深低温停循环前降温期不同血气管理方法脑电图监测结果分析

目的对深低温停循环(DHCA)前降温期行不同血气管理方法动物模型进行脑电图监测,探讨利于脑保护的体外循环血气管理方法。方法上海种白猪18头,年龄4~5周,体质量6~8 kg。随机分为A组、P组、PA组,每组各6头。基础麻醉后监测鼻咽部温度。胸部正中切口,显露心脏按临床方法建立体外循环,分别按下述方法转流降温20 min至鼻咽温度18℃。A组用α-稳态血气管理;P组用pH-稳态血气管理;PA组前15 min用pH稳态,后5 min用α-稳态血气管理。停循环60 min后各组均用α-稳态;灌注流量100 mL/(kg.min);灌注温度20~25℃复灌,5 min后复温至鼻咽温36℃。术中及降温期连续监测脑电图变化。结果脑电图监测示复温末P组脑电活动恢复最快,A组脑电活动无恢复。结论在实施DHCA的降温有限时间内,应用pH-或应用pH后用α稳态血气管理较用单纯α-稳态血气管理方法有更好的脑保护作用。     

深低温停循环灌注降温期血气管理对婴儿脑保护的研究

目的：探索一种适合于小婴儿深低温停循环灌注时的脑保护血气管理策略。方法：20例VSD（年龄2－13个月）婴儿按照不同血气管理和降温速度随机平均分4组对照，脑功能的监测包括：脑氧代谢参数、生代指标、脑温均匀度的比较及脑电图等。结果：快速降温期采用alpha稳态血气管理脑损害较重，在不同降温速度中应用pH稳态血气管理脑损害均较经。结论：小婴儿深低温体外循环快速降温期应用pH稳态血气管理对改善降温期的脑损害是安全有效的。     

大鼠深低温停循环模型的建立

为探讨建立大鼠深低温停循环(deep hypothermic circulatory arrest，DHCA)动物模型的可行性，对8只SD大鼠行尾动脉插管灌注，右颈静脉插管引流，建立大鼠体外循环(cardiopulmonary bypass，CPB)模型。转流降低肛温至18℃以下，暂停循环1h后转流复温，肛温恢复到术前水平后脱离CPB，呼吸机辅助呼吸直至脱离呼吸机，观察大鼠的血流动力学指标及存活情况。结果显示8只大鼠均心脏自动复跳，能够脱离呼吸机，脱机后2h内血流动力学稳定。提示DHCA大鼠模型可成功建立，为探讨DHCA时的病理生理变化提供了新的手段。     

细菌性脑膜炎患儿脑脊液中兴奋性氨基酸的变化及意义

目的观察细菌性脑膜炎患儿脑脊液(CSF)中兴奋性氨基酸、谷氨酸(Glu)和天冬氨酸(Asp)含量的变化,探讨其在细菌性脑膜炎病理生理过程中的作用和临床意义。方法将符合诊断依据的细菌性脑膜炎患儿分为重度组和轻度组。所有患儿于入院当天应用抗生素治疗前做腰穿留取CSF进行常规、生化及细菌学检查。结果(1)细菌性脑膜炎患儿CSF中Glu、Asp含量高于对照组患儿。(2)重度组CSF中Glu、Asp含量高于轻度组。(3)抗生素治疗21d后,兴奋性氨基酸浓度有24例降低,有8例维持较高水平,临床症状较差。(4)细菌性脑膜炎患儿CSF中Glu、Asp含量与CSF中蛋白质浓度呈正相关,与葡萄糖浓度呈负相关。结论细菌性脑膜炎患儿脑脊液中Glu、Asp含量较对照组明显升高,测定CSF中兴奋性氨基酸浓度对细菌性脑膜炎病情严重程度及预后的判断具有指导意义。     

黄芩甙对新生鼠脑血肿继发脑水肿的治疗研究

目的　探讨黄芩甙对实验性新生大鼠脑血肿继发脑水肿的作用机制和治疗效果。方法　新生 7日龄健康SD大鼠 39只 ,随机分为 3组 :脑血肿组 ,黄芩甙组和对照组。脑血肿组和黄芩甙组采用自体血制作脑出血模型 ,3组大鼠均测定脑系数并用干湿法测脑组织水分 ,同时病理镜检观察脑出血组和黄芩甙组脑组织变化 ,并采用高效液相色谱 荧光法测定兴奋性氨基酸脑组织谷氨酸 (Glu)和抑制性氨基酸γ 氨基丁酸 (GABA)含量变化。结果　脑血肿形成后 ,脑系数和脑组织含水量均明显增加 ,黄芩甙组明显小于脑血肿组 (P <0 0 1) ,而黄芩甙组与对照组比较脑系数和脑组织含水量均变化不大 ;脑血肿组大鼠脑组织Glu含量显著高于对照组和黄芩甙 (P <0 0 1) ,而黄芩甙组和对照组Glu含量变化不大 (P >0 0 5 ) ;在脑血肿组大鼠GABA含量增加 (P <0 0 1) ,而黄芩甙组增加更明显 ,与对照组和脑血肿组比较均有显著性差异 (P <0 0 1)。结论　黄芩甙能减轻实验性脑血肿继发的脑水肿 ,黄芩甙对实验性脑血肿继发性脑水肿的保护作用可能与黄芩甙通过抑制兴奋性氨基酸 (EAA)大量释放 ,同时大量增加抑制性氨基酸以拮抗兴奋性氨基酸Glu的神经毒性作用有关。     

注意缺陷障碍儿童血清兴奋性和抑制性氨基酸的检测及分析

目的　通过检测注意缺陷障碍(ADHD)儿童血中兴奋/抑制性氨基酸代谢水平,探求它们与ADHD的关系及与心理行为的相关性。方法　采用反向高效液相色谱法,测定2 0 0 3年8月在上海第二军医大学附属长征医院随机抽取的5 8例注意缺陷障碍儿童(ADHD组:其中注意缺陷为主型2 2例;多动 冲动为主型4例;混合型32例)和30例健康对照儿童血清兴奋性氨基酸中的谷氨酸(Glu)、天冬氨酸(Asp)和抑制性氨基酸甘氨酸(Gly)的浓度并进行比较。结果　(1)ADHD组儿童血清兴奋性氨基酸Glu、Asp浓度分别为(16 9. 13±2 6 . 6 2 ) μmol/L和(2 9 .19±2 . 5 6 ) μmol/L ,显著低于对照组(P <0 .0 1) ,而抑制性氨基酸Gly浓度为(489. 78±96 . 2 6 ) μmol/L ,显著高于对照组(P <0 .0 5 )。(2 )不同类型ADHD儿童之间血清兴奋性和抑制性氨基酸浓度未见有统计学意义上的差异。(3)兴奋性和抑制性氨基酸浓度和DSM Ⅳ父母版所得各项分数之间无相关性。结论　ADHD儿童血清中存在兴奋/抑制性氨基酸的失调,此种失调可能参与了ADHD的病理生理过程。     

脉络宁对新生鼠缺氧缺血后大脑皮质兴奋性氨基酸和一氧化氮合酶的影响

目的研究新生SD鼠缺氧缺血(HI)后大脑皮质谷氨酸(GLU)和天冬氨酸(ASP)的变化,观察脑神经元一氧化氮合酶(NOS)的免疫活性表达,探讨脉络宁对HI性脑损伤(HIBD)的保护作用。方法结扎新生7日龄SD大鼠右侧颈总动脉1h(缺血1 h),吸入8%氧气和92%氮气2 h(缺氧2 h),建立HIBD模型。用色谱分析仪测定右侧大脑皮质内GLU和ASP含量,在透射电镜下观察假手术、HI及脉络宁注射液治疗组新生大鼠右侧大脑皮质神经元超微结构变化。结果HI后大脑皮质兴奋性氨基酸(EAA)水平升高,脉络宁治疗组大脑皮质EAA明显减少,HI后大脑皮质神经元超微结构损伤明显,脉络宁治疗组大脑皮质神经元的超微结构破坏轻微。结论脉络宁通过改善神经元功能,减少EAA释放,对神经元起保护作用。     

不同类型脑性瘫痪患儿脑脊液氨基酸变化

目的：目前对于脑瘫与脑内神经递质的关系研究很少,该研究通过测定不同类型脑瘫患儿脑脊液中谷氨酸、天冬氨酸、γ-氨基丁酸的含量,以了解不同类型脑瘫患儿脑脊液中氨基酸变化。方法：选取13例痉挛型脑瘫患儿、14例徐动型脑瘫患儿及同期已排除神经系统疾病和感染性疾病的10例手术患儿,分别设为痉挛组、徐动组和对照组。每1例均于手术麻醉前自腰椎3,4椎间隙穿刺取无血污脑脊液2 mL,取上清液用高效液相色谱-荧光法测定谷氨酸、天冬氨酸、γ-氨基丁酸含量。结果：①对照组脑脊液中γ-氨基丁酸、天冬氨酸、谷氨酸分别为13.04±2.19 μmol/L,10.21±0.45 μmol/L,8.41±2.26 μmol/L;与对照组比较,痉挛型脑瘫患儿脑脊液中γ-氨基丁酸显著降低为8.02±2.03 μmol/L,（P0.05）。②线性相关分析发现痉挛型脑瘫患儿脑脊液中谷氨酸的水平与肌张力呈等级正相关;γ-氨基丁酸和天冬氨酸的水平与肌张力无相关性。结论： 脑瘫患者脑脊液中兴奋性氨基酸含量较正常儿童增高,抑制性氨基酸含量较正常儿童降低,且不同类型脑脊液中氨基酸含量存在差异,氨基酸水平的改变可能是脑瘫患儿的病理改变的基础之一。     

中枢神经系统疾病患儿脑脊液兴奋性氨基酸的变化

用丹酰化反应聚酰胺薄层层析及荧光法测定１９例化脓性脑膜炎、６例病毒性脑炎、８例癫痛持续状态（ＳＥ）和２１例热性惊厥患儿脑脊液中２２种氨基酸成分。结果表明，与对照组相比，化脓性脑膜炎时１８种氨基酸显著升高，其中谷氢酸、天冬氢酸、丝氨酸及甘氨酸为兴奋性氢基酸。ＳＥ时谷氢酸、天冬氨酸、丝氨酸、赖氨酸及谷氨酞胺显著升高。病毒性脑炎时除谷氨酸不高外，余同ＳＥ。热性惊厥时只有天冬氨酸显著升高。抑制性氨基酸γ－氨基丁酸在各病组均无明显改变。提示在四种常见神经系统疾病时脑内存在兴奋毒性。     

在体微透析检测胆红素脑病模型鼠EAA神经递质

探讨胆红素神经毒性脑组织兴奋性氨基酸(EAA)神经递质变化.应用方法制作胆红素脑病动物模型基础上在体脑内微透析、提取神经突触间细胞外液,HPLC检测分析天冬氨酸(Asp)、谷氨酸(Glu)、甘氨酸(Gly).结果显示胆红素毒性脑组织细胞外Gly较对照组明显升高,而Asp、Glu与对照组差异不显著.因此,胆红素神经毒性NMDA受体活性变化机制涉及Gly细胞外堆积,提高NMDA受体对EAA神经递质Asp、Glu敏感性.     

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.