bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gamma knife stereotactic radiosurgery for acromegaly
Authors: Vik-Mo Einar Osland , Øksnes Marianne , Pedersen Paal-Henning , Wentzel-Larsen Tore , Rødahl Eyvind , Thorsen Frits , Schreiner Thomas , Aanderud Sylvi , Lund-Johansen Morten 
Published: August 2007

Background: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion.
Objective: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment.
Design: Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation.
Setting: Norwegian National Center for gamma knife treatment.
Patients: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up.
Results: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period.
Conclusion: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.
Idiopathic short stature: will genetics influence the choice between GH and IGF-I therapy?
Authors: Savage Martin O , Camacho-Hübner Cecilia , David Alessia , Metherell Louise A , Hwa Vivian , Rosenfeld Ron G , Clark Adrian J L 
Published: September 2007

Background: Idiopathic short stature (ISS) includes a range of conditions. Some are caused by defects in the GH–IGF-I axis. ISS is an approved indication for GH therapy in the USA and a similar approval in Europe may be imminent. Genetic analysis for single-gene defects has made enormous contributions to understanding the physiology of growth regulation. Can this type of investigation help in predicting growth responses to GH or IGF-I therapy?
Methods: The rationale for choice of GH or IGF-I therapy in ISS is reviewed. Many ISS patients have low IGF-I, but most can generate IGF-I levels in response to short-term GH administration. Some GH resistance seems to be present. Mutation analysis in several cohorts of GHIS and ISS patients is reviewed.
Results: Low IGF-I levels suggest either unrecognised GH deficiency or GH resistance. In classical GHIS patients, there was a positive relationship between IGFBP-3 levels and height SDS. No relationship exists between mutations and phenotype. There is a wide variability of phenotype in patients carrying identical mutations. Heterozygous GH receptor (GHR) mutations were present in <5% of ISS patients and their role in causing growth defects is questionable. Exceptions are dominant negative mutations that have been shown to disturb growth.
Conclusions: Analysis for single-gene defects does not give sensitive predictions of phenotype and cannot predict responses to GH or IGF-I therapy. Endocrine abnormalities have closer correlations with phenotype and may thus be a better guide to therapeutic responsiveness.
High normal testosterone levels in infants with non-mosaic Klinefelter’s syndrome
Authors: Aksglaede Lise , Petersen Jørgen H , Main Katharina M , Skakkebæk Niels E , Juul Anders 
Published: August 2007

Objective: Klinefelter’s syndrome (KS) is associated with hypergonadotrophic hypogonadism in adulthood. However, limited information exists about the age at which hypogonadism occurs. The hypothalamic–pituitary–gonadal (HPG) axis is transiently activated during the first months of life, offering the opportunity to study testicular function by spontaneous, basal hormone levels. The aim of this study was to evaluate the HPG axis in KS infants.
Design: Cross-sectional study.
Methods: Ten KS infants aged 3.1 months (range 1.8–3.8) and 613 healthy controls aged 3.0 months (range 2.0–4.5). Serum levels of total and free testosterone (T), LH, FSH, inhibin B and sex hormone-binding globulin (SHBG) were determined.
Results: KS infants had significantly higher concentrations of total T (5.0 (2.2–11.2) vs 3.4 (0.7–8.3) nmol/l, P = 0.02), free T (31.6 (18.2–61.8) vs 22.1 (4.3–48.4) pmol/l, P = 0.01), LH (3.3 (1.3–4.6) vs 1.7 (0.6–4.3) IU/l, P = 0.005) and FSH (1.7 (1.1–4.1) vs 1.2 (0.4–3.0) IU/l, P = 0.007) than controls. SHBG and inhibin B did not differ from controls. LH/T and LH/free T ratios were normal, whereas the FSH/inhibin B ratio was elevated (6.5 (2.7–16.9) vs 3.0 (0.78–11.4), P = 0.005) when compared to controls. The majority of KS infants had normal bivariate hormonal combinations.
Conclusion: We found increased FSH/inhibin B ratio as a possible sign of Sertoli cell dysfunction. However, serum levels of T were high normal suggesting an altered pituitary–gonadal set point.
Interference by Carbamazepine and Oxcarbazepine With Serum- and Urine-Screening Assays for Tricyclic Antidepressants
Authors: Saidinejad Mohsen , Law Terence , Ewald Michele Burns 
Published: August 2007

OBJECTIVE. The purpose of this work was to evaluate the potential cross-reactivity of 2 antiepileptic medications containing 3-ringed structures, namely, carbamazepine and oxcarbazepine, with screening assays for tricyclic antidepressants.
METHODS. A cross-sectional study of 52 patients between 3 and 19 years of age who had been prescribed either carbamazepine or oxcarbazepine was conducted. A serum fluorescence-polarized immunoassay and a urine enzyme-linked immunoassay were used. The serum carbamazepine or oxcarbazepine level was measured. Gas chromatography/mass spectrometry, a confirmatory test for tricyclic antidepressant detection, was subsequently performed on the serum specimen.
RESULTS. A linear dependency on medication level was observed with the serum fluorescence-polarized immunoassay assay. This relationship was stronger for carbamazepine (4.2 μg/L tricyclic antidepressant detected per microgram/liter of carbamazepine) than for oxcarbazepine (0.7 μg/L tricyclic antidepressant detected per milligram/liter). At higher carbamazepine levels (8.0–11.6 mg/L), 12 of 13 patients had a positive serum fluorescence-polarized immunoassay result; at lower levels (0.1–7.9 mg/L), only 1 of 20 had a positive result. None of the patients who were receiving oxcarbazepine showed significant tricyclic antidepressant activity on either assay.
CONCLUSIONS. Carbamazepine interferes at a statistically significant level with serum fluorescence-polarized immunoassay assay and in a dose-dependent fashion. Neither carbamazepine nor oxcarbazepine exhibit significant tricyclic antidepressant activity on urine enzyme-linked immunoassay assay.
Predictors of Mycobacterium tuberculosis Infection in International Adoptees
Authors: Mandalakas Anna M. , Kirchner H. Lester , Iverson Sandra , Chesney Mary , Spencer Mary Jo , Sidler Angela , Johnson Dana 
Published: August 2007

OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees.
METHODS. A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed.
RESULTS. Adoptees (mean age: 26 months; range: 1–200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M tuberculosis infection. The odds of M tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children ≤24 months of age at baseline screening, and increased 15% with each additional year of age for children &gt;24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region.
CONCLUSIONS. Our study demonstrated a high prevalence of M tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.
Resuscitation in the “Gray Zone” of Viability: Determining Physician Preferences and Predicting Infant Outcomes
Authors: Singh Jaideep , Fanaroff Jon , Andrews Bree , Caldarelli Leslie , Lagatta Joanne , Plesha-Troyke Susan , Lantos John , Meadow William 
Published: August 2007

OBJECTIVE. We assessed physician preferences and physician prognostic abilities regarding delivery room management of exceedingly low birth weight/short gestation infants.METHODS. We surveyed US neonatologists to assess their behavior in the delivery room when confronted with infants with gestational ages of 22 to 26 weeks. We identified 102 infants in our NICU with birth weights/gestational ages of 400 g/23 weeks to 750 g/26 weeks, whose follow-up care was ensured because of their participation in ongoing clinical trials. We determined 4 proxy measures for “how the infant looked” in the delivery room (Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes) and assessed the predictive value of each marker for subsequent death or neurologic morbidity.RESULTS. For infants with birth weights of &lt;500 g and gestational ages of 23 weeks, only 4% of 666 responding neonatologists would provide full resuscitation. In contrast, for infants with birth weights of &gt;600 g and gestational ages of 25 weeks, &gt;90% of neonatologists considered resuscitation obligatory. For infants with birth weights of 500 to 600 g and gestational ages of 23 to 24 weeks, only one third of neonatologists responded that parental preference would determine whether they resuscitated the infant in the delivery room. The majority wanted “to see what the infant looked like.” For 102 infants with birth weights of ≤750 g, Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes were neither sensitive nor predictive for death before discharge, survival with a neurologic abnormality, or intact neurologic survival.CONCLUSIONS. The “gray zone” for delivery room resuscitation seems to be between 500 and 600 g and 23 and 24 weeks. For infants born in that zone, neonatologists' reliance on accurate prediction of death or morbidity in the delivery room may be misplaced.
“Masculinizing” Effect on Respiratory Morbidity in Girls From Unlike-Sex Preterm Twins: A Possible Transchorionic Paracrine Effect
Authors: Shinwell Eric S. , Reichman Brian , Lerner-Geva Liat , Boyko Valentina , Blickstein Isaac ,   in collaboration with the Israel Neonatal Network
Published: August 2007

OBJECTIVES. Preterm male infants are at a disadvantage when compared with female infants regarding the incidence of respiratory and neurologic morbidity and mortality. At term, female infants from unlike-sex twin pairs have birth weights that are closer to their male co-twins than to girls from like-sex twin pairs. We hypothesized that if the male disadvantage is mediated via factors that affect fetal lung development, there may be a potential effect on the incidence of respiratory distress syndrome and its complications in female infants from unlike-sex pairs.
PATIENTS AND METHODS. In this population-based study we used data from the Israel Neonatal Network, which included data from 8858 very low birth weight (500–1500 g) infants of 24 to 34 weeks' gestation. The incidence of morbidity and mortality was compared in male and female infants from singletons and like-sex and unlike-sex twin pairs. Multivariable analyses were used, accounting for relevant confounding variables.
RESULTS. Male singletons and like-sex twins were at increased risk for mortality, respiratory distress syndrome, pneumothorax, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, and periventricular leukomalacia. However, in unlike-sex twin pairs, no difference was seen in the incidence of respiratory morbidity between male and female twins. The male disadvantage was maintained for mortality and periventricular-intraventricular hemorrhage.
CONCLUSIONS. These findings suggest that the difference in morbidity and mortality between male and female premature infants represents a male disadvantage as opposed to a female advantage and that this disadvantage may be transferred from boys to girls in unlike-sex twin pairs, perhaps via an intrauterine paracrine effect.
Nutritional Content of Television Food Advertisements Seen by Children and Adolescents in the United States
Authors: Powell Lisa M. , Szczypka Glen , Chaloupka Frank J. , Braunschweig Carol L. 
Published: August 2007

OBJECTIVE. In light of the high rates of child and adolescent obesity, we examined the nutritional content of food advertising seen by American children and adolescents.
METHODS. We drew samples of top-rated television shows by using ratings data to examine the nutritional content for fat, saturated fat, sugar, sodium, and fiber of food-product advertisements seen on television by both children and adolescents. Food products were examined in aggregate and by 5 separate categories that included cereal, sweets, snacks, drinks, and other food products. For 2- to 11-year-olds and 12- to 17-year-olds, respectively, a sample of 50351 and 47955 30-second-equivalent food-product advertisements and their related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content of food advertising seen by children and adolescents.
RESULTS. Study results showed that 97.8% and 89.4% of food-product advertisements viewed by children 2 to 11 years old and adolescents 12 to 17 years old, respectively, were high in fat, sugar, or sodium. On average, 46.1% and 49.1% of total calories among the products advertised came from sugar in the advertisements seen by these respective age groups. A total of 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. No substantial differences were found in the nutritional content of advertisements seen by black and white children 2 to 11 years old. However, a slightly higher proportion of food advertisements in general and across all food-product categories seen by black versus white adolescents were for high-sugar products.
CONCLUSION. The overwhelming majority of food-product advertisements seen on television by American children and adolescents are of poor nutritional content.
Breastfeeding and Smoking: Short-term Effects on Infant Feeding and Sleep
Authors: Mennella Julie A. , Yourshaw Lauren M. , Morgan Lindsay K. 
Published: August 2007

OBJECTIVE. The present experimental study was designed to determine how breastfeeding from a mother who smokes affects infants in the short-term.METHODS. Fifteen mother-infant dyads were tested on 2 days separated by 1 week. Mothers smoked (not in the presence of their infants) on one test day and refrained from smoking on the other. For the next 3.5 hours, infants breastfed on demand. Sleep and activity patterns were monitored by placing an actigraph on the infants' leg, and milk intake was determined by weighing the infants before and after each feeding. The nicotine content of the milk was measured to determine the dose of nicotine delivered to the infants.RESULTS. Although there was no significant difference in breast milk intake, despite the taste changes in the milk, infants spent significantly less time sleeping during the hours immediately after their mothers smoked (53.4 minutes), compared with the session when their mothers abstained from smoking (84.5 minutes). This reduction was attributable to shortening of the longest sleep bout and reductions in the amounts of time spent in both active sleep and quiet sleep. With greater doses of nicotine delivered to the infant, less time was spent in active sleep.CONCLUSIONS. An acute episode of smoking by lactating mothers altered infants' sleep/wake patterning. Perhaps concerns that their milk would taste like cigarettes and their infants' sleep patterning would be disrupted would motivate lactating mothers to abstain from smoking and to breastfeed longer.
Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams: Neurocognitive Development at 5.3 Years' Corrected Age
Authors: Steinmacher Jochen , Pohlandt Frank , Bode Harald , Sander Silvia , Kron Martina , Franz Axel R. 
Published: August 2007

BACKGROUND. Iron deficiency in early childhood may impair neurodevelopment. In a masked, randomized, controlled trial of early versus late enteral iron supplementation in preterm infants with birth weights of &lt;1301 g, early iron supplementation reduced the incidence of iron deficiency and the number of blood transfusions.OBJECTIVE. We sought to examine whether early enteral iron supplementation improves neurocognitive and motor development in these infants.METHODS. Children who participated in the above mentioned trial were evaluated by applying the Kaufmann Assessment Battery for Children and the Gross Motor Function Classification Scale at the age of school entry.RESULTS. Of the 204 infants initially randomized, 10 died and 30 were lost to follow-up. A total of 164 (85% of the survivors) were evaluated at a median corrected age of 5.3 years. In this population (n = 164), the mean (±SD) mental processing composite in the early iron group was 92 (±17) versus 89 (±16) in the late iron group. An abnormal neurologic examination was found in 17 of 90 versus 26 of 74, and a Gross Motor Function Classification Scale score of &gt;1 was found in 2 of 90 versus 5 of 74, respectively. Fifty-nine of 90 children in the early iron group were without disability, compared with 40 of 74 in the late iron group. Severe disability was found in 5 of 90 versus 6 of 74 children and 67 of 90 versus 49 of 74 qualified for regular schooling, respectively.CONCLUSIONS. Early enteral iron supplementation showed a trend toward a beneficial effect on long-term neurocognitive and psychomotor development and showed no evidence for any adverse effect. Because the initial study was not designed to evaluate effects on neurocognitive development, the power was insufficient to detect small but potentially clinically relevant improvements. Additional studies are required to confirm the trend towards a better outcome observed in the early iron group.
Continuous Positive Airway Pressure Therapy for Infants With Respiratory Distress in Non–Tertiary Care Centers: A Randomized, Controlled Trial
Authors: Buckmaster Adam G. , Arnolda Gaston , Wright Ian M. R. , Foster Jann P. , Henderson-Smart David J. 
Published: August 2007

OBJECTIVE. Our objective was to determine whether continuous positive airway pressure therapy would safely reduce the need for up-transfer of infants with respiratory distress from nontertiary centers.METHODS. We randomly assigned 300 infants at &gt;30 weeks of gestation with respiratory distress to receive either Hudson prong bubble continuous positive airway pressure therapy or headbox oxygen treatment (standard care). The primary end point was “up-transfer or treatment failure.” Secondary end points included death, length of nursery stay, time receiving oxygen therapy, cost of care, and other measures of morbidity.RESULTS. Of 151 infants who received continuous positive airway pressure therapy, 35 either were up-transferred or experienced treatment failure, as did 60 of the 149 infants given headbox oxygen treatment. There was no difference in the length of stay or the duration of oxygen treatment. For every 6 infants treated with continuous positive airway pressure therapy, there was an estimated cost saving of $10000. Pneumothorax was identified for 14 infants in the continuous positive airway pressure group and 5 in the headbox group. There was no difference in any other measure of morbidity or death.CONCLUSIONS. Hudson prong bubble continuous positive airway pressure therapy reduces the need for up-transfer of infants with respiratory distress in nontertiary centers. There is a clinically relevant but not statistically significant increase in the risk of pneumothorax. There are significant benefits associated with continuous positive airway pressure use in larger nontertiary centers.
Cancer-Associated Neutropenic Fever: Clinical Outcome and Economic Costs of Emergency Department Care
Authors: Courtney D. Mark , Aldeen Amer Z. , Gorman Stephen M. , Handler Jonathan A. , Trifilio Steven M. , Parada Jorge P. , Yarnold Paul R. , Bennett Charles L. 
Published: August 2007

Abstract

Purpose.
Febrile neutropenia (FN) is a common, costly, and potentially fatal complication in oncology. While FN in the inpatient setting has been extensively studied, only one study has evaluated emergency department (ED) care for FN cancer patients. That study found that 96% of patients survived the complication. We evaluated clinical and economic outcomes for cancer patients with chemotherapy-associated FN treated in an ED.

Methods.
ED records for consecutive oncology patients with FN were reviewed for information on death, intensive care unit (ICU) use, blood cultures, and costs.

Results.
Forty-eight patients (n = 57 visits) were evaluated. Six patients died from FN (12%) and four received ICU care within 2 weeks and survived (8%). Blood cultures were positive for 37% of the ED visits. The median ED time was 3.3 hours. In 91% of visits, i.v. antibiotics were administered in the ED, ordered at a median of 1.7 hours from triage (interquartile range [IQR], 1.2–2.8 hours). All patients with death or ICU in 2 weeks and all but one patient with positive blood cultures received antibiotics. The median per patient ED costs were $1,455 (IQR, $1,300–$1,579)—42.4% for hospital/nursing, 23.5% for radiology, 20.8% for physician services, 10.9% for diagnostic tests, and 2.4% for antibiotics.

Conclusions.
Cancer patients with FN in this sample presenting to the ED frequently had no identified source of infection. One third of the patients had positive ED blood cultures and one fifth died or required ICU care within 2 weeks. Costs of ED care were similar to the cost of a single day of inpatient care.