bluuebunny/crossref_metadata_2025 huggingface dataset:
The molecular analysis of leaf senescence – a genomics approach
Authors: Buchanan‐Wollaston Vicky , Earl Simon , Harrison Elizabeth , Mathas Evy , Navabpour Saeid , Page Tania , Pink David
Published: March 2003

Senescence in green plants is a complex and highly regulated process that occurs as part of plant development or can be prematurely induced by stress. In the last decade, the main focus of research has been on the identification of senescence mutants, as well as on genes that show enhanced expression during senescence. Analysis of these is beginning to expand our understanding of the processes by which senescence functions. Recent rapid advances in genomics resources, especially for the model plant species Arabidopsis, are providing scientists with a dazzling array of tools for the identification and functional analysis of the genes and pathways involved in senescence. In this review, we present the current understanding of the mechanisms by which plants control senescence and the processes that are involved.
Taste, food intake and obesity
Authors: Nasser J.
Published: March 2003

Research in human eating behaviour prior to 1990 has shown that taste impacts the palatability and selection of food for intake; sensory‐specific satiety; satiation; and thermic effect of food. Research in the last decade has added information to these areas; expanded the field to comparisons of the impact of ‘wanting’ vs. ‘liking’ food on intake, and provided insight into the relationship of food intake and brain functioning through new imaging techniques. This article will review literature from the last decade on research in the area of taste and its impact on food intake. Emphasis will be placed on differences seen between lean and obese humans and how these may contribute to the development of human obesity. Suggestions for future research directions will also be discussed.
Long‐term weight development after pregnancy
Authors: Linné Y. , Barkeling B. , Rössner S.
Published: March 2003

For some women pregnancy is a trigger for developing overweight and obesity. Seventy‐three per cent of 128 female patients at our Obesity Unit indicated that they had retained more than 10 kg after each of their pregnancies, and for this subgroup weight development after pregnancy was of crucial importance for their future health. Although mean weight increases after pregnancy generally are modest, there are wide individual variations. In studies at the Obesity Unit, weight retention ranging from up to 26.5 kg one year after pregnancy to a loss of 12.3 kg was reported, although the mean weight gained was only 0.5 kg. Numerous studies have analysed factors explaining weight development after pregnancy and delivery, with a range of subjects from several hundred thousand women to fewer than one‐hundred, but overall it has been surprisingly difficult to identify strong predictors of weight development. Numerous confounders have been identified; in a review up to 31 such confounders were reported. Methodological problems include weight development over time also in non‐pregnant women and problems of identifying the optimal time‐point when the overall impact of the pregnancy on weight development should be evaluated. Lactation has consistently been found to play a small role in explaining weight retention up to one year after delivery. Few studies have examined the role of physical activity during pregnancy and after delivery to explain weight development. Our own ongoing follow‐up of women who gave birth during 1984–85, the so‐called SPAWN (Stockholm Pregnancy and Women’s Nutrition) study, illustrates that 15 years after delivery, a significant proportion of the 1423 women initially studied were available for re‐examination. Drop‐out analyses indicate that for most variables under study, the remaining women were representative for the initial sample. Pregnancy and weight development are intertwined in a complex pattern, which includes a change in lifestyle factors, such as eating behaviour, physical activity, smoking cessation and degree of lactation, but which are still not fully understood.
Twenty‐year changes in the prevalence of overweight in Japanese adults: The National Nutrition Survey 1976–95
Authors: Yoshiike N. , Seino F. , Tajima S. , Arai Y. , Kawano M. , Furuhata T. , Inoue S.
Published: March 2003

The aim of this study was to describe the 20‐year changes in body mass index (BMI; kg m−2) and the prevalence of overweight in Japanese adults. Cross‐sectional annual nationwide surveys (National Nutrition Survey, Japan) were carried out with a large probability sample of the Japanese population. Data sets of the 1976–95 surveys, comprising 91 983 men and 120 822 women (≥20 years of age), were used. The analyses were carried out in age and gender groups, and by residential area according to the size of the municipality (metropolitan areas, cities and small towns). The mean BMI increaseed in men with an increment of +0.44 kg m−2 10 years−1 and slightly decreased in women, by −0.09 kg m−2 10 years−1, after adjustment for age. A decreasing trend of mean BMI was most significant in the female 20–29 years age‐group (−0.38 kg m−2 10 years−1), in contrast to an increasing trend observed in elderly women (60–69 and 70+ years age‐groups). The prevalence of preobese (BMI: 25–29.9 kg m−2) and obese (BMI ≥ 30 kg m−2) men increased from 14.5% and 0.8%, respectively, in the time‐period 1976–80 to 20.5% and 2.01% during 1991–95. The increasing trend was most evident in the youngest age‐group (20–29 years) and in those from small towns. The overall prevalence of preobese and obese women did not change during the 20‐year study period. The prevalence in younger women decreased, this trend being more prominent in metropolitan areas. Although the prevalence of overweight (BMI ≥25 kg m−2) in Japanese men and elderly women has increased in the last 20 years, the mean BMI in younger women, especially those in metropolitan areas, has decreased. A population approach to control obesity and prevent obesity‐associated diseases should be mainly focused on men and women older than 40 years of age.
The lifecycle effects of nutrition and body size on adult adiposity, diabetes and cardiovascular disease
Authors: Yajnik C. S.
Published: March 2003

This study was undertaken to review the links between maternal nutrition, offspring's birth weight and the propensity to early insulin resistance and high diabetes rates in Indian adults. Studies included a comparison of maternal size and nutrition with birth weights in Pune, India, and Southampton, UK. In Pune, the growth, insulin resistance and blood pressure of four‐year‐old children were assessed. Adults >40 years of age, who were resident in rural areas, were compared with adults living in urban areas for size, glucose handling, lipid status and blood pressure. Newly diagnosed diabetic adults living in urban areas were also monitored. Height, weight, head, waist and hip circumferences, skin‐fold measurements and blood pressure were routinely measured. Fasting glucose, insulin, total and high‐density lipoprotein cholesterol and triglycerides were linked to the glucose and insulin responses during glucose tolerance tests. Cytokine levels were measured in plasma samples of urban and rural adults. Indian babies were lighter, thinner, shorter and had a relatively lower lean tissue mass than the Caucasian babies. However, the subcutaneous fat measurements of these babies were comparable to those of the white Caucasian babies. The Indian mothers were small, but relatively fat mothers produced larger babies. Maternal intake of green vegetables, fruit and milk, and their circulating folate and vitamin C levels, predicted larger fetal size. Rapid childhood growth promoted insulin resistance and higher blood pressure. Rural adults were thin, with a 4% prevalence of diabetes and a 14% prevalence of hypertension, but the risks increased within the normal body mass index (BMI) range. Type 2 diabetes was common in urban adults younger than 35 years of age. Although the average BMI was 23.9 kg m−2, central obesity and thin limbs were noteworthy. Levels of interleukin‐6 and tumour necrosis factor‐α were markedly increased in urban dwellers. Hence, there is evidence of a remarkably powerful, intergenerational effect on body size and total and central adiposity. Indians are highly susceptible to insulin resistance and cardiovascular risks, with babies being born small but relatively fat. Insulin resistance is amplified by rapid childhood growth. Dietary factors seem to have profound long‐term metabolic influences in pregnancy. Overcrowding with infections and central obesity may amplify cytokine‐induced insulin resistance and early diabetes in Indian adults with a low BMI.
Should obese patients be counselled to follow a low‐glycaemic index diet? Yes
Authors: Pawlak D. B. , Ebbeling C. B. , Ludwig D. S.
Published: March 2003

A reduction in dietary fat has been widely advocated for the prevention and treatment of obesity and related complications. However, the efficacy of low‐fat diets has been questioned in recent years. One potential adverse effect of reduced dietary fat is a compensatory increase in the consumption of high glycaemic index (GI) carbohydrate, principally refined starchy foods and concentrated sugar. Such foods can be rapidly digested or transformed into glucose, causing a large increase in post‐prandial blood glucose and insulin. Short‐term feeding studies have generally found an inverse association between GI and satiety. Medium‐term clinical trials have found less weight loss on high GI or high glycaemic load diets compared to low GI or low glycaemic load diets. Epidemiological analyses link GI to multiple cardiovascular disease risk factors and to the development of cardiovascular disease and type 2 diabetes. Physiologically orientated studies in humans and animal models provide support for a role of GI in disease prevention and treatment. This review examines the mechanisms underlying the potential benefits of a low GI diet, and whether such diets should be recommended in the clinical setting.
UNRELATED DONOR HEMATOPOIETIC TRANSPLANTATION
Authors: De Lima Marcos , Champlin Richard
Published: March 2003

Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for a range of malignant and non‐malignant diseases. Unfortunately, fewer than 30% of patients have a human leukocyte antigen (HLA)‐matched sibling. Advances in our understanding of the HLA system and the development of large international donor registries are supporting the increasing use of unrelated donors as an alternative source of stem cells. Unrelated donor transplantation, however, is still associated with higher complication rates than in HLA‐identical sibling donor transplants. Improvements in graft‐vs.‐host disease prevention and treatment, new conditioning regimens and better donor selection will likely expand the indications of unrelated donor HSCT in the next decade.
MIKADO: a multicentre, open‐label pilot study to evaluate the antiretroviral activity and safety of saquinavir with stavudine and zalcitabine
Authors: Katlama C , Pellegrin J‐L , Lacoste D , Aquilina C , Raffi F , Pialoux G , Vittecoq D , Raguin G , Lantz O , Mouroux M , Calvez V , Trylesinski A , Montestruc F , Dohin E , Goehrs Jm , Delfraissy Jf
Published: March 2003

Background  Since eradication of HIV is unlikely, long‐term management of the disease necessitates careful evaluation of the combinations of currently available drugs to determine the most potent and useful rational sequencing of regimens.

Objective  To determine the antiretroviral efficacy and tolerability of saquinavir soft gelatin capsule (SQV‐SGC) plus zalcitabine (ddC) and stavudine (d4T), as first‐line treatment in HIV‐infected patients.

Design  Multicentre, open‐label, non‐comparative study.

Patients and methods  Thirty‐five asymptomatic, HIV‐infected adults with no prior antiretroviral treatment, a CD4 count ≥ 250 cells/μL and baseline ≥ 5000 HIV RNA copies/mL were included in the study. Patients received SQV‐SGC 1200 mg three times a day (tid), ddC 0.75 mg tid and d4T 30 or 40 mg twice a day (bid) for 24 weeks. Plasma HIV RNA, CD4 and CD8 cell counts, HIV reverse transcriptase and protease resistance genotypes, SQV plasma concentration and tolerability were evaluated.

Results  At baseline, median HIV RNA (interquartile range) was 4.99 (4.81–5.48) log10 copies/mL, and median CD4 count was 370 (318–504) cells/μL (n = 35). At week 24, the median decrease in HIV RNA was 3.05 (2.19–3.68) log10 copies/mL. A viral load below the level of quantification (200 copies/mL and 20 copies/mL) was achieved in 63% and 34% of patients, respectively (intent‐to‐treat analysis). The only mutations detected were L90M substitutions in two patients. At week 24, the median CD4 count increased (P < 0.0001), and CD8 cell counts decreased (P < 0.0001), relative to baseline. In total, there were five cases of peripheral neuropathy (14%). Mean triglyceride and cholesterol levels remained within normal ranges.

Conclusions  Triple therapy with SQV‐SGC plus ddC and d4T is a reasonably well tolerated regimen that markedly and rapidly reduces viral load with immunological improvement. This combination is an effective

additional therapeutic option, with an efficacy that compares favourably to other triple regimens used in HIV treatment.
L‐Carnitine in the treatment of HIV‐associated lipodystrophy syndrome
Authors: Mauss S , Schmutz G
Published: March 2003

Summary

The objective of this pilot study was to assess the effect of L‐carnitine on the course of the HIV‐associated lipodystrophy syndrome. Twelve patients presenting with combined atrophic and hypertrophic changes of body fat were treated with L‐carnitine 1000 mg bid for 3 months. No marked improvement of the body changes was observed. However a reduction in serum cholesterol levels, but not triglycerides, was noted. These preliminary data do not support the use of L‐carnitine for the rapid reversal of advanced fat tissue alterations due to HIV‐associated lipodystrophy.
Resistance and cross‐resistance to abacavir
Authors: Moyle G
Published: March 2003

Background Abacavir (ABC) is a potent nucleoside reverse transcriptase inhibitor (NRTI) used in multi‐drug antiretroviral regimens and in combination with other NRTIs, protease and/or non‐nucleoside reverse transcriptase inhibitors (NNRTIs) in both treatment naive and treatment experienced patients.

Patterns of resistance Resistance to ABC has been demonstrated in vitro and in vivo. Patterns of emerging mutations may vary when ABC is combined with other NRTIs relative to the mutations observed in monotherapy. Additionally, thymidine NRTIs may select for mutations that, while not selected for by ABC, may confer diminished susceptibility and diminished clinical response to ABC.

Clinical use of ABC Resistance and clinical data indicate that ABC may be a suitable component of initial regimens and second or subsequent lines of therapy. It may be used as a substitution agent for persons wishing to discontinue protease inhibitor therapy who have not previously experienced viral rebound on NRTI therapy.
The changing demographics of new HIV diagnoses at a London centre from 1994 to 2000
Authors: Barry SM , Lloyd‐Owen SJ , Madge SJ , Cozzi‐Lepri A , Evans AJ , Phillips AN , Johnson MA
Published: March 2003

Objective

To document the demographic changes in new HIV diagnoses at the Royal Free Hospital, London, UK, between 1994 and 2000.

Design

Retrospective case note review.

Methods

Data were extracted from the Royal Free HIV database identifying new diagnoses for 1994, 1997 and 2000. All case notes were reviewed and patients were included if they had their first positive HIV test at the Royal Free Hospital, or if they first tested positive elsewhere and attended the Royal Free HIV unit for their initial HIV care. Data extracted included sex, ethnicity, age, risk factor(s) for HIV, reason for test, clinical stage of disease, CD4 count and HIV RNA viral load at diagnosis.

Results

One hundred and forty‐four patients were identified for 1994, 136 for 1997 and 110 for 2000. Over this time period the proportion of white patients dropped from 72% (n = 104) to 48% (n = 53), P= 0.0001, whilst the proportion of black Africans rose from 24% (n = 34) to 45% (n = 49), P= 0.0004. The median CD4 count at diagnosis of the white cohort was 475 cells/µL in 1994 and 286/µL in 2000, P= 0.005, whilst in the black African patients it was 240/µL and 230/µL for the same years.

Conclusions

There has been a reduction in new HIV diagnoses among the white population and a rise in the black Africans at this centre between 1994 and 2000. The clinical and immunological parameters of HIV disease have worsened over this time period for the white group, but have remained stable in the black Africans.
Atopic diseases among adults in the two geographically related arctic areas Nikel, Russia and Sør‐Varanger, Norway: possible effects of indoor and outdoor air pollution
Authors: Dotterud Lk , Odland Jø , Falk Es
Published: March 2003

Background Previous studies have shown lower prevalence of atopic diseases among adults and schoolchildren in Eastern Europe.

Objectives To compare the prevalence of atopic diseases among adults in two geographically related arctic areas, Nikel, Russia and Sør‐Varanger, Norway. Nikel is a heavily polluted town on the Kola Peninsula.

Methods The prevalence of eczema, asthma and allergic rhinoconjunctivitis (AR) was assessed using two identical questionnaire studies. The study in Sør‐Varanger was conducted in the autumn of 1991 and comprised 1102 adults. In the spring of 1994, 3368 adults in Nikel completed the 4‐page questionnaire.

Results The lifetime prevalence of atopic diseases was significantly higher in Sør‐Varanger than in Nikel (25.2% vs. 11.2%; P < 0.001), most pronounced for eczema (15.9% vs. 5.9%; P < 0.001) and AR (10.3% vs. 5.6%; P < 0.001). There was no significant difference in the prevalence of asthma between the two areas (5.6% vs. 4.9%; RR 1.1). Indoor dampness, carpeted floors and outdoor pollution were found to be significantly higher in Nikel than in Sør‐Varanger (P < 0.0001). Smoking habits were different in the two areas.

Conclusion Atopic diseases in Sør‐Varanger were more than twice that found in Nikel. Western lifestyle and new building techniques resulting in poorly ventilated homes may be the main reasons for these differences. Other factors, such as differences in seeking medical help for physical complaints and in the social and political environment, are also suggested.
Erythema multiforme along Blaschko’s lines
Authors: Micalizzi Claudia , Farris Alessandro
Published: March 2003

A case of erythema multiforme along Blaschko’s lines is reported in a 20‐year‐old female suffering from recurrent herpes labialis. Histological examination was compatible with the clinical features. Spontaneous resolution followed in 4 weeks without therapy.
Digital gangrene: a rare skin symptom in systemic lupus erythematosus
Authors: Vocks E , Welcker M , Ring J
Published: March 2003

A case of digital gangrene in a patient with systemic lupus erythematosus without secondary antiphospholipid syndrome is reported. The acute onset of the necrotizing acrovasculitis occurred without a history of Raynaud’s phenomenon. Preceding symptoms of the systemic lupus erythematosus were arthritis, photosensitivity, alopecia and anorexia. Despite the seriousness of the acute episode the patient achieved an excellent outcome.
Occupational protein contact dermatitis and paronychia from natural rubber latex
Authors: Kanerva L
Published: March 2003

Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.
Disseminated pagetoid reticulosis: plaques and tumoral lesions occurring simultaneously in the same patient
Authors: Bükülmez G , Atakan N , Taşkın M , Bilezikçi B , Üner A
Published: March 2003

Disseminated pagetoid reticulosis is considered to have a poor prognosis. Some authors regard this disease as an epidermotropic type of mycosis fungoides rather than a distinct entity. We report the case of an 83‐year‐old woman with disseminated pagetoid reticulosis who subsequently developed tumoral lesions and died soon after the appearance of these tumours. Our case is in agreement with findings that disseminated pagetoid reticulosis has an aggressive clinical behaviour.
Lupus erythematosus/lichen planus overlap syndrome with scarring alopecia
Authors: İnalöz HS , Chowdhury MMU , Motley RJ
Published: March 2003

Lupus erythematosus (LE) and lichen planus (LP) may occur as an overlap syndrome (LE/LP). The term comprises a heterogeneous group of patients who have clinical, histological and/or immunopathological characteristics of both diseases at the same time. The disease occurs so infrequently as to limit clinical cases for study. We present a case of scarring alopecia due to LE/LP overlap syndrome. Initial biopsy of the scalp showed scarring alopecia only, with subsequent biopsies showing histological features of LE. Direct immunofluorescence was negative for the LE band, but showed features consistent with LP. We report this case as an uncommon cause of scarring alopecia illustrating the importance of multiple biopsies in the diagnosis of LE/LP overlap syndrome.
Resolution of recurrent perianal condylomata acuminata by topical cidofovir in patients with HIV infection
Authors: Martinelli C , Farese A , Del Mistro A , Giorgini S , Ruffino I
Published: March 2003

Anogenital condylomata acuminata are the most frequent clinical manifestation of genital human papillomavirus (HPV) infection. Association between human immunodeficiency virus (HIV) and HPV infections is frequent (range: 26–60% in males). Topical cidofovir (a nucleotide analogue antiviral drug active against a broad range of DNA viruses) is a potential treatment for anogenital warts in immunocompromised patients. We treated three HIV‐infected patients with HPV perianal condylomas with topical 1% cidofovir in flexible collodion once a day for 2 weeks. The treatment resulted in complete clearance of the HPV lesions. The patients experienced mild transient erythema without any other side‐effects. None of the patients relapsed during the 10–14‐month follow‐up period.
Acne inversa (alias hidradenitis suppurativa)
Authors: Jansen T , Altmeyer P , Plewig G
Published: March 2003

Acne inversa is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. Once considered to be a disease of the apocrine glands, it is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned. In cases of familial acne inversa, the pattern of transmission and number of affected individuals are consistent with autosomal dominant inheritance. Aetiological factors such as hyperandrogenism, obesity, smoking and chemical irritants are not consistently associated with the affection. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process. Potential complications include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma. As spontaneous resolution is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention. Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of the disease.
Blue naevus with satellitosis mimicking malignant melanoma
Authors: Sahin MT , Demir MA , Yoleri L , Can M , Öztürkcan S
Published: March 2003

Blue naevus is an acquired benign melanocytic naevus. It is a firm, sharply defined dark blue to grey–black papule or nodule, which is likely to arise from the arrested dermal melanocytes in the dermis. In the last few years, blue naevus has attracted much attention due to the recognition of new entities and to its confusion with malignant melanoma. We report a 69‐year‐old man who developed a blue–black nodular lesion with satellitosis on his scalp. Although clinically it was thought to be a malignant melanoma, histopathological investigation and conservative methods such as dermatoscopy and power Doppler ultrasonography did not confirm this diagnosis. Histopathological examination excluded malignant melanoma, as there were no cellular atypia and mitotic activity in either the nodular lesion or the satellitosis. Doppler ultrasonography confirmed the benign nature of the lesion. Dermatoscopic examination showed homogeneous steel‐blue pigmentation with individual blue globules, dots and some brown veils, and confirmed the histopathological diagnosis. To the best of our knowledge, our case is the third reported case of a blue naevus with satellitosis mimicking malignant melanoma.
Seborrhoeic keratosis or occult malignant neoplasm of the skin?
Authors: Rigopoulos D , Rallis E , Toumbis‐Ioannou E , Christophidou E , Limas C , Katsambas A
Published: March 2003

Background Seborrhoeic keratosis is generally considered to be a benign lesion of the skin.

Observation We present the case of a 68‐year‐old male who presented with clinically typical seborrhoeic keratosis that later histological examination showed partially covered an occult basal cell carcinoma.

Objective To have an indication of what percentage of clinically apparent seborrhoeic keratoses may be associated with some form of histologically proven skin malignancy.

Methods We carried out a retrospective analysis of approximately 23 000 histopathological examinations done on specimens from dermatological lesions.

Results Fifty‐nine (11.9%) clinically apparent seborrhoeic keratoses were later histologically diagnosed as basal cell carcinomas, 17 (3.4%) as squamous cell carcinomas, and five (1.01%) as malignant melanomas.

Conclusions Although the association of seborrhoeic keratosis and skin malignancy appears to be relatively uncommon, the possibility of such an association cannot be ruled out.
Successful treatment of chromomycosis using carbon dioxide laser associated with topical heat applications
Authors: Hira K , Yamada H , Takahashi Y , Ogawa H
Published: March 2003

A 59‐year‐old Japanese man presented with a slightly elevated, pruritic, erythematous plaque on his left buttock measuring 5 × 5 cm in diameter. The man had a history of chromomycosis, dating 6 years prior to the current consultation, for which he had been treated with oral terbinafine. Diagnosis of a recurrence of chromomycosis of the skin due to infection by Foncecaea pedrosoi was made after careful analysis of the clinical features, skin biopsy, KOH mounts, and fungal culture results. We administered topical heat thereapy followed by treatment with CO2 laser to eradicate the unresponsive remnants of the lesion. The operative site re‐epithelized within 10 weeks, and 1 year after the treatment there was no evidence of recurrence.

 For a recalcitrant case of chromomycosis, as in this case, the use of CO2 laser combined with topical heat therapy may be a new therapeutic modality.
Are quality of family life and disease severity related in childhood atopic dermatitis?
Authors: Ben‐Gashir MA , Seed PT , Hay RJ
Published: March 2003

Background Atopic dermatitis (AD) can be traumatizing to family life. Little is known about the relationship between quality of life in AD and disease severity.

Objective To document family quality of life and relate this to severity of AD in children, for a 6‐month period from a given point in time.

Study design These data are part of a longitudinal study conducted in two parts of the UK to investigate risk factors for AD severity and its impact on quality of life.

Subjects and methods The targeted population comprised children with AD aged 5–10 years in a primary‐care setting. The general practitioners identified potential subjects and the UK diagnostic criteria for AD were used to verify the diagnosis. Both the children and their parents were interviewed. Eczema severity was assessed using a modified form of the SCORAD (SCORe Atopic Dermatitis) Index (SCORAD‐D) from which parents’ score of itching and sleep loss were excluded. The quality of family life was quantified by the Dermatitis Family Impact (DFI) questionnaire. These two parameters were evaluated on two occasions 6 months apart.

Analysis Multiple regression analysis was used to investigate the relationship between the quality of family life and the severity of the AD in the children, at a specific point in time and over the following 6‐month period.

Results Of the 116 children attending the first visit, mean age 8 years, 106 attended the second visit (91%) and were included in the analysis. Quality of family life was shown to be significantly affected in 48 (45%) cases at the first visit and 38 (36%) cases at the second visit. The initial means of the DFI and SCORAD‐D were 2.4 and 8.2, respectively. Six months later the mean final DFI and SCORAD‐D were 1.9 and 7.7, respectively. Using multiple regression on the first and second visits, each unit increase in SCORAD‐D was associated with 0.21 [95% confidence interval (CI) 0.06–0.37 P = 0.008] and 0.37 (95% CI 0.15–0.59, P = 0.001) units increase in quality of family life, respectively. This relationship remained significant even after adjustment for potential confounders (black skin, social class, sex, child's age, family size and location) each unit increase in SCORAD‐D led to a 0.25 unit (95% CI 0.11–0.4, P = 0.001) and 0.23 unit (95% CI 0.05–0.42, P = 0.014) increase in DFI on the first and second visits, respectively. Changes in the DFI scores were significantly related to changes in the SCORAD‐D scores (regression coefficient; 0.17 (95% CI 0.06–0.29, P = 0.002).

Conclusions We show that quality of family life is related to the severity of AD in children. This confirms the importance of parental assessment of the impact of the disease in the management of AD, because the disease affects the entire family. Also, these results show the response of DFI to change predictably with disease severity. This may imply that the DFI questionnaire could be used as an extra measure of outcome in everyday clinical practice as well as in research studies.
Granuloma annulare possibly triggered by antitetanus vaccination
Authors: Baykal C , Özkaya‐Bayazit E , Kaymaz R
Published: March 2003

We report the case of a 6‐year‐old girl with granuloma annulare (GA) possibly related to antitetanus vaccinations. The first episode occurred 2 months after the girl had been vaccinated but the lesions were not located at the vaccination site. After 1 year of being free of lesions, she had a second episode unrelated to vaccination. After another 6‐month lesion‐free period, the girl was administered another antitetanus vaccination and a solitary lesion developed at the vaccination site within 3 days. A few lesions developed on her legs in the 2 months following the appearance of the initial plaque. The literature includes two reports of cases with papular lesions limited to the hepatitis B vaccination site, both histopathologically consistent with necrobiotic granuloma, but clinically not suggestive of GA. To the best of our knowledge, GA following antitetanus vaccination and occurring at the vaccination site has not been reported before. Either the trauma alone from the injection or a vaccine‐induced immunological reaction might have triggered the necrobiosis of collagen through some unexplained mechanisms.
Intellectual and Daily Living Skills of 30‐year‐olds with Down's Syndrome: Continuation of a Longitudinal Study
Authors: Carr Janet
Published: March 2003

A cohort of infants with Down's syndrome (DS) born in 1964 were followed up again at the age of 30. They were tested on intelligence, language, reading and arithmetic, and their daily living skills were assessed. Comparison with the same tests given 9 years earlier showed almost no change. As before, higher scores were found for the women, those brought up at home, and, for language and reading, for those from social class nonmanual (NM) families but fewer of the differences were now significant. These results, demonstrating considerable stability over the period from age 21–30, are discussed with reference to other relevant research.
Parents telling their Offspring about Down Syndrome and Disability
Authors: Cunningham C. C. , Glenn S. , Fitzpatrick H.
Published: March 2003

The aim of the present study was to explore the role that parents play in fostering the understanding of Down Syndrome (DS) and intellectual disability in their offspring. The participants were 77 young people with DS, aged from 17 to 24 years, and their parents, who were part of the Manchester Down syndrome Cohort. Parents were asked if and how they had told the young person (and their siblings) about DS and disability. The young people with DS were interviewed and photographs were also used to determine whether or not they recognized DS. In addition, verbal mental ages were obtained as an approximation of cognitive level. The majority of families reported an open system of discussion and only five indicated that they had deliberately avoided the issue. However, 43% had not tried to tell explicitly; 53% of these parents felt that the young person would not understand and 32% felt that it was not an issue that affected their lives. The majority of these young people had verbal mental ages of less than 6 years and no demonstrated awareness of DS or disability on the measures used. The results were congruent with a developmental model of the appearance of social categorization. A relatively small number of young people had negative views or denied they had DS, but no association was found with parental telling.
Use of a Modified Azrin–Foxx Toilet Training Procedure with Individuals with Angelman Syndrome
Authors: Didden Robert , Sikkema Simone P. E. , Bosman Irma T. M. , Duker Pieter C. , Curfs Leopold M. G.
Published: March 2003

Incontinence of urine and faeces is commonly observed among children with intellectual disability. Although various procedures to establish toileting skills do exist, studies on their effectiveness with children with Angelman syndrome (AS) are lacking. In the present study, a procedure based on Azrin–Foxx toilet training was used to establish toileting skills in six children with intellectual disability and AS. All children showed improved toilet skills. Maintenance was documented by follow‐up recordings for up to 2.5 years. The results are discussed in terms of the specific relationship between the characteristics of trainees with AS and the present training procedure.
The Functional Analysis Checklist: Inter‐rater and Test–Retest Reliability
Authors: Sturmey Peter
Published: March 2003

The inter‐rater and test–retest reliability of the Functional Analysis Checklist (FAC) was evaluated for a random sample of target behaviours from a random sample of individuals in behaviour therapy programmes in a state school population. The reliability of the FAC was uniformly poor. This poor reliability was ascribed to the low frequency with which most items on the FAC were endorsed, the lack of training in functional assessment that most raters had, and the very variable forms and rates of behaviour problems rated.
Moving Home: Social Integration for Adults with Intellectual Disabilities Resettling into Community Provision
Authors: Ager Alastair , Myers Fiona , Kerr Patricia , Myles Susan , Green Ann
Published: March 2003

The present study examined levels of social integration for individuals resettling into community provision following the phased closure of Gogarburn Hospital, Edinburgh, UK, and the personal and service‐related characteristics which were influential on such integration. The study sample comprised 76 out of 95 individuals consecutively discharged over a 19‐month period. Post‐move data were collected between 6 and 9 months after community resettlement. At this time, mean ‘quality of life’ scores, established using the Life Experiences Checklist (LEC), were broadly equivalent to those reported from previous reprovisioning studies in the UK. However, scores in the domains of Relationships and Freedom remained well below general population norms. A pre‐move to post‐move comparison across the domains of the LEC suggested that the greatest impact of reprovisioning was in the areas of physical quality of residential provision (with overall standards above general population norms) and personal freedoms. Index of Community Involvement (ICI) scores showed a general increase in community presence, although activities requiring a high degree of personal autonomy remained infrequent. Social contacts recorded through diaries suggested a heavy bias towards contacts with staff and other service users as opposed to general community contacts (e.g. neighbours and shop workers). On average, over half the time spent outwith the home was in specialist or segregated service settings. For 18 individuals, there were losses or no gains in community involvement pre‐move to post‐move. A majority of these individuals were elderly. These findings are discussed in the context of policy targeting community participation, and the need for strengthening service features which encourage higher levels of social integration.
Chromosomal anomalies in fetal congenital heart disease
Authors: Allan L. D. , Sharland G. K. , Chita S. K. , Lockhart S. , Maxwell D. J.
Published: March 2003

A series of 467 cases of congenital heart disease detected in prenatal life were analyzed to identify the forms of cardiac malformation associated with karyotypic defects and to calculate the incidence of chromosomal abnormalities associated with such malformations. Of these, 77 were proved to have chromosomal anomalies although not all were karyotyped.

The results were analyzed in two ways. First, the whole series of 77 cases was examined in order to describe the form of congenital heart disease found in association as, although many cases were forms of heart disease known to be associated with chromosomal defects, several were unexpected. In many cases which proved positive, there were other abnormal findings on ultrasound, further suggesting a high likelihood of a chromosomal defect. Some cardiac defects, however, such as atrial isomerism or transposition of the great arteries, were not associated with trisomies.

The second part of the study examined in detail the records of 124 cases of congenital heart disease seen in 1989, as these were more completely documented than the previous cases. No chromosomal anomaly was therefore thought to be missed. Of this group, 20 (16%) proved positive. This is a higher rate than would be expected in an unselected population of live births. The difference between prenatal and postnatal life can be accounted for by the increased rate of spontaneous fetal loss in those with chromosomal defects.

We conclude that, because of the high rate of chromosomal anomaly, all continuing pregnancies where congenital heart disease has been found in the fetus should be karyotyped unless specific types of heart defect which are rarely associated are confidently defined. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Vanishing twins: the frequency of spontaneous fetal reduction of a twin pregnancy
Authors: Sampson A. , de Crespigny L. Ch.
Published: March 2003

This study examines the outcome of 126 twin pregnancies diagnosed by ultrasound examination at 6–16 weeks' gestation. Fifty‐nine patients conceived by in vitro fertilization (IVF) and embryo transfer and had a routine scan. The 67 non‐IVF pregnancies had a scan for other clinical indications including threatened abortion.

When live twins were detected prior to 7 weeks'gestation, only 71% of pregnancies resulted in live twin neonates. Each fetus of a multiple pregnancy had a 19% chance of dying in utero or in the neonatal period of diagnosed prior to 7 weeks, and 11% if both were found to be alive between 7 and 10 weeks. The fetal loss rate was similar for IVF and non‐IVF pregnancies. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Coronal transcerebellar diameter: an alternate view
Authors: Sarno A. P. , Rose G. S. , Harrington R. A.
Published: March 2003

Evaluation of the fetal cerebellum in the axial plane has become an important part of obstetric sonography. We report our experience with an alternate view, the coronal transcerebellar view, in 134 fetuses at gestational ages of 13–30 weeks. There is a linear first‐order correlation between axial and coronal transcerebellar diameters. Additionally, the coronal view was more reliably obtained, especially at gestational ages between 24 and 30 weeks. We believe that this view warrants further study, particularly in pathological states. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The sonographically thick placenta: a predictor of increased perinatal morbidity and mortality
Authors: Dombrowski M. P. , Wolfe H. M. , Saleh A. , Evans M. I. , O'Brien J.
Published: March 2003

In order to determine the prevalence and significance of sonographically thick placentas, we reviewed the computerized records of 18 827 viable, singleton pregnancies. Of these, 116 (0.6%) had thick placentas diagnosed by ultrasound examination. Perinatal mortality was markedly increased among pregnancies with thick placentas (odds ratio = 13.1, 95% confidence limits (CL) = 8.3–20.8), accounting for 6.2%; of the total. The rates of abruptio placentae (odds ratio = 2.9, CL = 1.1–8.1), neonatal intensive care unit admissions (odds ratio = 4.6, CL = 3.1–6.9) and anomalies (odds ratio = 8.4, CL = 4.9–14.4) were also significantly increased among the thick placenta cohort compared to controls. The 106 liveborn neonates with thick placentas had lower Apgar scores, were delivered at an earlier gestational age, and weighed less than controls. Anomalies, hydrops fetalis and abruptio placentae complicated 16 of the 24 cases of perinatal mortalities. Sonographically thick placentas should alert the clinician to the possibility of compromised perinatal outcome. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Early prediction of preterm delivery by transvaginal ultrasonography
Authors: Okitsu O. , Mimura T. , Nakayama T. , Aono T.
Published: March 2003

The clinical value of transvaginal ultrasonography in the evaluation of the uterine cervix of pregnant women was studied. Comparison with conventional transabdominal ultrasound in 24 pregnant subjects revealed that transvaginal ultrasound was superior, because the transabdominal technique usually requires a full bladder, which causes deformation and elongation of the cervix. Digital examination showed dilatation of the internal os in only ten (38.5%) of 26 patients in whom it had previously been shown by transvaginal sonography. Transvaginal ultrasonography has the advantage of providing natural and objective information on the cervix. The values of three sonographic signs found transvaginally for predicting preterm delivery were evaluated in a total of 130 at‐risk patients and 129 control subjects. Shortening of the cervical length by −1.5 SD or more was associated with an increased risk of preterm delivery (11.3% vs. 2.8%, p < 0.01). A dilated internal os of more than 5 mm before 30 weeks of gestation was associated with preterm delivery more often than an undilated internal os (33.3% vs. 3.5%, p < 0.01). Dynamic changes in the degree of dilatation of the cervical canal which were found in nine women were significantly related with preterm delivery (p < 0.05). But, in the at‐risk group, only dilatation of the internal os had a predictive value for preterm birth. From these data, dilatation of the internal os on transvaginal ultrasonography was proved to be an early and important predictor of preterm delivery. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester Down's syndrome screening using nuchal translucency: a prospective study in patients undergoing chorionic villus sampling
Authors: Brambati B. , Cislaghi C. , Tului L. , Alberti E. , Amidani M. , Colombo U. , Zuliani G.
Published: March 2003

The value of the measurement of nuchal translucency thickness for predicting fetal Down's syndrome and other aneuploidies was prospectively evaluated at 8–15 weeks of gestation in 1819 consecutive pregnancies scheduled for karyotyping by chorionic villus sampling. In 43 cases, a chromosomal unbalanced aberration was found. Two teams of ultrasonologists who examined patients attending either National Health Service (Series 1) or private practice clinics (Series 2) were involved in the study. The same type of ultrasound machine and standardized approach were used in both study groups. In those cases in which the maximum subcutaneous thickness of the translucency was 3 mm or greater, the incidence of chromosomal aberration was 18.6% compared to 1.7% in the cases in which this was below 3 mm. The sensitivity, specificity and relative risk for all aneuploidies were 30%, 96% and 10.83, respectively, and no difference was found between trisomy 21 and other types of aneuploidy. The sensitivity and specificity and relative risk were significantly higher at 9–10 weeks than between 11 and 15 weeks. The results were concordant in the two series; however, the overall values for sensitivity (20% vs. 39%), specificity (94% vs. 98%) and relative risk (4.13 vs. 24.20) were clearly higher in the group of private patients. The results obtained confirm the potential application of the measurement of nuchal translucency thickness for fetal aneuploidy screening before the end of the first trimester and suggest that a multiplicity of individual, structural and organizational factors may interact and play a crucial role in determining the actual efficiency of ultrasound screening programs. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology