大鼠实验性脑创伤挫伤灶内皮屏障抗原和Ⅳ型水通道蛋白免疫反应性的动态改变

目的研究实验性脑创伤中内皮细胞屏障的损伤修复以及与位于星形细胞足突的Ⅳ型水通道的关系。方法成年雄性SD大鼠32只,随机分入对照组,伤后1h组,4h组,1d组,3d组,6d组和11d组。在大鼠重度冲击加速性伤模型中,应用免疫组化法观察脑创伤灶中内皮屏障抗原(EBA)和Ⅳ型水通道蛋白(AQP4)免疫反应性在不同时点的动态改变。采用图像分析技术对挫伤病灶免疫反应性进行定量分析。结果在血脑屏障损伤的皮质挫伤灶,伤后1dAQP4和EBA免疫反应性明显消失,AQP4阴性反应区面积明显大于EBA阴性反应区(P<0.05)。伤后3d,EBA表达重新出现。伤后6d,EBA表达延伸至挫伤中心区,AQP4表达始见于边缘。伤后11d,二者免疫反应性基本恢复。结论挫伤灶血管源性水肿形成同时伴有内皮屏障功能和星形细胞足突水通道的改变。同一创伤强度下,星形细胞足突AQP4损伤范围较内皮EBA大,恢复较慢。     

A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy

This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I−III) were randomized to intervention (10wks therapeutic programme; 26 males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females; mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children's gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP.     

Bacterial endocarditis in a child presenting with acute arterial ischemic stroke: should thrombolytic therapy be absolutely contraindicated?

Thrombolysis is considered to be contraindicated in acute ischemic stroke secondary to infective endocarditis (IE). We report a 12-year-old female who presented with acute dense right hemiparesis and aphasia. Cranial magnetic resonance imaging and angiography showed multiple diffusion-restricted lesions in the left hemisphere and absence of flow in the left internal carotid artery. She was treated with intra-arterial tissue plasminogen activator within 6 hours of her presentation. Subsequently she was diagnosed with pneumococcal endocarditis and underwent debridement of vegetations and patch repair of the mitral valve. The patient did not have hemorrhagic complications following thrombolytic therapy or surgery. Pathological analysis of the mitral valve vegetations revealed mostly fibrin thrombus. Follow-up imaging showed complete recanalization of the left internal carotid artery, and the patient had a remarkable neurological recovery. This is the first case report of successful intra-arterial thrombolytic therapy in childhood IE-related stroke. We believe that thrombolytic therapy contributed to a favorable outcome in our patient and may be safe in selected patients with childhood IE-related acute ischemic stroke.     

Lipoprotein Alterations and Plasma Lipoprotein Lipase Reduction in Familial Hemophagocytic Lymphohistiocytosis

ABSTRACT. Serum lipid abnormalities are common in familial hemophagocytic lymphohistocytosis (FHL), a disorder also characterized by fever, hepatosplenomegaly, pancytopenia and a prominent lymphohistiocytic accumulation in the mononuclear phagocyte system. The lipoprotein pattern in nine children with FHL was studied with a quantitative method measuring cholesterol and triglycerides in each major class of lipoproteins. Triglycerides were markedly elevated during active FHL in serum, very low density lipoproteins, and low density lipoproteins. Cholesterol was increased in very low density lipoproteins whereas both triglycerides and cholesterol were extremely low in high density lipoproteins. These lipoprotein abnormalities, reversible on successful therapy, are compatible with a depressed lipolytic activity. Post-heparin levels of lipoprotein lipase and hepatic lipase in plasma were studied in four children and found to be markedly low during active FHL. We suggest that inflammatory cytokines, which may strongly suppress lipoprotein lipase activity, can be important mediators in the pathophysiology of FHL and that they may participate in the development of the lipid abnormalities.     

Evaluation of a Transcutaneous Oxygen and Carbon Dioxide Monitor in a Neonatal Intensive Care Department

Transcutaneous-Po₂; (tc-Po₂ (tc-Pco₂) at 44^oC and transcutaneous-Pco₂) at 38, 42, 43 and 44^oC were measured with a currently available monitoring system (TCM222, Radiometer, Copenhagen) in 64 newborn infants with severe respiratory insufficiency during the first five days of life. Tc-Pco₂ at all four temperatures correlated better with arterial blood-Pco₂ (aB-Pco₂)> than tc-Po₂ with aB-Po2. However, the sensitivity and specificity of tc-Po₂ and tc-Pco₂ were similar with regard to maintaining aB-Po₂, and aB-Pco₂ within specified limits. Tc-Pco₂ increased relatively with increasing electrode temperature by a factor which was similar to the anaerobic temperature coefficient of Po₂, in blood. The coefficient of variation of duplicate measurements was 10 % for tc-Po₂ and 5 % for tc-Pco₂. Electrode drift after an average of 3 hours patient monitoring was 2%±6% (1SD) for tc-Pco₂, and -3 %±6 % for tc-Pco₂- We conclude that tc-Po₂ and tc-Pco₂ are a valuable supplement to arterial blood gas measurements, but the variable correlation with arterial blood gas values and the electrode drifts which may occur, mean that they cannot fully replace arterial sampling.     

Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension

Summary. One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.     

THE INTERACTION BETWEEN THE INFANT AND THE ENVIRONMENT: THE IMPORTANCE OF MOTHER-CHILD CONTACT AFTER DELIVERY

Abstract. Birth is more than just the physical beginning of a new life — it is also the start of the psychosocial development of the newborn infant together with its family. Immediately after delivery parents and infants can start to exchange signals that maybe are of major importance for this development. The early post partum period has been regarded to have great potentials and especially the mother has been regarded to play a very powerful role, whereas the infant's contribution has been accorded little discussion. The individual reactive capacity of the newborn baby and its influence on the environment can be illustrated in a number of ways. In recent years studies of fetal movements have been made by means of ultra sound registration and it has been discussed whether these are precursors of later behavior in the neonate-infant. The transition at birth can be considered either to be continuous or discontinuous, the outcome of this discussion has great bearing on the importance of early neonate-environment interactions.
Short and long term outcome of different routine care procedures around the time of delivery and transition are controversial subjects. Although several studies support the importance of early post delivery interaction, other studies do not seem to find correlations between early experiences and later developmental outcome measurements. In this paper several of these aspects will be discussed, examples from the literature given and possible clinical applications suggested, as well as their impact on the care of healthy and sick newborns and their families.     

Salivary oestriol in normal and abnormal pregnancies

Summary. Profiles of daily salivary oestriol concentrations throughout the third trimester of pregnancy have been constructed for 14 normal and 11 abnormal pregnancies. Day-to-day variations were significantly higher than those reported for unconjugated oestriol in plasma or serum. A sustained decline in salivary oestriol concentrations was observed in one pregnancy in which intrauterine death occurred. Sustained falls were also observed in two pregnancies in which a healthy infant was born at term. In all other patients a normal salivary oestriol profile correlated with a favourable outcome. Salivary oestriol measurements provide similar information to plasma unconjugated oestriol measurements while offering the advantages of a simple, non-invasive sample collection procedure.