bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Clerkship Performance in Diverse Community Clinical Settings
Authors: Kurlandsky Lawrence E. , Potts Michael , Kumar Ashir 
Published: December 2021

Objective. To determine whether multiple and diverse clinical settings and resources in a pediatric clerkship result in satisfactory performance by medical students and affect their choice of a pediatric residency after graduation.
Design. Retrospective study 1985 through 1990.
Setting. Medical students in a pediatric clerkship in a medical school that is part of a land grant university where the clinical curriculum is conducted in six geographically distinct communities.
Main outcome measure. (1) Three performance criteria including: multiple choice final examination score, clinical performance evaluations by preceptors, and formal evaluation of patient written records. (2) Students matching with a pediatric or combined internal medicine/pediatric residency.
Results. Of 499 students 92.8% successfully passed all three criteria with no statistically significant differences between communities. A smaller percentage of students (15.2%) (community range, 6 to 18.5%) entered straight or combined pediatric residencies, whether or not a pediatric residency was present in the community.
Conclusions. Medical students can achieve satisfactory competency in pediatric clerkships offered in diverse clinical settings, and choose pediatric residency training whether or not they are exposed to a pediatric residency during their clerkship. A problem-based learning curriculum does not hinder selecting pediatrics as a career choice.
Altered Blood Pressure Reactivity in Adolescent Diabetics
Authors: Newkumet Kathleen M. , Goble Monica Martin , Young Reuben B. , Kaplowitz Paul B. , Schieken Richard M. 
Published: December 2021

Objective. We examined hemodynamic responses to a variety of physiologic stimuli in 14 normotensive adolescents with type I diabetes and 45 healthy controls to determine whether structural vascular changes contribute to a reduced vasodilator capacity in adolescent diabetics. We asked, in adolescents with type I diabetes: (1) Are structural vascular changes present? (2) Are changes in the systemic vascular bed reflected in abnormal blood pressure regulation? and (3) Is abnormal vascular reactivity associated with either diabetes duration or control?
Methodology. Diabetic subjects were outpatients treated at the Medical College of Virginia, ages 13 to 18 years. Diabetes duration averaged 7.5 years. Each subject underwent an echocardiogram, dynamic and isometric exercise testing, and forearm plethysmography.
Results. Compared to controls, diabetic subjects had (1) higher systolic and diastolic blood pressure during dynamic and handgrip exercise, (2) decreased forearm vasodilator capacity in response to ischemia, and (3) an increased aortic peak velocity. Group diastolic filling abnormalities were found, but these did not persist after adjustment for heart rate. The following variables were related to both diabetes duration and control (average glycosylated hemoglobin): (1) diastolic blood pressure during dynamic exercise, (2) resting forearm vascular resistance, and (3) forearm vascular reactivity. In addition, diabetes duration correlated with isometric exercise diastolic blood pressure, and diabetes control correlated with resting diastolic blood pressure.
Conclusion. In young diabetics we found that (1) abnormalities of the resistance vessels of the forearm may be present, (2) the degree of vascular change is related to diabetes duration and control, and (3) aortic distensibility may be impaired.
Nitric Oxide Synthase Is Deficient in the Aganglionic Colon of Patients With Hirschsprung's Disease
Authors: Bealer John F. , Natuzzi Eileen S. , Buscher Cori , Flake Alan W. , Adzick N. Scott , Harrison Michael R. , Ursell Philip C. 
Published: December 2021

Objectives. The cause of Hirschsprung's disease is unknown but defects in nonadrenergic, noncholinergic innervation could prevent relaxation of aganglionic colon in patients with this disease. Nonadrenergic, noncholinergic nerves induce relaxation by using nitric oxide synthase to produce the smooth muscle relaxant nitric oxide (NO). In this study we asked whether aganglionic colon in patients with Hirschsprung's disease is deficient in NO synthase-containing nerves.
Methodology. Using the tetrazolium blue dye method of demonstrating nicotinamide adenine dinucleotide phosphate-diaphorase enzymes, we examined eight colon specimens (four aganglionic and four ganglionic) from patients with Hirschsprung's disease for the presence of NO synthase. We further quantified NO synthase enzyme activity in these eight specimens by using the [3H]arginine-to-[3H]citrulline conversion assay.
Results. The nicotinamide adenine dinucleotide phosphate-diaphorase staining showed that aganglionic colon contained less NO synthase than ganglionic colon. This NO synthase deficiency was located primarily in the nerves of the circular muscle layer of the colon. In addition, there was a striking difference in the NO synthase enzyme activity between aganglionic and ganglionic colon as measured by the [3H]arginine-to-[3H]citrulline conversion assay. Total NO synthase activity, as measured by this assay, was found to be less in aganglionic than in ganglionic colon. When the total activity was divided into its four known isoforms, aganglionic colon was noted to be striking deficient in the isoform derived primarily from nerves.
Conclusion. We conclude that aganglionic colon is deficient in NO synthase-containing nerves. This deficiency could prevent smooth muscle relaxation in the aganglionic colon of patients with Hirschsprung's disease.
Recommended Timing of Routine Measles Immunization for Children Who Have Recently Received Immune Globulin Preparations
Authors:   Committee on Infectious Diseases
Published: December 2021

Passively acquired antibody can block replication of live viral vaccines and subsequent active immune responses.1-3 The persistence of transplacentally acquired maternal measles antibodies can interfere with the response to measles vaccine in some infants up to 12 months of age.4,5 Simultaneous or prior administration of immune globulin administered through the intramuscular or intravenous route has a similar blunting or blocking effect on the host response to certain live virus vaccines.1,6,7 The American Academy of Pediatrics previously recommended a 3-month interval after administration of immune globulin before parenteral administration of live viral vaccines, including measles, mumps, and rubella vaccines (MMR). This recommendation was based on the half-life of passively administered immune globulin and data from individuals who received low doses of immune globulin.2 However, immune globulin is now used in larger doses for treatment or prevention of several diseases, 8 necessitating a lengthening in the interval between use of immune globulin and the administration of certain live virus vaccines.
INTERFERENCE WITH MEASLES IMMUNIZATION
In a recent study high doses of immune globulin interfered with the response to measles immunization for more than 3 months.1 Children who received bacterial polysaccharide immune globulin (BPIG), a product under clinical evaluation, in a dose of 0.5 mL/kg (80 mg of IgG per kilogram) intramuscularly had reduced measles antibody response when measles vaccine was given as long as 5 months after administration of BPIG (Figure). The measles antibody concentrations (pen gram of protein) in BPIG were similar to concentrations found in preparations of immune globulin (IG) for intramuscular administration, specific immune globulin preparations (eg, VZIG, HBIG, and TIG), and immune globulin for intravenous administration (IGIV).
Barriers To Use of Oral Rehydration Therapy
Authors: Reis Evelyn Cohen , Goepp Julius G. , Katz Scott , Santosham Mathuram 
Published: December 2021

Objective. To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners.
Design. Cross-sectional, anonymous, self-administered survey of physicians' ORT knowledge, attitudes, and practice.
Setting. A national continuing medical education conference.
Participants. One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%).
Measurements and results. Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians' practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P &lt; .001), support staff preference for intravenous versus ORT (P &lt; .001), need for additional training of support staff to implement ORT (P &lt; .01), and likelihood of reimbursement for intravenous versus ORT (P = .07). Notably, degree of importance of ORT was not associated with physician ORT knowledge.
Conclusion. Efforts to improve use of ORT should be expanded beyond physician education and focus on such barriers as support staff limitations and financial constraints.
Association of Pulmonary Inflammation and Increased Microvascular Permeability During the Development of Bronchopulmonary Dysplasia: A Sequential Analysis of Inflammatory Mediators in Respiratory Fluids of High-Risk Preterm Neonates
Authors: Groneck Peter , Götze-Speer Bettina , Speer Christian P. , Oppermann Martin , Eiffert Helmut 
Published: December 2021

Objectives. Bronchopulmonary dysplasia (BPD) of preterm neonates is associated with an increased recruitment of inflammatory cells into the airways. To evaluate further the role of inflammation in the pathogenesis of BPD, tracheobronchial aspirate fluid of neonates with birth weight &lt;1200 g (n = 59) was sequentially analyzed in a prospective study.
Methods. Tracheobronchial aspirate fluid was assessed for chemotactic activity, neutrophil cell count, concentrations of elastase-α1-proteinase inhibitor and activity of free elastase, concentrations of chemoattractants (complement component C5-derived anaphylatoxin, leukotrien B4, interleukin-8), and albumin concentrations as well as α1-proteinase inhibitor activity. The secretory component for immunoglobulin A was used as reference protein. Only specimens without evidence of microbiological colonization were studied.
Results. In neonates with prolonged respiratory disease (BPD-risk neonates, n = 24, fraction of inspired oxygen ≥ 0.3 and/or peak inspiratory pressure ≥ 16 cm H2O at day 10 postnatal age, birth weight 892 ± 36 g, gestational age 27.2 ± 0.3 weeks) chemotactic activity, cell count, concentrations of the chemoattractants complement component C5-derived anaphylatoxin, leukotriene B4, interleukin-8, as well as levels of elastase-α1-proteinase inhibitor were significantly higher at day 10 and/or day 15 of postnatal age compared with neonates without chronic pulmonary disease (total n = 35; day 10, n = 11; day 15, n = 8). There was no difference in free elastolytic activity. Concentrations of albumin as well as α1-proteinase inhibitor activity were higher in BPD-risk patients on day 15, indicating an increased pulmonary leak.
Conclusion. We conclude that preterm neonates at risk for the development of BPD show an enhanced inflammatory reaction in the lungs and an associated increase in pulmonary microvascular permeability. We speculate that inflammation may play an important role in the pathogenesis of BPD.
LORENZO'S OIL AND ADENOLEUKODYSTROPHY
Authors: L. J. F. 
Published: December 2021

The new movie "Lorenzo's Oil" tells how the parents of a child with a rare illness overcame indifference in the medical establishment and, by themselves, invented a cure.
The message is that medical science has become detached from the needs of those it serves, but that individuals can leap bureaucratic impediments to find new cures with their own faith and efforts ...
According to the movie and the account of the parents, Augusto and Michaela Odone of Fairfax, Va., they refused to accept doctors' advice that there was no hope for their son, Lorenzo, after they were told in 1984 that he was suffering from a rare hereditary disease known as adenoleukodystrophy ...
... they defied the medical establishment's pessimism, read obscure medical journals and figured that a mixture of two natural oils, known as erucic and oleic acids, would correct an important symptom of the disease ...
Dr. Rizzo began the first pilot study of the oil in August 1987. Six of 8 boys in the study deteriorated rapidly. The other two seemed to stabilize for a time, but one has now had a relapse and investigators have lost contact with the other.
In a study by Dr. Hugo Moser of Johns Hopkins University School of Medicine, 70 children with the rapidly progressing disease used the oil from the time of their first symptoms until they lost sight and movement. The oil, Dr. Moser concluded, "did not make any difference."
Dr. Moser said that so far he had seen no evidence that Lorenzo's disease could be prevented in boys who were otherwise destined to get it ...
Oxidation of Proteins in Neonatal Lungs
Authors: Gladstone Igor M. , Levine Rodney L. 
Published: December 2021

Objective. To develop a method capable of quantifying the oxidative modification of proteins in pulmonary fluid obtained during routine suctioning of neonates receiving ventilation, thus providing an integrated assessment of antioxidant defenses.
Design. Consecutive sample of neonates receiving ventilation.
Setting. Neonatal intensive care unit.
Patients. Twenty-six neonates receiving ventilation with a gestational age of 24 to 42 weeks, from whom 246 samples were collected and analyzed.
Measurements and results. The carbonyl content in the lavage samples was measured by reaction with 2,4-dinitrophenylhydrazine followed by high-pressure liquid chromatography. Oxidation of proteins caused introduction of carbonyl groups into the side chains of the protein, providing a convenient and relatively specific marker of oxidative damage. On the first day of life, the initial protein-bound carbonyl for each neonate was usually low and consequently was not significantly related to birth weight, gestational age, or initial ventilatory requirements. Examination of the changes in pulmonary protein carbonyl in the first days of life revealed correlations of interest. In the first day of life, four neonates whose average inspired oxygen were &lt;40% showed no increase in carbonyl content, whereas four neonates whose inspired oxygen was &gt;40% showed an average increase in carbonyl of 51% (P &lt; .001). Also, the need for ventilation &gt;3 days was correlated with elevated carbonyl in those first 3 days. The carbonyl content averaged over the first 3 days was 0.13 ± 0.02 mol carbonyl/mol protein for the eight neonates receiving ventilation &lt; 72 hours, whereas the nine needing longer ventilation had a carbonyl content of 0.28 ± 0.03 mol carbonyl/mol protein (P &lt; .05). Seven neonates were treated with dexamethasone because of ventilator dependence at 14 days of age. In these neonates, treatment was associated with a 50% reduction in carbonyl content within 48 hours (P &lt; .02).
Conclusions. Oxidative damage to pulmonary proteins can be quantitated in samples obtained during routine suctioning of neonates receiving ventilation. The amount of oxidatively modified protein may provide a quantitative assessment of oxygen toxicity and of pulmonary antioxidant defenses.
Doppler-Derived Systolic Pulmonary Artery Pressure in Acute Neonatal Respiratory Distress Syndrome
Authors: Seppänen Marko P. , Kääpä Pekka O. , Kero Pentti O. , Saraste Markku 
Published: December 2021

Objective. To determine the course of systolic pulmonary artery pressure (PAP) in association with ductal shunting and cardiac output (CO) in preterm neonates.
Design. During the acute phase of respiratory distress syndrome (RDS) with and without surfactant treatment, serial Doppler ultrasound examinations were performed at the ages of 2, 12, 24, 48, and 72 hours in 51 neonates with RDS and 21 healthy, preterm controls. Twenty-eight of the distressed neonates received two or four doses of synthetic exogenous surfactant at intervals of 12 hours. Measurements of hemodynamic variables in these neonates were performed before and after 8 hours following surfactant treatments. PAP was estimated by the Doppler method from the maximal tricuspid regurgitant flow velocity. Doppler ultrasound was also used to determine simultaneously CO, and the direction and magnitude of the ductal shunting.
Results. The PAP was initially at the same level, but remained significantly higher in distressed than in healthy, preterm control neonates between the ages of 12 to 48 hours. The systolic systemic arterial blood pressures did not differ between the distressed and control neonates, but increased gradually during the study period. Consequently, the ratio of systolic pulmonary and systemic pressure was also higher in neonates with RDS than in controls during the first day of life. Bidirectional ductal shunting disappeared in all neonates studied after 2 days of life. Significant left-to-right shunting through the ductus arteriosus persisted more frequently in distressed neonates, especially those with surfactant treatment, than in control neonates during the study period, and more often caused the need for medical or surgical closure. Doppler-derived CO remained stable throughout the study in the distressed neonates, being significantly higher in surfactant-treated neonates than nontreated distressed neonates or healthy controls at 72 hours of life.
Conclusions. The data of the present study confirms that the postnatal decrease in PAP is delayed in acute RDS. Further, significant patent ductus arteriosus shunting persists longer in RDS and may contribute to elevated CO during the resolution of the disease.
THE VACCINE SCAPEGOAT
Authors: L. J. F. 
Published: December 2021

Cynics argue that the reason Bill and Hillary Clinton pistol-whipped the drug industry over vaccine prices just days before the State of the Union was to intimidate the rest of U.S. industry into silence oven the tax-laden economic proposal. And the reason cynicism like this is coming back into vogue is that the Clintons, as elsewhere, had so transparently demagogued the vaccine issue, leaving huge and obvious parts of the immunization problem unmentioned ...
A more honest explanation of the problem at least would have mentioned both the famous liability suits that pushed up the cost of vaccines and the government bureaucracy's own failed efforts to immunize the poor.
That brings us to the second widely known reason that so many children don't receive the proper immunizations: The bureaucracy can't figure out how to get the job done. Any child in any state can receive free vaccines at a public-health clinic paid for by state and federal money. So why don't more parents respond? One large reason is that the public system is very inconvenient.
Before they will administer a vaccination, many public-health clinics require a physician's referral or a complete physical. They don't phone with a reminder that it's time again for the shots. And, like the department of motor vehicles, their hours often aren't convenient for working parents ....
So yes, there's a problem, but clearly it's about something more complicated than just price. The President's answer is to spend $300 million to "improve outreach efforts" and hire more staff for the public clinics.
INFANT BONDING AND GUILTY MOTHERS
Authors: L. J. F. 
Published: December 2021

In "Mother-Infant Bonding: A Scientific Fiction," just published by Yale University Press, Diane E. Eyer examines mother-infant bonding, one theory that turned out to have a short but influential life span, roughly the 1970's.
Bonding managed to have a major impact despite slender evidence for its existence: a study by the original researchers of only 28 mothers, analogies from studies of mother-offspring attachment and rejection in nonhuman mammals as well as interpretations drawn from the behavior of infants in pathological situations. Though the early research has largely been dismissed, the theory of bonding continues to have an impact.
"One of the things I wanted to see," Ms. Eyer said in a recent interview about her work, "was how research that was so patently untrue was so credible to so many people. I didn't expect to find villains, but it was clear that medicine was benefiting more than women were" ...
Ms. Eyer does not argue that all child-rearing experts offer scientifically indefensible advice, simply that consumers of the advice should be skeptical of the science it's based on and treat it more like religion—and therefore a question of belief—than as absolute truth.
Emergency Medical Services for Children: The Report From the Institute of Medicine
Authors: Weinberg Joseph A. , Medearis Donald N. 
Published: December 2021

The scope and complexity of the problems posed by attempting to provide emergency medical services for children (EMS-C) are great. Of the 90 million emergency department visits in the United States each year, one third, or 30 million, are by children. Many of these are due to injury. In 1990, 266 000 injured children were admitted to hospitals; &gt; 20 000 children died of injuries in 1988 and many more were disabled permanently. In addition to this human cost, the monetary cost of childhood injuries has been estimated to be $7.5 billion annually.1
Most emergency department visits by children, however, are for illnesses, many of which may be serious, such as asthma, pneumonia, or bacterial meningitis.
Poststreptococcal Reactive Arthritis and Silent Carditis: A Case Report and Review of the Literature
Authors: Schaffer Frederick M. , Agarwal Ravinder , Helm Jutta , Gingell Robert L. , Roland J. Michael A. , O'Neil Kathleen M. 
Published: December 2021

Between 1984 and 1988, a resurgence of acute rheumatic fever (ARF) was reported in several pediatric centers.1-3 During the same time, pediatric cases,4-6 and, recently, adult cases6 of poststreptococcal reactive arthritis (PSRA) have been reported. Although several of these patients had or developed multisystemic manifestations,4,5 none of these cases fully adhered to the guidelines of the revised Jones criteria.7 Thus, these individuals were given the diagnosis of PSRA or poststreptococcal rheumatic syndrome (PSRS) rather than ARF.4-6,8-10
One of the leading causes of acquired pediatric heart disease in North America is carditis of ARF,3 and severe cases can result in congestive heart failure, the need for valve replacement, or death.11