bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial Infarction in Healthy Adolescents
Authors: Lane John R. , Ben-Shachar Giora
Published: October 2007

OBJECTIVE. Chest pain in children and adolescents is a frequent cause for office or emergency department visits. However, it is unclear whether myocardial infarction occurs in children with no anatomic abnormality presenting with chest pain.

METHODS. Clinical history, electrocardiography, echocardiography, and cardiac enzyme levels were evaluated in patients presenting to the emergency department over a period of 11 years (June 1995 to May 2006). Patients in whom findings were suggestive of acute myocardial infarction, in addition, underwent drug screening, serum lipid profile, and hypercoagulability workup and, when myocardial infarction was diagnosed, heart catheterization with coronary angiography.

RESULTS. Nine patients (8 boys; age range: 12–20 years; mean: 15.5 years) met established criteria for myocardial infarction. Abnormal electrocardiograms were found in 8 patients (6 with ST elevation and 2 with nonspecific ST-T abnormalities), abnormal cardiac enzyme levels in all, and echocardiographic abnormalities in 3. Cardiac dysrhythmias were found in 4 patients, 3 with nonsustained ventricular tachycardia. Drug abuse, lipid profile, and hypercoagulability studies were negative in all. Left ventricular focal hypokinesia was seen by echocardiogram or angiography in 5 patients and abnormal coronary anatomy in none. Cardiac function normalized in 8 patients. One patient had a persistent focal inferior hypokinesis. Calcium channel blocker therapy was initiated in all of the patients with no recurrence of anginal chest pain on follow-up. One patient complained of chest pain distinct from anginal pain.

CONCLUSIONS. Myocardial infarction can occur in adolescents with normal coronary arterial anatomy. Adolescents who present for emergency care with typical chest pain need electrocardiographic and cardiac enzyme workups. Those with results that are suggestive of acute infarction require additional workup. Coronary vasodilation therapy seems helpful, but given the lack of coronary thrombosis in these patients, thrombolytic therapy seems unwarranted. Long-term follow-up is necessary, and adjustments in therapy may be required with time.
Persistent Beneficial Effects of Breast Milk Ingested in the Neonatal Intensive Care Unit on Outcomes of Extremely Low Birth Weight Infants at 30 Months of Age
Authors: Vohr Betty R. , Poindexter Brenda B. , Dusick Anna M. , McKinley Leslie T. , Higgins Rosemary D. , Langer John C. , Poole W. Kenneth ,   for the National Institute of Child Health and Human Development National Research Network
Published: October 2007

BACKGROUND. We previously reported beneficial effects of breast milk ingestion by infants with extremely low birth weight in the NICU on developmental outcomes at 18 months’ corrected age. The objective of this study was to determine whether these effects of breast milk in infants with extremely low birth weight persisted at 30 months’ corrected age.

METHODS. Nutrition data, including enteral and parenteral feeds, were prospectively collected, and 30 months’ corrected age follow-up assessments were completed on 773 infants with extremely low birth weight who participated in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial. A total of 593 ingested some breast milk during the neonatal hospitalization, and 180 ingested none. Neonatal feeding characteristics and morbidities and 30-month interim history, neurodevelopmental outcomes, and growth parameters were analyzed. Children were divided into quintiles of breast milk volume to evaluate the effects of volume of human milk ingested during the NICU hospitalization.

RESULTS. At 30 months, increased ingestion of breast milk was associated with higher Bayley Mental Developmental Index scores, higher Bayley behavior score percentiles for emotional regulation, and fewer rehospitalizations between discharge and 30 months. There were no differences in growth parameters or cerebral palsy. For every 10 mL/kg per day increase in breast milk, the Mental Developmental Index increased by 0.59 points, the Psychomotor Developmental Index by 0.56 points, and the total behavior percentile score by 0.99 points, and the risk of rehospitalization between discharge and 30 months decreased by 5%.

CONCLUSIONS. Beneficial effects of ingestion of breast milk in the NICU persist at 30 months’ corrected age in this vulnerable extremely low birth weight population. Continued efforts must be made to offer breast milk to all extremely low birth weight infants both in the NICU and after discharge.
Determinants of Child-Parent Agreement in Quality-of-Life Reports: A European Study of Children With Cerebral Palsy
Authors: White-Koning Melanie , Arnaud Catherine , Dickinson Heather O. , Thyen Ute , Beckung Eva , Fauconnier Jerome , McManus Vicki , Michelsen Susan I. , Parkes Jackie , Parkinson Kathryn , Schirripa Giorgio , Colver Allan
Published: October 2007

OBJECTIVES. The differences between child self-reports and parent proxy reports of quality of life in a large population of children with cerebral palsy were studied. We examined whether child characteristics, severity of impairment, socioeconomic factors, and parental stress were associated with parent proxy reports being respectively higher or lower than child self-reports of quality of life.

METHODS. This study was conducted in 2004–2005 and assessed child quality of life (using the Kidscreen questionnaire, 10 domains, each scored 0–100) through self-reports and parent proxy reports of 500 children aged 8 to 12 years who had cerebral palsy and were living in 7 countries in Europe.

RESULTS. The mean child-reported scores of quality of life were significantly higher than the parent proxy reports in 8 domains, significantly lower for the finances domain, and similar for the emotions domain. The average frequency of disagreement (child-parent difference greater than half an SD of child scores) over all domains was 64%, with parents rating their child's quality of life lower than the children themselves in 29% to 57% of child-parent pairs. We found that high levels of stress in parenting negatively influenced parents’ perception of their child's quality of life, whereas the main factor explaining parents’ ratings of children's quality of life higher than the children themselves is self-reported severe child pain.

CONCLUSIONS. This study shows that the factors associated with disagreement are different according to the direction of disagreement. In particular, parental well-being and child pain should be taken into account in the interpretation of parent proxy reports, especially when no child self-report of quality of life is available. In the latter cases, it may be advisable to obtain additional proxy reports (from caregivers, teachers, or clinicians) to obtain complementary information on the child's quality of life.
Lumbar Puncture Success Rate Is Not Influenced by Family-Member Presence
Authors: Nigrovic Lise E. , McQueen Alisa A. , Neuman Mark I.
Published: October 2007

OVERVIEW. The presence of a family member during invasive pediatric procedures such as lumbar puncture has been shown to reduce patient anxiety. However, family presence might also affect clinicians’ stress and anxiety, with uncertain consequences for procedural success.

OBJECTIVE. Our goal was to evaluate the association between family-member presence and lumbar puncture success rates.

DESIGN/METHODS. We performed a prospective cohort study of all children who underwent a lumbar puncture in a single pediatric emergency department between July 2003 and January 2005. The presence of a family member was documented by the physician who performed the lumbar puncture. Success rates were assessed by using 2 main outcomes: (1) the rate of traumatic (cerebrospinal fluid red blood cells ≥ 10000 cells per μL) or unsuccessful lumbar puncture (no cerebrospinal fluid sent for cell counts) and (2) the number of lumbar puncture attempts. Multivariate analyses were adjusted for patient age, race, time of day, physician experience, use of local anesthetic, catheter stylet removal, and patient movement during the procedure.

RESULTS. Of the 1474 eligible lumbar punctures, 1459 (99%) were included in the analysis. A family member was present for 1178 (81%) of the procedures studied. A total of 1267 (87%) lumbar punctures were nontraumatic, and 192 (13%) were traumatic or unsuccessful. Neither the rate of traumatic or unobtainable lumbar punctures nor the number of lumbar puncture attempts differed based on whether a family member was present for the procedure.

CONCLUSIONS. The presence of a family member was not associated with an increased risk of traumatic or unobtainable lumbar puncture, nor was it associated with more attempts at the procedure. The benefits of having a family member present during the procedure were not counterbalanced by adverse effects on procedural success.
Trends in Pediatric Organ Donation After Cardiac Death
Authors: Mazor Robert , Baden Harris P.
Published: October 2007

OBJECTIVE. Organ donation after cardiac death is viewed as one way of partially closing the current gap between organ supply and demand. There are no published guidelines for organ donation after cardiac death specific to the pediatric population. The objective of this study was to examine the cumulative pediatric donation-after-cardiac-death experience to set the context for the development and sharing of best-practice guidelines.

PATIENTS AND METHODS. This was a retrospective, descriptive study that used data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database from 1993 to 2005. Organ data from all donors after cardiac death who were <18 years of age were analyzed. The list of donor medical centers was then cross-referenced with the member list from the National Association of Children's Hospitals and Related Institutions.

RESULTS. There were 683 organs from donation-after-cardiac-death donors <18 years of age. Of those, <5% were used for pediatric recipients. In comparison, ∼20% of non–donation-after-cardiac-death organs from pediatric donors were used for pediatric recipients. The vast majority of donation-after-cardiac-death organs donated were kidneys and livers. More than 50% of medical centers that had a pediatric organ-donation-after-cardiac-death donor had just 1. The medical center with the largest pediatric organ-donation-after-cardiac-death donation experience had 14 donors. Forty-three percent of medical centers that had ≥1 pediatric donation-after-cardiac-death donor were members of the National Association of Children's Hospitals and Related Institutions. Fifty-six percent of all of the pediatric donation-after-cardiac-death organs were donated from the National Association of Children's Hospitals and Related Institution member centers.

CONCLUSIONS. Data regarding the use of pediatric donation-after-cardiac-death organs for pediatric recipients remain sparse. Few medical centers have had enough donation-after-cardiac-death donor experience to report a tried-and-true approach. We advocate for comprehensive collection and reporting of outcome data for all-aged recipients of pediatric donation-after-cardiac-death organs to help facilitate the generation of evidence-based best-practice guidelines for pediatric donation after cardiac death.
Children's Television Exposure and Behavioral and Social Outcomes at 5.5 Years: Does Timing of Exposure Matter?
Authors: Mistry Kamila B. , Minkovitz Cynthia S. , Strobino Donna M. , Borzekowski Dina L.G.
Published: October 2007

BACKGROUND. The American Academy of Pediatrics recommends children ≥2 years of age limit daily media exposure to ≤1 to 2 hours and not have a television set in children's bedrooms. However, there are limited prospective studies to address how timing of media exposure influences children's health.

OBJECTIVE. Our goal was to examine relations among children's early, concurrent, and sustained television exposure and behavioral and social skills outcomes at 5.5 years.

METHODS. We analyzed data collected prospectively from the Healthy Steps for Young Children national evaluation. Television exposure was defined as >2 hours of daily use (at 30–33 months and 5.5 years) and television in child's bedroom (at 5.5 years). At 5.5 years, outcomes were assessed by using the Child Behavior Checklist and social skills using the Social Skills Rating System. Linear regression was used to estimate the effect of television exposure on behavioral and social skills outcomes.

RESULTS. Sixteen percent of parents reported that their child watched >2 hours of television daily at 30 to 33 months only, 15% reported >2 hours of television daily at 5.5 years only, and 20% reported >2 hours of television daily at both times. Forty-one percent of the children had televisions in their bedrooms at 5.5 years. In adjusted analyses, sustained television viewing was associated with behavioral outcomes. Concurrent television exposure was associated with fewer social skills. For children with heavy television viewing only in early childhood, there was no consistent relation with behavioral or social skills outcomes. Having a television in the bedroom was associated with sleep problems and less emotional reactivity at 5.5 years but was not associated with social skills.

CONCLUSIONS. Sustained exposure is a risk factor for behavioral problems, whereas early exposure that is subsequently reduced presents no additional risk. For social skills, concurrent exposure was more important than sustained or early exposure. Considering the timing of media exposure is vital for understanding the consequences of early experiences and informing prevention strategies.
Parent Presence During Complex Invasive Procedures and Cardiopulmonary Resuscitation: A Systematic Review of the Literature
Authors: Dingeman R. Scott , Mitchell Elizabeth A. , Meyer Elaine C. , Curley Martha A.Q.
Published: October 2007

We conducted a systematic review of the literature on parent presence during complex invasive pediatric procedures and/or resuscitation. We identified 15 studies that met our inclusion criteria. All studies were summarized chronologically according to level of evidence. The studies all demonstrated that parents prefer to have the choice about whether they remain at their child's side during complex invasive procedures and resuscitation, but they also revealed that apprehensions and controversy abound among clinicians regarding this practice. Despite the endorsements of the American Academy of Pediatrics and the Society of Critical Care Medicine and the recommendations of the American Heart Association, few pediatric institutions have drafted guidelines, conducted clinical education, or committed sufficient staff resources to fully support this practice. We present this review not only to illustrate the various perspectives of parents/guardians, clinicians, and pediatric patients themselves that have been reported to date but also to encourage more research so that the practice can be performed safely and benefit parents, their children, and clinicians alike.
Contribution of Inherited Heart Disease to Sudden Cardiac Death in Childhood
Authors: Hofman Nynke , Tan Hanno L. , Clur Sally-Ann , Alders Mariel , van Langen Irene M. , Wilde Arthur A. M.
Published: October 2007

BACKGROUND. In children aged 1 to 18 years, the causes of sudden cardiac death may remain unresolved when autopsy results are negative. Because inherited cardiac diseases are likely, cardiologic and genetic investigations of relatives may still yield the diagnosis in these cases. Moreover, these investigations provide timely identification of relatives who are also at risk of sudden cardiac death. We aimed to establish the cause of sudden cardiac death in the children of whom the family was referred to our cardiogenetics department and the diagnostic yield of these investigations.

METHODS AND RESULTS. We genetically counseled 25 consecutive, unrelated families after sudden cardiac death of a child (aged 1 to 18 years) who was disease-free during lifetime and in whose family there was no known inherited heart disease. We performed cardiac investigation (electrocardiography, exercise testing, and echocardiography) of first-degree and second-degree relatives and performed diagnosis-directed DNA analysis. Autopsy was performed in 20 case subjects. A diagnosis was identified in 14 of 25 families. In addition, we studied 10 children after aborted sudden cardiac death; in 6 of them, a diagnosis was made. Overall, in 17 of the 19 families in whom an inherited disease was diagnosed, a disease-causing mutation in either a first-degree relative or the index patient confirmed the diagnosis.

CONCLUSIONS. Sudden cardiac death in children seems to be caused often by inherited cardiac diseases. Cardiac and genetic examination of relatives combined, if possible, with postmortem analysis after sudden cardiac death of a child has a high diagnostic yield (14 of 25), comparable to analysis in surviving victims of sudden cardiac death (6 of 10). Because sudden cardiac death can be prevented by timely treatment, these results warrant active family screening after unexplained sudden cardiac death of a child.
A Geographical Comparison of Prevalence of Overweight School-aged Children: The National Survey of Children's Health 2003
Authors: Tudor-Locke Catrine , Kronenfeld Jennie J. , Kim Sam S. , Benin Mary , Kuby Michael
Published: October 2007

OBJECTIVES. This study presents a geographical comparison of state-specific prevalence estimates of children who are at risk of overweight and/or overweight using the 2003 National Survey of Children's Health.

METHODS. Using the 2003 National Survey of Children's Health, we computed prevalence estimates of children who are at risk of overweight and/or overweight among a nationally representative sample of 69000 children between 5 and 17 years old.

RESULTS. Overall, 36.4% of the children (39.8% of the boys and 32% of the girls) in the sample were in the combined category of at risk of overweight or overweight, representing an estimated 17 million US children. We found geographic variation at the state and the regional levels. The southeastern states, especially those west of the Appalachians and in the lower Mississippi region, had the highest prevalence of children who are at risk of overweight and/or overweight. The central Rocky Mountain states of Colorado, Utah, and Wyoming had the lowest prevalence, followed by the northwestern quadrant of the lower 48 states and New England.

CONCLUSIONS. These National Survey of Children's Health data provide clinicians and public health professionals with useful data required for policy and planning related to childhood obesity at state levels. These data also serve as important baseline indicators and can be used to track changes over time.
Neurodevelopmental Outcome in Survivors of Periventricular Hemorrhagic Infarction
Authors: Bassan Haim , Limperopoulos Catherine , Visconti Karen , Mayer D. Luisa , Feldman Henry A. , Avery Lauren , Benson Carol B. , Stewart Jane , Ringer Steven A. , Soul Janet S. , Volpe Joseph J. , du Plessis Adré J.
Published: October 2007

OBJECTIVES. Periventricular hemorrhagic infarction is a serious complication of germinal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricular hemorrhagic infarction survivors and identify early cranial ultrasound predictors of adverse outcome.

METHODS. We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a cranial ultrasound–based periventricular hemorrhagic infarction severity score (range: 0–3) on the basis of whether periventricular hemorrhagic infarction (1) involved ≥2 territories, (2) was bilateral, or (3) caused midline shift. We then performed neuromotor, visual function, and developmental evaluations (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale). Developmental scores below 2 SD from the mean were defined as abnormal.

RESULTS. Median adjusted age at evaluation was 30 months (range: 12–66 months). Eighteen subjects (60%) had abnormal muscle tone, and 7 (26%) had visual field defects. Developmental delays involved gross motor (22 [73%]), fine motor (17 [59%]), visual receptive (13 [46%]), expressive language (11 [38%]), and cognitive (14 [50%]) domains. Impairment in daily living and socialization was documented in 10 (33%) and 6 (20%) infants, respectively. Higher cranial ultrasound–based periventricular hemorrhagic infarction severity scores predicted microcephaly and abnormalities in gross motor, visual receptive, and cognitive function.

CONCLUSIONS. In the current era, two thirds of periventricular hemorrhagic infarction survivors develop significant cognitive and/or motor abnormalities, whereas adaptive skills are relatively spared. Higher cranial ultrasound–based periventricular hemorrhagic infarction severity scores predict worse outcome in several modalities and may prove to be a valuable tool for prognostication.
Impact of Clinical Alerts Within an Electronic Health Record on Routine Childhood Immunization in an Urban Pediatric Population
Authors: Fiks Alexander G. , Grundmeier Robert W. , Biggs Lisa M. , Localio A. Russell , Alessandrini Evaline A.
Published: October 2007

OBJECTIVES. The objective of this study was to test the hypothesis that clinical alerts for routine pediatric vaccinations within an electronic health record would reduce missed opportunities for vaccination and improve immunization rates for young children in an inner-city population.

METHODS. A 1-year intervention study (September 1, 2004, to August 31, 2005) with historical controls was conducted in 4 urban primary care centers affiliated with an academic medical center. All children who were younger than 24 months were enrolled. Electronic health record–based clinical reminders for routine childhood vaccinations were programmed to appear prominently at every patient encounter with vaccines due. The main outcome measures were rates of captured immunization opportunities and overall immunization rates at 24 months of age.

RESULTS. Immunization alerts appeared at 15928 visits during the intervention. Alert implementation was associated with increases in captured immunization opportunities from 78.2% to 90.3% at well visits and from 11.3% to 32.0% at sick visits. Adjusted up-to-date immunization rates at 24 months of age increased from 81.7% to 90.1% from the control to intervention period. Children in the intervention group also became up-to-date earlier than control patients. Patient characteristics were stable throughout the study.

CONCLUSIONS. An electronic health record–based clinical alert intervention was associated with increases in captured opportunities for vaccination at both sick and well visits and significant improvements in immunization rates at 2 years of age. As electronic health records become more common in medical practice, such systems may transform immunization delivery to children.
Childhood Overweight Increases Hospital Admission Rates for Asthma
Authors: Carroll Christopher L. , Stoltz Petronella , Raykov Neviana , Smith Sharon R. , Zucker Aaron R.
Published: October 2007

OBJECTIVES. Although childhood overweight has been associated with increased hospital lengths of stay for patients with asthma, the possible relationship between overweight and hospital admission for asthma has not been well studied. We hypothesized that overweight children who presented to the emergency department with asthma exacerbations were more likely to be admitted to the hospital than nonoverweight children.

METHODS. A retrospective chart review was conducted of all children who were older than 2 years and presented to the emergency department with an asthma exacerbation in calendar year 2005. Children with chronic medical conditions other than asthma were excluded. Children were classified as nonoverweight (≤95% weight-for-age percentile) or overweight (>95% weight for age).

RESULTS. During the study period, there were 884 visits to the emergency department for an asthma exacerbation by 813 children; 238 (27%) were admitted to the hospital, and 33 (4%) were admitted to the ICU. Overall, hospital admission was associated with higher clinical asthma score but not with age, gender, or poverty status (as quantified as home in zip-code areas designated as “impoverished”). Overweight children (n = 202 [23%]) were significantly older (8.5 ± 4.4 vs 7.3 ± 4.3 years) and more likely to live in an impoverished area (37% vs 28%). Presenting clinical asthma score and therapeutic interventions in the emergency department were similar for overweight and nonoverweight children; however, overweight children were significantly more likely to be admitted to the hospital.

CONCLUSIONS. Overweight children who present to the emergency department with acute asthma exacerbations are significantly more likely to be admitted to the hospital than nonoverweight children. This identifies an important area in which childhood overweight has a significant impact on the health of children with asthma.
Motor and Executive Function at 6 Years of Age After Extremely Preterm Birth
Authors: Marlow Neil , Hennessy Enid M. , Bracewell Melanie A. , Wolke Dieter ,   for the EPICure Study Group
Published: October 2007

BACKGROUND. Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure.

METHODS. We studied children who were born at ≤25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement.

RESULTS. Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non–right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender.

CONCLUSIONS. Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.
Down Syndrome: A Novel Risk Factor for Respiratory Syncytial Virus Bronchiolitis— A Prospective Birth-Cohort Study
Authors: Bloemers Beatrijs L.P. , van Furth A. Marceline , Weijerman Michel E. , Gemke Reinoud J.B.J. , Broers Chantal J.M. , van den Ende Kimberly , Kimpen Jan L.L. , Strengers Jan L.M. , Bont Louis J.
Published: October 2007

OBJECTIVES. Respiratory syncytial virus is the single-most important cause of lower respiratory tract infections in children. Preterm birth and congenital heart disease are known risk factors for severe respiratory syncytial virus infections. Although Down syndrome is associated with a high risk of respiratory tract infections, little is known about the incidence of respiratory syncytial virus infections in this group. The aim of our study was to determine the incidence of respiratory syncytial virus lower respiratory tract infection–associated hospitalization among children with Down syndrome.

PATIENTS AND METHODS. We performed a retrospective observational study and a prospective nationwide birth-cohort study of children with Down syndrome. The retrospective cohort comprised 176 children with Down syndrome. A birth cohort of 219 children with Down syndrome was prospectively followed until 2 years of age. All 276 siblings of the birth cohort were used as controls.

RESULTS. Of the 395 patients with Down syndrome, 180 (45.6%) had a known risk factor for severe respiratory syncytial virus infections; 39 (9.9%) of these were hospitalized for respiratory syncytial virus lower respiratory tract infections. Two control children (0.7%) versus 9 term children with Down syndrome without congenital heart disease (7.6%) were hospitalized for respiratory syncytial virus lower respiratory tract infections. The median duration of hospitalization was 10 days; mechanical ventilation was required for 5 children (12.8%).

CONCLUSIONS. This is the first study, to our knowledge, to demonstrate that Down syndrome is a novel independent risk factor for severe respiratory syncytial virus lower respiratory tract infections. These findings should prompt studies to investigate possible mechanisms that underlie severe respiratory syncytial virus lower respiratory tract infections in children with Down syndrome. The effect of respiratory syncytial virus prophylaxis in this specific population needs to be established.
Disease Progression in Hutchinson-Gilford Progeria Syndrome: Impact on Growth and Development
Authors: Gordon Leslie B. , McCarten Kathleen M. , Giobbie-Hurder Anita , Machan Jason T. , Campbell Susan E. , Berns Scott D. , Kieran Mark W.
Published: October 2007

OBJECTIVES. Hutchinson-Gilford progeria syndrome is a rare and uniformly fatal segmental “premature aging” disease that affects a variety of organ systems. We sought to more clearly define the bone and weight abnormalities in patients with progeria as potential outcome parameters for prospective clinical trials.

PATIENTS AND METHODS. We collected and analyzed longitudinal medical information, both retrospectively and prospectively, from a total of 41 children with Hutchinson-Gilford progeria syndrome spanning 14 countries, from the Progeria Research Foundation Medical and Research Database at the Brown University Center for Gerontology.

RESULTS. In addition to a number of previously well-defined phenotypic findings in children with progeria, this study identified abnormalities in the eruption of secondary incisors lingually and palatally in the mandible and maxilla, respectively. Although bony structures appeared normal in early infancy, clavicular resorption, coxa valga, avascular necrosis of the femoral head, modeling abnormalities of long bones with slender diaphyses, flared metaphyses, and overgrown epiphyses developed. Long bones showed normal cortical thickness centrally and progressive focal demineralization peripherally. The most striking finding identified in the retrospective data set of 35 children was an average weight increase of only 0.44 kg/year, beginning at ∼24 months of age and persisting through life, with remarkable intrapatient linearity. This rate is >2 SD below normal weight gain for any corresponding age and sharply contrasts with the parabolic growth pattern for normal age- and gender-matched children. This finding was also confirmed prospectively.

CONCLUSIONS. Our analysis shows evidence of a newly identified abnormal growth pattern for children with Hutchinson-Gilford progeria syndrome. The skeletal and dental findings are suggestive of a developmental dysplasia rather than a classical aging process. The presence of decreased and linear weight gain, maintained in all of the patients after the age of 2 years, provides the ideal parameter on which altered disease status can be assessed in clinical trials.
Professionalism in Pediatrics: Statement of Principles
Authors:   Committee on Bioethics
Published: October 2007

The purpose of this statement is to delineate the concept of professionalism within the context of pediatrics and to provide a brief statement of principles to guide the behavior and professional practice of pediatricians.
Professionalism in Pediatrics
Authors: Fallat Mary E. , Glover Jacqueline ,   the Committee on Bioethics
Published: October 2007

The purpose of this report is to provide a concrete overview of the ideal standards of behavior and professional practice to which pediatricians should aspire and by which students and residents can be evaluated. Recognizing that the ideal is not always achievable in the practical sense, this document details the key components of professionalism in pediatric practice with an emphasis on core professional values for which pediatricians should strive and that will serve as a moral compass needed to provide quality care for children and their families.
Rituximab in patients with rheumatoid arthritis: systematic review
Authors: Brodszky Valentin , Czirják László , Géher Pál , Hodinka László , Kárpáti Krisztián , Péntek Márta , Poór Gyula , Szekanecz Zoltán , Gulácsi László
Published: October 2007

A rheumatoid arthritis terápiájában legújabban alkalmazott gyógyszerek a biológiai szerek. Legutóbb a B-lymphocyta-gátló rituximabot törzskönyvezték rheumatoid arthritis indikációjában. A rituximabot eddig a non-Hodgkin-lymphoma kezelésében alkalmazták. Európai és a magyar reumatológusok ajánlása szerint a rituximab rheumatoid arthritisben azoknak a betegeknek javasolható, akiknél a kórtörténetben eredménytelenség vagy toxicitás miatt sikertelen TNF-α-gátló kezelés szerepel.Célkitűzés:A rituximabkezelés klinikai hatásosságáról rheumatoid arthritisben rendelkezésre álló szakirodalom áttekintése. A rituximabkezelés hatásosságának és biztonságának értékelése.Módszer:A szerzők a MEDLINE- és Cochrane-adatbázisokban megkeresték az összes randomizált, kontrollált rituximabvizsgálatot rheumatoid arthritisben. Elvégezték az adatok metaanalízisét.Eredmények:Az irodalomkeresés során 3 randomizált kontrollált klinikai vizsgálatot azonosítottak a szerzők, amelyekben összesen 1145 beteget követtek. A TNF-α-gátló kezelésre nem reagáló, súlyos gyulladásos tüneteket mutató betegeknél rituximabkezelés mellett 33%-kal több betegnek (95%; KI: 25–41%) javulnak a tünetei az American College of Rheumatology 20 kritérium szerint, mint ha nem kezelnék őket. Majdnem 5-ször nagyobb (relatív kockázat = 4,77; 95%; KI, 3,12–7,31) esélyük van a javulásra, mint kezelés nélkül. A funkcionális állapotot jelző Health Assessment Questionnaire pontszám is szignifikánsan nagyobb mértékben (p< 0,001) javult a rituximabcsoportban (–0,4 pont), mint a kontrollcsoportban (–0,1 pont). Rituximabkezelés hatására a mérsékelt vagy jó választ adó betegek aránya 38%-kal nagyobb (95% KI, 32–44%) a rituximabkezelési ágon, mint a kontrollcsoportban, a különbség szignifikáns (p< 0,00001). A rituximab a radiológiai progressziót is javítja a TNF-α-gátló kezelésre nem reagáló betegek között.Következtetések:A rituximab új, hatásos terápiás lehetőség a rheumatoid arthritis terápiájában. A TNF-α-gátló kezelésre nem reagáló vagy azt nem toleráló betegeknél is javulás érhető el.
Our social dilemma: prison or asylum? Is the Penrose thesis valid for Hungary at the turn of the millennium?
Authors: Kalapos Miklós Péter
Published: October 2007

Az európai összehasonlító statisztikai adatok alapján kidolgozott Penrose-törvény szerint inverz összefüggés van az egy országban található pszichiátriai ágyak száma és a börtönben lévő populáció létszáma között.
Célkitűzés:
A dolgozat a börtönpopuláció és az elmeosztályi ágyszám közötti összefüggéseket vizsgálja 1990 és 2005 közötti időszakban Magyarországon.
Módszerek:
Az adatok a Központi Statisztikai Hivatal kiadványaiból származnak. A dolgozatban a szerző az összefüggések leírására matematikai statisztikai módszereket alkalmaz.
Eredmények:
A pszichiátriai ágyak száma és a börtönpopuláció létszáma között Magyarország esetében is megfigyelhető inverz összefüggés van. A kényszergyógykezelt betegek száma a vizsgált időszakban a jogerősen szabadságvesztéses büntetésüket töltő személyek számával párhuzamosan emelkedett, és a pszichiátriai ágyak számával inverz összefüggést mutatott.
Következtetések:
Mind a börtön, mind pedig az elmeosztályon történő kezelés a közösség egy társadalmi jelenségre adott szegregációs válaszaként jelenik meg. Az adatok alapján feltételezhető, hogy mindkét rendszerben többségében ugyanazon populáció tagjaival találkozhatunk. A jelenség mélyebb összefüggéseinek elemzése céljából az országos vizsgálat elindítása szükségesnek tűnik.
Effect of green tea flavanols on the functions of the endoplasmic reticulum
Authors: Révész Katalin , Tüttő Anna , Konta Laura
Published: October 2007

A zöld tea sokrétű egészségmegőrző (pl. tumorellenes és antidiabetikus) hatásai, melyek a flavanoloknak, közülük is elsősorban az epigallokatechin-gallátnak tulajdoníthatók, felkeltették a kutatók érdeklődését. Az endoplazmás retikulum a karcinogén mérgek metabolizmusában, a sejtfelszíni és szekretált fehérjék szintézisében, illetve a glükóztermelésben betöltött szerepe miatt a tumorellenes és antidiabetikus hatóanyagok kiváló célpontja lehet, ezért fontos kérdés, hogyan befolyásolják működését a teaflavanolok. Mikroszómán és hepatomasejteken végzett kísérletek eredményei azt mutatják, hogy a flavanolok az endoplazmás retikulumban gátolják a glukuronidtranszportot, így csökkenthetik a rákkeltő anyagok reaktiválását; gátolják a glukozidáz II enzimet, ami endoplazmás retikulum stresszt és apoptosist idézhet elő hepatomasejtekben; és akadályozzák a glükózkiáramlást, amely a máj glükóztermelését és így a vércukorszintet csökkentheti. Ezek a megfigyelések egyrészt az érintett transzportfolyamatok, illetve transzporterek további vizsgálata szempontjából fontosak, másrészt hozzájárulnak a flavanolok hatásmechanizmusának jobb megértéséhez is.
Effect of mechanically activated raw materials on β-sialon formation by combustion synthesis
Authors: Sivakumar Ramasamy , Aoyagi Kazuhiko , Akiyama Tomohiro
Published: October 2007

The influence of different raw material mixtures on β-sialon (Si6−zAlzOzN8−z, 1 ⩽ z ⩽ 4) formation through mechanical activation coupled combustion synthesis (MA-CS) was investigated in low nitriding atmosphere of 1 MPa without diluent inclusions. The MA-CS performed for the first time on sialon raw materials with milling time of 18 min obtained sialons more than three times as pure as those obtained by CS of mixtures ball milled to 1 h (z = 3). The starting materials containing silicon, aluminum, and alumina (z = 4) after MA-CS had an increment of sialon amounts up to 88 mass%.
Ultramarine colored: Solid-phase elution of Pt into perovskite oxides
Authors: Nomura Katsuhiro , Daté Masakazu , Kageyama Hiroyuki , Tsubota Susumu
Published: October 2007

We have found a new route for preparing Pt containing perovskites. Ba containing perovskite powder, (La0.7Sr0.2Ba0.1)ScO3–δ(LSBS), reacted with Pt foil at 1898 K in air, and formed ultramarine colored Pt containing perovskite, (La0.7Sr0.2Ba0.1)(Sc,Pt)O3–δ, without changing the GdFeO3-type structure. The chemical compositions of the samples before and after firing, measured with inductively coupled plasma (ICP) optical emission spectrometry, were La: Sr: Ba: Sc = 0.70(1): 0.206(4): 0.101(2): 0.98(2) and La: Sr: Ba: Sc: Pt = 0.70(1): 0.197(4): 0.085(2): 0.95(2): 0.0062(2), respectively. The reaction proceeded not only at the interface between perovskite powder and Pt foil, but also over whole powder surface. We name this new preparation method the “solid-phase elution (SE) method”, because the process involves elution of Pt ions from the Pt foil to the LSBS perovskite lattice. It is expected that we can control the amount of Pt introduced into perovskites by using the SE method after optimizing the reaction time and temperature.
Residual stress model for CaF2
Authors: Zhang Q. , Lambropoulos J.C.
Published: October 2007

Nanoindentation tests and finite element analysis that considers elastic-mesoplastic deformation for single crystals were used to investigate the mechanical properties of CaF2 under spherical indentation. The goal was to gain a better understanding of microfractures and crystalline anisotropy and their effect on the surface quality of CaF2 during manufacturing. In this analysis, indentations of the three main crystallographic planes (100), (110), and (111) were studied and compared to examine the effects of crystalline anisotropy on the load–displacement curves, surface profiles, contact radius, spherical hardness, stress distributions, and cleavage at two stages, namely at the maximum indentation load and after the load had been removed. Our model results were compared with experimental observation of surface microroughness, subsurface damage, and material removal rate in grinding of CaF2.
Microstructural evolution and interfacial reactions of fluxless-bonded Au-20Sn/Cu solder joint during reflow and aging
Authors: Yoon Jeong-Won , Chun Hyun-Suk , Lee Hoo-Jeong , Jung Seung-Boo
Published: October 2007

The microstructural evolution and interfacial reactions of fluxless-bonded, Au-20wt%Sn/Cu solder joint were investigated during reflow and aging. After reflowing at 310 °C, only one thick and irregularly shaped ζ(Cu) layer was formed at the interface. After the prolonged reflow reaction, the AuCu layer was formed between the ζ(Cu) layer and the Cu substrate. During reflowing, the Cu substrate reacted primarily with the ζ-phase in the solder matrix. The solid-state interfacial reaction was much faster at 250 °C than at 150 °C. After aging at 250 °C for 100 h, thick ζ(Cu), AuCu and AuCu3IMC layers were formed at the interface. The formation of the AuCu3intermetallic compound (IMC) was caused by Cu enrichment at the AuCu/Cu layer interface. After aging for 500 h, cracks were observed inside the interfacial AuCu layer. The study results clearly demonstrate the need for an alternative surface finish on Cu, to ensure the high temperature reliability of the Au-20Sn/Cu solder joint.
Thermal effects on mechanical grinding-induced surface texture in tetragonal piezoelectrics
Authors: Chang Wonyoung , King Alexander H. , Bowman Keith J.
Published: October 2007

The effect of temperature on grinding-induced texture in tetragonal lead zirconate titanate (PZT) and lead titanate (PT) has been investigated using in situ x-ray diffraction (XRD) with an area detector. In contrast with previous results on electrical poling, mechanically-ground PT and soft PZT materials retain strong ferroelastic textures during thermal cycling, even after excursions to temperatures slightly above the Curie temperature. The relationship between the residual stresses in the surface region, caused by grinding, and those resulting from domain wall motion is elucidated by in situ texture measurements obtained during thermal cycling.
Understanding indentation-induced two-way shape memory effect
Authors: Zhang Yijun , Cheng Yang-Tse , Grummon David S.
Published: October 2007

Spherical indents in NiTi shape memory alloys can have reversible depth change: deeper depth in the martensitic phase at low temperature and shallower depth in the austenitic phase at high temperature. This is the indentation-induced two-way shape memory effect. After polishing the indents, two-way reversible surface protrusions can occur on the shape memory alloy surfaces upon heating and cooling. The height of the surface protrusion is about the same as the depth of the reversible indent. Further polishing reduces the height of the surface protrusion, which disappears completely when the polished depth is about the length of the contact radius. By comparing finite element analysis and experimental data, we show that the depth at which a protrusion disappears is close to the 10% strain boundary. This suggests that slip-plasticity is responsible for the observed indentation-induced two-way shape memory effect.
The depth distribution of residual stresses in (Ti,Al)N films: Measurement and analysis
Authors: Zhao Sheng-Sheng , Du Hao , Hua Wei-Gang , Gong Jun , Li Jia-Bao , Sun Chao
Published: October 2007

A method is introduced to determine the depth distribution of the residual stresses in (Ti,Al)N films. The films were gradually stripped by chemical corrosion, an optical system was designed to test the curvature change of the specimens, and the depth distribution of the residual stresses was calculated. The results show that the residual stresses increase gradually from the interface of film/substrate and reach a maximum value at the middle region, then decrease until the surface.
Fabrication, characterization and chemical modification of anthracene based nanostructures
Authors: Gupta Alka , Goel Shubhra , Mehrotra Ranjana , Kandpal H.C.
Published: October 2007

Anthracene based nano/microstructures of different sizes and shapes like tubes/fibers are synthesized using a simple open air chemical vapor deposition technique. Thermal solid phase reaction between anthracene 9-carboxylic acid and calcium oxide reported recently [H. Liu et al., J. Am. Chem. Soc.125, 10794 (2003)] is used to obtain organic molecular nanostructures. The products of temperature (320 °C) induced reaction get deposited on the substrates placed inside the reaction chamber as well as on the inner walls in different nano/micrometer forms, tubes/rods/fibers and having different sizes. Structural characterization of the reaction products is performed using optical microscopy, field emission electron microscopy (FE-SEM) and transmission electron microscopy (TEM). Chemical composition studies are conducted using infrared (IR), nuclear magnetic resonance (NMR), and gas chromatography (GC)-Mass spectroscopy, as well as elemental analysis. IR studies of the nanostructures obtained on the substrate using IR spectroscopy reveal the presence of C=O groups, the confirmatory evidence of which is obtained using energy dispersive x-ray spectroscopic (EDS) analysis. Interaction study of the C=O groups with ammonia vapor is conducted and resulting changes are monitored using Fourier transform infrared (FTIR). A strong covalent modification of anthracene based structures by exposure to ammonia molecules is indicated.
In situ bulge testing in an atomic force microscope: Microdeformation experiments of thin film membranes
Authors: Schweitzer E.W. , Göken M.
Published: October 2007

A new bulge testing setup for the measurement of the mechanical properties of thin films is presented. This self-built device can be incorporated in an atomic force microscope (AFM), which allows the recording of topographic images of the observed sample membranes under load conditions. Bulge test experiments on different silicon nitride films are presented and compared to nanoindentation experiments. The measured elastic moduli from nanoindentation and bulge testing are in good agreement. Apart from that, the ability to extract stress–strain data from AFM scans is shown, and the results are compared to standard bulge testing experiments. Imaging of the sample microstructure under load conditions is demonstrated on a thin Cu film.