bluuebunny/crossref_metadata_2025 huggingface dataset:
Plastic modifications induced by object recognition memory processing
Authors: Clarke Julia Rosauro , Cammarota Martín , Gruart Agnès , Izquierdo Iván , Delgado-García José María
Published: January 2010

Long-term potentiation (LTP) phenomenon is widely accepted as a cellular model of memory consolidation. Object recognition (OR) is a particularly useful way of studying declarative memory in rodents because it makes use of their innate preference for novel over familiar objects. In this study, mice had electrodes implanted in the hippocampal Schaffer collaterals–pyramidal CA1 pathway and were trained for OR. Field EPSPs evoked at the CA3-CA1 synapse were recorded at the moment of training and at different times thereafter. LTP-like synaptic enhancement was found 6 h posttraining. A testing session was conducted 24 h after training, in the presence of one familiar and one novel object. Hippocampal synaptic facilitation was observed during exploration of familiar and novel objects. A short depotentiation period was observed early after the test and was followed by a later phase of synaptic efficacy enhancement. Here, we show that OR memory consolidation is accompanied by transient potentiation in the hippocampal CA3-CA1 synapses, while reconsolidation of this memory requires a short-lasting phase of depotentiation that could account for its well described vulnerability. The late synaptic enhancement phase, on the other hand, would be a consequence of memory restabilization.
Alternative end-joining catalyzes robust IgH locus deletions and translocations in the combined absence of ligase 4 and Ku70
Authors: Boboila Cristian , Jankovic Mila , Yan Catherine T. , Wang Jing H. , Wesemann Duane R. , Zhang Tingting , Fazeli Alex , Feldman Lauren , Nussenzweig Andre , Nussenzweig Michel , Alt Frederick W.
Published: January 2010

Class switch recombination (CSR) in B lymphocytes is initiated by introduction of multiple DNA double-strand breaks (DSBs) into switch (S) regions that flank immunoglobulin heavy chain (
IgH
) constant region exons. CSR is completed by joining a DSB in the donor Sμ to a DSB in a downstream acceptor S region (e.g., Sγ1) by end-joining. In normal cells, many CSR junctions are mediated by classical nonhomologous end-joining (C-NHEJ), which employs the Ku70/80 complex for DSB recognition and XRCC4/DNA ligase 4 for ligation. Alternative end-joining (A-EJ) mediates CSR, at reduced levels, in the absence of C-NHEJ, even in combined absence of Ku70 and ligase 4, demonstrating an A-EJ pathway totally distinct from C-NHEJ. Multiple DSBs are introduced into Sμ during CSR, with some being rejoined or joined to each other to generate internal switch deletions (ISDs). In addition, S-region DSBs can be joined to other chromosomes to generate translocations, the level of which is increased by absence of a single C-NHEJ component (e.g., XRCC4). We asked whether ISD and S-region translocations occur in the complete absence of C-NHEJ (e.g., in Ku70/ligase 4 double-deficient B cells). We found, unexpectedly, that B-cell activation for CSR generates substantial ISD in both Sμ and Sγ1 and that ISD in both is greatly increased by the absence of C-NHEJ.
IgH
chromosomal translocations to the
c-myc
oncogene also are augmented in the combined absence of Ku70 and ligase 4. We discuss the implications of these findings for A-EJ in normal and abnormal DSB repair.
A truncated lipoglycan from mycobacteria with altered immunological properties
Authors: Birch Helen L. , Alderwick Luke J. , Appelmelk Ben J. , Maaskant Janneke , Bhatt Apoorva , Singh Albel , Nigou Jerome , Eggeling Lothar , Geurtsen Jeroen , Besra Gurdyal S.
Published: January 2010

Maintenance of cell-wall integrity inMycobacterium tuberculosisis essential and is the target of several antitubercular drugs. For example, ethambutol targets arabinogalactan and lipoarabinomannan (LAM) biosynthesis through the inhibition of several arabinofuranosyltransferases. Apart from their role in cell-wall integrity, mycobacterial LAMs also exhibit important immunomodulatory activities. Here we report the isolation and detailed structural characterization of a unique LAM molecule derived fromMycobacterium smegmatisdeficient in the arabinofuranosyltransferase AftC (AftC-LAM). This mutant LAM expresses a severely truncated arabinan domain completely devoid of 3,5-Araf–branching residues, revealing an intrinsic involvement of AftC in the biosynthesis of LAM. Furthermore, we found that ethambutol efficiently inhibits biosynthesis of the AftC-LAM arabinan core, unambiguously demonstrating the involvement of the arabinofuranosyltransferase EmbC in early stages of LAM-arabinan biosynthesis. Finally, we demonstrate that AftC-LAM exhibits an enhanced proinflammatory activity, which is due to its ability to activate Toll-like receptor 2 (TLR2). Overall, our efforts further describe the mechanism of action of an important antitubercular drug, ethambutol, and demonstrate a role for specific arabinofuranosyltransferases in LAM biosynthesis. In addition, the availability of sufficient amounts of chemically defined wild-type and isogenic truncated LAMs paves the way for further investigations of the structure–function relationship of TLR2 activation by mycobacterial lipoglycans.
Deficient CD40-TRAF6 signaling in leukocytes prevents atherosclerosis by skewing the immune response toward an antiinflammatory profile
Authors: Lutgens Esther , Lievens Dirk , Beckers Linda , Wijnands Erwin , Soehnlein Oliver , Zernecke Alma , Seijkens Tom , Engel David , Cleutjens Jack , Keller Anna M. , Naik Shalin H. , Boon Louis , Oufella Hafid Ait , Mallat Ziad , Ahonen Cory L. , Noelle Randolph J. , de Winther Menno P. , Daemen Mat J. , Biessen Erik A. , Weber Christian
Published: January 2010

The CD40–CD40 ligand (CD40L) signaling axis plays an important role in immunological pathways. Consequently, this dyad is involved in chronic inflammatory diseases, including atherosclerosis. Inhibition of CD40L in apolipoprotein E (Apoe)–deficient (Apoe−/−) mice not only reduced atherosclerosis but also conferred a clinically favorable plaque phenotype that was low in inflammation and high in fibrosis. Blockade of CD40L may not be therapeutically feasible, as long-term inhibition will compromise systemic immune responses. Conceivably, more targeted intervention strategies in CD40 signaling will have less deleterious side effects. We report that deficiency in hematopoietic CD40 reduces atherosclerosis and induces features of plaque stability. To elucidate the role of CD40–tumor necrosis factor receptor-associated factor (TRAF) signaling in atherosclerosis, we examined disease progression in mice deficient in CD40 and its associated signaling intermediates. Absence of CD40-TRAF6 but not CD40-TRAF2/3/5 signaling abolishes atherosclerosis and confers plaque fibrosis in Apoe−/− mice. Mice with defective CD40-TRAF6 signaling display a reduced blood count of Ly6Chigh monocytes, an impaired recruitment of Ly6C+ monocytes to the arterial wall, and polarization of macrophages toward an antiinflammatory regulatory M2 signature. These data unveil a role for CD40–TRAF6, but not CD40–TRAF2/3/5, interactions in atherosclerosis and establish that targeting specific components of the CD40–CD40L pathway harbors the potential to achieve therapeutic effects in atherosclerosis.
An Integrated Approach to Methicillin-ResistantStaphylococcus aureusControl in a Rural, Regional-Referral Healthcare Setting
Authors: Bowler William A. , Bresnahan Jeanine , Bradfish Ann , Fernandez Christine
Published: January 2010

Objective.

To curtail the prevalence and cross-transmission of methicillin-resistantStaphylococcus aureus(MRSA) in a rural healthcare setting.

Design.

Before-after, quasi-experimental quality improvement study.

Setting.

A regional-referral hospital, 5 affiliated nursing homes, and an outpatient MRSA clinic.

Interventions.

Residents of the 5 nursing homes were screened for MRSA at baseline and 1 year later. Active surveillance cultures were performed on subsequently admitted nursing home residents, “high-risk” patients admitted to the hospital, and household contacts of clinic patients. The decolonization regimen consisted of systemic therapy with minocycline and rifampin and topical therapy with nasal mupirocin ointment and 5% tea tree oil body wash. Three separate samples for cultures to document clearance of MRSA colonization were obtained at 1-week intervals 1 month after the completion of decolonization therapy. Samples for follow-up cultures were obtained at month 6 and month 12 after the completion of decolonization therapy.

Results.

After intervention and follow-up for 12 months or more, the prevalence of MRSA carriage at the nursing homes decreased by 67% (P<.001), and 120 (82%) of 147 nursing home residents and 111 (89%) of 125 clinic patients remained culture-negative for MRSA. Twenty-three (24%) of 95 new clinic patients had at least 1 MRSA-positive contact. Mupirocin resistance did not develop. In the hospital, the incidence rate of nosocomial MRSA infection decreased from 0.64 infections per 1,000 patient-days before the interventions to 0.40 infections per 1,000 patient-days 1 year after the interventions and to 0.32 infections per 1,000 patient-days 2 years after the intervention (P<.01).

Conclusions.

Use of active surveillance cultures and decolonization therapy was effective in decreasing the prevalence of asymptomatic carriage, the incidence of nosocomial infection, and the overall prevalence of MRSA in our rural healthcare setting.
ZnO sublimation using a polyenergetic pulsed electron beam source: numerical simulation and validation
Authors: Tricot S , Semmar N , Lebbah L , Boulmer-Leborgne C
Published: January 2010

This paper details the electro-thermal study of the sublimation phase on a zinc oxide surface. This thermodynamic process occurs when a ZnO target is bombarded by a pulsed electron beam source composed of polyenergetic electrons. The source delivers short pulses of 180 ns of electrons with energies up to 16 keV. The beam total current reaches 800 A and is focused onto a spot area 2 mm in diameter. The Monte Carlo CASINO program is used to study the first stage of the interaction and to define the heat source space distribution inside the ZnO target. Simulation of the second stage of interaction is developed in a COMSOL multiphysics project. The simulated thermal field induced by space and time heat conduction is presented. Typically for a pulsed electron beam 2 mm in diameter of electrons having energies up to 16 keV, the surface temperature reaches a maximum of 7000 K. The calculations are supported by SEM pictures of the target irradiated by various beam energies and numbers of pulses.
Chemical-solution deposition and nonlinear dielectric characteristics of nanocrystalline (Pb0.5Sr0.5)TiO3 thin films
Authors: Ambika D , Kumar V
Published: January 2010

Nanocrystalline dielectric thin films of (Pb1−x
Sr
x
)TiO3 were dip-coated on different substrates from highly stable precursor solutions derived from a unique metal organic system. Highly crystalline, fine-grained, uniform and crack-free thin films were obtained at temperatures as low as 450 °C. The structural and dielectric properties of the thin films have been investigated to study the suitability of the thin films for tunable dielectric applications.
Physical characterization of molybdenum microtips field emitter arrays
Authors: Cipriani F , Leblanc F , Illiano J M , Berthelier J J , Müller F
Published: January 2010

We used a dedicated hemispherical energy analyzer to measure energetic and angular distributions of electrons emitted from molybdenum microtips integrated in a 1 cm2 field emitter array designed by the CEA/LETI laboratory. Such cathodes typically deliver about 25 mA at an extraction voltage of 100 V, and are studied in order to replace heated wires as electron sources for space applications. We find that the energy distribution of the beam strongly depends on the extraction voltage, and is therefore expected to vary across the emission lifetime of the device, at a rate depending both on the alteration of the resistive structure with time and on the fate of adsorbed contaminants at the tip surface. A semi-empirical model of the emitters is proposed and used to determine parameters of energetic and angular distributions. The energy dispersion of the beam is found to increase from 2 eV ± 20% up to 9 eV ± 20% eV, for extraction voltages varying from 40 to 100 V. The mean angular dispersion of the beam is found to be 42° ± 20% when a null electric field is set at the grid extraction surface.
Effects of alagebrium, an advanced glycation end‐product breaker, in patients with chronic heart failure: study design and baseline characteristics of the BENEFICIAL trial
Authors: Willemsen Suzan , Hartog Jasper W.L. , Hummel Yoran M. , Posma Jan L. , van Wijk Leen M. , van Veldhuisen Dirk J. , Voors Adriaan A.
Published: January 2010

Aims

Previous small open label studies have shown that the advanced glycation end‐product (AGE) breaker alagebrium may improve cardiac function in patients with chronic heart failure (HF). We report the design, methods and baseline characteristics of a double‐blind, placebo‐controlled, randomized trial evaluating the efficacy and safety of alagebrium (BENEFICIAL) in patients with HF and a left ventricular ejection fraction (LVEF) ≤ 0.45.

Methods and results

Patients with NYHA II–IV stable HF for at least 3 months were eligible for this study. One hundred and two patients were included in the study and randomized to either 200 mg alagebrium twice daily or placebo for a period of 36 weeks. The mean age of patients was 60 ± 11 years, 78% were male, and 17% were diabetic. Mean peak VO2 was 21.7 ± 5.9 mL/min/kg, mean LVEF was 0.32 ± 0.09. Diastolic function was worse (mean early tissue diastolic velocity (E′) 4.6 ± 1.7 vs. 6.1 ± 2.0 cm/s; P < 0.001) in patients with LVEF ≤ 0.35 compared to patients with LVEF between 0.35 and 0.45.

Conclusion

The BENEFICIAL study is a proof‐of‐concept study that will provide new data on the efficacy and safety of the AGE crosslink breaker alagebrium in systolic HF patients. EudraCT number of this trial is NCT00516646.
Lebedev scheme for the numerical simulation of wave propagation in 3D anisotropic elasticity‡
Authors: Lisitsa Vadim , Vishnevskiy Dmitriy
Published: January 2010

This paper presents a Lebedev finite difference scheme on staggered grids for the numerical simulation of wave propagation in an arbitrary 3D anisotropic elastic media. The main concept of the scheme is the definition of all the components of each tensor (vector) appearing in the elastic wave equation at the corresponding grid points, i.e., all of the stresses are stored in one set of nodes while all of the velocity components are stored in another. Meanwhile, the derivatives with respect to the spatial directions are approximated to the second order on two‐point stencils. The second‐order scheme is presented for the sake of simplicity and it is easy to expand to a higher order.

Another approach, widely‐known as the rotated staggered grid scheme, is based on the same concept; therefore, this paper contains a detailed comparative analysis of the two schemes. It is shown that the dispersion condition of the Lebedev scheme is less restrictive than that of the rotated staggered grid scheme, while the stability criteria lead to approximately equal time stepping for the two approaches. The main advantage of the proposed scheme is its reduced computational memory requirements. Due to a less restrictive dispersion condition and the way the media parameters are stored, the Lebedev scheme requires only one‐third to two‐thirds of the computer memory required by the rotated staggered grid scheme. At the same time, the number of floating point operations performed by the Lebedev scheme is higher than that for the rotated staggered grid scheme.
Evaluation of reproductive histories constructed by linking vital records
Authors: Adams Melissa M. , Berg Cynthia J. , McDermott Jeanne M. , Gaudino James A. , Casto Dale L. , Wilson Hoyt G. , McCarthy Brian J.
Published: January 2010

Summary We used 1.4 million fetal death and birth certificates filed in Georgia between 1980 and 1992 to construct 369 686 chains of two or more reproductive events occurring to the same woman. We evaluated these chains using both information on the certificates and information independently collected in interviews with 1311 women. Overall, 86.6% of the chains had the expected number of events, based on the certificate's information about previous pregnancies. Seventy‐nine per cent of the chains had the expected number of events based on the maternal interviews. Consistency between the observed number of events in the chain and the number expected, based either on data from the certificates or from the maternal interviews, was greatest for chains with two or three events. Mothers born in Georgia were more likely to have complete chains than mothers born elsewhere. Among the 551 391 non‐linked certificates, 48.7% were the mother's first birth, 40.2% were second or higher‐order births to women whose previous pregnancy occurred before 1980, and 11.1% were second or higher‐order births to women whose previous pregnancy occurred after 1980. Fetal death and livebirth certificates can be linked to construct pregnancy histories with reasonably low levels of underlinkage and overlinkage.
Early Oligocene alkaline lamprophyric dykes from the Jandaq area (Isfahan Province, Central Iran): Evidence of Central–East Iranian microcontinent confining oceanic crust subduction
Authors: Torabi Ghodrat
Published: January 2010

The Jandaq lamprophyres occur as eight mostly parallel dykes, which cross‐cut Eocene volcanic and sedimentary rocks of the Pis‐Kuh Formation in dominant north to south direction. These lamprophyres are mainly composed of kaersutite, clinopyroxene, olivine, feldspar, ilmenite, and spinel as primary minerals. The rocks studied here are enriched in alkalis, TiO2, large ion lithophile elements, and light rare‐earth elements (LREE), with SiO2 content between 41.7 and 46.2 wt%, and are classified as camptonite and alkaline lamprophyre according to the mineralogical and chemical characteristics. These rocks exhibit positive Eu anomalies (Eu/Eu* = 1.08–1.39) and are characterized by strong enrichment in LREE relative to heavy REEs, and also by varied Zr/Hf ratios. The geochemical features of the rocks suggest that the lamprophyre magmas were derived from low‐degree melting of an amphibole garnet lherzolite that experienced strong metasomatism by carbonate‐rich fluids in response to dehydration melting from the subducted slab. The Jandaq lamprophyric magmatism has been attributed to the former subduction of the Central–East Iranian microcontinent confining oceanic crust from the Triassic to Eocene, and decompression melting induced by the extensional basin of the Jandaq area in the early Oligocene.
Twin–twin transfusion syndrome, coarctation of the aorta and hypoplastic aortic arch: A case series report
Authors: Van Den Boom Jutta , Battin Malcolm , Hornung Tim
Published: January 2010

Aim:  The twin–twin transfusion syndrome (TTTS) complicates 10–30% of monochorionic pregnancies. The incidence of pulmonary stenosis and endocardial fibroelastosis is especially high in the recipient twin. We report a novel finding of four cases of coarctation of the aorta and hypoplastic aortic arch in the donor to raise awareness of cardiac lesions in twins affected by TTTS.

Method:  Retrospective review of both neonatal database and mortality data from 2002 to 2007 with cross‐validation from the local tertiary cardiology unit data (1998–2006) to identify children presenting with coarctation who were also twins.

Results:  We identified four monochorionic twin pairs affected by the TTTS, delivered between 25 weeks and 36 weeks' gestation, where the donor was found to have coarctation of the aorta or a hypoplastic aortic arch. In addition, two of the four recipients also had cardiac abnormalities. There was a high mortality rate of 30% for both twins, and a high morbidity rate, especially for neurological sequelae.

Conclusion:  We believe that the types of abnormalities seen may be explained by the altered fetal blood flow and haemodynamics in TTTS. Given the increased prevalence of congenital heart disease in TTTS, with an increased risk of coarctation in the donor twin and pulmonary stenosis in the recipient, intra‐uterine surveillance and a post‐natal comprehensive cardiac assessment for both twins is warranted.
Sleep habits and disturbances in Malaysian children with epilepsy
Authors: Ong Lai Choo , Yang Wai Wai , Wong Sau Wei , AlSiddiq Feizel , Khu Yi Soon
Published: January 2010

Aims:  To compare sleep habits and disturbances between Malaysian children with epilepsy and their siblings (age range 4–18 years) and to determine the factors associated with greater sleep disturbance.

Methods:  The Sleep Disturbance Scale for Children (SDSC) questionnaire was completed by the primary caregiver for 92 epileptic children (mean age 11.1 years, 50 male, 42 females) and their healthy siblings (mean age 11.1 years, 47 males, 45 females). Details of sleep arrangements and illness severity were obtained. Multiple regression analysis was used to determine factors associated with high Total SDSC scores in epileptic patients.

Results:  Compared with their siblings, epileptic children had significantly higher total SDSC score (difference between means 8.7, 95% confidence interval (CI) 6.4–11.1) and subscale scores in disorders of initiating and maintaining sleep (3.9, 95% CI 2.8–5.2), sleep–wake transition disorders (2.1, 95% CI 1.3–2.9), sleep‐disordered breathing (0.7, 95% CI 0.3–1.1) and disorders of excessive sleepiness (1.5, 95% CI 0.6–2.4). Epileptic children had a higher prevalence of co‐sleeping (73.7% vs 31.5%) and on more nights per week (difference between means 3, 95% CI 2.0–3.9) than their siblings. Higher Epilepsy Illness Severity scores were associated with higher total SDSC scores (P= 0.02).

Conclusion:  Co‐sleeping was highly prevalent in children with epilepsy, who also had more sleep disturbances (especially problems with initiating and maintaining sleep and sleep–wake transition disorders) than their siblings. Epilepsy severity contributed to the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with severe epilepsy.
Higher protein and energy intake is associated with increased weight gain in pre‐term infants
Authors: Collins Carmel T , Chua Mei Chien , Rajadurai Victor S , McPhee Andrew J , Miller Lisa N , Gibson Robert A , Makrides Maria
Published: January 2010

Aim:  To characterise and compare the nutritional management and growth in infants <33 weeks' gestation in two tertiary centres.

Methods:  An audit of daily intake and growth from birth to discharge home was undertaken in two neonatal units: The KK Women's and Children's Hospital Singapore and the Adelaide Women's and Children's Hospital, South Australia. Mixed models were used to model intake and daily weight (g/day) accounting for repeated day per subject.

Results:  The clinical characteristics of the two cohorts were similar. The Adelaide cohort had a higher initial energy intake in the first 5 days compared with the Singapore cohort, and a significantly greater weekly increase of 21.0 kcal/week (95% CI 7.7–34.3; P = 0.002). The Adelaide cohort also had a higher initial protein intake and a significantly greater weekly increase of 0.88 g/week (95% CI 0.5, 1.3), P < 0.001) compared with the Singapore cohort. The weight gain of the Adelaide cohort was 9 g/day more than the Singapore cohort (95% CI 7.3, 10.7; P < 0.001). Post‐natal growth failure was evident in 32% (n = 64) of the Adelaide cohort and 64% (n = 94) of the Singapore cohort.

Conclusions:  The two centres showed distinct differences in nutritional management. A higher energy and protein intake was associated with improved growth yet growth in both cohorts was still below current recommendations.
Coping strategies for hospital‐related fears in pre‐school‐aged children
Authors: Salmela Marja , Salanterä Sanna , Ruotsalainen Taru , Aronen Eeva T
Published: January 2010

Aim:  The aim of this study was to describe the child‐reported coping strategies for hospital‐related fears in 4–6‐year‐old children.

Method:  The data were collected by semi‐structured interviews of 4–6‐year‐old volunteering children (n= 82) in Finland. Thirty‐four children were interviewed in hospital, and 48 in kindergarten. The children were chosen through a purposive sampling method, in which volunteers were asked to take part in the study. The data were analysed with quantitative and qualitative methods.

Results:  The most frequent child‐reported coping strategies were: the presence of parents and other family members (81/517, 15.7%), the help of the hospital personnel (58/517, 11.2%), positive images and humour (57/517, 11%), play (57/517, 11%) and the child's own safety toy (45/517, 8.7%). The children interviewed in hospital mentioned significantly more often play (P= 0.000) as their coping strategy than children interviewed in a kindergarten. Children interviewed in kindergarten expressed significantly more often the presence of parents (P= 0.032) and the help of the doctor (P= 0.012) as their coping strategy than the children interviewed in the hospital.

Conclusions:  The results showed that children have many coping strategies, especially ones in which the children themselves play an active role. Besides, the traditional methods for alleviating fear, children need possibilities to use coping methods in which they have an active role giving them a feeling of some control over the hospital environment and medical procedures.
Breast milk macro‐ and micronutrient composition in lactating mothers from suburban and urban Shanghai
Authors: Qian Jihong , Chen Tongxin , Lu Weiming , Wu Shengmei , Zhu Jianxing
Published: January 2010

Aim:  The objective of this study was to measure and compare the macro‐ and micronutrient composition of breast milk in urban and suburban lactating mothers living in Shanghai, China.

Methods:  Primiparous women residing in three urban regions (n= 30/region) and a suburban area of Shanghai (n= 30) were recruited. Breast milk samples were collected 8–10 days postpartum and dietary intake was determined.

Results:  Women from the suburban area were of lower socio‐economic status as indicated by levels of education, occupation and income. With the exception of carbohydrates, mothers in all urban areas had significantly higher macronutrient intake levels than suburban area mothers. Sodium, potassium, phosphorus and calcium intake levels were significantly lower in suburban compared to all urban women. Concentrations of protein, lipids, copper, sodium, potassium, chlorine, zinc, manganese, phosphorus and iron were all significantly lower in milk obtained from suburban compared to urban women. Concentrations of carbohydrates in milk from suburban women were significantly higher than concentrations in than two of the three urban groups. Offspring from women in Chongming county gained significantly less weight between birth and 6 months than did offspring born to women from the three other counties.

Conclusions:  In summary, there were significant differences in macro‐ and micronutrient intake levels and breast milk concentrations between women from urban and suburban Shanghai. These differences may have important implications for the growth and development of breastfed infants.
Physical activity in survivors of childhood acute lymphoblastic leukaemia
Authors: Heath John A , Ramzy John M , Donath Susan M
Published: January 2010

Aim:  To objectively measure levels of physical activity in children, following treatment for acute lymphoblastic leukaemia (ALL).

Methods:  Nineteen children who had completed treatment for ALL 6 months–5 years prior to study enrolment wore an accelerometer for 2 weekdays and 2 weekend days.

Results:  The children spent an average of 141 ± 74 min/day engaged in moderate to vigorous physical activity (MVPA), an amount similar to that previously documented in healthy children. Only three of the 19 subjects averaged less MVPA than the recommended amount (at least 60 min/day). MVPA levels were significantly higher on weekdays than weekend days (P= 0.006). Overall, boys engaged in significantly more MVPA than girls (P= 0.029). MVPA time was negatively correlated with age (r =−0.80) and age at diagnosis (r =−0.87). No trend between MVPA and time off treatment or body mass index was identified.

Conclusions:  Survivors of childhood ALL appear to be engaging in similar amounts of MVPA as those of the healthy children and are meeting recommended levels of physical activity.
Internal jugular vein deformities after central venous catheterisation in neonates: Evaluation by Doppler ultrasound
Authors: Kim Myung Joon , Chang Hye Kyung , Lee Mu Sook , Han Seok Joo , Oh Jung‐Tak
Published: January 2010

Aim:  The use of a central venous catheter (CVC) through the internal jugular vein (IJV) in neonates is associated with various complications. We postulated that the risk of vein deformity after removing the CVC is underestimated. This study aimed to evaluate, using Doppler ultrasound, morphological changes in the IJV that had undergone CVC insertion during the neonatal period.

Methods:  The study consisted of 23 cases, in which 2.7 Fr Broviac (Bard Access Systems, Salt Lake City, Utah, USA) CVCs were inserted through the IJVs of newborns over a 2‐year period. After the removal of the CVCs, the IJVs were examined by Doppler ultrasound.

Results:  Seventeen cases had normal appearances, but six (26%) cases had deformities. One case had a completely obstructed IJV, and five had abnormal compressibility, echogenic intravascular masses or monophasic waveforms of blood flow. On follow‐up, IJV deformities were not improved but tended to be aggravated. There were significant differences in gestational age (36.6 ± 3.2 weeks vs. 30.0 ± 3.9 weeks, P= 0.002), body weight at time of CVC insertion (2.60 ± 0.72 kg vs. 1.32 ± 0.47 kg, P= 0.001) and duration of catheter use (25.9 ± 13.6 days vs. 49.0 ± 22.0 days, P= 0.016) between the normal and deformity groups, respectively.

Conclusions:  IJV deformities after central venous catheterisation in neonates are common. A lower gestational age, a lower body weight, and more catheter indwelling days are significant factors affecting the incidence of IJV deformities.
Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China
Authors: Xin Ying , Yang Min , Chen Xiao Juan , Tong Ya Jie , Zhang Li Hua
Published: January 2010

Aim:  To describe the clinical picture and laboratory features of Chinese children with newly diagnosed type 1 diabetes mellitus.

Methods:  The clinical and laboratory data of a total of 203 children who presented with newly diagnosed type 1 diabetes mellitus during a 5‐year period (2004–2008) were retrospectively analysed based on hospital records.

Results:  There were 88 boys (43.3%) and 115 girls (56.7%) with a median age of 8.3 years. The age distribution was categorised as 0–4 years: 52 (25.6%), 5–9 years: 57 (28.1%) and 10–14 years: 94 (46.3%). We found a peak incidence rate in the older age group. No significant seasonality was observed. The most common symptoms were polydipsia, polyuria and weight loss. Eighty‐five (41.9%) of all patients presented with diabetic ketoacidosis (DKA). The average duration of presenting symptoms before the hospital encounter was 24.5 days. Young age group children had shorter duration (17.1 days, P= 0.03) and significantly lower levels of C‐peptide (P= 0.003) and haemoglobin A1c (P= 0.049) than the other groups. Children with DKA had a higher incidence of preceding infections (P= 0.032), lower free triiodothyronine and free thyroxine levels (P= 0.035, 0.046), and higher white blood cell counts (P= 0.000) than the non‐DKA group.

Conclusion:  The duration between the onset of the symptoms and diagnosis was long, and the proportion of DKA in children with newly diagnosed diabetes mellitus was high. These findings call for a collaborative effort for the early recognition of symptoms by patients and physicians in order to avoid more severe types of presentation.
Evidenced‐based clinical practice guideline for management of newborn pain
Authors: Spence Kaye , Henderson‐Smart David , New Karen , Evans Cheryl , Whitelaw Jan , Woolnough Rowena ,   Australian and New Zealand Neonatal Network
Published: January 2010

Aim:  To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.

Method:  An audit of practice and an appraisal of clinical practice guidelines were undertaken to establish current practices and guideline availability for the management of newborn pain in 23 hospitals in Australia. Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation instrument. A literature search was undertaken to acquire the evidence for best practice for management of newborn pain.

Results:  Neonatal units in 17 hospitals had clinical practice guidelines. Each was peer reviewed and assessed according to the domains of the Appraisal of Guidelines for Research and Evaluation instrument. There was lack of consistency across the guidelines. As a result, a best practice guideline was developed based on current best evidence and the Royal Australian College of Physicians recommendations. To facilitate an ongoing compliance with the guideline, an audit tool was included together with algorithms for procedural pain and pain assessment.

Conclusion:  The clinical practice guideline can be used by clinicians in varying settings such as the neonatal intensive care and special care unit. The document can be used to support existing practices or challenge clinicians to close the evidence practice gap for the management of newborn pain.
Lipoastrocytoma: Case report and review of the literature
Authors: Gheri Chiara Francesca , Buccoliero Anna Maria , Pansini Gastone , Castiglione Francesca , Garbini Francesca , Moncini Daniela , Maccari Cecilia , Mennonna Pasquale , Pellicanò Gianni , Ammannati Franco , Taddei Gian Luigi
Published: January 2010

Lipoastrocytoma is an extremely rare tumor, with only six cases described. We report the case of an astrocytoma involving the upper part of the cerebellar‐pontine angle and the right portion of the clivus starting from the brainstem with a diffuse lipomatous component in a 39 year‐old man. The patient was admitted with headache of 1 year's duration and diplopia over the previous 3 months. MRI revealed a ponto‐cerebellar lesion that showed irregular enhancement after contrast administration. Subtotal excision of the tumor was accomplished. Adjuvant chemotherapy and radiation therapy were not administered. Histologically the tumor showed the classical histology of low‐grade astrocytoma and a portion of the lesion was composed of lipid‐laden cells. Immunohistochemistry for glial fibrillary acid and S‐100 proteins clearly demonstrated the glial nature of these cells. Ki‐67/Mib‐1 labeling index was low (2%). The patient remains in good neurological conditions after 10 months. Our case has a benign postoperative behavior, also after subtotal excision, with restrictions due to the short follow‐up. It is important to record each new case of this rare tumor to produce a better characterization of this lesion.
A bench test to confirm the core features of volume‐assured non‐invasive ventilation
Authors: OSCROFT Nicholas S. , SMITH Ian E.
Published: January 2010

Background and objective:  Volume‐assured non‐invasive positive pressure ventilation (va‐NIPPV) is a novel mode designed to adapt pressure support (PS) to achieve a target minute ventilation (TgV). This may optimize ventilation; however, no data confirm that va‐NIPPV compensates appropriately for the changes in pulmonary mechanics and circuit leak seen in clinical practice. Bench testing assessed these principles.

Methods:  A ventilator featuring a va‐NIPPV mode was studied. A test lung with varying compliance and resistance, and pneumotachograph were used. Eight lung model settings were chosen: (i) low resistance and high compliance; (ii) low resistance and low compliance; (iii) high resistance and high compliance; and (iv) high resistance and low compliance, all with and without additional circuit leak. An expiration valve, respiratory rate of 15, inspiratory time of 1 s and PS between 3 and 21 cm H2O were used. Va‐NIPPV was tested with varying TgV after establishing the range of minute ventilation possible in a pressure preset mode.

Results:  At a TgV of 10 L/min, va‐NIPPV delivered minute ventilation of (median (interquartile range) ): 11 (10.9–11, 10.2 (10.2–10.3), 12.4 (12.4–12.4) and 11.2 (10.9–11.2) L/min in test lung settings 1, 2, 3 and 4, respectively. Additional leak between 8–33 L/min had little effect. Similar results were seen at other TgV, within the ventilator's PS capabilities.

Conclusions:  These data confirm that va‐NIPPV is able to approximate a preset TgV with varying lung compliance and resistance, and that additional circuit leak has little effect on the delivered minute ventilation.
Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS)
Authors: NG Susanna S.S. , CHAN Tat‐On , TO Kin‐Wang , NGAI Jenny , TUNG Alvin , KO Fanny W.S. , HUI David S.C.
Published: January 2010

Background and objectives:  This study aimed to evaluate the diagnostic accuracy of Embletta portable diagnostic system (PDS, Medcare, Reykjavik, Iceland) for the screening of sleep apnoea in clinical practice.

Methods:  The Embletta PDS is a digital three‐channel recording device that measures airflow through a nasal cannula connected to a pressure transducer, oxygen saturation plus both respiratory and abdominal movements via built‐in effort and body position sensors. An AHI is determined based on recording time. Nocturnal polysomnography (Alice 4, Healthdyne, Atlanta, USA), with airflow measured by a nasal pressure transducer (PTAF2, Pro‐Tech, Woodinville, WA, USA)) and Embletta PDS recordings, was performed simultaneously in consecutive patients with suspected OSA syndrome. The PSG recordings were analysed manually by a blinded investigator.

Results:  Ninety subjects were recruited and 10 failed Embletta PDS studies due to measurement failure. Among the remaining 80 subjects, 63 were males. The mean age (SD) was 51.4 (11.9) years old, BMI 27.1(4.2) kg/m2, neck circumference 38.6 (3.6) cm and Epworth Sleepiness Score 9.7 (5.3). The AHI obtained by the Embletta PDS correlated closely with that obtained by PSG (Pearson correlation, r = 0.979, P < 0.001). Comparison of AHI based on the Embletta PDS against the PSG demonstrated high sensitivity at AHI ≥ 5/h (sensitivity 0.924 and specificity 0.857) and high specificity at AHI ≥ 20/h (sensitivity 0.853 and specificity 0.957).

Conclusions:  The Embletta PDS is a highly sensitive and specific screening device in quantifying AHI when compared against PSG in patients with suspected OSA syndrome.
Asthma: Time to confront some inconvenient truths
Authors: HANCOX Robert J. , LE SOUËF Peter N. , ANDERSON Gary P. , REDDEL Helen K. , CHANG Anne B. , BEASLEY Richard
Published: January 2010

Despite major advances in the understanding of the pathogenesis of asthma and improvements in management, the accompanying benefits from public health initiatives and clinical practice have arguably been less than expected. For example, there are no effective public health strategies or treatment regimes that reduce the risk of developing asthma or influence its natural history. These represent priority areas for future translational research, which would need to investigate genetic and environmental interactions and vaccine strategies. In terms of asthma management it is tempting to focus on novel drug therapies; however, a case can be made that the priority is to undertake research that leads to improvements in the use of existing treatments through public health and primary care initiatives. Guidelines represent an important component of this approach, with recommendations for asthma imbedded within respiratory guidelines that can be implemented in the developing world where other acute and chronic respiratory disorders are common. This approach offers the best opportunity to close the gap between what is currently achieved in asthma management and that which is potentially achievable.
Celiac disease prevalence in children and adolescents with type 1 diabetes from Serbia
Authors: Djurić Zlatko , Stamenković Hristina , Stanković Tatjana , Milićević Radovan , Branković Ljiljana , Ćirić Vesna , Katić Vuka
Published: January 2010

Background:  The association between celiac disease (CD) and type 1 diabetes mellitus (T1DM) is well known. Up to now, CD prevalence in children and adolescents with T1DM in Serbia has not been reported. The aim of the present study was to determine CD prevalence and its clinical manifestations in patients with T1DM.

Methods:  One hundred and twenty‐one patients (70 girls, 51 boys; mean age, 10.8 years) with T1DM (mean duration of diabetes, 3.4 years) and 125 control group participants (75 girls, 50 boys; mean age, 10.4 years) were tested for CD on tissue transglutaminase antibodies (tTG). In seven serologically positive T1DM patients endoscopic small bowel biopsies were taken and examined on histopathology. In all patients with CD and T1DM age, duration of T1DM, height for age, body mass index, glycosylated hemoglobin and clinical symptoms were noted.

Results:  Nine patients with T1DM were positive on IgA tTG antibodies. In seven of them small bowel biopsy was performed, and all were proven to have CD on histopathology. The prevalence of biopsy‐proven CD in children and adolescents with T1DM was significantly higher in the study group compared to controls (5.79%. vs 0.8%, P < 0.05).

Conclusion:  The significantly higher prevalence of CD in children with type 1 diabetes, in accordance with the large volume of data published in the literature, underlines the need for yearly screening of CD in patients with diabetes in order to promptly start a gluten‐free diet when appropriate.
Urinary N‐telopeptides of type I collagen in healthy children
Authors: Sato Jun , Hasegawa Kosei , Tanaka Hiroyuki , Morishima Tsuneo
Published: January 2010

Background:  Urinary N‐telopeptides of type I collagen (NTx) is a specific marker of bone resorption. The NTx levels of children have been reported to be higher than in adults, but such reports are limited. The aim of the present study was to measure the urine NTx of healthy children to define reference values, and study the circadian rhythm of urine NTx excretion between the first and second voided urines.

Methods:  Three hundred and sixty‐two healthy Japanese children (209 boys and 153 girls; age range, 6–11 years) served as subjects to study age‐related changes in NTx. Urine samples were collected as the first voided specimen of the day. To evaluate the circadian variation, we measured the excretion of urinary NTx of the first and second voided urine specimens in 30 healthy Japanese children (15 boys and 15 girls), 6–12 years of age. Urine NTx was measured on enzyme‐linked immunosorbent assay (ELISA).

Results:  Urinary NTx levels were higher in children of both genders than in healthy adults. In boys, the urinary NTx levels decreased with age. In girls, the urinary NTx levels decreased with age between 6 and 9 years of age, but increased between 9 and 10 years of age. NTx of the first voided urine specimen was significantly higher than the second voided urine specimen. Moreover, a significant linear relationship between the first voided urine and the second void urine existed in both genders.

Conclusions:  Urinary NTx levels in children are higher than in adults. The urine NTx of the first voided urine specimen may be a good marker of bone resorption for children.
Diagnosis of infectious mononucleosis caused by Epstein–Barr virus in infants
Authors: Dohno Sumitaka , Maeda Akihiko , Ishiura Yoshihito , Sato Tetsuya , Fujieda Mikiya , Wakiguchi Hiroshi
Published: January 2010

Background:  The diagnosis of infectious mononucleosis (IM) is usually on serologic tests. The responses of anti‐Epstein–Barr virus (anti‐EBV) antibodies are weak in infants. The authors encountered some IM infants in whom anti‐EBV antibodies were undetectable during early stage, although EBV genome was found in their blood. The aim of the present study was therefore to clarify the frequency of anti‐EBV‐antibody negative IM cases.

Methods:  The EBV serostatus of 104 IM children diagnosed on Sumaya criteria was retrospectively studied. The EBV genome in peripheral blood mononuclear cells was measured.

Results:  The anti‐viral capsid antigen‐IgM (anti‐VCA‐IgM)‐positive rate in the acute phase was only 25% in infants but 80% in patients ≥4 years of age. Twenty percent of the infants were negative for all anti‐EBV antibodies and required repeated serologic tests. For infants, the significant rise in anti‐VCA‐IgG was the most sensitive marker. Three seronegative infants with IM symptoms, with circulating EBV genome during acute phase, were eventually considered as having IM on anti‐VCA‐IgG seroconversion thereafter.

Conclusions:  To diagnose IM in infants the serologic test alone in the acute phase is not sensitive enough. It is proposed that the EBV genome be evaluated in peripheral blood mononuclear cells when infants presenting with IM symptoms are negative for anti‐EBV antibodies during the acute phase.
Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006
Authors: Lin Yahui T. , Manlhiot Cedric , Ching Joyce C.Y. , Han Ra K. , Nield Lynne E. , Dillenburg Rejane , Pepelassis Dion , Lai Lillian S. , Smythe John F. , Chahal Nita , Yeung Rae S.M. , McCrindle Brian W.
Published: January 2010

Background:  Rising incidences of Kawasaki disease (KD) have been reported worldwide. Reported herein are the results of 4 triennial KD surveillances conducted in Ontario.

Methods:  Between 1995 and 2006 all hospitals in Ontario were asked on 4 occasions to identify all patients with discharge diagnoses of KD and report incident cases.

Results:  The latest surveillance identified 697 new KD patients (100% response rate) for a total of 2378 KD patients through all 4 surveillances. Yearly incidence was 26.2/100 000 for <5 years old, 6.7/100 000 for 5–9 years old and 0.9/100 000 for 10–14 years old. KD incidence significantly increased from 1995 to 2006, although the increase seemed to plateau between the 3rd and 4th surveillance. There was an increase in the proportion of patients diagnosed with incomplete KD and a significant reduction in the rate of coronary artery abnormalities, possibly due to better disease recognition and treatment. Hospitals reporting <20 cases per surveillance were found to be more likely to report cases with incomplete KD. These patients were also less likely to be treated with i.v. immunoglobulin and aspirin but were more likely to be treated with antibiotics, suggesting uncertainties regarding diagnosis and management of KD patients in those centers.

Conclusions:  The incidence of KD in Ontario is possibly one of the highest outside of Asia and has been rising since 1995. Although the most recent surveillance demonstrated improved cardiac outcomes, treatment delays or absence thereof continue to be a problem. Effective diagnosis and prompt treatment remain critical aspects of KD management.