Special management of insulin lispro in continuous subcutaneous insulin infusion in young diabetic children: a randomized cross-over study

OBJECTIVE: To compare the safety, efficacy and management of insulin lispro (LP) with regular human insulin (RH) in young diabetic children treated with continuous subcutaneous insulin infusion (CSII). STUDY DESIGN: 27 very young diabetic children (age 4.6 +/- 2.2 years) treated with CSII participated in an open-label, randomized cross-over multicenter study comparing 2 periods of 16 weeks of CSII with LP or RH. RESULTS: Mean daily basal rate was significantly higher during the LP period (p = 0.04). No differences were seen in changes in HbA1c levels, number of hypoglycemic events, cutaneous infections and catheter occlusions. There was no significant difference between the two treatments for preprandial and postprandial glucose values, although prandial glucose excursions tended to be lower with LP (significant at dinner, p = 0.01). Mean blood glucose levels were significantly higher at 0.00 and 3.00 a.m. during LP therapy (p < 0.05). No episode of ketoacidosis occurred during LP treatment. More parents indicated that LP made their own and the child's daily life easier (p = 0.02) and preferred LP (p = 0.01). CONCLUSIONS: LP in CSII therapy in children is safe, as effective as RH, improved postprandial excursions, met the needs of young children in their daily life well, and gained their parents' satisfaction and preference. However, a shorter duration of LP resulted in hyperglycemia during the first part of the night, which must be compensated for by increasing nocturnal basal rates during this time.     

One night of partial sleep deprivation affects biomarkers of cardiac damage,but not cardiovascular and lipid profiles,in young athletes

Sleep loss is among the most common yet frequently overlooked problems. This disruptive influence is associated with an adverse lipid profile (LP) and consequently results in an increased risk of cardiovascular disease. Furthermore, it has been well established that athletes are increasingly confronted with sleep problems. The aim of this study was to explore the effect of one night of partial sleep deprivation (PSD) on the cardiovascular profile and LP in young, trained athletes. Ten male Taekwondo athletes were randomized for three sleep conditions in a counterbalanced order: (i) following a baseline sleep night (BN), (ii) following PSD at the beginning of the night (PSDBN), and (iii) following PSD at the end of the night (PSDEN). Basal cardiovascular physiological measures were recorded, and blood samples were taken in the fasted state following each sleep session (i.e., in the morning at 07:00 h). The results showed that myoglobin and creatine phosphokinase increased significantly after PSDEN but not after PSDBN. By contrast, no alteration was observed in the LP and physiological parameters following the two types of PSD. In conclusion, these results show that PSDEN increases cardiac damage biomarkers significantly, even though they do not reach clinical significance. Thus, one night of PSD does not affect the physiological responses and biomarkers of LP in Taekwondo athletes.     

Clinico-roentgenologic signs of osteo- and arthropathy in children with syringomyelia

Syringomyelia is a severe dysontogenetic lesion of the nervous system with polymorphous clinical and x-ray manifestations. The authors followed up 10 children aged 4-12 with osteo- and arthropathies, and presented a clinical and x-ray picture characterizing this process. They described in detail x-ray signs of this lesion over time and the formation of neoarthroses in the fracture areas, changes in zones of preliminary calcification and epiphyseal cartilage as well as in flat pelvic bones.     

Thorough clinical evaluation of skin, as well as oral, genital and anal mucosa is beneficial in lichen planus patients

Lichen planus (LP) is a common mucocutaneous disease of unknown aetiology with various geographical prevalence, may be related to some serious disorders such as squamous cell carcinoma and often remains underdiagnosed. The aim of this retrospective study was to thoroughly determine localization and clinical characteristics of LP lesions in a cohort of 173 Slovenian patients in association to the presence of accompanying symptoms and history of potential stressful events. Isolated cutaneous lesions of LP were found in 56.6% and isolated oral LP in 3.5% of patients. Thirty-four percent presented orocutaneous LP, whereas genitocutaneous LP was noted in 1.2%, orogenito-cutaneous LP in 4% and orogenital LP in 0.5% of patients. Underlying stressful events were noted in 36 out of 137 (26.3%) patients. Despite obviously visible localization of the lesions various medical specialists should be familiar with LP and thoroughly examine the complete skin, as well as oral, genital and anal mucosa in each LP patient to avoid a delay in diagnosing this disease and possibly disclose a much serious underlying condition. Psychological support should be offered, if needed.     

Development of specific PCR primers for the detection of Rhizoctonia solani AG 2-2 LP from the leaf sheaths exhibiting large-patch symptom on zoysia grass

Detection of Rhizoctonia solani AG 2-2 LP isolates causing large-patch disease on zoysia grass was done using polymerase chain reaction (PCR). Specific primers were designed based on an amplified region using random amplified polymorphic DNA (RAPD)-PCR. Fifteen primers and three cultural types of R. solani AG 2-2 (types IIIB, IV and LP) were used for RAPD-PCR. The banding patterns by RAPD-PCR showed that the three cultural types were clearly distinguishable. A dendrogram constructed from the results of RAPD-PCR showed that the three cultural types of AG 2-2 clustered separately. The sequence of one PCR-amplified region which appeared only in LP isolates using primer A09 was selected for designing specific primers. Primer pair A091-F/R gave a single product from pure fungal DNA of LP isolates but not from those of the other two types (IIIB and IV), R. solani AG 1, 2-1, 2-3, 2-tulip, 3-10 and BI isolates and other turfgrass fungal pathogens. Primer pair A091-F/R also gave a single product from diseased leaf sheaths and this product was in accordance with those of pure fungal DNA of LP isolates. Primer pair A091-F/R did not yield PCR product from healthy leaf sheaths. The frequencies of detection of LP isolates from leaf sheaths of zoysia grass using PCR with primer pair A091-F/R were higher than those of the conventional isolation technique. These results showed that the PCR-based technique using specific primers A091-F/R is useful for the rapid detection of LP isolates from leaf sheaths of zoysia grass exhibiting large-patch symptoms.     

X-ray diagnosis of acute respiratory distress syndrome in acute hematogenous osteomyelitis in children

OBJECTIVE: to analyze the x-ray signs of acute respiratory distress syndrome (ARDS) in children with the septicopyemic form of acute hematogenous osteomyelitis (AHO) for the first time, by using the authors' material. METHODS: X-ray study of respiratory organs was conducted in 221 children with AHO. SUBJECTS AND BASIC RESULTS: ARDS had a rather characteristic x-ray pattern that permitted a differential diagnosis of this condition and another abnormality, that with septic pneumonia in particular.     

Differential diagnosis of an accumulation of fluid in the pleural spaces

Altogether 345 patients with pleural effusion were investigated; 22 nosological entities were diagnosed. Of them four diseases (tuberculosis, metastatic cancer, pneumonia, and pleural mesothelioma) accounted for 79.7%. Failures of outpatient clinical investigation and late referral of patients to special diagnostic departments were noted. Possibilities to diagnose the type of disease on the basis of x-ray symptoms, clinical and laboratory tests and their combinations were analyzed. A necessity of the use of various types of biopsy with respect to an x-ray picture was recommended. Early thoracoscopic biopsy was indicated for progressive or stable pleural effusion of obscure etiology.     

The Influence of Hand Preference on Grip Strength in Children and Adolescents; A Cross-Sectional Study of 2284 Children and Adolescents

Introduction

In adults the preferred hand is often considered to be around 10% stronger than the non-preferred hand. Whether the same is true for children and adolescents remains unclear. The objective of this study is therefore to determine whether there is a difference in grip strength between the preferred and non-preferred hand in developing children, to establish whether this difference is similar for children of a different gender or hand preference, and whether there is a difference in grip strength of the preferred hand of left-preferent (LP) and right-preferent (RP) children.

Design

Cross-sectional study.

Participants

Participants were recruited from schools in the northern provinces of the Netherlands. The study included healthy children and adolescents in the age range of 4–17 years.

Outcome Measures

Each child was allowed a total of four attempts using the JAMAR hand dynamometer, two attempts with each hand. All individual attempts were scored. Hand preference was determined by asking which hand was used to write, or in the case of 4- and 5-year-olds, which hand was used to draw a shape.

Results

The study population comprised 2284 children and adolescents. RP boys and girls scored significantly higher with their preferred hand, the difference amounting to 9.5 and 10.1% respectively. LP girls scored significantly higher with their preferred hand, but this difference was only 3.0%. For LP boys no significant difference was found in favor of either hand. LP children score higher with the non-preferred hand and tie scores on both hands more often than RP children.

Conclusion

The 10% rule of hand preference is applicable to RP children ranging in age between 4 and 17 years, but not to LP children. In contrast to LP boys, LP girls are generally significantly stronger with their preferred hand.     

Emerging medicinal roles for lysophospholipid signaling

The two lysophospholipids (LPs) lysophosphatidic acid and sphingosine 1-phosphate (S1P) regulate diverse biological processes. Over the past decade, it has become clear that medically relevant LP activities are mediated by specific G protein-coupled receptors, implicating them in the etiology of a growing number of disorders. A new class of LP agonists shows promise for drug therapy: the experimental drug FTY720 is phosphorylated in vivo to produce a potent S1P receptor agonist (FTY720-P) and is currently in Phase III clinical trials for kidney transplantation and Phase II for multiple sclerosis. Recent genetic and pharmacological studies on LP signaling in animal disease models have identified new areas in which interventions in LP signaling might provide novel therapeutic approaches for the treatment of human diseases.     

Apoptosis: one of the mechanisms that maintains unresponsiveness of the intestinal mucosal immune system

Intestinal mucosa is constantly exposed to environmental AGS: Activation of lamina propria (LP) T cells by luminal Ags may lead to the production of inflammatory cytokines and subsequent mucosal inflammation and tissue damage. However, in normal circumstances, LP T cells do not respond to antigenic stimulation. The mechanisms of this unresponsiveness in healthy subjects are not fully understood. In this study, we found by in vivo analysis that, except for T cells in lymph nodules of the mucosa, 15% of LP T cells underwent apoptosis in normal individuals. In contrast, there was a marked reduction in apoptosis of LP T cells in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) and those with specific colitis. Our findings suggest that apoptosis might be a mechanism that turns off mucosal T cell responses to environmental Ags in healthy subjects, and resistance to apoptosis could be an important cause of mucosal immune dysregulation and tissue inflammation in colitis.     

Cholelithiasis and Cholecystitis in Childhood

Six cases of cholecystitis and cholelithiasis confirmed by x-ray examination and surgical operation were observed in a ten-year period. Due to the wide variability in signs and symptoms in children, cholecystitis and cholelithiasis can be diagnosed only with a high degree of clinical suspicion and roentgenological examination. Gallbladder disease is uncommon in childhood but should be considered in children with vague abdominal pains or bouts of unexplained jaundice. If a normal appendix is found at laparotomy in the “acute abdomen,” the surgeon would be wise to palpate other specific organs within the abdomen, including the liver and gallbladder.The treatment of choice is cholecystectomy. The prognosis for recovery is excellent if there is no complicating systemic disease.     

Endotoxin-lipoprotein complex formation as a factor in atherogenesis: associations with hyperlipidemia and with lecithin:cholesterol acyltransferase activity

A potential role of endotoxin–lipoprotein (bacterial lipopolysaccharide–lipoprotein, LPS–LP) complex formation as a pathogenic factor for atherosclerosis has not been studied yet. The aim of this study was to test the hypothesis that in endotoxinemia in humans hyperlipidemia associated with atherosclerosis development can favor an excessive LPS–LP complex formation, and endotoxin presented in blood can inhibit lecithin:cholesterol acyltransferase (LCAT), one of the key enzymes of reverse cholesterol transport. Endotoxin-binding capacity of lipoproteins (LP) in patients with normolipidemia and hyperlipidemia types IIa and IV was estimated from label incorporation into different LP fractions isolated by means of sequential ultracentrifugation following serum preincubation with Salmonella minnesota R595 ¹²⁵I-labeled LPS. The effect of varied concentrations of S. minnesota R595 LPS on LCAT activity was evaluated from the overall esterifying activity of serum using [1,2-³H₂]cholesterol-labeled substrate. The elevation of low density LP (LDL) and very low density LP (VLDL) contents in blood serum in hyperlipidemia types IIa and IV, respectively, resulted in significant elevation of LPS binding to these fractions. LPS added to the blood serum leads to the dose-dependent decrease in LCAT activity. The revealed phenomena of elevated LPS binding to atherogenic LP fractions in hypercholesterolemia and endotoxin-induced LCAT inhibition suggest the pathogenic role of LPS–LP complexes in atherogenesis.     

X-ray characterization of changes of the lungs in juvenile rheumatoid arthritis

The results of chest x-ray were analyzed in 66 pediatric patients with juvenile rheumatoid arthritis (JRA). X-ray signs of pneumofibrosis were revealed in 37 (56%) patients. Besides, rare pulmonary changes (emphysema, rheumatic nodules, infiltrates) were detected in the JRA patients. The absence of clinical symptoms in the presence of x-ray changes necessitates the performance of chest x-ray in JRA for early detection of the pulmonary symptoms of this disease.     

阿托伐他汀对冠心病患者脂蛋白(a)及CETP水平的影响

目的:分析阿托伐他汀对冠心病患者脂蛋白(a)、血清胆固醇酯转运蛋白(CETP)水平的影响及临床疗效。方法:将112例冠心病患者随机分为对照组与观察组,每组56例。对照组患者采用辛伐他汀治疗,观察组患者采用阿托伐他汀治疗。观察并比较两组患者治疗前后血清LP(a),CETP,超敏C-反应蛋白(hs-CRP)及脑钠肽(BNP)水平,冠状动脉血流储备、舒张期峰流速及收缩期峰流速变化,左心室后壁厚度(LVPWT)、左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD)情况,以及临床疗效。结果:治疗后,观察组LP(a),CETP,hs-CRP及BNP水平均低于对照组,差异有统计学意义(P0.05);观察组冠状动脉血流储备、舒张期峰流速、收缩期峰流速均高于对照组,差异有统计学意义(P0.05);观察组LVPWT、LVESD、LVEDD均低于对照组,差异有统计学意义(P0.05);观察组总有效率高于对照组,差异有统计学意义(P0.05);两组安全性比较,差异无统计学意义(P0.05)。结论:阿托伐他汀对冠心病患者的临床疗效比较明确,可下调LP(a)及血清CETP表达。     

Giant-cell pneumonia caused by measles and methotrexate in childhood leukaemia in remission.

Four children who had acurate lymphoblastic leukaemia in remission and developed pneumonia were studied. Investigations including electron microscopy and immunofluorescence of lung biopsy material disclosed measles, although there was no clinical evidence of the disease. Despite an identical presentation, two types of illness developed: two children died of giant-cell pneumonia, while the other two developed pneumonia indistinguishable from that associated with methotrexate treatment, recovering when treated with steroids and gammaglobulin. Measles infection is easily overlooked in the absence of rash. The diagnosis may be suggested by clinical and radiological features and confirmed by specific immunofluorescence staining of lung biopsy tissue.     

Characterization of human high-density lipoprotein subclasses LP A-I and LP A-I/A-II and binding to HepG2 cells

Plasma HDL can be classified according to their apolipoprotein content into at least two types of lipoprotein particles: lipoproteins containing both apo A-I and apo A-II (LP A-I/A-II) and lipoproteins with apo A-I but without apo A-II (LP A-I). LP A-I and LP A-I/A-II were isolated by immuno-affinity chromatography. LP A-I has a higher cholesterol content and less protein compared to LP A-I/A-II. The average particle mass of LP A-I is higher (379 kDa) than the average particle weight of LP A-I/A-II (269 kDa). The binding of 125I-LP A-I to HepG2 cells at 4 degrees C, as well as the uptake of [3H]cholesteryl ether-labelled LP A-I by HepG2 cells at 37 degrees C, was significantly higher than the binding and uptake of LP A-I/A-II. It is likely that both binding and uptake are mediated by apo A-I. Our results do not provide evidence in favor of a specific role for apo A-II in the binding and uptake of HDL by HepG2 cells.     

Serum zinc and copper in hyperlipoproteinemia

Starting from experimental observations demonstrating that a high ratio of zinc to copper led to hypercholesterolemia in rats, serum Zn and Cu levels were measured by atomic absorption spectrophotometry in 65 normolipemic controls and in 100 subjects with various types of hyperlipoproteinemia (HLP). Serum Zn levels did not significantly differ from control values in any type of HLP. However, hyperlipoproteinemic patients with obvious clinical atherosclerosis displayed significantly lower serum-Zn concentration than hyperlipo-proteinemic subjects without clinical symptoms. On the other hand, when compared to control subjects, serum Cu levels were not found to be decreased, but rather increased, in hyperlipoproteinemic patients with or without atherosclerosis. As a result, the Zn∶Cu ratio appeared to be lower than normal in hyperlipoproteinemic patients with cardiovascular disease. It is conceivable that changes of these trace elements should be rather connected to vessel injury and associated disease than to HLP which, at least in humans, is not accompanied by a high Zn∶Cu ratio.     

小儿病毒性腹泻的临床预后及危险因素分析

目的:探讨小儿病毒性腹泻的临床预后及危险因素。方法:纳入病例是2018年1月至2019年12月本院收治的200例小儿病毒性腹泻患者,回顾性分析其临床资料,分析小儿病毒性腹泻的临床特点。根据疾病痊愈情况分组,将128例痊愈患者作为实验组,72例未痊愈患者作为参照组,Logistic分析小儿病毒性腹泻患者疾病痊愈的危险因素。结果:200例患者中,HAstV感染121例,占60.50%;HAD感染36例,占18.00%;HUCV感染15例,占7.50%;HRV感染10例,占5.00%;混合感染18例,占9.00%。HAstV类型病毒性腹泻患者临床症状以呼吸道症状、发热、呕吐为主;HAD类型病毒性腹泻患者临床症状以发热、呕吐为主;HUCV类型病毒性腹泻患者临床症状以呼吸道症状、发热为主;HRV类型病毒性腹泻患者临床症状以发热、呕吐为主;混合感染类型病毒性腹泻患者临床症状以呼吸道症状、发热、呕吐为主。年龄、中枢神经损害、心肌损害、近1 w是否接触过腹泻是小儿病毒性腹泻患者疾病痊愈的危险因素,P0.05。结论:小儿病毒性腹泻不同感染类型,临床症状各不相同。小儿病毒性腹泻患者预后与年龄、中枢神经损害、心肌损害、近1 w是否接触过腹泻有着极为密切的联系,应当引起临床重视与关注。