bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors of back pain frequency in schoolchildren: a search for explanations to a public health problem
Authors: Kristjansdottir G , Rhee H
Published: August 2010

This study examined physical, behavioral and social factors associated with schoolchildren's back pain. Factors associated with back pain were also identified using a stepwise regression method. The study was based on a self‐administered questionnaire survey of a random national sample of 2173 Icelandic 11–12 and 15–16‐y‐old schoolchildren. It found that older subjects tended to report back pain more frequently than younger children. Back pain showed significant associations with different aspects of physical condition such as chronic health conditions, tiredness and physical fitness. A number of behavioral factors including participation in sports, television viewing, eating habits and smoking also had a relationship with back pain. Finally, children with lower social support were more likely to experience back pain.

Conclusion: Overall, four major factors (age, morning tiredness, eating habits and parental support) emerged as factors associated with back pain in the study subjects. These results highlighted the roles of lifestyle and social factors in the experience of back pain in schoolchildren.
Acta Paediatrica 50 years ago
Authors: BYLLENSTEN Lars J. , HELLSTRÖM BO E. , Zetterström Rolf
Published: August 2010

The following changes have been found in the eyes of 1–3 weeks old fullterm mice, who were exposed to pure oxygen intermittingly from birth: haemorrhages, retinal folding and formation of a vascular, cellular and fibrous tissue in the vitreous body.
Subacute hepatic failure after the perinatal period with haemochromatotic siderosis at the age of 11 months: an unusual perspective on neonatal haemochromatosis
Authors: Ku SW , Luk ISC , Yuen MK , Wong CP
Published: August 2010

Neonatal haemochromatosis is a rare disease characterized by the early onset of liver failure, a rapidly deteriorating clinical course and high mortality. An unusual case is presented of subacute hepatic failure in which autopsy findings at the age of 11 mo showed a haemochromatotic pattern of siderosis. Despite the similarity in the pattern of iron distribution to neonatal haemochromatosis, the clinical course was highly atypical in that the infant had later and milder presentation at 1 mo of age and slow progression into liver failure. This case illustrates the heterogeneous nature of the haemochromatotic phenotype in newborns and infants.

Conclusion: The entity “neonatal haemochromatosis” may reflect a spectrum of diseases with diverse aetiologies. Fulminant liver disease in the newborn period can also result in similar pattern of iron distribution.
Effects of enzyme replacement therapy with agalsidase alfa on glomerular filtration rate in patients with Fabry disease: preliminary data
Authors: Dehout F , Schwarting A , Beck M , Mehta A , Ricci R , Widmer U ,   on behalf of the FOS Investigators
Published: August 2010

Progressive deposition of globotriaosylceramide results in severe complications involving the kidney, heart and brain in both hemizygous male and heterozygous female patients with Fabry disease. Analysis of renal data from FOS ‐ the Fabry Outcome Survey ‐ suggests that enzyme replacement therapy with agalsidase alfa can significantly improve renal function in patients with Fabry disease, at least in those with a mild decrease in glomerular filtration rate, and may also be able to slow down the natural decline in renal function in patients with a moderate reduction in glomerular filtration rate.

Conclusion: Initial results from the large cohort of patients within FOS indicate that treatment with agalsidase alfa has beneficial effects on kidney function in patients with Fabry disease.
Gaucher and Fabry diseases: from understanding pathophysiology to rational therapies
Authors: Brady RO
Published: August 2010

Over the past 40 years there has been remarkable development in our understanding of the pathophysiology of lysosomal storage disorders. This review describes the research carried out on the sphingolipid storage disorders from the first demonstration of the underlying metabolic abnormality in Gaucher disease to the development of enzyme replacement therapy for Gaucher and Fabry diseases. Initial developments in gene therapy are also described.

Conclusion: The introduction of enzyme replacement therapy has provided a lifeline for patients with Gaucher or Fabry disease. It is anticipated that future developments, including gene therapy, will provide additional therapeutic options.
Hearing improvement in patients with Fabry disease treated with agalsidase alfa
Authors: Hajioff D , Goodwin S , Quiney R , Zuckerman J , MacDermot KD , Mehta A
Published: August 2010

Aim: To describe the nature and prevalence of hearing loss in Fabry disease, and its response to enzyme replacement therapy (ERT) with agalsidase alfa. Methods: Fifteen male patients with Fabry disease were enrolled in a randomized, double‐blind study and received placebo (n= 8) or ERT (n= 7) with agalsidase alfa for 6 months. This was followed by an open‐label extension of 36 months thus far. Alongside this trial, an additional eight men and two women have so far received open‐label ERT for between 6 and 30 months. Pure‐tone audiometry, impedance audio‐metry and otoacoustic emission testing were performed at 0 (baseline), 6, 18, 30 and 42 months. Results: Nine patients (36%) had bilateral and ten (40%) had unilateral high‐frequency sensorineural hearing loss (SNHL). Three (12%) had unilateral middle ear effusions with conductive losses persisting beyond 6 months. Only five patients (20%) had normal hearing. The high‐frequency SNHL deteriorated over the first 6 months in both placebo and active treatment groups by a median 6.3 dB (p < 0.0001, Wilcoxon matched‐pairs). This hearing loss subsequently improved above baseline by 1.5 dB at 18 months (p = 0.07), by 5.0 dB at 30 months (p= 0.006) and by 4.0 dB at 42 months (p= 0.01).

Conclusion: Significant hearing loss, usually high‐frequency SNHL, is a common manifestation of Fabry disease in adults. α‐Galactosidase A replacement therapy with agalsidase alfa appears to reverse the hearing deterioration in these patients. This improvement, however, is gradual, suggesting the need for long‐term ERT.
Are animal models useful for understanding the pathophysiology of lysosomal storage disease?
Authors: Suzuki K , Ezoe T , Tohyama J , Matsuda J , Vanier MT , Suzuki K
Published: August 2010

Spontaneously occurring genetic lysosomal storage diseases are as rare in other mammalian species as in man. However, the advent of gene targeting technology has revolutionized the state of animal models of genetic diseases. Nearly all lysosomal storage diseases known in man have been duplicated in the mouse. The technology now allows, not only complete inactivation of endogenous genes, but also the introduction of essentially any type of mutation. These animal models can overcome many of the limitations inherent in studies of human patients ‐ rarity of the disease, extremely complex genetic background and logistical and ethical constraints in the design and execution of experiments with human subjects. For example, genetic manipulations of germ cells or cross‐breeding experiments between two mutants are readily feasible with animal models. Two major areas of the utility of animal models are the clarification of the pathophysiology/pathogenetic mechanism of disease and the exploration of therapeutic approaches. Examples of experiments using animal models of lysosomal storage disease are presented, primarily from studies undertaken in our own laboratory.

Conclusion: Animal models have proved invaluable in extending our knowledge of the lysosomal storage diseases and exploring potential therapies.
Metachromatic leukodystrophy: consequences of sulphatide accumulation
Authors: Gieselmann V , Franken S , Klein D , Mansson JE , Sandhoff R , Rauch R Lüllmann , Hartmann D , Saravanan VPM , De Deyn PP , D'Hooge R , Van Der Linden AM , Schaeren‐Wiemers N
Published: August 2010

Metachromatic leukodystrophy is a lysosomal lipid storage disorder. It is caused by mutations in the gene for arylsulphatase A, an enzyme involved in the degradation of the sphingolipid 3′‐O‐sulphogalactosylceramide (sulphatide). This membrane lipid can be found in various cell types, but in particularly high concentrations in the myelin of the nervous system. Patients suffer from progressive, finally lethal, demyelination due to accumulation of sulphatide. In the nervous system, lipid storage not only affects oligodendrocytes but also neurons and, in addition, leads to astrogliosis and activation of microglia. At the cellular level, lysosomal sulphatide storage also affects the lipid composition of myelin itself and has consequences for the amount and localization of particular myelin membrane‐associated proteins. Here we review data, largely based on an arylsulphatase A knock‐out mouse model of metachromatic leukodystrophy.

Conclusion: The knock‐out mouse model of metachromatic leukodystrophy has provided insights into the histopathological and cellular consequences of sulphatide storage.
Risk factors in the development of early technetium‐99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children
Authors: Fernández‐Menéndez JM , Málaga S , Matesanz JL , Solís G , Alonso S , Pérez‐Méndez C
Published: August 2010

Aim: To establish the variables that correlate with uptake defects in dimercaptosuccinic acid (DMSA) scintigraphy performed in the acute phase of a first episode of urinary tract infection (UTI). Methods: A prospective observational study was conducted in a cohort of 158 consecutive children with a first episode of symptomatic UTI. The therapeutic delay time (TDT) was recorded. DMSA scintigraphy was performed in all children and voiding cystourethrography in 150 of them. Results: 85% of the patients were younger than 2 y. Mean TDT was 33.5 h. The aetiological agent was Escherichia coli in 140 children. DMSA scintigraphy was normal in 81. Vesicoureteric reflux was detected in 33. After a multivariate logistic regression analysis the following variables were retained in the final model: TDT ≥48 h, growth of bacteria other than E. coli, percentage of polymorphonuclear cells ≥60% and C‐reactive protein ≥30 mg−1.

Conclusion: TDT ≥48 h, bacteria other than E. coli, percentage of polymorphonuclear cells ≥60% and CRP ≥30 mg−1 influence the findings detected in the DMSA scintigraphy performed in the acute phase of a first episode of UTI.
Early determinants of first hospital admissions for asthma and acute bronchitis among Swedish children
Authors: Bråbäck L , Björ O , Nordahl G
Published: August 2010

Aim: To assess the changing impact of prenatal and perinatal factors with increasing age on first admissions for asthma and acute bronchitis. Methods: The Swedish Medical Birth Registry was linked to the National Hospital Discharge Registry for 214276 Swedish children born in 1987 and 1988. The linkage comprised first admissions for acute bronchitis or asthma from 1987 to 1995. First admissions for gastroenteritis were included to distinguish between factors specific to asthma or bronchitis and non‐specific factors related to an increased risk of hospital admission. Results: Admissions for asthma and acute bronchitis before 2y of age had a close dose‐response relationship with maternal smoking, low gestational age, low maternal age and older siblings. Very premature children exposed to more than 9 cigarettes a day in utero ran a 10 times higher risk of hospitalization than postmature children without exposure to maternal smoking. However, the proportion of admissions attributed to maternal smoking was only 4.7% after adjustments for significant covariates. The number of significant determinants declined in children with their first admission for asthma after 2 y of age but male gender and low educational level were independent determinants in all age groups. Older siblings were related to an increased risk of first asthma admission before 2 y of age but a slightly reduced risk of first admission after 2 y of age.

Conclusion: This study illustrates the varied epidemiology of asthma in different age groups. Maternal smoking was an important determinant for admission before 2 y of age but mainly in combination with other factors. The decline in hospital admissions in early childhood would therefore be small, even after the elimination of maternal smoking, if other significant perinatal and socioeconomic factors were unchanged.
One hundred cases of recurrent abdominal pain in children: diagnostic procedures and criteria for a psychosomatic diagnosis
Authors: Alfvén G
Published: August 2010

Aims: To highlight the diagnostic difficulties involved in elucidating the aetiology of recurrent abdominal pain and to evaluate the use of special premises and criteria for the diagnosis of psychosomatic pain. Methods: The study included 100 consecutive cases of recurrent abdominal pain in 6 to 15 y‐old children who were evaluated at a special paediatric clinic for recurrent abdominal pain and who were followed for at least one year. The investigation included a semi‐structured questionnaire, laboratory investigations based on clinical data and diagnoses based on defined criteria. Three premises and seven criteria, based on the assumption that chronic negative stress can cause recurrent pain, were used for the diagnosis of psychosomatic pain. Results: When the presented premises and criteria were employed for the diagnosis of psychosomatic pain, nearly half of the cases (48%) of recurrent abdominal pain could be explained. An organic or possibly organic diagnosis was found in 25% of the cases. Fourteen children had a possible psychosomatic diagnosis and in 9 cases no known diagnosis could be reached. Conclusion. The presented premises and criteria for the diagnosis of psychosomatic pain can be helpful when diagnosing recurrent abdominal pain, but further validation is needed. According to these criteria, a psychosomatic diagnosis was common in this series, accounting for nearly half of the cases. A medical diagnosis was evident in a quarter of the cases.
Unpowered scooter injuries in children
Authors: Kubiak R , Slongo T
Published: August 2010

Aim: An increasing number of scooter‐related injuries is being seen in emergency department. This study was initiated to establish the demographic profile and injury characteristics of the children involved, to examine the circumstances and to suggest preventive measures. Methods: During this descriptive cohort study, data from year 2000 were collected from all children below 16 y of age who were seen in the emergency department of a Swiss hospital following an accident with an unpowered scooter. Between January and September, information regarding age, gender, injury sustained and medical management was reviewed. From October to December, data were collected prospectively. A questionnaire was sent (January‐September) or handed out personally (October‐December) to the patients, to gather information on the circumstances surrounding the injury and the use of safety equipment. Results: Thirty‐six children (15M, 21F) were included in the study. The mean age was 8.8 y (range 3.0–15.8 y). The most common injuries involved the face (including six children with dental injuries) (44%) and the head (19%). Thirteen children (36%) (6M, 7F) sustained a fracture. The majority of injuries resulted from falls forward or to the side, caused by a loss of control or collision with an obstacle. Only one patient used any safety equipment.

Conclusion: Accidents with unpowered scooters can produce severe injuries in children. Although the majority of patients sustained minor injuries (e.g. lacerations, contusions), more serious injuries can occur. The head and face were the most vulnerable. The use of protective gear, especially helmets, may reduce the number and severity of injuries. Parents, doctors and healthcare workers should be aware of the causes and prevention of injuries caused by this rapidly growing recreational activity in childhood.
Wolfram (DIDMOAD) syndrome: a multidisciplinary clinical study in nine Turkish patients and review of the literature
Authors: Simsek E , Simsek T , TekgüT S , Hosal S , Seyrantepe V , Aktan G
Published: August 2010

Aim: To study Wolfram syndrome (WFS) with multidisciplinary consultations and compare the results with the literature. Methods: Nine patients fulfilled the ascertainment criteria of WFS (insulin‐dependent diabetes mellitus and optic atrophy). All patients were evaluated by the departments of paediatrics, ophthalmology, audiology, urology and medical biology. Results: The earliest manifestation of WFS was insulin‐dependent diabetes mellitus (at a median age of 6.9 y), followed by optic atrophy (8.9 y), diabetes insipidus (10.2 y) and deafness (10.5 y). Short stature was found in five cases, delayed puberty in two cases and hypergonadotropic hypogonadism in one case. Audiography disclosed hearing loss at high frequency in all patients (100%), but only five patients had clinical subjective hearing problems. Intravenous pyelography revealed hydro‐ureteronephrosis in eight patients. Urodynamics revealed a normal bladder in only one patient. Three patients had a low‐capacity, low‐compliance bladder, detrusor external sphincteric dyssynergia and emptying problem, while five had an atonic bladder. Ocular findings were optic atrophy, low visual acuity and colour vision defects. Visual field tests revealed concentric and/or peripheral diminution in five patients. Visual evoked potentials were abnormal (reduced amplitude to both flash and pattern stimulation) in seven patients. Cranial magnetic resonance imaging showed mild or moderate atrophy of the optic nerves, chiasm, cerebellum, basal ganglia and brainstem in six patients; there was a partially empty sella in one case. There was no evidence of mitochondrial tRNALeu (UUR) A to G (nucleotide 3243) mutation.

Conclusion: Wolfram syndrome should be evaluated in a multidisciplinary manner. Some specific and dynamic tests are necessary to make a more precise estimate of the prevalence and median age of the components of WFS. Short stature is a common feature in WFS. Hypogonadism may be hypogonadotropic or hypergonadotropic. Bladder dysfunction does not always present as a large atonic bladder in WFS. A low‐capacity, high‐pressure bladder with sphincteric dyssynergia is also common.
Nasal continuous positive airway pressure versus nasal intermittent positive pressure ventilation for preterm neonates: a systematic review and meta‐analysis
Authors: De Paoli AG , Davis PG , Lemyre B
Published: August 2010

Aim: To determine whether nasal intermittent positive pressure ventilation (NIPPV) is more effective in preterm infants than nasal continuous positive airway pressure (NCPAP) in reducing the rate of extubation failure following mechanical ventilation, and reducing the frequency of apnoea of prematurity and subsequent need for endotracheal intubation. Methods: Randomized trials of NIPPV versus NCPAP were sought and their data extracted and analysed independently by the authors using the methodology of the Cochrane Collaboration. The analysis used relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals. Results: The three studies identified, comparing NIPPV with NCPAP in the postextubation period, all used synchronized NIPPV (SNIPPV), which was more effective than NCPAP in preventing failure of extubation [RR 0.21 (0.10, 0.45), RD ‐0.32 (‐0.45, ‐0.20), NNT 3 (2, 5)]. Two studies compared NIPPV versus NCPAP for the treatment of apnoea of prematurity. Although meta‐analysis was not possible one trial showed a reduction in apnoea frequency with NIPPV and the other a trend favouring NIPPV.

Conclusion: SNIPPV is an effective method of augmenting the beneficial effects of NCPAP in preterm infants in the postextubation period. Further research is required to delineate the role of NIPPV in the management of apnoea of prematurity.
Influences on participation rate in a national Norwegian child development screening questionnaire study
Authors: Janson H
Published: August 2010

Aim: To describe the influence of demographic variables on participation rate in a child development screening questionnaire study, and to discuss the implications for data analysis and for the design of future similar studies. Methods: Appropriate Ages and Stages Questionnaires were mailed to 2392 mothers of children aged 4–60 mo. The bivariate and multivariate influence of demographic variables on responding was investigated. Results: The response rate decreased roughly linearly with the age of the child (ranging from 76% at 8 mo to 32% at 60 mo). Mother's educational level, civil status and (marginally) child's gender also contributed independently to the prediction of response.

Conclusion: Participation rate may be interpreted in terms of interest/saliency and time demands, if a mother's interest in her baby's normative development is assumed to be great, though decreasing as the child grows. Weighting for demographic variables seems to be a viable procedure in the present project; future studies may consider measures to increase the immediacy of questionnaire completion for mothers of children aged 3 y and older.
Benefits and risks of calcium resonium therapy in hyperkalaemic preterm infants
Authors: Grammatikopoulos T , Greenough A , Pallidis C , Davenport M
Published: August 2010

The occurrence of an intestinal perforation in a prematurely born infant following rectal administration of a calcium resonium resin prompted a literature review to determine whether use of resins in neonates was evidence based. This revealed that the results of anecdotal series suggested that resins were useful, but the only randomized trial including prematurely born infants demonstrated that resins were less efficacious than glucose and insulin infusions. Important side effects were reported including colonic necrosis and impaction with perforation.

Conclusion: The risks and benefits of exchange resins in prematurely born infants should be assessed in an appropriately sized randomized trial.
Conversion reaction presenting as a polyradiculonevritis
Authors: Rigante D , Torrioli MG , Ferrara P , Buonuomo PS , Pulitanò S , Stabile A
Published: August 2010

Aim: To show that conversion reactions should be suspected when symptomatology or instrumental checking does not conform to a precise pathological pattern in its anatomical and physiological keys.Methods: We report the case of a 14‐y‐old girl who presented with signs and symptoms of Guillain‐Barré polyradiculonevritis. Negative instrumental and laboratory tests led us to consider a possible diagnosis of conversion reaction.Results: After a more detailed history emphasizing the close bond between the patient and her father, a poor peer‐relation exchange and psychological stress, we were able to identify conversion reactions through the patient's motor signs.

Conclusion: Conversion symptoms must be suspected and searched for when the neurologic outline is difficult to clarify, and also in the case of Guillain‐Barré syndrome that does not respond to plasmapheresis.
Industrial and agricultural pollution: a threat to the health of children living in the Arctic region
Authors: Zetterström R
Published: August 2010

Various environmental pollutants of industrial or agricultural origin such as persistent organic pollutants (POCs) are causing great concern owing to their toxicity to humans and animals. At the Stockholm Convention on POCs in 2001, 12 of these pollutants, i.e. dioxins, PCBs (polychlorinated biphenyls) and DDT were referred to as “the dirty dozen”.

Conclusion: Collaborative studies by scientists from Canada, Russia, Scandinavia and other countries representing different fields such as environmental chemistry, ecology and medical sciences may increase our knowledge about the present threat of toxic chemicals to ecology and human health in the Arctic region. It is hoped that improved understanding will promote preventive political decisions.
Why women don't breastfeed: a national survey
Authors: Hofvander Y
Published: August 2010

Breastfeeding is a behaviour that is influenced by many complex factors and confounders. Various social and psychological factors may thus be missed in studies of the prevalence and duration of breastfeeding. The prevalence of breastfeeding is extremely high in the rich Scandinavian countries where the mothers are given paid maternity leave for at least one year.

Conclusion: National and international women's organizations could improve the conditions for breastfeeding by pressing for a prolongation of the period of maternity leave worldwide.
Association between serum oncofetal antigens CA 19–9 and CA 125 and clinical status in patients with cystic fibrosis
Authors: Gronowitz E , Pitkänen S , Kjellmer I , Heikinheimo M , Strandvik B
Published: August 2010

In cystic fibrosis (CF), mucus plugging in the airways and in the gastrointestinal tract leads to severe morbidity and mortality. The mucin‐associated antigens CA 19–9 and CA 125 are markers of gastrointestinal malignancy, and CA 19–9 has also been reported in association with pulmonary function in CF. Aim: To test whether these antigens might serve as markers for the severity of pulmonary and gastrointestinal disease in CF. Methods: In 99 patients, aged 1 to 48 y, serum levels of CA 19–9 and CA 125 were measured by RIA and ELISA and related to clinical data. Results: Patients with severe mutations had significantly increased serum levels of CA 125, indicating an association with a more severe CF phenotype. This was further supported by the association with lung function, chronic pulmonary colonization of Pseudomonas aeruginosa and pancreatic insufficiency. CA 19–9 was also shown to be associated with lung function and Ps. aeruginosa colonization. No gastrointestinal malignancy was found in our patients despite very high values of CA 19–9 in some patients. During a 5‐y follow‐up, the very high serum levels of CA 19–9 decreased along with improved general condition of the patients.

Conclusion: Increased serum levels of CA 125 in CF patients were associated with severe cystic fibrosis transmembrane conductance regulator mutations and a severe phenotype. Both antigens were associated with pseudomonas colonization and lung function and CA 125 also with pancreatic insufficiency. The estimates of CA 19–9 are hampered by the influence of the Lewis histo‐blood group system on the synthesis of CA 19–9.
Adhesion molecules, endogenous granulocyte colony‐stimulating factor levels and replating capacity of progenitors in autoimmune neutropenia of childhood
Authors: Perdikogianni Ch , Dimitriou H , Stiakaki E , Markaki E‐A , Kalmanti M
Published: August 2010

Aim: To investigate the role of granulocyte colony‐stimulating factor (G‐CSF) and adhesion molecules and the response of bone marrow to peripheral cytopenia in autoimmune neutropenia of childhood (AIN). Methods: Thirty‐five children with AIN, 25 with acute leukaemia in remission, 10 of whom developed chemotherapy‐associated neutropenia, and 28 non‐neutropenic age‐matched children were studied. The methods included haemopoietic progenitor cells’colony growth, replating of colony‐forming unit‐granulocyte macrophage (CFU‐GM) of the 7th day and ELISA for the detection of serum levels of cytokines and adhesion molecules. Results: In cases of severe autoimmune neutropenia, haemopoietic progenitors showed increased proliferative capacity compared to the control group (p= 0.03). Intercellular adhesion molecule‐1 (ICAM‐1), E‐selectin, tumour necrosis factor‐α (TNF‐α) and interleukin‐1 β (IL‐1 β) levels inversely correlated with neutrophil counts (r= ‐0.8, p < 0.001 for ICAM‐1, r= ‐0.5, p= 0.04 for E‐selectin, r=‐0.58, p= 0.01 for TNF‐α, r= ‐0.62, p= 0.04 for IL‐1 β). Serum ICAM‐1, TNF‐α and IL‐1 β levels correlated positively with G‐CSF levels (r= 0.47, p= 0.03 for ICAM‐1, r= 0.65, p= 0.01 for TNF‐α, r= 0.67, p= 0.04 for IL‐1 β). Serum G‐CSF levels were widely distributed and did not correlate with neutrophil counts (r= ‐0.44, p= 0.09). In secondary neutropenias the respective levels were lower than those in autoimmune neutropenia.

Conclusions: Haemopoietic progenitors show increased proliferative capacity in cases of severe autoimmune neutropenia. G‐CSF seems to act as an inducer of endothelium activation. The degree of neutropenia correlates with serum ICAM‐1, E‐selectin, TNF‐α and IL‐1 β levels, indicating the existence of an activated endothelium and presumably of a latent, low‐grade, inflammatory process in severe autoimmune neutropenia.
Laryngeal and diaphragmatic muscle activities after central nervous system lesions in cats
Authors: Hutchison AA , Speck DF
Published: August 2010

Aim: To examine the central control and coordination of respiratory pump muscles and laryngeal valve muscles by systematic decerebration (DECER), cerebellectomy (CBELL), pontine respiratory group lesioning (PRG) and pontomedullary section (PMED). Methods: Activities of posterior cricoarytenoid (PCA), thyroarytenoid (TA) and diaphragm (D) muscles and their responses to inspiratory (I) and expiratory (E) total occlusions were determined in 10 adult cats. Results: INTACT anesthetized cats (n= 6) exhibited inspiratory PCA (PCAI) and D activities. Expiratory PCA (PCAE) was present but TA activity was absent. It was found that successive DECER, CBELL and PRG lesions attenuated PCAE, the intact pattern being noted in 7/10, 4/10 and 0/6 cats, respectively. After PMED, variable PCA, TA and continuous D activities occurred only with blood gas abnormalities. Augmented PCA and D responses to I‐ and E‐loads occurred after PRG lesions: the I‐load PCAI and D responses resembled apneusis and the E‐load PCAE and D responses resembled central apnea.

Conclusion: The decreasing PCAE activity observed with successive DECER, CBELL and PRG lesions suggests that these areas influence laryngeal abductor control of glottic size. The synchronous activities after PMED transection suggest a role for more rostral structures in coordinating laryngeal and diaphragmatic muscle activities.
Why primiparous mothers do not breastfeed in the United States: a national survey
Authors: Taylor JS , Risica PM , Cabral HJ
Published: August 2010

Aim: To investigate primiparous women's primary reason for not breastfeeding. Methods: We used the 1995 National Survey of Family Growth to analyze the breastfeeding behaviors of a national probability sample of 6733 first‐time US mothers, aged 15 to 44 y. Main outcome measures in this cross‐sectional study were the reasons for never breastfeeding and reasons for stopping breastfeeding using closed‐ended, multiple choice questions. Results: Most commonly, women did not breastfeed because they “preferred to bottle feed” (66.3%). The most common reason for stopping breastfeeding was that the child was “old enough to wean” (35.7%), although 15%, 34%, 54%, and 78% of those women had stopped breastfeeding by 3, 6, 9, and 12 mo, respectively. “Physical or medical problem” was reported by 14.9% of women who did not breastfeed and 26.9% of women who had stopped breastfeeding, making it the second most common reason for not breastfeeding in each group. There were significant differences across racial and ethnic groups.

Conclusion: Additional studies are needed to better understand why women “prefer to bottle feed”, especially black women. Increasingly effective programs and policies to promote breastfeeding will logically follow. Since physical and medical problems are such common reasons both for never breastfeeding and for stopping breastfeeding, individual healthcare providers can have a significant impact on breastfeeding rates and duration.
Syncope in a child owing to intramural course of the left coronary artery
Authors: Daehnert I , Rotzsch C , Krause S , Dorszewski A , Kostelka M
Published: August 2010

Coronary abnormalities are a rare cause of syncope or sudden death in childhood or adolescence. We report on a 14‐y‐old girl who had suffered for many years from repeated syncope after or during exertion. She had to be resuscitated twice. The left coronary artery arose from the right coronary aortic sinus and took a proximal intramural course. After successful reimplantation, the patient has now been free of symptoms for 12 mo. The pitfalls of differential diagnosis of this rare anomaly are discussed.

Conclusion: Investigation of the coronary anatomy is indicated in otherwise unexplained chest pain, syncope or life‐threatening events.
Adolescent homosexuality: we need to learn more about causes and consequences
Authors: Berg‐Kelly K
Published: August 2010

In this issue a descriptive study of various aspects of homosexual orientation among adolescents is presented. In agreement with previous American studies, the authors identify three separate domains of homosexuality: attraction, fantasy and self‐identification. This knowledge is important in understanding an adolescent struggling with homosexual thoughts.

Conclusion: The development of an homosexual identity is a process connected with serious health hazards related to both physical and mental health. Most adolescents are not given adequate support because heterosexuality is considered the norm in most cultures.
Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4–6 months: a longitudinal prospective study based on daily records of feeding
Authors: Aarts C , Kylberg E , Hofvander Y , Gebre‐Medhin M
Published: August 2010

Aim: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4–6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) “12‐month breastfed pooled data set” and the Euro‐Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. Methods: 147 exclusively breastfed infants and 325 non‐exclusively breastfed Swedish infants, with a birthweight of ≥3 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. Results: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non‐exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12–16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the “WHO pooled breastfed data set” and the Euro‐Growth references for exclusively breastfed infants.

Conclusion: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non‐exclusively breastfed infants with a high breastfeeding rate.
Vitamin A and sudden infant death syndrome in Scandinavia 1992–1995
Authors: Alm B , Wennergren G , Norvenius SG , Skjærven R , Lagercrantz H , Helweg‐Larsen K , Irgens LM
Published: August 2010

Aim: To assess the effect of vitamin supplementation on the risk of sudden infant death syndrome (SIDS). Methods: The analyses are based on data from the Nordic Epidemiological SIDS Study, a case‐control study in which parents of SIDS victims in the Scandinavian countries were invited to participate together with parents of four matched controls between 1 September 1992 and 31 August 1995. The odds ratios presented are computed by conditional logistic regression analysis. Results: The crude odds ratio in Scandinavia for not giving vitamin substitution was 2.8 (95% CI (1.9,4.3)). This effect was statistically significant in Norway and Sweden, which use A and D vitamin supplementation, but not in Denmark, where only vitamin D supplementation is given. The odds ratios remained significant in Sweden when an adjustment was made for confounding factors (OR 28.4, 95% CI (4.7,171.3)).

Conclusion: We found an association between increased risk of sudden infant death syndrome and infants not being given vitamin supplementation during their first year of life. This was highly significant in Sweden, and the effect is possibly connected with vitamin A deficiency. This effect persisted when an adjustment was made for potential confounders, including socio‐economic factors.
Epidemiological changes in diagnosed coeliac disease in a population of Spanish children
Authors: López‐Rodríguez MJ , Macías ML Canal , García JM Lavado , Belda M Sánchez , Andrés P Robledo , Zamorano JD Pedrera
Published: August 2010

Aim: To investigate the incidence rate of diagnosed coeliac disease among the paediatric population in the province of Cáceres and the changes over the years. Methods: The incidence rate of diagnosed coeliac disease between the years 1981 and 1999, age at diagnosis and clinical presentation form were investigated. The study was carried out over two periods: A (1981 to 1990) and B (1991 to 1999). Results: The incidence rate for period A was 6.87/100000 (CI 95%: 5.26–8.83) and for period B 16.04/100000 (CI 95%: 12.99–19.59) (p < 0.0001). The relative risk of receiving a diagnosis of coeliac disease during the first four years of life was 2.31% (CI 95%: 1.61–3.31) greater in period B than in period A. The mean age at diagnosis was 37.4 ± 47.4 mo and 43.9 ± 43.7 mo in A and B, respectively (p= 0.0058). The typical clinical pattern was the most frequent (83.6% in A and 58.3% in B). The mean age of introduction of gluten to the diet was 4.6 ± 2.0 mo and 6.9 ± 1.7 mo, for period A and B, respectively (p < 0.0001).

Conclusion: The incidence rate of coeliac disease has increased during the two periods studied. In recent years, the relative risk of receiving a diagnosis of coeliac disease during the first four years of life has increased. The atypical clinical presentation has also increased, although the typical clinical form is still the most frequent in younger children.
Impact of nutritional status on antibody responses to different vaccines in undernourished Gambian children
Authors: Moore SE , Goldblatt D , Bates CJ , Prentice AM
Published: August 2010

Aim: To test the efficacy of T‐cell‐dependent and T‐cell‐independent vaccines in rural Gambian children suffering from a range of energy/protein and micronutrient deficiencies. Methods: Nutritional status (anthropometry, haemoglobin, plasma leptin and micronutrient status) and response to two vaccinations (23 valent pneumococcal capsular polysaccharide vaccine, Pneumo‐vax® and the Human Diploid‐Cell Rabies Vaccine) were assessed in 472 children aged 6½ to 9½ y. Results: Anthropometry and micronutrient status (as z‐scores against European reference values) indicated a range from moderate to severe levels of undernutrition [mean (interquartile range): weight‐for‐age z‐score –1.58 (–2.18 to –0.95); height‐for‐age z‐score –0.94 (–1.51 to –0.35); body‐mass‐index‐for‐age z‐score –1.43 (–2.05 to –0.84); mid‐upper arm circumference ‐1.41 (–1.72 to –1.13); leptin –1.06 (–1.10 to –1.03); haemoglobin (Hb) –0.30 (–1.18 to 0.79); zinc ‐1.29 (–2.42 to –0.55); vitamin C –0.01 (–1.18 to 1.15); retinol –1.33 (–1.97 to –0.77)]. A seasonal effect was observed in haemoglobin levels and in all micronutrients (with the exception of zinc and retinol) and in the response to vaccination. After adjusting for seasonality, age and gender, no consistent associations were found between any of the measures of nutritional status and the effectiveness of seroconversion to either of the vaccines.

Conclusion: The successful short‐term seroconversion to whole inactivated viral and bacterial polysaccharide vaccines indicates that the processes leading to antibody secretion remain intact over a wide range of single and combined nutrient deficiencies.
Lactic dehydrogenase isoenzyme in cerebrospinal fluid of children with febrile convulsions
Authors: Nussinovitch M , Avitzur Y , Finkelstein Y , Amir J , Harel D , Volovitz B
Published: August 2010

Aim: To study the lactic dehydrogenase isoenzyme values in children with simple and complex febrile convulsions. Methods: Cerebrospinal fluid samples were collected from 115 children, 57 with simple febrile convulsions, 27 with complex febrile convulsions and 31 with no neurological or intracranial pathology (controls). Lactic dehydrogenase activity and isoenzyme levels were measured on a Hitachi analyser. Results: Mean total lactic dehydrogenase activity was similar in the three groups. In the control group, lactic dehydrogenase‐1 was the main fraction, followed by lactic dehydrogenase‐2 and lactic dehydrogenase‐3; only small percentages of lactic dehydrogen‐ase‐4 and lactic dehydrogenase‐5 were detected. In the febrile convulsion group, the lactic dehydrogenase‐1 fraction percentage was lower and lactic dehydrogenase‐2, lactic dehydrogenase‐3 percentages were higher than those in the control group; and the differences were statistically significant between the control and study groups (p < 0.01). Values of lactic dehydrogenase‐4 and lactic dehydrogenase‐5 were similar in all three groups.

Conclusion: This is the first report on the lactic dehydrogenase isoenzyme pattern in the cerebrospinal fluid of patients with simple and complex febrile convulsions. The important finding that focal and general febrile convulsions are not associated with cell damage and changes in aerobic and anaerobic metabolism as lactic dehydrogenase remained unchanged. Analysis of cerebrospinal fluid lactic dehydrogenase isoenzyme levels can assist clinicians in differentiating febrile convulsions from clinical situations that might mimic them.
Perinatal bile acid metabolism: analysis of urinary unsaturated ketonic bile acids in preterm and full‐term infants
Authors: Maeda K , Kimura A , Yamato Y , Matsuishi T
Published: August 2010

Aim: To compare urinary concentrations of unsaturated ketonic bile acids in preterm and full‐term infants. Methods: Urinary unsaturated ketonic bile acids were determined using gas chromatographymass spectrometry. Results: Urinary concentrations of total bile acids in early preterm infants (of less than 29 wk gestational age) exceeded concentrations in late preterm (between 30 and 37 wk) and full‐term infants (between 38 and 41 wk; p < 0.01). The percentage of ketonic bile acids (7a, 12a‐dihydroxy‐3‐oxo‐4‐cholenoic acid and 7a‐hydroxy‐3‐oxo‐4‐cholenoic acid) among total urinary bile acids in full‐term infants (20.2 ± 14.1%) was higher than that in early preterm infants (8.9 ± 8.1%; p < 0.05). The percentage of unsaturated bile acids (3β‐hydroxy‐Δ5‐bile acids) among total bile acids in urine did not differ greatly between groups.

Conclusion: The percentage of 3‐oxo‐Δ4 bile acids among total bile acids in urine gradually increased from early to late preterm infants, while healthy full‐term infants excreted large amounts of 3‐oxo‐Δ4 bile acids in urine at delivery.
Role of cytokines (interleukin‐1β, 6, 8, tumour necrosis factor‐α, and soluble receptor of interleukin‐2) and C‐reactive protein in the diagnosis of neonatal sepsis
Authors: Reyes C Santana , García‐Muñoz F , Reyes D , González G , Dominguez C , Domenech E
Published: August 2010

Aim: To investigate whether the serum levels of interleukin‐1β, 6, 8, tumour necrosis factor‐α and the soluble receptor of IL‐2 are useful in the diagnosis of neonatal sepsis, and whether their diagnostic power is increased when in combination with classical markers such as C‐reactive protein and white blood cell count. Methods: Blood samples were collected at admission from 40 neonates with suspected infection. Patients were included in different groups according to the bacteriological and laboratory results: Group I consisted of 20 newborns with positive blood cultures and other biological tests suggestive of infection. Group II included 20 neonates with negative blood cultures and biological tests not suggestive of infection. The control group included 20 healthy neonates with no clinical or biological data of infection. Results: Mean values of C‐reactive protein were significantly higher in Group I. No differences were found between the groups for white blood cell count, with the exception of the presence of leucocytosis in Group II. Levels of interleukin‐1β, 6, 8, tumour necrosis factor‐α, soluble receptor of interleukin‐2, and C‐reactive protein were significantly higher in infected neonates than in the control groups. Detection sensitivity and specificity were 80 and 92% for C‐reactive protein, 60 and 87% for interleukin‐1β, 61 and 80% for interleukin‐6, 62 and 96% for interleukin‐8, 54 and 92% for tumour necrosis factor‐α and 63 and 94% for soluble receptor of interleukin‐2. The discriminant analysis showed that the best combination for sepsis diagnosis was C‐reactive protein + interleukin‐8 + soluble receptor of interleukin‐2, with a sensitivity of 85% and a specificity of 97.1%.

Conclusion: Our study suggests that no individual test can on its own identify infected neonates, and that although the combination of C‐reactive protein, interleukin‐8 and the soluble receptor of interleukin‐2 exhibits a high specificity, its sensitivity is limited.
Prevalence and dimensions of sexual orientation in Swiss adolescents: a cross‐sectional survey of 16 to 20‐year‐old students
Authors: Narring F , Huwiler SM Stronski , Michaud P‐A
Published: August 2010

Aim: Sexual orientation plays an important part in building identity during adolescence. The aim of this study was to describe patterns of sexual orientation, including sexual attraction, fantasies, affiliations and behaviour.Methods: The study was based on the analysis of data from computerized self‐administered questionnaires of a Swiss national survey on the sexual life of 16 to 20‐year‐old adolescents (n= 2075 girls and 2208 boys.).Results: Overall, 95.0% of girls and 96.2% of boys described themselves as predominantly heterosexual; 1.4% of girls and 1.7% of boys as predominantly homosexual or bisexual; and 2.8% of teenagers (girls: 3.6%; boys: 2.1%) were “unsure” of their sexual orientation. The reported prevalence of homosexual attraction (girls: 2.0%; boys: 2.9%) exceeded homosexual fantasies (girls: 0.4%; boys: 0.5%) and affiliations (girls: 0.3%; boys: 0.5%). Among the 4205 respondents, 31 girls (1.5% of girls) and 56 boys (2.5% of boys) reported sexual behaviour (experience or penetrative intercourse) with a person of the same sex. Among 1.5% of girls and 2.5% of boys who reported sexual behaviour with a person of the same sex, 65% of boys and 80% of girls nevertheless considered themselves as heterosexual.

Conclusion: For a comprehensive understanding of sexual orientation in adolescence a differentiated look at dimensions of sexual orientation is indispensable. This applies to clinical settings, public health and research.
Urinary effects of morphine in preterm infants
Authors: Bengtsson B‐OS , Wootton‐Gorges SL , Poulain FR , Sherman MP
Published: August 2010

Aim: To describe the association between morphine administration in preterm infants, hydronephrosis, and renal dysfunction. Methods: The findings were based on serial ultrasound examinations and blood studies. Results: Two preterm infants had bladder distension and hydronephrosis after they received intravenous morphine for analgesia. Morphine was used at a low dose. Each patient had a normal urine output and normal serum creatinine before the signs and symptoms of urinary retention were observed. Within 24 h of morphine administration, each infant concurrently developed oliguria and elevation of the serum creatinine. Cessation of morphine and urinary drainage resulted in rapid and complete resolution of the hydronephrosis and the elevated creatinine.

Conclusion: Morphine, even at low dosages, can be associated with hydronephrosis in hospitalized preterm infants.