bluuebunny/crossref_metadata_2025_split huggingface dataset:
First‐trimester ultrasound and biochemical markers of aneuploidy and the prediction of impending fetal death
Authors: Spencer K. , Cowans N. J. , Avgidou K. , Nicolaides K. H. 
Published: September 2006

AbstractObjectivesTo examine the clinical utility of the first‐trimester markers of aneuploidy in their ability to predict future fetal loss.MethodsWe examined 54 722 singleton pregnancies with no chromosomal abnormality and with complete outcome data that had undergone screening for trisomy 21 by a combination of fetal nuchal translucency (NT) thickness, maternal serum free β‐human chorionic gonadotropin (β‐hCG) and pregnancy‐associated plasma protein‐A (PAPP‐A) at 11 + 0 and 13 + 6 weeks' gestation. The biochemical markers were converted to multiples of the expected normal median for a pregnancy of the same gestation (MoM) and the measurements of fetal NT were expressed as the difference (delta) from the normal median NT for crown–rump length (CRL). The association between free β‐hCG, PAPP‐A and delta NT and the incidence of fetal loss prior to 24 weeks, at or after 24 weeks or at any time, was assessed by comparing the relative incidence at a number of MoM or delta NT cut‐offs and at various centile cut‐offs. At various marker levels the likelihood ratio (LR) for fetal loss was also calculated.ResultsThe rate of fetal loss increased with decreasing maternal serum free β‐hCG and PAPP‐A and increasing delta NT. At the 5th centile of the normal outcome group for free β‐hCG (0.41 MoM) the odds ratio for fetal loss before 24 weeks, at or above 24 weeks and at any gestation was 3.1, 1.8 and 2.6, respectively. The respective values for the 5th centile of PAPP‐A (0.415 MoM) were 3.3, 1.9 and 2.8 and for the 95th centile of delta NT they were 2.5, 1.9 and 2.2, respectively. There was almost no correlation between reduced levels (≤0.50 MoM) of PAPP‐A and reduced levels of free β‐hCG in either the normal pregnancy group (r = 0.041) or the group with fetal death (r = 0.072), indicating relatively independent prediction by either biochemical marker.ConclusionsLow levels of maternal serum PAPP‐A and free β‐hCG and increased fetal NT are associated, in the absence of an abnormal karyotype, with an increased risk of impending fetal death. The likelihood ratio profiles provided at various levels of PAPP‐A or free β‐hCG may be of some help in counseling women with such results and raise awareness among health‐care professionals for increased surveillance in such cases. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Heme oxygenase/carbon monoxide‐biliverdin pathway down regulates neutrophil rolling, adhesion and migration in acute inflammation
Authors: Freitas A , Alves‐Filho J C , Secco D D , Neto A F , Ferreira S H , Barja‐Fidalgo C , Cunha F Q 
Published: September 2006

Background and purpose:Heme oxygenase (HO) activity is known to down‐regulate inflammatory events. Here, we address the role of HO and its metabolites, carbon monoxide (CO) and biliverdin (BVD), in leukocyte rolling, adhesion and neutrophil migration during inflammatory processes.Experimental approach:Intravital microscopy was used to evaluate leukocyte rolling and adhesion in the mesenteric microcirculation of mice. TNFα and IL‐1β were determined by ELISA and HO‐1 protein expression by Western blot.Key results:Intraperitoneal challenge with carrageenan enhanced HO‐1 protein expression in mesentery and bilirubin concentration in peritoneal exudates. Pretreatment of mice with a non‐specific inhibitor of HO (ZnDPBG) or with a HO‐1 specific inhibitor (ZnPP IX) enhanced neutrophil migration, rolling and adhesion on endothelium induced by carrageenan. In contrast, HO substrate (hemin), CO donor (DMDC) or BVD reduced these parameters. The reduction of neutrophil recruitment promoted by HO metabolites was independent of the production of chemotactic cytokines. Inhibitory effects of CO, but not of BVD, were counteracted by treatment with a soluble guanylate cyclase (sGC) inhibitor, ODQ. Furthermore, inhibition of HO prevented the inhibitory effect of a nitric oxide (NO) donor (SNAP) upon neutrophil migration, while the blockade of NO synthase (NOS) activity by aminoguanidine did not affect the CO or BVD effects.Conclusions and Implications:Metabolites of HO decreased leukocyte rolling, adhesion and neutrophil migration to the inflammatory site by a mechanism partially dependent on sGC. Moreover, inhibition by NO of neutrophil migration was dependent on HO activity.British Journal of Pharmacology(2006)149, 345–354. doi:10.1038/sj.bjp.0706882
Opposite diastereoselective activation of P2Y1 and P2Y11 nucleotide receptors by adenosine 5′‐O‐(α‐boranotriphosphate) analogues
Authors: Ecke D , Tulapurkar M E , Nahum V , Fischer B , Reiser G 
Published: September 2006

Background and purpose:We explored the stereoselective activation of the P2Y11 receptor, stably expressed and tagged with GFP, in 1321N1 cells, in comparison to its closest homologue, the P2Y1 receptor.Experimental approach:The potency of several chiral ATP analogues was determined by measuring increases in intracellular calcium concentration ([Ca2+]i). In a series of ATP‐α‐B and ATP‐α‐S analogues, a non‐bridging oxygen atom of P was substituted by BH3 or sulphur, respectively, introducing a chiral center at P. The pairs of diastereoisomers (A and B isomers) were each applied as purified compounds.Key results:The (B) isomers (ATP‐α‐B Sp isomers and ATP‐α‐S Rp isomers) of all derivatives tested were more potent at the P2Y11 receptor than the corresponding (A) isomers (ATP‐α‐B Rp isomers and ATP‐α‐S Sp isomers) and the parent compounds. This characteristic of the P2Y11 receptor is opposite to the behaviour of the same diastereoisomers at the P2Y1 receptor, at which the (A) isomers are more active.Conclusions and implications:The distinctly opposite diastereoselective activity of ATP derivatives at the P2Y11 and the P2Y1 receptor will allow the deciphering of structural differences of the ligand recognition sites between these receptor subtypes and may aid in the development of subtype‐selective agonists. Moreover, ATP‐α‐B diastereoisomers are not active at the P2Y2 receptor. Thus, they are compounds suitable for distinguishing the functional contribution of the two ATP‐activated P2Y receptors, the P2Y2 and P2Y11 receptor, in physiological or pathophysiological responses of cells.British Journal of Pharmacology (2006) 149, 416–423. doi:10.1038/sj.bjp.0706887
CONSUMERS, CLIENTS OR CITIZENS? POLITICS, POLICY AND PRACTICE IN THE REFORM OF SOCIAL CARE
Authors: Clarke John 
Published: September 2006

ABSTRACT
In the United Kingdom, New Labour articulated a consumerist view of the relationship between the public and public services. Its view of the citizen-as-consumer was the source of considerable political controversy and debate – both within and beyond public services. In this paper, I explore four aspects of consumerism in relation to social care in the United Kingdom: the political context of the rise of the ‘citizen-consumer’; the place of the citizen-consumer in social care policy; the responses of organisations providing social care to consumerist pressures and lastly the impact of consumerism on characteristic tensions in public services.
CARING FOR PEOPLE OR CARING FOR PROXY CONSUMERS?
Authors: Vabø Mia 
Published: September 2006

ABSTRACT
Reforms that aim at empowering recipients as ‘consumers’ are often seen as self-evidently favourable and unavoidable. Current narratives on public-sector change describe the previous service regimes as rigid, uniform and inhumane, whereas reforms are regarded as offering a flexible and responsive future. Accordingly, consumerism has become a major driving force behind Nordic welfare reforms. This paper presents a more nuanced analysis of the suppositions about the past systems for home care services and offers a critical view on current reforms and the assumptions underlying them. Empirical examples are drawn from field research and personal interviews undertaken before (1995) and after (2000) the Norwegian home care service was caught in the wave of New Public Management reforms. The paper demonstrates how contractual arrangements implemented in the name of the consumer run counter to established practices based on personal trust and continuous dialogue on needs.
CONSUMERS IN CHARGE OF CARE: THE DUTCH PERSONAL BUDGET AND ITS IMPACT ON THE MARKET, PROFESSIONALS AND THE FAMILY
Authors: Kremer Monique 
Published: September 2006

ABSTRACT
One of the icons of the Dutch welfare state reforms is the Personal Budget. With the introduction of this budget, care patients now have become consumers. They can manage their own budget and employ a care worker who cares according to the cared-for's wishes. The Personal Budget intends to create a market of care, as well as a shift of balance of power from professionals to care receivers. In practice, the market has not come yet. Instead, the majority of budget holders employ a family member. This is important as it gives recognition to informal carers. On the other hand, this may hamper the employment career of people with care responsibilities as they are likely to be constrained in their care relationship. Another caveat is that the Personal Budget undermines the professionalisation process of care workers. When consumers are in charge, care workers are no longer the custodians of their professional development. This may have unwelcome consequences for the quality of care in the long term.
Subclinical Exocrine Pancreatic Dysfunction Resulting From Decreased Cholecystokinin Secretion in the Presence of Intestinal Villous Atrophy
Authors: Nousia‐Arvanitakis Sanda , Fotoulaki Maria , Tendzidou Kyriaki , Vassilaki Constantina , Agguridaki Christina , Karamouzis Michael 
Published: September 2006

ABSTRACTThe aim of this study was to evaluate the concept that pancreatic dysfunction in patients having gluten sensitivity (celiac disease [CD]) or cow's milk protein enteropathy (CMPE) may result from the lack of pancreatic enzyme stimulation in the absence or decrease of cholecystokinin (CCK) secretion caused by villous atrophy.Patients and Methods:The following parameters were measured: plasma CCK in response to a fatty meal and human pancreatic fecal elastase in 24 patients with CD while on gluten‐free diet and after gluten provocation and in 12 patients with CMPE at diagnosis and after a 6‐month period of cow's milk‐free diet. Intestinal mucosa morphology was examined by small bowel biopsy. Sixty‐three controls having no organic gastrointestinal problems were investigated once at the time of diagnostic evaluation.Results:Fasting CCK, obtained at a time when patients with CD or CMPE had normal intestinal mucosa, was significantly different from postprandial and comparable to that of the control group. Fasting CCK obtained from patients with villous atrophy was also statistically different, but not significantly, from the postprandial. Fasting and postprandial plasma CCK and fecal pancreatic elastase values from patients having normal intestinal mucosa were significantly higher than those obtained from patients with villous atrophy. Significant correlation of intestinal mucosa morphology and CCK with fecal elastase concentration was documented.Conclusion:Exocrine pancreatic dysfunction in individuals having villous atrophy may be the consequence of decreased CCK secretion. Cholecystokinin and pancreatic secretion is restored to normal, with intestinal mucosa regeneration.
Adequacy and Safety of an Infant Formula With a Protein/Energy Ratio of 1.8 g/100 kcal and Enhanced Protein Efficiency for Term Infants During the First 4 Months of Life
Authors: Turck Dominique , Grillon Christophe , Lachambre Emmanuelle , Robiliard Patrick , Beck Laurence , Maurin Jean‐Luc , Kempf Christian , Bernet Jean‐Paul , Marx Jacques , Lebrun Françoise , Van Egroo Louis‐Dominique 
Published: September 2006

ABSTRACTObjective:Excess protein in infant formula may lead to renal overload and play a role in later obesity. The objective of this controlled, prospective, randomized, double‐blind study was to assess the suitability and safety of a modified protein content infant formula and its noninferiority as compared to a conventional formula.Patients and Methods:Healthy term infants age <7 days were either breast‐fed or randomized to be fed exclusively with a conventional casein‐predominant formula (protein/energy ratio: 2.6 g/100 kcal) or the isocaloric whey‐predominant study formula (protein/energy ratio: 1.8 g/100 kcal) for 120 days. Primary outcome was daily weight gain between D0 and D120 (noninferiority criterion: difference in daily weight gain ≤4 g). Secondary outcomes were daily gain in weight, length, head circumference and body mass index at monthly intervals. Tolerance and safety were assessed at each visit.Results:162 infants were enrolled, 84% of the formula‐fed infants and 36% of the breast‐fed infants completing the study. Mean daily weight gain from D0 to D120 in the formula‐fed groups differed by 0.38 g/day [95% CI: −2.59; 1.83] signifying the noninferiority of the study formula. Secondary outcomes did not differ between the 2 groups at any time and were comparable to outcomes in the breast‐fed group. Tolerance was good and adverse events were not different between study groups.Conclusions:The whey‐predominant study infant formula with a protein/energy ratio of 1.8 g/100 kcal and enhanced protein efficiency is safe and not inferior to a conventional formula in ensuring normal growth during the first four months of life.
Effect of Esophageal Ligation on Small Intestinal Development in Normal and Growth‐retarded Fetal Rabbits
Authors: Cellini Christina , Xu Jian , Buchmiller Terry L. 
Published: September 2006

ABSTRACTObjective:The uninterrupted passage of amniotic fluid through the gastrointestinal tract is hypothesized to influence both intestinal and overall fetal somatic development. The effect of in utero esophageal ligation (EL) and therefore the exclusion of AF on somatic growth, small intestinal (SI) morphology and proliferation, and the expression of the glucose transporter sodium‐glucose cotransporter 1 (SGLT‐1) in both normal and intrauterine growth‐retarded (IUGR) fetal rabbits were evaluated.Methods:Thirteen pregnant New Zealand white rabbits underwent surgery on day 24 of their normal 31‐day gestation. Ipsilateral normal and IUGR fetuses underwent EL; the contralateral normal and IUGR fetuses underwent cervical exploration only forming 4 study groups (control‐normal, control‐IUGR, EL‐normal and EL‐IUGR). Rabbits were killed on day 31. Small intestinal villus height was measured, and epithelial cell proliferation was deter mined by proliferating cell nuclear antigen staining. Sodium‐glucose cotransporter 1 messenger RNA (mRNA) and protein expressions were analyzed. Statistical analysis was performed using 2‐way analysis of variance.Results:Esophageal ligation reduced fetal weight in IUGR by 15% and in normal by 10%. Villus height was significantly reduced in IUGR versus normal in both control and EL (control, P = 0.01; EL, P = 0.05). Intrauterine growth‐retarded fetuses had reduced SI proliferation versus normal in both control and EL. Sodium‐glucose cotransporter 1 mRNA production in EL fetuses was equal to control fetuses. Esophageal ligation‐normal and EL‐IUGR fetuses exhibited reduced protein levels and decreased staining for SGLT‐1 in villus enterocytes.Conclusions:Amniotic fluid exclusion by in utero EL reduced fetal weight. Small intestinal proliferation was not affected by EL. Although SGLT‐1 mRNA and protein were produced in all 4 groups, exposure of the fetal gastrointestinal tract to amniotic fluid appears necessary for proper brush border expression of nutrient transporter proteins.
Clinical Features of Celiac Disease in Indian Children
Authors: Poddar Ujjal , Thapa Babu Ram , Singh Kartar 
Published: September 2006

ABSTRACTObjective:This study was designed to prospectively evaluate the clinical features of celiac disease (CD) in a large group of Indian children and to compare them with those from the West.Patients and Methods:Over a period of 5 years, a total of 549 children (≤14 years) with a clinical suspicion of CD were evaluated. Their detailed clinical features, investigations, and follow‐up data were recorded. Complete hemogram, endoscopic duodenal biopsy, and celiac serology were done in all of the cases. Celiac disease was diagnosed on the basis of modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition criteria.Results:Celiac disease was diagnosed in 300 children; 39 were excluded because of lack of follow‐up or poor response to gluten‐free diet. The remaining 210 had normal villous architecture and served as controls. The mean (± standard deviation) age of children with CD was 6.7 ± 3 years, and the mean duration of symptoms was 3.5 ± 2.5 years. The majority (84%) presented with diarrhea; other features were failure to thrive in 91%, anemia in 84%, wasting in 87%, and stunting in 60% of cases. Among the serological tests, the best results were obtained with tissue transglutaminase. On follow‐up (19.4 ± 15.5 months), symptoms subsided in all cases of CD with a significant weight and height gain.Conclusions:Indian children with CD present late, with a significant delay in diagnosis. The majority presents with classic symptoms of diarrhea, failure to thrive, and anemia. There is a need for increasing awareness to pick up the atypical forms of the disease.
Pepsin, a Reliable Marker of Gastric Aspiration, Is Frequently Detected in Tracheal Aspirates From Premature Ventilated Neonates
Authors: Farhath Sabeena , Aghai Zubair H. , Nakhla Tarek , Saslow Judy , He Zhaoping , Soundar Sam , Mehta Devendra I. 
Published: September 2006

ABSTRACTObjectives:To determine the frequency of pepsin detection in tracheal aspirate (TA) samples of mechanically ventilated premature neonates and its association with feedings and methylxanthine therapy.Patients and Methods:Serial TA samples (days 1, 3, 5, 7, 14, 21, 28 and >28vdays) were collected from premature neonates receiving ventilatory support. An enzymatic assay with a fluorescent substrate was used to detect pepsin. Pepsin was also measured in 10 serum samples collected in conjunction with the TA samples from 8 neonates.Results:A total of 239 TA samples was collected from 45 premature neonates (mean birth weight, 762 ± 166 g; mean gestational age, 25.5 ± 1.5 wk). Pepsin was detectable in 222 of 239 TA samples (92.8%) and in none of the serum samples. Pepsin was significantly lower on day 1 (mean, 170 ± 216 ng/mL) when compared with all other time points (P < 0.05). Mean concentration of pepsin was significantly lower when infants were unfed (265 ± 209 ng/mL) compared with levels during feeding (390 ± 260 ng/mL, P = 0.02). The mean level of pepsin was significantly higher in infants during xanthine therapy (419 ± 370 ng/mL) compared with no xanthine therapy (295 ± 231 ng/mL, P = 0.037).Conclusion:Pepsin, a marker of gastric contents, was detected in more than 92% of TA samples from premature infants on mechanical ventilation. The level of pepsin was higher in fed infants when compared with unfed infants. Xanthine therapy was also associated with increased pepsin in TA samples. Chronic aspiration of gastric contents may worsen lung disease in premature infants.
Zinc Supplementation for the Treatment of Diarrhea in Infants in Pakistan, India and Ethiopia
Authors: Fischer Walker Christa L. , Bhutta Zulfiqar A. , Bhandari Nita , Teka Telahun , Shahid Farhana , Taneja Sunita , Black Robert E. ,   Zinc Study Group
Published: September 2006

ABSTRACTObjective:This randomized, placebo controlled trial was designed to assess the safety and efficacy of 10‐mg zinc supplementation for the treatment of acute diarrhea in infants.Methods:A total of 1110 infants aged 28 days to 5 months with acute diarrhea were enrolled and randomized to receive either zinc (n = 554) or placebo (n = 556) for 14 days. Diarrhea history, anthropometric status, breast‐feeding status and socioeconomic indicators were assessed at baseline. The homes of all infants were visited every 3 days until the diarrhea episode was over. The number of stools, presence of blood and additional illnesses were recorded daily.Results:The geometric mean duration of the diarrhea episode was 0.21 days longer among infants receiving zinc versus those receiving placebo, but this was not statistically significant and no difference was observed after controlling for sex, exclusive breast‐feeding and length for age Z score. There were no differences in any subgroup (ie, sex, baseline length for age Z score, exclusive breast‐feeding or site after controlling for the remaining subgroup variables). There were no differences in reported stool frequency or among the proportion of episodes lasting longer than 7 days. Rates of vomiting were similar in the zinc and placebo groups.Conclusions:Young infants do not appear to benefit from zinc supplementation for the treatment of diarrhea.
Azathioprine Monotherapy for Maintenance of Remission in Pediatric Patients With Autoimmune Hepatitis
Authors: Banerjee Sanjoy , Rahhal Riad , Bishop Warren P. 
Published: September 2006

ABSTRACTAutoimmune hepatitis (AIH) is a chronic disorder characterized by unresolving liver inflammation and has a fluctuating clinical course. Standard therapy has been corticosteroids given daily, alone or in combination with azathioprine (AZA). The potential for significant side effects from prolonged corticosteroid use remains high. To date, no pediatric literature describes long‐term AZA monotherapy after induction of remission with corticosteroids. We conducted a retrospective chart review from 1990 to 2002, which revealed 8 patients with AIH. Three patients were excluded because of other diseases requiring continued or intermittent use of corticosteroids. The time to complete biochemical remission on corticosteroids and AZA was 230 days (range, 74‐288 days). Azathioprine was introduced early following the diagnosis (range, 1‐35 days). All 5 patients were successfully weaned off corticosteroids after a median of 378 days and were maintained on AZA monotherapy for a median of 37 months (range, 28‐82 months). One patient had a disease exacerbation on AZA monotherapy 75 months after the discontinuation of corticosteroids. She responded quickly to a corticosteroid burst and has been on AZA monotherapy for 7months. One patient relapsed after self‐discontinuing all medications. Long‐term remission of AIH was possible in our case series with the early introduction and maintenance treatment with AZA as monotherapy.