bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroplasticity of the Hypothalamic–Pituitary–Adrenal Axis Early in Life Requires Recurrent Recruitment of Stress-Regulating Brain Regions
Authors: Fenoglio Kristina A. , Chen Yuncai , Baram Tallie Z.
Published: March 2006

An eloquent example of experience-induced neuroplasticity involves the enduring effects of daily “handling” of rat pups on the expression of genes regulating hormonal and behavioral responses to stress. Handling-evoked augmentation of maternal care of pups induces long-lasting reduction of hypothalamic corticotropin releasing hormone (CRH) expression and upregulates hippocampal glucocorticoid receptor levels. These changes promote a lifelong attenuation of hormonal stress responses. We have found previously that handling-evoked downregulation of CRH expression occurs already by postnatal day 9, implicating it as an early step in this experience-induced neuroplasticity. Here, we investigated the neuronal pathways and cellular mechanisms involved. CRH mRNA expression in hypothalamic paraventricular nucleus (PVN) diminished after daily handling but not after handling once only, indicating that “recurrent” handling was required for this effect. Return of handled pups to their cage provoked a burst of nurturing behavior in dams that, in turn, induced transient, coordinate Fos expression in selected regions of the pups’ brains. These included central nucleus of the amygdala (ACe) and bed nucleus of the stria terminals (BnST), regions that are afferent to PVN and influence CRH expression there. Whereas handling once sufficed to evoke Fos expression within ACe and BnST, expression in thalamic paraventricular nucleus, a region involved in storing and processing stress-related experience, required recurrent handling. Fos induction in all three regions elicited reduced transcription factor phosphorylation, followed by attenuated activation of CRH gene transcription within the PVN. These studies provide a neurobiological foundation for the profound neuroplasticity of stress-related genes evoked by early-life experience.
Brain-Specific Regulator of G-Protein Signaling 9-2 Selectively Interacts with α-Actinin-2 to Regulate Calcium-Dependent Inactivation of NMDA Receptors
Authors: Bouhamdan Mohamad , Yan Hai-Dun , Yan Xiu-Hua , Bannon Michael J. , Andrade Rodrigo
Published: March 2006

Regulator of G-protein signaling 9-1 (RGS9-1) and RGS9-2 are highly related RGS proteins with distinctive C termini arising from alternative splicing of RGS9 gene transcripts. RGS9-1 is expressed in photoreceptors where it functions as a regulator of transducin. In contrast, RGS9-2 is abundantly expressed in the brain, especially in basal ganglia, where its specific function remains poorly understood. To gain insight into the function of RGS9-2, we screened a human cDNA library for potential interacting proteins. This screen identified a strong interaction between RGS9-2 and α-actinin-2, suggesting a possible functional relationship between these proteins. Consistent with this idea, RGS9-2 and α-actinin-2 coimmunoprecipitated after coexpression in human embryonic kidney 293 (HEK-293) cells. Furthermore, endogenous RGS9-2 and α-actinin-2 could also be coimmunoprecipitated from extracts of rat striatum, an area highly enriched in both these proteins. These results supported the idea that RGS9-2 and α-actinin-2 could act in concert in central neurons. Like α-actinin-2, RGS9-2 coimmunoprecipitated NMDA receptors from striatal extracts, suggesting an interaction between RGS9-2, α-actinin-2, and NMDA receptors. Previous studies have shown that α-actinin mediates calcium-dependent inactivation of NMDA receptors. In HEK-293 cells expressing NMDA receptors, expression of RGS9-2 significantly modulated this form of NMDA receptor inactivation. Furthermore, this modulation showed remarkable preference for NMDA receptor inactivation mediated by α-actinin-2. Using a series of deletion constructs, we localized this effect to the RGS domain of the protein. These results identify an unexpected functional interaction between RGS9-2 and α-actinin-2 and suggest a potential novel role for RGS9-2 in the regulation of NMDA receptor function.
Why Does Fever Trigger Febrile Seizures? GABAAReceptor γ2 Subunit Mutations Associated with Idiopathic Generalized Epilepsies Have Temperature-Dependent Trafficking Deficiencies
Authors: Kang Jing-Qiong , Shen Wangzhen , Macdonald Robert L.
Published: March 2006

With a worldwide incidence as high as 6.7% of children, febrile seizures are one of the most common reasons for seeking pediatric care, but the mechanisms underlying generation of febrile seizures are poorly understood. Febrile seizures have been suspected to have a genetic basis, and recently, mutations in GABAAreceptor and sodium channel genes have been identified that are associated with febrile seizures and generalized seizures with febrile seizures plus pedigrees. Pentameric GABAAreceptors mediate the majority of fast synaptic inhibition in the brain and are composed of combinations of α(1–6), β(1–3), and γ(1–3) subunits. In αβγ2 GABAAreceptors, the γ2 subunit is critical for receptor trafficking, clustering, and synaptic maintenance, and mutations in the γ2 subunit have been monogenically associated with autosomal dominant transmission of febrile seizures. Here, we report that whereas trafficking of wild-type α1β2γ2 receptors was slightly temperature dependent, trafficking of mutant α1β2γ2 receptors containing γ2 subunit mutations [γ2(R43Q), γ2(K289M), and γ2(Q351X)] associated with febrile seizures was highly temperature dependent. In contrast, trafficking of mutant α1β2γ2 receptors containing an α1 subunit mutation [α1(A322D)] not associated with febrile seizures was not highly temperature dependent. Brief increases in temperature from 37 to 40°C rapidly (<10 min) impaired trafficking and/or accelerated endocytosis of heterozygous mutant α1β2γ2 receptors containing γ2 subunit mutations associated with febrile seizures but not of wild-type α1β2γ2 receptors or heterozygous mutant α1(A322D)β2γ2 receptors, suggesting that febrile seizures may be produced by a temperature-induced dynamic reduction of susceptible mutant surface GABAAreceptors in response to fever.
TRPV1 Recapitulates Native Capsaicin Receptor in Sensory Neurons in Association with Fas-Associated Factor 1
Authors: Kim Sangsung , Kang Changjoong , Shin Chan Young , Hwang Sun Wook , Yang Young Duk , Shim Won Sik , Park Min-Young , Kim Eunhee , Kim Misook , Kim Byung-Moon , Cho Hawon , Shin Youngki , Oh Uhtaek
Published: March 2006

TRPV1, a cloned capsaicin receptor, is a molecular sensor for detecting adverse stimuli and a key element for inflammatory nociception and represents biophysical properties of native channel. However, there seems to be a marked difference between TRPV1 and native capsaicin receptors in the pharmacological response profiles to vanilloids or acid. One plausible explanation for this overt discrepancy is the presence of regulatory proteins associated with TRPV1. Here, we identify Fas-associated factor 1 (FAF1) as a regulatory factor, which is coexpressed with and binds to TRPV1 in sensory neurons. When expressed heterologously, FAF1 reduces the responses of TRPV1 to capsaicin, acid, and heat, to the pharmacological level of native capsaicin receptor in sensory neurons. Furthermore, silencing FAF1 by RNA interference augments capsaicin-sensitive current in native sensory neurons. We therefore conclude that FAF1 forms an integral component of the vanilloid receptor complex and that it constitutively modulates the sensitivity of TRPV1 to various noxious stimuli in sensory neurons.
Thalidomide and Lenalidomide Extend Survival in a Transgenic Mouse Model of Amyotrophic Lateral Sclerosis
Authors: Kiaei Mahmoud , Petri Susanne , Kipiani Khatuna , Gardian Gabrielle , Choi Dong-Kug , Chen Junyu , Calingasan Noel Y. , Schafer Peter , Muller George W. , Stewart Charles , Hensley Kenneth , Beal M. Flint
Published: March 2006

Accumulating evidence suggests that inflammation plays a major role in the pathogenesis of motor neuron death in amyotrophic lateral sclerosis (ALS). Important mediators of inflammation such as the cytokine tumor necrosis factor-α (TNF-α) and its superfamily member fibroblast-associated cell-surface ligand (FasL) have been implicated in apoptosis. We found increased TNF-α and FasL immunoreactivity in lumbar spinal cord sections of ALS patients and G93A transgenic mice. Both increased TNF-α and FasL immunostaining in the lumbar spinal cord of the G93A SOD1 transgenic mice occurred at 40–60 d, well before the onset of symptoms and loss of motor neurons. We tested the neuroprotective effect of thalidomide and its analog lenalidomide, pharmacological agents that inhibit the expression of TNF-α and other cytokines by destabilizing their mRNA. Treatment with either thalidomide or lenalidomide attenuated weight loss, enhanced motor performance, decreased motor neuron cell death, and significantly increased the life span in G93A transgenic mice. Treated G93A mice showed a reduction in TNF-α and FasL immunoreactivity as well as their mRNA in the lumbar spinal cord. Both compounds also reduced interleukin (IL)-12p40, IL-1α, and IL-1β and increased IL-RA and TGF-β1 mRNA. Therefore, both thalidomide and lenalidomide bear promise as therapeutic interventions for the treatment of ALS.
Determination of the Thermo and Magneto Phoresis by the Dissipative Function
Authors: van Vaerenbergh Stéfan , Hennenberg Marcel , Weyssow Boris
Published: February 2006

Three different thermally induced phoresis of magnetic colloids are indentified using thermodynamics of irreversible processes. Has been used an exact and original implementation of the mechanical balance that conciliates it with the usual hydrodynamic description of phoresis used to quantify the transport coefficients. Here, only the “translational” approximation has been developed. Are so distinguished: thermomagneto chemophoresis, reversibly coupled to chemophoresis (diffusion), and irreversibly coupled to them, the thermophoresis and magnetophoresis that occurs because the system is a polarized one. The two latter are quantified respectively by the “heat of transport” and the here introduced “magnetisation of transport”. The effects are better compared to thermophoresis, that can be measured individually, and reference measurements of them are mandatory to understand the experimental results.
Barossa Slow: The Representation and Rhetoric of Slow Food's Regional Cooking
Authors: peace adrian
Published: March 2006

The concept of regional cooking plays a prominent part in the rhetoric of the Slow Food movement. But how is the notion of a regional cuisine translated into practice by the organizers of events which must satisfy the expectations of an informed and a discerning membership? This essay examines one such Australian event from an anthropological perspective. It is argued that ideas about region and community, heritage and tradition, the authentic and the original, were as carefully attended to by the organizers of Barossa Slow as the rich foods and fine wines that were put on the table. Particular attention is accorded to the part played by organized tours in which prominent artisans detailed the local materials, the well-tried technologies and the social relations which were brought together in the production of regionally specific foods and wines. In order to satisfy the cultural expectations of Slow Food's predominantly middle class membership, the manufacture of myth proved quite as significant as the consumption of cuisine in the success of this particular occasion.
Wheat into Flour: A Story of Milling
Authors: gage fran
Published: March 2006

This article chronicles the milling of wheat beginning with its cultivation about ten thousand years ago. It describes the milling of the grain, starting with primitive hand tools, progressing to larger mills, then the use of animal power to turn milling stones. Changes in the design of the mills made them more efficient. Using flowing water to turn the millstone greatly increased output; people without access to flowing water devised mills turned by the wind. As wheat became a more important crop, an automated system, using elevators and gravity chutes, made it possible to mill even more grain. Technological advances led to changes——rollers replaced stones, steam replaced water, and electricity eventually replaced steam as the mill's energy source. Modern mills employ sophisticated machinery in an attempt to extract as much flour from the wheat kernels as possible.
Using Video Recording to Identify Management Errors in Pediatric Trauma Resuscitation
Authors: Oakley Ed , Stocker Sergio , Staubli Georg , Young Simon
Published: March 2006

OBJECTIVE. To determine the ability of video recording to identify management errors in trauma resuscitation and to compare this method with medical record review.

METHOD. The resuscitation of children who presented to the emergency department of the Royal Children's Hospital between February 19, 2001, and August 18, 2002, for whom the trauma team was activated was video recorded. The tapes were analyzed, and management was compared with Advanced Trauma Life Support guidelines. Deviations from these guidelines were recorded as errors. Fifty video recordings were analyzed independently by 2 reviewers. Medical record review was undertaken for a cohort of the most seriously injured patients, and errors were identified. The errors detected with the 2 methods were compared.

RESULTS. Ninety resuscitations were video recorded and analyzed. An average of 5.9 errors per resuscitation was identified with this method (range: 1–12 errors). Twenty-five children (28%) had an injury severity score of >11; there was an average of 2.16 errors per patient in this group. Only 10 (20%) of these errors were detected in the medical record review. Medical record review detected an additional 8 errors that were not evident on the video recordings. Concordance between independent reviewers was high, with 93% agreement.

CONCLUSIONS. Video recording is more effective than medical record review in detecting management errors in pediatric trauma resuscitation. Management errors in pediatric trauma resuscitation are common and often involve basic resuscitation principles. Resuscitation of the most seriously injured children was associated with fewer errors. Video recording is a useful adjunct to trauma resuscitation auditing.
A Typical Feeding Enhances Memory for Spoken Words in Healthy 2- to 3-Day-Old Newborns
Authors: Valiante A. Grace , Barr Ronald G. , Zelazo Philip R. , Papageorgiou Apostolos N. , Young Simon N.
Published: March 2006

OBJECTIVE. The objective of this study was to determine whether healthy 2- to 3-day-old newborns have better memory of a spoken word after a typical feeding (breast milk or formula) than before a feeding and, if so, whether memory is related to blood glucose.

METHODS. A naturalistic study was conducted in which delayed recognition memory of a spoken word was examined in 60 healthy 2- to 3-day-old newborns either 120 minutes after their previous feeding (preprandial) or 30 minutes after their last feeding (postprandial). In this procedure, infants initially turn their head toward a novel word (orientation) and with repeated presentations cease turning toward it (habituation). Mean number of trials to reach orientation and habituation criteria provides measures of attention and rate of learning, respectively. After a 100-second delay, the word is presented again. Infants either turn toward it, indicating that they have forgotten it, or remain habituated, indicating that they remembered the word. Percentage of trials with head turns toward the word after the delay is the principal dependent measure.

RESULTS. The postprandial group was split at the median for blood glucose to define high- and low-glucose groups. All 3 groups showed similar rates of orientation and habituation. On reexposure to the word during postdelay trials, the preprandial group displayed less retention than the postprandial high and low groups. No correlation was found between memory and blood glucose levels. The postprandial high blood glucose level differed statistically from the preprandial level, whereas the postprandial low level did not.

CONCLUSIONS. Memory for spoken words in newborns is better after a typical milk feeding than before a feeding. This feeding effect is specific to memory and does not include attention or rate of learning. Also, it is not necessarily associated with increased blood glucose. It remains to be seen whether feeding enhances memory for other types of stimuli and what implications this may have for development.
Reasons for Testing and Clinical and Demographic Profile of Adolescents With Non–Perinatally Acquired HIV Infection
Authors: Grant Althea M. , Jamieson Denise J. , Elam-Evans Laurie D. , Beck-Sague Consuelo , Duerr Ann , Henderson Sheryl L.
Published: March 2006

OBJECTIVES. We sought to examine the demographic, clinical, and behavioral characteristics; reasons for HIV testing; and factors that contribute to delays in entry into specialized HIV care after diagnosis of HIV infection among adolescents in an urban clinic in Georgia.

METHODS. All of the data for this study were obtained solely by medical chart review. Demographic, clinical, behavioral, and HIV testing data were abstracted from medical charts of 59 non–perinatally HIV-infected adolescents who were aged 13 to 18 years and entered care at the pediatric and adolescent HIV clinic of a Georgia hospital during 1999–2002. HIV-infected adolescents were compared by demographic, clinical, and behavioral characteristics as well as by circumstances surrounding HIV testing. Recent seroconversion was defined as having a documented negative or indeterminate HIV antibody test (confirmed) or a self-reported negative HIV test (probable) ≤6 months before HIV diagnosis.

RESULTS. Of 59 HIV-infected adolescents, 35 (59%) were female and 56 (95%) were black/African American. Fifteen (25%) had ≥1 sexually transmitted infection when they entered care. All female (vs 38% male) adolescents were infected through heterosexual sexual intercourse; 9 (26%) were pregnant at the time of HIV diagnosis. Adolescents whose HIV was diagnosed at non–health care facilities entered HIV care much later than adolescents whose HIV was diagnosed at health care facilities (median: 108 vs 25 days). Approximately one half of adolescents had CD4+ T-cell counts <350 cells per μL and/or HIV-1 viral loads >55000 copies per mL at entry into care. Twenty-seven (46%) adolescents had a previous negative HIV test; 7 had confirmed recent seroconversion, and 3 had probable recent seroconversion. Among adolescents with a documented reason for testing, routine medical screening was the most frequent reason for HIV testing; few adolescents were documented as having self-initiated HIV testing.

CONCLUSIONS. Strategies are needed to implement timely linkage to medical services of adolescents who receive a diagnosis of HIV infection at non–health care facilities and to increase HIV testing, prevention efforts, and recognition of recent HIV infection among sexually active adolescents.
A Behavioral and Cognitive Profile of Clinically Stable HIV-Infected Children
Authors: Nozyce Molly L. , Lee Sophia S. , Wiznia Andrew , Nachman Sharon , Mofenson Lynne M. , Smith Mary E. , Yogev Ram , McIntosh Kenneth , Stanley Kenneth , Pelton Stephen
Published: March 2006

OBJECTIVE. The purpose of this research was to characterize behavioral and cognitive profiles of clinically and immunologically stable antiretroviral-experienced HIV-infected children.

METHODS. Two hundred seventy-four previously treated HIV-infected children aged 2 to 17 years were assessed for behavioral, developmental, and cognitive functioning. Correlations between neuropsychological measures, age, and CD4 lymphocyte count were investigated.

RESULTS. The most common behavioral problems, as measured by the Conners' Parent Rating Scale, were psychosomatic (28%), learning (25%), hyperactivity (20%), impulsive-hyperactive (19%), conduct (16%), and anxiety (8%) problems. Mean Wechsler Intelligence Scale for Children-III scores were less than established population norms; the mean verbal IQ was 85, the mean performance IQ was 90, and the mean full-scale score was 86. Hyperactivity was more frequent in children with a Wechsler Intelligence Scale for Children-III performance IQ of <90. Anxiety problems were more likely in children ≥9 years of age. Children with CD4 counts of <660 cells per mm3 were more likely to be identified as having a conduct disorder. No association was noted between behavioral problems and neuroimaging.

CONCLUSIONS. Clinically and immunologically stable HIV-infected children had more frequent behavioral problems and lower developmental and cognitive scores than established childhood norms.
Birth Characteristics and Risk of Low Intellectual Performance in Early Adulthood: Are the Associations Confounded by Socioeconomic Factors in Adolescence or Familial Effects?
Authors: Bergvall Niklas , Iliadou Anastasia , Tuvemo Torsten , Cnattingius Sven
Published: March 2006

OBJECTIVE. In this study we investigated whether the association between measures of fetal growth restriction and intellectual performance was mediated by socioeconomic or familial factors.

METHODS. This was a population-based cohort study of 357768 Swedish males born as singletons without congenital malformations between 1973 and 1981. The main outcome measure was intellectual performance at military conscription.

RESULTS. Compared with men born with appropriate birth weight for gestational age, men born light for gestational age suffered an increased risk of low intellectual performance after adjustment for maternal and socioeconomic factors. The increase in risk of low intellectual performance related to a decrease in birth weight for gestational age was similar between families and within families. Men born short or with a small head circumference for gestational age were also at increased risk of low intellectual performance, both when adjusting for maternal and socioeconomic factors and within families.

CONCLUSIONS. We found that all of the studied dimensions of restricted fetal growth are independently associated with increased risks of low intellectual performance and that these associations are only partly mediated by socioeconomic or familial factors.
Prevalence, Stability, and Outcomes of Cry-Fuss and Sleep Problems in the First 2 Years of Life: Prospective Community-Based Study
Authors: Wake Melissa , Morton-Allen Elise , Poulakis Zeffie , Hiscock Harriet , Gallagher Susan , Oberklaid Frank
Published: March 2006

OBJECTIVE. To report the prevalence and stability of cry-fuss problems during the first 4 months of life and sleep problems from 2 to 24 months and relationships between the persistence of cry-fuss and sleep problems and outcomes at 24 months.

METHODS. The study was a prospective cohort study in maternal and child health centers in 3 local government areas in Melbourne, Australia. A total of 483 first-born infants were monitored prospectively from 2 weeks through 2, 4, 8, 12, 18, and 24 months. Child behavior, maternal depression, parenting stress, and marital quality were assessed. Predictor variables were parent reports of moderate or greater cry-fuss problems (2 and 4 months) and sleep problems (8, 12, 18, and 24 months) and parent-reported, 24-hour, sleep/cry-fuss diaries (2, 4, and 12 months).

RESULTS. The response rate was 68% (483 of 710 infants); the attrition rate was <6%. The prevalence of cry-fuss problems decreased from 19.1% at 2 months to 12.8% at 4 months, with 5.6% of mothers reporting cry-fuss problems at both ages. Prevalence rates of sleep problems were 21.2%, 16.2%, 10.0%, and 12.1% at 8, 12, 18, and 24 months, respectively; 6.4% had a problem at ≥3 of these ages. In multivariate analyses, cry-fuss/sleep problems at ≥3 previous time points (but not 1 or 2 time points) contributed significantly to depression (2.8% of variance), total behavior (1.4% of variance), and total stress (4.6% of variance) scores. Repeated problems had a greater impact than a concurrent sleep problem on depression and stress scores, whereas the reverse was true for behavior scores.

CONCLUSIONS. Most cry-fuss and sleep problems in the first 2 years of life are transient. Persistent, rather than transient, problems contribute to maternal depression, parenting stress, and subsequent child behavior problems.
Parents' Perceptions of Their Child's Weight and Health
Authors: Eckstein Kathryn C. , Mikhail Laura M. , Ariza Adolfo J. , Thomson J. Scott , Millard Scott C. , Binns Helen J. ,   for the Pediatric Practice Research Group
Published: March 2006

OBJECTIVE. This study explored parents' perceptions about their child's appearance and health and evaluated a tool to determine parents' visual perception of their child's weight.

METHODS. Parents of children aged 2 to 17 years were surveyed concerning their child's appearance and health and opinions about childhood overweight. They also selected the sketch (from 7 choices) that most closely matched the body image of their child using 1 of 8 gender–and age-range–specific panels of sketches. Children's height and weight were measured. Respondents were grouped by child body mass index (BMI) percentile (<5th, 5–84th, 85–94th [at risk for overweight (AROW)], and ≥95th [overweight]). Those with BMI ≥5th percentile were analyzed. Logistic regression was used to examine factors influencing parental perceptions and levels of worry about their overweight or AROW child.

RESULTS. Of the 223 children, 60% were <6 years old, 42% were male, 17% were black, 35% were Hispanic, 42% were white, and 7% were other; 19% were AROW, and 20% were overweight. Few parents (36%) identified their overweight or AROW child as “overweight” or “a little overweight” using words, but more (70%) selected a middle or heavier sketch. Among parents of overweight and AROW children, 18% recalled a doctor’s concern and 26% were worried about their child’s weight. If the overweight or AROW child was age ≥6 years, parents were more likely to identify their child as “overweight” or “a little overweight” using words, select a middle or heavier sketch, and to be worried. Parents of older children were more likely to be worried if they perceived their child as less active/slower than other children or recalled a doctor’s concern.

CONCLUSIONS.Few parents of overweight and AROW children recognized their child as overweight or were worried. Recognition of physical activity limitations and physicians’ concerns may heighten the parent's level of concern. Sketches may be a useful tool to identify overweight children when measurements are not available.
Emergency Physicians' Prescribing of Asthma Controller Medications
Authors: Scarfone Richard J. , Zorc Joseph J. , Angsuco Cherrie J.
Published: March 2006

OBJECTIVES. To determine the frequency with which emergency department (ED) physicians prescribe long-term controller medications (LTCMs) for children with asthma, to assess ED physicians' awareness of and level of agreement with national guidelines for LTCM use, and to identify criteria ED physicians use to prescribe LTCMs and barriers to the use of LTCMs.

METHODS. A survey of all physician members of the American Academy of Pediatrics Section on Emergency Medicine who provide care for children in an ED was performed.

RESULTS. Surveys were returned by 391 (50%) of 782 physicians. The majority (80%) indicated that fewer than one half of children with persistent asthma were using LTCMs on ED arrival. Although 99% believe that children with persistent asthma should be treated with LTCMs, <20% provide LTCMs for the majority of such children at ED discharge. For 49%, the main reason for not prescribing these medications was the belief that this was the role of the primary care provider or asthma specialist. Practice setting, prior training, and annual patient volume were not associated significantly with prescribing LTCM. Patient's age and likelihood of compliance and physician's belief in efficacy and concerns about adverse effects were not important criteria in the decision to begin LTCM.

CONCLUSIONS. ED physicians often encounter children with persistent asthma who are not receiving LTCMs, they believe in the efficacy and safety of LTCMs, and they think that children with persistent disease should be treated with LTCMs, but they prescribe LTCMs infrequently.
Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents: A Randomized, Controlled Pilot Study
Authors: Ebbeling Cara B. , Feldman Henry A. , Osganian Stavroula K. , Chomitz Virginia R. , Ellenbogen Sheila J. , Ludwig David S.
Published: March 2006

OBJECTIVE. The role of sugar-sweetened beverages (SSBs) in promoting obesity is controversial. Observational data link SSB consumption with excessive weight gain; however, randomized, controlled trials are lacking and necessary to resolve the debate. We conducted a pilot study to examine the effect of decreasing SSB consumption on body weight.

METHODS. We randomly assigned 103 adolescents aged 13 to 18 years who regularly consumed SSBs to intervention and control groups. The intervention, 25 weeks in duration, relied largely on home deliveries of noncaloric beverages to displace SSBs and thereby decrease consumption. Change in SSB consumption was the main process measure, and change in body mass index (BMI) was the primary end point.

RESULTS. All of the randomly assigned subjects completed the study. Consumption of SSBs decreased by 82% in the intervention group and did not change in the control group. Change in BMI, adjusted for gender and age, was 0.07 ± 0.14 kg/m2 (mean ± SE) for the intervention group and 0.21 ± 0.15 kg/m2 for the control group. The net difference, −0.14 ± 0.21 kg/m2, was not significant overall. However, baseline BMI was a significant effect modifier. Among the subjects in the upper baseline-BMI tertile, BMI change differed significantly between the intervention (−0.63 ± 0.23 kg/m2) and control (+0.12 ± 0.26 kg/m2) groups, a net effect of −0.75 ± 0.34 kg/m2. The interaction between weight change and baseline BMI was not attributable to baseline consumption of SSBs.

CONCLUSIONS. A simple environmental intervention almost completely eliminated SSB consumption in a diverse group of adolescents. The beneficial effect on body weight of reducing SSB consumption increased with increasing baseline body weight, offering additional support for American Academy of Pediatrics guidelines to limit SSB consumption.
Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children
Authors: Montgomery-Downs Hawley E. , O’Brien Louise M. , Gulliver Tanya E. , Gozal David
Published: March 2006

OBJECTIVE. The objective of this study was to describe overnight polysomnographic measures in normal children aged 3 to 7 years. We conducted a retrospective analysis of normal polysomnographic evaluations from participants in 2 large community-based studies of sleep-disordered breathing among preschoolers and early school-aged children at Kosair Children’s Hospital Sleep Medicine Research Center at the University of Louisville. Participants included 542 healthy children with ages ranging from 3.2 to 8.6 years.

RESULTS. Subjects were excluded from analysis if they had documented snoring during polysomnography, an obstructive apnea-hypopnea index of ≥1.0, or a periodic leg-movement index of ≥5.0. Because the greatest differences in polysomnography occurred between ages 5 and 6 years, analyses were performed for children 3 to 5 years and for ages ≥6. Sleep cyclicity was distinct between age groups, with both showing an initial brief rapid-eye-movement period, which lengthened across the night, but only the older group showing a decrease in cycle length across the night. Average obstructive apnea indices were 0.03 per hour of total sleep time (TST) for 3- to 5-year-old children and 0.05 per hour of TST for ≥6-year-old children, whereas central apnea indices were 0.82 and 0.45 per hour of TST, respectively. Older children spent a greater percentage of sleep time supine, and the apnea-hypopnea index differed according to body position. Twenty percent of all subjects had end tidal carbon dioxide values of >45 mm Hg, and 2.2% had recorded values >50 mm Hg during ≥50% TST. High variance was present on all measures.

CONCLUSIONS. Developmental changes occur in several polysomnographic measures among normal children from 3 to 7 years of age, particularly during transition from preschool to early school age. Our findings in a large number of healthy community children comprise the most extensive compilation of normative reference values for laboratory-based pediatric polysomnography to date.
Patterns of Infantile Hemangiomas: New Clues to Hemangioma Pathogenesis and Embryonic Facial Development
Authors: Haggstrom Anita N. , Lammer Edward J. , Schneider Richard A. , Marcucio Ralph , Frieden Ilona J.
Published: March 2006

OBJECTIVES. Large facial infantile hemangiomas have higher rates of complications than small localized hemangiomas, more often require treatment, and can be associated with neurological, ophthalmologic, and cardiac anomalies (PHACE syndrome). The anatomic patterns of these hemangiomas are often referred to as “segmental” despite a lack of precise anatomic definitions. Our study aims to define “segmental” hemangiomas based on clinically observed patterns. Our secondary goal is to relate the observed patterns to currently accepted developmental patterns to gain insight into hemangioma pathogenesis and craniofacial development.

METHODS. Photographic data were extracted from a large cohort of patients with infantile hemangiomas. We mapped 294 hemangiomas and recorded common morphologic patterns. Anatomic descriptions of the most common patterns were described and compared with accepted concepts of craniofacial development.

RESULTS. Four primary segments were identified (Seg1–Seg4). Seg2 and Seg3 correspond with the previously recognized maxillary and mandibular prominences. Seg1 and Seg4 differ from standard human embryology texts. The frontotemporal segment, Seg1, encompasses the lateral forehead, anterior temporal scalp, and lateral frontal scalp. The segment Seg4, encompassing the medial frontal scalp, nasal bridge, nasal tip, ala, and philtrum, is substantially narrower on the forehead than the previously described frontonasal prominence.

CONCLUSIONS. The patterns provide new clues regarding facial development. The observed patterns resemble previously described facial developmental units on the lower face but are distinctly different on the upper face. The patterns suggest that neural crest derivatives may play a role in the development of facial hemangiomas. Finally, these patterns (Seg1–Seg4) help standardize the nomenclature of facial segmental hemangiomas to analyze more effectively hemangioma risks and behavior.
Racial and Socioeconomic Disparity in Perforated Appendicitis Among Children: Where Is the Problem?
Authors: Nwomeh Benedict C. , Chisolm Deena J. , Caniano Donna A. , Kelleher Kelly J.
Published: March 2006

OBJECTIVE. Significant racial, ethnic, and socioeconomic disparities have been observed in the rates of perforated appendicitis among children, by using large administrative databases. This study evaluated whether these factors had an impact on the care of patients with appendicitis at a major children's hospital with a well-established, comprehensive, primary referral system.

METHODS. A retrospective analysis was performed for all children between the ages of 2 and 20 years who were treated for appendicitis between January 1, 2001, and December 31, 2003. Demographic variables included patient age, gender, race, insurance status, parental educational status, and income level. Coding data were used to identify patients with perforated appendicitis. The use of radiologic imaging was also analyzed.

RESULTS. During the 3-year period, 788 patients were treated for appendicitis. The racial distribution (white: 81%; black: 12%; other: 7%) was consistent with the demographic composition of the local population. The overall perforation rate was 25%, and the rate was significantly greater in the age group of <6 years, compared with older children. However, there were no significant differences in the perforation rate with respect to race, insurance status, educational level, or income status. Rates of radiologic imaging use were similar among all racial and socioeconomic groups.

CONCLUSIONS. Although racial and socioeconomic disparities in the rates of perforated appendicitis among children have been reported, we found no significant evidence for such inequality at our institution. This may reflect improved access, early diagnosis, and referral by primary care physicians in the community. Pooled national and multiple-state administrative databases have been used to highlight persistent disparities in health care. This study illustrates how single-institution data sources can be used to test a local hypothesis generated by national data, with surprisingly different results.
Prophylaxis With Acetaminophen or Ibuprofen for Prevention of Local Reactions to the Fifth Diphtheria-Tetanus Toxoids-Acellular Pertussis Vaccination: A Randomized, Controlled Trial
Authors: Jackson Lisa A. , Dunstan Maya , Starkovich Patty , Dunn John , Yu Onchee , Nelson Jennifer C. , Rees Thom , Zavitkovsky Ann
Published: March 2006

BACKGROUND. The frequency of local vaccination reactions increases with successive doses of diphtheria-tetanus toxoids-acellular pertussis (DTaP) vaccine, and local reactions occur for the majority of children receiving the fifth DTaP vaccination. It is not known whether these reactions can be prevented with prophylactic use of acetaminophen or ibuprofen.

METHODS. In this 3-group, randomized, blinded, controlled trial, 372 children were assigned randomly, in a 2:2:1 ratio, to receive 3 doses of acetaminophen, ibuprofen, or placebo. The first dose of study medication was administered within 2 hours before the fifth DTaP vaccination, and the remaining 2 doses were given at 6-hour intervals. The primary outcome measures included a local reaction with an area of redness or discoloration ≥5 cm in diameter on the evening of or during the 2 days after vaccination, an increase in mid-limb circumference of ≥2 cm on the evening of or during the 2 days after vaccination, and a persistent local reaction, defined as an area of redness or discoloration present on the third day after vaccination.

RESULTS. Local reactions with a ≥5-cm area of redness or discoloration were reported for 35% of children in the placebo group, compared with 33% of children in the acetaminophen group and 37% of children in the ibuprofen group. There was also no significant difference between the placebo and treatment groups in the proportions of children with a ≥2-cm increase in mid-limb circumference or with a persistent local reaction.

CONCLUSIONS. We did not find evidence that prophylaxis with acetaminophen or ibuprofen offers a clinically significant benefit in prevention of local reactions to the fifth DTaP vaccination.
Clinical Characteristics and Natural History of Freeman-Sheldon Syndrome
Authors: Stevenson David A. , Carey John C. , Palumbos Janice , Rutherford Ann , Dolcourt Joyce , Bamshad Michael J.
Published: March 2006

OBJECTIVE. Freeman-Sheldon syndrome (FSS) is a rare, multiple congenital contracture syndrome that is nonetheless relatively well-known, because affected children have a striking appearance: it was historically called “whistling-face syndrome” because of involvement of the facial muscles. FSS is often confused with other congenital contracture syndromes and, as a result, the clinical characteristics and natural history are poorly understood. The objective of this study was to analyze the presentation, natural history, and outcome of a cohort of individuals ascertained using strict diagnostic criteria for FSS.

METHODS. Data from questionnaires, medical charts, examination, and photographs were analyzed to describe the physical features, therapeutic interventions, and functional outcomes in 73 individuals referred with the diagnosis of FSS.

RESULTS. Only 32 referred cases (∼40%) met diagnostic criteria for FSS. In addition to contractures, common features in these cases included severe scoliosis (85%), strabismus (42%), and hearing loss (30%). Most infants required supplementary feedings via a nasogastric (45%) or gastrostomy tube (17%). Children walked by an average age of 19 months, but ∼80% required ambulation-assist devices. An average of ∼10 surgeries was performed on each child, and anesthetic and/or surgical complications were reported in 50% of individuals. All individuals were cognitively normal.

CONCLUSIONS. The clinical characteristics and natural history of FSS distinguish it from other forms of arthrogryposis, yet FSS is frequently misdiagnosed. Children with FSS require considerable nutritional, surgical, and rehabilitative intervention. Such intensive therapeutic demands differ substantially from most other congenital contracture syndromes. These findings underscore the necessity of making an accurate diagnosis.
Survival of Infants With Neural Tube Defects in the Presence of Folic Acid Fortification
Authors: Bol Kirk A. , Collins Julianne S. , Kirby Russell S. ,   for the National Birth Defects Prevention Network
Published: March 2006

OBJECTIVE. Neural tube defects (NTDs) are preventable through preconceptional and periconceptional folic acid intake. Although decreases in the prevalence of NTDs have been reported since folic acid fortification of United States grain products began, it is not known whether folic acid plays a role in reducing the severity of occurring NTDs. Our aim was to determine whether survival among infants born with spina bifida and encephalocele has improved since folic acid fortification and to measure the effects of selected maternal, pregnancy, and birth characteristics on first-year (infant) survival rates.

METHODS. A retrospective cohort study was conducted and included 2841 infants with spina bifida and 638 infants with encephalocele who were born between 1995 and 2001 and were registered in any of 16 participating birth defects monitoring programs in the United States. First-year survival rates for both spina bifida and encephalocele cohorts were measured with Kaplan-Meier estimation; factors associated with improved chances of first-year survival, including birth before or during folic acid fortification, were measured with Cox proportional-hazards regression analysis.

RESULTS. Infants with spina bifida experienced a significantly improved first-year survival rate of 92.1% (adjusted hazard ratio: 0.68; 95% confidence interval: 0.50–0.91) during the period of mandatory folic acid fortification, compared with a 90.3% survival rate for those born before fortification. Infants with encephalocele had a statistically nonsignificant increase in survival rates, ie, 79.1% (adjusted hazard ratio: 0.76; 95% confidence interval: 0.51–1.13) with folic acid fortification, compared with 75.7% for earlier births.

CONCLUSIONS. Folic acid may play a role in reducing the severity of NTDs in addition to preventing the occurrence of NTDs. This phenomenon contributes to our understanding of the efficacy of folic acid. Additionally, as survival of NTD-affected infants improves, health care, education, and family support must expand to meet their needs.
Successful Implementation of a Radiology Sedation Service Staffed Exclusively by Pediatric Emergency Physicians
Authors: Pershad Jay , Gilmore Barry
Published: March 2006

OBJECTIVE. As the number of diagnostic imaging studies performed has increased, the demand for sedation in support of these radiologic tests has also increased. Our objectives were to (1) assess the safety and efficacy of a radiology sedation service that is staffed exclusively by pediatric emergency medicine (PEM) physicians, (2) determine the frequency and the type of commonly performed pediatric imaging studies that require procedural sedation, and (3) assess the average duration of procedural sedation for commonly performed radiologic studies.

METHODS. We conducted a retrospective observational study of patient encounters in 2004 involving procedural sedation to facilitate diagnostic imaging. We are a university-affiliated group of PEM physicians that provide a radiology sedation service during weekdays at a freestanding urban children's hospital.

RESULTS. The sedation service participated in 1285 patient encounters during the study period. Deep sedation was provided to 1027 patients. Moderate sedation was administered to 258 patients. Procedural sedation times for the most frequently performed imaging studies ranged from 5 to 183 minutes. Agents that were used to provide deep sedation were pentobarbital (with midazolam, fentanyl, or both) in 65% of cases, propofol in 31%, and ketamine (with or without midazolam) in 4%. Moderate sedation was achieved with chloral hydrate in 86% and oral diazepam in 14% of the cases. A total of 99.1% of the imaging studies were completed successfully. Six imaging studies were aborted because of failed sedation or occurrence of adverse event. Five patients who were deemed high risk on their presedation evaluation were referred electively for general anesthesia.

CONCLUSIONS. Our data suggest that a dedicated sedation team in support of diagnostic imaging services, staffed exclusively by PEM physicians, can be a successful clinical enterprise. The service consumes significant resources and physician time.
Popular Ergogenic Drugs and Supplements in Young Athletes
Authors: Calfee Ryan , Fadale Paul
Published: March 2006

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.