bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state
Authors: Gruber A , Horwood F , Sithole J , Ali NJ , Idris I
Published: November 2006

Obstructive sleep apnoea (OSA) is a cardio-metabolic disorder. Whether metabolic syndrome (MS), insulin resistance (IR) and albuminuria are independently associated with OSA is unclear, but defining the interactions between OSA and various cardiovascular (CV) risk factors independent of obesity facilitates the development of therapeutic strategies to mitigate their increased CV risks. We prospectively recruited 38 subjects with OSA and 41 controls. Anthropometric measurements, glucose, lipids, insulin and blood pressure (BP) were measured after an overnight fast. IR state was defined as homeostasis model assessment (HOMA) value >3.99 and MS diagnosed according to the International Diabetes Federation (IDF) criteria. Subjects with OSA were more obese, more insulin resistant, more hyperglycaemic, had higher Epworth score (measure of day time somnolence) and systolic blood pressure levels. The prevalence of MS was higher in OSA compared with non-OSA subjects (74% vs 24%, p < 0.001). The prevalence of microalbuminuria in both groups was negligible. Logistic regression adjusted for age, BMI and smoking showed that the patient with OSA was 5.9 (95% CI 2.0–17.6) times more likely to have MS than non-OSA patient. Triglyceride (p = 0.031), glucose (0.023) and Epworth score (0.003) values were independently associated with OSA after adjusting for BMI and other covariates whilst IR status was found not to be significant. Using the ROC curve analysis, we found that a waist circumference of >103 cm would predict MS in patients with OSA at 75–78% sensitivity and 61–64% specificity. The agreement between MS and IR state in this cohort is poor. Thus, OSA is associated with MS independent of obesity predominantly due to increased triglyceride, glucose and Epworth score values but not IR or microalbuminuria status. This observation suggests an alternative pathogenic factor mediating the increased cardiovascular risk in patients with OSA and MS, other than that due to IR. The independent link between Epworth score and MS in patients with OSA implicates the role of daytime sleepiness and chronic hypoxia as a potential mediator. Given the discordant between MS and IR state, measurement of waist is useful for predicting mainly MS but not insulin resistance status in patients with OSA. Appropriate pharmacological intervention targeting these independent factors is important in reducing the increased CV risks among patients with OSA.
Interactions between IL-32 and tumor necrosis factor alpha contribute to the exacerbation of immune-inflammatory diseases
Authors: Shoda Hirofumi , Fujio Keishi , Yamaguchi Yumi , Okamoto Akiko , Sawada Tetsuji , Kochi Yuta , Yamamoto Kazuhiko
Published: November 2006

IL-32 is a newly described cytokine in the human found to be an in vitro inducer of tumor necrosis factor alpha (TNFα). We examined the in vivo relationship between IL-32 and TNFα, and the pathologic role of IL-32 in the TNFα-related diseases – arthritis and colitis. We demonstrated by quantitative PCR assay that IL-32 mRNA was expressed in the lymphoid tissues, and in stimulated peripheral T cells, monocytes, and B cells. Activated T cells were important for IL-32 mRNA expression in monocytes and B cells. Interestingly, TNFα reciprocally induced IL-32 mRNA expression in T cells, monocyte-derived dendritic cells, and synovial fibroblasts. Moreover, IL-32 mRNA expression was prominent in the synovial tissues of rheumatoid arthritis patients, especially in synovial-infiltrated lymphocytes by in situ hybridization. To examine the in vivo relationship of IL-32 and TNFα, we prepared an overexpression model mouse of human IL-32β (BM-hIL-32) by bone marrow transplantation. Splenocytes of BM-hIL-32 mice showed increased expression and secretion of TNFα, IL-1β, and IL-6 especially in response to lipopolysaccharide stimulation. Moreover, serum TNFα concentration showed a clear increase in BM-hIL-32 mice. Cell-sorting analysis of splenocytes showed that the expression of TNFα was increased in resting F4/80+ macrophages, and the expression of TNFα, IL-1β and IL-6 was increased in lipopolysaccharide-stimulated F4/80+ macrophages and CD11c+ dendritic cells. In fact, BM-hIL-32 mice showed exacerbation of collagen-antibody-induced arthritis and trinitrobenzen sulfonic acid-induced colitis. In addition, the transfer of hIL-32β-producing CD4+ T cells significantly exacerbated collagen-induced arthritis, and a TNFα blockade cancelled the exacerbating effects of hIL-32β. We therefore conclude that IL-32 is closely associated with TNFα, and contributes to the exacerbation of TNFα-related inflammatory arthritis and colitis.
Cytoplasmic activated protein kinase Akt regulates lipid-droplet accumulation inDrosophilanurse cells
Authors: Vereshchagina Natalia , Wilson Clive
Published: November 2006

The insulin/insulin-like growth factor signalling (IIS) cascade performs a broad range of evolutionarily conserved functions, including the regulation of growth, developmental timing and lifespan, and the control of sugar, protein and lipid metabolism. Recently, these functions have been genetically dissected in the fruit fly Drosophila melanogaster, revealing a crucial role for cell-surface activation of the downstream effector kinase Akt in many of these processes. However, the mechanisms regulating lipid metabolism and the storage of lipid during development are less well characterized. Here, we use the nutrient-storing nurse cells of the fly ovary to study the cellular effects of intracellular IIS components on lipid accumulation. These cells normally store lipid in a perinuclear pool of small neutral triglyceride-containing droplets. We find that loss of the IIS signalling antagonist PTEN, which stimulates cell growth in most developing tissues, produces a very different phenotype in nurse cells, inducing formation of highly enlarged lipid droplets. Furthermore, we show that the accumulation of activated Akt in the cytoplasm is responsible for this phenotype and leads to a much higher expression of LSD2, the fly homologue of the vertebrate lipid-storage protein perilipin. Our work therefore reveals a signalling mechanism by which the effect of insulin on lipid metabolism could be regulated independently of some of its other functions during development and adulthood. We speculate that this mechanism could be important in explaining the well-established link between obesity and insulin resistance that is observed in Type 2 diabetes.
Eggs regulate sperm flagellar motility initiation, chemotaxis and inhibition in the coralAcropora digitifera,A. gemmiferaandA. tenuis
Authors: Morita Masaya , Nishikawa Akira , Nakajima Ayako , Iguchi Akira , Sakai Kazuhiko , Takemura Akihiro , Okuno Makoto
Published: November 2006

Corals perform simultaneous mass spawning around the full moon. Most Acropora species release gamete bundles, which are a complex of eggs and sperm, into the seawater. Then, gamete bundles are separated into eggs and sperm. Eggs are fertilized when sperm and eggs come in contact with each other. However, it is still unclear how sperm meet the eggs of the same species in the presence of many eggs of different species and how eggs guard against the fertilization attempts by sperm of different species. In this study, we observed that A. digitifera, A. gemmifera and A. tenuis sperm showed motility initiation/attraction close to eggs. Sperm were completely immotile in seawater, but they began to swim in circular motion when they came in close proximity to eggs, and then approached the eggs in straightforward paths. Sperm flagellar motility was not activated by an egg from different species, suggesting that motility initiation by the egg is species specific. In addition, hybridization among these species did not occur under observed conditions. Furthermore, motility-activated sperm became quiescent when many sperm approached the eggs. This study is the first report to show that the egg secretes immobilization factor(s). Our results suggest that the flagellar motility regulation has evolved to avoid hybridization among different species during the mass spawning.
Dolphin foraging sounds suppress calling and elevate stress hormone levels in a prey species, the Gulf toadfish
Authors: Remage-Healey Luke , Nowacek Douglas P. , Bass Andrew H.
Published: November 2006

The passive listening hypothesis proposes that dolphins and whales detect acoustic signals emitted by prey, including sound-producing (soniferous)fishes. Previous work showed that bottlenose dolphins (Tursiops truncatus) behaviorally orient toward the sounds of prey, including the advertisement calls of male Gulf toadfish (Opsanus beta). In addition, soniferous fishes constitute over 80% of Tursiops diet, and toadfishes alone account for approximately 13% of the stomach contents of adult bottlenose dolphins. Here, we used both behavioral (vocalizations) and physiological (plasma cortisol levels) parameters to determine if male Gulf toadfish can, in turn, detect the acoustic signals of bottlenose dolphins. Using underwater playbacks to toadfish in their natural environment, we found that low-frequency dolphin sounds (`pops') within the toadfish's range of hearing dramatically reduce toadfish calling rates by 50%. Highfrequency dolphin sounds (whistles) and low-frequency snapping shrimp pops (ambient control sounds) each had no effect on toadfish calling rates. Predator sound playbacks also had consequences for circulating stress hormones, as cortisol levels were significantly elevated in male toadfish exposed to dolphin pops compared with snapping shrimp pops. These findings lend strong support to the hypothesis that individuals of a prey species modulate communication behavior in the presence of a predator, and also suggest that short-term glucocorticoid elevation is associated with anti-predator behavior.
Seasonal adjustment of energy budget in a large wild mammal, the Przewalski horse (Equus ferus przewalskii) II. Energy expenditure
Authors: Arnold Walter , Ruf Thomas , Kuntz Regina
Published: November 2006

Many large mammals show pronounced seasonal fluctuations of metabolic rate(MR). It has been argued, based on studies in ruminants, that this variation merely results from different levels of locomotor activity (LA), and heat increment of feeding (HI). However, a recent study in red deer (Cervus elaphus) identified a previously unknown mechanism in ungulates -nocturnal hypometabolism - that contributed significantly to reduced energy expenditure, mainly during late winter. The relative contribution of these different mechanisms to seasonal adjustments of MR is still unknown, however. Therefore, in the study presented here we quantified for the first time the independent contribution of thermoregulation, LA and HI to heart rate(fH) as a measure of MR in a free-roaming large ungulate,the Przewalski horse or Takhi (Equus ferus przewalskii Poljakow).

f H varied periodically throughout the year with a twofold increase from a mean of 44 beats min-1 during December and January to a spring peak of 89 beats min-1 at the beginning of May. LA increased from 23% per day during December and January to a mean level of 53% per day during May, and declined again thereafter. Daily mean subcutaneous body temperature (Ts) declined continuously during winter and reached a nadir at the beginning of April (annual range was 5.8°C),well after the annual low of air temperature and LA.

Lower Ts during winter contributed considerably to the reduction in fH. In addition to thermoregulation, fH was affected by reproduction, LA, HI and unexplained seasonal variation, presumably reflecting to some degree changes in organ mass. The observed phase relations of seasonal changes indicate that energy expenditure was not a consequence of energy uptake but is under endogenous control, preparing the organism well in advance of seasonal energetic demands.
Severe laryngeal stenosis repair: Long‐term follow‐up using conjoint hyoid bone segments
Authors: Abedi Esrafil , Frable Mary Ann Smith
Published: November 2006

In early 1983 the authors presented an innovative procedure for the management of severe laryngeal stenosis. Because of the severity of the stenosis and the large surgical defect created by excision of the stenosis, multiple pieces of the hyoid bone were sewn together conjointly to bridge the surgical defect. The authors are now able to report follow‐up in 6 patients ranging from 11 to 60 months and discuss their favorable experience with this procedure.
Combined intracranial and extracranial excision of nasopharyngeal angiofibroma
Authors: Standefer John , Holt G. Richard , Brown Willis E. , Gates George A.
Published: November 2006

Of all angiofibromas, 10% to 20% may have intracranial extensions or receive vascular supply from the internal carotid artery. Until recently, the treatment of intracranial involvement has been radiation therapy. However, with improved anesthetic and neurosurgical techniques, transfusion capabilities and embolotherapy, the combined intracranial and extracranial excision of an angiofibroma has resulted in a low morbidity and mortality and a greater chance for complete excision of the tumor. The authors present the management of three patients with intracranial involvement of their tumors. Use of the midfacial degloving approach to the nasal cavity and paranasal sinuses has resulted in a significant improvement in the cosmetic appearance postoperatively.
Primary cysts of the mastoid process
Authors: Zimmerman Bruce E. , Proud G. O.
Published: November 2006

Two patients with primary mastoid cysts are presented. These examples stress the importance of regular follow‐up of patients with chronic serous otitis media so that the complications or associated abnormalities may be treated early prior to extensive destructive erosion. The formation of these cysts may be due to changes brought about by chronic serous otitis media, or they may be of congenital origin with middle ear effusion as a sequela.
Total glossectomy sans laryngectomy — Are we justified?
Authors: Pradhan Sultan A. , Rajpal Ram M.
Published: November 2006

Eighty‐five cases of cancer of the tongue treated with total glossectomy are presented; 82 had a squamous carcinoma. The majority had a large primary with no disease in the neck. Thus only 6 patients required concurrent therapeutic radical neck dissection. A laryngectomy was done in 9 cases for gross extension of disease and in 1, as prophylaxis against aspiration.

In 75 cases the larynx was preserved. Mortality from aspiration pneumonitis was 4%. Local recurrence rate was 42% for predominantly posterior lesions and 27% for anterior lesions. The speech, though not quite articulate, was fairly understandable. Thus, in cases of total glossectomy preservation of larynx is worthwhile and justifiable except when involved with disease, when the risk of even minor degrees of aspiration is high (elderly, frail individuals) and with associated extensive pharyngeal resection hampering the swallowing machanism.
Office treatment by cryotherapy for severe posterior nasal epistaxis … update.
Authors: Hicks Julyus N. , Norms Joel W.
Published: November 2006

We have used cryotherapy as an office treatment for severe posterior nasal epistaxis for 15 years. In 1971 we reported a retrospective study on 42 consecutive patients with severe posterior nasal bleeding; 26 had cryotherapy and 16 had anterior and posterior nasal packing. Our data showed that cryotherapy controlled epistaxis with less morbidity. We have now used cryotherapy for posterior epistaxis in over 450 patients.

In this presentation we review the history of cryotherapy, rationale for treatment with cryotherapy, experimental tissue changes in cryotherapy, and the method for freezing in cryotherapy. We then discuss 50 recent patients with severe posterior nasal bleeding whom we have treated with cryotherapy. We have found that cryotherapy is a successful way to manage patients with severe posterior nasal bleeding.
Laryngeal granuloma as a complication of the co2 laser
Authors: Feder Robert J.
Published: November 2006

Since the introduction of the carbon dioxide laser by Strong and Jako,1 complications reported in the literature have been limited primarily to those associated with ignition of the endotracheal tube and its resultant sequelae. Many such cases have been reported but are fortunately rare in relation to the frequency of laser use. Other than the associated tissue injury which is minor when the loser is accidently fired at normal tissue, no other tissue complications have been reported in the literature to date. A granuloma appearing clinically as a lesion of the true cord following laser debulking of a paralytic vocal cord is reported herein.
Modulation of Dorsolateral Prefrontal Delay Activity during Self-Organized Behavior
Authors: Procyk Emmanuel , Goldman-Rakic Patricia S
Published: November 2006

The regulation of cognitive activity relies on the flexibility of prefrontal cortex functions. To study this mechanism we compared monkey dorsolateral prefrontal activity in two different spatial cognitive tasks: a delayed response task and a self-organized problem-solving task. The latter included two periods, a search by trial and error for a correct response, and a repetition of the response once discovered. We show that (1) delay activity involved in the delayed task also participates in self-generated responses during the problem-solving task and keeps the same location preference, and (2) the amplitude of firing and the strength of spatial selectivity vary with task requirement, even within search periods while approaching the correct response. This variation is dissociated from pure reward probability, but may have a link with uncertainty because the selectivity dropped when reward predictability was maximal. Overall, we show that spatially tuned delay activity of prefrontal neurons reflects the varying level of engagement in control between different spatial cognitive tasks and during self-organized behavior.
Experience-Dependent Eye Movements, Awareness, and Hippocampus-Dependent Memory
Authors: Smith Christine N. , Hopkins Ramona O. , Squire Larry R.
Published: November 2006

We asked what kind of memory is operating when eye movements change as the result of experience. Participants viewed scenes that were either novel, repeated, or manipulated (i.e., a change was introduced in one region of the scene). Eye movements differed depending on the past viewing history of each scene. Participants made fewer fixations and sampled fewer regions when scenes were repeated than when scenes were novel. When scenes were altered, participants made more fixations in the altered region, spent more time looking at the altered region, and made more transitions into and out of the altered region than in unchanged (matched) regions in the repeated scenes. Importantly, these effects occurred only when individuals were aware that a change had occurred. Participants who were unaware that the scene had been altered looked at the changed scenes in the same way that they looked at repeated scenes. Thus, there was no indication that eye movements could reveal an unaware (unconscious) form of memory. Instead, eye movements reflected conscious memory of whether the scene was repeated or manipulated. The findings were the same when awareness was assessed after viewing all the scenes (experiment 1) and when awareness was assessed after each scene was presented (experiment 2). In experiment 3, memory-impaired patients with damage limited to the hippocampus were impaired at deciding whether scenes were novel, repeated, or manipulated. Thus, the ability to consciously recollect recent encounters with scenes reflects a form of hippocampus-dependent memory. The findings show that experience-dependent eye movements in response to altered scenes reflect conscious, declarative memory, and they support the link between aware memory, declarative memory, and hippocampus-dependent memory.
Noradrenergic Inputs to the Bed Nucleus of the Stria Terminalis and Paraventricular Nucleus of the Hypothalamus Underlie Hypothalamic–Pituitary–Adrenal Axis But Not Hypophagic or Conditioned Avoidance Responses to Systemic Yohimbine
Authors: Banihashemi Layla , Rinaman Linda
Published: November 2006

The α2 adrenoceptor antagonist yohimbine (YO) increases transmitter release from adrenergic/noradrenergic (NA) neurons. Systemic YO activates the hypothalamic–pituitary–adrenal (HPA) axis, inhibits feeding, and supports conditioned flavor avoidance (CFA) in rats. To determine whether these effects require NA inputs to the bed nucleus of the stria terminalis (BNST), vehicle or saporin toxin conjugated to an antibody against dopamine β hydroxylase (DSAP) was microinjected bilaterally into the BNST to remove its NA inputs. Subsequent tests failed to reveal any lesion effect on the ability of YO (5.0 mg/kg, i.p.) to inhibit food intake or to support CFA. Conversely, HPA axis responses to YO were significantly blunted in DSAP rats. In a terminal experiment, DSAP and control rats were perfused 90–120 min after intraperitoneal injection of YO or vehicle. Brains were processed to reveal Fos immunolabeling and lesion extent. NA fibers were markedly depleted in the BNST and medial parvocellular paraventricular hypothalamus (PVNmp) in DSAP rats, evidence for collateralized NA inputs to these regions. DSAP rats displayed significant loss of caudal medullary NA neurons, and markedly blunted Fos activation in the BNST and in corticotropin-releasing hormone-positive PVNmp neurons after YO. We conclude that a population of medullary NA neurons provides collateral inputs to the BNST and PVNmp, and that these inputs contribute importantly to Fos expression and HPA axis activation after YO treatment. Conversely, NA-mediated activation of BNST and PVNmp neurons is unnecessary for YO to inhibit food intake or support CFA, evidence for the sufficiency of other intact neural pathways in mediating those effects.
The Clinical Spectrum of Developmental Language Impairment in School-Aged Children: Language, Cognitive, and Motor Findings
Authors: Webster Richard I. , Erdos Caroline , Evans Karen , Majnemer Annette , Kehayia Eva , Thordardottir Elin , Evans Alan , Shevell Michael I.
Published: November 2006

OBJECTIVE. Our goal was to evaluate detailed school-age language, nonverbal cognitive, and motor development in children with developmental language impairment compared with age-matched controls.

METHODS. Children with developmental language impairment or normal language development (controls) aged 7 to 13 years were recruited. Children underwent language assessment (Clinical Evaluation of Language Fundamentals-4, Peabody Picture Vocabulary-3, Goldman-Fristoe Test of Articulation-2), nonverbal cognitive assessment (Wechsler Intelligence Scale for Children-IV), and motor assessment (Movement Assessment Battery for Children). Exclusion criteria were nonverbal IQ below the 5th percentile or an acquired language, hearing, autistic spectrum, or neurologic disorder.

RESULTS. Eleven children with developmental language impairment (7:4 boys/girls; mean age: 10.1 ± 0.8 years) and 12 controls (5:7 boys/girls; mean age: 9.5 ± 1.8 years) were recruited. Children with developmental language impairment showed lower mean scores on language (Clinical Evaluation of Language Fundamentals-4—developmental language impairment: 79.7 ± 16.5; controls: 109.2 ± 9.6; Goldman-Fristoe Test of Articulation-2—developmental language impairment: 94.1 ± 10.6; controls: 104.0 ± 2.8; Peabody Picture Vocabulary-3—developmental language impairment: 90.5 ± 13.8; controls: 100.1 ± 11.6), cognitive (Wechsler Intelligence Scale for Children-IV—developmental language impairment: 99.5 ± 15.5; controls: 113.5 ± 11.9), and motor measures (Movement Assessment Battery for Children percentile—developmental language impairment: 12.7 ± 16.7; controls: 66.1 ± 30.6) and greater discrepancies between cognitive and language scores (Wechsler Intelligence Scale for Children-IV/Clinical Evaluation of Language Fundamentals-4—developmental language impairment: 17.8 ± 17.8; controls: 1.2 ± 12.7). Motor impairment was more common in children with developmental language impairment (70%) than controls (8%).

CONCLUSIONS. Developmental language impairment is characterized by a broad spectrum of developmental impairments. Children identified on the basis of language impairment show significant motor comorbidity. Motor assessment should form part of the evaluation and follow-up of children with developmental language impairment.
Slight/Mild Sensorineural Hearing Loss in Children
Authors: Wake Melissa , Tobin Sherryn , Cone-Wesson Barbara , Dahl Hans-Henrik , Gillam Lynn , McCormick Lisa , Poulakis Zeffie , Rickards Field W. , Saunders Kerryn , Ukoumunne Obioha C. , Williams Joanne
Published: November 2006

OBJECTIVE. The goal was to determine the prevalence and effects of slight/mild bilateral sensorineural hearing loss among children in elementary school.

METHODS. A cross-sectional, cluster-sample survey of 6581 children (response: 85%; grade 1: n = 3367; grade 5: n = 3214) in 89 schools in Melbourne, Australia, was performed. Slight/mild bilateral sensorineural hearing loss was defined as a low-frequency pure-tone average across 0.5, 1, and 2 kHz and/or a high-frequency pure-tone average across 3, 4, and 6 kHz of 16 to 40 dB hearing level in the better ear, with air/bone-conduction gaps of <10 dB. Parents reported children's health-related quality of life and behavior. Each child with slight/mild bilateral sensorineural hearing loss, matched to 2 normally hearing children (low-frequency pure-tone average and high-frequency pure-tone average of ≤15 dB hearing level in both ears), completed standardized assessments. Whole-sample comparisons were adjusted for type of school, grade level, and gender, and matched-sample comparisons were adjusted for nonverbal IQ scores.

RESULTS. Fifty-five children (0.88%) had slight/mild bilateral sensorineural hearing loss. Children with and without sensorineural hearing loss scored similarly in language (mean: 97.2 vs 99.7), reading (101.1 vs 102.8), behavior (8.4 vs 7.0), and parent- and child-reported child health-related quality of life (77.6 vs 80.0 and 76.1 vs 77.0, respectively), but phonologic short-term memory was poorer (91.0 vs 102.8) in the sensorineural hearing loss group.

CONCLUSIONS. The prevalence of slight/mild bilateral sensorineural hearing loss was lower than reported in previous studies. There was no strong evidence that slight/mild bilateral sensorineural hearing loss affects adversely language, reading, behavior, or health-related quality of life in children who are otherwise healthy and of normal intelligence.
Direct Medical Cost of Influenza-Related Hospitalizations in Children
Authors: Keren Ron , Zaoutis Theoklis E. , Saddlemire Stephanie , Luan Xian Qun , Coffin Susan E.
Published: November 2006

OBJECTIVE. Our goal was to determine the cost of influenza-related hospitalization in children with community-acquired laboratory-confirmed influenza and to identify predictors of high hospitalization costs.

PATIENTS AND METHODS. This was a retrospective cohort study of patients 21 years and younger hospitalized at a children's hospital with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (2000–2004). The main outcome measure was the direct medical cost of influenza-related hospitalizations, including the cost of diagnostics, therapeutics, room, and physician services.

RESULTS. Electronic billing data were retrievable for 727 (98%) of 745 patients hospitalized for community-acquired laboratory-confirmed influenza during the study period. A total of 478 (66%) children were in a high-risk group for whom the Advisory Committee on Immunization Practices recommended influenza vaccine (patients with Advisory Committee on Immunization Practices–designated chronic medical conditions or aged 6–23 months). The mean total cost of hospitalization for influenza-related illness was $13159 ($39792 for patients admitted to an ICU; $7030 for patients cared for exclusively on the wards). High-risk patients had higher mean total costs ($15269) than low-risk patients ($9107). Cardiac, metabolic, and neurologic/neuromuscular diseases and age of 18 to 21 years were independently associated with the highest hospitalization costs (>15th percentile).

CONCLUSIONS. The cost of influenza-related hospitalizations in children may be considerably higher than previously estimated. The presence of certain Advisory Committee on Immunization Practices–designated chronic medical conditions is associated with higher influenza-related hospitalization costs. Successfully immunizing patients with these conditions has the potential for significant cost savings.
Delayed Extubation to Nasal Continuous Positive Airway Pressure in the Immature Baboon Model of Bronchopulmonary Dysplasia: Lung Clinical and Pathological Findings
Authors: Thomson Merran A. , Yoder Bradley A. , Winter Vicki T. , Giavedoni Luis , Chang Ling Yi , Coalson Jacqueline J.
Published: November 2006

OBJECTIVE. Using the 125-day baboon model of bronchopulmonary dysplasia treated with prenatal steroid and exogenous surfactant, we hypothesized that a delay of extubation from low tidal volume positive pressure ventilation to nasal continuous positive airway pressure at 5 days (delayed nasal continuous positive airway pressure group) would not induce more lung injury when compared with baboons aggressively weaned to nasal continuous positive airway pressure at 24 hours (early nasal continuous positive airway pressure group), because both received positive pressure ventilation.

METHODS AND RESULTS. After delivery by cesarean section at 125 days (term: 185 days), infants received 2 doses of Curosurf (Chiesi Farmaceutica S.p.A., Parma, Italy) and daily caffeine citrate. The delay in extubation to 5 days resulted in baboons in the delayed nasal continuous positive airway pressure group having a lower arterial to alveolar oxygen ratio, high Paco2, and worse respiratory function. The animals in the delayed nasal continuous positive airway pressure group exhibited a poor respiratory drive that contributed to more reintubations and time on mechanical ventilation. A few animals in both groups developed necrotizing enterocolitis and/or sepsis, but infectious pneumonias were not documented. Cellular bronchiolitis and peribronchiolar alveolar wall thickening were more frequently seen in the delayed nasal continuous positive airway pressure group. Bronchoalveolar lavage levels of interleukin-6, interleukin-8, monocyte chemotactic protein-1, macrophage inflammatory protein-1 α, and growth-regulated oncogene-α were significantly increased in the delayed nasal continuous positive airway pressure group. Standard and digital morphometric analyses showed no significant differences in internal surface area and nodal measurements between the groups. Platelet endothelial cell adhesion molecule vascular staining was not significantly different between the 2 nasal continuous positive airway pressure groups.

CONCLUSIONS. Volutrauma and/or low-grade colonization of airways secondary to increased reintubations and ventilation times are speculated to play causative roles in the delayed nasal continuous positive airway pressure group findings.
Psychological Problems in Children With Daytime Wetting
Authors: Joinson Carol , Heron Jon , von Gontard Alexander ,   and the ALSPAC Study Team
Published: November 2006

OBJECTIVE. This population-based study investigated the psychological problems associated with daytime wetting in children.

METHODS. A sample of 8213 children (age range: 7 years 6 months to 9 years 3 months) who were enrolled in the population-based Avon Longitudinal Study of Parents and Children participated in this study. Parents completed a postal questionnaire asking about their children's toileting behavior and assessing psychological problems, including childhood emotional and behavioral problems (99% completed the questionnaire by the time their child was 8 years 3 months of age). The rate of psychological problems was compared in children with daytime wetting and in those with no daytime wetting. Analyses adjusted for developmental delay, gender, sociodemographic background, stressful life events, and soiling.

RESULTS. χ2 tests of association and multivariable logistic regression indicate that children with daytime wetting have a higher rate of parent-reported psychological problems than children who have no daytime wetting. It is particularly notable that the reported rates of attention and activity problems, oppositional behavior, and conduct problems in daytime wetting children were around twice the rates reported in children with no daytime wetting.

CONCLUSIONS. The increased vulnerability to psychological problems in children as young as 7 years of age with daytime wetting highlights the importance of parents seeking early intervention for the condition to help prevent later psychological problems. Although treatment in a pediatric setting is often successful, clinicians should be aware of the increased risk of disorders, such as attention-deficit/hyperactivity disorder, in children with daytime wetting, because this is likely to interfere with treatment.
Atopic Disposition, Wheezing, and Subsequent Respiratory Syncytial Virus Hospitalization in Danish Children Younger Than 18 Months: A Nested Case-Control Study
Authors: Stensballe Lone Graff , Kristensen Kim , Simoes Eric A.F. , Jensen Henrik , Nielsen Jens , Benn Christine Stabell , Aaby Peter ,   for the Danish RSV Data Network
Published: November 2006

OBJECTIVES. This study examined whether atopic disposition, wheezing, and atopic disorders increased the risk of hospitalizations because of respiratory syncytial virus in children between birth and 18 months of age.

PATIENTS AND METHODS. Relative risks for respiratory syncytial virus hospitalization were studied in a nested 1:5 case-control design using exposure information obtained from interviews with mothers of 2564 case and 12816 control children who had been followed prospectively from birth and until 18 months of age as participants in the Danish National Birth Cohort. Information on the children's ages at respiratory syncytial virus hospitalization, presentation of infrequent wheezing, recurrent wheezing, and atopic dermatitis were used to study these associations chronologically.

RESULTS. The adjusted relative risk of respiratory syncytial virus hospitalization in the offspring was 1.11 for maternal atopic dermatitis, 1.72 for maternal asthma, and 1.23 for paternal asthma. Atopic dermatitis in the child was associated with an increased risk of subsequent respiratory syncytial virus hospitalization among infants <6 months of age. Infrequent wheezing was associated with a relative risk of subsequent respiratory syncytial virus hospitalization of 2.98 and recurrent wheezing with a relative risk of 5.90. These associations were present also if infants with medical risk factors were excluded from the analysis.

CONCLUSIONS. Asthmatic disposition and wheezing were strong determinants of subsequent respiratory syncytial virus hospitalization in Danish children <18 months of age.
Reduction of Bronchopulmonary Dysplasia After Participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative
Authors: Payne Nathaniel R. , LaCorte Meena , Karna Padmani , Chen Song , Finkelstein Marsha , Goldsmith Jay P. , Carpenter Joseph H. ,   on behalf of the Breathsavers Group
Published: November 2006

OBJECTIVE. The objective of this study was to compare the primary and secondary outcomes of very low birth weight infants before and after participation in the Breathsavers Group of the Vermont Oxford Network–sponsored Neonatal Intensive Care Quality Collaborative.

METHODS. Hospitals that participated in the Breathsavers Group contributed clinical data on the outcomes of their very low birth weight infants to the Vermont Oxford Network using standardized clinical definitions, data forms, and inclusion criteria. Outcomes from the last year of the collaborative, 2003, were compared with those from the baseline year, 2001. Models for treatment practices and outcomes measures were adjusted for within-hospital correlation (clustering) and standard risk factors that were present at birth.

RESULTS. Bronchopulmonary dysplasia dropped significantly in 2003 compared with the baseline year. Survival improved but not significantly. In addition, severe retinopathy of prematurity, severe intraventricular hemorrhage, and supplemental oxygen at discharge dropped significantly. The use of conventional ventilation at any time during the initial hospitalization, postnatal steroids, and time to first dose of surfactant all decreased significantly. The use of nasal continuous positive airway pressure at any time during hospitalization increased. The use of high-frequency ventilation, delivery room intubation, and surfactant at any time during hospitalization did not change.

CONCLUSIONS. The Breathsavers Group improved both clinical care processes and clinical outcomes during the Neonatal Intensive Care Quality Collaborative.
Implementation and Case-Study Results of Potentially Better Practices for Collaboration Between Obstetrics and Neonatology to Achieve Improved Perinatal Outcomes
Authors: Zabari Mara , Suresh Gautham , Tomlinson Mark , Lavin Justin P. , Larison Kristine , Halamek Louis , Schriefer Janice A.
Published: November 2006

OBJECTIVE. The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care.

METHODS. One area of practice improvement was the management of the pregnancy at the margin of viability. Another included the use of team training and video simulation to improve team performance during high-risk deliveries using aviation-based communication techniques. Another focus of the collaborative was the creation of a multicenter database to measure combined perinatal and neonatal outcomes.

RESULTS. The principle outcomes are increased patient satisfaction with teamwork between neonatology and obstetric services and improved team response times for emergent deliveries and the increased use of team communication skills during video simulations of high-risk deliveries.

CONCLUSIONS. Implementing these potentially better practices can result in improved communication and collaboration related to perinatal and neonatal care.
Association Between Health Care Providers' Influence on Parents Who Have Concerns About Vaccine Safety and Vaccination Coverage
Authors: Smith Philip J. , Kennedy Allison M. , Wooten Karen , Gust Deborah A. , Pickering Larry K.
Published: November 2006

OBJECTIVES. Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety.

METHODS. Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, ≥3 doses of polio vaccine, ≥1 dose of measles-mumps-rubella vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine.

RESULTS. Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).

CONCLUSIONS. Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.
Chronic Conditions, Functional Limitations, and Special Health Care Needs in 10- to 12-Year-Old Children Born at 23 to 25 Weeks' Gestation in the 1990s: A Swedish National Prospective Follow-up Study
Authors: Farooqi Aijaz , Hägglöf Bruno , Sedin Gunnar , Gothefors Leif , Serenius Fredrik
Published: November 2006

BACKGROUND. Children born extremely immature (gestational age <26 weeks' gestation) increasingly reach school age. Information on their overall functioning and special health care needs is necessary to plan for their medical and educational services. This study was undertaken to examine neurosensory, medical, and developmental conditions together with functional limitations and special health care needs of extremely immature children compared with control subjects born at term.

METHODS. We studied 11-year-old children born before 26 completed weeks of gestation in all of Sweden from 1990 through 1992. All had been evaluated at 36 months' corrected age. Identification of children with chronic conditions lasting ≥12 months was based on a questionnaire administered to parents. Neurosensory impairments were identified by reviewing health records. Information regarding other specific medical diagnoses and developmental disabilities was obtained by standard parent and teacher questionnaires.

RESULTS. Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. Logistic-regression analyses adjusting for social risk factors and gender showed that significantly more extremely immature children than controls had chronic conditions, including functional limitations (64% vs 11%, respectively), compensatory dependency needs (59% vs 25%), and services above those routinely required by children (67% vs 22%). Specific diagnoses or disabilities with higher rates in extremely immature children than in controls included neurosensory impairment (15% vs 2%), asthma (20% vs 6%), poor motor skills of >2 SDs above the mean (26% vs 3%), poor visual perception of >2 SDs above the mean (21% vs 4%), poor learning skills of >2 SDs above the mean (27% vs 3%), poor adaptive functioning with T scores of <40 (42% vs 9%), and poor academic performance with T score <40 (49% vs 7%).

CONCLUSIONS. Children born extremely immature have significantly greater health problems and special health care needs at 11 years of age. However, few children have severe impairments that curtail major activities of daily living.
Circumcision Status and Risk of Sexually Transmitted Infection in Young Adult Males: An Analysis of a Longitudinal Birth Cohort
Authors: Fergusson David M. , Boden Joseph M. , Horwood L. John
Published: November 2006

OBJECTIVES. Previous research suggests that male circumcision may be a protective factor against the acquisition of sexually transmitted infections; however, studies examining this question have produced mixed results. The aim of this study was to examine the association between circumcision status and sexually transmitted infection risk using a longitudinal birth cohort study.

METHODS. Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (1) the circumcision status of males in the cohort before 15 years old, (2) measures of self-reported sexually transmitted infection from ages 18 to 25 years, and (3) childhood, family, and related covariate factors.

RESULTS. Being uncircumcised had a statistically significant bivariate association with self-reported sexually transmitted infection. Adjustment for potentially confounding factors, including number of sexual partners and unprotected sex, as well as background and family factors related to circumcision, did not reduce the association between circumcision status and reports of sexually transmitted infection. Estimates of the population-attributable risk suggested that universal neonatal circumcision would have reduced rates of sexually transmitted infection in this cohort by 48.2%.

CONCLUSIONS. These findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision.
Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population
Authors: Basch Charles E. , Wolf Randi L. , Brouse Corey H. , Shmukler Celia , Neugut Alfred , DeCarlo Lawrence T. , Shea Steven
Published: November 2006

Objectives. We compared the effectiveness of a telephone outreach approach versus a direct mail approach in improving rates of colorectal cancer (CRC) screening in a predominantly Black population.

Methods. A randomized trial was conducted between 2000 and 2003 that followed 456 participants in the New York metropolitan area who had not had recent CRC screening. The intervention group received tailored telephone outreach, and the control group received mailed printed materials. The primary outcome was medically documented CRC screening 6 months or less after randomization.

Results. CRC screening was documented in 61 of 226 (27.0%) intervention participants and in 14 of 230 (6.1%) controls (prevalence rate difference=20.9%; 95% CI = 14.34, 27.46). Compared with the control group, the intervention group was 4.4 times more likely to receive CRC screening within 6 months of randomization.

Conclusions. Tailored telephone outreach can increase CRC screening in an urban minority population.