bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic and environmental effects on exhaled nitric oxide and airway responsiveness in a population-based sample of twins
Authors: Lund M. B. , Kongerud J. , Nystad W. , Boe J. , Harris J. R.
Published: November 2006

Elevated levels of exhaled nitric oxide (eNO) and airway hyperresponsiveness are intermediate phenotypes of asthma. Using population-based data collected from a sample of twins, the present authors estimated the relative contribution of genes, family environment and nonshared environmental influences to variations in eNO and airway responsiveness (AR). In addition, the genetic and environmental sources of covariation between these two asthma-related phenotypes were investigated.

The study population comprised a random sample of 377 adult twins identified through the Norwegian Twin Registry. The main outcome variables were eNO and AR to methacholine.

Genetic effects accounted for 60% of the variation in eNO. Family environment accounted for 30% of the variation in AR, while nonshared environmental influences explained the remaining variation for both measures. For both eNO and AR, there were significant regression effects for atopy and smoking. The small, but significant association between eNO and AR was primarily explained by genetic factors. Sub-analyses restricted to atopic and nonsmoking twins strengthened the observation.

In conclusion, variations in exhaled nitric oxide and airway responsiveness appear to be explained by different genetic and environmental variance structures. Variation in exhaled nitric oxide is explained by genetic and nonshared environmental effects, whereas an environmental model best explains the variation in airway responsiveness. Common genetic effects explain the small but significant association between exhaled nitric oxide and airway responsiveness.
Self-management in bronchiectasis: the patients' perspective
Authors: Lavery K. , O'Neill B. , Elborn J. S. , Reilly J. , Bradley J. M.
Published: November 2006

Self-management programmes for chronic disease are a high priority for healthcare providers. The content and method of delivery of self-management should give consideration to the specific requirements of the disease population. The aims of the present study were to assess the physical and psychosocial impact of bronchiectasis, to determine whether patients with bronchiectasis are receptive to self-management and to identify any obstacles or sources of support for a disease-specific self-management programme.

A total of 32 patients with a diagnosis of bronchiectasis attended four focus groups. Each focus group was videotaped and subjected to qualitative analysis using the grounded theory approach.

Bronchiectasis had an impact on patients’ physical and psychosocial well-being. Patients demonstrated the potential to self-manage with strategies including self-regulation of medication and airway clearance. Perceived obstacles to self-management included lack of information and confidence. Patients suggested that self-management could be promoted through disease-specific information and appropriate healthcare procedures.

In summary, patients with bronchiectasis have their lives disrupted by this chronic condition, but are receptive to self-management. The present study has provided information from the patients' perspective of elements which need to be included in a successful disease-specific self-management programme.
An in-depth study of patent medicine sellers' perspectives on malaria in a rural Nigerian community
Authors: Okeke Theodora A , Uzochukwu Benjamin SC , Okafor Henrietta U
Published: November 2006

Background

Malaria remains a major cause of mortality among under five children in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with antimalarial drugs bought from medicine sellers. These have led to increasing calls for interventions to improve treatment obtained in these outlets. However, information about the current practices of these medicine sellers is needed before such interventions. This study aims to determine the medicine sellers' perspectives on malaria and the determinants that underlie their dispensing patterns of antimalarial drugs.

Methods

The study was conducted in Ugwugo-Nike, a rural community in south-east Nigeria. It involved in-depth interviews with 13 patent medicine sellers.

Results

A majority of the medicine sellers were not trained health professionals and malaria is recognized as a major health problem by them. There is poor knowledge and poor dispensing behaviour in relation to childhood malaria episodes. Although referral of severe malaria is common, there are those who will not refer. Verbal advice is rarely given to the care-givers.

Conclusion

More action research and interventions to improve prescription and referral practices and giving verbal advice to care-givers is recommended. Ways to integrate the drug sellers in the health system are also recommended.
POL and PLL1 phosphatases are CLAVATA1 signaling intermediates required forArabidopsisshoot and floral stem cells
Authors: Song Sang-Kee , Lee Myeong Min , Clark Steven E.
Published: November 2006

The post-embryonic development of above-ground tissues in plants is dependent upon the maintenance and differentiation of stem cells at the shoot meristem. The Arabidopsis WUSCHEL (WUS) transcription factor establishes an organizing center within the shoot meristem that is essential for specification of stem-cell identity in overlying cells. The CLAVATA (CLV)signaling pathway, including the CLV1 receptor-kinase, promotes the differentiation of stem cells by limiting the WUS expression domain,yet the mechanism of CLV signaling is largely unknown. Previously, we have shown that mutations in two protein phosphatases, POLTERGEIST (POL) and PLL1,partially suppress clv mutant phenotypes. Here, we demonstrate that POL and PLL1 are integral components of the CLV1 signaling pathway. POL and PLL1 are essential for stem-cell specification, and can also block stem-cell differentiation when overexpressed. We provide extensive evidence that POL and PLL1 act downstream of CLV signaling to maintain WUS expression and that they regulate WUS at a transcriptional level. Our findings suggest that POL and PLL1 are central players in regulating the balance between stem-cell maintenance and differentiation, and are the closest known factors to WUS regulation in the shoot meristem.
Mechanical adaptability of a sponge extracellular matrix: evidence for cellular control of mesohyl stiffness inChondrosia reniformisNardo
Authors: Wilkie I. C. , Parma L. , Bonasoro F. , Bavestrello G. , Cerrano C. , Carnevali M. D. Candia
Published: November 2006

The marine sponge Chondrosia reniformis Nardo consists largely of a collagenous tissue, the mesohyl, which confers a cartilaginous consistency on the whole animal. This investigation was prompted by the incidental observation that, despite a paucity of potentially contractile elements in the mesohyl, intact C. reniformis stiffen noticeably when touched. By measuring the deflection under gravity of beam-shaped tissue samples, it was demonstrated that the flexural stiffness of the mesohyl is altered by treatments that influence cellular activities, including [Ca2+]manipulation, inorganic and organic calcium channel-blockers and cell membrane disrupters, and that it is also sensitive to extracts of C. reniformis tissue that have been repeatedly frozen then thawed. Since the membrane disrupters and tissue extracts cause marked stiffening of mesohyl samples, it is hypothesised that cells in the mesohyl store a stiffening factor and that the physiologically controlled release of this factor is responsible for the touch-induced stiffening of intact animals.
Interaction of two swimming Paramecia
Authors: Ishikawa Takuji , Hota Masateru
Published: November 2006

The interaction between two swimming Paramecium caudatum was investigated experimentally. Cell motion was restricted between flat plates,and avoiding and escape reactions were observed, as well as hydrodynamic interactions. The results showed that changes in direction between two swimming cells were induced mainly by hydrodynamic forces and that the biological reaction was a minor factor. Numerical simulations were also performed using a boundary element method. P. caudatum was modelled as a rigid spheroid with surface tangential velocity measured by a particle image velocimetry (PIV) technique. Hydrodynamic interactions observed in the experiment agreed well with the numerical simulations, so we can conclude that the present cell model is appropriate for describing the motion of P. caudatum.
Management of the airway in patients with angioedema
Authors: Pruet Charles W. , Kornblut Alan D. , Brickman Chaim , Kaliner Michael A. , Frank Michael M.
Published: November 2006

Angiodema can be frequently encountered in clinical practice, and usually represents transient areas of tissue edema and erythema. In general, lesions involve the deep dermis as well as subcutaneous or submucosal sites and can affect multiple organ systems, including the respiratory and gastrointestinal tracts. Although the underlying cause for the angioedema is frequently not known, it can result from atopy, specific antigen sensitivities, physical stimuli, as well as disorders that affect the complement cascade. These latter entities may be congenital or acquired. Pathogenesis for angioedema is generally thought to be activation of mast cells or basophils, with subsequent release of histamine and other mediator products which can induce inflammatory changes.

In most patients with physical and allergic causes of angioedema, swelling can usually be treated with epinephrine, antihistamines and/or steroids. Management of the airway in such patients is usually symptomatic, although certain patients require hospitalization for supervised care. On the other hand, patients with hereditary angioedema do not often respond well to these agents. In such patients, we currently add infusions of epsilonaminocaproic acid as well as nembulized racemic epinephrine to our therapeutic regimen, but even this may not be satisfactory. At the National Institute of Allergy and Infectious Disease, endotracheal intubation is usually preferred to tracheostomy for securing a temporary airway, though certain patients may require placement of tracheostomies for better control of the airway. Patients with frequent recurrences of airway obstruction are rarely seen — even among those patients with known hereditary angioedema. However, such patients may require tracheal fenestrations to secure long‐term protection of the airway.

The Institute's experiences in the management of patients with angioedema are reviewed, and therapies employed are described.
The pectoralis major myocutaneous flap: An angiographic study
Authors: Saraceno Carmelo A. , Santini Hector , Endicott James N. , Martinez Carlos , Shah Chunilal
Published: November 2006

A new era in head and neck reconstruction has been opened with the use of myocutaneous flaps. The pectoralis major myocutaneous flap is considered the most reliable of its kind but flap failures still occur secondary to tension and infection. Our standard procedure has been to follow the acromioxiphoid line as a guide to the location of the blood supply of the pectoralis major muscle. We have noticed in the operating room and during cadaver dissection that the vascular supply is sometimes more laterally located than usually described. A review of the vascular supply of this anatomic area using angiographic studies of the subclavian and its branches is presented, with important findings critical to the surgical technique used to protect the flap's blood supply.
Sicca syndrome … diagnostic perplexities.
Authors: Lyons George D. , Martinez Anthony J. , Biundo Joseph J.
Published: November 2006

Patients presenting with xerostomia and other signs of Sjogren's syndrome pose diagnostic problems. Many other underlying diseases cause these symptoms and a systematic evaluation is necessary to make an accurate diagnostic assessment.

There are immunological tests and histological studies which help make them distinctive and are herein outlined. Patients with this information presenting with sicca syndrome, therefore, can be more accurately assessed and have better treatment regimens instituted.

The “sicca syndrome,” which is a disorder discussed primarily in the rheumatology literature, is rarely a topic in the otolaryngology literature, although there are often presenting symptoms of this problem in the head and neck. This paper reviews this problem, discusses the confusion regarding terminology, and outlines a practical method of diagnosis for the clinician.
Programming the cochlear implant based on electrical acoustic reflex thresholds: Patient performance
Authors: Spivak Lynn G. , Chute Patricia M. , Popp Amy L. , Parisier Simon C.
Published: November 2006

The electrical acoustic reflex threshold (EART) has been shown to be a reliable estimate of behavioral comfort levels in both child and adult cochlear implant patients. The purpose of this study was to investigate the potential for using EARTs for programming the Nucleus cochlear implant. EARTs and behavioral comfort levels were obtained from 7 adult implant patients. Two programs or “maps” were made for each patient, one based on behavioral comfort levels and one based on EARTs. Performance on open set tests of speech recognition was measured with each map. Mean data suggest that speech perception is similar with both maps. Analysis of individual data revealed that, whereas 2 subjects performed better with the C‐level maps, the remaining 5 subjects tended to perform either better with the EART map or equally well with both maps. These results suggest that EARTs may be an adequate substitute for comfort levels when programming the implant for patients who are unable to make reliable psychophysical judgments.
Artificial reflex arc: A potential solution for chronic aspiration. III: Stimulation of implanted cervical skin as a functional graft triggering glottic closure in the canine
Authors: Broniatowski Michael , Sohn Jinho , Kayali Hani , Bold E. Luke , Miller Frank R. , Jacobs Gordon B. , Tucker Harvey M.
Published: November 2006

Stroke often impairs the ability of the vocal cords to close during deglutition, resulting in aspiration. The current study is a further advance on the application of the concept of an artificial reflex arc during swallowing. The second and third cervical branches were bilaterally isolated in four dogs and baseline sensory nerve traffic was detected via tripolar perineural electrodes. Cervical skin pressure‐induced suprathreshold signals were used to trigger vocal cord contraction via bipolar electrodes passed around the recurrent laryngeal nerves. Skin subtended by the cervical nerves was implanted over the lateral aspect of the pyriform sinuses for 1 week. After reexploration, glottic closure was verified on videotape as surges in sensory nerve traffic were induced by mechanical stimulation of the pharynx. The possibility of artifactual stimulation was ruled out by lack of electrode motion during pharyngeal stimulation, spontaneous firing in the sensory nerve during light anesthesia, and sensory frequency differing from ambient 60‐Hz noise. This article introduces the concept of autogenous functional graft as a basis for afferent information in electronic systems for dynamic rehabilitation of swallowing disorders.
Collagen‐assisted healing of facial wounds after mohs surgery
Authors: Becker Gary D. , Adams Lawrence A. , Hackett James
Published: November 2006

Allowing selected full‐thickness skin defects to heal by secondary intention offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. The topical use of bovine collagen has been suggested as a method of enhancing wound closure and final cosmetic appearance.

This study evaluated the effect of bovine collagen on wound healing in patients undergoing facial Mohs surgery using the fresh‐tissue technique. A total of 111 consecutive patients were assigned to a collagen or no‐collagen group. Wound care was identical except for the weekly addition of bovine collagen to the wound of patients in the collagen group. Evaluation was at weekly intervals until the wound epithelialized, then bimonthly for at least 6 months. There was no difference in the rate of wound epithelialization or final cosmetic appearance.

This study provides no evidence that the topical use of bovine collagen in a facial wound after Mohs surgery enhances wound epithelialization or the final cosmetic appearance.
Elective percutaneous (rapitrac) tracheotomy: Results of a prospective trial
Authors: Cole Ian E.
Published: November 2006

A prospective trial was carried out to assess the incidence of complications from percutaneous tracheotomies by the Rapitrac method performed by one member of an otolaryngology unit and to compare them to the dissection method over the same time period. The first 32 patients had a Rapitrac carried out blindly. Three had paratracheal or anterior tracheal insertions, one of which resulted in death of the patient. The procedure was aborted in 5 patients (16%) because of difficulty introducing the curved needle. Primary hemorrhage, damage to the posterior wall, and surgical emphysema occurred in 2 (6%) patients each. Because of the high rate of complications due to the blind nature of the procedure, the following 23 procedures were carried out using a fiberoptic bronchoscope inserted through the endotracheal tube. This procedure resulted in only 2 minor complications and is recommended if the Rapitrac technique of percutaneous tracheotomy is the method of choice.
Meniere's disease: Role of antibodies against basement membrane antigens
Authors: Fattori Bruno , Ghilardi Pier Luigi , Casani Augusto , Migliorini Paola , Riente Lucrezia
Published: November 2006

Recently, high levels of anti‐collagen II (CII) antibodies have been found in a significant percentage of patients with Meniere's disease (MD). An immune response against other collagens (C) present in the basal membranes has also been suggested by the presence of anti‐CIV and anti‐laminin antibodies in a number of instances of progressive systemic sclerosis (PSS) and Raynaud's phenomenon (RP).

The aim of the present study was to measure the levels and frequency of anti‐CI, ‐CII, ‐CIV ‐CV, and anti‐laminin antibodies by enzyme‐linked immunosorbent assay (ELISA) in 45 patients affected by MD, 24 patients with PSS, 24 patients with RP, and 25 normal subjects.

Immunoglobulin G (IgG) anti‐CII antibodies were detected in 15.5% of MD sera, and 6.6% of MD sera were positive on CV, 11.1% were positive on laminin, 4.4% were positive on CI, and 4.4% were positive on CIV. Alow incidence of anti‐CI, ‐CII, ‐CIV, ‐CV, and antilaminin antibodies was found. Positive sera did not react on immunoblot with peptides obtained by cyanogen bromide (CNBr) digestion of CH. These results contrast with those of Yoo, et al.; differences in the washing procedure used and in the ethnic background of the patients may explain this divergence.

Our results would seem to indicate that autoimmune responses do not play a role in the pathogenesis of MD.
Improved Marker Combination for Detection of De Novo Genetic Variation and Aberrant DNA in Colorectal Neoplasia
Authors: Kann Lisa , Han James , Ahlquist David , Levin Theodore , Rex Douglas , Whitney Duncan , Markowitz Sanford , Shuber Anthony
Published: November 2006

Background: The genetic heterogeneity of sporadic colorectal cancer (CRC) makes the choice of genetic markers and sequence variation–detection technologies critical to the performance of screening assays. We have previously described the effectiveness of a CRC assay composed of 22 known variants in KRAS, APC, TP53, and BAT-26 (V1). We introduce a new marker formulation (V2) that includes detection of de novo variation in APC, PIK3CA, and CTNNB1, hypermethylated sequences within SMARCA3 and VIM, and a single-base variation within BRAF. We compared the abilities of the V1 and V2 markers to detect aberrant DNA in colorectal neoplasias.

Methods: V1 and V2 marker formulations were used to analyze 144 colorectal tissue samples comprising 50 precancerous adenomas, 94 carcinomas, and 11 nonpathologic tissues. V1 analysis consisted of single-base extension analysis of the 22 V1 variants. V2 analysis consisted of DNA scanning of the APC mutation cluster region, PIK3CA exons 9 and 20, CTNNB1 exon 3, analysis for the BRAF Val600Glu substitution, and methylation-specific PCR analysis of VIM and SMARCA3.

Results: The V2 marker formulation had significantly higher sensitivity than the V1 markers for carcinomas (93.6% and 72.3%, respectively; P = 0.0002) and adenomas (92.0% and 62.0%, respectively; P = 0.0006). None of the nonpathologic samples were positive for any marker.

Conclusions: We demonstrate improved sensitivity of a new marker formulation (V2) to detect aberrant DNA in CRC and precancerous adenoma tumor tissues.
Estimate of the Chloride Concentration in a Central Glutamatergic Terminal: A Gramicidin Perforated-Patch Study on the Calyx of Held
Authors: Price Gareth D. , Trussell Laurence O.
Published: November 2006

The function of presynaptic terminals is regulated by intracellular Cl−, the levels of which modify vesicular endocytosis and transmitter refilling and mediate the effects of presynaptic ligand-gated Cl−channels. Nevertheless, the concentration of Cl−in a central nerve terminal is unknown, and it is unclear whether terminals can regulate Cl−independently of the soma. Using perforated-patch recording in a mammalian synapse, we found that terminals accumulate Cl−up to 21 mm, between four and five times higher than in their parent cell bodies. Changing [Cl−] did not alter vesicular glutamate content in intact terminals, unlikein vitroexperiments. Thus, glutamatergic terminals maintain an elevated Cl−concentration without compromising synaptic transmission.
Emotional Modulation of Pain: Is It the Sensation or What We Recall?
Authors: Godinho Fabio , Magnin Michel , Frot Maud , Perchet Caroline , Garcia-Larrea Luis
Published: November 2006

Emotions modulate pain perception, although the mechanisms underlying this phenomenon remain unclear. In this study, we show that intensity reports significantly increased when painful stimuli were concomitant to images showing human pain, whereas pictures with identical emotional values but without somatic content failed to modulate pain. Early somatosensory responses (<200 ms) remained unmodified by emotions. Conversely, late responses showed a significant enhancement associated with increased pain ratings, localized to the right prefrontal, right temporo-occipital junction, and right temporal pole. In contrast to selective attention, which enhances pain ratings by increasing sensory gain, emotions triggered by seeing other people's pain did not alter processing in SI–SII (primary and second somatosensory areas), but may have biased the transfer to, and the representation of pain in short-term memory buffers (prefrontal), as well as the affective assignment to this representation (temporal pole). Memory encoding and recall, rather than sensory processing, appear to be modulated by empathy with others' physical suffering.
Definition and Classification of Negative Motor Signs in Childhood
Authors: Sanger Terence D. , Chen Daofen , Delgado Mauricio R. , Gaebler-Spira Deborah , Hallett Mark , Mink Jonathan W. ,   the Taskforce on Childhood Motor Disorders
Published: November 2006

In this report we describe the outcome of a consensus meeting that occurred at the National Institutes of Health in Bethesda, Maryland, March 12 through 14, 2005. The meeting brought together 39 specialists from multiple clinical and research disciplines including developmental pediatrics, neurology, neurosurgery, orthopedic surgery, physical therapy, occupational therapy, physical medicine and rehabilitation, neurophysiology, muscle physiology, motor control, and biomechanics. The purpose of the meeting was to establish terminology and definitions for 4 aspects of motor disorders that occur in children: weakness, reduced selective motor control, ataxia, and deficits of praxis. The purpose of the definitions is to assist communication between clinicians, select homogeneous groups of children for clinical research trials, facilitate the development of rating scales to assess improvement or deterioration with time, and eventually to better match individual children with specific therapies.

“Weakness” is defined as the inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint. “Reduced selective motor control” is defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement. “Ataxia” is defined as an inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints. “Apraxia” is defined as an impairment in the ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity. “Developmental dyspraxia” is defined as a failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness, or involuntary motor activity.
Reducing Children's Television-Viewing Time: A Qualitative Study of Parents and Their Children
Authors: Jordan Amy B. , Hersey James C. , McDivitt Judith A. , Heitzler Carrie D.
Published: November 2006

OBJECTIVES. The American Academy of Pediatrics recommends that children over age 2 years spend ≤2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children.

METHODS. The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old.

RESULTS. Most of the children reported spending ∼3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics.

CONCLUSIONS. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.
Evaluation and Development of Potentially Better Practices to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants
Authors: Payne Nathaniel R. , LaCorte Meena , Sun Shyan , Karna Padmani , Lewis-Hunstiger Martha , Goldsmith Jay P. ,   on behalf of the Breathsavers Group
Published: November 2006

OBJECTIVE. The objective of this study was to describe development and implementation of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants (birth weight: 501–1500 g).

METHODS. Results of Breathsavers Group meetings, conference calls and critically appraised topic summaries were used to construct potentially better practices. Implementation plans and experiences were reported by participants and collated.

RESULTS. The Breathsavers Group developed 13 potentially better practices, based on published evidence and expert opinion. Participants determined which potentially better practices to implement and implementation methods. Participating NICUs implemented an average of 5 potentially better practices (range: 3–9). The Breathsavers Group also developed a resource kit, identified common obstacles to implementation, and initiated research to define bronchopulmonary dysplasia better.

CONCLUSIONS. Multiinstitutional collaboration facilitated development and implementation of potentially better practices to reduce bronchopulmonary dysplasia.
National Trends in the Use of Antireflux Procedures for Children
Authors: Lasser Michael S. , Liao Jason G. , Burd Randall S.
Published: November 2006

OBJECTIVE. The purpose of this study was to analyze recent nationwide trends in the use of and outcomes after antireflux surgery for children.

METHODS. We conducted a retrospective cohort study of children (age: <18 years) undergoing antireflux surgery by using data from 1996 to 2003 from the Nationwide Inpatient Sample. Census data were used to calculate the population-based rates of procedures stratified according to age and presence of neurologic impairment. Multivariate analyses were performed to determine factors associated with length of stay and in-hospital death.

RESULTS. During the study period, 48 665 antireflux procedures were performed for children in the US. Although procedure rates were generally higher in 2003 than in 1996, no trends in rates were observed among different age groups and census regions during the study period. The highest population-based procedure rates were observed among infants (49–101 procedures per 100 000 population). There was a significant decrease in the percentages of children undergoing antireflux procedures who were neurologically impaired between 1996 and 2003 (53% vs 40%). Neurologically impaired children had longer lengths of stay and higher mortality rates than did neurologically normal children.

CONCLUSIONS. Although procedure rates have not changed, the use of antireflux surgery has evolved during the laparoscopic era, with a decreasing percentage of neurologically impaired children undergoing this procedure. Antireflux procedures were performed predominantly for infants, most of whom were neurologically normal. Neurologically impaired children remain a group at high risk for death after antireflux procedures.
Improved Outcomes of Extremely Premature Outborn Infants: Effects of Strategic Changes in Perinatal and Retrieval Services
Authors: Lui Kei , Abdel-Latif Mohamed E. , Allgood Catherine L. , Bajuk Barbara , Oei Julee , Berry Andrew , Henderson-Smart David ,   New South Wales and Australian Capital Territory Neonatal Intensive Care Unit Study Group
Published: November 2006

OBJECTIVE. The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia.

METHODS. The intervention included additional, network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system, with preferential admission of retrieved infants (outborn infants) to perinatal centers instead of freestanding pediatric hospitals, from the middle of 1995. Population birth and NICU admission cohorts of infants of 23 to 28 weeks of gestation were studied. Outcomes of epoch 1 (1992 to the middle of 1995; 1778 births and 1100 NICU admissions) were compared with those of epoch 2 (1997–2002; 3099 births and 2100 NICU admissions), after an 18-month washout period.

RESULTS. There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.

CONCLUSIONS. Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.
Prevention and Management of Pain in the Neonate: An Update
Authors:   American Academy of Pediatrics,   Committee on Fetus and Newborn and Section on Surgery,   Section on Anesthesiology and Pain Medicine,   Canadian Paediatric Society,   Fetus and Newborn Committee
Published: November 2006

The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.
Spatial Allocation of Shrimp Catch Based on Fishing Effort: Adjusting for the Effects of the Texas Opening
Authors: Cole John G. , Gallaway Benny J. , Martin Larry R. , Nance James M. , Longnecker Michael
Published: November 2006

Estimates of fishing effort for the Gulf of Mexico penaeid shrimp fishery depend on the ability of National Marine Fisheries Service port agents to accurately assign fractional catches within a fishing trip to 5-fathom-depth bins within 21 Gulf of Mexico statistical areas. In previous studies, we showed that the method used for assigning landings was inaccurate and developed an algorithm for assigning landings based up observer and captain's logbook data on fishing effort and catch. The resulting algorithm explained over 92% of the variance in actual catch. Results of regression analyses of new observer data collected for over 7,700 tows confirm that the algorithm provides reliable estimates of fractional catches associated with the different subareas fished within a trip (adjusted r2 = 0.96 when 11 outliers are removed from 1,845 observations). Nine of the 11 outliers occurred within a month of the Texas opening, a period when catches are initially high but then decay rapidly. Here, we have incorporated this decay as part of the allocation algorithm for this period. The agreement of expected and actual shrimp catch declined slightly from the regression with outliers removed (adjusted r2 = 0.95). Nevertheless, we suggest that data from this period should be modeled separately to better evaluate the consequences of management actions that might be taken during the Texas opening time frame.
Sobering Thoughts: Town Hall Meetings on Fetal Alcohol Spectrum Disorders
Authors: Ryan Doreen Major , Bonnett Doreen M. , Gass Callie B.
Published: November 2006

Prenatal exposure to alcohol is one of the leading causes of preventable birth defects and developmental disabilities. During the past 30 years, fetal alcohol spectrum disorders (FASD), including fetal alcohol syndrome, have gradually begun to attract attention. However, awareness and understanding of the disorders remain low, and people who are affected are seriously underserved.

The FASD Center for Excellence held a series of town hall meetings in 2002 and 2003 to gauge the issues surrounding FASD nationwide. On the basis of its findings, the center proposed a series of recommendations to begin to remedy some of the deficiencies that were identified.
The Influence of Maternal Weight and Glucose Tolerance on Infant Birthweight in Latino Mother–Infant Pairs
Authors: Kieffer Edith C. , Tabaei Bahman P. , Carman Wendy J. , Nolan George H. , Guzman J. Ricardo , Herman William H.
Published: November 2006

Objectives. We assessed the influence of maternal anthropometric and metabolic variables, including glucose tolerance, on infant birthweight.

Methods. In our prospective, population-based cohort study of 1041 Latino mother–infant pairs, we used standardized interviews, anthropometry, metabolic assays, and medical record reviews. We assessed relationships among maternal sociodemographic, prenatal care, anthropometric, and metabolic characteristics and birthweight with analysis of variance and bivariate and multivariate linear regression analyses.

Results. Forty-two percent of women in this study entered pregnancy overweight or obese; at least 36% exceeded weight-gain recommendations. Twenty-seven percent of the women had at least some degree of glucose abnormality, including 6.8% who had gestational diabetes. Maternal multiparity, height, weight, weight gain, and 1-hour screening glucose levels were significant independent predictors of infant birthweight after adjustment for gestational age.

Conclusion. Studies of birthweight should account for maternal glucose level. Given the increased risk of adverse maternal and infant outcomes associated with excessive maternal weight, weight gain, and glucose intolerance, and the high prevalence of these conditions and type 2 diabetes among Latinas, public health professionals have unique opportunities for prevention through prenatal and postpartum interventions.
Detection of 90K/MAC‐2BP in the Seminal Plasma of Infertile Males With Accessory Gland Infection and the Autoimmune Pathogenetic Hypothesis
Authors: Caroppo Ettore , Niederberger Craig , Iacovazzi Palma A. , Correale Mario , D'Amato Giuseppe
Published: November 2006

ABSTRACT: The purpose of the study was to evaluate 90K/MAC‐2BP, a glycoprotein member of the Scavenger Receptor Cystein Rich superfamily, in the seminal plasma of infertile male patients with male accessory gland infection in order to investigate a putative autoimmune pathogenesis. 90K seminal concentration and sperm parameters were evaluated in 50 patients with male accessory gland infection at baseline and after cycles of treatment with Levofluoxacin 500 mg daily for 15 days plus serratiopeptidase 10 mg daily for 30 days. Treatment was continued for up to 6 cycles in cases of persistant bacteriospermia and/or clinical and ejaculatory signs of the disease. Patients with persistant male accessory gland infection after 6 cycles were defined as nonresponders. The same parameters were evaluated at baseline and after a 2‐month period in 30 healthy controls. Patients with male accessory gland infection showed impaired sperm parameters and had lower seminal 90K concentration compared to controls. After treatment, seminal 90K level significantly increased in patients compared to controls. Twenty‐two patients responded to treatment (44%), while 28 were nonresponders (56%). No difference in pretreatment and posttreatment sperm parameters and seminal 90K was observed between the 2 subgroups. Thirteen patients (26%) had identifiable bacteriospermia: significantly less pretreatment seminal 90K was observed compared to patients without bacteriospermia. Seminal 90K is decreased in patients with male accessory gland infection, and may be restored by a treatment with quinolones. However, the clinical utility of a 90K assay in these patients remains uncertain, as its level is not predictive of response to treatment.
Enhanced Binding of Sperm With Superior Volume Regulation to Oviductal Epithelium
Authors: Khalil A. A. Y. , Petrunkina A. M. , Sahin E. , Waberski D. , Töpfer‐Petersen E.
Published: November 2006

ABSTRACT: The plasma membrane is a key organelle with respect to sperm fertilizing ability. A sensitive way of testing plasma membrane functionality is to examine the sperm ability to moderate its swelling in response to hypo‐osmotic stress (volume regulatory ability) using an electronic cell counter to assess cell volume changes. In this study of frozen‐thawed bull sperm, we examined the relationship among sperm‐oviductal epithelium binding capacity, osmotically induced swelling response, volume regulatory ability, and standard spermatologic parameters. Sperm cell volume distributions were measured under iso‐osmotic conditions and after hypo‐osmotic stress. The relative volume shift was calculated by comparing modal values of the cell volume distributions during transition from iso‐osmotic to hypo‐osmotic conditions. Significant correlations were found between volumetric parameters and sperm‐oviduct binding capacity. Both the relative volume shift and regulative volume decrease correlated positively and significantly with the sperm‐oviduct binding capacity. No significant correlations were found between sperm volumetric parameters and any of the standard sperm parameters with the exception of forward motility of Percoll‐washed sperm. However, the use of multiple regression models improved the prediction level for binding capacity when motility parameters were combined with membrane integrity and volumetric parameters (R2 = .84). Spermatozoa of bulls with high nonreturn rates responded to hypotonicity as “perfect osmometers.” Subfertile bulls had lower binding indices and deficiencies in volume recovery after hypotonic challenge, indicating that intact volume regulatory ability is a necessary prerequisite for binding to oviductal epithelium and is related to fertility. Volumetric parameters therefore could be used as tools in semen evaluation programs.
The Sertoli‐Spermatid Junctional Complex Adhesion Strength Is Affected In Vitro by Adjudin
Authors: Wolski Katja M. , Mruk Dolores D. , Cameron Don F.
Published: November 2006

ABSTRACT: The actin‐based cell‐cell adherens junction (AJ) between the Sertoli cell and the germ cell in the mammalian testis is important not only in mechanical adhesion of the cells, but in the morphogenesis and differentiation of the germ cells. The Sertoli ectoplasmic specialization (ES), a specialized type of AJ, is associated with Sertoli‐spermatid binding and is important in cell‐cell adhesion in the seminiferous epithelium. Abnormal or absent Sertoli ESs have been associated with step‐8 spermatid sloughing and oligospermia in conditions associated with reduced fertility potential. The reproductive hormones, follicle stimulating hormone (FSH), and testosterone (T) have also been shown to play a role in the regulation of binding of spermatids at the Sertoli‐spermatid junctional complex (STJC). Adjudin [1‐(2,4‐dichlorobenzyl)‐1H‐indazole‐3‐carbohydrazide] is a potential male contraceptive and is thought to exhibit its contraceptive effects by interrupting the STJC. It has been shown that this compound induces reversible germ cell loss from the seminiferous epithelium, particularly elongating/elongate/round spermatids and spermatocytes. Using a micropipette pressure transducing system (MPTS) to measure the force needed to detach step‐8 spermatids from Sertoli cells, this study examined the strength of the STJC in Sertoli‐spermatid cocultures in the presence of Adjudin (1 ng/mL, 50 ng/mL, 125 ng/mL, or 500 ng/mL in EtOH) and hormones [FSH (0.1 μg/mL, NIDDK‐oFSH‐20, AFP7028D, 175 × NIH‐FSH‐S1), T (100 nM)] to optimize in vitro binding. The average forces required to detach the spermatids from the underlying Sertoli cells in the presence of 1 ng/mL, 50 ng/mL, 125 ng/mL, and 500 ng/mL Adjudin were 18.2 × 10−10 pN, 14.3 × 10−10 pN, 7.74 × 10−10 pN, and 6.51 × 10−10 pN, respectively. The average force required to detach step‐8 spermatids in the presence of vehicle only (control) was 19.0 × 10−10 pN. A significant difference for Adjudin concentrations at or above 125 ng/mL was determined by one‐way ANOVA (P < .05). These data confirm that Adjudin is effective in reducing the strength of the STJC, identifying Adjudin as a potential contraceptive agent in the male by inducing spermatid sloughing and therefore oligospermia.
The Effect of α‐Adrenergic Antagonists in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Meta‐Analysis of Randomized Controlled Trials
Authors: Yang Gang , Wei Qiang , Li Hong , Yang Yuru , Zhang Sixiao , Dong Qiang
Published: November 2006

ABSTRACT: The effectiveness of α‐adrenergic antagonists on patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has not been supported by well‐evaluated study. The meta‐analysis was performed to supply the best evidence about use of this class of drugs in CP/CPPS. A fully recursive literature search to June 2005 was conducted in PubMed, EMBASE, the Cochrane Controlled Trials Register, and the Chinese Biomedicine Database to identify potentially relevant randomized controlled trials. RevMan4.2 was used for statistical analysis. Nine studies with 734 patients were included. Combined analysis showed a significant reduction of total NIH‐CPSI or I‐PSS in patients with treatment duration of more than 3 months. There were also valuable results in urinary symptom alleviation. Alphα‐adrenergic antagonists did not show benefit in pain. The meta‐analysis revealed that the use of α‐adrenergic antagonists was warranted in CP/CPPS, and the treatment duration should be long enough (more than 3 months).
Protamine Levels Vary Between Individual Sperm Cells of Infertile Human Males and Correlate With Viability and DNA Integrity
Authors: Aoki Vincent W. , Emery Benjamin R. , Liu Lihua , Carrell Douglas T.
Published: November 2006

ABSTRACT: Sperm protamine deficiency has been associated with human male infertility. However, most studies have adopted a global approach to assessing sperm protamine levels. Thus, it is not known whether sperm cells from individual human males possess variations in protamine protein content. The objectives of this study were to evaluate variations in protamine‐1 (P1) and protamine‐2 (P2) content between individual sperm cells of fertile and infertile men and to correlate DNA integrity and sperm cell viability with protamine levels in individual sperm cells. The semen samples of fertile and infertile men were evaluated globally for protamine protein content using nuclear protein extraction, gel electrophoresis, and densitometry analysis. Individual sperm cell P1 and P2 levels were assessed using immunofluorescence microscopy in conjunction with automated image analysis. The terminal transferase dUTP nick end labeling (TUNEL) assay was performed simultaneously with protamine immunostaining to assess the relationship between protamine levels and DNA integrity in individual spermatozoa. Additionally, the relationship between sperm cell viability and protamine levels was assessed via viability staining concomitant with protamine staining. The protamine fluorescence data demonstrate significant variations in protamine content within individual sperm cells of human males. Overall population‐based measures of DNA integrity and sperm cell viability correlate significantly with population‐based measurements of protamine levels. The data also demonstrate individual sperm cells displaying the lowest protamine levels display diminished viability and increased sperm cell susceptibility to DNA damage.