cerebral av differences were studied in approximately 50% of the subjects. Mean values were: CBF 0.65 ml X g^-1 X min^-1, cerebral exchange in nmoles Xg^-1 X min^-1: oxygen 1348, glucose 248, acetoacetate 12,3-hydroxybutyrate 34 (uptake), lactate-48, pyruvate-8 (release). No net exchange of amino acids was found with the exception of histidine (uptake). Neither CBF nor the cerebral exchange of oxygen and circulating substrates showed any correlation to age within the group. Compared with adults anesthetized by the same technique (barbiturate induction, nitrous oxide-oxygen relaxant) the children had a slightly higher mean CBF, while the cerebral up-take of oxygen and glucose were equal to values in adults. The cerebral uptake of ketone bodies was higher in children than reported values in adults investigated in the awake state after comparable periods of fasting.     

Association of Mediterranean diet adherence during pregnancy with maternal and neonatal lipid,glycemic and inflammatory markers: The GESTAFIT project

To examine the association of Mediterranean diet (MD) adherence during pregnancy with maternal and neonatal lipid, glycemic, and inflammatory markers. This study included 152 women from the GESTAFIT trial and a subsample of 35 newborns. The Mediterranean Diet Score, derived from food frequency questionnaires, was employed to assess MD adherence. Total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides, and glucose were assessed in the mother (at the 16th and 34th gestational weeks [g.w.]) and in cord arterial and venous serum with standard procedures using an autoanalyzer. Pro-inflammatory and anti-inflammatory cytokines (interleukin [IL]−6, IL-8, IL-10, IL-1beta, interferon gamma, and tumour necrosis factor alpha [TNF-α]) were measured with Luminex xMAP technology. A greater MD adherence was associated with higher HDL-C and lower LDL-C, LDL-C/HDL-C ratio, triglycerides, triglycerides/HDL-C ratio, and TNF-α in the mother at the 16th and the 34th g.w. (|β|: 0.191–0.388, p < 0.05). A higher intake of whole grain cereals, fruits, vegetables and fish and a lower intake of sweets were associated with higher HDL-C and lower LDL-C, LDL-C/HDL-C ratio, triglycerides, triglycerides/HDL-C ratio, and TNF-α at the 16th and 34th g.w. (|β|: 0.188–0.334, p < 0.05). No associations were found with the cord arterial and venous serum markers (p > 0.05). A greater MD adherence during pregnancy, driven by a higher intake of whole grain cereals, fruits, vegetables and fish, and a lower intake of sweets, was positively associated with the maternal lipid and inflammatory serum markers throughout gestation. MD adherence during pregnancy was not associated with cord serum markers.     

ULTRASONOGRAPHY IN THE DIAGNOSIS OF NEONATAL ADRENAL HAEMORRHAGE

Abstract. Nordshus, T. and Monn, E. (Department of Radiology, Section of Paediatric Radiology and Department of Paediatrics, Rikshospitalet, The National Hospital, University of Oslo, Oslo, Norway). Ultrasonography in the diagnosis of neonatal adrenal haemorrhage. Acta Paediatr Scand 69: 695, 1980.—Two cases of neonates with adrenal haemorrhage are presented. The clinical, radiological and ultrasonographical signs are described. The future role of echography as compared to other radiological procedures, including computerized tomography, is discussed. Ultrasonography is recommended as a screening method, and is well suited for assessing the size and internal structure of pathological processes.