bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging and modelling of digestion in the stomach and the duodenum
Authors: Schulze K.
Published: February 2006

Abstract  Gastroduodenal physiology is traditionally understood in terms of motor‐secretory functions and their electrical, neural and hormonal controls. In contrast, the fluid‐mechanical functions that retain and disperse particles, expose substrate to enzymes, or replenish the epithelial boundary with nutrients are little studied. Current ultrasound and magnetic resonance imaging allows to visualize processes critical to digestion like mixing, dilution, swelling, dispersion and elution. Methodological advances in fluid mechanics allow to numerically analyse the forces promoting digestion. Pressure and flow fields, the shear stresses dispersing particles or the effectiveness of bolus mixing can be computed using information on boundary movements and on the luminal contents. These technological advances promise many additional insights into the mechanical processes that promote digestion and absorption.
Intestinal epithelial cell signalling and host‐derived negative regulators under chronic inflammation: to be or not to be activated determines the balance towards commensal bacteria
Authors: Haller D.
Published: February 2006

Abstract  Advancing knowledge regarding the cellular mechanisms of intestinal inflammation has led to a better understanding of the disease pathology in patients with chronic disorders of the gut including inflammatory bowel disease, coeliac disease, lymphocytic colitis and irritable bowel syndrome. An emerging new paradigm suggests that changes in the homeostasis of bacteria‐ and host‐derived signal transduction at the epithelial cell level may lead to functional and immune disturbances of the intestinal epithelium. It has become clear from numerous studies that enteric bacteria are a critical component in the development and prevention/treatment of chronic intestinal inflammation. Signal‐specific activation of mitogen‐activated protein kinases (MAPK), interferon‐regulated factors (IRF) and the transcription factor NF‐κB through pattern recognition receptor signalling effectively induce inflammatory defence mechanisms. Unbalanced activation of these innate signalling pathways because of host genetic predispositions and/or the lack of adequate anti‐inflammatory feedback mechanisms may turn a physiological response into a pathological situation including failure of bacterial clearance and development of chronic inflammation. Host‐derived regulators from the immune and enteric nerve system crosstalk to the innate signalling network of the intestinal epithelium in order to shape the extent and duration of inflammatory processes.
The impact of sequence divergence and DNA mismatch repair on homeologous recombination in Arabidopsis
Authors: Li Liangliang , Jean Martine , Belzile François
Published: February 2006

We examined the effects of substrate divergence and DNA mismatch repair (MMR) on recombination in Arabidopsis thaliana. Relative to the frequency observed in plants with a homologous construct (0% divergence), recombination was decreased 4.1‐, 9.6‐, 11.7‐ or 20.3‐fold, respectively, in lines with constructs containing 0.5%, 2%, 4% or 9% divergence between the recombination substrates. To evaluate the contribution of the MMR system in this decrease, 12 independent reporter lines (two or three lines per reporter construct) were crossed to an AtMSH2 T‐DNA insertional mutant. We examined the recombination frequency in progeny homozygous for a reporter T‐DNA and homozygous either for the wild type or the mutant allele of AtMSH2. The loss of MMR activity led to a two‐ to ninefold increase in homeologous recombination and the size of the increase did not seem to correlate with the amount of divergence. Inversely, complementation of the insertional mutant with a wild‐type cDNA of AtMSH2 reduced recombination. Our results demonstrate clearly that sequence divergence can dramatically reduce the recombination frequency in plants and that the MMR system plays a part in this decrease.
The Agrobacterium vitis T‐6b oncoprotein induces auxin‐independent cell expansion in tobacco
Authors: Clément Bernadette , Pollmann Stephan , Weiler Elmar , Urbanczyk‐Wochniak Ewa , Otten Léon
Published: February 2006

Among the Agrobacterium T‐DNA genes, rolB, rolC, orf13, orf8, lso, 6b and several other genes encode weakly homologous proteins with remarkable effects on plant growth. The 6b oncogene induces tumors and enations. In order to study its properties we have used transgenic tobacco plants that carry a dexamethasone‐inducible 6b gene, dex‐T‐6b. Upon induction, dex‐T‐6b plants develop a large array of morphological modifications, some of which involve abnormal cell expansion. In the present investigation, dex‐T‐6b‐induced expansion was studied in intact leaves and an in vitro leaf disc system. Although T‐6b and indole‐3‐acetic acid (IAA) both induced expansion and were non‐additive, T‐6b expression did not increase IAA levels, nor did it induce an IAA‐responsive gene. Fusicoccin (FC) is known to stimulate expansion by increasing cell wall plasticity. T‐6b‐ and FC‐induced expansion were additive at saturating FC concentrations, indicating that T‐6b does not act by a similar mechanism to FC. T‐6b expression led to higher leaf osmolality values, in contrast to FC, suggesting that the T‐6b gene induces expansion by increasing osmolyte concentrations. Metabolite profiling showed that glucose and fructose played a major role in this increase. We infer that T‐6b disrupts the osmoregulatory controls that govern cell expansion during development and wound healing.
Peroxiredoxin Q of Arabidopsis thaliana is attached to the thylakoids and functions in context of photosynthesis†
Authors: Lamkemeyer Petra , Laxa Miriam , Collin Valérie , Li Wenxue , Finkemeier Iris , Schöttler Mark A. , Holtkamp Volker , Tognetti Vanesa B. , Issakidis‐Bourguet Emmanuelle , Kandlbinder Andrea , Weis Engelbert , Miginiac‐Maslow Myroslawa , Dietz Karl‐Josef
Published: February 2006

Peroxiredoxin Q (Prx Q) is one out of 10 peroxiredoxins encoded in the genome of Arabidopsis thaliana, and one out of four that are targeted to plastids. Peroxiredoxin Q functions as a monomeric protein and represents about 0.3% of chloroplast proteins. It attaches to the thylakoid membrane and is detected in preparations enriched in photosystem II complexes. Peroxiredoxin Q decomposes peroxides using thioredoxin as an electron donor with a substrate preference of H2O2 > cumene hydroperoxide ≫ butyl hydroperoxide ≫ linoleoyl hydroperoxide and insignificant affinity towards complex phospholipid hydroperoxide. Plants with decreased levels of Prx Q did not have an apparently different phenotype from wildtype at the plant level. However, similar to antisense 2‐cysteine (2‐Cys) Prx plants [Baier, M. et al. (2000)Plant Physiol., 124, 823–832], Prx Q‐deficient plants had a decreased sensitivity to oxidants in a leaf slice test as indicated by chlorophyll a fluorescence measurements. Increased fluorescence ratios of photosystem II to I at 77 K and modified transcript levels of plastid‐ and nuclear‐encoded proteins show that regulatory mechanisms are at work to compensate for the lack of Prx Q. Apparently Prx Q attaches to photosystem II and has a specific function distinct from 2‐Cys peroxiredoxin in protecting photosynthesis. Its absence causes metabolic changes that are sensed and trigger appropriate compensatory responses.
Stream communities across a rural–urban landscape gradient
Authors: Urban Mark C. , Skelly David K. , Burchsted Denise , Price William , Lowry Sarah
Published: February 2006

Rapid urbanization throughout the world is expected to cause extensive loss of biodiversity in the upcoming decades. Disturbances associated with urbanization frequently operate over multiple spatial scales such that local species extirpations have been attributed both to localized habitat degradation and to regional changes in land use. Urbanization also may shape stream communities by restricting species dispersal within and among stream reaches. In this patch‐dynamics view, anthropogenic disturbances and isolation jointly reduce stream biodiversity in urbanizing landscapes. We evaluated predictions of stream invertebrate community composition and abundance based on variation in environmental conditions at five distinct spatial scales: stream habitats, reaches, riparian corridors and watersheds and their spatial location within the larger three‐river basin. Despite strong associations between biodiversity loss and human density in this study, local stream habitat and stream reach conditions were poor predictors of community patterns. Instead, local community diversity and abundance were more accurately predicted by riparian vegetation and watershed landscape structure. Spatial coordinates associated with instream distances provided better predictions of stream communities than any of the environmental data sets. Together, results suggest that urbanization in the study region was associated with reduced stream invertebrate diversity through the alteration of landscape vegetation structure and patch connectivity. These findings suggest that maintaining and restoring watershed vegetation corridors in urban landscapes will aid efforts to conserve freshwater biodiversity.
Porphyromonas gingivalis gingipains mediate the shedding of syndecan‐1 from the surface of gingival epithelial cells
Authors: Andrian E. , Grenier D. , Rouabhia M.
Published: February 2006

Porphyromonas gingivalis gingipains are thought to be critical virulence factors in periodontitis. Increased serum levels of the soluble ectodomains of surface effectors have been reported to occur during bacterial infections. In the present study, we show that the cell surface proteoglycan syndecan‐1 was highly expressed on human gingival epithelial cells. Treatments with P. gingivalis culture supernatants consistently mediated the shedding of syndecan‐1 from the surface of epithelial cells. Concomitantly, the amount of soluble syndecan‐1 detected in the culture medium increased significantly in a time‐dependent manner. However, neither a heat‐inactivated supernatant nor a supernatant from a gingipain‐deficient mutant had a significant effect on syndecan‐1 shedding. Such a shedding process may play an important role in the bacterial invasion of periodontal tissue and the modulation of host defences.
Detection and quantification of herpesviruses in Kostmann syndrome periodontitis using real‐time polymerase chain reaction: a case report
Authors: Yildirim S. , Yapar M. , Kubar A.
Published: February 2006

Background/aims:  Kostmann syndrome, or severe congenital neutropenia, is an autosomal recessive disease of neutrophil production and is associated with severe periodontal pathology. The aim of this study was to determine whether human cytomegalovirus (HCMV) and Epstein‐Barr virus (EBV) contribute to the pathogenesis of Kostmann syndrome periodontitis.

Methods:  Supragingival plaque and saliva samples were taken from a 6‐year‐old boy and his 3‐year‐old sister suffering from Kostmann syndrome, and from two age‐ and gender‐matched healthy children serving as controls. The samples were taken before and 24 months after periodontal treatment. Real‐time polymerase chain reaction (TaqMan Real‐Time PCR) assay was used to quantify HCMV and EBV DNA.

Results:  EBV was detected in baseline samples from the Kostmann syndrome patients but not in samples from the healthy control subjects. HCMV was only detected in the saliva of the boy with Kostman syndrome at baseline. Herpesviruses numbers decreased dramatically in the post‐treatment samples.

Conclusion:  EBV and HCMV were detected in the two subjects with Kostmann syndrome periodontitis. The results of the study indicate that nonsurgical treatment of Kostmann syndrome periodontitis can reduce supragingival and salivary herpes viral loads.
Serum IgG1 and IgG2 antibody responses to Porphyromonas gingivalis in patients with periodontitis
Authors: Booth V. , Solakoglu Ö. , Bavisha N. , Curtis M. A.
Published: February 2006

Background/aims:  Protein and carbohydrate antigens of Porphyromonas gingivalis interact with the host to produce antibody of different subclasses. IgG1 and IgG2 antibodies frequently account for approximately 90% of the total serum IgG. This work aimed to investigate serum IgG1 and IgG2 antibody responses of periodontitis patients to protein and carbohydrate‐rich antigens of P. gingivalis.

Methods:  Sodium dodecyl sulphate‐polyacrylamide gel electrophoresis and Western blots of P. gingivalis antigens and proteinase K digested antigens rich in carbohydrates were used to investigate the molecular weight of antigen recognised by serum IgG1 and IgG2. Enzyme‐linked immunosorbent assay was used to measure levels of IgG1 and IgG2 antibody to P. gingivalis and radial immunodiffusion was used to estimate the total concentration of IgG1 and IgG2 in serum.

Results:  Serum IgG antibodies bound to antigens of molecular weights 47, 39 and 32 kDa. Antigen most frequently recognised by both IgG1 and IgG2 antibody had a molecular weight of 47 kDa. Serum IgG2 antibody bound to carbohydrate antigen with a molecular weight of 32 kDa but there was no recognition of carbohydrate antigens by IgG1 antibodies. There was no correlation between the titre of anti‐P. gingivalis IgG1 or IgG2 antibody and the total concentration of serum IgG1 or IgG2 antibodies of all specificities.

Conclusion:  Both IgG1 and IgG2 antibodies recognised a dominant antigen of 47 kDa, probably Arg‐gingipain. Much of the response to carbohydrate antigen is of the IgG2 subclass. Neither the level of IgG1 nor the IgG2 antibody specific to P. gingivalis was related to the total serum concentration of that antibody.
Human immunodeficiency virus test‐seeking motivation in blood donors, São Paulo, Brazil
Authors: Goncalez T. T. , Sabino E. C. , Murphy E. L. , Chen S. , Chamone D. A. F. , McFarland W.
Published: February 2006

Background and Objective  Previous studies have shown that volunteer, community‐recruited donors have a higher prevalence of human immunodeficiency virus (HIV) infection in São Paulo, Brazil, than replacement donors. One hypothesis which may explain this unexpected finding is that some individuals donate blood because they are seeking HIV testing. The objective of this study was to characterize test‐seeking blood donors and to determine whether they are at higher risk for HIV infection compared with other donors.

Materials and Methods  Subjects presenting for blood donation were asked to participate in a study assessing their motivations (including test seeking) to donate, as measured by perceiving donation as a means to obtain infectious disease test results. Participants completed the standard blood bank predonation screening questions plus our additional survey, and were tested for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), human T‐cell lymphocytotrophic virus (HTLV) I/II, syphilis and Chagas’ disease. As a result of anticipated low statistical power to directly measure the association between test‐seeking motivation and HIV infection, we tested for herpes simplex virus type 2 (HSV‐2) as a marker of sexual risk for HIV. Our survey includes accepted donors as well as persons whose risk‐behaviour histories would result in their exclusion from donation according to routine screening procedures.

Results  Of 1720 potential blood donors randomly selected and approached, 1600 (93·0%) participated. Overall, 141 (8·8%) were classified as test seekers; 15·6% of these were HSV‐2 positive. The proportion of test seekers was the same among community‐recruited and replacement donors. Test seekers had a higher prevalence of HSV‐2 [adjusted odds ratio (AOR) 1·66; 95% confidence interval (CI): 1·06–2·59] adjusting for age, gender and prior donation. The association was significant among community‐recruited blood donors whose previous donation was more than 1 year ago (i.e. ‘lapsed donors’) (AOR 2·55; 95% CI: 1·20–5·44). Test seekers were not more likely to be rejected from blood donation as a result of health reasons, self‐reported HIV risk‐related behaviour, or by their own confidential unit exclusion. We found no difference in HSV‐2 prevalence between persons accepted for donation (15·7%) and those rejected because of self‐reported sexual risk (16·7%).

Conclusions  We did not detect a difference in the proportion of test seekers across different types of blood donors; however, we did detect an association between HSV‐2 infection and test seeking, especially among community‐recruited lapsed blood donors. Of note, questions on test‐seeking behaviour detected donors with increased prevalence of HSV‐2, but the self‐reported sexual risk behaviours currently used for deferral criteria did not. Incentives to get tested at sites other than blood banks may decrease the residual risk of HIV in the blood supply.
Sequence variation in the 5′ untranslated region of the human A4GALT gene is associated with, but does not define, the P1 blood‐group polymorphism
Authors: Tilley L. , Green C. , Daniels G.
Published: February 2006

Background and Objective  The gene responsible for the P1 polymorphism of the P blood‐group system remains unidentified, although the A4GALT gene, whose product is responsible for the production of Pk, has been implicated. No coding differences in A4GALT account for the P1 polymorphism, but homozygosity for two polymorphisms (−551_−550insC and −160A>G) in the 5′ untranslated region of the gene has been reported to be unique to Japanese P1– individuals. This study aimed to confirm this correlation in a larger number of British individuals.

Materials and Methods  Serologically confirmed P1+ (n = 35) and P1– (n = 15) individuals were genotyped for polymorphisms in the 5′ untranslated region of A4GALT.

Results  In addition to those previously reported, a further polymorphism, −164C>T, was identified. All P1– individuals were homozygous for −551_−550insC and −160G as compared with 10 of 35 (29%) P1+ individuals (P = 0·000003, two‐tailed Fisher's exact test). Allele frequencies for all polymorphisms and estimated haplotype frequencies across the region differed significantly between P1+ and P1– groups.

Conclusions  Homozygosity for the A4GALT−551_−550insC and −160G allele is significantly associated with, but not restricted to, the P1– phenotype. No single A4GALT genotype or haplotype was unique to P1– individuals. Thus, A4GALT cannot be unequivocally confirmed as the gene responsible for the P1 phenotype.
Treatment of thrombotic thrombocytopenic purpura
Authors: Fontana S. , Kremer Hovinga J. A. , Lämmle B. , Mansouri Taleghani B.
Published: February 2006

Thrombotic thrombocytopenic purpura (TTP), characterized by thrombocytopenia and microangiopathic haemolytic anaemia, was almost universally fatal until the introduction of plasma exchange (PE) therapy in the 1970s. Based on clinical studies, daily PE has become the first‐choice therapy since 1991. Recent findings may explain its effectiveness, which may include, in particular, the removal of anti‐ADAMTS13 autoantibodies and unusually large von Willebrand factor multimers and/or supply of ADAMTS13 in acquired idiopathic or congenital TTP. Based on currently available data, the favoured PE regimen is daily PE [involving replacement of 1–1·5 times the patient's plasma volume with fresh‐frozen plasma (FFP)] until remission. Adverse events of treatment are mainly related to central venous catheters. The potential reduction of plasma related side‐effects, such as transfusion‐related acute lung injury (TRALI) or febrile transfusion reactions by use of solvent–detergent treated (S/D) plasma instead of FFP is not established by controlled clinical studies. Uncontrolled clinical observations and the hypothesis of an autoimmune process in a significant part of the patients with acquired idiopathic TTP suggest a beneficial effect of adjunctive therapy with corticosteroids. Other immunosuppressive treatments are not tested in controlled trials and should be reserved for refractory or relapsing disease. There is no convincing evidence for the use of antiplatelet agents. Supportive treatment with transfusion of red blood cells or platelets has to be evaluated on a clinical basis, but the transfusion trigger for platelets should be very restrictive. Further controlled, prospective studies should consider the different pathophysiological features of thrombotic microangiopathies, address the prognostic significance of ADAMTS13 and explore alternative exchange fluids to FFP, the role of immunosuppressive therapies and of new plasma saving approaches as recombinant ADAMTS13 and protein A immunoadsorption.
Ex vivo expansion of umbilical cord blood CD34+ cells in a closed system: a multicentric study
Authors: Astori G. , Larghero J. , Bonfini T. , Giancola R. , Di Riti M. , Rodriguez L. , Rodriguez M. , Mambrini G. , Bigi L. , Iacone A. , Marolleau J. P. , Panzani I. , Garcia J. , Querol S.
Published: February 2006

Background and Objectives  The Dideco ‘Pluricell System’ is a CE‐marked medical device allowing haematopoietic stem cell (HSC) expansion. It comprises a kit of cGMP cytokines and reagents, a closed‐cell expansion chamber and a cell‐washing set. We tested the system in a multicentric study by expanding CD34+ cells from eight fresh umbilical cord blood (UCB) samples.

Materials and Methods  During culture, the mean nucleated cell (NC) count, the mean CD34+ cell count, fold expansion, viability and apoptosis were measured. Clonogenic assays and immunophenotypical characterization were performed on days 0, 7 and 12. On the expanded cellular product, in three cases cell genotyping, endotoxin level and mycoplasma detection (by polymerase chain reaction) were performed.

Results  The mean CD34+ cell expansion on days 7 and 12 was sevenfold and 12‐fold respectively and the mean NC expansion was 69‐fold and 180‐fold. The mean NC viability on day 12 was 96·9% (94·4–99·1). After 12 days, granulocyte–macrophage colony‐forming units (GM‐CFU) showed a 20‐fold increase: a slight increase in CD34+ cell apoptosis was observed during culture. In all of three cases neither chromosomal alterations nor mycoplasma contamination was detected. No significant endotoxin levels were detected after expansion.

Conclusions  The device allows the ex vivo expansion of NC and CD34+ cells in a closed system. The expanded cellular product is a mixture of progenitors (CD34+ cells) and differentiated (mainly myeloid and megakaryocytic) cells. To reduce cell apoptosis, more frequent cell feeding during culture should be tested.
No evidence of West Nile virus infection in Dutch blood donors
Authors: Koppelman M. H. G. M. , Sjerps M. S. , de Waal M. , Reesink H. W. , Cuypers H. T. M.
Published: February 2006

Background and Objectives  West Nile virus (WNV) can be transmitted by transfusion through infected blood components. This study aimed to determine the prevalence of WNV infection among Dutch blood donors to assess whether WNV is a possible threat for the Dutch blood supply.

Materials and Methods  Plasma samples from 61 992 blood donations were pooled in 7749 test pools of eight donations using a Tecan robot. These samples were collected between April and October 2004. The pools were tested for the presence of WNV RNA by using the Procleix WNV assay.

Results  No WNV RNA‐positive pools were detected. Based on Poisson distribution statistics, extrapolation of our data to all the Dutch donations in 2004 revealed that between 0 and 55 cases of WNV infection could be expected.

Conclusions  No evidence of the presence of WNV RNA in Dutch blood donor samples from 2004 was found. However, surveillance of this emerging infection is of importance to safeguard the blood supply in the future because the transmission cycle of WNV is complex and hard to predict.
Balancing infection control practices and family‐centred care in a cohort of paediatric suspected severe acute respiratory syndrome patients in Hong Kong
Authors: Chan Sophia SC , Leung Daisy YK , Wong Emmy MY , Tiwari Agnes FY , Wong David CN , Lo SL , Lau YL
Published: February 2006

Objective: To identify key nursing issues for paediatric patients suspected of severe acute respiratory syndrome (SARS) in relation to the family‐centred model of nursing care and to develop a data‐based model of paediatric nursing care to be better applied in situations of suspected SARS or where outbreaks of other infectious diseases occur.

Methods: This is a retrospective descriptive case series, which analysed the medical and nursing records of all highly‐suspected/suspected SARS patients admitted to a major acute hospital in Hong Kong. Key nursing personnel were also interviewed.

Results: The study included a total of 17 highly‐suspected and 49 suspected SARS paediatric patients (age: 1–16). None of the paediatric patients was eventually diagnosed of SARS. Most cases presented fever (highly‐suspected: 76.5%/ suspected: 100%), cough (64.7%/71.4%), nausea and vomiting (35.3%/28.6%). Nursing care was provided to the patients as necessary. Both the children and parents experienced fear of SARS, as well as separation anxiety arisen from hospitalization in a strict isolation setting.

Conclusions: Infection control overshadowed the family‐centred nursing practices in the management of SARS paediatric patients. A major nursing care issue for SARS paediatric patients was to achieve a careful balance between attending to patients' physical and psychological needs and adhering to the infection control guidelines, while at the same time offering psychological support to family members. The current philosophy and practice of family‐centred nursing model neglect the special needs of children with infectious diseases and predominantly apply to children with non‐infectious diseases that family visits are allowed and nursing care by parents are encouraged.
Pain assessment and procedural pain management practices in neonatal units in Australia
Authors: Harrison Denise , Loughnan Peter , Johnston Linda
Published: February 2006

Objective: To identify current pain assessment and procedural pain management practices in neonatal units in Australia.

Methods: Postal survey conducted during December 2003 and January 2004. The survey comprised questions relating to pain assessment scores, pain reduction strategies for minor painful procedures and the use of articulated policies relating to procedural pain management. Participants were the Nurse Unit Managers or their nominees of neonatal intensive care units, special care units and newborn emergency transport services in Australia.

Results: Surveys were sent to 181 eligible organizations, and 105 of these were returned (58%). Six units (6%) used pain assessment scores on a regular basis, and 16 units (15%) had an articulated policy directing pain management practices during painful procedures. Non‐nutritive sucking and various nursing comfort measures were the pain reduction strategies most frequently used during minor painful procedures. Twenty‐four units (23%) used sucrose or other sweet‐tasting solutions during procedures; however, the reported frequency of their usage was low. Breast‐feeding during venepuncture, heel lance and intramuscular or subcutaneous injection was infrequently practised and topical anaesthetic agents were rarely used.

Conclusion: This survey demonstrates that the majority of Australian neonatal units have no articulated policy to guide pain management during painful procedures and do not regularly undertake pain assessments. Current evidence‐based strategies to reduce procedural pain in hospitalized infants are used infrequently.
Pain relief for neonates in Australian hospitals: A need to improve evidence‐based practice
Authors: Gray Peter H , Trotter Jane A , Langbridge Peter , Doherty Claire V
Published: February 2006

Objective: To ascertain the extent to which neonatal analgesia was used in Australia for minor invasive procedures as an indicator of evidence‐based practice in neonatology.

Methods: A cross‐sectional telephone survey of hospitals in all Australian states and territories with more than 200 deliveries per year was carried out. Questions were asked regarding awareness of the benefits and the use of analgesia for minor invasive procedures in term and near term neonates. Analysis was undertaken according to state and territory, annual birth numbers and the level of neonatal nursery care available.

Results: Data were available from 212 of 214 eligible hospitals. Of the total respondents, 51% and 70% respectively were aware of the benefits of sucrose and breast‐feeding for neonatal analgesia. Eleven per cent of units administered sucrose before venepuncture and 25% of units used breast‐feeding. Ten per cent of units used sucrose before heel prick with 49% utilizing breast‐feeding. Expressed breast milk was used in 10% of units. Analgesia was given less frequently before intravenous cannulation compared to venepuncture and heel prick. Awareness and implementation of neonatal analgesia varied widely in the states and territories. There was a trend for hospitals providing a higher level of neonatal care to have a greater awareness of sucrose as an analgesic (P < 0.0001) and the use of sucrose for venepuncture (P = 0.029), heel prick (P = 0.025) and intravenous catheter insertion (P = 0.013). Similar trends were found on analysis according to birth number of the maternity units. Smaller units had a greater usage of breast‐feeding as an analgesic for heel prick (P = 0.017).

Conclusion: Despite good evidence for the administration of sucrose and breast milk in providing effective analgesia for newborn infants, it is not widely used in Australia. It is imperative that the gap between research findings and clinical practice with regard to neonatal analgesia be addressed.
Neonatal resuscitation educational experience of staff in New South Wales and Australian Capital Territory hospitals
Authors: Foster Kirsty , Craven Paul , Reid Shelley
Published: February 2006

Objective: There is international recognition that health personnel involved in deliveries should be adequately trained in neonatal resuscitation. A survey was carried out in New South Wales (NSW) and the Australian Capital Territory (ACT) to ascertain the type, frequency and availability of training in neonatal resuscitation to staff who may need to resuscitate an infant at birth. The survey included a self‐perception rating of confidence and competence in neonatal resuscitation.

Methods: Questionnaires were sent to 117 hospitals carrying out deliveries in NSW and ACT. Questionnaires were distributed to staff members who may be present at a delivery in a designated 24‐h period.

Results: In total, 1457 questionnaires from 101 hospitals were returned and analysed. Overall response rate was 86.3% with 96.1% able to be assigned to tertiary, urban non‐tertiary or rural areas. Eighty‐five per cent of tertiary respondents had a training programme available to them compared with 59% of urban non‐tertiary staff and 31% of rural practitioners. Approximately one‐third of respondents in rural and urban non‐tertiary units had either never been trained or had training more than 2 years before the survey. In rural areas more than 25% staff were not confident in their resuscitation skills and only 9% felt very competent.

Conclusion: Three‐quarters of all births in NSW and ACT take place in rural or urban non‐tertiary hospitals where one‐third of health personnel are inadequately trained in neonatal resuscitation and many do not feel confident in their skills. Effective neonatal resuscitation training for these areas is urgently required.
Survey of childhood malnutrition at Dili National Hospital, East Timor
Authors: Bucens Ingrid K , Maclennan Carolyn
Published: February 2006

Objectives: To describe the characteristics and short‐term outcomes of children with malnutrition admitted to Dili National Hospital (DNH), East Timor.

Methods: A prospective observational survey using caretaker interviews and medical record review was conducted on the paediatric ward at DNH for 12 months from March 2002. Patients were children aged 2 months to 12 years, admitted with moderate to severe malnutrition as either a primary or secondary diagnosis.

Results: Malnutrition was present in 31.8% (280/880) of paediatric admissions during the study period. Sixty‐one per cent of the malnutrition cases were severe malnutrition (weight‐for‐height below −3 Z‐scores and/or oedema) and 53.7% were both wasted and stunted. The hospital case‐fatality rate was 12.9% (36/280). Immunization coverage was low, with 39% of cases never immunized and 29% incompletely immunized according to the national immunization schedule.

Conclusions: There is a high rate of malnutrition among paediatric inpatients at DNH, consistent with results of anthropometric surveys in the newly independent East Timor. Despite the introduction of a standardized protocol following WHO guidelines and associated training on the management of severe malnutrition, the hospital case‐fatality rate for severe malnutrition was still high (12.9%).
Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy
Authors: Wilkinson Dominic J , Baikie Gordon , Berkowitz Robert G , Reddihough Dinah S
Published: February 2006

Objective: Some children with severe cerebral palsy develop symptoms of upper airway obstruction (UAO) while awake. The aetiology, natural history and treatment of this complication have not previously been systematically described. This study documents a case series of children with severe cerebral palsy admitted to hospital because of severe awake UAO and reviews the relevant literature.

Methods: The case records of children admitted to hospital with UAO while awake over an 8‐month period were reviewed. Details of antecedent illness, comorbidities, acute management and follow up were collated. One case is presented in detail.

Results: Eight children were admitted with UAO. Seven children required intensive care admission. One child died, and two underwent tracheostomy. Nasendoscopy showed pharyngeal collapse without anatomical obstruction in the majority. One child was discovered to have a brainstem malignancy.

Conclusions: Upper airway obstruction is a potentially severe and life‐threatening complication of cerebral palsy. In this series, a majority of children had obstruction related to pharyngeal hypotonia and collapse. This can lead to prolonged hospitalization and intensive care admission. It may raise difficult management issues.
Spontaneous neonatal chylothorax treated with octreotide
Authors: Siu Sylvia LY , Lam David SY
Published: February 2006

Abstract:  Chylothorax is the most common cause of pleural effusion causing respiratory distress in the neonate. Cases unresponsive to conservative management usually require surgery. We report a case of spontaneous neonatal chylothorax where surgery was avoided with the compassionate trail of octreotide. The chylothorax resolved promptly with no observed side effects. After reviewing the literature reporting the use of octreotide in the neonatal period, we found that neonates with isolated spontaneous chylothorax might be viewed as a group different from those with major cardiac malformations. They are at a lower risk for adverse effect of octreotide and lower threshold for commencement of octreotide may benefit them most.
Maternal primary hyperparathyroidism: Discordant outcomes in a twin pregnancy
Authors: McDonnell Ciara M , Zacharin Margaret R
Published: February 2006

Abstract:  The case reports a neonate (twin 2 of a twin girl pregnancy) presenting with seizures due to hypocalcaemia. The presumptive cause of the hypocalcaemia was maternal hyperparathyroidism with concurrent vitamin D deficiency. The first twin remained free of hypocalcaemia and was vitamin D replete, despite similar exposure in the pregnancy and similar postnatal care.
Granulocyte functions and changes in ability with age in newborns; Report no. 2: Activation of granulocyte functions by cytokines
Authors: MORIGUCHI NAOHIKO , YAMAMOTO SEIICHIROU , ISOKAWA SADAYUKI , ANDOU ATUSHI , MIYATA HIROSHI
Published: February 2006

Background: The aim of the present study was to examine the function of granulocytes in newborns from the perspective of granulocyte activation by cytokines.

Methods: Granulocytes were stimulated with tumor necrosis factor‐α, granulocyte‐macrophage colony stimulating factor (GM‐CSF) or granulocyte colony stimulating factor, and the reactivity of granulocytes to these substances was then compared between newborns (umbilical cord blood, peripheral blood obtained at age 5 days and at age 1 month) and peripheral blood obtained from adults. In addition, the expression of cytokine receptors on the surface of granulocytes was measured for each age group.

Results: The amplification of CD11b expression on the surface of granulocytes and suppression of l‐selectin expression were weaker for cord blood regardless of which cytokine was added. In addition, the increases in the activity of intracellular elastase when stimulated with tumor necrosis factor‐α or GM‐CSF were significantly lower for cord blood. Moreover, the expression of GM‐CSF receptors and granulocyte colony stimulating factor receptors on the surface of granulocytes was lower for cord blood, and this expression approached the level found in adults as age increased.

Conclusion: Granulocytes during early infancy exhibit low reactivity to inflammatory cytokines, and this was considered to be one of the factors contributing to the higher incidence of serious bacterial infections in infants.
Pediatric visceral Leishmaniasis in Turkey
Authors: TANIR GÖNÜL , TAYLAN ÖZKAN AYSEGÜL , DAĞLAR EDA
Published: February 2006

Background: Visceral Leishmaniasis (VL) type in Turkey is consistent with the Mediterranean type of VL, a fatal debilitating disease, which is mostly seen in infants.

Methods: Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from January 2000 to December 2003.

Results: The median age of the patients was 36 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Fever, pallor, hepatomegaly, splenomegaly, thrombocytopenia and elevated C‐reactive protein were observed in all cases, anemia in 18 (95%), leucopenia in 17 (89.4%) and elevated erythrocyte sedimentation rate in 14 (77.7%) of the cases. A bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in 15 (78.9%). Fifteen patients (78.9%) were treated initially with meglumine antimonate and four (21%) with sodium stibogluconate. The four patients who received sodium stibogluconate suffered from adverse side‐effects during treatment and were subsequently treated with lipid formulations of amphotericin B.

Conclusions: Presentation of VL in the pediatric age group in Turkey is characterized by pallor, fever, splenomegaly and hepatomegaly. Hematological and biochemical indices are typical with cytopenias, hypoalbuminemia, and hyperproteinemia. In most of the cases, microscopic examination provided a positive diagnosis and the remaining patients were diagnosed by serology. Lipid formulations of amphotericin B may be useful in cases of treatment failure with antimonials or significant adverse effects of the drug.
Morbidity and mortality of infants born at the threshold of viability: Ten years’ experience in a single neonatal intensive care unit, 1991–2000
Authors: HOSONO SHIGEHARU , OHNO TSUTOMU , KIMOTO HIROFUMI , SHIMIZU MASAKI , HARADA KENSUKE
Published: February 2006

Background: The purpose of the present paper was to evaluate the mortality and morbidity of infants born at 22–24 weeks gestation.

Methods: A total of 78 infants born at 22–24 weeks gestation, who were admitted between January 1991 through December 2000, were retrospectively studied.

Results: Seventy‐one of 78 infants were enrolled in the present study. One year survival rates at 22, 23 and 24 weeks were 40.0% (2/5), 61.1% (11/18), and 50.0% (24/48), respectively. Failure of response to surfactant and air leak were associated with death in infants born at 23 weeks gestation. Low Apgar score, intraventricular hemorrhage (≥III), and sepsis were correlated with death in infants born at 24 weeks gestation. The handicap rates of survivors born at 22, 23, and 24 weeks gestation were 100, 36.4, and 26.1%, respectively.

Conclusions: The present study indicates that infants born at 22 weeks gestation, in whom pulmonary structure is established, that is, a viable lung that can exchange gas with exogenous surfactant, have a chance to survive, but neurological outcome is still poor. Every possible effort should be made to extend gestation beyond 22 weeks.
Urinary oxidative stress markers in young patients with type 1 diabetes
Authors: HATA IKUE , KAJI MASAYUKI , HIRANO SATOKO , SHIGEMATSU YOSUKE , TSUKAHARA HIROKAZU , MAYUMI MITSUFUMI
Published: February 2006

Background: Involvement of oxidative stress in the pathogenesis of diabetic vascular complications has been proposed. However, there are few methods to determine the status of oxidative stress both directly and quantitatively in young patients with type 1 diabetes.

Methods: A total of 27 young patients with type 1 diabetes (mean age ± SD, 12.6 ± 4.2 years) with normal renal function and 38 healthy control subjects (13.0 ± 4.6 years) were investigated. Early morning voiding urine samples were collected. The concentrations of acrolein‐lysine adducts, 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) were determined using competitive enzyme‐linked immunosorbent assay, and nitric oxide metabolites were measured using the colorimetric, non‐enzymatic assay.

Results: Urinary concentrations of 8‐OHdG, but not acrolein‐lysine adducts and nitric oxide metabolites, were significantly increased in the diabetic group. For diabetic patients, microalbuminuria was significantly correlated with higher concentrations of all three markers. Hemoglobin A1c values were significantly correlated with 8‐OHdG values.

Conclusions: These findings indicate that increased oxidative stress and the risk of vascular complications may be present at early stages of type 1 diabetes.
Microchip, reverse transcription‐polymerase chain reaction and culture methods to detect enterovirus infection in pediatric patients
Authors: TSAO LON‐YEN , LIN CHI‐YUNG , YU YA‐YAN , WANG BAO‐TYAN
Published: February 2006

Background: Enterovirus infection usually presents with mild and self‐limited illness in children. However, Enterovirus type 71 can be characterized by neurotropism and may cause severe illness or even sudden death. Early detection of the virus will allow a physician to provide intensive or aggressive intervention. The purpose of the present study was to compare sensitivity of two innovative laboratory methods, that is, the DR.EV microchip method (DR. Chip Biotechnology, Shin‐Tsu, Taiwan) and the reverse transcription‐polymerase chain reaction (RT‐PCR) method following conventional virus culture in detecting enterovirus infection in pediatric patients with herpangina or hand–foot–mouth disease.

Methods: A total of 87 children (age range: 1–8 years) were enrolled because of typical clinical findings of herpangina and hand–foot–mouth disease. Two hundred children selected after a careful clinical history review and physical examinations, were included as controls. All of these children had at least throat swab and rectal swab specimens taken and tested for evidence of enterovirus infection by microchip, RT‐PCR and virus culture methods. In addition, 21 patients also had cerebrospinal fluid (CSF) specimens taken to test for possible central nervous system involvement.

Result: The test results obtained from the 200 healthy kindergarten children were all negative for enteroviral infection by these three methods. Among the 87 test patients, the positive rates for throat swab, rectal swab and CSF by DR.EV chip, RT‐PCR and virus culture were 71%, 68%, and 45% (throat swab); 66%, 61%, and 33% (rectal swab); and 52%, 29%, and 5% (CSF), respectively. There was no significant difference in the positive rates between the DR.EV chip and the RT‐PCR methods (P > 0.1) on all types of specimens. However, statistically significant differences in positive rates were noted between the DR.EV chip and the conventional virus culture methods on all types of specimens (P < 0.001). Sensitivity of the microchip, RT‐PCR and virus culture methods, was 82%, 72%, and 53%, respectively.

Conclusion: The DR.EV chip method yielded a statistically higher positive rate and faster test results than the conventional viral culture method.
Neurodevelopmental outcome of infants with birth asphyxia treated with magnesium sulfate
Authors: ICHIBA HIROYUKI , YOKOI TOSHIAKI , TAMAI HIROSHI , UEDA TORU , KIM TAE‐JANG , YAMANO TSUNEKAZU
Published: February 2006

Background:A neuroprotective effect of MgSO4has been shown in some animal models of perinatal hypoxic–ischemic brain damage. The aim of the present paper was to determine whether postnatal MgSO4infusion (250 mg/kg per day i.v. for 3 days, in combination with dopamine) is safe in infants with severe birth asphyxia, and also observe effects on neurodevelopmental outcome at 18 months.

Methods:Inclusion criteria were clinical history consistent with perinatal asphyxia; gestational age at least 37 weeks; 5 min Apgar score ≤6; failure to initiate spontaneous respiration within 10 min after birth; and symptoms of encephalopathy. On each day MgSO4was infused over 1 h in combination with dopamine (5 μg/kg per min). Changes in vital signs, clinical course of encephalopathy, laboratory variables, and adverse events were monitored. Infants were followed for 18 months.

Results:Thirty infants were studied. Mean birthweight was 2878 g; mean gestational age, 39.6 weeks, and median 5 min Apgar score, 3. All required endotracheal intubation for resuscitation. Median age at MgSO4initiation was 5 h. All infants had moderate or severe hypoxic–ischemic encephalopathy. Mean serum Mg2+concentration remained at least 1.3 mmol/L. MgSO4caused no change in physiological variables including mean arterial pressure. Two infants died as neonates, while six of 28 survivors had severe neurodevelopmental disability at 18 months; the remaining 22 had no neurodevelopmental disability.

Conclusion:Postnatal infusion of MgSO4with dopamine caused no change in physiological variables. Deaths and severe sequelae were less frequent than in reported cases with the same grade of hypoxic–ischemic encephalopathy severity, and this treatment may improve neurodevelopmental outcome in infants with severe birth asphyxia.
Ability of preschool children to use dry powder inhalers as evaluated by In‐Check Meter
Authors: ADACHI YOKO S , ADACHI YUICHI , ITAZAWA TOSHIKO , YAMAMOTO JUNKO , MURAKAMI GYOKEI , MIYAWAKI TOSHIO
Published: February 2006

Background: Although current guidelines recommend the pressurized metered‐dose inhaler with a spacer for preschool children with asthma, dry powder inhalers (DPI) may be a valuable treatment alternative.

Methods: To evaluate the ability of preschool children to inhale through DPI, peak inspiratory flow rates (PIFR) of 57 healthy children aged 3–6 years were measured with In‐Check Meter after practising with an instructor. Two different calibrated resistances were attached to the Meter to mimic the internal resistance of each inhaler; Diskus and Turbuhaler.

Results: The ability of children to generate adequate inspiratory flow increased with age. The percentages of the 3‐, 4‐, 5‐, and 6‐year‐old children who were able to inhale reliably through the devices were 30% (3/10), 79.0% (15/19), 100% (16/16), and 100% (12/12), respectively. In these children, 100%, 93.3%, 100%, and 100% achieved an adequate PIFR for the Diskus (30 L/min). In contrast, 66.7%, 66.7%, 62.5%, and 91.7% generated an adequate PIFR for the Turbuhaler (60 L/min).

Conclusions: The In‐Check Meter is a useful device to assess the ability of preschool children to generate adequate PIFR for each inhaler. Most children aged ≥5 years could use DPI.