Research directions in augmentative and alternative communication for preschool children

Purpose: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). Method: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. Results: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. Conclusion: SAL is a viable communication intervention approach for young children.     

Stomal varices: a rare cause of stomal hemorrhage. A report of three cases

Stomal varices secondary to portal hypertension are a rare but potentially fatal cause of hemorrhage. Management, determined by the site of the bleeding, centers on preventing additional bleeds and may include providing local pressure, applying silver nitrate, injection sclerotherapy, suture ligation of the bleeding point, and/or the placement of transjugular intrahepatic portosystemic shunts and refashioning the stoma. Two patients (60- and 69-year-old women) had panproctocolectomy for inflammatory bowel disease and presented at the authors' hospital with bleeding from the ileostomy 1 and 19 years, respectively, following the creation of their stomas. A third patient (a 72-year-old man) bled from an end colostomy following an abdominoperineal resection for Duke's C rectal adenocarcinoma performed 3 years previous. All three patients had recurrent admissions for stomal bleeding and stomal varices secondary to portal hypertension and were initially treated with local measures (pressure, silver nitrate, and suture ligation). Two had undergone revision of their stomas prior to current treatment. One patient responded to local treatment but later died due to liver failure, one stopped bleeding after transjugular portosystemic shunt placement, and one died from metastatic cancer. Clinicians should maintain a high index of suspicion of stomal varices in patients with underlying liver disease who present with recurrent stomal bleeds and provide appropriate treatment to stop active bleeding and reduce portal venous pressure.     

Parents' and health-care workers' understanding of wheeze in children: a systematic review

Background

Parent-reported wheeze is often used as a proxy for childhood asthma. However, discordance in labelling of wheeze among parents and health-care workers (HCWs) affects true estimates of population wheeze. This systematic review aimed to summarise the evidence of parents' and HCWs' understanding of wheeze in children, and the relevant factors affecting this knowledge.

An ex vivo swine tracheal organ culture for the study of influenza infection

Background  The threat posed by swine influenza viruses with potential to transmit from pig populations to other hosts, including humans, requires the development of new experimental systems to study different aspects of influenza infection. Ex vivo organ culture (EVOC) systems have been successfully used in the study of both human and animal respiratory pathogens. Objectives  We aimed to develop an air interface EVOC using pig tracheas in the study of influenza infection demonstrating that tracheal explants can be effectively maintained in organ culture and support productive influenza infection. Methods  Tracheal explants were maintained in the air interface EVOC system for 7 days. Histological characteristics were analysed with different staining protocols and co‐ordinated ciliary movement on the epithelial surface was evaluated through a bead clearance assay. Explants were infected with a swine H1N1 influenza virus. Influenza infection of epithelial cells was confirmed by immunohistochemistry and viral replication was quantified by plaque assays and real‐time RT‐PCR. Results  Histological analysis and bead clearance assay showed that the tissue architecture of the explants was maintained for up to 7 days, while ciliary movement exhibited a gradual decrease after 4 days. Challenge with swine H1N1 influenza virus showed that the EVOC tracheal system shows histological changes consistent with in vivo influenza infection and supported productive viral replication over multiple cycles of infection. Conclusion  The air interface EVOC system using pig trachea described here constitutes a useful biological tool with a wide range of applications in the study of influenza infection.     

脐血干细胞和胎盘间充质干细胞在妇产科应用中的前景

目的:介绍脐血干细胞和胎盘间充质干细胞的研究进展,以及干细胞在妇产科中的应用前景。资料来源:应用计算机检索Medline1996-01/2006-12与脐血干细胞和胎盘间充质干细胞、以及干细胞在妇产科中的应用相关的文章,检索词为“human cord blood,mesenchy malstem cell,placenta,gene therapy in the uterus”,限定文献语种为“English”;同时检索万方数据库2000-01/2006-12相关文章,检索词为“脐血,间充质干细胞,胎盘,宫内治疗,卵巢癌,子宫癌”,限定文献语种为中文。资料选择:共检索到相关文献500余条,进一步查找全文,优先选择与临床应用靠近的文章,无论观察对象是人还是动物均纳入,筛除干细胞的提取、分化或培养等基础类研究,明显重复和综述文献也排除,最后纳入31条文献进行综述。资料提炼:31条文献中论述脐血干细胞和胎盘间充质干细胞的特点及应用文章有26篇,关于宫内移植干细胞治疗的文章有2篇,其他为研究干细胞在妇产科中应用的文章。资料综合:①大量实验证明脐血是骨髓、外周血后的第3种非常有潜力的造血干细胞资源。目前应用脐血移植治疗的疾病有急(慢)性白血病、恶性淋巴瘤、多发性骨髓瘤、再生障碍性贫血、严重免疫缺陷症等,而且已经有一定疗效。②胎盘作为胚胎发育中维系母体和胎儿氧气及营养物质交换的重要暂时性器官,无论从解剖结构还是在发育行为上,都包含了较为幼稚的胚胎及趋于成熟的成体干细胞成分,而且胎盘不会涉及伦理道德问题,目前已成为寻找人类间充质干细胞新来源及提高临床应用效果的研究热点。③干细胞宫内移植为先天性疾病治疗开辟了一条新途径。另外干细胞在器官再造、男性不育治疗和保存生育能力等生殖医学领域的研究也取得了重大进展,在妇科肿瘤方面,如以化疗保护为目标的基因治疗已逐步应用于临床。结论:脐血和胎盘取材方便、安全,还能避免免疫排斥和伦理问题,已成为人类间充质干细胞新来源。干细胞在宫内治疗、生殖疾病和妇科肿瘤方面也有广泛的临床应用前景。     

Quantitative,noninvasive assessment of antidiarrheal actions of codeine using an experimental model of diarrhea in man

Enteric coating of a capsule has been used to deliver a bolus of radioisotope to the ileocecal region. This has allowed quantitative assessment of regional colonic transit in a group of healthy subjects whose proximal colonic transit was accelerated by lactulose 20 ml thrice daily. In this experimental model of diarrhea, codeine delayed transit from mouth to terminal ileum and also delayed transit through the ascending colon from 5.3±2.5 hr to 7.4±2.5 hr,N=11,P<0.05. Furthermore, codeine delayed whole colon transit, as assessed by geometric center analysis, which showed the delay to be most marked in the right colon with little effect noted in the left colon. In addition, codeine significantly reduced the number of retrograde movements observed and reduced the colonic response to eating. The antidiarrheal effect of codeine appears to be due to a combination of delayed mouth-cecum transit plus an additional delay in the ascending colon. This colonic delay may be partially explained by a reduction in postprandial propulsive movements that were seen in this model of diarrhea.