Pediatric intestinal transplantation

Advancements in donor management, organ preservation and operative techniques, as well as immunosuppressive therapies, have provided children with intestinal failure and its complications a chance not only for enteral autonomy but also long-term survival through intestinal transplantation (ITx). First described in the 1960’s, experience has grown in managing these complex patients both pre- and post-transplant. The goals of this review are to provide a brief history of intestinal transplantation and intestinal rehabilitation in pediatric patients, followed by focused discussions of the indications for ITx, induction and maintenance immunosuppression therapies, common post-operative complications, and outcomes/quality of life post-transplant.     

Placental tissue stem cells and their role in neonatal diseases

Neonatal diseases such as hypoxic ischemic encephalopathy, diseases of prematurity and congenital disorders carry increased morbidity and mortality. Despite technological advancements, their incidence remains largely unabated. Stem cell (SC) interventions are novel therapies in the neonatal world. In pre-clinical models of neonatal diseases, SC applications have shown encouraging results. SC sources vary, with the bone marrow being the most utilized. However, the ability to harvest bone marrow SCs from neonates is limited. Placental-tissue derived SCs (PTSCs), provide an alternative and highly attractive source. Human placentas, the cornerstone of fetal survival, are abundant with such cells. Comparing to adult pools, PTSCs exhibit increased potency, decreased immunogenicity and stronger anti-inflammatory effects. Several types of PTSCs have been identified, with mesenchymal stem cells being the most utilized population. This review will focus on PTSCs and their pre-clinical and clinical applications in neonatology.     

Low-dose FSH therapy for anovulatory infertility associated with polycystic ovary syndrome: rationale, results, reflections and refinements

Low-dose follicle stimulating hormone (FSH) regimens for induction of ovulation for women with polycystic ovaries have succeeded in reducing the rate of ovarian hyperstimulation syndrome (OHSS) almost to nil and the rate of multiple pregnancies to a minimum of 6%. This has been achieved by reaching, but not exceeding, the threshold level of FSH, starting with a daily dose of 75 IU for 14 days, using small incremental dose rises where necessary, and inducing uniovulation in 70% of cycles. Conception rates are as good, if not better, than those achieved with conventional therapy. The miscarriage rate is still relatively high (20-25%) and obese women fare worse. Serum oestradiol concentrations and the number of large and intermediate follicles on the day of human chorionic gonadotrophin administration are much lower, in parallel with lower serum FSH concentrations. Inhibin values increase with the rise in serum FSH concentrations but those of luteinizing hormone decrease steadily throughout the follicular phase. New data using recombinant hFSH (rhFSH), rather than urinary gonadotrophin as the ovarian stimulant, demonstrate that treatment time is shortened. However, the ideal regimen has still to be formulated.     

Turner's syndrome and pregnancies after oocyte donation

A total of 20 clinical pregnancies was achieved among 18 women with Turner's syndrome who were treated in an oocyte donation programme. The oocytes were donated by voluntary unpaid donors. A mean of 1.8 embryos per transfer was given to each recipient by way of 28 fresh and 25 frozen embryo transfers. With fresh and frozen embryos, 13 and seven pregnancies respectively were achieved. The clinical pregnancy rate per fresh embryo transfer was 46%, and the implantation rate 30%, being similar to the corresponding rates among our oocyte recipients with primary ovarian failure in general. The corresponding rates with frozen embryos were 28 and 19%. Of these pregnancies, 40% ended in miscarriage. This high rate may be explained by uterine factors. Six women were hypertensive during pregnancy, a rate comparable with that in other oocyte donation pregnancies. All these women delivered by Caesarean section. Pregnancy and implantation rates after oocyte donation were high in women with Turner's syndrome, but the risk of cardiovascular and other complications is high. Careful assessment before and during follow-up of pregnancy are important. Transfer of only one embryo at a time to avoid the additional complications caused by twin pregnancy is recommended.     

Oocyte quality and treatment outcome in intracytoplasmic sperm injection cycles of polycystic ovarian syndrome patients

Patients with polycystic ovarian syndrome (PCOS) have higher miscarriage rates. It is postulated that this is caused by a lower rate of mature oocytes, and a lower quality of embryos. Retrospectively we analysed 51 intracytoplasmic sperm injection (ICSI) cycles of 31 PCOS patients. These data were compared to age-matched controls (105 cycles) during the same period. All patients of both groups received gonadotrophin-releasing hormone (GnRH) agonists prior to gonadotrophin treatment. The rate of metaphase II oocytes (MII) was not different. However, the mean absolute number of normally fertilized oocytes was significantly higher in PCOS patients (5.00 versus 3.56, P < 0.01), due to a higher number of oocytes retrieved. More embryos were transferred by cycle in the PCOS group (2.69 versus 2.17, P < 0.05), with a higher cumulative embryo score. The overall and multiple pregnancy rate showed no differences and the clinical abortion rate was lower (21 versus 41.67%, P < 0.05) in the controls. Our findings demonstrate that negative factors unconnected to oocyte morphology must be present in PCOS patients. It is possible that only cytoplasmic, not nuclear, maturity is influenced in these patients.     

右侧房室旁道的射频消融治疗

目的：报道２０例右侧房室折返性心动过速（ＡＶＲＴ）的射频消融疗效和体会。　方法：２０例ＡＶＲＴ患者,其中显性右侧旁路１５例,隐匿性右侧旁路５ 例,均给予射频消融治疗。　结果：１５ 例右侧显性旁道１３例消融成功,其中复发１例,再次消融成功;５ 例隐匿性旁路全部消融成功,消融成功率为９０％ ,无并发症。　结论：射频消融是一种治疗右侧ＡＶＲＴ安全而有效的方法。     

κ阿片受体介导100 Hz电针对吗啡戒断大鼠心动过速的缓解作用

目的：研究１００Ｈｚ电针缓解吗啡戒断大鼠心动过速的受体机制。方法：在吗啡戒断１８～２４ｈ的大鼠模型上,腹腔注射阿片受体拮抗剂纳络酮（ｎａｌｏｘｏｎｅ,ＮＸ）或侧脑室注射κ阿片受体拮抗剂ｎｏｒｂｉｎａｌｔｏｒｐｈｉｍｉｎｅ（ｎｏｒＢＮＩ）,给予１００Ｈｚ电针刺激,记录吗啡戒断大鼠清醒状态下的心率和血压。结果：１００Ｈｚ电针的作用可被腹腔注射ＮＸ１ｍｇ·ｋｇ－１完全翻转、被侧脑室注射ＮｏｒＢＮＩ１２ｎｍｏｌ完全阻断。结论：１００Ｈｚ电针抑制吗啡戒断大鼠心动过速的作用主要是通过中枢κ阿片受体介导的。     

开肺化痰解毒法治疗小儿病毒性肺炎痰热壅肺证临床观察

目的：应用开肺化痰解毒活血的清肺口服液方治疗小儿病毒性肺炎痰热壅肺证。方法：观察治疗组用清肺口服液（麻黄、杏仁、石膏、葶苈子、虎杖等）;对照组辨证用药加用头孢菌素Ｖ等抗生素,２组对照观察。结果：观察组显效率及有效率分别为８６．７％和９６．７％,同中药辨证加西药抗生素的对照组相比,疗效无显著性差异。观察组的咳嗽咯痰好转时间为（６．９０±２．０６）ｄ,显著短于对照组的（９．９３±２．９３）ｄ（Ｐ＜０．０５）;观察组治疗后的甲皱微循环总积分为０．５１±０．３９,显著小于对照组的１．８３±１．１９（Ｐ＜０．０１）。结论：清肺口服液方治疗小儿病毒性肺炎痰热壅肺证具有肯定的疗效。     

慢性肾功能衰竭中医证型标准化研究探讨

本文对２次全国性慢性肾衰中医辨证分型标准进行了分析和总结,并按现行慢性肾衰辨证分型方案对４４４例患者进行证候学研究,列出了慢性肾衰中出现率高且具有鉴别诊断价值的症状及体征,并发现慢性肾衰尿毒症患者其气血阴阳虚损的积分值明显高于其它各期,提出现行方案的不足之处及有待改进的探讨意见