Viral Infections During Pregnancy:The Big Challenge Threatening Maternal and Fetal Health

Viral infections during pregnancy are associated with adverse pregnancy outcomes,including maternal and fetal mortality,pregnancy loss,premature labor,and congenital anomalies.Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens.Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns.Despite this,the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission,which was not fully understood until now.In this review,we summarize diverse aspects of the major viral infections relevant to pregnancy,including the characteristics of pathogenesis,related maternal-fetal complications,and the underlying molecular and cellular mechanisms of vertical transmission.We highlight the fundamental signatures of complex placental defense mechanisms,which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.     

新生儿疾病临床研究进展

1 新生儿缺氧缺血性脑病与脑损伤 新生儿脑损伤仍是引起新生儿死亡和伤残的重要原因,早期诊断和干预十分重要.在利用磁共振成像(MRI)判断新生儿脑损伤及预后评估方面,中国医科大学附属第二医院做了较多工作.     

儿童结节性硬化症合并左肾血管平滑肌脂肪瘤1例

病例资料:患者,女,14岁.主因间断腹痛20d,加重1周入院.查体:精神反应可,面部鼻唇沟区多发皮肤皮脂腺瘤,心肺正常,腹部稍胀,左上腹可扪及一8cm×10cm大肿物,压痛明显,边缘欠清晰,肾区叩击痛(+).     

发绀

发绀(cyanosis)是指血液中还原血红蛋白增多(>50g·L-1)或变性血红蛋白增多,使皮肤、黏膜呈青紫色.在皮肤薄、色素较少和毛细血管丰富的部位,如口唇、鼻尖、耳垂、颊部与甲床等处发绀较为明显,贫血时则不易发现.     

原发性肾病综合征患儿血清胆红素、尿酸水平与脂质代谢紊乱的关系

目的 探讨原发性肾病综合征(PNS)患儿血清胆红素、尿酸(UA)水平与脂质代谢紊乱的关系.方法 检测PNS患儿和健康儿童各50例血清总胆红素(TBIL)、结合胆红素(DBIL)、未结合胆红素(IBIL)、UA、脂蛋白a(LPa)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)及载脂蛋白B(ApoB)水平,并计算血脂综合指数.结果 1.肾病组UA、LPa、TC、TG、HDL.C、LDL-C、ApoB、TC/(HDL-C TBIL)和LDL-C/(HDL-C TBIL)明显高于健康对照组(Pа=0),而TBIL、DBIL和IBIL与健康对照组比较均无显著性差异(Pа>0.05);2.健康对照组血清胆红素、UA水平与血脂代谢无明显相关(Pа>0.05),而肾病组HDL-C与TBIL呈正相关(r=0.31 P=0.04),LDL-C分别与TBIL、IBIL呈负相关(r=-0.36 P=0.03,r=-0.33 P=0.04);3.肾病组UA分别与TBIL、IBIL呈正相关(r=0.37 P=0.02,r=0.45 P:0).结论 血清胆红素及UA水平变化对健康儿童血脂代谢不构成影响,但对PNS患儿,TBIL、IBIL降低,UA升高与脂质代谢紊乱密切相关.血脂综合指数可用于评价PNS患儿脂质代谢紊乱的严重程度及可能并发心血管疾病的危险性.     

小儿艾滋病58例

获得性免疫缺陷综合征(AIDS)即艾滋病是由人类免疫缺陷病毒(HIV)引起的严重危害人类健康的一种疾病。小儿患病自成人传播而来,1982年报道了首例儿童HIV感染后,此病在小儿的发生日益增多,治疗困难,预后极差。有关小儿AIDS报告尚少见,作者2005年2月至2007年2月在援赞比亚医疗队工     

新生儿阿托品中毒一例

患儿男,6 h,重度窒息复苏后呼吸急促6 h入院.患儿第1胎第1产,胎龄39周,顺产娩出,产前1 d发现孕母有严重高血压(BP 170/100 mm Hg),产时羊水、脐带、胎盘无异常,生时重度窒息,Apgar评分1 min 0分,5 min 5分,10 min 7分,15 min 8分,生后立即予以保暖,给氧,正压人工呼吸及药物纳洛酮、阿托品、ATP等措施,肤色好转后转当地镇卫生院继续治疗,因呼吸急促不缓解转入我院.     

肾盂输尿管连接部梗阻研究进展

肾盂输尿管连接部梗阻(UPJO)是肾积水的常见原因,多为先天发育异常、异位血管压迫、输尿管瓣膜、迂曲等.由于其发病隐匿,肾积水呈渐进性发展,难以在早期发现,患者多以间歇性或持续性腰部酸胀不适、腹部肿块,或体检发现肾积水而就诊,但常已有不同程度的肾功能损害.所以,如何早期预防及诊断,仍是当今重要的研究课题.     

哮喘、变应性鼻炎59例对尘螨变应原特异性免疫治疗的耐受性和不良反应

目的 了解哮喘和(或)变应性鼻炎患儿对尘螨变应原特异性免疫治疗(SIT)的耐受性和不良反应.方法 对2004年12月-2006年2月在育英儿童医院哮喘专科门诊就诊并诊断为哮喘和(或)变应性鼻炎的患儿59例,于治疗前测定其血清屋尘螨特异性lgE(sIgE)、粉尘螨sIgE,应用标准化屋尘螨提取液皮下注射进行特异性免疫治疗.观察每次免疫注射后不良反应的发生情况,同时在每次变应原注射前后30 min测定其呼气高峰流速(PEF).结果 尘螨sIT中59例患儿注射总次数为1 419例次,共发生全身不良反应20/1 419例次(1.41%),局部不良反应1 135/1 419例次(79.98%).患儿发生速发局部不良反应1 043/1 419例次(73.50%),11/59例(18.64%)共发生18/1 419例次(1.27%)速发全身不良反应,13/59例(22.03%)共发生92/1 419例次(6.48%)迟发局部不良反应,2/59例(3.39%)共发生2/1 419例次(0.14%)迟发全身不良反应.治疗中的PEF平均值总体呈上升趋势,剂量递增阶段PEF平均值上升较平缓,而注射第15次后PEF平均值上升迅速.注射第12次前,治疗前后30 min PEF平均值差距不大,而注射第12次后差距明显增大.48例无速发全身不良反应患儿与11例有速发全身不良反应患儿血清总IgE(TIgE)、屋尘螨aIgE、粉尘螨slgE比较.差异均有统计学意义,有速发全身不良反应患儿血清TIgE、屋尘螨sIrE、粉尘螨sIgE均明显高于无速发不良反应患儿(U=2.05,2.25,2.75 Pa<0.05).结论 哮喘和(或)变应性鼻炎患儿SIT是一种比较安全有效的办法.在起始治疗完成后,患儿平均PEF值增高明显,自觉症状开始改善.患儿治疗前血清TIgE、屋尘螨sIgE、粉尘螨sIgE值越高,在SIT治疗中发生速发全身不良反应的可能性越大.     

早产儿脑发育与脑损伤的影像学评价

毛健 博士Huppi教授在早产儿脑发育与脑损伤的MRI研究方面做了大量的工作，邹丽萍教授、姜玉武博士也对这一领域很感兴趣，此次以“上海国际儿科神经与精神论坛”的时机我们聚在一起，就早产儿脑发育与脑损伤的影像学评价，特别是MRI技术的应用进行讨论。     

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     

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.     

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.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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.     

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.     

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.