bluuebunny/crossref_metadata_2025 huggingface dataset:
Asthma is more prevalent in rural New South Wales than metropolitan Victoria, Australia
Authors: Woods Rosalie K. , Burton Deborah L. , Wharton Cathryn , McKenzie Geoffrey H. , Walters E. Haydn , Comino Elizabeth J. , Abramson Michael J.
Published: March 2003

Objective:

The aim of this study was to compare the prevalence of adult respiratory symptoms and conditions in a rural setting with a metropolitan setting.

Methodology:

We used cross‐sectional population surveys of respiratory health using the European Respiratory Health Survey screening questionnaire. A random sample of 4455 eligible young adults aged 20–44 years, from electoral rolls in south‐eastern metropolitan Melbourne, Victoria, and 4521 from rural south‐western New South Wales were surveyed.

Results:

Response rates of 72% (n = 3194) and 69% (n = 3121) were achieved in Melbourne and the Riverina, respectively. Respondents from the Riverina reported significantly higher prevalences of nocturnal dyspnoea (P < 0.01), chronic bronchitis (P = 0.03), an asthma attack in the previous 12 months (P < 0.001), ever having had asthma (P < 0.001) and doctor‐diagnosed asthma (P < 0.001) compared to those from Melbourne. However, among those with ‘asthma attacks in the last 12 months’, Melbourne respondents experienced a higher frequency of attacks (P < 0.05). Riverina respondents reported a higher prevalence of smoking (P < 0.05) and smoked more cigarettes on average (P < 0.001) than Melbourne respondents. However, annoyance from air pollution was higher in Melbourne than in the Riverina.

Conclusions:

These results suggest that asthma is more prevalent in rural southern New South Wales than in Melbourne but follows a different pattern of exacerbations.
Primary spontaneous pneumothorax: Treatment practices in Australia
Authors: Sutherland Michael , Burdon Jonathan , Hart David
Published: March 2003

Objective:

The aim of the present study was to determine treatment practices for spontaneous pneumothorax (PTX) in Australia.

Methodology:

A questionnaire regarding treatment of PTX was posted to all medically qualified members of the Thoracic Society of Australia and New Zealand resident in Australia.

Results:

Fifty‐three per cent (n = 226) of questionnaires were returned. Twenty‐one responses were judged to be informal and rejected from analysis. The results indicate a general agreement in the treatment of small and large PTX but a wide variation in PTX of intermediate size.

Conclusion:

Opinion regarding the optimal treatment for PTX of intermediate size was found to vary considerably. There is a need for evidence‐based development and publication of best practice guidelines for PTX.
Pulmonary nocardiosis in a patient treated with corticosteroid therapy
Authors: NARUSHIMA MICHIAKI , SUZUKI HAJIME , KASAI TOMIHIKO , TSUZURA YUTAKA , TOMITA SHOGO , ENDOH SHIGERU , YAMADA MINEHIKO , OHTSUKA HIDEHIKO
Published: March 2003

Abstract: We report a case of pulmonary nocardiosis in a 69‐year‐old man with rheumatoid arthritis who was receiving corticosteroid treatment. The patient received prednisolone for rheumatoid arthritis and antibiotics for his fever and pneumonia in another hospital, but the response to the therapy was poor. After admission to our hospital, he improved following treatment with imipenem/cilastatin for Nocardia asteroides. Pulmonary nocardiosis is difficult to diagnose and should be considered in the differential diagnosis, especially in an immunocompromised host.
Optimization of sputum‐processing methods for the measurement of interleukin‐5: Effects of protease inhibition
Authors: SIMPSON JODIE L. , GIBSON PETER G. , WARK PETER A. B.
Published: March 2003

Background:

Interleukin (IL)‐5 measurement in sputum samples has produced variable results that appear to be due to methodological problems. The aim of the present study was to investigate the effects of dithiothreitol (DTT), sputum protease inhibition and sample storage on IL‐5 recovery in order to develop a method to accurately measure IL‐5 in dispersed sputum supernatant.

Methodology:

Measurement of IL‐5 in sputum was performed in 22 subjects with airway disease. Interleukin‐5 recovery was measured in samples spiked with recombinant human IL‐5 using a commercial ELISA. A mix of four protease inhibitors (PI) was added to sputum processed using the selection method with dispersion using DTT and stored with and without inhibitors.

Results:

The addition of PI to sputum resulted in a 24% increase in IL‐5 recovery. Recovery was not further increased with the addition of a blocking protein. Storage of IL‐5‐spiked sputum gave significantly less recovery. The addition of PI to sputum processed with DTT had no effect on total cell count, viability or cell differential.

Conclusion:

Interleukin‐5 recovery is increased by the addition of PI to samples processed using the selected portion method with DTT dispersion. A protease inhibitor cocktail should be added to sputum for IL‐5 assay.
Long‐term observations of the clinical course after step down of corticosteroid inhalation therapy in adult chronic asthmatics: Correlation with serum levels of eosinophil cationic protein
Authors: BABA Kenji , SAKAKIBARA Ayako , YAGI Takeo , NIWA Sayaka , WAKAYAMA Hideo , TAKAGI Kenzo
Published: March 2003

Background: Symptoms often deteriorate in well‐controlled asthmatics after a step down in inhaled beclomethasone dipropionate (iBDP) therapy if the serum concentration of eosinophil cationic protein (sECP) is high. This deterioration is significantly abrogated by pranlukast, a leukotriene receptor antagonist, or by seratrodast, a thromboxane A2 receptor antagonist. However, these results were based on short‐term (less than 6 months) observations.

Methods: We studied 35 well‐controlled adult asthmatics. We assigned the patients into different groups according to their sECP levels before the step down: (i) group A, sECP < 25 μg/L; (ii) group B, sECP ≥ 25 μg/L; and (iii) group C, sECP ≥ 25 μg/L but patients treated with pranlukast or seratrodast. We began the study with a step down in iBDP therapy (initial step down), then followed the clinical course of the asthma for 2 years. During the study period, we decreased, increased or maintained the iBDP dose on the basis of the stepwise approach described in the National Institutes of Health guidelines. We monitored the time and frequency of exacerbation and evaluated the iBDP dose required to control the asthma symptoms.

Results: The rates of exacerbation after the step down were high in groups A and B. In group A, the conditions were again qualified for the step down in all patients, but this was not the case for most group B patients. From 15 to 21 months after the initial step down, the average dose of iBDP required to control symptoms was significantly higher in group B than in group A patients (P = 0.0127–0.0373). The exacerbation rate in group C after 12 months tended to be lower than in the other two patient groups (P = 0.0743). In group C, the average dose of iBDP from 9 to 24 months after the initial step down was significantly lower than before the step down (P < 0.0001) and was not significantly different from the mean dose of iBDP in groups A or B.

Conclusions: High sECP in well‐controlled asthma may indicate the necessity for a higher iBDP dose over a long period than when the sECP concentration is not high. Even if sECP is high, pranlukast or seratrodast help to prevent exacerbation of asthma and enable successful step down in iBDP therapy for at least 2 years thereafter.
CD4+ T cells in lung tissue predict responsiveness to cyclosporin A in interstitial pneumonia
Authors: YOSHIOKA YASUKO , OHWADA AKIHIKO , DAMBARA TAKASHI , FUKUCHI YOSHINOSUKE
Published: March 2003

Objective: A limited number of case studies have demonstrated the steroid‐sparing and disease stabilization effects of cyclosporin A (CsA) combined with corticosteroid in patients with chronic interstitial pneumonia (IP). Although CsA is known to inhibit the proliferation and function of CD4+ T cells, it is not clear what type of IP is responsive to CsA administration.

Methodology: In order to evaluate whether any lymphocyte subsets in alveolar tissue predict the responsiveness to CsA, morphometric analysis was performed on lung tissue obtained from six IP patients who were treated with a combination of CsA and steroid because the therapeutic effect of steroid alone had been limited.

Results: Cell densities of CD4+ T cells were significantly decreased in the alveolar tissues obtained from CsA responders (n = 3) compared to non‐responders (n = 3) (120 ± 86/mm2vs 503 ± 172/mm2, P=0.0495). CD4/CD8 ratios of CsA responders were also significantly lower than those of non‐responders (0.315 ± 0.070 vs 1.975 ± 0.965, P=0.0463). However, cell densities of CD8+ T cell and areas of B cells aggregates were similar in both groups.

Conclusions: The present observations, contrary to expectation, reveal that lower cell densities of CD4+ T cells and lower CD4/CD8 ratios are associated with responsiveness to CsA in combination therapy, suggesting that pharmacological actions other than suppression of CD4+ T cells explain the efficacy of CsA in patients with chronic IP.
Addition of a 2‐month low‐dose course of levofloxacin to long‐term erythromycin therapy in sinobronchial syndrome
Authors: FUJIMURA MASAKI , MIZUGUCHI MASAYUKI , NAKATSUMI YASUTO , MIZUHASHI KEIICHI , SASAKI SHIGEKI , YASUI MASAHIDE
Published: March 2003

Background: We previously reported that a 6‐month low‐dose course of ofloxacin combined with long‐term low‐dose erythromycin therapy (EM therapy) was superior to EM therapy alone for sinobronchial syndrome (SBS), especially during the initial 2 months of treatment. However, there was no data as to whether discontinuation of low‐dose ofloxacin after 2 months results in symptom relapse. This study was designed to clarify this issue.

Methodology: Twenty‐three patients with SBS received a 2‐month course of levofloxacin (LVFX) therapy (100 mg once a day) concurrent with a 6‐month course of EM therapy (200 mg three times a day) (group A). Eighteen other patients were given the EM therapy alone (group B). Clinical parameters, including quantity of morning sputum, were recorded in a daily symptom diary, and reviewed by each doctor in charge at 2–4 week intervals.

Results: The quantity of morning sputum decreased more rapidly in group A than in group B. No relapse of symptoms was recognized after discontinuation of LVFX in group A.

Conclusions: A 2‐month low‐dose course of LVFX in conjunction with long‐term EM therapy may be efficacious for the treatment of SBS, as evidenced by rapid improvement of expectoration without any relapse after LVFX discontinuation.
Effect of flower number on the pollinator attractiveness and the threshold plant size for flowering in Pertya triloba (Asteraceae)
Authors: Kawarasaki Satoko , Hori Yoshimichi
Published: March 2003

Pertya triloba (Asteraceae) is a perennial herb growing in the understory of deciduous broad‐leaved forests in central Japan. Its capitulum consists of a single floret that differs from those of most other Asteraceae species. A bagging experiment clearly showed that breeding of P. triloba required cross‐pollination. By using female fertility as a measure of pollination success, the effect of an attractive floral display on the threshold plant size for flowering in P. triloba was surveyed. The number of florets per plant in a P. triloba population was artificially adjusted between one and 30. In both control plants and experimental plants with adjusted floret number, the seed set increased with an increase in the number of florets per plant and became constant (60%) when the floret number per plant was more than 10. Thus, the number of florets per plant has an important role in attracting pollinators, and more than 10 florets per plant must be the effective floral display size. In the P. triloba population, 98.5% of the flowering plants had 10 or more flowers. The effective floral display size might be determined through the mutual relationship between plants and pollinators. The number of florets per plant increased with an increase in the plant leaf area. Therefore, the threshold plant size for flowering might be determined by the productivity needed to support an attractive floral display.
Molecular systematics in the genusClintoniaand related taxa based onrbcLandmatKgene sequence data
Authors: Hayashi Kazuhiko , Yoshida Seiji , Utech Frederick H. , Kawano Shoichi
Published: March 2003

In an attempt to elucidate the affinity and phylogeny of the disjunct North American–eastern Asian genusClintonia, two chloroplast genes,rbcLandmatK, were sequenced for all five species (Clintonia andrewsiana, Clintonia borealis, Clintonia umbellulata, Clintonia unifloraandClintonia udensis). Similar sequence data sets for both genes supported the idea that a monophyly ofClintoniaconsists of two clades, one in eastern Asia and one in North America. The North American lineage resolves into an eastern group and a western group. There are surprisingly few site substitutions within these two genes, notwithstanding the wide morphological diversity of the genus. To root theClintoniatrees,Cardiocrinum(=Lilium)cordatum,Medeola virginiana,Scoliopus bigeloviiandScoliopus halliiwere used as outgroup taxa. Similar topologies forClintoniaresulted when both therbcLandmatKgene sequences were combined. However, when an amino acid tree was generated for thematKsequence, all differences between the North American species were reduced to similarities due to synonymous codon sequences. Differentiation patterns of some selected morphological, karyological and embryological characters inClintoniawere also reviewed in comparison to the resulting molecular topologies. The unique,Clintonia‐type megasporogenesis that produced identical, maternally derived, diploid zygotes and endosperm coupled to polyploid buffering provides a considerable constraint on variability. A search of possible sister genera toClintoniawas also attempted based on the molecular analyses and outgroup analysis, andMedeola virginianafrom eastern North America turned out to be the closest relative found.
Stepwise multimodal approach in the treatment of Kasabach–Merritt syndrome
Authors: Shin Hee Young , Ryu Kyung Ha , Ahn Hyo Seop
Published: March 2003

Background
: The purpose of the present study was to evalutate the various treatment modalities for Kasabach–Merritt syndrome (KMS) and to identify the most reliable treatment modalities.

Methods
: A retrospective analysis was performed on 37 KMS patients who were admitted to Seoul National University Hospital between January 1979 and June 1999. Age, sex, locations of the hemangiomas, clinical symptoms and hematologic data were analyzed by multivariate logistical regression analysis to determine the response to various treatment modalities.

Results
: Twenty‐four of 37 patients (20 boys and 17 girls) were diagnosed during infancy. The locations of hemangioma were superficial skin in 31 patients, combined skin and visceral organs in four patients and visceral organs only in two patients. Tumor size was more than 5 cm in diameter in all cases, except for one. The treatment principle of KMS in our center involves a stepwise multimodal approach. Of the 37 cases, surgical resection was performed in two. Steroids were tried initially in 35 patients over a 1 week period, with an initial response rate of 11.4% (4/35). Combined steroid/radiation treatment was given in 28 cases, with a response rate of 75.0% (21/28). Four of five patients with additional interferon (IFN)‐α therapy improved. No significant correlations were found between the prognostic factors, such as age, sex, size and locations of the hemangioma, hematologic data and the treatment modalities.

Conclusions
: Based on the experiences in a single center over a period of 20 years, we recommend a stepwise multimodal approach for the treatment of KMS; for example, steroid, radiation therapy and IFN‐α in this order. However, surgical treatment is helpful if total resection is possible.
Severe upper airway obstruction in the tropics requiring intensive care
Authors: Chan Pwk , Goh Ayt , Lum Lcs
Published: March 2003

Background
: The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics.

Methods
: The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score.

Results
: Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P=0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3~1.0; median 9.0). Non‐survivors had a significantly higher PRISM II score than survivors (27.4~9.7 vs 8.1~4.9, respectively; P=0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy.

Conclusions
: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.
Anti‐interleukin‐8 autoantibody in the tracheobronchial aspirate of infants with chronic lung disease
Authors: Takasaki Jiro , Ogawa Yunosuke
Published: March 2003

Background
: A high concentration of interleukin (IL)‐8 has been observed in the tracheobronchial aspirate of infants with chronic lung disease (CLD), although the pattern varies depending on the type of CLD. Alveolar fluid from patients with adult respiratory distress syndrome (ARDS) also contains an elevated level of IL‐8. Recently, the presence of anti‐IL‐8 autoantibody was demonstrated in the alveolar fluid from patients with ARDS.

Methods and Results
: The concentration of anti‐IL‐8 autoantibody in the tracheobronchial aspirate of infants with CLD was measured in order to discover whether there was any correlation with the concentration of IL‐8. Similar to IL‐8 concentration, the anti‐IL‐8 IgM antibody concentration in all infants with CLD following intrauterine infection was already high during the first 48 h. However, the concentration in infants with CLD following respiratory distress syndrome began to increase after 11 days of life, in contrast with the rise in IL‐8 between 48 h after birth and day 5.

Conclusions
: The presence of anti‐IL‐8 autoantibody may provide a mechanism that limits the bioavailability of free IL‐8 in the lungs. In addition, the time lag between the increase in IL‐8 and anti‐IL‐8 IgM autoantibody demonstrated in the present study could be used to estimate the time when the inflammation begins, even if the IL‐8 concentration is already high.
Infant abuse in Osaka: Health center activities from 1988 to 1999
Authors: Kobayashi Michiko
Published: March 2003

Abstract

Background
: In 1988, the first survey of child abuse in Japan was conducted in Osaka Prefecture as a joint effort between medical, health and welfare agencies. Ensuing surveys in 1988 revealed that infant abuse had a death rate of 10% in Health Center.

Methods
: In 1996 and 1999, surveys were performed on 130 and 215 abused children under 18 years of age. They were studied in terms of their activity of Health Center, including help, means of involvement by health visitors.

Results
: Fifty‐five percent of children were detected via health centers. In 69% of cases, health visitors listened to parents and promptly contacted other agencies. Ninety‐five percent of cases had home visits. The concerted effort of the health centers with allied disciplines in Osaka Prefecture yielded the following changes: the mortality rate decreased from 9.8% in 1988 to 2.3% in 1996, and institutionalized cases tripled from 13.7% in 1988 to 39.5% in 1999. The rate of admission to day care centers increased from 22.4% in 1988 to 58.7% in 1999. Along with the constant support of health visitors, day care centers provided secure support and protection for parents and infants.

Conclusions
: Effective prevention and treatment become possible only when treatment of the child’s physical and psychological health, mental care for parents and tangible support for childrearing and daily life were undertaken in a concerted way. To this end, a systematic commitment of all child agencies, child guidance centers, as well as medical, health educational, welfare and other allied disciplines is required.
Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetes
Authors: Alsaeid Mayra , Qabazard Maryam , Shaltout Azza , Sharma Prem N
Published: March 2003

Abstract
 

Background
: Lipoprotein (a) (Lp (a)) is an independent risk factor for coronary artery disease (CAD), a major cause of death in patients with type 1 diabetes mellitus. Both type 1 diabetes and CAD represent major problems in Kuwait. Data on the effect of metabolic control on Lp (a) in diabetic children are limited and this is particularly true for Arab children. The objectives of the present study were to analyze serum Lp (a) levels in patients with type 1 diabetes compared with non‐diabetic children, taking into account the effect of glycemic control.

Methods
: Circulating lipids, including Lp (a), were measured in serum samples from 60 prepubertal non‐diabetic children and 58 prepubertal children with type 1 diabetes. Comparisons of Lp (a) concentrations were made between the non‐diabetic and diabetic children with good to fair control (glycosylated hemoglobin (GHb) <11%) and a group of diabetic children with poor control (GHb ≥ 11%).

Results
: The mean serum Lp (a) level in all diabetic children was 187.62+160.43 mg/L, compared with 162.88+156.06 mg/L in the control group. The group of children with poor glycemic control had higher median Lp (a) levels (147.50 mg/L) than either the group of diabetic children with good to fair control (95 mg/L; P<0.028) or the group of non‐diabetic children (125 mg/L; P<0.04). Moreover, 38.3% of poorly controlled diabetic children had elevated Lp (a) levels ≥ 250 mg/L, compared with 12.5% of diabetic children with good to fair control and 16.7% of non‐diabetic children (P<0.025 and P<0.039, respectively). No association was found between Lp (a), diabetes duration and insulin dose.

Conclusions
: In Arab children, highest Lp (a) levels are associated with poorest metabolic control. The prevalence of Lp (a) levels associated with cardiovascular risk is higher in poorly controlled diabetic children. Increased levels of Lp (a) may be another contributing factor to the high risk for CAD in diabetic patients.
Ala/Thr60 variant of the Leydig insulin‐like hormone is not associated with cryptorchidism in the Japanese population
Authors: Takahashi Ikuko , Takahashi Tsutomu , Komatsu Masaki , Matsuda Jun , Takada Goro
Published: March 2003

Abstract
 

Background
: Leydig insulin‐like hormone (Insl3), a member of the insulin‐like superfamily, is specifically expressed in Leydig cells of fetal and postnatal murine testis. Recently, the absence of the Insl3 gene has been reported to result in bilateral cryptorchidism in male mice and it has been suggested that mutations of the INSL3 gene may cause cryptorchidism in humans.

Methods
: We sequenced the INSL3 gene from five Japanese patients with sporadic bilateral cryptorchidism. Patients’ genome DNA was prepared from blood leukocytes. Two exons of the INSL3 gene were amplified by polymerase chain reaction and were sequenced directly. A restriction fragment length polymorphism assay was performed on 70 control samples for analysis of polymorphism.

Results
: Three of five cases had a heterozygous single‐base change, a G to A transition at position 178 of the INSL3 gene, which predicts an alanine (GCC) to threonine (ACC) change at codon 60 (designated A60T). However, the A60T mutation was also found in the normal Japanese population at an allele frequency of 26%, which suggests that this mutation is a common polymorphism and is not associated with the occurence of cryptorchidism.

Conclusions
: No mutation has been found in the INSL3 gene from Japanese patients with idiopathic cryptorchidism. We did find the A60T polymorphism, which was not associated with the occurence of cryptorchidism.
Primary Duhamel–Martin operations in neonates and infants
Authors: Mir Erol , Karaca İrfan , Günsar Cüneyt , Sencan Aydin , Fesçekoğlu Orhan
Published: March 2003

Abstract

Background
: With advances in neonatal anesthetic and surgical care, a safe, one stage, definitive procedure has been possible in Hirschsprung’s disease. Since 1996, we have performed this type of operation in the neonatal and early infancy period. We aimed to review our data to state the feasibility of this operation in these age groups.

Methods
: At Dr Behçet Uz Children’s Hospital, we treated 10 patients with a single stage Duhamel–Martin operation between 1996 and 2000. Of the 10 patients, seven were boys. Six patients were diagnosed in the first week of the neonatal period. We evaluated these 10 patients by means of age, sex, age at diagnoses, operational age, diagnostic tools, properties of operation, complications and results.

Results
: The patients were all full‐term delivery and had a mean birthweight of 3 kg. The presenting clinical features were abdominal distention (100%), constipation (100%) and vomiting (70%). One patient was a Down syndrome patient, while another patient showed familial Hirschsprung’s disease. Contrast enemas gave positive results in eight patients. Definitive diagnoses were performed with rectal biopsy specimens. The extention of the disease was rectosigmoid in nine patients and descending colon in one patient. Five patients were in the newborn period at the time of the operation, while the oldest one was 7 months old. In the postoperative period, two children were treated because of early abdominal eventration and evisceration of the wound. Postoperative enterocolitis occurred in two patients. These 10 patients have been followed‐up for a period of 3 years, and spontaneous defecation and weight gain was observed in all of the patients.

Conclusions
: Our study confirmed the published data that this operation could be performed as an easy and safe procedure in the neonatal and early infancy period.
Failure of cortisone acetate therapy in 21‐hydroxylase deficiency in early infancy
Authors: Jinno Kazuhiko , Sakura Nobuo , Nomura Shinji , Fujitaka Michiko , Ueda Kazuhiro , Kihara Mikio
Published: March 2003

Abstract

Background
: Pediatric endocrinologists initially treat congenital adrenal hyperplasia with either cortisone acetate (CA) or hydrocortisone (HC). Despite high doses of CA, we noted that 17‐hydroxyprogesterone (17‐OHP) and corticotropin were not fully suppressed in serum from neonates with 21‐hydroxylase deficiency (21‐OHD) until they were 40‐ to 80‐days‐old. In contrast, serum concentrations of 17‐OHP were suppressed immediately by oral treatment with HC.

Methods
: We sought to understand the reason for this discrepancy. Serum cortisol (F), cortisone (E), and 17‐OHP were measured by radioimmunoassay or high‐performance liquid chromatography in seven neonates with 21‐OHD and in 118 normal subjects. From the time of diagnosis, CA was administered to four of the neonates with 21‐OHD, while HC was given to the other three.

Results
: In normal subjects serum E concentrations were greater than F during the first 2 months after birth, whereas F concentrations exceeded E after 2 months of age. Although infants receiving CA initially were given a high dose, serum F concentrations were extremely low, while 17‐OHP concentrations were high until about 2 months of age. Then serum F exceeded E, and 17‐OHP became fully suppressed even though infants received only a moderate dose of CA. In contrast, HC administration successfully normalized serum 17‐OHP in the neonatal period. With temporary switching of neonates from HC to CA, serum F concentrations immediately decreased and 17‐OHP concentrations increased.

Conclusion
: Conversion of E to F may be limited during early infancy, adversely affecting treatment with CA. Cortisone acetate may be inappropriate as a glucocorticoid replacement during early infancy in patients with 21‐OHD.
Effect of lactational exposure to 1,2,3,4‐ tetrachlorodibenzo‐p‐dioxin on cytochrome P‐450 1A1 mRNA in the neonatal rat liver: Quantitative analysis by the competitive RT‐PCR method
Authors: Kono Yumi , Okada Shin’Ichi , Tazawa Yusaku , Kanzaki Susumu , Mura Tetsuo , Ueta Etsuko , Nanba Eiichi , Otsuka Yuzuru
Published: March 2003

Abstract

Background and Methods
: The aim of this study was to assess the effect of lactational exposure to dioxins in neonates on the cytochrome P450 1A1 (CYP1A1) induction in the level of gene expression. Maternal rats were treated with a single dose of 50 or 100 μmol/kg 1,2,3,4‐tetrachlorodibenzo‐p‐dioxin (1,2,3,4‐TCDD), a low potent congener of dioxins, on the first day post‐partum (day 1). Induction of CYP1A1 mRNA expression was quantitatively analyzed by the competitive reverse transcription–polymerase chain reaction (RT–PCR) method.

Results
: The CYP1A1 mRNA was detectable at extremely low amounts in the liver of control neonates and mothers. The mRNA ratios of CYP1A1 to β‐actin in neonates were dose‐dependently increased by the treatment of 1,2,3,4‐TCDD of their mothers. Its peak occurred on day 6 and was sustained at the same level on day 10. Increases of the ratio with 100 μmol/kg 1,2,3,4‐TCDD on day 2, 6 and 10 were 26‐, 40‐ and 40‐fold of the appropriate controls, respectively. These levels paralleled the activity of ethoxyresorufin‐o‐deethylase, representing CYP1A mediated monooxygenase. In the mother, the mRNA ratio was increased only to threefold of the control, 10 days after treatment.

Conclusion
: Current RT‐PCR procedure enabled to assess both constitutive and induced levels of CYP1A1 mRNA in the neonatal rat livers. Although the dose of 1,2,3,4‐TCDD selected in this study was about 5000 times higher than the daily intake of dioxins in breast‐fed infants, CYP1A1 mRNA was highly induced for a longer period of time in neonatal rats receiving 1,2,3,4‐TCDD via lactation than the treated maternal rats.
Preventive management of hypoglycemia in very low‐birthweight infants following indomethacin therapy for patent ductus arteriosus
Authors: Hosono Shigeharu , Ohono Tsutomu , Kimoto Hirofumi , Nagoshi Ren , Shimizu Masaki , Nozawa Masayo
Published: March 2003

Abstract

Background
: To evaluate the effects of an increase in glucose infusion rate of 2 mg/kg per min from the basal infusion rate on the prevention of hypoglycemia in very low‐birthweight (VLBW) infants, following indomethacin therapy for patent ductus arteriosus (PDA).

Methods
: Forty VLBW infants with PDA were given indomethacin 0.2 mg/kg intravenously up to three doses. In 15 of the 40 infants (supplemented group: between April 1995 and March 1996) the glucose infusion rate was increased in 2 mg/kg per min increments from the basal rate just before the initial indomethacin administration, compared with 25 historical control infants who received a fixed glucose infusion rate during the first 12 h after the initial dose. We evaluated the changes in blood glucose levels and glucose infusion rates in both groups.

Results
: In the control group 11 of 25 (44%) infants had a blood glucose value below 40 mg/dL between 12 and 60 h (mean 32.7 h). In contrast only two out of 15 infants in the supplemented group reached the glucose level below 40 mg/dL between 72 and 96 h but both two were light‐for‐dates infants (defined as birthweight below the 10th percentile for gestational age on the standard intrauterine growth curve). Blood glucose values in the supplemented group were significantly higher than those in the control group between 12 and 96 h. However, glucose infusion rates were similar before and between 72 and 96 h.

Conclusions
: This retrospective study shows that an increase in glucose infusion rate of 2 mg/kg per min, in addition to the pre‐existing stable maintenance glucose intake, might prevent against the occurrence of unexpected hypoglycemia in VLBW infants following indomethacin therapy.
Non‐surgical closure of atrial septal defect
Authors: Ishizawa Akira , Oho Shinichi , Dodo Hidemi
Published: March 2003

Abstract

Background
: Recently many devices for the transcatheter closure of atrial septal defect (ASD) were developed in the world. Several ASD closing devices, such as Clamshell device, buttoned device, ASD occluder system (ASDOS), Angel Wings, are not fully acceptable from a practical point of view. We reported the clinical trials of transcatheter closure of ASD for Clamshell double umbrella device and Amplatzer septal occluder (ASO) in Japan.

Methods
: Clamshell devices were implanted in 11 patients. Clinical trials for ASO device were carried out in 34 patients in Japan. We reported the results of 17 patients in National Children’s Hospital.

Results
: Clamshell devices were implanted in all of the patients successfully. Minimal residual shunt was present in four patients (36%), 1 year after the procedure by Doppler color flow imaging. Nine of 11 umbrellas demonstrated fracture of the stainless steel arm. Arm fracture occurred between 1 week and 12 months after implantation. The implantations of ASO device were successful in all of the 17 patients. Sixteen out of 17 (94.1%) had complete closure in the average observation period of 5.5 months. Complications were minimal and transient.

Conclusions
: With respect to complete closure rate, easy manipulation, and complication rate, ASO is the best transcatheter ASD closure device among all the devices at the present time.
Effect of hemodialysis on carnitine levels in children with chronic renal failure
Authors: Mir Sevgi , Kantar Mehmet , Yalaz Mehmet , Keskinoglu Ahmet , Coker I¸Sil , Huseyinov Afig
Published: March 2003

Background
: Impaired structural and metabolic integrity of the kidney in chronic renal failure (CRF) effects carnitine metabolism by means of many factors. Depletion due to hemodialysis (HD) is one of the major concerns. The aim of the study was to investigate the effects of chronic renal failure and HD on plasma free carnitine (FC) concentrations in children.

Methods
: Plasma FC concentrations were
measured in age‐matched 14 undialyzed patients, 20 dialyzed patients
and 12 healthy children. In the HD group, measurements were done
pre‐ and postdialysis and an hour after ceasing HD. None of the
children have been receiving exogenous l‐carnitine replacement.

Results
: Plasma FC concentrations on either
HD or conservative treatment were found to be decreased as compared
to the healthy subjects (P < 0.001
and P = 0.001, respectively).
The patients on HD had lower levels of plasma FC at the predialysis
period than those on conservative treatment (P = 0.01).
The FC levels significantly dropped at the postdialysis period as
compared to those at the predialysis period (P < 0.001), but recovered at 1 h after ceasing HD. The mean duration of HD did not correlate with plasma FC levels at predialysis period.

Conclusions
: Children with CRF, either dialyzed or undialyzed, have decreased plasma FC levels. Hemo­dialysis treatment significantly depletes plasma FC concentrations during the procedure, but predialysis levels are reached 1 hr after ceasing HD.
Incidence of acute respiratory infections and the relationship with some factors in infancy in Antalya, Turkey
Authors: Etiler Nilay , Velipasaoglu Sevtap , Aktekin Mehmet
Published: March 2003

Background: Acute respiratory infections (ARI) are one of the major problems of childhood in developing countries. The objective of the study was to obtain the incidence of ARI and its risk factors in Antalya, Turkey.

Methods
: We carried out a prospective cohort study on 204 infants who were born between 1 November and 31 December 1997, in the area of two primary health‐care units in the Antalya city center. The research group was followed periodically every 2 months by home visits and the infants were investigated to determine their symptoms of ARI. The weight and length of children were measured in every home visit. Additional questions about socioeconomic status, some environmental characteristics, and nutrition practice were asked. Data were entered into the computer and the Z‐scores were calculated by the Epi Info 5 package program. The incidence rates, relative risks and confidence intervals were calculated by Microsoft Excel version 5.0 program.

Results
: The incidence of ARI was 6.53 episodes per child per year among the children in the research group. The factors that influenced the incidence of ARI were lack of mother’s and father’s education, heating by wood stove, being a low‐birthweight infant, not being completely breast‐fed in the first 4 months of life and being stunted. There were no associations between the number of persons per room or smoking status of family members with ARI incidence.

Conclusion
: Our results demonstrated that ARI were also associated with some socioeconomic, environ­mental and nutritional status characteristics such as paternal education, house ownership, breast‐feeding, stunting, prematurity and burning of biomass fuels in Turkey.
Increased production of serum IgA‐class antibody to lipid A in Kawasaki disease
Authors: Takeshita Seiichiro , Kawase Hiroko , Shimizu Tooru , Yoshida Maki , Sekine Isao
Published: March 2003

Background
: The etiology of Kawasaki disease (KD) remains unknown. To investigate whether a conventional bacterial antigen is involved in the pathogenesis of KD, we studied the serum response to lipopolysaccharide (LPS).

Methods
: We measured the serum levels of IgG‐, IgM‐ and IgA‐class antibodies (Ab) to lipid A, a toxic site of LPS, using enzyme‐linked immunosorbent assay in 20 patients with KD, 11 patients with Gram‐negative bacterial infection (GNBI), 27 healthy children and 12 healthy adults.

Results
: The serum levels of anti‐lipid A IgG, IgM and IgA tended to increase with advancing age in healthy children older than 6 months of age. The mean level of anti‐lipid A IgM in the acute phase of GNBI and the mean levels of anti‐lipid A IgM and IgA in the acute phase of KD were found to increase significantly, in comparison to the age‐matched controls. Furthermore, the mean level of anti‐lipid A IgA also showed a significant increase from the acute to the subacute phases of KD. Regarding the IgA‐subclass response, higher titers of anti‐lipid A specific Ab were seen in the IgA2 subclass than in the IgA1 subclass.

Conclusion
: These findings indicate that KD patients demonstrate an intense response to lipid A in the IgA, especially IgA2‐subclass, thus suggesting that an unusual activation of the mucosal immune response to a ubiquitous antigen derived from Gram‐negative bacteria may be involved in the pathogenesis of KD.
Towards an international theory of nursing
Authors: Hisama Kay K.
Published: March 2003

Abstract During the latter half of the 20th century, the development of numerous nursing theories has enriched nursing scholarship and education worldwide, a movement initially led by North American scholars. Recently, nurses outside of North America have begun to reformulate these theories in order to make them relevant in other contexts. This study summarizes those movements in developing an international theory of nursing and suggests future directions for such a theory.
Comparisons of tympanic membrane, abdominal skin, axillary, and rectal temperature measurements in term and preterm neonates
Authors: Jirapaet Veena , Jirapaet Kriangsak
Published: March 2003

Abstract Quasi‐experimental research was conducted to investigate the optimum placement time and normative values of temperature measurements from the tympanic membrane, abdominal skin, axilla, and rectum of neonates at a newborn nursery of a university medical center in Thailand. A convenience sample of 52 growing preterm and 57 healthy term neonates was enrolled. Simultaneous temperature measurements were made at the four sites. Temperatures were recorded when they had remained unchanged for 2 min. The axillary temperature was as accurate as the rectal temperature measured with a glass thermometer if the placement times were optimal. The mean placement times in preterm and term neonates were 2.8 and 3.4 min for the rectum, 5.4 and 7.9 min for axilla, and 4.0 and 6.1 min for abdominal skin, respectively. The rectal temperature equalled the abdominal skin temperature plus 0.3°C for preterm and plus 0.2°C for term neonates. However, temperatures obtained with an infrared tympanic thermometer in the rectal‐equivalent mode did not give an accurate reading and are not recommended as a substitute for rectal temperatures in neonates.
Hyperglycemia and its related factors in Taiwanese middle‐aged adults
Authors: Lai Shih‐Wei , Tan Chee‐Keong , Ng Kim‐Choy
Published: March 2003

Abstract Our study used data collected in Chung‐Hsing Village to evaluate the relationship between hyperglycemia and its related factors in Taiwanese middle‐aged adults in May 1998. All government employees at the Taiwan Provincial Government in Chung‐Hsing Village aged 40–64 years were candidates for this study. Only 708 volunteers completed a structured questionnaire and underwent venous blood tests. To study the significant related factors of hyperglycemia, the t‐test, χ2 analysis and multivariate logistic regression were used. Our results showed that 40% of the 708 subjects were men and 60% were women. The mean age was 50.5 ± 6.8 years. The mean values of fasting glucose were 4.68 ± 1.92 mmol/L in men and 4.70 ± 1.70 mmol/L in women (P > 0.05). The proportions of hyperglycemia were 6.4% in men and 5.7% in women (P > 0.05). After controlling for other covariates, the multivariate logistic regression analysis showed that the significant related factors for hyperglycemia were older age (odds ratio = 2.86, 95%; confidence interval = 1.36–6.05; P < 0.01) and hypertriglyceridemia (odds ratio = 3.34, 95%; confidence interval = 1.68–6.64; P < 0.001).
Changes in the regression slope correlating between urinary contents of α‐1‐microglobulin and ulinastatin and its relation to severity in mood disorders
Authors: Shikimi Tadahiro , Uegaki June , Inagaki Takuji , Mitsuoka Setsuko
Published: March 2003

Abstract With mood disorders, clinical portrayals alone do not always reflect the exact state and progress of the disease. The present study attempted to evaluate whether changes in regression slope correlating between urinary contents of α‐1‐microglobulin and ulinastatin provided objective information on the severity of mood disorders, based on our previous findings that the regression slope was more steeply inclined in patients with mood disorders than in age‐matched healthy subjects. As a result, a close association between scores of the Hamilton Rating Scale for Depression and the regression slopes was found: the more inclined the slope, the greater the severity of symptoms of depression. These results suggest that changes in the slope of the regression plot correlating between urinary contents of α1M and UT may afford a useful objective index when monitoring the state of patients with mood disorders.
Introduction
Authors: Shin Kyung Rim
Published: March 2003

The symposium was held at Ewha Womans University in conjunction with the 7th Annual Qualitative Health Research Conference and was supported by the Korean Academic Society of Women's Health. Approximately 100 participants attended from six countries: Australia, Canada, China, Japan, Korea, and the USA. The abstracts of this symposium consist of two parts: (A) Invited Presentations, and (B) Concurrent Sessions. Among the invited specialists Dr Young Hee Choi, member of the Korean National Assembly, delivered an impressive speech on ‘Health‐care policy for Korean elderly’. The speech helped all to better understand the health care of the elderly at present, as well as future plans for care in Korea. The presentation by Dr Beum Seang Kim (Catholic University, Korea), ‘What is Alzheimer's disease?’, gave the attendees an opportunity to gain greater knowledge about dementia and Alzheimer's disease. The other invited speakers, Drs Wendy Duggleby, Kiyoko Makimoto, Chun‐Ok Lee, and Kaoru Nishimura also provided impressive and stimulating addresses. In addition to invited presentations, 20 papers were presented at the concurrent sessions.
Community Palliative Care in Australia
Authors: McMillan M. , Armitage D.
Published: March 2003

Globally, the provision of health care has made an increasing move towards community‐based care over the past decade. Early discharge programs, hospital‐in‐the‐home and community rehabilitation are concepts that have been espoused as solutions to the increasing demands on inpatient facilities. Although there can be no doubt that reduced length of hospital stays has benefits to the health‐care system, questions still remain as to whether the services provided in the community are adequate to meet the needs of the patients who are now encouraged to utilize the community health‐care services. This study examines the deficits between the need for services and the services provided from the perspective of community palliative care in Australia.
Elderly Women's Grief in Korea
Authors: Kim Kwuy Bun
Published: March 2003

The purpose of this phenomenological study was to determine nursing interventions which would facilitate positive lives for elderly Korean women, by investigating the causes for their grief and its meaning to them. Data collection was performed from December 2000 until April 2001, through systematic interviews and participatory observations of six elderly women attending a welfare center in downtown Seoul, Korea. Each subject was interviewed five or six times for 11/2 h each time. Analysis based upon the Giorgi method produced the following results of causes for the elderly womens’ grief and its meanings to them: (i) physical and physiological decline caused by growing old: husband's health problem, own physical suffering, lack of attention to surroundings, insomnia; (ii) unpleasant memories of spouse: husband's infidelity, husband's incapability, husband's disregard; (iii) pity for children: unfaithful children, uncertain of children's future, children's early death; (iv) regrettable fate: painful daily lives, unreliable life, unlucky destiny, sense of emptiness; (v) anxiety about the future: sense of despair, sense of loneliness, economic hardship, fear of imminent death. It was concluded that a variety of programs and social meetings for the elderly so that they may overcome their physiological or psychological crisis need to be developed and supported by the government. In addition, in order to implement successful social welfare for elderly women, special consideration, whether at the governmental level or at the personal level, needs to be devoted to those who are without financial support or social concern.
Relocation of Older Australians
Authors: Stein Irene
Published: March 2003

The relocation of older Australians from their homes to a residential aged care facility is a time of stress. This stress can manifest itself in many ways. This study examined the types of relocation, the reasons for relocation, the effects of relocation on individuals, and a model of care that can minimize the stress experienced by relocatees.