益生菌在儿童过敏性疾病应用进展

近年来我国儿童过敏性疾病的患病率呈逐年增加趋势,现代生活方式和饮食结构变化,以及剖宫产率增加和生命早期抗生素应用等因素,均直接或间接地影响生命早期肠道菌群定植、演替和免疫的发展方向,并与婴儿远期健康和疾病（尤其过敏性疾病）的发生风险密切相关。大量研究也支持了“卫生假说”理论,认为肠道菌群失衡是过敏性疾病发生的前提和基础,微生态学策略可作为防治过敏性疾病的一个重要手段。文章系统回顾和探讨了生命早期肠道菌群发育在过敏性疾病发生发展中的作用地位,以及益生菌在儿童过敏性疾病应用的研究进展,以期指导过敏性疾病的一级预防和精准靶向治疗。     

剖宫产与儿童过敏性疾病

文章介绍了新生儿肠道菌群的形成过程,肠道菌群的构成及其对人体免疫系统的调控作用;剖宫产和非母乳喂养方式对新生儿肠道菌群的不良影响,由此而发生过敏症等疾病的机制.简要介绍了益生菌的定义,其生理学意义和治疗及预防婴儿过敏性疾病的作用.     

儿童粪菌移植研究进展

正常稳定的肠道菌群在维持机体健康方面发挥着关键作用,基于肠道微生态的治疗手段逐渐受到关注。近年来,通过移植健康人肠道菌群重塑患者肠道稳态的粪菌移植疗法迅速发展,许多研究证实粪菌移植对于儿童艰难梭菌感染、炎症性肠病、肠易激综合征、便秘、神经系统疾病、过敏性疾病与内分泌代谢等疾病具有一定疗效。文章就儿童粪菌移植的供体筛选、菌液制备、移植途径以及临床应用现状及前景等进行阐述,以期更好地指导临床实践。     

过敏性疾病与肠道菌群

过敏件疾病是一种免疫变态反应,随着感染性疾病的控制和工业化程度的提高,近年来有逐年增加的趋势,并已成为人们关注的伞球性健康问题.临床上最常见的有支气管哮喘、过敏件鼻炎、春季卡他性结膜炎、食物过敏、过敏性皮肤病如湿疹(包括特应性皮炎)、荨麻疹等.变态反应性疾病在儿童多发,将近40%的儿童曾患过该病 [1].近年有关过敏性疾病的流行病学调查、粪便菌群分析和临床研究提示,过敏性疾病的发生、发展与早期肠道菌群的紊乱密切相关.     

益生菌与婴幼儿健康

肠道是机体最大的免疫器官和微生态体系,肠道菌群通过调整免疫应答影响机体健康。小儿在不同生长时期存在肠道菌群结构的个体差异,并受许多因素影响,如饮食、生活环境、用药和特定疾病状况等。益生菌是由食物供给,通过改善机体微生态环境,对宿主产生有益作用的活的微生物,在预防急性腹泻、抗生素相关性腹泻、过敏性疾病、炎症性肠病和坏死性小肠结肠炎方面发挥重要作用,大量研究证实益生菌应用是安全有效的。     

金银花水提物对卵清蛋白过敏小鼠肠道菌群的影响

食物过敏(food hypersensitivity,FA)是儿童尤其婴儿临床常见的过敏性疾病。有假说认为过敏性疾病发病率的增加可能与生命早期肠道菌群的暴露减少有关眼1演。近年来研究发现食物过敏儿肠道的双歧杆菌、乳杆菌比例减少,而以需氧菌为主,尤其是大肠杆菌、链球菌占多数,梭菌计数增加眼2演。不少临床研究也显示双歧杆菌、乳杆菌有一定预防和治疗食物过敏作用眼3,4演。现代微生态学研究表明含有多糖类的中药多可以作为双歧因子增加体内双歧杆菌眼5演,调节肠道菌群。金银花水溶剂提取物含有葡萄糖、鼠李糖、木糖、阿拉伯糖等多糖类物质眼6演,本研…     

新生儿脓毒症与肠道微生态研究进展

近年来,脓毒症越来越受到人们的关注,是新生儿死亡的常见原因。肠道是人体最大的细菌储备库,在多种疾病发生发展中起始动作用。抗生素的使用、喂养方式、分娩方式及胎龄均可影响新生儿肠道菌群的定植。近期的研究表明,肠道菌群失调可以激活不受控的促炎反应从而导致脓毒症的发生。脓毒症新生儿肠道微生态可发生菌群紊乱、多样性降低及菌群移位...     

益生菌在儿童过敏性疾病的应用

过敏性疾病包括过敏性鼻炎、过敏性结膜炎、支气管哮喘、特应性皮炎、食物过敏等,已经被证实与肠道菌群的紊乱有关。过敏动物模型研究显示,益生菌能够通过诱导调节性T细胞产生,降低过敏原特异性Ig E和Th2细胞因子分泌,减轻靶器官嗜酸性粒细胞浸润和过敏性炎性反应,从而改善过敏表现。益生菌在临床上应用于婴幼儿湿疹有比较确切的治疗效果,但是用于过敏性疾病的预防证据不一致,仅在过敏性疾病高危人群中推荐使用。     

肠道菌群与川崎病关系研究进展

川崎病是一种以全身性血管炎为病理基础的疾病,已成为儿童获得性心脏病的最常见疾病,但其病因和发病机制仍不明确。肠道菌群稳态对机体免疫系统成熟及免疫调节有重要作用,肠道菌群紊乱参与儿童多种炎症免疫性疾病。研究发现,川崎病患儿存在肠道菌群组成的改变,肠道菌群紊乱与川崎病的发生发展有关,可能通过肠道黏膜屏障功能障碍、免疫炎症反...     

新生儿和婴儿肠道菌群的构成及影响因素

肠道菌群与人类健康和疾病的关系成为近年来胃肠道功能研究的热点。本文综述新生儿和婴儿肠道菌群的构成和形成的影响因素,即时间、分娩方式、环境和地域、喂养方式、抗生素的应用和细菌间相互作用。     

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.