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.     

新生儿肠系膜上动脉综合征二例

例1:患儿女,16 d,因呕吐6 d入院.呕吐发生在喂奶1 h后,每日呕吐4～9次,量较多,为奶汁和黄色胆汁样物质,无腹胀、腹泻,呕吐后饥饿感明显.入院查体:生命体征平稳,体重2 950 g(出生体重3 200 g),腹软、肝脾无肿大、肠鸣正常,心肺、神经系统及其他均无异常.     

出血性休克与脑病综合征4例

1 临床资料 例1,男,9个月,因发热40℃,呕吐、腹泻2d,抽搐12h,收住本院内科病房.查体:嗜睡,面色苍白,反复抽搐,呼吸急促,轻度腹胀;血常规无异常,CRP52mg/L大便黄稀.     

胸腺增生致上腔静脉压迫综合征1例

1 临床资料 患儿,女,9个月,因右眼肿胀4 d,右面部肿胀3 d,右胸壁肿胀0.5 d入院.4 d前患儿被玩具撞伤右眼角处,开始出现右眼睑肿胀、淤血,到本院眼科就诊,诊断:右眼外伤.予局部处理,肿胀逐渐消退.     

深圳地区2004-2006年儿童腹泻病病原体分布情况

目的 探讨深圳地区2004-2006年儿童腹泻病病原体分布情况.方法 收集深圳地区2004年1月-2005年4月腹泻病患儿粪便标本,采用ELISA法检测轮状病毒(RV),2005年5月-2006年12月采用胶体金法检测RV.真菌性腹泻以40倍高倍镜下同时可见菌丝和孢子为实验诊断标准.阿米巴性腹泻以见溶组织内活动性阿米巴原虫(滋养体或包囊)为实验诊断标准.细菌性腹泻(菌痢)以40倍高倍镜下WBC( )以上,同时可见RBC为实验诊断标准.不确定性腹泻为排除以上4种腹泻外的腹泻.结果 RV腹泻主要发生在10月至次年2月,但夏季6-7月也有一个小高峰,共占40.49%;真菌性腹泻无明显季节性,占3.59%;细菌性腹泻明显在每年的6-9月高发,占39.67%;阿米巴性腹泻仅检测到10例,除1例是春末检测出来外,余皆在夏季检出,占0.03%;不确定性腹泻主要发生在12月至次年的3月,占16.24%.腹泻最高发年龄为＞1～2岁,占24.83%(8 287/33 382例),≤6个月组为最低发年龄组,占6.65%(2 217/33 382例).结论 婴幼儿腹泻种类出现明显的感染交叉性、季节交叉性的特点,具有一定的复杂多样性.加强饮食与环境卫生,切断传播途径,提高儿童主动免疫水平是预防急性腹泻的重要环节.     

褪黑素对哮喘大鼠CD4+CD25+调节性T细胞的影响及抗感染作用

目的 探讨褪黑素(MT)对哮喘大鼠CD4 CD25 调节性T细胞(CD4 CD25 Tr)的影响及抗感染作用.方法 SPF级SD大鼠32只随机分成4组,每组8只.哮喘组:造模第1、7天,大鼠腹腔注射卵清蛋白(OVA)和氢氧化铝混悬液体,第14天,用10g/L的OVA溶液对大鼠进行雾化激发,1次/d,20min/次,连续7d;MT组:致敏、诱导哮喘方法同哮喘组,在每次激发前30min,腹腔注射MT0.1mg/kg;地塞米松组:致敏、诱导哮喘方法同哮喘组,在每次激发前30min,腹腔无菌注射地塞米松0.5mg/kg;对照组:注射、雾化方法同哮喘组,以9g/L盐水替代OVA和氢氧化铝致敏液及雾化液.各组于最后1次雾化激发后取其外周血涂片染色,计数其外周血嗜酸性粒细胞(EOS)百分比;收集其肺泡灌洗液(BALF),计数其炎性细胞总数;制作肺组织石蜡切片,HE染色计数其呼吸道周围EOS数目;用免疫增强浊度法检测其血清IgE水平;用流式细胞术检测其外周血CD4 CD25 Tr水平.采用SPSS 10.0软件进行统计学分析.结果 哮喘组外周血CD4 CD25 Tr/CD4 T细胞值与呼吸道周围EOS细胞数呈高度负相关(r=-0.73 P<0.05),与BALF细胞总数亦呈高度负相关(r=-0.78 P<0.05),与血清IgE水平未见显著相关.CD4 CD25 Tr/CD4 T细胞值哮喘组显著高于其他各组(Pa<0.01),其他3组比较,差异无统计学意义(Pa>0.05).MT组呼吸道周围EOS计数、外周血EOS比例、BALF细胞总数及IgE水平显著低于哮喘组(Pa<0.01).结论 CD4 CD25 Tr参与哮喘的发病.MT能显著降低哮喘大鼠CD4 CD25 Tr的数目,对哮喘大鼠CD4 CD25 Tr的调节作用与地塞米松相当,可有效减轻哮喘大鼠呼吸道炎性反应和血清IgE上升水平.     

腹腔镜Palomo手术治疗精索静脉曲张的疗效

目的 通过与儿童精索静脉曲张精索内静脉结扎术比较,探讨儿童精索静脉曲张腹腔镜Palomo手术治疗的效果.方法 收集2000年1月-2007年6月本院收治的8～15岁儿童精索静脉曲张64例(65侧,其中1例为双侧),精索静脉曲张的诊断依据为一般检查能摸到静脉曲张团块, Valsalva试验团块增大,外观血管显露.采用精索内静脉结扎术治疗29例(常规手术组,29侧),平均10.8岁, Valsalva平均分度2.6度;腹腔镜Palomo手术治疗35例(腹腔镜组,36侧),平均12.1岁, Valsalva平均分度2.6度,比较二组患儿手术时间、住院时间、复发率、并发症发生率及术后异常率(复发加并发),以评价二组手术疗效.采用SPSS 11.0软件进行t检验和X2检验.结果 腹腔镜组的平均住院时间(2.7d)与常规手术组比较(5.5d)有统计学差异(P<0.05),腹腔镜组并发症发生率(2.8%)与常规手术组比较(17.2%)有统计学差异(P<0.05).手术时间(腹腔镜组平均37min,常规手术组平均33min)、复发率(腹腔镜组2.8%,常规手术组6.9%),二组间比较均无统计学差异(Pа>0.05).患儿术后异常率(复发加并发)腹腔镜组(5.6%)低于常规手术组(24.1%),二组比较有统计学差异(P<0.05).结论 腹腔镜Palomo手术治疗儿童精索静脉曲张的疗效优于精索内静脉结扎术,并且该手术方法简单易掌握.     

婴幼儿进食行为异常的临床评估和干预

目的 对婴幼儿单纯性进食行为异常进行临床评估和有效干预.方法 采用进食行为评估、体格测量、膳食分析、多元回归分析等评估77例上海市6个月～3岁婴幼儿的异常进食行为,分析异常进食行为与婴幼儿膳食能最摄入的相关性;对其中47例婴幼儿完成了为期3个月的综合干预,并对干预前后的婴幼儿膳食及生长状况进行对比分析.采用SPSS 10.0软件进行统计学处理.结果 在评估的婴幼儿中最常见的3位异常进食行为是进餐时间不固定[36/77例(46.8%)]、挑食[34/77例(44.2%)]、进餐位置不固定[34/77例(44.2%)].72.7%进食行为异常婴幼儿的膳食能量摄入不足,少部分婴幼儿有生长落后;而与膳食能量摄入不足相关的异常进食行为依次为:进餐时间不固定、挑食、拒绝新食物、进餐位置不固定.经干预后,婴幼儿的膳食能量摄入有明显增加(P<0.01),体质量和身长增长加快,按年龄体质量和按身长体质量的Z-score均明显较干预前改善(Pа<0.01).结论 上海婴幼儿的异常进食行为有其本身的特点,异常进食行为可造成膳食能量摄入不足而影响体格生长,针对性的综合措施可以进行有效干预.     

儿童结核性脑膜炎的诊断和治疗

结核性脑膜炎是严重威胁儿童生命健康的神经系统感染性疾病.在小儿肺外结核病中结核性脑膜炎是最常见的,尽管目前开展了足量的化疗,结核性脑膜炎仍有高发病率和病死率的特点.虽然近年来研究者从细菌学、分子生物学及免疫学等方面对小儿结核性脑膜炎的诊断进行了研究,但均末获得突破性进展,对小儿结核性脑膜炎的诊断仍依靠综合分析患儿的临床特点以及通过辅助检查的结果判断.早期及时诊断和完善的治疗是降低结核性脑膜炎病死率及后遗症发生率的关键.     

新生儿惊厥的处理

惊厥是新生儿期常见急症之一,是中枢神经系统或全身性多种疾病的一个症状,是提示脑损伤可能恶化的指标.反复惊厥可影响新生儿脑的发育,产生后遗症.对惊厥患儿,应立即给予紧急处理,同时积极查找病因.     

The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus

Solid-organ transplantation is the optimal long-term treatment for most patients with end-stage organ failure. After solid-organ transplantation, short-term graft survival significantly improved (1). However, due to chronic allograft nephropathy and death with functioning graft, long-term survival has not prolonged remarkably (2). Posttransplant immunosuppressive medications consist of one of the calcineurin inhibitors in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroids. All of them have different adverse effects, among which posttransplant diabetes mellitus (PTDM) is an independent risk factor for cardiovascular (CV) events and infections causing the death of many transplant patients and it may directly contribute to graft failure (3). According to the criteria of the American Diabetes Association (4), diabetes mellitus (DM) is defined by symptoms of diabetes (polyuria and polydipsia and weight loss) plus casual plasma glucose concentration ≥ 11.1 mmol/L or fasting plasma glucose (FPG) ≥ 7.0 mmol/L or 2-h plasma glucose level ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). This metabolic disorder occurring as a complication of organ transplantation has been recognized for many years. PTDM, which is a combination of decreased insulin secretion and increased insulin resistance, develops in 4.9/15.9% of liver transplant patients, in 4.7/11.5% of kidney recipients, and in 15/17.5% of heart and lung transplants [cyclosporine A (CyA)/tacrolimus (Tac)-based regimen, respectively] (5). Risk factors of PTDM can be divided into non-modifiable and modifiable ones (6), among which the most prominent is the immunosuppressive therapy being responsible for 74% of PTDM development (7). Emphasizing the importance of the PTDM, numerous studies have determined the long-term outcome. On the basis of these studies, graft and patient survival is tendentiously (8) or significantly (9, 10) decreased for those developing PTDM.     

GENETICS OF CARNEY COMPLEX AND RELATED FAMILIAL LENTIGINOSES, AND OTHER MULTIPLE TUMOR SYNDROMES

Carney complex is a multiple endocrine neoplasia (MEN) syndrome that affects the adrenal cortex, the pituitary and thyroid glands, and the gonads. The complex is also associated with skin and mucosa pigmentation abnormalities and myxoid and other neoplasms of mesenchymal and neural crest origin. Thus, this syndrome also belongs to another group of genetic disorders, the lentiginoses (or lentigenoses), which include the Peutz-Jeghers, LEOPARD, arterial dissections and lentiginosis, and Laugier-Hunziker syndromes, Cowden disease and Ruvalcaba-Myhre-Smith (Bannayan-Zonana) syndrome and the centrofacial, benign patterned and segmental lentiginoses, all of which can be associated with a variety of developmental defects. The inheritance of Carney complex, just like that of the other MENs and the lentiginoses, is autosomal dominant. Genetic loci or genes have been identified for Carney complex, Peutz-Jeghers and Ruvalcaba-Myhre-Smith syndromes, but not for other lentiginoses. Elucidation of the molecular defects responsible for these disorders is expected to shed light on aspects of early neural crest differentiation, the regulation of pigmentation, the development of autonomous endocrine function, and endocrine and nonendocrine tumorigenesis.     

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.     

All you ever wanted to know about infant formulas (but were afraid to ask)

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 health care professionals) will experiment with the infant formula available and often 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.     

Differential effects of inhaled budesonide on serum osteocalcin in children and adolescents with asthma

In recent years, measurement of serum osteocalcin has been introduced for assessment of bone turnover in patients treated with exogeneous glucocorticoids. Studies in children with asthma on inhaled glucocorticoids, however, have shown inconsistent results. The aim of the present study is to assess bone turnover in prepubertal children and in adolescents with asthma treated with inhaled budesonide using three different osteocalcin assays: the Pharmacia Osteocalcin CAP FEIA, the CIS OSTK-PR and CIS IRMA ELSA-OSTEO assays. Two studies were conducted: 1) a randomised double blind two-period crossover study of 22 prepubertal children aged 5-12 years. In one period 800 μg budesonide was given once in the morning, in the other 400 μg was given twice daily; 2) a randomised double blind placebo controlled two period crossover study of inhaled budesonide 400 μg twice daily in fourteen 13-16 year old adolescents with pubertal stages II-V. In both studies, treatment periods were of four weeks duration, and blood samples were collected at the last day of each period. In the prepubertal children none of the osteocalcin assays detected any statistically significant differences between any of the periods. In the adolescent group reduced levels of osteocalcin were seen during budesonide treatment. The suppression reached statistical significance with the CAP FEIA (P = 0.03) and the OSTK-PR (P =0.01) assays, but not with the ELSA-OSTEO assay (P = 0.06). Correlation analyses showed statistically significant correlation coefficients varying between 0.58 and 0.91 (P=0.03 and P < 0.0001, respectively). The effect of inhaled glucocorticoids on serum osteocalcin may depend on the assay applied, and inhaled glucocorticoids have differential effects in children and adolescents.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.     

Représentations émotionnelles de la maladie chez 22 enfants drépanocytaires

Background

The emotional and psychological impact of chronical disease among children is considerable. The aim of this study was to explore the emotional representations of sickle cell children followed up at Bordeaux University Hospital in both qualitative and quantitative ways.

Methods

Prospective observational study, conducted from February to May 2010 among 22 sickle cell children (SS, SC and Sβ) followed at Bordeaux University Hospital and among their parents. A questionnaire evaluating depressive symptoms and emotional representations was proposed to children and to their parents separately, measuring their child's emotions. Children were asked to draw themselves during sickle cell crisis and without any painful episode, in order to illustrate their perception of their disease.

Results

Emotional and psychological impact on sickle cell children was important in this study. Eighty-six percent of children have commonly had negative feelings such as sadness, anger or fear. Thirty-six percent of them had depressive symptoms. Parents largely underestimated this impact. Drawings and answers to the questionnaire emphasized an important lack of disease understanding, social consequences, and depressive affects.

Conclusion

Psychological and emotional difficulties in sickle cell children should be identified and supported. Resources for psychological and educational support are necessary to improve the quality of life of sickle cell patients in France.     

Limiting light-induced lipid peroxidation and vitamin loss in infant parenteral nutrition by adding multivitamin preparations to Intralipid

Parenteral lipids are susceptible to light-induced peroxidation, particularly under phototherapy. Ascorbic acid is protective. The aim of this study was to investigate whether dark delivery tubing and/or coadministration of multivitamin preparations could prevent peroxidation of Intralipid without undue vitamin loss. In experiments carried out on the benchtop, lipid peroxidation occurred in ambient light and was more extensive under phototherapy. Dark tubing decreased peroxide formation, but only by about 65%. In simulated clinical conditions in which solutions were pumped through standard clear or dark minibore plastic tubing, Intralipid accumulated lipid peroxides as measured by the FOX assay (280 µM) or as triglyceride hydroperoxides (52 µM). Multivitamin preparations (MVIP or completely, and were fully protective when used with dark tubing. There was loss of riboflavin (65% from Soluvit and 35% from MVIP) in clear tubing but this was decreased to 18% and 11%, respectively, in dark tubing. Ascorbate loss was 20% (MVIP) and 50% (Soluvit) and only slightly less in dark tubing. Ascorbate loss was also seen in the absence of Intralipid and is due to riboflavin-induced photo-oxidation.Conclusion: Multivitamin preparations protect Intralipid against light-induced formation of lipid hydroperoxides, and administering multivitamins with Intralipid via dark delivery tubing provides a practical way of preventing peroxidation of the lipid while limiting vitamin loss. This procedure should be considered for routine use as well as with phototherapy. Soluvit/Vitlipid) inhibited peroxide formation almost     

SociaBillyQuizz,un jeu pour l’entraînement aux habiletés sociales chez l’enfant et l’adolescent : étude exploratoire

Background

The SociaBillyQuizz is a therapeutic game designed for social skills training groups with children and adolescents. Using an entertaining method, this media requests several dimensions: exposure, cognition, communication skills, imagination, emotional expression and sign decoding. In this preliminary study, the setting includes two groups of six adolescents, one with social anxiety disorder and the other with Asperger syndrome.

Objective

To evaluate, in an exploratory study, the effects of a therapeutic device involving this game for these two clinically different groups of adolescents.

Methods

During 26 of 1 hour weekly sessions, two adolescents groups participate to a program including the SociaBillyQuizz and cognitive behavioral therapies. The groups are moderated by two therapists. The SociaBillyQuizz is a board game for two to six players; its goal is to collect points by answering instructions from the different thematic cards. There are four thematic cards: action cards (players have to do something), brainstorming cards (players have to use their imagination and demonstrate cognitive flexibility), interview cards (players have to express themselves about what they think or feel) and mystery cards (unexpected instructions). According to the groups’ clinical characteristics, some aims are specifically highlighted. In the anxiety disorder group, the cognitive dimension is privileged and in the Asperger syndrome group, we emphasise the pretend, cognitive flexibility and theory of mind. The effects are measured by the Rathus Assertiveness Schedule and the Fear Avoidance Hierarchy (FAH) for the social anxiety disorder group and by the Faux Pas Recognition Test and the Social Responsiveness Scale (parent version) for the Asperger group.

Results

These assessment tools indicate, for both groups, a significant increase of the scores corroborating the observed clinical effects. For eleven of the twelve adolescents, a clinical interview 6 months after the retest shows a continuity of therapeutic benefit.

Discussion

These early results suggest that a social skills training device featuring the SociaBillyQuizz produces clinical improvements in these two groups of adolescents. In future researches, with control group and more complete follow-up, nature and effectiveness of its contribution should be specified.

Conclusion

In this preliminary study, the SociaBillyQuizz appears to be an interesting therapeutic tool that can increase implication, motivation, participation and cohesiveness of the group. It also makes easier the cognitive-behavioural-strategies learning.     

Les effets de l’incarcération chez les mineurs

Aim of this study

In this article we wish to question the effects of incarceration on minors. The history of prison reveals that it is the work of a humanist and philanthropic discourse that ensued from the effects of revolutionary ideas. However, from the moment of its reform – that transformed it from a place of confinement to a penal institution – it has only demonstrated its dysfunctional aspect. Our objective is to initiate a reflection on the effects of incarceration, whether it be collective or individual and in particular when it involves adolescents.