bluuebunny/crossref_metadata_2025 huggingface dataset:
Concentration‐controlled use of sirolimus associated with reduced exposure of cyclosporine in black recipients of primarily living renal allograft donors: 12‐month results
Authors: Ferreira Alexandra N , Machado Paula G , Felipe Cláudia R , Motegi Sofia A , Hosaka Beatriz H , Tanaka Márcia K , Kamura Luciana A , Park Sung I , Garcia Riberto , Franco Marcello , Alfieri Fernando , Casarini Dulci E , Tedesco‐Silva Hélio , Medina‐Pestana José O
Published: September 2005

Abstract: Aim: This study was designed to identify optimal therapeutic sirolimus (SRL) concentrations in black kidney transplant recipients on reduced cyclosporine (CsA) exposure and prednisone.

Methods: Seventy patients (64 living/six deceased) received CsA (8–10 mg/kg/d), prednisone, and 15 mg loading dose followed by 5‐mg fixed doses of SRL till day 7 when they were randomized to maintain SRL trough concentrations (high‐performance liquid chromatography) of 8–12 (GI = 34) or 15–20 (GII = 36) ng/mL.

Results: Mean CsA concentrations were 109 ± 53 vs. 89 ± 41 ng/mL and 75 ± 54 vs. 60 ± 35 ng/mL (ns) at 2 and 6 months. Accordingly, mean SRL trough concentrations were 12.4 ± 6.1 vs. 20.0 ± 9.5 ng/mL (p < 0.001) and 10.8 ± 5.8 vs. 18.0 ± 6.1 ng/mL (p < 0.001). The incidence of biopsy‐proven acute rejection [13% (GI: 18% vs. GII: 8%, ns)], graft loss or death was 16% (GI: 21% vs. GII: 11%, ns]. There were no deaths and three graft losses (GI = 1; GII = 2). Creatinine clearance was higher in GI (64.5 ± 17 vs. 54.4 ± 14.7 mL/min, p = 0.011). The incidence of post‐transplant diabetes mellitus was 13% and no CMV disease was observed.

Conclusion: In black recipients of primarily living renal allograft donors reduced CsA exposure and SRL concentration‐controlled regimens produced low incidences of acute rejection, post‐transplant diabetes mellitus and CMV disease, with no significant impairment in graft function.
Long term efficacy of simvastatin in renal transplant recipients treated with cyclosporine or tacrolimus
Authors: Imamura Ryoichi , Ichimaru Naotsugu , Moriyama Toshiki , Shi Yi , Namba Yukiomi , Nonomura Norio , Matsumiya Kiyomi , Toki Kiyohide , Takahara Shiro , Okuyama Akihiko
Published: September 2005

Abstract:  Background:  Hyperlipidemia is frequently developed following renal transplantation and results in worsening of the patient's prognosis.

Methods:  In this study, 14 patients who had hypercholesterolemia [total cholesterol (TC) >200 mg/dL] and hypertriglyceridemia [triglyceride (TG) >150 mg/dL] 1 month after renal transplantation (post‐transplantation), seven patients each under the treatment with immunosuppressant, either cyclosporine or tacrolimus started simvastatin treatment of 5–10 mg/d and continued the treatment for 4 yr. The effect of simvastatin treatment was assessed by comparison in serum lipid levels (TC, TG, cholesterol in lipoprotein fractions, and apolipoproteins) and the lipid metabolism related enzyme activities for post‐transplantation, after 6‐month and 4‐yr simvastatin treatment.

Results:  Simvastatin treatment of 4 yr significantly decreased the elevated levels of serum TC from 234.5 ± 30.8 to 186.3 ± 20.5 mg/dL (p < 0.001), low density lipoprotein cholesterol (LDL‐C) from116.7 ± 22.5 to 82.7 ± 16.6 mg/dL (p < 0.05) and TG from 200.3 ± 109.2 to 97.0 ± 45.2 mg/dL (p < 0.001). In addition, there were significant decreases in elevated serum very‐low‐density lipoprotein cholesterol (VLDL‐C) from 47.8 ± 18.4 to 28.6 ± 9.5 mg/dL (p < 0.001) and LDL2 cholesterol (LDL2‐C) from 20.8 ± 8.2 to 5.7 ± 1.8 mg/dL (p < 0.001).

Conclusion:  The results indicate that 4‐yr treatment of simvastatin improves profiles of the atherogenic lipids in renal transplant patients with immunosuppressant caused hypercholesterolemia and hypertriglyceridemia treated either cyclosporine or tacrolimus in similar manner.
Sirolimus‐associated interstitial pneumonitis in solid organ transplant recipients
Authors: Garrean Sean , Massad Malek G. , Tshibaka Michael , Hanhan Ziad , Caines Amitra E. , Benedetti Enrico
Published: September 2005

Abstract:  Sirolimus is a potent immunosuppressive agent used with increasing frequency in solid organ transplantation (SOT). However, it has been associated with rare but devastating pulmonary toxicity. We describe a case of pulmonary toxicity associated with the use of sirolimus in a 64‐yr‐old heart transplant recipient. We also review all reported cases of sirolimus‐associated lung toxicity among SOT recipients in an effort to better understand the pathophysiology, risk factors, and outcomes of this rare but serious complication. A total of 64 cases have been reported since January 2000 including the present case. These consisted of 52 kidney, four lung, three liver, three heart, one heart–lung and one islet cell transplants. In most cases, patients presented with a constellation of symptoms consisting of fever, dyspnea, fatigue, cough, and occasionally hemoptysis. Although the risk factors for this association have not been clearly established, high dose, late exposure to the drug and male gender have been noticed among most. In almost all of the reported cases, sirolimus was added later in the course of immunosuppressive therapy, usually in an effort to attenuate the nephrotoxic effects of a previous regimen containing a calcineurin inhibitor. There were three deaths (4.8%) among 62 patients with known status at follow up; all deaths were among heart transplant recipients. Most patients (95%) resolved their clinical and radiographic findings with discontinuation or dose‐reduction of the drug. Sirolimus‐induced pulmonary toxicity is a rare but serious entity that should be considered in the differential diagnosis of a transplant recipient presenting with respiratory compromise. Dose‐reduction or discontinuation of the drug can be life saving.
Surgical management of spinal disease in renal recipients
Authors: Yoon Do Heum , Shin Hyun Chul , Kim Keung Nyun , Lee Sang Won , Yi Seong , Park Ki II , Kim Yoo Sun , Kim Sun II
Published: September 2005

Abstract:  Object and background:  The survival of renal recipients improved dramatically and long‐term survival of renal graft patients is common, which in turn increases the chance of these patients requiring spinal surgery. However, there are few appropriate reports about the results of spine surgery on renal recipients. This study was undertaken to analyze the authors’ experience of spine surgery after renal transplantation.

Methods:  Thirty‐two renal recipients who underwent spine surgery with regular follow‐up of more than 24 months were included in this study. The patients’ medical records and the radiological reports were reviewed retrospectively and their postoperative conditions were evaluated during their regular visits or by telephone.

Results:  The mean duration from the renal transplantation to spinal surgery was 6 ± 1.2 yr. Among spinal diseases of renal recipients, there were 23 cases of degenerative spinal diseases, seven cases of vertebral compression fracture, and two spinal cord tumors. The operation methods were conventional spine surgery with or without bone fusion (27 cases), percutaneous vertebroplasty (three cases) and tumor resection (two cases). The mean values of the Prolo scale in the preoperative (4.5 ± 0.3) and postoperative (7.4 ± 0.4) period showed significant clinical improvement after the operation. Postoperative renal function was not deteriorated in any patients and there were no major complications.

Conclusion:  Spine surgery can be performed with acceptable clinical results and without major complications in renal recipients. Spine surgery has no aggravating effect on the patients’ renal function. Surgery is a valuable, safe option for the treatment of spinal disease in this rare distinct group of patients.
The effects of renal transplantation on peripheral blood dendritic cells
Authors: Womer Karl L , Peng Ruihua , Patton Pamela R , Murawski Matthew R , Bucci Michael , Kaleem Ayesha , Schold Jesse , Efron Phillip A , Hemming Alan W , Srinivas TR , Meier‐Kriesche Herwig‐Ulf , Kaplan Bruce , Clare‐Salzler Michael J
Published: September 2005

Abstract:  Recent advances allow accurate quantification of peripheral blood (PB) myeloid and plasmacytoid dendritic cell (DC) populations (mDC and pDC, respectively), although the response to renal transplantation (RT) remains unknown. Using flow cytometry, PBDC levels were quantified in patients with end stage renal disease (ESRD) undergoing RT. PBDC levels were significantly reduced in ESRD patients pre‐RT compared to healthy controls, with further reduction noted immediately following a hemodialysis session. RT resulted in a dramatic decrease in both subsets, with a greater reduction of pDC levels. Both subset levels were significantly lower than in control patients undergoing abdominal surgery without RT. Subgroup analysis revealed significantly greater mDC reduction in RT recipients receiving anti‐lymphocyte therapy, with preferential binding of antibody preparation to this subset. Samples from later time points revealed a gradual return of PBDC levels back to pre‐transplant values concurrent with overall reduction of immunosuppression (IS). Finally, PBDC levels were significantly reduced in patients with BK virus nephropathy compared to recipients with stable graft function, despite lower overall IS. Our findings suggest that PBDC levels reflect the degree of IS in renal allograft recipients. Furthermore, PBDC monitoring may represent a novel strategy to predict important outcomes such as acute rejection, long‐term graft loss and infectious complications.
Post‐transplant lymphoproliferative disorders after live donor renal transplantation
Authors: Jain Manoj , Badwal Sonia , Pandey Rakesh , Srivastava Aneesh , Sharma RK , Gupta Ramesh Kumar
Published: September 2005

Abstract:  The development of post‐transplant lymphoproliferative disorders (PTLD) is a well‐recognized complication of solid organ transplantation in patients receiving immunosuppressive therapy. The literature on PTLD in live renal allograft recipients is scarce and most of the data pertains to PTLD in cadaveric transplants. As live donor grafts form the mainstay of transplantation programme in India, this study was carried out to define the profile of PTLD in live donor renal allograft recipients. On retrospective evaluation, nine cases of PTLD amongst 1700 live donor allograft recipients from January 1989 to August 2004, were detected at a tertiary care hospital in north India. The clinicopathological features of these cases were evaluated. Mean age at diagnosis of PTLD was 38 yr with median post‐transplant latency period of 7 yr. All cases were from extra‐renal sites, five being in ileum/jejunum, three in retroperitoneal lymph nodes and one in epididymus. All cases received cyclosporin, azathioprine and prednisolone in varying combinations as immunosuppressive therapy. One case was treated for rejection by anti‐thymocyte globulin. Seven patients were seronegative for Epstein–Barr virus at the time of diagnosis. All were B‐cell monomorphic PTLD, classifiable as B‐cell diffuse large cell lymphomas, with five extranodal and three nodal lymphomas. Management included reduction in immunosuppression, acyclovir therapy, surgical excision and chemotherapy. On follow‐up, four patients died, two presented with recurrence, two were in remission and one was lost to follow‐up. This study comprising of live related/unrelated renal allograft recipients observed late onset high grade monomorphic PTLD with paucity of early onset polymorphic lesions. Long post‐transplant latency period, aggressive behaviour and poor response to treatment necessitate long‐term cancer surveillance to facilitate early detection and newer therapeutic strategies to improve the outcome in these patients.
Constraints to growth of annual nettle (Urtica urens) in an elevated CO2atmosphere: Decreased leaf area ratio and tissue N cannot be explained by ontogenetic drift or mineral N supply
Authors: Marriott David J. , Stirling Clare M. , Farrar John
Published: September 2005

The current literature indicates that the stimulation of relative growth rate (RGR) by an elevated atmospheric CO2concentration is transient.Urtica urensL. was exposed to an elevated atmospheric CO2concentration for 26 days to better understand the factors involved in this constraint to growth. Plants were grown hydroponically without nutrient limitation in controlled‐environment cabinets. Consistent with studies of other C3 species, the initial CO2stimulation of RGR ofU. urenswas not sustained and declined in the early stages of exposure. Whilst the decline in RGR was most strongly linked to a reduction in the CO2stimulation of net assimilation rate (NAR), its initial increase was constrained by an early and persistent reduction in leaf area ratio (LAR) due to a decreased specific leaf area (SLA). The decline in NAR could not be linked to any down‐regulation of photosynthetic capacity of individual leaves, despite an accumulation of soluble sugars in them. The reductions in LAR and SLA reflected an accumulation of structural weight in addition to an accumulation of total non‐structural carbohydrate (TNC). To account for the impact of ontogenetic drift on the partitioning of weight and leaf area, this study extends the usual allometric approach to include an analysis of effects on the vertical placement of regression lines (i.e. their elevations). Using this approach, we argue that CO2‐induced reductions in LAR and SLA cannot be explained by ontogenetic drift. By monitoring the tissue N concentration, external N supply was shown unambiguously to be non‐limiting for growth at any plant size. Nevertheless, tissue N was consistently lower in elevated CO2, independent of both ontogeny and TNC accumulation, raising the possibility that the reductions in NAR, LAR and SLA are related to some internal constraint on N utilization.
Optimized Scansystem™ platelet kit for bacterial detection with enhanced sensitivity: detection within 24 h after spiking
Authors: Schmidt Michael , Weis Christina , Heck Julia , Montag Thomas , Nicol Sven‐Boris , Hourfar Michael K. , Schaefer Volker , Sireis Walid , Roth W. Kurt , Seifried Erhard
Published: September 2005

Background and Objectives  The prevention and detection of bacterial contamination of platelet concentrates remains a major challenge for transfusion medicine. To be suitable for blood‐transfusion services, the contamination detection method must be highly sensitive, easy to perform and preferably of low cost. In this spiking study, we evaluated the new optimized Scansystem™ Platelet Kit detection method for use on apheresis platelets.

Study Design and Methods  Apheresis platelet concentrates (APCs) were individually spiked with 10 colony‐forming units (CFU)/ml of one of 10 different strains of bacteria. The spiked APCs were analysed at specific time‐points during incubation by using the optimized Scansystem™ Platelet Kit. Bacterial enumeration was performed by plating onto blood agar.

Results  All the bacterial strains tested were detected by using the optimized Scansystem™ Platelet Kit when sampled 24 h after spiking. Compared to the Scansystem™ standard kit, sensitivity was increased to < 50 CFU/ml. The identity of the spiked bacteria was confirmed by Gram staining and DNA fingerprinting.

Conclusion  The optimized Scansystem™ Platelet Kit was able to reliably detect, within 70 min, 10 transfusion‐relevant bacterial species in APCs when a sample volume was taken 24 h after spiking. This is the first study carried out by using the optimized Scansystem™ bacterial detection that was found to have an enhanced sensitivity compared to the standard kit.
Variance components and heritabilities for sow productivity traits estimated from purebred versus crossbred sows
Authors: Ehlers M.J. , Mabry J.W. , Bertrand J.K. , Stalder K.J.
Published: September 2005

Genetic parameters were estimated for number of pigs born alive (NBA), adjusted litter weaning weight (ALWT), and the interval from weaning to first service (W2E) using 2002 purebred litter records and 14 583 crossbred litter records from a swine production unit with a defined great‐grandparent, grandparent, and parent stock genetic system structure. Estimation of (co)variance components was carried out by REML methods. Heritability estimates from this study for NBA were 0.155, 0.146, 0.145 for the purebred, crossbred, and pooled data, respectively. Heritability estimates for ALWT were 0.162, 0.195, and 0.183 for the purebred, crossbred and pooled data, respectively. Heritability estimates for W2E were 0.205, 0.239 and 0.202 for the purebred, crossbred and pooled data, respectively. Genetic correlations between NBA and ALWT were weak and positive for the three groups. The genetic correlation between W2E and ALWT were −0.158 for the purebred Yorkshires, 0.031 for the crossbreds and 0.051 for the pooled data. The genetic correlation between W2E and NBA was −0.027 for the purebred Yorkshires, 0.310 for the crossbreds and 0.236 for the pooled data. These similarities suggest that pooling of purebred and crossbred data may be considered, which may potentially increase the accuracy of breeding value estimates, which would result in increased genetic progress.
Genetic components in contemporary Faroe Islands Cattle as revealed by microsatellite analysis
Authors: Li M.H. , Sternbauer K. , Haahr P.T. , Kantanen J.
Published: September 2005

The gene pool of indigenous Faroe Islands Cattle is strongly affected by crossing with Norwegian Red. In this study, the genetic structure in 191 animals representing five North European cattle breeds (Faroe Islands, Icelandic, Blacksided Troender, Western Fjord and Norwegian Red) and the genetic admixture in the contemporary Faroe Islands Cattle at the population and individual level were evaluated using 20 polymorphic microsatellite loci. Only 6.7% of the total genetic variation could be attributed to the differences amongst the breeds. The factorial correspondence analysis based on all allele frequencies could hardly reveal a divergence between Faroe Islands Cattle and Norwegian Red. In addition, a Neighbor‐Net tree constructed to examine the allocation of individuals of Faroe Islands Cattle and Norwegian Red provided a detailed interrelationship network for all the 72 animals. An estimation of the population admixture proportion showed a strong genetic contribution by Norwegian Red (47.3%) in the contemporary Faroe Islands Cattle. On the other hand, individual admixture analysis demonstrated that only seven of the individual Faroe Islands Cattle analysed, which also showed more traditional colour patterns, could be assigned to the Faroe Islands Cattle cluster, probably representing the breed's remaining purebred animals. Strategies for preserving the original native genes in Faroe Islands Cattle should be considered in order to prevent the breed from becoming extinct and to strengthen the breed's capability in future breeding programmes.
Non‐additive effects on milk production in Czech dairy cows
Authors: Wolf J. , Zavadilová L. , Němcová E.
Published: September 2005

Crossbreeding effects on milk production traits of Czech dual‐purpose and dairy cattle breeds were estimated. Nearly 370 000 cows with known gene proportions from Czech Pied, Ayrshire or Holstein cattle were selected from the national milk recording data base. Single‐trait animal models were calculated for milk, fat and protein yield, fat and protein content. The model of Dickerson including additive, additive maternal, heterotic and recombination effects was used for the part of the animal model describing the crossbreeding effects in all calculations. For milk yield, the additive genetic effect (defined as deviation from Czech Pied cattle) was 850–900 kg for Holstein and 240–480 kg for Ayrshire. The maternal effects were low and negative. Low significant positive heterotic effects were observed being up to approximately 100 kg for Czech Pied × Holstein. The recombination effects were negative and statistically significant for Czech Pied × Holstein. The results for fat and protein yield were similar to the results for milk yield. For fat and protein content, nearly no statistically significant crossbreeding effects were found.
The coding sequence of the ASIP gene is identical in nine wild‐type coloured cattle breeds
Authors: Royo L.J. , Álvarez I. , Fernández I. , Arranz J.J. , Gómez E. , Goyache F.
Published: September 2005

The aim of this study was to ascertain the role of the Agouti signaling peptide (ASIP) gene coding region in the Agouti locus variation within wild‐type coat colour in cattle. We determined the Extension genotype in 241 individuals from six Spanish and three French brown cattle breeds representative of wild‐type coat variation. Polymerase chain reaction–single‐strand conformation polymorphism (PCR‐SSCP) analysis was carried out in individuals of each Extension genotypes within the same breed in an attempt to identify variants in the three coding exons of the ASIP gene. No SSCP variants were found. Results were confirmed by sequencing the coding exons of the ASIP gene in 20 individuals. Our results suggest that the ASIP coding region does not play a central role in coat colour variation in cattle.
Phenotypic and genetic parameter estimates for racing traits of Arabian horses in Turkey
Authors: Ekiz B. , Kocak O.
Published: September 2005

The racing records for Arabian horses used in the study were obtained from the Turkish Jockey Club. The traits used in the study were racing time, best racing time, rank, annual earnings, earnings per start, log annual earnings and log earnings per start. Genetic parameters were estimated by the restricted maximum likelihood (REML) procedure using the DFREML program. The effects of age, sex and origin of horse were significant for each trait. The effect of year was significant on time and earning traits, but not rank. The effect of month on time traits was also significant. Heritability estimates of the entire data set were 0.280, 0.281, 0.069, 0.139, 0.174, 0.152 and 0.171 for racing time, best racing time, rank, annual earnings, earnings per start, log annual earnings and log earnings per start respectively. Estimates of repeatability varied from 0.349 to 0.500 for racing time, from 0.430 to 0.524 for best racing time and from 0.129 to 0.171 for rank depending on the data set used in the analyses. Best racing time was the most appropriate trait for selection in this study, as this might lead to genetic improvement than other traits.
Community‐based programmes to prevent falls in children: A systematic review
Authors: McClure Rod , Nixon Jim , Spinks Anneliese , Turner Catherine
Published: September 2005

Objective:  We systematically reviewed the literature to examine the evidence for the effectiveness of community‐based interventions to reduce fall‐related injury in children aged 0–16 years.

Methods:  We performed a comprehensive search of the literature using the following study selection criteria: community‐based intervention study; target population was children aged 0–16 years; outcome measure was fall‐related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors.

Results:  Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre‐ and post‐intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult.

Conclusion:  There is a paucity of research studies from which evidence regarding the effectiveness of community‐based intervention programmes for the prevention of fall‐related injury in children could be based.
Changing epidemiology of intussusception in Australia
Authors: Justice Frances , Carlin John , Bines Julie
Published: September 2005

Objectives:  Oral rotavirus vaccines are expected to become available in Australia within the next 2 years. In light of evidence for an association between a rotavirus vaccine and intussusception, it is important to define the baseline epidemiology of intussusception in Australia and establish a system for intussusception surveillance in the immediate post‐licensure period. This study reports on incidence and epidemiology of intussusception in Australia.

Methods:  Data were obtained from the Australian Institute of Health and Welfare on all patients with a discharge diagnosis of intussusception from public and private hospitals in each state and territory of Australia from 1994 to 2000. We examined age at presentation, sex, month and year of presentation, indigenous status and clinical outcomes. The incidence of intussusception was calculated and annual trends examined. Surveillance data on rotavirus gastroenteritis hospitalizations over the same time period were also obtained to compare seasonal patterns.

Results:  From 1994 to 2000, a 39% reduction in intussusception incidence in infants aged <1 year was observed in Australia (13.1/10 000 to 8.1/10 000; P < 0.001). The incidence of intussusception was lower in indigenous infants (3.3/10 000 <1 year) compared to non‐indigenous infants (10.4/10 000 <1 year; P < 0.001). There was no association between the seasonality of rotavirus infection and intussusception. Only one of 12 deaths due to intussusception was reported in an infant <1 year.

Conclusions:  This study documents the epidemiology of intussusception in Australia from 1994 to 2000 and provides important baseline information for future rotavirus vaccines. A lower risk of intussusception was identified in indigenous compared to non‐indigenous infants.
Cerebral palsy in Victoria: Motor types, topography and gross motor function
Authors: Howard Jason , Soo Brendan , Graham H Kerr , Boyd Roslyn N , Reid Sue , Lanigan Anna , Wolfe Rory , Reddihough Dinah S
Published: September 2005

Objectives: To study the relationships between motor type, topographical distribution and gross motor function in a large, population‐based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries.

Methods: An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990–1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS).

Results: Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large majority of young people having the spastic motor type (86%).

Conclusions: The VCPR is ideal for population‐based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.
Diagnosis, treatment and outcome of Kawasaki disease in an Australian tertiary setting: A review of three years experience
Authors: Singh‐Grewal Davinder , Wong Melanie , Isaacs David
Published: September 2005

Objective:  To examine the patient characteristics, diagnostic criteria, treatment, complications and outcomes of Kawasaki disease (KD) in children diagnosed and treated in an Australian tertiary hospital setting and compare this to previously reported experience.

Methods:  Data were collected prospectively for 14 patients in 2002 and retrospectively for 31 patients in 2000 and 2001. Demographics, clinical features, laboratory features, treatment and outcome details were collected, analysed and compared to previous experience.

Results:  The median age at diagnosis was 2.77 years (0.28–8.84) and diagnosis was made after a mean 6.1 days of fever. Twenty‐eight patients (62.2%) had classical KD and those with less than four criteria were younger than those with four or more criteria (P = 0.04). Patients were treated with intravenous immunoglobulin and aspirin. Twelve (26.7%) required re‐treatment. Re‐treatment was associated with treatment within 5 days of fever onset (P = 0.03). Twelve patients (27.3%) developed coronary artery abnormalities and the development of such abnormalities was associated with lower serum albumin at diagnosis (P = 0.008) and need for re‐treatment (P = 0.03). There was no difference in coronary outcome between classical and incomplete presentations. Only two patients had coronary lesions at 12 months follow‐up.

Conclusions:  We found a trend towards earlier diagnosis and treatment of KD in the tertiary hospital setting, which may reflect heightened physician awareness of the disease. Our study confirms that children who present with incomplete disease are at risk of coronary artery abnormality. We recommend that clinicians continue to maintain high levels of suspicion, even in the absence of the complete clinical picture of KD, particularly in infants below 1 year of age.
Sleep‐related breathing disorder in Duchenne muscular dystrophy: Disease spectrum in the paediatric population
Authors: Suresh Sadasivam , Wales Patricia , Dakin Carolyn , Harris Margaret‐Anne , Cooper David (Gus) M
Published: September 2005

Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disease with death usually occurring because of respiratory failure. Signs of early respiratory insufficiency are usually first detectable in sleep.

Objective:  To study the presentation of sleep‐related breathing disorder (SRBD) in patients with DMD.

Method:  A retrospective review of patients with DMD attending a tertiary paediatric sleep disorder clinic over a 5‐year period. Symptoms, lung function and polysomnographic indices were reviewed.

Results:  A total of 34 patients with DMD were referred for respiratory assessment (1–15 years). Twenty‐two (64%) reported sleep‐related symptomatology. Forced vital capacity (FVC) was between 12 and 107% predicted (n = 29). Thirty‐two progressed to have polysomnography of which 15 were normal studies (median age: 10 years) and 10 (31%) were diagnostic of obstructive sleep apnoea (OSA) (median age: 8 years). A total of 11 patients (32%) showed hypoventilation (median age: 13 years) during the 5‐year period and non‐invasive ventilation (NIV) was offered to them. The median FVC of this group was 27% predicted. There was a significant improvement in the apnoea/hypopnoea index (AHI) (mean difference = 11.31, 95% CI = 5.91–16.70, P = 0.001) following the institution of NIV.

Conclusions:  The prevalence of SRBD in DMD is significant. There is a bimodal presentation of SRBD, with OSA found in the first decade and hypoventilation more commonly seen at the beginning of the second decade. Polysomnography is recommended in children with symptoms of OSA, or at the stage of becoming wheelchair‐bound. In patients with the early stages of respiratory failure, assessment with polysomnography‐identified sleep hypoventilation and assisted in initiating NIV.
Intracranial suppuration
Authors: Leotta Nicole , Chaseling Ray , Duncan Glen , Isaacs David
Published: September 2005

Objective:  To evaluate prevalence, age, position, predisposing factors, bacteriology, clinical features and outcomes of children with subdural empyema (SDE) and brain abscess (BA).

Design:  Retrospective hospital‐based study in a tertiary children's hospital.

Methods:  Clinical data were reviewed on all children classified as having SDE or BA for 10.75 years from 1 January 1992 to 31 August 2003 at the Royal Alexandra Hospital for Children, Sydney, Australia.

Results:  Forty‐six children with intracranial suppuration were identified: 26 had BA, 16 had SDE and four children had both SDE and BA.

Significant differences between SDE and BA were that: sinusitis was a predisposing factor for SDE (P = 0.01), Streptococcus milleri was the main organism isolated in SDE (P = 0.02), periorbital oedema (P = 0.005) and photophobia (P = 0.02) were clinical features specifically associated with SDE, and 75% of multiple abscesses were in females (P = 0.005).

The age distribution of SDE was biphasic, with peaks at <2 years and >7 years. Cases of BA peaked at age 9–11 years. Forty‐eight per cent of all children were between 9 and 13 years old; 20% were <1 year old. All the children with SDE and BA were aged 1 year or less.

Three of the 46 children died, all with BA. Eighteen (39.1%) returned to normal and 25 (54.3%) had neurological complications. Neurological complications were more common in the BA group.

Conclusion:  The mortality rate of intracranial suppuration is low, but morbidity remains high. A high degree of suspicion is needed to diagnose and treat intracranial infections early.
Neonatal diabetes mellitus: Insulin pump as an alternative management strategy
Authors: Bharucha Tara , Brown Justin , McDonnell Ciara , Gebert Robecca , McDougall Peter , Cameron Fergus , Werther George , Zacharin Margaret
Published: September 2005

Abstract:  Neonatal diabetes mellitus (hyperglycaemia within the first month of life, with an insulin requirement) may be transient or permanent. Management is complex, due to lack of subcutaneous fat and the need for small doses of insulin, and may be complicated by additional medical problems. Three cases are presented, the first of which was treated with conventional insulin therapy. The latter two were successfully treated with subcutaneous insulin pump therapy. We present suggested guidelines for treatment of neonatal diabetes, using this novel approach to management.
A case of duodenal web occurring in Prader‐Willi syndrome
Authors: Vitug‐Sales Maribel I , Lemberg Daniel A , Cunningham Clare , Henry Guy , Day Andrew S
Published: September 2005

Abstract:  Vomiting and abdominal symptoms are uncommonly seen in children with Prader–Willi syndrome (PWS). A case is described of a child with PWS who presented with vomiting, abdominal distension and abdominal pain due to a duodenal web causing gross gastric distension. Prompt attention to the onset of such clinical features in children with PWS may prevent excess morbidity and complications.
Acute idiopathic pulmonary haemorrhage in infancy: Case report and review of the literature
Authors: Habiba Ayman
Published: September 2005

Abstract:  This report presents the case of a 4‐month‐old male infant with recurrent bouts of haemoptysis for which no cause could be detected after extensive investigation. Literature reports of this condition from other geographic locations around the world are reviewed, together with epidemiologic studies attempting to provide a link with certain environmental exposures, toxic and infectious. A diagnostic entity of acute idiopathic pulmonary haemorrhage in infancy has recently been proposed. To my knowledge, this is the first case reported from New Zealand. Although the incidence of such reported cases appears to be rare, they constitute an interesting public health problem, particularly because some of the risk factors appear to overlap with risk factors for sudden infant death. They can therefore trigger an investigation into the home and outdoor environments, and may provide valuable insights into a possible underlying genetic factor and potentially harmful exposures in the modern urban or rural settings.
Failed intubation secondary to complete tracheal rings: a case report and literature review
Authors: ALI M.I. , BRUNSON CLAUDE D. , MAYHEW JAMES F.
Published: September 2005

Unanticipated difficult intubation in asymptomatic infants is a rare event. Most infants with congenital tracheal anomalies will present with airway problems. We present a case of failed intubation in an asymptomatic 8‐day‐old infant with complete tracheal rings. The infant could be ventilated with an LMA and surgery for placement of a ventricular–peritoneum shunt was completed. This is a report of the case and review of the literature.
Central venous catheterization in infants and children – small caliber audio‐Doppler probe versus ultrasound scanner
Authors: ARAI TOSHIMI , MASAO YAMASHITA
Published: September 2005

Background : Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio‐Doppler probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children.

Methods : Fifty‐two infants and 29 children scheduled for open‐heart surgery were enrolled. Cannulation was guided using a small caliber audio‐Doppler probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups.

Results : In children (>12 months), both methods were equally efficient. But in infants (<12 months), success rate at the first attempt using audio‐Doppler was worse than the rate using an ultrasound scanner and there were more complications when audio‐Doppler was used.

Conclusions : We conclude that application of both the audio‐Doppler and the ultrasound scanner is useful in children over 1 year of age for access to the internal jugular vein. However, in infants and neonates, the ultrasound scanner would be more useful than the audio‐Doppler.
Enrichment for enhanced competitive plant root tip colonizers selects for a new class of biocontrol bacteria
Authors: Kamilova Faina , Validov Shamil , Azarova Tatiyana , Mulders Ine , Lugtenberg Ben
Published: September 2005

Our group studies tomato foot and root rot, a plant disease caused by the fungus Forl (Fusarium oxysporum f.sp. radicis‐lycopersici ). Several bacteria have been described to be able to control the disease, using different mechanisms. Here we describe a method that enables us to select, after application of a crude rhizobacterial mixture on a sterile seedling, those strains that reach the root tip faster than our best tomato root colonizer tested so far, the Pseudomonas fluorescens biocontrol strain WCS365. Of the five tested new isolates, four appeared to be able to reduce the number of diseased plants. Analysis of one of these strains, P. fluorescens PCL1751, suggests that it controls the disease through the mechanism ‘competition for nutrients and niches’, a mechanism novel for biocontrol bacteria. Moreover, this is the first report describing a method to enrich for biocontrol strains from a crude mixture of rhizobacteria. Another advantage of the method is that four out of five strains do not produce antifungal metabolites, which is preferential for registration as a commercial product.
Genomic comparisons among γ‐proteobacteria
Authors: Mrázek Jan , Spormann Alfred M. , Karlin Samuel
Published: September 2005

Predicted highly expressed (PHX) genes are compared for 16 γ‐proteobacteria and their similarities and differences are interpreted with respect to known or predicted physiological characteristics of the organisms. Predicted highly expressed genes often reflect the organism's predominant lifestyle, habitat, nutrition sources and metabolic propensities. This technique allows to predict principal metabolic activities of the microorganisms operating in their natural habitats. Among our findings is an unusually high number of PHX enzymes acting in cell wall biosynthesis, amino acid biosynthesis and replication in the ant endosymbiont Blochmannia floridanus. We ascribe the abundance of these PHX genes to specific aspects of the relationship between the bacterium and its host. Xanthomonas campestris is unique with a very high number of PHX genes acting in flagellum biosynthesis, which may play a special role during its pathogenicity. Shewanella oneidensis possesses three protein complexes which all can function as complex I in the respiratory chain but only the Na+‐transporting NADH:ubiquinone oxidoreductase nqr‐2 operon is PHX. The PHX genes of Vibrio parahaemolyticus are consistent with the microorganism's adaptation to extremely fast growth rates. Comparative analysis of PHX genes from complex environmental genomic sequences as well as from uncultured pathogenic microbes can provide a novel, useful tool to predict global flux of matter and key intermediates.
Development and validation of a prototype 16S rRNA‐based taxonomic microarray for Alphaproteobacteria
Authors: Sanguin Hervé , Herrera Aude , Oger‐Desfeux Christine , Dechesne Arnaud , Simonet Pascal , Navarro Elisabeth , Vogel Timothy M. , Moënne‐Loccoz Yvan , Nesme Xavier , Grundmann Geneviève L.
Published: September 2005

The microarray approach has been proposed for high throughput analysis of the microbial community by providing snapshots of the microbial diversity under different environmental conditions. For this purpose, a prototype of a 16S rRNA‐based taxonomic microarray was developed and evaluated for assessing bacterial community diversity. The prototype microarray is composed of 122 probes that target bacteria at various taxonomic levels from phyla to species (mostly Alphaproteobacteria). The prototype microarray was first validated using bacteria in pure culture. Differences in the sequences of probes and potential target DNAs were quantified as weighted mismatches (WMM) in order to evaluate hybridization reliability. As a general feature, probes having a WMM > 2 with target DNA displayed only 2.8% false positives. The prototype microarray was subsequently tested with an environmental sample, which consisted of an Agrobacterium‐related polymerase chain reaction amplicon from a maize rhizosphere bacterial community. Microarray results were compared to results obtained by cloning‐sequencing with the same DNA. Microarray analysis enabled the detection of all 16S rRNA gene sequences found by cloning‐sequencing. Sequences representing only 1.7% of the clone library were detected. In conclusion, this prototype 16S rRNA‐based taxonomic microarray appears to be a promising tool for the analysis of Alphaproteobacteria in complex ecosystems.
Methylation is the initial reaction in anaerobic naphthalene degradation by a sulfate‐reducing enrichment culture
Authors: Safinowski Michael , Meckenstock Rainer U.
Published: September 2005

The sulfate‐reducing culture N47 can utilize naphthalene or 2‐methylnaphthalene as the sole carbon source and electron donor. Here we show that the initial reaction in the naphthalene degradation pathway is a methylation to 2‐methylnaphthalene which then undergoes the subsequent oxidation to the central metabolite 2‐naphthoic acid, ring reduction and cleavage. Specific metabolites occurring exclusively during anaerobic degradation of 2‐methylnaphthalene were detected during growth on naphthalene, i.e. naphthyl‐2‐methyl‐succinate and naphthyl‐2‐methylene‐succinate. Additionally, all three enzymes involved in anaerobic degradation of 2‐methylnaphthalene to 2‐naphthoic acid that could be measured in vitro so far, i.e. naphthyl‐2‐methyl‐succinate synthase, succinyl‐CoA:naphthyl‐2‐methyl‐succinate CoA‐transferase and naphthyl‐2‐methyl‐succinyl‐CoA dehydrogenase were also detected in naphthalene‐grown cells with similar activities. Induction experiments were performed to study the growth behaviour of the cell when transferred from naphthalene to 2‐methylnaphthalene or vice versa. When the cells were transferred from naphthalene to 2‐methylnaphthalene they grew immediately, indicating that no new enzymes had to be induced. On the contrary, the transfer of cells from 2‐methylnaphthalene to naphthalene caused a lag‐phase of almost 100 days demonstrating that an additional catabolic enzyme has to be activated in this case. We propose the methylation as a novel general mechanism of activation reactions in anaerobic degradation of unsubstituted aromatic hydrocarbons.
Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder?
Authors: Manoharan Murugesan , Reyes Martha A. , Kava Bruce R. , Singal Rakesh , Kim Sandy S. , Soloway Mark S.
Published: September 2005

OBJECTIVE

To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle‐invasive and high‐risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis.

PATIENTS AND METHODS

We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high‐risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed.

RESULTS

Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow‐up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups.

CONCLUSIONS

Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.
The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy
Authors: Antunes Alberto A. , Srougi Miguel , Dall’oglio Marcos F. , Crippa Alexandre , Campagnari João C. , Leite Kátia R.M.
Published: September 2005

OBJECTIVE

To analyse the prognostic value of the percentage of positive biopsy cores (PPBC) in determining the pathological features and biochemical outcome of patients with prostate cancer treated by radical prostatectomy, as published data evaluating the prognostic value of PPBC in such patients have limitations.

PATIENTS AND METHODS

A group of 534 patients with clinically localized prostate cancer was selected. The PPBC was defined as the number of positive biopsy cores/total number of biopsy cores × 100, and grouped into categories of <25%, 25.1–50%, 50.1–75% and 75.1–100%. Patients were divided in low‐, intermediate‐ and high‐risk groups according to the usual variables.

RESULTS

The mean follow‐up was 60.5 months. PPBC was associated with the preoperative serum prostate‐specific antigen (PSA) level, biopsy Gleason score and clinical stage. On multivariate analysis, PPBC was a significant predictor of extraprostatic disease and seminal vesicle involvement. Of patients in the four PPBC categories, 16%, 27%, 33% and 60%, respectively, had biochemical recurrence (P < 0.001), and on Cox regression analysis, PPBC was an independent predictor of disease recurrence. After segregating patients into risk groups the PPBC further stratified patients using thresholds of 75% (P = 0.006), 25% (P = 0.026) and 50% (P = 0.011) for low‐, intermediate‐ and high‐risk groups, respectively.

CONCLUSIONS

We confirmed, with a longer follow‐up, the clinical utility of the PPBC in determining the pathological features and biochemical outcome of patients with prostate cancer treated with radical prostatectomy, and established thresholds for use in patients in the three risk groups.