bluuebunny/crossref_metadata_2025 huggingface dataset:
High dose estrogen treatment increases bone mineral density in male-to-female transsexuals receiving gonadotropin-releasing hormone agonist in the absence of testosterone
Authors: Mueller Andreas , Dittrich Ralf , Binder Helge , Kuehnel Werner , Maltaris Theodoros , Hoffmann Inge , Beckmann Matthias W
Published: July 2005

Objective: To study the effect of estrogen (E) on the male skeleton in the absence of testosterone (T).

Design: Retrospective analyses of 40 middle-aged transsexuals treated with subcutaneous injections of gonadotropin-releasing hormone agonist every 4 weeks and oral 17-beta-estradiol-valerat 6 mg/day over two years until reassignment surgery.

Methods: The bone mineral density (BMD) in the femoral neck and lumbar spine (L2–L4) was measured with dual-energy X-ray absorptiometry at the beginning of cross-sex hormone treatment, after 12 and 24 months, and serum T, E, sex hormone-binding globulin (SHBG), calcitonin (CAL), osteocalcin (OSC), and urinary free deoxypyridinoline (DPD) were measured.

Results: After 12 months, a significant increase in BMD in the lumbar spine from 1.2 to 1.234 g/cm2 and after 24 months to 1.274 g/cm2 was observed. There was a significant increase in BMD in the femoral neck area from 1.068 to 1.109 g/cm2 after 24 months. There was a significant decrease in serum T levels from 18.65 to 0.57 nmol/l after 12 months, and to 0.62 nmol/l after 24 months, a significant increase in SHBG levels from 50.09 to 125 nmol/l after 12 months, and to 130 nmol/l after 24 months, and a significant increase in serum E levels from 73.42 to 881.6 pmol/l after 12 months, and to 923.62 pmol/l after 24 months of cross-sex hormone treatment. Serum levels of CAL, OSC and urinary DPD were unchanged.

Conclusion: We conclude that high dose E treatment is able to increase BMD significantly in the femoral neck and lumbar spine independently of serum T levels in middle-aged men. There is no risk of osteoporosis developing in male-to-female transsexuals receiving GnRHa when there is an adequate E substitution.
Mutational spectrum of steroid 21-hydroxylase and the genotype-phenotype association in Middle European patients with congenital adrenal hyperplasia
Authors: Dolž;an V , Sólyom J , Fekete G , Kovács J , Rakosnikova V , Votava F , Lebl J , Pribilincova Z , Baumgartner-Parzer SM , Riedl S , Waldhauser F , Frisch H , Stopar-Obreza M , Krž;išnik C , Battelino T
Published: July 2005

Objective: To analyze the mutational spectrum of steroid 21-hydroxylase (CYP21) and the genotype– phenotype correlation in patients with congenital adrenal hyperplasia (CAH) registered in the Middle European Society for Pediatric Endocrinology CAH database, and to design a reliable and rational approach for CYP21 mutation detection in Middle European populations.

Design and methods: Molecular analysis of the CYP21 gene was performed in 432 CAH patients and 298 family members. Low-resolution genotyping was performed to detect the eight most common point mutations. High-resolution genotyping, including Southern blotting and sequencing was performed to detect CYP21 gene deletions, conversions, point mutations or other sequence changes.

Results: CYP21 gene deletion and In2 and Ile172Asn mutation accounted for 72.7% of the affected alleles in the whole study group. A good genotype–phenotype correlation was observed, with the exception of Ile172Asn and Pro30Leu mutations. In 37% of patients low resolution genotyping could not identify the causative mutation or distinguish homozygosity from hemizygosity. Using high-resolution genotyping, the causative mutations could be identified in 341 out of 348 analyzed patients. A novel mutation Gln315Stop was found in one simple virilising CAH (SV-CAH) patient from Austria. In the remaining seven patients polymorphisms were identified as the leading sequence alteration. The presence of elevated basal and ACTH-stimulated 17-hydroxyprogesterone, premature pubarche, advanced bone age and clitoral hypertrophy directly implicated Asn493Ser polymorphism in the manifestation of nonclassical- (NC) and even SV-CAH.

Conclusions: By genotyping for the most common point mutations, CYP21 gene deletion/conversion and the 8 bp deletion in exon 3, it should be possible to identify the mutation in 94–99% of the diseased alleles in any investigated Middle European population. In patients with a mild form of the disease and no detectable mutation CYP21 gene polymorphisms should be considered as a plausible disease-causing mutation.
Endoplasmic reticulum stress induces Wfs1 gene expression in pancreatic β-cells via transcriptional activation
Authors: Ueda Kohei , Kawano June , Takeda Komei , Yujiri Toshiaki , Tanabe Katsuya , Anno Takatoshi , Akiyama Masaru , Nozaki Junichi , Yoshinaga Takeo , Koizumi Akio , Shinoda Koh , Oka Yoshitomo , Tanizawa Yukio
Published: July 2005

Objective: TheWFS1gene encodes an endoplasmic reticulum (ER) membrane-embedded protein. HomozygousWFS1gene mutations cause Wolfram syndrome, characterized by insulin-deficient diabetes mellitus and optic atropy. Pancreatic β-cells are selectively lost from the patient’s islets. ER localization suggests that WFS1 protein has physiological functions in membrane trafficking, secretion, processing and/or regulation of ER calcium homeostasis. Disturbances or overloading of these functions induces ER stress responses, including apoptosis. We speculated that WFS1 protein might be involved in these ER stress responses.

Design and methods: Islet expression of the Wfs1 protein was analyzed immunohistochemically. Induction of Wfs1 upon ER stress was examined by Northern and Western blot analyses using three different models: human skin fibroblasts, mouse pancreatic β-cell-derived MIN6 cells, and Akita mouse-derivedIns296Y/Yinsulinoma cells. The humanWFS1gene promoter-luciferase reporter analysis was also conducted.

Result: Islet β-cells were the major site ofWfs1expression. This expression was also found in δ-cells, but not in α-cells.WFS1expression was transcriptionally up-regulated by ER stress-inducing chemical insults. Treatment of fibroblasts and MIN6 cells with thapsigargin or tunicamycin increasedWFS1mRNA. WFS1 protein also increased in response to thapsigargin treatment in these cells.WFS1gene expression was also increased inIns296Y/Yinsulinoma cells. In these cells, ER stress was intrinsically induced by mutant insulin expression. TheWFS1gene promoter-luciferase reporter system revealed that the humanWFS1promoter was activated by chemically induced ER stress in MIN6 cells, and that the promoter was more active inIns296Y/Ycells thanIns2wild/wildcells.

Conclusion:Wfs1expression, which is localized to β- and δ-cells in pancreatic islets, increases in response to ER stress, suggesting a functional link betweenWfs1and ER stress.
Efficacy of chimeric molecules directed towards multiple somatostatin and dopamine receptors on inhibition of GH and prolactin secretion from GH-secreting pituitary adenomas classified as partially responsive to somatostatin analog therapy
Authors: Jaquet P , Gunz G , Saveanu A , Dufour H , Taylor J , Dong J , Kim S , Moreau J-P , Enjalbert A , Culler M D
Published: July 2005

Objective: This study compared the potency of a somatostatin receptor (sstr)2–sstr5 analog, BIM-23244, of an sstr2-dopamine D2 receptor (sstr2-DAD2) molecule, BIM-23A387 and of new somatostatin-dopamine chimeric molecules with differing, enhanced affinities for sstr2, sstr5 and DAD2, BIM-23A758, BIM-23A760 and BIM-23A761, to suppress GH and prolactin (PRL) from 18 human GH adenomas that are partially responsive to octreotide or lanreotide.

Materials and methods: The sstr2, sstr5 and DAD2 mRNA levels were determined by RT-PCR. The effect of drugs was tested in cell cultures at various concentrations.

Results: In all tumors, the sstr2, sstr5 and DAD2 mRNA levels were coexpressed (mean levels±s.e.m.0.4±0.1, 5.3±1.9 and 2.0±0.4 copy/copy β-glucuronidase). In 13 tumors, the maximal suppression of GH secretion produced by BIM-23A387 (30±3%) and BIM-23244 (28±3%) was greater than that produced by octreotide (23±3%). In six out of 13 tumors, BIM-23A758, BIM-23A760 and BIM- 23A761 produced greater maximal suppression of GH secretion than octreotide (33±5, 38±2 and 41±2 vs 24±2%). Their EC50values were 10, 2 and 4 pmol/l. BIM-23A761 was more effective than BIM-23A387 in GH suppression (41±2 vs 32±4%). The new chimeric molecules produced maximal PRL suppression greater than octreotide (62±8 to 74±5 vs 46±11%).

Conclusions: Novel dopamine-somatostatin chimeric molecules with differing, enhanced activity at sstr2, sstr5 and DAD2, consistently produced significatly greater suppression of GH and PRL than either octreotide or single-receptor-interacting ligands in tumors from patients classified as only partially responsive to octreotide therapy. The higher efficacy of the chimeric compounds was, at least partially, linked to their high affinity for sstr2 (IC501–10 pmol/l). The other mechanisms by which such molecules produce an enhanced inhibition of GH remain to be elucidated.
Children's Residential Weight-Loss Programs Can Work: A Prospective Cohort Study of Short-Term Outcomes for Overweight and Obese Children
Authors: Gately Paul J. , Cooke Carlton B. , Barth Julian H. , Bewick Bridgette M. , Radley Duncan , Hill Andrew J.
Published: July 2005

Objective. The evidence base for child obesity treatment is weak. Children's weight-loss camps, despite their popularity, have not been properly evaluated. This study evaluated the effectiveness of a residential weight-loss camp program for overweight and obese children.

Methods. A total of 185 overweight children (mean age: 13.9 years) enrolled in 1 of 4 consecutive programs between 1999 and 2002 (intervention group) were compared with 94 children of similar ages who were not camp attendees, ie, 38 overweight children and 56 normal-weight children. The intervention group attended a 6-week (maximum) summer residential weight-loss camp. The program included a daily schedule of six 1-hour, skill-based, fun, physical activity sessions, moderate dietary restriction, and group-based educational sessions. All children were assessed for body weight, height, and other anthropometric measures, blood pressure, aerobic fitness, self-esteem, and selected sports skills.

Results. Campers, who stayed for a mean of 29 days, lost 6.0 kg, reduced their BMI by 2.4 units, and reduced their BMI SD scores by 0.28. Fat mass decreased significantly (from 42.7 to 37.1 kg), whereas fat-free mass did not change. In contrast, both comparison groups gained weight during this period. Camp attendees also showed significant improvements in blood pressure, aerobic fitness, and self-esteem. Longer durations of stay were associated with greater improvements in outcomes.

Conclusions. In the short term at least, this weight-loss program was effective across a range of health outcomes. Ongoing research is examining the maintenance of these improvements. Future research should investigate whether benefits can be generalized across weight-loss camps and how the intervention can be adapted to nonresidential, term-time settings.
Effects of Atomoxetine on Growth After 2-Year Treatment Among Pediatric Patients With Attention-Deficit/Hyperactivity Disorder
Authors: Spencer Thomas J. , Newcorn Jeffrey H. , Kratochvil Christopher J. , Ruff Dustin , Michelson David , Biederman Joseph
Published: July 2005

Objective. Treatment for attention-deficit/hyperactivity disorder is maintained typically over periods of months or years and, as a result, the potential effects on growth of pharmacotherapy for this disorder have been an area of concern. This meta-analysis examined the effect on growth of atomoxetine, now approved in the United States for the treatment of attention-deficit/hyperactivity disorder.

Methods. Patients (N = 412) were 6 to 16 years of age at the start of the treatment period and received atomoxetine treatment (maximal dose: 1.8 mg/kg per day) for ≥2 years. Weight and height measurements were analyzed both as actual values and after conversion to percentiles and z scores with growth charts from the Centers for Disease Control and Prevention. Expected weight and height at the end point were calculated through extrapolation from patients' baseline percentiles with the growth charts.

Results. Results indicated that, after 2 years, observed weight and height were close to those predicted on the basis of the patients' baseline weight and height. Weight increased an average of 10.8 kg, a decrease relative to baseline normative weight of 2.7 percentiles, corresponding to 0.87 kg. Height increased an average of 13.3 cm, a decrease relative to baseline normative heights of 2.2 percentiles, corresponding to 0.44 cm. For both weight and height, the quartile of patients who were smallest at baseline had an increase in end-point percentile, whereas patients in the highest quartile had a decrease.

Conclusions. These findings suggested that, at the group level, there was only a minimal effect on height after 2 years of treatment with atomoxetine and, for patients most at risk (the lowest quartile), there seemed to be no effect.
Effect of Nutrition on Growth in Short Stature Before and During Growth-Hormone Therapy
Authors: Zadik Zvi , Sinai Tali , Zung Amnon , Reifen Ram
Published: July 2005

Objective. Although nutritional counseling is an integral part of the management of rapidly growing children, few studies have focused on the importance of nutritional supervision during growth-hormone (GH) therapy. The objective of this study was to study the effect of caloric intake on growth before and during GH therapy.

Methods. A total of 115 short normal prepubertal children who were 7.4 ± 1.2 years of age (mean ± SD) and had height SD score (SDS) of −2.5 ± 0.6 were treated with a GH dose range of 0.13 to 0.52 mg/kg per week for 1 year. A 3-day nutritional recall and blood chemistry analysis were repeated every 3 months.

Results. Caloric intake (expressed as % recommended dietary allowance) was positively correlated with the pretreatment growth velocity (SDS) and the increment in growth velocity SDS during the first year of GH therapy (r = 0.363 and 0.493). By stepwise regression analysis, we identified 4 parameters that could predict the 1-year increment in growth velocity SDS: the contribution of each factor (% variability) was pretreatment growth velocity SDS 36%, GH dose (27%), caloric intake 4%, and the integrated concentration of GH 2% (r2 = 0.689). GH therapy induced an alkaline phosphatase increment of 59 ± 49 IU/mL, an insulin-like growth factor-I increment of 32.6 ± 11.9 nmol/L, and a GH binding protein increment of 10.2 ± 2.7%. During GH therapy, an increase in serum transferrin (56.5 ± 35.2 mg/dL) and a decrease in serum iron (20.5.5 ± 20.2 μg/dL) were noted. These changes could not be detected through hemoglobin levels or hematopoietic indexes. Dietary iron supplementation reversed this phenomenon.

Conclusions. The nutritional status of GH-treated patients before and throughout the course of GH treatment should be monitored closely to improve the growth response and prevent nutritional deficiencies. Special emphasis should be placed on iron nurture.
The Incidence and Course of Retinopathy of Prematurity: Findings From the Early Treatment for Retinopathy of Prematurity Study
Authors:   Early Treatment for Retinopathy of Prematurity Cooperative Group
Published: July 2005

Objectives. To estimate the incidence of retinopathy of prematurity (ROP) in the Early Treatment for Retinopathy of Prematurity (ETROP) Study and compare these results with those reported in the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Study.

Methods. The ETROP Study, as part of its protocol, screened 6998 infants at 26 centers throughout the United States. Serial eye examinations were conducted for infants born weighing <1251 g, making it possible to estimate the frequency of ROP in different birth weight and gestational age categories. ROP was categorized according to the International Classification for ROP.

Results. The incidence of any ROP was 68% among infants of <1251 g. The findings were compared with those for infants born in 1986 and 1987 in the CRYO-ROP Study. The overall incidences of ROP were similar in the 2 studies, but there was more zone I ROP in the ETROP Study. Among infants with ROP, more-severe ROP (prethreshold) occurred for 36.9% of infants in the ETROP Study and 27.1% of infants in the CRYO-ROP Study. The gestational age of onset of ROP of different severities has changed very little since the CRYO-ROP Study was conducted.

Conclusions. ROP remains a common important problem among infants with birth weights of <1251 g. The incidence of ROP, time of onset, rate of progression, and time of onset of prethreshold disease have changed little since the CRYO-ROP natural-history study.
Frequency of Fungemia in Hospitalized Pediatric Inpatients Over 11 Years at a Tertiary Care Institution
Authors: Abelson Jonathan A. , Moore Theodore , Bruckner David , Deville Jaime , Nielsen Karin
Published: July 2005

Objectives. To determine the frequency of bloodstream fungal infections in children who were admitted to our tertiary institution over an 11-year period.

Methods. We conducted a retrospective cohort study of patients who were aged 0 to 21 years, had bloodstream fungal infections, and were admitted to the University of California, Los Angeles from 1991 through 2001. Patients were identified through the microbiology laboratory database. All positive fungal cultures for pediatric inpatients were reviewed. For each fungemic patient, a review of clinical course, cause, and outcome was performed.

Results. Over 11 years, 1124 pediatric inpatients with 3633 positive cultures had evidence of fungal colonization or infection. The mean incidence of positive fungal cultures increased from 105 between 1991 and 1996 to 129 patients per year between 1997 and 2001. Fungal isolates were mainly Candida species (85%) obtained primarily from respiratory (41%) and urine (27%) cultures. Only 7.5% of positive fungal cultures were from blood, although 24490 pediatric admissions prompted 72960 bacterial and fungal blood cultures, at charges of $2.52 million. Of 14592 fungal blood cultures, <2% (n = 272) were positive, involving <1% (n = 97) of patients. The mean rise in number of children with fungemia was significant, from 6.8 between 1991 and 1996 to 13.0 patients per year between 1997 and 2001. Fungemia was associated with a high all-cause mortality rate (46%), particularly in immunocompromised patients (57%). Organisms recovered were primarily Candida species (91%). There was a decline in C albicans and C glabrata fungemia and an increase in C parapsilosis organisms. In 84% of patients, fungal organisms were isolated from both bacterial and fungal blood cultures, and in 74%, the same organism was isolated from additional body sites.

Conclusions. Episodes of fungemia increased significantly over 11 years as compared with a moderate increase in positive fungal cultures and were associated with high all-cause mortality rates. More sensitive assays for early identification of fungal bloodstream infections are warranted.
Children With Idiopathic Short Stature Are Poor Eaters and Have Decreased Body Mass Index
Authors: Wudy Stefan A. , Hagemann Sandra , Dempfle Astrid , Ringler Gundula , Blum Werner F. , Berthold Lars D. , Alzen Gerhard , Gortner Ludwig , Hebebrand Johannes
Published: July 2005

Objective. In children with idiopathic short stature (ISS), studies investigating body mass index (BMI) or parameters of satiety regulation are scarce, and studies analyzing eating behavior are lacking.

Methods. We recruited 214 children (123 index cases and 91 siblings) with ISS from 123 families. Affected children had to have a body height <5th percentile, or, in the case of siblings, the body height of 1 child had to be <5th percentile and the other <15th percentile. Medical histories were recorded by using structured and standardized interviews. Eating behavior was assessed by using the Child Eating Behavior Questionnaire. Percent energy intake as fat was assessed by using the Leeds Food Frequency Questionnaire. Endocrine markers of body weight regulation (leptin, ghrelin) were determined in serum.

Results. Compared with population norms, BMI was significantly lower (mean: −0.33 standard deviation score). Furthermore, there was decreased food responsiveness (mean Child Eating Behavior Questionnaire score: 1.9; population mean: 2.4), reduced enjoyment of food (3.2 vs 3.9), emotional undereating (2.6 vs 3.0), lower desire to drink (2.0 vs 2.8), and increased fussiness over food (3.2 vs 2.9). When the sample was subdivided into the 2 groups of “good” and “poor” eaters according to the mothers' assessment of the current eating behavior, reduction in BMI as well as the behavioral characteristics already delineated in the total sample were found to be even more consistent in the subgroup of poor eaters. In the total sample of our children, as well as in both subgroups, serum leptin (adjusted for gender, BMI, and Tanner stage) was found to be moderately raised but did not differ between poor and good eaters. Total serum ghrelin was not different between poor and good eaters.

Conclusions. Our clinical, behavioral, and endocrinologic findings in patients with ISS point to an altered eating behavior that possibly contributes to their short stature.
The Epidemiology of Recurrent Abdominal Pain From 2 to 6 Years of Age: Results of a Large, Population-Based Study
Authors: Ramchandani Paul G. , Hotopf Matthew , Sandhu Bhupinder , Stein Alan ,   and the ALSPAC Study Team
Published: July 2005

Objective. Recurrent abdominal pain (RAP) is one of the most common complaints of childhood and is associated with several adverse outcomes in adulthood. Few large, population-based, longitudinal studies have been conducted. The purpose of this study was to investigate the prevalence and epidemiologic features of RAP through early childhood.

Design. We report findings from a large, population-based, cohort study of childhood (the Avon Longitudinal Study of Parents And Children). The prevalence and continuity of RAP from 2 to 6 years of age were explored, with associated physical and psychological symptoms among the children and their parents.

Results. In a population cohort of 13971 children, RAP was reported for 11.8% of 6-year-old children. It was less common at ages 2 years (3.8%) and 3 years (6.9%). There was a striking degree of continuity of RAP between the ages of 2 and 6 years. RAP was associated with headaches and limb pains among children and with higher rates of anxiety among both children (adjusted odds ratio: 2.12; 95% confidence interval: 1.70–2.65) and their mothers (odds ratio: 1.75; 95% confidence interval: 1.30–2.36).

Conclusions. In a large, population-based, cohort study, RAP was found to be increasingly common up to the age of 6 years. Children with RAP at a young age have a high risk of RAP later in childhood. RAP is associated with other somatic pain symptoms among children and with symptoms of anxiety among children and their mothers. These findings highlight the high prevalence and continuity of RAP through early childhood and the importance of considering psychological symptoms for these children and their families.
Not Your Routine Foreign Body: Endobronchial Tuberculosis in an Infant
Authors: Agarwal Swati , Hong David K. , Soslow Jonathan , Chang Kay W.
Published: July 2005

Foreign-body aspiration is a common cause of respiratory distress among children. Here we describe an 8-month-old, previously 34-week premature, male patient who presented with a 1-day history of fever and increased work of breathing. Of note, 3 weeks before presentation, the patient had been treated with orally administered amoxicillin for presumed pneumonia and exhibited good clinical response. No chest radiograph was obtained at that time. A current chest radiograph revealed hyperexpansion of the left lung, with a mediastinal shift. Although the patient was referred because of possible foreign-body aspiration, no clear history of an aspiration event was obtained, and computed tomographic scans of the chest were recommended. These showed extensive hilar and mediastinal lymphadenopathy, resulting in obstruction of the left bronchus. Bronchoscopy revealed a cheesy granulomatous mass in the left mainstem bronchus, which was ball-valving into the upper bronchus. Removal resulted in improvement of the patient's respiratory status. Pathology, bronchial lavage, and gastric aspirate specimens all revealed acid-fast bacilli, consistent with Mycobacterium tuberculosis infection. This unusual presentation of tuberculosis may become more common in the United States as the incidence of immigrants carrying tuberculosis increases.
Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior
Authors: Knishkowy Barry , Amitai Yona
Published: July 2005

Narghile, or water-pipe smoking (WPS), has been practiced extensively for ∼400 years. It is common in the Arabian Peninsula, Turkey, India, Pakistan, and other countries. In recent years, there has been a revival of WPS, notably among youth. Most US health professionals are unfamiliar with the practice and health consequences of WPS. Therefore, this trend presents a new challenge for adolescent health care providers. The composition of the tobacco used in WPS is variable and not well standardized. Studies that have examined narghile smokers and the aerosol of narghile smoke have reported high concentrations of carbon monoxide, nicotine, “tar,” and heavy metals. These concentrations were as high or higher than those among cigarette smokers. The few scientific data regarding the adverse health consequences of WPS point to dangers that are similar to those associated with cigarette smoking: malignancy, impaired pulmonary function, low birth weight, and others. Additional dangers not encountered with cigarette smoking are infectious diseases resulting from pipe sharing and the frequent addition of alcohol or psychoactive drugs to the tobacco. Public health strategies for controlling the emerging epidemic of WPS include carrying out epidemiologic and toxicologic research; implementation of laws to limit acquisition and use; and health education, targeting adolescents in particular.
Adenoidectomy Does Not Significantly Reduce the Incidence of Otitis Media in Conjunction With the Insertion of Tympanostomy Tubes in Children Who Are Younger Than 4 Years: A Randomized Trial
Authors: Hammarén-Malmi Sari , Saxen Harri , Tarkkanen Jussi , Mattila Petri S.
Published: July 2005

Objective. To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes.

Methods. A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured.

Results. During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (≥3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80–3.46).

Conclusion. Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.
Safety and Immunogenicity of the American Academy of Pediatrics–Recommended Sequential Pneumococcal Conjugate and Polysaccharide Vaccine Schedule in Pediatric Solid Organ Transplant Recipients
Authors: Lin Philana Ling , Michaels Marian G. , Green Michael , Mazariegos George V. , Webber Steven A. , Lawrence Kathy S. , Iurlano Kathy , Greenberg David P.
Published: July 2005

Objective. Solid organ transplant recipients are at increased risk for invasive pneumococcal disease. The American Academy of Pediatrics recommends immunization with sequential pneumococcal vaccines for this group; however, data are lacking. Accordingly, this study was designed to evaluate the safety and immunogenicity of the recommended regimen.

Methods. Pediatric solid organ transplant recipients (n = 25) between 2 and 18 years of age who had not previously received 7-valent conjugate pneumococcal vaccine (PCV7) were enrolled. These patients received 2 doses of the PCV7 and a single dose of the 23-valent polysaccharide pneumococcal vaccine (23V). Each vaccine dose was given 2 months apart. Healthy age-matched controls (n = 23) were enrolled for comparison. Controls received a single dose of PCV7 followed 2 months later by a single dose of 23V. Antibody concentrations to serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, and 23F were measured by enzyme-linked immunosorbent assay prevaccination, 2 months after each vaccine dose and 5 to 7 months after 23V. Local and systemic reactions to each vaccine dose were recorded.

Results. Systemic and injection-site reactions were comparable between the 2 groups. Significant rises in serotype-specific pneumococcal antibody geometric mean concentrations from prevaccination levels were observed in both groups; however, final antibody responses to serotypes 1, 4, 9V, 14, 18C, 19F, and 23F were significantly lower in solid organ transplant recipients compared with the control group. Antibody concentrations did not increase significantly among solid organ transplant patients after the second dose of PCV7. No additional increase in PCV7-associated serotype-specific antibody levels was observed after the 23V dose in both groups. Heart transplant recipients had lower antibody responses compared with liver transplant recipients.

Conclusions. Although the pneumococcal vaccine regimen was safe and immunogenic among pediatric solid organ transplant recipients, the patients did not seem to benefit from the second dose of PCV7 or from the 23V dose given 2 months later. Additional studies are needed to determine the number of PCV7 doses and the interval between PCV7 and 23V to induce optimal responses.
Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy
Authors: Giurgea Irina , Ulinski Tim , Touati Guy , Sempoux Christine , Mochel Fanny , Brunelle Francis , Saudubray Jean-Marie , Fekete Claire , de Lonlay Pascale
Published: July 2005

Clinical history and inappropriate insulin secretion during hypoglycemic episodes permit the diagnosis of hyperinsulinism. We report 2 cases of factitious hyperinsulinism leading to partial pancreatectomy. Case 1 was an 8-year-old girl who presented with severe hypoglycemia and elevated insulin and C-peptide levels. Catheterization of pancreatic veins was performed to localize the excess insulin secretion. Insulinoma was suspected, and partial pancreatectomy was performed. Ten days after surgery, severe hypoglycemia recurred with severely elevated plasma insulin levels (×100) but very low C-peptide plasma levels, suggesting factitious hyperinsulinemia. Hypoglycemic episodes before surgery were provoked by oral sulfonamides; postoperative episodes were caused by parenteral insulin. Falsified prescriptions for sulfonamides and insulin by the mother, a nurse, were found. Case 2 was a 6-month-old girl who presented with seizures and hypoglycemia but had a symptom-free interval of many months afterward. At 2 years of age, repeated hypoglycemic seizures and elevated insulin plasma levels suggested congenital hyperinsulinism. C-peptide plasma level, measured once, was normal, but blood sampling was performed 15 minutes after a hypoglycemic episode. Partial pancreatectomy was performed. Two weeks after surgery, hypoglycemic seizures recurred, and the patient was admitted for pancreatic vein catheterization. This investigation was performed during hypoglycemia and revealed high insulin levels and undetectable C-peptide levels, suggesting factitious hypoglycemia. Insulin/C-peptide ratio analysis is crucial to assess factitious hypoglycemia, although sulfonamide-induced hypoglycemia is not thereby detected. One percent (2 of 250) of all cases of hyperinsulinemic hypoglycemia in our unit have been identified as Munchausen syndrome by proxy. Atypical disease history should raise the question of factitious hypoglycemia.
Risk Factors Associated With Sudden Unexplained Infant Death: A Prospective Study of Infant Care Practices in Kentucky
Authors: Shields Lisa B. E. , Hunsaker Donna M. , Muldoon Susan , Corey Tracey S. , Spivack Betty S.
Published: July 2005

Objective. To ascertain the prevalence of infant care practices in a metropolitan community in the United States with attention to feeding routines and modifiable risk factors associated with sudden unexplained infant death (specifically, prone sleeping position, bed sharing, and maternal smoking).

Methods. We conducted an initial face-to-face meeting followed by a telephone survey of 189 women who gave birth at a level I hospital in Kentucky between October 14 and November 10, 2002, and whose infants were placed in the well-infant nursery. The survey, composed of questions pertaining to infant care practices, was addressed to the women at 1 and 6 months postpartum.

Results. A total of 185 (93.9%) women participated in the survey at 1 month, and 147 (75.1%) mothers contributed at 6 months. The racial/ethnic composition of the study was 56.1% white, 30.2% black, and 16.4% biracial, Asian, or Hispanic. More than half of the infants (50.8%) shared the same bed with their mother at 1 month, which dramatically decreased to 17.7% at 6 months. Bed sharing was significantly more common among black families compared with white families at both 1 month (adjusted odds ratio [OR]: 5.94; 95% confidence interval [CI]: 2.71–13.02) and 6 months (adjusted OR: 5.43; 95% CI: 2.05–14.35). Compared with other races, white parents were more likely to place their infants on their back before sleep at both 1 and 6 months. Black parents were significantly less likely to place their infants on their back at 6 months compared with white parents (adjusted OR: 0.14; 95% CI: 0.06–0.33). One infant succumbed to sudden infant death syndrome at 3 months of age, and another infant died suddenly and unexpectedly at 9 months of age. Both were bed sharing specifically with 1 adult in the former and with 2 children in the latter.

Conclusions. Bed sharing and prone placement were more common among black infants. Breastfeeding was infrequent in all races. This prospective study additionally offers a unique perspective into the risk factors associated with sudden infant death syndrome and sudden unexplained infant death associated with bed sharing by examining the survey responses of 2 mothers before the death of their infants combined with a complete postmortem examination, scene analysis, and historical investigation.
Hormonal Effects in Infants Conceived by Assisted Reproductive Technology
Authors: Rojas-Marcos Patricia Martin , David Raphael , Kohn Brenda
Published: July 2005

Objective.

The purpose of this report is to describe 7 infants conceived by assisted reproductive technology (ART) who presented with breast development and/or pubic hair. The clinical presentation in these infants raises awareness that an altered intrauterine hormonal milieu may impact the fetal and infant stages of children conceived by ART.

Methods.

Between May 2001 and April 2004, 7 children between the ages of 5 and 21 months conceived by ART were referred by their pediatricians to the Division of Pediatric Endocrinology at the New York University School of Medicine for evaluation of possible precocious puberty. Patients were evaluated for the possibility of centrally mediated precocious puberty and pseudoprecocious puberty, with a possible ovarian or adrenal origin.

Results.

Endocrine evaluation in all patients indicated sex-steroid and hormone levels in the prepubertal range; pelvic sonography confirmed prepubertal ovaries with unstimulated uteri. Clinical follow-up of our patients thus far has not revealed progression of breast development, pubarche, or elevation in sex steroids.

Conclusions.

It is well established that the developing endocrine system in the fetus and maturation of endocrine-control systems are influenced by hormone concentrations in the fetus. Whether ART alters the intrauterine hormonal milieu for the growing fetus conceived by ART is as yet unknown and is an area of ongoing investigation. Patients conceived through ART, including our patients who presented with hormonal manifestations, will need to be monitored throughout childhood and into adolescence and adulthood to determine if any perturbation exists on the timing of puberty and later fertility.
Effectiveness of the 2003–2004 Influenza Vaccine Among Children 6 Months to 8 Years of Age, With 1 vs 2 Doses
Authors: Ritzwoller Debra P. , Bridges Carolyn Buxton , Shetterly Susan , Yamasaki Kristi , Kolczak Margarette , France Eric K.
Published: July 2005

Objective. To evaluate the effectiveness of 1 and 2 doses of the 2003–2004 influenza vaccine in preventing medically attended influenza-like illness (ILI) among children 6 to 23 months and 6 months to 8 years of age.

Design and Methods. Outpatient and emergency department visits and immunization records were used to conduct a retrospective cohort study among children 6 months to 8 years of age. ILI and pneumonia and influenza (P&I) outcomes were defined on the basis of International Classification of Diseases, Ninth Revision, codes. Influenza vaccine effectiveness (VE) was calculated as (1 − hazard rate ratio) × 100.

Results. A total of 29726 children were included in the analyses; 17.3% were 6 to 23 months of age. By November 19, 2003, the start of peak influenza activity, 7.5% and 9.9% of children 6 months to 8 years were fully or partially vaccinated against influenza, respectively. For fully vaccinated children 6 to 23 months of age, VE against ILI and P&I was 25% and 49%, respectively. No statistically significant reduction in ILI or P&I rates was observed for partially vaccinated children 6 to 23 months of age (−3% and 22%, respectively). For fully vaccinated children 6 months to 8 years of age, VE against ILI and P&I was 23% and 51%, respectively. For partial vaccination, VE was significant only for P&I (23%).

Conclusions. Despite a suboptimal match between the influenza vaccine and predominant circulating strains, influenza vaccination provided substantial protection for fully vaccinated children and possibly some protection for partially vaccinated children <9 years of age. These findings support vaccinating targeted children even when the vaccine match is suboptimal, and they highlight the need to vaccinate previously unvaccinated children with 2 doses for optimal protection.
The Food and Drug Administration’s Deliberations on Antidepressant Use in Pediatric Patients
Authors: Leslie Laurel K. , Newman Thomas B. , Chesney P. Joan , Perrin James M.
Published: July 2005

On February 2, 2004, the Food and Drug Administration organized a joint meeting of the Neuro-Psychopharmacologic Advisory Committee and Pediatric Subcommittee of the Anti-Infective Drugs Advisory Committee to examine the occurrence of suicidality in clinical trials that investigate the use of the newer antidepressant drugs in pediatric patients. Committee members reconvened on September 13–14, 2004, and concluded that there was a causal link between the newer antidepressants and pediatric suicidality. This article provides a summary of the Food and Drug Administration deliberations for the pediatric clinician. We also provide research, regulation, education, and practice implications for care for children and adolescents who may be eligible for treatment with these medications.
Screening and Interventions for Overweight in Children and Adolescents: Recommendation Statement
Authors:   US Preventive Services Task Force
Published: July 2005

The U.S. Preventive Services Task Force (USPSTF) is an independent panel of non-federal experts in prevention and primary care that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. This recommendation addresses the evidence for the accuracy of screening children and adolescents using BMI, the effectiveness of behavioral and pharmacologic interventions in improving health outcomes in these children, and the potential harms of routine screening and intervention. Using USPSTF methodology, an analytic framework with key questions was developed to guide the systematic review, which serves as the basis for this recommendation.

The number of children and adolescents who are overweight has more than doubled in the last 25 years. Childhood and adolescent overweight is associated with increased health risks. The USPSTF found insufficient evidence for the effectiveness of behavioral counseling or other preventive interventions with overweight children and adolescents that can be conducted in primary care settings. Currently, available studies are limited by factors such as small sample sizes, poor generalizability, and variable follow-up. Based upon this critical gap in the evidence for effectiveness, the USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for overweight in children and adolescents as a means to prevent adverse health outcomes (“I” recommendation). There are several gaps in the research evidence on screening and interventions for overweight children and adolescents in the primary care setting. Research is needed to provide well-defined and effective approaches to medical and psychological screening in children, as well as effective clinical approaches for the prevention and treatment of overweight in children that can be implemented by primary care clinicians.
Pediatric Care Recommendations for Freestanding Urgent Care Facilities
Authors:   Committee on Pediatric Emergency Medicine
Published: July 2005

Freestanding urgent care centers are not emergency departments or medical homes, yet they are sometimes used as a source of pediatric care. The purpose of this policy statement is to provide updated and expanded recommendations for ensuring appropriate stabilization in pediatric emergency situations and timely and appropriate transfer to a hospital for definitive care when necessary.
Seasonal Harvest, Exploitation, Size Selectivity, and Catch Preferences Associated with Winter Yellow Perch Anglers on South Dakota Lakes
Authors: Isermann Daniel A. , Willis David W. , Lucchesi David O. , Blackwell Brian G.
Published: July 2005

We evaluated harvest patterns, exploitation, size selectivity, and angler catch preferences associated with winter fisheries for yellow perch Perca flavescens (i.e., ice fishing) on South Dakota lakes. Seasonal trends in the percentage of anglers targeting yellow perch and in yellow perch harvest were apparent in creel surveys on seven lakes; trends varied among lakes. Exploitation of yellow perch was estimated on two lakes through tag-return studies. Nonreporting rates estimated from surrogate postcards varied between angler groups (19–52%). On East 81 Slough, where the relative stock density (RSD) of yellow perch of 254 mm or longer (RSD-254) was low (RSD-254 = 10), exploitation was only 7% during the winter of 2000–2001; much of the total annual mortality (48%) in the population was attributed to natural causes (40%). Conversely, the estimated exploitation rate on Pelican Lake, where size structure was dominated by larger fish (RSD-254 = 92), was 61% from December to June. Anglers on East 81 Slough demonstrated size-selective harvest of yellow perch, harvesting higher proportions of older, larger fish than were observed in trap-net samples. High percentages of anglers on both lakes reported preferences for catching or harvesting fewer, larger yellow perch rather than catching or harvesting more, but smaller, fish. Variation in the size structure of the yellow perch available to anglers will probably result in variable exploitation rates both among populations and among years within a single population. Angler catch preferences and size selectivity suggest that future management strategies should be designed to provide reasonable numbers of large yellow perch to meet angler desires.
Descriptive complexity of finite structures: Saving the quantifier rank
Authors: Pikhurko Oleg , Verbitsky Oleg
Published: July 2005

We say that a first order formula Φ distinguishes a structure M over a vocabulary L from another structure M′ over the same vocabulary if Φ is true on M but false on M′. A formula Φ defines an L-structure M if Φ distinguishes M from any other non-isomorphic L-structure M′. A formula Φ identifies an n-element L-structure M if Φ distinguishes M from any other non-isomorphic n-element L-structure M′.

We prove that every n-element structure M is identifiable by a formula with quantifier rank less than and at most one quantifier alternation, where k is the maximum relation arity of M. Moreover, if the automorphism group of M contains no transposition of two elements, the same result holds for definability rather than identification.

The Bernays-Schönfinkel class consists of prenex formulas in which the existential quantifiers all precede the universal quantifiers. We prove that every n-element structure M is identifiable by a formula in the Bernays-Schönfinkel class with less than quantifiers. If in this class of identifying formulas we restrict the number of universal quantifiers to k, then less than quantifiers suffice to identify M and. as long as we keep the number of universal quantifiers bounded by a constant, at total quantifiers are necessary.
The superintuitionistic predicate logic of finite Kripke frames is not recursively axiomatizable
Authors: Skvortsov Dmitrij
Published: July 2005

We prove that an intermediate predicate logic characterized by a class of finite partially ordered sets is recursively axiomatizable iff it is “finite”, i.e., iff it is characterized by a single finite partially ordered set. Therefore, the predicate logic LFin of the class of all predicate Kripke frames with finitely many possible worlds is not recursively axiomatizable.
A note on superstable groups
Authors: Gagelman Jerry
Published: July 2005

It is proved that all groups of finite U-rank that have the descending chain condition on definable subgroups are totally transcendental. A corollary is that any stable group that is definable in an o-minimal structure is totally transcendental of finite Morley rank.
Data Mining
Authors: Hand David J.
Published: July 2005

Data mining seeks unexpected, interesting, or valuable structures in large data sets. There are two distinct classes of data mining tool, modeling, and pattern discovery. Difficulties arise in coping with data distortion and errors. The tools of data mining hold great promise for scientific and medical advance, but many theoretical questions remain open.
Case Fatality
Authors: Hakulinen T.
Published: July 2005

Case fatality indicates how serious a disease condition is in causing death to patients, usually within a defined period of time. Conceptually, case fatality may be seen as a complement to survival, and thus the methods of survival analysis can be employed in assessing case fatality.
Conception
Authors: Macfarlane Alison
Published: July 2005

Conception rates are difficult to compile because of the difficulty in collecting data about miscarriage and these difficulties may be compounded if gestational age is not recorded at birth registration. In England and Wales, estimated conception rates are derived from live and stillbirth registrations combined with notifications of legal abortions.