益生菌和酸奶对乳糖不耐受者的作用研究

目的:研究益生菌和酸奶对乳糖不耐症(lactoseintolerance,LI)者的作用及其机制。方法:以经乳糖负荷试验筛选的乳糖不耐受者11名为对象,持续摄入益生菌(含B.longum)和酸奶(含L.bulgaricus,S.thermophilus,B.animalis)14d进行补充研究。试验分3个阶段,第1阶段为基值阶段1w,第2阶段为补充阶段2w,第3阶段为补充后阶段1w。在第2阶段前后1d分别进行双标稳定同位素13C-lactose/2H-glucose负荷试验,分析受试者摄入底物后6h呼气H2浓度值,以及血浆13C-glucose和2H-glucose浓度,并计算乳糖消化指数(lactosedigestionindex,LDI),乳糖消化量和口—结肠转运时间(orocecaltransittime,OCTT)。整个实验期间共收集5次粪便样本,分析β-半乳糖苷酶活性。结果:在第2阶段补充结束后个体LI症状评分显著低于补充前(7.09±5.50vs16.09±10.03,P<0.05);LDI、乳糖消化量、OCTT和各时间点呼气H2浓度在补充前后无显著性改变;粪便β-半乳糖苷酶活性在补充第1w即开始升高,补充第2w显著高于基值(147.6±165.8IUvs77.3±77.2IU,P<0.05)。结论:持续摄入益生菌和酸奶具有明显改善乳糖不耐受症状的作用,其原因可能与结肠β-半乳糖苷酶活性的增加有关。     

Poliomyelitis-like illness after acute asthma

Two children had pain in one arm, followed by weakness and wasting, after an acute exacerbation of bronchial asthma. Similar cases in which a poliomyelitis-like illness was associated with acute asthma have been reported, but the relationship between the two remains conjectural.     

24-Hour urinary glucose excretion in assessment of control in juvenile diabetes mellitus

24-Hour urinary glucose excretion was measured in 43 juvenile diabetics during treatment as outpatients. In 20 children studied twice over 1-3 months there was good correlation between glucose excretion on each occasion. Subdivision of the collections into the periods 08 therefore 00-20 therefore 00 and 20 therefore 00-08 therefore 00 hours gave slightly less consistent results with correlation coefficients of 0 therefore 83 and 0 therefore 80, respectively, between the results of the repeat tests. In 37 prepubertal children, 24-hour glucose concentration and height velocity over the previous year were compared, and a highly significant negative correlation found. 10 of the 12 children with glucose excretion greater than 40 g/d had height velocities more than 1 SD below the mean for age, while only 2 of the 25 subjects excreting less than 40 g/d had height velocities more than 1 SD below the mean. The results indicate that estimation of 24-hour urine glucose excretion can be a useful index for monitoring treatment and that subdivision of the total collection may be of value in selecting the most suitable insulin regimen for the patient.     

Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation

OBJECTIVES: To investigate outcome, management, and prevention in Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. DESIGN: Ascertainment through British Paediatric Surveillance Unit and questionnaires to responding paediatricians. SETTING: The UK and Republic of Ireland, September 1992 to August 1994. SUBJECTS: Children under 14 years diagnosed with the above. MAIN OUTCOME MEASURES: Placement and child protection measures for victims and siblings; morbidity and reabuse rates for victims; abuse of siblings; prosecution of perpetrators. RESULTS: Outcome data for 119 with median follow up of 24 months (range 12 to 44 months). No previously diagnosed factitious disease was found to have been caused by genuine disease. Forty six children were allowed home without conditions at follow up. Children who had suffered from suffocation, non-accidental poisoning, direct harm, and those under 5 years were less likely to go home. Twenty seven (24%) children still had symptoms or signs as a result of the abuse at follow up; 108/120 were originally on a child protection register and 35/111 at follow up. Twenty nine per cent (34/118) of the perpetrators had been prosecuted and most convicted; 17% of the milder cases of Munchausen syndrome by proxy allowed home were reabused. Evidence in siblings suggests that in 50% of families with a suffocated child and 40% with non-accidental poisoning there would be further abuse, some fatal. CONCLUSIONS: This type of abuse is severe with high mortality, morbidity, family disruption, reabuse, and harm to siblings. A very cautious approach for child protection with reintroduction to home only if circumstances are especially favourable is advised. Paediatric follow up by an expert in child protection should also occur.     

Sleeping position for infants and cot death in The Netherlands 1985-91

Until the early 1970s the traditional sleeping position for Dutch infants was not prone. After a much publicised lecture in October 1987 on the possible relation between sleeping prone and cot death, the fairly new habit of placing infants prone is being replaced by more traditional positions. The decrease in the prevalence of the prone sleeping position has been documented in six studies. Since 1987 the incidence of registered cot deaths has decreased from 1.04/1000 live births in 1986 to 0.44 in 1991; the real decrease of sudden unexpected death in infancy, however, is greater.     

A survey of basic resuscitation knowledge among resident paediatricians

A telephone questionnaire was undertaken to evaluate the knowledge of resident paediatricians on the subject of the basic resuscitation of the acutely sick child. The questionnaire was targeted at 88 resident paediatricians in hospitals accepting paediatric emergencies in four health regions. Outcome was measured as a correct response to questions based on several emergency scenarios and on the confidence expressed of basic resuscitation knowledge. The subject of emergency management of the child with a compromised upper airway was poorly answered with 40/73 (55%) resident paediatricians suggesting an incorrect endotracheal tube size for an 8 year old child. Fluid management was also deemed unsatisfactory with only 36/73 (49%) providing adequate transfusion secondary to haemorrhagic shock. In addition only 19/73 (26%) mentioned the intraosseous route as a means of obtaining vascular access in a child in extremis. Confidence of the knowledge of basic resuscitation of children was low among resident paediatricians with only 30/73 (41%) expressing confidence and 69/73 (94%) expressing a desire for more formal training in paediatric resuscitation. Resident paediatricians are usually the key personnel in the management of very sick children. This survey demonstrates a low level of basic resuscitation knowledge among resident paediatricians of all grades that must be remedied at a local and national level.     

Psychological response to growth hormone treatment in short normal children

Indian childhood cirrhosis (ICC) is an almost uniformly fatal disease whose outcome may be modified with penicillamine if given at a sufficiently early stage. Twenty nine children with ICC seen in Pune, India, in 1980-7, who had survived at least five years from onset of penicillamine treatment, were reviewed aged 6.3 to 13 years. They were assessed clinically, biochemically, histologically, and by duplex Doppler ultrasound examination. None had symptoms suggestive of liver disease. There were no toxic effects of penicillamine other than asymptomatic proteinuria. Hepatosplenomegaly reduced significantly and liver function tests returned to normal in all. In four children, significant hepatosplenomegaly was associated with an abnormal duplex Doppler hepatic vein flow pattern and micronodular cirrhosis on biopsy. Clinical findings, growth and development, and ultrasound examination were normal in the remainder. Review of serial liver biopsy specimens showed a sequence of recovery from ICC through inactive micronodular cirrhosis to virtually normal histological appearances. The four children who still have micronodular cirrhosis beyond four years from onset remain on penicillamine treatment. In the others penicillamine was stopped after 1-7 (mean 3.5) years without relapse, strong evidence that ICC is not due to an inborn error of copper metabolism.     

The bile ducts after a fatty meal: further sonographic observations

The sonographic appearance of the response of the common hepatic duct to physiologic stimulation by a fatty meal was assessed in 131 patients referred because of right upper quadrant symptoms or abnormal liver chemical studies. In the determination of the presence or absence of biliary obstruction, the sensitivity of the examination was 84%, the accuracy of a positive test was 84%, and the accuracy of a negative test was 93%. This test proved helpful in several circumstances: equivocal duct caliber (6-10 mm); abnormal caliber (6-14 mm) with normal laboratory values; normal caliber duct with abnormal laboratory values; persistent question of cholelithiasis or asymptomatic pancreatic duct dilatation. Measurements of bile duct caliber alone may be insufficient to ascertain the presence of bile duct obstruction and fatty meal stimulation significantly improves diagnostic accuracy.     

Impairment-targeted exercises for older adults with knee pain: protocol for a proof-of-principle study

Background  

Exercise therapy for knee pain and osteoarthritis remains a key element of conservative treatment, recommended in clinical guidelines. Yet systematic reviews point to only modest benefits from exercise interventions.