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  • ISSN: 2373-9312
    Volume 3, Issue 1
    Review Article
    Kaoru Okazaki1*, Toru Kuboi1, Takashi Kusaka2, Masatoshi Kondo3 and Hirokazu Kimura4
    Abstract The essential pathophysiology of perinatal asphyxia (PA) may beattributed to ischemia-reperfusion injuries.The resultant circulation failurescontribute to cardio-respiratory dysfunctions at birth. The damage affects tissues andorgans, leading to irreparable sequelae such as persistent cerebral palsy. In addition, ischemia-reperfusion injuries due to PA may cause aberrant immunological responses in various organs, such as excessive inflammation. These inflammatory responses appear to involve mainly the activation of microvascular endothelial cells and leukocytes thatproduce and release various cytokines. These cytokines modulate inflammation and tissue damage in PA, andinflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α may be dramatically induced in PA. In contrast, anti-inflammatory cytokines such as IL-10 are also induced in an attempt to reduce the excessive inflammation caused by PA. Therefore, to understand better the pathophysiology of PA, it is essential to unravel the various roles of cytokines. In this review, we mainly focus on the cytokine-associated pathophysiology in the brain linked with PA.
    Selene K Bantz, Zhou Zhu and Tao Zheng*
    Abstract The detrimental effects of vitamin D deficiency in pediatrics have become increasingly apparent and extend beyond skeletal health. Unfortunately, vitamin D deficiency is highly prevalent in atopic pediatric patients, in whom it may disrupt the immune system and induce significant worsening of reactive airways. This review presents evidence that lung development and immune regulatory functions are vitamin D-dependent. We also review clinical studies that explore how vitamin D supplementation may prevent respiratory infections and help improve asthma control, and we elaborate how these effects may vary among populations. We reveal the strong need of screening measures for vitamin D deficiency in high risk pediatric populations, particularly African-Americans, Hispanic-Americans, and children with obesity. Finally, we emphasize that all children, especially those who are asthmatic, should be assessed to ensure adequate intake or supplementation with at least the minimum recommended doses of vitamin D. The simple intervention of vitamin D supplementation may provide significant clinical improvement in atopic disease, especially asthma.
    Jay R Lucker*
    Abstract Four cases of children with Lyme disease having auditory hypersensitivity are presented. Auditory testing revealed no consistent pattern of problems except for the low loudness discomfort levels (LDL) found. Medical professionals who see children with Lyme disease should consider audiological testing to include LDL measures. Treatments for auditory hypersensitivity are discussed.
    Research Article
    Lydia H Pecker1*, Michael Roth1,2, Sari Landman1, Leslie Cunningham1,2, Ellen Johnson Silver3 and Deepa Manwani1,2
    Abstract Adolescents with sickle cell disease (SCD) and their parents are more optimistic about their future than their physicians. This may affect treatment preferences and therapy adherence. Disease specific recommendations for discussing disease course of children with SCD do not exist. To begin to address this gap, we held focus groups for adolescents with SCD 14-21 years old (n=6), parents of adolescents with SCD (n=4) and with pediatric (n=3) and adult (n=2) hematologists. SCD prognosis is complicated due to the uncertain disease course. Fear and worry are associated with discussing the future. Parents disagree with adolescents and hematologists about the best approach to discussing prognosis and oppose prognosticating that includes life expectancy. Guidelines to improve communication between physicians and families are needed.
    Miguel Marin-Padilla*
    Abstract The cerebral cortex microvascular system of normal (unaltered) brains is described and compared with that of altered ones by perinatal brain damage. The brain' microvascular system evolves from the pial capillary plexus an important meningeal compartment poorly studied. A pial capillary anastomotic plexus already cover the cortex in 6-week-old embryos, although its vascularization will not start until the eight-week. This plexus expands covering cortex entire surface throughout life. The cortex has two basic intracerebral microvascular compartments an extrinsic one represented by the perforating vessels and an intrinsic one represented by the anastomotic capillary plexus established among contiguous perforators. Throughout the developing and the adult cortex, the perforating vessels are separated from each other by a distance raging from 400 to 600 micrometers. The equidistant distance among perforators is considered to represent a biological constant necessary for the functional activity of gray matter neurons. All perforating vessels are within the Virchow-Robin Compartment and hence extrinsic to the nervous tissue. This compartment remains open to the meningeal interstitium and serves as the cortex sole drainage system (mammals' brain lacks a lymphatic system). The cortex' intrinsic microvascular compartment is represented by the anastomotic capillary plexus established between contiguous perforators. The neurons, glial cells, fibers terminals and synaptic profiles within the intrinsic microvascular compartment represent the functional center of each cortical region. The interexchange of information among these elements determines the blood flow through each region in response to its neurons functional demands. Each cortical region may function independently or in combination with proximal as well as distant regions functionally interconnected with it. There are more perforating vessels and intrinsic capillaries in the gray than in the white matter, which explains their different neuronal activities and different vulnerabilities to perinatal brain damage. In hemorrhagic and/or ischemic brain lesions, damaged intrinsic capillaries are replaced by post-inflammatory ones, which lack their functional efficiency. In any reappeared cortical lesion, the local neurons, intrinsic neuropil and vascularitywill are transformed. Local neuronal alterations could affect the functional activity of proximal and distant regions interconnected with them and eventually the whole brain. This ongoing mechanism could play a role in the pathogenesis of neurological sequelae secondary to perinatal brain damage.
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