bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic covalent adduct formation with zomepirac in the CD26‐deficient mouse
Authors: WANG MIN , GORRELL MARK D , ABBOTT CATHERINE A , JAGGI RENE , MARGUET DIDIER , DICKINSON RONALD G
Published: March 2003

Background and Aims: Zomepirac (ZP), a non‐steroidal anti‐inflammatory drug (NSAID), has been reported to cause immune‐mediated liver injury. In vivo, ZP is metabolized to a chemically reactive acyl glucuronide conjugate (ZAG) which can undergo covalent adduct formation with proteins. Such acyl glucuronide‐derived drug‐protein adducts may be important in the development of immune and toxic responses caused by NSAID. We have shown using immunoabsorptions that the 110 kDa CD26 (dipeptidyl peptidase IV) is one of the hepatic target proteins for covalent modification by ZAG. In the present study, a CD26‐deficient mouse strain was used to examine protein targets for covalent modification by ZP/metabolites in the liver.

Methods and Results: The CD26‐deficient phenotype was confirmed by immunohistochemistry, flow cytometry analysis, RT‐PCR, enzyme assay and immunoblotting. Moreover, by using monoclonal antibody immunoblots, CD26 was not detected in the livers of ZP‐treated CD26‐deficient mice. Immunoblots using a polyclonal antiserum to ZP on liver from ZP‐treated mice showed three major sizes of protein bands, in the 70, 110 and 140 kDa regions. Most, but not all, of the anti‐ZP immunoreactivity in the 110 kDa region was absent from ZP‐treated CD26‐deficient mice.

Conclusion: These data definitively showed that CD26 was a component of ZP‐modified proteins in vivo. In addition, the data suggested that at least one other protein of approximately 110 kDa was modified by covalent adduct formation with ZAG.
Plasma and urine levels of urinary trypsin inhibitor in patients with acute and fulminant hepatitis
Authors: LIN SHI DE , SATO AKIHIRO , TAKIKAWA YASUHIRO , SHIRAKAWA KAMON , SUZUKI KAZUYUKI
Published: March 2003

Background and Aim Urinary trypsin inhibitor (UTI) is synthesized by hepatocytes and excreted into urine. Plasma and urine UTI levels have been measured to evaluate whether these levels may be useful markers in various pathological conditions. However, there has been no study on plasma and urine UTI levels in patients with acute liver diseases. The aim of the present study was to evaluate plasma and urine UTI levels and their relationship with the severity of hepatic damage in patients with acute liver diseases.

Methods Plasma and urine UTI levels were measured by newly developed enzyme‐linked immunosorbent assay in 15 patients with acute hepatitis (AH), 12 patients with acute severe hepatitis (ASH) and 10 patients with fulminant hepatitis (FH), as assessed on admission. The serial changes in plasma and urine UTI were also observed in some patients with AH and ASH.

Results Plasma UTI levels (U/mL, median [25–75th percentile]) were: 11.0, (9.5–16.1) in patients with AH; 7.8 (5.6–11.5) in those with ASH; 6.5 (4.0–9.5) in patients with FH; and 9.7 (7.3–11.0) in normal controls. Plasma UTI levels in patients with FH were significantly lower than in those with AH. Plasma UTI levels showed significant positive correlations with the levels of prothrombin time (PT), hepaplastin test, antithrombin III, α2‐plasmin inhibitor, plasminogen (Plg) and fibrinogen. After the recovery of liver dysfunction, increased plasma UTI levels in patients with AH were decreased, whereas previously decreased plasma UTI levels in patients with ASH were increased. Urine UTI levels were significantly increased in patients with AH compared with those of normal controls. In patients with ASH and FH, urine UTI levels were increased but not significantly. Urine UTI levels significantly positively correlated with PT and Plg. After the recovery of liver dysfunction, previously increased urine UTI levels in patients with AH were decreased. The correlation between plasma UTI and urine UTI levels was not significant.

Conclusions The findings of the present study suggested that the levels of plasma and urine UTI changed in patients with AH and were closely related to the abnormalities of coagulo‐fibrinolysis, including PT. Further studies are needed to clarify whether these levels may be useful markers to predict the prognosis of acute hepatitis.
Relationship between nuclear factor‐κB activation and virulence factors of Helicobacter pylori in Japanese clinical isolates
Authors: MAEDA SHIN , ANARSANAA JAZAG , MITSUNO YUZO , HIRATA YOSHIHIRO , AKANUMA MASAO , IKENOUE TSUNEO , OGURA KEIJI , YOSHIDA HARUHIKO , SHIRATORI YASUSHI , OMATA MASAO
Published: March 2003

Abstract

Background:
Several factors have been proposed as a possible virulence determinant of Helicobacter pylori infection. The aim of the present study was to evaluate these candidates in nuclear factor (NF)‐κΒ activation, which is a critical regulator of genes involved in inflammatory reactions.

Methods:
We determined the status of cagE, iceA, HP0441 (a virB4 homolog), the s1 signal sequence of vacA and babA2 by polymerase chain reaction, all of which are candidate virulence determinants, in 107 H. pylori strains isolated from Japanese patients. Nuclear factor‐κΒ activation was evaluated by the luciferase reporter assay. The gastric mucosa of the hosts was examined histologically.

Results:
The cagE gene was positive in 102 (95.3%) strains, iceA1 was positive in 71 (66.4%) strains, HP0441 was positive in 68 (63.6%) strains, vacA s1 was positive in 105 (98.1%) strains and babA2 was positive in 103 (96.3%) strains. Nuclear factor‐κΒ was activated by all cagE‐positive strains, but was not activated by any of the cagE‐negative strains. The status of iceA or HP0441 was not associated with NF‐κΒ activation. Neutrophil infiltration in gastric mucosa was significantly more severe in patients infected with cagE‐positive strains than in patients infected with negative strains. No association was found between the degree of neutrophil infiltration and the status of HP0441 or iceA. Due to very high positivity of vacA s1 and babA2 in Japanese strains, their roles remain to be investigated.

Conclusions:
The cag pathogenicity island (PAI) status, as determined by cagE polymerase chain reaction, but not the status of iceA or HP0441, is closely associated with NF‐κΒ activation and the degree of gastric mucosal inflammation in the hosts.

© 2002 Blackwell Publishing Asia Pty Ltd
Comparison of clinical manifestations and epidemiology between acute hepatitis A and acute hepatitis E in Taiwan
Authors: Su Chien‐Wei , Wu Jaw‐Ching , Huang Yi‐Shin , Huo Teh‐Ia , Huang Yi‐Hsiang , Lin Chen‐Chun , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Background and Aims
: Acute hepatitis A (AHA) and acute hepatitis E (AHE) are endemic in developing countries. They share similar transmission routes and clinical manifestations. To compare the differences in epidemiology, clinical picture and prognosis between these two enterically transmitted forms of hepatitis, we enrolled 58 consecutive AHA or AHE patients (42 men and 16 women; age 16–74 years) from January 1990 to April 2001.

Results
: In comparison to AHA, patients with AHE were older (56.2 ± 15.4 vs 30.7 ± 11.0 years, P < 0.0001), and more frequently had a history of travel within 3 months before onset of illness (68.8 vs 30.8%, P = 0.003). In laboratory data, AHE patients had lower serum levels of albumin (3.4 ± 0.4 vs 3.8 ± 0.4 g/dL, P = 0.016), alanine aminotransferase (1912 ± 1587 vs 3023 ± 1959 U/L, P = 0.015), and aspartate aminotransferase (1681 ± 1444 vs 2374 ± 2869 U/L, P = 0.24), but a higher serum bilirubin level (17.8 ± 12.3 vs 8.7 ± 5.0 mg/dL, P = 0.003) than AHA patients. Moreover, five (15.6%) patients with AHE compared with none with AHA died. This probably indicates that AHE had a worse outcome than AHA in our study. In analysis of epidemiological factors, older age of onset of illness was the only significant predicator of outcome. From an epidemiological survey, most AHE patients were imported while most AHA patients were not. However, native AHE and imported AHA did occur in Taiwan.

Conclusion
: Patients with AHE in Taiwan had older age of onset, more records of traveling history, and poorer clinical manifestations than those with AHA, and age seemed to be the most important factor to influence outcome.

© 2002 Blackwell Publishing Asia Pty Ltd
Relationship between human leukocyte antigen‐DRB1 and autoimmune hepatitis type I in Chinese patients
Authors: QIU DE‐KAI , MA XIONG
Published: March 2003

Aim: To analyze the association of human leukocyte antigen (HLA)‐DRB1 with autoimmune hepatitis type I (AIH) among Chinese patients in the Shanghai area.

Methods: In 32 patients and 48 healthy controls, polymerase chain reaction amplified with sequence‐specific primers (PCR‐SSP) was performed to elucidate the relevance of certain alleles or polymorphic sequences of HLA‐DRB1 with autoimmune hepatitis.

Results: The HLA‐DRB1 typing by PCR‐SSP showed that DR4 had a significantly increased frequency among patients with AIH versus that of healthy controls (46.9 vs 20.8%; relative risk = 3.35, P = 0.014). In the subtypes of DR4, there was a trend of an increase in the gene frequency of DRB1*0405 in patients with AIH versus that of healthy controls (21.9 vs 6.3%, P = 0.04, but corrected P (Pc) = 0.08). In addition, our analysis indicated a significant increase in the alleles frequency encoding Leu‐Leu‐Glu‐Gln‐Lys‐Arg (LLEQRR) from the third hyperpolymorphic region (HVR3) of DR4 in the patients with AIH (86.7% of DR4 positive patients vs 40.0% in DR4 positive controls, P = 0.016, Pc = 0.028, relative risk (RR) = 9.75).

Conclusion: Type I AIH among Chinese patients is associated with HLA‐DR4. There is a relevance of type I AIH and LLEQRR sequence within the third hyperpolymorphic region of the DRB1 allele.

© 2003 Blackwell Publishing Asia Pty Ltd
Clinical characteristics of Japanese reflux esophagitis patients as determined by Los Angeles classification
Authors: INAMORI MASAHIKO , TOGAWA JUN‐ICHI , NAGASE HAJIME , ABE YASUNOBU , UMEZAWA TADASHI , NAKAJIMA ATSUSHI , SAITO TOSHIFUMI , UENO NORIO , TANAKA KATSUAKI , SEKIHARA HISAHIKO , KAIFU HIROKI , TSUBOI HIDEO , KAYAMA HIDEYUKI , TOMINAGA SHIZUO , NAGURA HIROSHI
Published: March 2003

Background:  Recent studies have shown that the number of patients with reflux esophagitis is increasing in Japan, but the prevalence and risk factors associated with reflux esophagitis in Japanese patients are not well defined.

Methods:  By using all endoscopic records in the Katta General Hospital from April through to September 1999, we identified 392 patients. We examined the Los Angeles classification, peptic ulcer, gastric mucosal atrophy, hiatal hernia and other medical variable factors for their contribution to esophagitis in the patients.

Results:  Patients (13.8%) were diagnosed as having reflux esophagitis with a mucosal break. In a multivariate analysis, reflux esophagitis was associated with hiatal hernia (odds ratio (OR) 2.276, 95% confidence interval (CI) 1.164–4.450), with patients over 65 years of age (OR 2.521, 95% CI 1.238–5.134) and the open type of gastric mucosal atrophy (OR 0.420, 95% CI 0.225–0.785). There was no significant difference between esophagitis and Helicobacter pylori infection and peptic ulcer.

Conclusions:  We observed that age, hiatal hernia and a lower rate of gastric mucosal atrophy were associated with the proportion of mucosal breaks accompanying esophagitis.
22q11 deletions in patients with conotruncal heart defects
Authors: WORTHINGTON S , BOWER C , HARROP K , LOH J , WALPOLE I
Published: March 2003

Objective:

To ascertain the frequency of 22q11 deletions in a representative population of conotruncal heart defects (CTD) and determine which children are at risk of having a deletion.

Methodology:

A clinical and laboratory evaluation of 90 children with CTD, including isolated and syndromic cases.

Results:

Fifteen children (17%) were shown to have 22q11 deletions by fluorescence in situ hybridization (FISH) studies with the Oncor probe N25. Varying degrees of developmental delay/learning disabilities and facial dysmorphism were common in these children. None of the isolated cases without dysmorphism had a deletion.

Conclusion:

22q11 deletions are a significant cause of a specific form of congenital heart disease, CTD. It is important to have a high index of suspicion of the 22q11 deletion disorders in children with CTD and other extracardiac manifestations so that the diagnosis can be made early and appropriate interventions implemented.
Magnetic resonance imaging evaluation of the pituitary gland and hypothalamus in thalassaemic children with elevated serum ferritin levels
Authors: LAU KY , CHAN YL , LAM WWM , LI CK , METREWELI C
Published: March 2003

Objective:

Despite modern treatment with hypertransfusion and chelation therapy, growth retardation continues to be observed in a significant proportion of thalassaemic children. The underlying reason remains unclear, but hypothalamic‐pituitary axis disorder has been implicated. We aimed to assess iron overloading in the hypothalamus and pituitary gland in thalassaemic children with elevated serum ferritin, with and without growth retardation.

Methodology:

Twelve thalassaemic children on hypertransfusion and chelation therapy with high serum ferritin were investigated with magnetic resonance imaging (MRI). Five children, all over 10 years of age, had growth retardation. Gradient recalled echo sequence was used to highlight any susceptibility effect that could be due to iron in the hypothalamus or pituitary gland.

Result:

There was no evidence of abnormal hypointense signal in the hypothalamus or pituitary gland in the patients studied, regardless of the presence of growth retardation.

Conclusion:

There was no apparent characteristic MRI appearances of iron deposition in the hypothalamus or pituitary gland in thalassaemic children with high serum ferritin.
Predicting readmission to hospital with asthma
Authors: RAYMOND D , HENRY RL , HIGGINBOTHAM N , COORY M
Published: March 2003

Objectives:

To determine whetherreadmission to hospital for children aged 1–7 years with asthma can be predicted; and to discover whether factors related to the severity of the attack and past pattern of asthma, assessment of the parents’ intention to treat the child with inhaled therapy, perceived consequences of treatment, habits of treatment and self‐efficacy show a difference between those children subsequently readmitted and those who were not.

Methods:

A specifically developed questionnaire was administered to parents of 121 children admitted with asthma. Clinical assessment was made of severity of the acute attack and past pattern of the asthma. One year after admission subjects were reviewed to determine those who had been readmitted.

Results:

On univariate analysis, the negative perceived consequences of treatment with inhaled therapy were associated with an increased risk of readmission over a one‐year period (P=0.04). After adjusting for confounders (place of birth of mother, two‐ or one‐parent family) and the effect‐modifier of past pattern of the asthma (infrequent episodic, frequent episodic, persistent), the greater the negative perceived consequences of treatment, the more likely there would be readmission in children with infrequent episodic asthma. After adjusting for potential confounders, using logistic regression a decrease of one standard deviation in the negative perceived consequences score resulted in a one‐third decrease in the odds of readmission (odds ratio (OR)=0.31, 95% CI 0.12–0.83).

Conclusions:

Parents whose children are readmitted see greater negative perceived consequences of treatment. If asthma is infrequent episodic, the negative perceived consequences may be an inhibitor of treatment, whereas for more severe past patterns of asthma the severity is the controller of treatment. If parental negative consequences could be decreased, admissions for asthma may decrease.
Nocturnal enuresis: What is happening?
Authors: Harari MD , Moulden A
Published: March 2003

Abstract: Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed‐wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short‐term solution for children attending school camps or sleeping over at friends’ houses and as treatment in the medium term for those unresponsive to treatment with a bed‐wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.
Hearing in children after meningococcal meningitis
Authors: Drake R , Dravitski J , Voss L
Published: March 2003

Objective: To review the outcome of sensorineural hearing loss in children who have had confirmed meningococcal meningitis.

Methods: A retrospective audit of children admitted to the Starship Children’s Hospital with a confirmed diagnosis of meningococcal meningitis during a 4‐year period.

Results: Sixty‐five children had confirmed meningococcal meningitis. Dexamethasone was administered according to recommended guidelines in 46 children (72%) while 12 children (19%) did not receive steroids at any stage. All children were appropriately referred for hearing assessment. Forty‐nine children (75%) had their hearing tested and reliable sensorineural evaluation was obtained in all but one case. Thirty‐four children (70%) were seen up to 6 weeks from discharge, 86% by 12 weeks. Sixteen cases (25%) did not attend for audiological assessment. Sensorineural hearing impairment was found in two children (4.2%).

Conclusions: Children with meningococcal meningitis were reliably referred for audiological assessment but 39% either failed to attend for an outpatient hearing evaluation (25%) or had an unacceptable delay between discharge and testing (14%). Of those reliably tested, two children (4.2%) had significant sensorineural hearing loss.
Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates
Authors: Agarwal P , Rajadurai Vs , Pradeepkumar Vk , Tan Kw
Published: March 2003

Objective: The aim of the present prospective cohort study was to evaluate the relationship between lower respiratory tract colonization with Ureaplasma urealyticum and development of chronic lung disease (CLD) in a high‐risk neonatal population.

Methods: Prospective cohort study of preterm infants with a birthweight < 1500 g needing mechanical ventilation within 24 h of birth in a tertiary care neonatal unit. Endotracheal aspirates from these infants were cultured within 24 h for U. urealyticum and the rate of colonization was determined. The primary outcome measure was the incidence of CLD at 28 days of life.

Results: Of the 41 infants studied, 10 (24%) infants were colonized with U. urealyticum. The colonization rate was higher in babies < 1000 g compared with babies weighing 1000–1500 g (P = 0.04). There was no significant difference between the colonized and non‐colonized groups with regard to the antenatal use of steroids, maternal prolonged rupture of membranes, gestational age, birthweight, sex, respiratory distress syndrome, use of surfactant, patent ductus arteriosus and gastrooesophageal reflux. Of the 37 survivors, 20 (54%) developed CLD; eight infants (88.5%) in the colonized group developed CLD compared with 12 infants (42.8%) in the non‐colonized group (P = 0.01).

Conclusions: Neonates colonized with U. urealyticum were twice as likely to have CLD than non‐colonized babies (relative risk 2.01; 95% confidence interval 1.27–3.37). These data suggest a significant association between colonization with U. urealyticum and CLD in infants weighing < 1500 g.
Pitfalls of gastric intubation in premature infants
Authors: Sudhakaran N , Kirby CP
Published: March 2003

Abstract: Gastric intubation, by oral or nasal route is an essential procedure in the management of premature infants, for gastric aspiration and for feeding. Oesophageal perforation is a rare but important complication of this commonly performed procedure. An illustrative case is presented. Difficulty passing a tube into the stomach is the first clue to the diagnosis. Understanding the evolution of clinical signs and recognizing the radiological changes facilitates an early diagnosis, thereby enabling successful non‐operative management.
Transient hyperphosphatasaemia: An important condition to recognize
Authors: Carroll AJ , Coakley JC
Published: March 2003

Objective: To investigate the prevalence and aetiology of transient hyperphosphatasaemia (TH) of infancy and childhood in a tertiary referral paediatric hospital.

Methodology: Retrospective review of the medical records of patients with measured plasma alkaline phosphatase (ALP) activity of over 1000 U/L.

Results: Over a period of 1 year, 68 children with plasma ALP activity of over 1000 U/L were identified. The main aetiologies were liver disease (34 cases), TH (21 cases) and bone disease (11 cases). The mean age of children with TH was 1 year and 5 months and there was a male predominance (3:1). The children with liver and bone disease were older (mean ages of 6 years, 6 months and 5 years, 1 month, respectively) and there was no gender difference. The mean plasma ALP activity for the children with TH was 3395 U/L, and in those patients in whom ALP activity was measured sequentially, mean ALP returned to within normal limits after an average of 70 days. There was a seasonal predominance of TH cases, with a significant number presenting during the winter, suggesting a viral aetiology. The most common clinical presentation of children with TH was gastroenteritis (8/21).

Conclusion: Cases of TH can be clearly identified by considering the age of the patient and by excluding other known causes of markedly elevated ALP, in particular liver or bone disease. Using these exclusion criteria, the prevalence of TH was found to be high. Early recognition of this benign condition may prevent misdiagnosis and further unnecessary investigations.
Childhood speech disorders: Reported prevalence, comorbidity and socioeconomic profile
Authors: Keating D , Turrell G , Ozanne A
Published: March 2003

Objective: To describe the reported prevalence, comorbidity and socioeconomic status (SES) of children with speech disorders.

Methodology: Data from the 1995 Australian Health Survey were used. Information relating to the health of 12 388 children aged 0–14 years was collected via face‐to‐face interviews with a responsible adult. Speech disorders were recorded if children had reported difficulty talking, producing speech sounds, or who stuttered.

Results: The prevalence of childhood speech disorders (CSD) was 1.7% (n = 209). Of this group, 25.8% (n = 54) had a developmental delay or intellectual impairment; when these were excluded, the prevalence of CSD was reduced to 1.3% (n = 155). Among males, the peak prevalence occurred at age 5 (6.5%), for females the highest rates were for 3–4‐year‐olds (1.8%). Children with a speech disorder had a greater number of additional health problems. No relationship was found between SES and CSD.

Conclusions: Children with speech disorders often have complex health and developmental needs. Developing effective prevention programs with a view to improving the long‐term health and social outcomes of these children will require a mix of individual (clinical) and population‐based (public‐health) strategies.
Scooter injuries in children
Authors: Chapman S , Webber C , O'Meara M
Published: March 2003

Objectives: To study the causes, patterns of injury and use of safety equipment in children presenting with ‘push/kick’ scooter‐related injuries. To draw comparisons with in‐line skate, skateboard and bicycle injuries and to suggest strategies for injury prevention.

Methods: A retrospective review of medical data was undertaken for 12 consecutive months to September 2000. All children aged < 15 years who had attended the Sydney Children’s Hospital with scooter, in‐line skate (rollerblade), skateboard or bicycle injuries were identified. Children with scooter injuries for the latter 6 month period were contacted by telephone and interviewed, together with their parents, using a structured questionnaire.

Results: There was a marked rise in the number of scooter injuries from October 1999 to September 2000. Sixty‐one per cent of these injuries occurred during the final 3 months of the study period, making scooters the most common cause of injury in the studied groups for this period. Forty‐two per cent of scooter injuries were fractures. Only 3% of children used safety equipment at the time of injury, despite 86% owning some form of safety equipment. Children were less likely to use safety equipment with a scooter than with any other form of activity studied. (Chi‐squared P = 0.000).

Conclusions: Scooters are a common cause of childhood injury, resulting in injury patterns similar to those caused by in‐line skates, skateboards and bicycles. Safety equipment is rarely worn when scooters are ridden. Injury patterns and riding styles suggest that if existing guidelines for in‐line skating, skateboarding and bicycling are modified and applied to scooters, a reduction in injury numbers may be achieved.
Incidence of alveolar capillary dysplasia in severe idiopathic persistent pulmonary hypertension of the newborn
Authors: Tibballs J , Chow CW
Published: March 2003

Objective:  To determine the incidence and outcome and to review the management of alveolar capillary dysplasia (ACD) among newborns with severe idiopathic persistent pulmonary hypertension (PPHN).

Methods:  A retrospective review of medical records of infants admitted to a paediatric intensive care unit from 1982 to 2000 with a diagnosis of severe PPHN, and re‐examination of lung histological sections was carried out.

Results: Thirteen new‐born infants with pulmonary hypertension not associated with any known cause were identified. All were treated with conventional mechanical ventilation or high‐frequency oscillatory ventilation with high inspired‐oxygen and non‐specific pulmonary vasodilators. Nine infants were also treated with inhaled nitric oxide therapy and eight with extracorporeal membrane oxygenation (ECMO). Seven infants died and six survived. At autopsies, the histological features of ACD were seen in the six who had died in the newborn period. All these had been treated with ECMO. In two of these six infants, lung biopsies had been performed showing similar features, suggesting the possibility of diagnosis during life. In the remaining infant, who died at 3 months of age, there was only marked hypertrophy of the muscle coat in the small pulmonary arteries.

Conclusions:  Alveolar capillary dysplasia is probably not as rare a condition as previously suggested in sporadic case reports from literature on the subject. It should be entertained as a cause of otherwise severe idiopathic PPHN of the newborn, particularly if ECMO is required. Diagnosis during life is possible by lung biopsy. It is uncertain if survival occurs with milder forms of the condition.
Organophosphate poisoning complicated by a tachyarrhythmia and acute respiratory distress syndrome in a child
Authors: Nel L , Hatherill M , Davies J , Andronikou S , Stirling J , Reynolds L , Argent A
Published: March 2003

Abstract:  A 9‐year‐old child presented with documented organophosphate insecticide poisoning. His course was initially complicated by a tachyarrhythmia with QT‐interval prolongation that responded promptly to intravenous magnesium. However, following partial recovery, he developed progressive acute respiratory distress syndrome characterized by irreversible fibrosis and obliteration of the lung parenchyma.
Child and parent satisfaction with the use of spacer devices in acute asthma
Authors: Cotterell EM , Gazarian M , Henry RL , O'Meara MW , Wales SR
Published: March 2003

Objective:  To evaluate child and parent satisfaction with the use of spacers in acute asthma.

Methods:  All parents of children presenting to the emergency department of Sydney Children's Hospital over a 3‐month period with mild to moderately severe acute asthma who were treated with bronchodilators by spacer device were asked to complete an anonymous questionnaire. Children aged 8 years and older completed a separate questionnaire independently.

Results:  One hundred and eleven of 158 parents (70%) responded. The majority (84%) found it ‘easy’ or ‘very easy’ to use the spacer and 85% reported that they intended to use the spacer at home. Of those parents who had previously used a nebulizer (n = 73), 84% said that the spacer was easier to use, 77% said that the spacer was better tolerated by their child and 84% said that overall they preferred the spacer. Seventeen of 31 children aged 8−14 years treated with a spacer (55%) responded to the satisfaction survey. All respondents found it ‘easy’ or ‘OK’ to use the spacer and the majority (82%) ‘liked it’ or thought ‘it was OK’. The majority of children (82%) said that they preferred using spacers because it was quicker (29%) or easier to use (53%).

Conclusion:  The use of spacer devices in mild to moderately severe acute asthma is highly acceptable for children and parents; the majority prefer this mode of drug delivery to nebulization.
Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit
Authors: Fisher JRW , Feekery CJ , Rowe‐Murray HJ
Published: March 2003

Objective: To characterize psychological distress of women admitted with their infants to a private hospital mother–baby unit.

Methods: A cross‐sectional self‐report survey including standardized psychometric questionnaires of consecutive admissions to Masada Private Hospital Mother–Baby Unit, Melbourne between 1 June and 30 November 1997. Scores on the Profile of Mood States, Edinburgh Postnatal Depression Scale, Intimate Bonds Measure, Parental Bonding Instrument, Social Support Questionnaire, Vulnerable Personality Scale self‐report instruments and responses to a structured self‐report questionnaire. Of the women admitted, 109 out of 146 participated in the survey.

Results: Clinically significant fatigue was almost universal in this cohort. Psychological distress clustered into three distinct groups: (i) probable depression; (ii) fatigue and distress; and (iii) fatigue only. It may be more accurate to conceptualise postpartum psychological distress either as a continuum, or as a wide range of distinct states, rather than as a dichotomous condition in which individuals are categorized as being or not being cases. In this cohort, the severity of distress was associated most consistently with the quality of a woman’s relationship with her partner and with infants who were difficult to settle.

Conclusions: It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention.
Asthma in children: Gaps between current management and best practice
Authors: Haby MM , Powell CVE , Oberklaid F , Waters EB , Robertson CF
Published: March 2003

Objectives:  To determine the extent to which steps three to six of the Australian six‐step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management.

Methods:  A cross‐sectional descriptive study was conducted at the Royal Children’s Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty‐one 2−5‐year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent‐completed questionnaire.

Results:  Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child’s asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or ‘triggers’ their child’s asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department.

Conclusions:  Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child’s asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.
The impact of new technology on cholecystectomy rates in New South Wales
Authors: ROB MI , CORBEN P , RUSHWORTH RL
Published: March 2003

This study examined the impact of the introduction of laparoscopic cholecystectomy (LC) on the rate and pattern of cholecystectomy in New South Wales, Australia. An analysis of the hospital data for the period 1981–94/95 was performed, which encompassed patients of both public and private hospitals. Cholecystectomy rates in the years after the introduction of LC in mid‐1990 were 24% higher on average than rates in the prior years and rose from an average 1.68–2.09 per 1000. In the 5‐year period of the study after the introduction of LC, the average age of private hospital patients increased from 50.6 to 53.4·years, while that of public hospital patients declined slightly from 53.5 to 52.4·years. Laparoscopic cholecystectomy was introduced more rapidly in private than public hospitals. By June 1995, 96% of private compared with 71% of public hospitals had introduced LC, and cholecystectomy patients in private hospitals were more likely to have laparoscopic surgery than patients in public hospitals (92% compared with 80%). The introduction of LC has been accompanied by a marked and sustained increase in the cholecystectomy rate. While the unit cost for the laparoscopic procedure is lower because of a shorter length of stay, the increase in the number of procedures means that there have been no net savings for the health system from the increased efficiency. While the new procedure offers superior advantages to patients with symptomatic gallbladder disease, the effect of the apparent lower threshold for surgery needs investigation.
A classification for adverse drug events
Authors: Malpass A , Helps SC , Sexton EJ , Maiale D , Runciman WB
Published: March 2003

Abstract There is considerable evidence that a large number of patients suffer adverse events arising from their health‐care management. A significant proportion of these iatrogenic injuries occur as a result of medication errors. Before prevention strategies can be developed, it is necessary to understand the types of errors that are occurring. In order to set priorities, it is necessary to identify the frequency and impact of the various types of medication errors. To fully investigate medication incidents, it is necessary to classify the information in a way that allows the frequencies, causes and contributing factors to be analysed. The development of a sub‐branch of the ‘Generic Occurrence Classification’, specific to medication incidents, allows this analysis to occur.
Beyond evidence‐based guidelines to implementation: A model for integrating care for people with diabetes
Authors: Boyages Sc , Sheridan J , Close G
Published: March 2003

Abstract There is a growing realization in the health system that integration of effort may be the best way of ensuring optimal outcomes of management both for clinicians and for people using the health system. It is also hypothesized that the impact of diabetes (chronic disease) and its sequelae could be reduced by the provision of well‐organized care, based on agreed evidence‐based guidelines for best practice, incorporating patient education and early detection of complication. This paper defines the characteristics of an integrated model of providing care to people with diabetes.
Initiation of quality improvement activities in mental health services
Authors: Tobin M , Chen L
Published: March 2003

Abstract In the public sector mental health service setting, accountability for quality has often been considered the responsibility of the individual clinician. This presents a particular challenge for introducing an organization‐wide quality improvement culture in this setting. The introduction of a systemic view of quality may encounter resistance from individual clinicians reluctant to accept that some clinical autonomy must be subsumed within more standardized patterns of intervention and evaluation. Services must firstly tackle the issue of clinicians’ readiness to embrace such a culture, which requires strong direction from the executive level. The area of recently diagnosed psychosis was selected in one public sector mental health service as a starting point for initiating the quality improvement culture. The eventual outcome for the organization has been a positive commitment to improvement, but the journey was long and hard. This paper describes the beginning of this ultimately rewarding journey.
The evaluation of wound infection after arterial surgery
Authors: Hall John C , Hall Jane L
Published: March 2003

Abstract Many of the wound infections that occur after arterial surgery require prolonged attention with frequent changes of dressings. However, the traditional way of reporting wound infections is to only declare the overall incidence of this adverse event. In this study, we have evaluated 302 patients undergoing arterial surgery to determine the relationship between the incidence of wound infection, the length of time that wounds were dressed, and the results of a modified ASEPSIS wound scoring system. The overall incidence of wound infection was 14% (43/302). It was noted that patients with high wound scores had a correspondingly high incidence of conventionally defined wound infections; and, in addition, such patients required dressing changes over prolonged periods. It is concluded that the documentation of both the duration of wound dressings and a wound scoring system are useful tools when evaluating the outcome of patients after arterial surgery.
Institute for Health Care Improvement Collaborative Trial to improve process times in an Australian emergency department
Authors: Toncich Gino , Cameron Peter , Virtue Elizabeth , Bartlett Jenny , Ugoni Antony
Published: March 2003

Abstract This study describes an Australian emergency department’s (ED) experience with a quality improvement methodology from the USA. The Institute for Health Care Improvement (IHI) conducts collaboratives between clinical groups with similar interests, in this case ED. Their quality improvement model is described. Our involvement with the IHI showed the model to be transferable outside the USA. In applying the model to operational and clinical projects we were successful in meeting our goals to reduce clinical times: for time to analgesia (P = 0.34), time to thrombolysis (P = 0.30) and time to antibiotics in neutropenic patients (P = 0.015). We were unable to reach statistical significance in improvements due to the small sample sizes and sampling techniques. Changes in operational times were not clinically significant but almost reached statistical significance (e.g. median total length of stay in the ED fell 4 min (P = 0.06)). The near statistical significance of a small change was due to the large numbers of patients sampled.
Partition of metals in the Vistula River and in effluents from sewage treatment plants in the region of Cracow (Poland)
Authors: Guéguen C. , Dominik J. , Pardos M. , Benninghoff C. , Thomas R. L.
Published: March 2003

The Vistula River suffers from heavy pollution with multiple origins. In the upper reaches, metallic and chlorine pollution originates from the mining and industrial region of Upper Silesia. Downstream from Upper Silesia, urban and industrial sewage adds more metallic and organic contaminants from the large urban agglomeration of Cracow. Although the river status is monitored routinely, little is known about the partition of metals between particulate and dissolved forms. This study focuses on metal partitioning and on the impact of the two main wastewater treatment plants at Cracow on metal concentrations in the Vistula River. The Cd, Co, Cu, Mn, Pb and Zn content was measured in both dissolved and particulate fractions. High metal concentrations in the Vistula River persist, although current levels seem to be lower than those in the past. Metal concentrations in the Vistula River and effluents from the sewage treatment plants at Cracow are similar, indicating a relatively minor contribution from the treated sewage. However, untreated sewage may be a significant source of contaminants. Despite high anthropogenic metal concentrations, the metal partitioning coefficients (Kd) in the Vistula are similar to these found in unpolluted rivers. Within a narrow pH range, Kd values depend on the metal affinity to particles, but there is no evidence of dependence on particle or chloride concentrations. An important fraction of the toxic metals Pb and Cd is associated with particles, which may decrease their immediate availability to the biota of the river.
Watershed influences on the transport, fate and bioavailability of mercury in Lake Superior: Field measurements and modelling approaches
Authors: Back Richard C. , Hurley James P. , Rolfhus Kristopher R.
Published: March 2003

The issuance of fish consumption advisories in US states bordering Lake Superior has heightened the need for understanding the biogeochemical cycling and transformations of mercury in this great lake. Major routes of mercury (Hg) transport to lakes include atmospheric deposition (wet and dry), direct discharges and riverine (watershed) inputs. The specific objectives of this ongoing study are to: (i) determine the speciation and bioavailability of Hg transported to Lake Superior (ii) determine the importance of watershed‐specific characteristics that control physical and chemical forms of Hg; (iii) identify key mechanisms controlling Hg bioavailability and speciation in near‐shore zones relative to open lake regions; and (iv) provide process‐level information to compliment concurrent development of Hg fate and transport models of the Lake Superior ecosystem. Three tributaries of Lake Superior were chosen for detailed field study based on previous results and particular watershed characteristics. Mixing zones represent a potentially important zone of Hg entry into the food chain, and were sampled for biota, water and sediment in transects between the tributary mouth and the lake end member. Sampling of open‐water sites was conducted during Environmental Protection Agency‐sponsored cruises on the research vessel Lake Guardian. Results from our work on Lake Superior tributaries demonstrate that dissolved organic carbon and methylmercury (MeHg) export was greatest from watersheds containing wetlands. In Lake Superior, concentrations of Hg species were small at pelagic stations (total mercury (HgT) averaged 0.49 ng/L, MeHg averaged 6.4 pg/L). In contrast, MeHg concentrations in tributaries ranged from 100 to 250 pg/L. Watershed sites dominated by wetlands exhibited the greatest MeHg concentrations, occasionally in excess of 12 ng/L. Samples of bulk zooplankton ranged from 20 to 130 ng/g dry weight HgT and from 15 to 45 ng/g dry weight MeHg, and demonstrated typical bioacculmulation of mercury as well as distinct seasonality in concentrations.
Microglial reaction and neuronal death in the hippocampus of rat models of epilepsy
Authors: Tooyama Ikuo , Nishimura Tsutomu , Nakagawa Eiji , Morita Hiroyuki , Uemura Shuji , Aimi Yoshinari , Yasuhara Osamu , Kimura Hiroshi
Published: March 2003

Reaction of microglial cells as well as DNA fragmentation in pyramidal cells was investigated using immunohisto‐chemistry and in situ end‐labeling method (TUNEL) in the hippocampus of rats after rapid kindling or kainic acid treatment. In intact rats, no or very little DNA fragmentation was detected in the hippocampus. Resting microglia distributed evenly throughout the hippocampus. Neither major histocompatibility complex antigens class I (MHC I) nor class II (MHC II) immunoreactivity was seen in the hippocampus. In the rapid‐kindling model, no DNA fragmentation, reactive microglia or MHC antigen‐positive cells were present in the hippocampus. In rats given an intraperitoneal injection of kainic acid (12 mg/kg), reactive microglial cells were seen around pyramidal neurons in the CA1 and CA3 field of the hippocampus as well as in the hilus of the dentate gyrus at 3 h. At that point in time, DNA fragmentation was not detected. DNA fragmentation was clearly observed, mainly in the CA1 region of the hippocampus, from 24 h to 4 weeks after the kainic acid injection. The number of reactive microglia was quickly increased and reached a maximum at 7 days after the injection, and continued until 8 weeks thereafter. During this period, many reactive microglia expressed MHC I and MHC II. The present study indicates that epileptic seizures do not depend on microglial activation and that microglial activation is closely related to the neuronal death process induced by kainic acid.
Diffuse Lewy body disease
Authors: Kosaka Kenji
Published: March 2003

Diffuse Lewy body disease (DLBD) has been studied from various viewpoints and, although clinical diagnostic criteria for DLBD have been proposed, diagnosis remains difficult. DLBD has been reported to be the second most common form of dementia in the aged, following Alzheimer‐type dementia. It has, however, been clinically under‐diagnosed. Therefore, the search for diagnostic markers for DLBD must continue. Very recently, ‘dementia with Lewy bodies’ (DLB) was proposed as a generic term for various forms of dementia with Lewy bodies, including DLBD and similar disorders. Cortical Lewy bodies are the most important pathologic marker for diagnosis of DLBD. At present, however, the mechanism responsible for cortical Lewy body formation has yet to be disclosed.
Kii ALS dementia
Authors: Yase Yoshiro , Yoshida Sohei , Kihira Tameko , Wakayama Ikuro , Komoto Junko
Published: March 2003

Epidemiological surveys in the foci of ALS of the Kii Peninsula of Japan started in the early 1960s. Continuous surveys conducted for decades revealed that there have been two foci in the Kii Peninsula: one in Kozagawa in the southern part, and the other in Hobara in the south‐east. Clinically, ALS patients of the Kii foci occasionally showed parkinsonian features or dementia that have not been reported in the sporadic form of ALS. Neuropathologically, numerous NFT that are identical to those of Alzheimer's disease were observed in the cerebral cortex and in the brainstem nuclei. To elucidate the etiopathogenesis of this unique form of ALS, an analysis was conducted of the environment in the focus areas and of the specimens from the patients with ALS. It was hypothesized that the long exposure of these environments to low calcium and magnesium, and an excess of aluminum and manganese in the drinking water and the soil, might lead to the deposition of some trace elements in the CNS, eventually causing neuronal degeneration and death.