bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developmental Dysplasia of the Hip
Authors: Aronsson David D. , Goldberg Michael J. , Kling Thomas F. , Roy Dennis R. 
Published: December 2021

Objective. The definition and early treatment of congenital dysplasia of the hip are controversial. The purpose of this study was to discuss the reasons for changing the acronym to developmental dysplasia of the hip (DDH) and to address its early detection and treatment.
Design. This multicenter study was designed to provide an updated assessment of the definition, pathologic anatomy, prevalence, etiology, natural history, early detection, and treatment of DDH.
Results. DDH more accurately describes the condition previously termed congenital dysplasia of the hip. The disorder is not always present at birth (congenital) and an infant may have a normal neonatal hip screening examination and subsequently develop a dysplastic or dislocated hip. Developmental dysplasia encompasses the wide spectrum of hip problems seen in infants and children. Physicians should understand that a normal neonatal screening examination does not assure normal hip development. The diagnosis of developmental dysplasia is made by physical examination. The Ortolani and Barlow maneuvers were designed to detect a subluxatable, dislocatable, or dislocated hip in the neonatal period. In the older child, limited abduction becomes a more reliable sign. The examination is variable depending on the type of dysplasia and changes with growth. The ultrasound is proving to be a sensitive tool in confirming the diagnosis in newborns and infants from birth to 4 months of age. The ultrasound is also valuable in older infants in terms of documenting that the dysplasia is responding to treatment. However, the ultrasound depends on an experienced sonographer and, in some cases, may be too sensitive, resulting in overtreatment. After 3 to 4 months of age, an anteroposterior pelvis radiograph can confirm the diagnosis.
Conclusions. All newborns should have a neonatal hip screening physical examination. After screening, the hips should be re-examined during health examination visits at 2 weeks, 2 months, 4 months, 6 months, 9 months, and 1 year of age. If any question arises during these visits or if there are associated risk factors, we recommend an ultrasound if the infant is &lt;4 months of age or an anteroposterior pelvis radiograph if &gt;4 months of age.
The Inconspicuous or "Disappearing" Penis
Authors: Little James R. 
Published: December 2021

I see that male genitalia are once again conspicuous in the pages of the Green Journal.1-3 I was horrified to read and see what is happening to young males in the Phoenix area, as described in the article by Bergeson et al.1 Their primary care pediatricians are threatened with litigation. All for a common, normal developmental phenomenon, whose only treatment should be simple reassurance.
I first became aware of this "problem" 15 or 20 years ago when an occasional father would show up for the 9- or 12-month well-child visit.
SURVEY OF FATALITIES FROM SKIN TESTING AND IMMUNOTHERAPY, 1985 TO 1989
Authors: Fischer Thomas J. 
Published: December 2021

Purpose of the Study. This study was a survey of fatalities from skin testing and immunotherapy performed by the American Academy of Allergy and Immunology (AAAI) for the period 1985 to 1989. (An initial study dating from 1959 to 1984 was reported by Lockey in 1987 (J Allergy Clin Immunol. 1987;79:660).)
Methods. Questionnaires were sent to all members of the AAAI and ACAI requesting reports of any fatalities known to have been associated with skin testing or immunotherapy. An extensive clinical history of these fatalities was obtained and reviewed.
Findings. Seventeen fatalities were associated with immunotherapy from 1985 to 1989 (in this same period, no fatalities were reported with skin testing). The mean age of the patients who died was 36 years; 69% were female. Of note, four patients were 18 years of age or younger. Of the patients who died, 76% had asthma, and most were reported to have had factors associated with increased severity. High allergic sensitivity was reported by 71%; 36% reported prior systemic reactions. Additional factors associated with fatalities were: changing to a new vial of extract (5), dosing error or inappropriate dose adjustment (5), allergen season (3), symptoms before injection (4), no waiting after injection (2), and home injection (1). The authors note that the annual fatality rate for administration of allergen extracts in the United States remains low: one fatality per 2 million doses, but that additional educational efforts to reduce the fatality rate are needed.
Reviewer's Comments. The observation that 76% of the fatalities occurred in patients with asthma is similar to the observation that patients who die from stinging insect hypersensitivity and food-induced anaphylaxis are more likely asthmatics.
INFLUENCE OF GRASS POLLEN IMMUNOTHERAPY ON CELLULAR INFILTRATION AND CYTOKINE EXPRESSION DURING ALLERGEN-INDUCED LATE-PHASE CUTANEOUS RESPONSES
Authors: Nimmagadda Sai , Spahn Joseph 
Published: December 2021

Purpose of the Study. The mechanism by which immunotherapy (IT) provides its beneficial effects are poorly understood. This study examines the effects of grass pollen IT on cellular infiltration and cytokine mRNA expression during allergen induced late phase cutaneous responses.
Methods. Forty subjects were enrolled in this double blind, placebo controlled study to receive twice weekly injections of either a standardized grass pollen extract or placebo. Once maintenance was reached, injections were administered monthly for 9 months. Skin biopsies following intradermal infection with Timothy extract were performed prior to and following IT. Monoclonal antibody staining was used to detect surface markers on lymphocytes. In situ hybridization was used to identify cells expressing cytokine mRNA.
Findings. Both patient groups were matched for age, disease severity, and duration. Thirty-seven patients (17 placebo, 20 active) completed the study. The treated group had a significant decrease in symptoms, medication use, and size of the immediate and late phase reaction (LPR) after intradermal allergen injection upon completion of the IT. Skin biopsy cell counts from actively treated subjects obtained after subcutaneous allergen challenge showed a significant decrease in T helper and eosinophil cell numbers compared to the placebo group. Increases in the expression of CD25 and HLA-DR (markers of T cell activation) were seen in the treatment group. No differences in amount of HA and IL5 mRNA-expressing cells (TH2) were noted, but there was an increase in IFN-γ and IL2 mRNA expressing cells (ie, TH1) in the actively treated group. A significant correlation was noted between the size of the LPR and the numbers of CD4+ cells in the placebo group.
IDENTIFICATION, CHARACTERIZATION AND FUNCTIONAL ROLE OF PHOSPHODIESTERASE ISOZYMES IN HUMAN AIRWAY SMOOTH MUSCLE
Authors: Hopp Russell 
Published: December 2021

Purpose of the Study. Theophylline, a widely used bronchodilator, has been traditionally thought to exert its effect by inhibiting phosphodiesterase (PDE), which increases cAMP levels. It has become apparent that there are actually five different PDE isozymes, each encoded by a different gene or gene family. It may be possible to selectively target the lung PDE isozyme using specific inhibitors for the pulmonary smooth muscle type of PDE. The specific type of airway smooth muscle PDE isozyme, the effect of specific PDE inhibitors, individually or additively, and regional differences in PDE enzyme types was the focus of this study.
Methods. Human trachea was obtained from brain-dead subjects, processed within 24 hours by separating the muscle from surrounding tissues, and homogenized. Human lung was similarly obtained and processed, with the ultimate isolation of individual bronchial smooth muscle from several generations of bronchial diameters. PDE isozyme separation was performed by using a combination of DEAE-Sepharose and calmodulin-Sepharose affinity chromatography.
Results. Trachael smooth muscle contained all five PDE isozymes. Using specific inhibitors of each PDE isozyme, inhibitors of PDE type III were &gt;PDE Type IV which were &gt;PDE type III, respectively, as bronchial smooth muscle relaxants. This bias toward Type III and IV PDE was found in large and small bronchial preparations. Inhibitors of PDE III and IV acted synergistically, and PDE III inhibitors assisted beta-agonist-induced relaxation.
Reviewer's Comments. If the only action of theophylline is its' effect on PDE, drugs that do a better job of blocking specific PDE isozyme(s) in bronchial smooth muscle should be developed.
A SPECIFIC ENDOTHELIN-1 ANTAGONIST BLOCKS INHALED ENDOTHELIN-1-INDUCED BRONCHOCONSTRICTION IN SHEEP
Authors: Kobayashi Roger 
Published: December 2021

Purpose of the Study. Endothelin (ET) is a potent bronchoconstrictor. The study was designed to determine the functional activity and specificity of a new ET-1 antagonist in the airways of conscious sheep.
Methods. Fourteen conscious ewes (passive female specimens) had measurements of airway mechanics determined by several methods. Aerosol delivery was by a medical nebulizer with dosimeter aerosolizing ET-l, ET-l antagonist, carbachol, or control peptides. Protocol I determined concentration-response curves to inhaled ET-1 and ET-3 measuring lung resistance before and immediately after increasing ET concentrations. Subsequently, the protective effect of ET-1 antagonist to ET-1-induced bronchospasm was studied. Protocol II determined the effect of increasing concentrations of ET-l antagonist on bronchoconstriction and on protection against ET-1-induced bronchoconstriction. The specificity of protection of ET-1 antagonist was further studied against carbachol- and LTD4-induced bronchoconstriction.
Results. Both inhaled ET-1 and ET-3 caused concentration-dependent increases in lung resistance, but ET-1 was 400-fold more potent. Pretreatment with ET-1 antagonist produced marked inhibition of ET-1-induced bronchoconstriction (P value less than .001). ET-3 antagonist also provided a small but significant protection against ET-1-induced bronchospasm. None of the control peptides provided any protection. ET-1 antagonist had no effect on carbachol- or LTD4-induced bronchoconstriction suggesting receptor specificity. Increasing doses of ET-1 antagonist was safe, however at very high concentrations, there was some suggestion of bronchoconstriction (indicating that some irritant effect may exist).
Reviewer's Comments. ET-1 is a newly described, potent bronchoconstrictor and has been measured in bronchial lavage fluid from asthmatics. ET-1 appears to act on specific receptors as ET-1 antagonist effectively blocks the affect of ET-1 but not the bronchoconstrictive activity of LTD4 and carbachol.
HOW USEFUL DO PARENTS FIND HOME PEAK FLOW MONITORING FOR CHILDREN WITH ASTHMA?
Authors: Bell Thomas 
Published: December 2021

Purpose of the Study. This study seeks to assess the actual utility of the home peak flow meter (PFM).
Methods. In a clinic where all children aged over 5 years receive a peak flow meter, 50 consecutive outpatients' families were given a questionnaire to explore the knowledge of the family consequent to the use of the PFM and their assessment of its utility.
Findings. Eighty-four percent of the 50 respondents were familiar with key PFM parameters for their child, and 70% rated the PPM as very useful, another 28% as useful, and one patient as useless. Eighty-eight percent found the PPM useful during an attack of asthma; 46% as useful in assessing the response to bronchodilator therapy. A finding in a small number (20%) of detecting asthma in asymptomatic patients, is also of significance.
Conclusion and Comments. These findings support the usefulness of the PPM in home management of asthma in children. There remains some debate over whether its use should be stressed for asthma attacks and asymptomatic patients; some feel that patients should be taught to assess how asthma interferes with their daily life to best judge asthma's need for treatment. This study would have been more useful if such a group had been compared to the PFM group. I personally find that patients are increasingly technology-oriented and use the PFM in the home management of asthma.
SENSITIVITY, SPECIFICITY, AND PREDICTIVE VALUE OF PHYSICAL EXAMINATION, CULTURE, AND OTHER LABORATORY STUDIES IN THE DIAGNOSIS DURING EARLY INFANCY OF VERTICALLY ACQUIRED HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Authors: Pacheco Susan E. , Shearer William T. 
Published: December 2021

Purpose of the Study. To determine the HIV vertical transmission rate in an unselected group of infants born to HIV-infected mothers, and to examine the sensitivity, specificity, and positive and negative predictive values of physical examination and diagnostic laboratory studies (HIV culture, serum quantitative immunoglobulins and HIV-1 p24 antigen) in the diagnosis of HIV infection.
Study Population. A group of 142 infants referred solely because they were born to HIV-infected mothers were selected for this study.
Methods. Epidemiological and clinical data were obtained retrospectively from the Baylor Pediatric AIDS Clinical Trials Group HIV Infection Registry and medical records. The information recorded included results of physical examination and diagnostic laboratory tests (HIV culture, serum quantitative immunoglobulins, and HIV-1 p24 antigen). HIV cultures were performed according to a consensus protocol developed for the National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group.
Results. Of 142 infants whose HIV infection status was known at the time of the study, 17 (20%) had confirmed infection, and 68 (80%) had seroreverted with no evidence of infection. All HIV-infected infants were at least 3 months old when abnormal physical exam findings became apparent (lymphadenopathy and hepatosplenomegaly), but similar findings were noted in an equal number of HIV-uninfected infants. All infected infants available were HIV culture positive by 6 months of age (16/16). There was no positive cultures reported in the infants who seroreverted (32/32). Elevated immunoglobulins (IgG, IgA, IgM) were present by 6 months of age in a high percentage of infected infants. Nearly one-half of the uninfected infants had elevated immunoglobulin levels during the first 6 months of life, but in 50% of the cases it was IgG alone.
DEFICIENT EXPRESSION OF A B CELL CYTOPLASMIC TYROSINE KINASE IN HUMAN X-LINKED AGAMMAGLOBULINEMIA
Authors: Abernathy-Carver Katherine J. , Liu Andrew 
Published: December 2021

Purpose of the Studies. X-linked agammaglobulinemia (XLA) is a humoral immunodeficiency characterized by recurrent bacterial infections. Affected males lack mature B cells and serum immunoglobulins of all isotypes. They have a normal number of pre-B cells in the bone marrow, which suggests a defect in the pathway of B cell development. These two research groups sought to identify the gene and protein product responsible for this disorder.
Findings. Both groups, using different methodologies, successfully identified the mutant gene on the X chromosome, and characterized the defective protein product in a total of 10 XLA patients. The protein is a cytoplasmic tyrosine kinase. Other tyrosine kinases are known to play a critical role in signal transduction pathways that stimulate cell growth and differentiation.
Reviewers' Comments. These papers represent a major breakthrough in the understanding of XLA. More research is needed to explain how this defective protein results in this disorder. However, this opens the door for prenatal diagnosis and possible gene therapy in the future.
THE CD40 LIGAND gp39, IS DEFECTIVE IN ACTIVATED T CELLS FROM PATIENTS WITH X-LINKED HYPER-IgM SYNDROME
Authors: Levy Arden , Liu Andrew 
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.
Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.
Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease
Authors: Young Paul C. , Shyr Yu , Schork M. Anthony 
Published: December 2021

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease.
Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital.
Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease.
Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness.
Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness.
Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.
Reference Values for Respiratory Rate in the First 3 Years of Life
Authors: Rusconi Franca , Castagneto Manuela , Porta Norberto , Gagliardi Luigi , Leo Gualtiero , Pellegatta Antonio , Razon Sultana , Braga Mario 
Published: December 2021

Background. Raised respiratory rate is a useful sign to diagnose lower respiratory infections in childhood. However, the normal range for respiratory rate has not been defined in a proper, large sample.
Objective. To assess the respiratory rate in a large number of infants and young children in order to construct percentile curves by age; to determine the repeatability of the assessment using a stethoscope and compare it with observation.
Methods. Respiratory rate was recorded for 1 minute with a stethoscope in 618 infants and children, aged 15 days to 3 years old, without respiratory infections or any other severe disease when awake and calm and when asleep. In 50 subjects we compared respiratory rate taken 30 to 60 minutes apart to assess repeatability, and in 50 others we compared simultaneous counts obtained by stethoscope versus observation.
Results. Repeatability was good as the standard deviation of differences was 2.5 breaths/minute in awake and 1.7 breaths/minute in asleep children. Respiratory rate obtained with a stethoscope was systematically higher than that obtained by observation (mean difference 2.6 breaths/minute in awake and 1.8 breaths/minute in asleep children; P = .015 and P &lt; .001, respectively). A decrease in respiratory rate with age was seen for both states, and it was faster in the first few months of life when also a greater dispersion of values was observed. A second degree polynomial curve accurately fitted the data. Reference percentile values were developed from these data.
Conclusions. The repeatability of respiratory rate measured with a stethoscope was good. Percentile curves would be particularly helpful in the first months of life when the decline in respiratory rate is very rapid and prevents to use cut off values for defining "normality."
DOCTORS CUSTOMERS
Authors: L. J. F. 
Published: December 2021

Dr. Stephen Jones of Rockville, MD, calls me his patient. I like that word; it make me feel secure. Dr. Richard Selzer, the surgeon and writer, once told a Mayo Medical School graduating class that the word patient comes from the Latin pati, "to suffer," adding: "Doctors have patients. This is, above all, what distinguishes us from lawyers, who have clients . . . We have patients, and they suffer."
Clients suffer, too, at the hands of some lawyers, but the distinction is valid. In recent years, however, a dehumanizing note has crept into the medical language: patients have become health care consumers. Victor Cohen, the former Washington Post health columnist, was among the first to deride the trend toward calling doctors caregivers and healthcare [one word] producers; the new terms lump the MDs among less well-trained professionals.
The big word now is provider, which has taken care of caregiver.
Thanks to the info explosion, it's spreading. I used to be a writer. Now I'm a content provider. Don't laugh; it could happen to you.