bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beneficial Effects of Continuous Subcutaneous Insulin Infusion and Flexible Multiple Daily Insulin Regimen Using Insulin Glargine in Type 1 Diabetes
Authors: Alemzadeh Ramin , Ellis James N. , Holzum Mary K. , Parton Elaine A. , Wyatt David T. 
Published: August 2004

Objective. The aim of this study was to evaluate the metabolic effects of continuous subcutaneous insulin infusion (CSII) with flexible multiple daily insulin (FMDI; premeal lispro + bedtime glargine) therapy as determined by glycosylated hemoglobin (HbA 1c), body mass index (BMI), and hypoglycemic episodes in a group of patients who made the transition from multiple daily insulin (premeal lispro + bid ultralente) to either CSII or FMDI therapy.
Methods. Data from 40 (27 female and 13 male) patients (10.1–17.8 years of age) who were on CSII and 40 age- and gender-matched (27 female and 13 male) patients (10.3–17.3 years of age) who were on FMDI were collected during regularly scheduled visits at a similar frequency over a 1-year period.
Results. The total daily insulin dose did not change in CSII (0.97 ± 0.24 vs 0.91 ± 0.22 U/kg) and FMDI (0.98 ± 0.21 vs 0.97 ± 0.21 U/kg) patients, whereas the bolus:basal insulin ratio was significantly increased in both CSII (1.01 ± 0.43 vs 1.32 ± 0.52) and FMDI (1.07 ± 0.0.41 vs 1.29 ± 0.47) patients. The total cohort of CSII patients showed a decrease in HbA1c from 8.4 ± 1.0% to 7.8 ± 0.8%, whereas the FMDI cohort did not show a significant change in HbA1c (8.5 ± 1.1% to 8.2 ± 0.9%). However, 40% of the CSII group and 22.5% of the FMDI group showed ≥1.0% improvement in HbA1c. Also, a similar number of patients in CSII (52.5%; 8.0 ± 1.1 to 7.2 ± 0.5%) and FMDI (47.5%; 8.0 ± 0.5% to 7.5 ± 0.4%) maintained or achieved target HbA1c values &lt;8.0%. The BMI increased significantly in the CSII group (21.6 ± 3.2 vs 23.0 ± 3.0 kg/m2) but did not change in the FMDI group (21.9 ± 3.9 vs 22.6 ± 3.8 kg/m2). There was a significant reduction in the rate of severe hypoglycemia (events/100 patient-years) in both cohorts: 20.6 to 8.2 in the CSII and 18.8 to 7.5 in the FMDI. Similarly, the rate of moderate hypoglycemia decreased in both CSII (68.3–35.4) and FMDI (56.3–30.4).
Conclusions. CSII therapy resulted in a significant improvement in HbA 1c in the entire group, whereas FMDI therapy improved HbA1c in only a subgroup of patients. However, almost half of the patients in each of the treatment groups maintained or achieved target glycemic control. Both CSII and FMDI treatment groups demonstrated a decreased rate of hypoglycemia without an abnormal increase in BMI. Although the design of this study does not allow direct comparison of the metabolic effects of CSII and FMDI therapies, both regimens seem to be superior to basal ultralente and lispro multiple daily insulin regimen and offer desirable therapeutic alternatives in pediatric diabetes care.
Triage of the Pediatric Patient in the Emergency Department: Are We All in Agreement?
Authors: Maldonado Theresa , Avner Jeffrey R. 
Published: August 2004

Objective. To compare triage categorization as a measure of perceived patient acuity on presentation to the emergency department by pediatric emergency medicine (PEM) attending physicians, nurses, and pediatric residents with their general emergency medicine (GEM) counterparts.
Methods. A questionnaire that contained 12 pediatric triage scenarios was sent to all PEM attending physicians, triage-trained nurses, and pediatric residents and their GEM counterparts at a large urban hospital with separate pediatric and general emergency departments. Participants were asked to use a 3-tier triage system (emergent, urgent, nonurgent) to assign a triage level for each patient scenario.
Results. The response rate was 99%. The κ level of agreement was highest (.39) among the PEM physicians. Significantly more GEM attending physicians triaged the following scenarios at a higher acuity level as compared with PEM attending physicians with a trend toward emergent triage: simple febrile seizure, 50% (95% confidence interval [CI]: 30%–70%) versus 7.7% (95% CI: 1%–34%); 18-month-old with fever and bumps on lips, 21% (95% CI: 9%–43%) versus 0% (95% CI: 0%–23%); and 15-month-old well-appearing child with high fever, 50% (95% CI: 30%–70%) versus 7.7% (95% CI: 1%–34%). Significant differences were found between GEM and PEM triage-trained nurses only in the 15-month-old high fever scenario and between GEM and pediatric residents in the 15-month-old high fever scenario, the 18-month-old with fever and bumps on lips scenario, and a fever/limp scenario.
Conclusions. The level of agreement of triage assignment within each group was only fair. GEM participants and PEM participants agreed on most scenarios. However, GEM participants were more likely to triage children with certain febrile illnesses at higher acuity levels as compared with their PEM counterparts.
Can an Alternative Umbilical Arterial Catheter Solution and Flush Regimen Decrease Iatrogenic Hemolysis While Enhancing Nutrition? A Double-Blind, Randomized, Clinical Trial Comparing an Isotonic Amino Acid With a Hypotonic Salt Infusion
Authors: Jackson Jodi K. , Biondo Deborah J. , Jones Janice M. , Moor Pamala J. , Simon Stephen D. , Hall Robert T. , Kilbride Howard W. 
Published: August 2004

Objective. In the process of sampling blood through an umbilical arterial catheter (UAC), infant blood comes into stagnant contact with infusion solution in the “waste syringe” before being reinfused. We have previously demonstrated in vitro that this process is associated with less hemolysis of red blood cells (RBCs) with use of an isotonic solution compared with a hypotonic 0.25 normal saline (NS) solution. The objective of this study was to compare the in vivo effect on hemolysis of 2 UAC infusion/flush regimens (an isotonic regimen vs a hypotonic regimen) and to assess the early nutritional benefit of an amino acid solution as the isotonic UAC infusion solution.
Methods. Infants who had a birth weight of ≤1.5 kg and were expected to have a UAC for ≥3 days were enrolled within 24 hours of life into this prospective, double-blind, randomized, clinical trial of 2 UAC infusion solution/flush regimens. Power analysis demonstrated that 40 infants were needed to determine differences in hemolysis quantified by plasma-free hemoglobin (PFH) level. Nutrition from glucose was evaluated by measurement of daily dextrose calories. C-peptide was measured to evaluate endogenous insulin production. Adverse events and protein tolerance were tracked.
Results. Twenty-two infants (mean gestational age: 27 weeks; 945 g birth weight) were enrolled in each group, for an average of 4.2 days (range: 2.5-8 days). There were no group differences in demographics. PFH levels were lower for infants who received isotonic amino acid (IAA) in comparison with 0.25 NS (33 ± 14 mg/dL vs 62 ± 27 mg/dL, respectively). C-peptide was higher in those who received IAA, as were nonprotein calories received on days 4 to 6 of the study (51 ± 11 kcal/kg/day vs 44 ± 12 kcal/kg/day, IAA vs 0.25 NS, respectively).
Conclusions. Lower PFH levels in IAA versus 0.25 NS group were consistent with our hypothesis of decreased hemolysis with an isotonic infusion/flush regimen. IAA use may also allow greater early glucose nutrition, as indicated by the higher level of endogenous insulin production and improved glucose tolerance. IAA seems to be a superior UAC solution to 0.25 NS in that it is associated with less hemolysis and improved nutrition.
Terminal 22q Deletion Syndrome: A Newly Recognized Cause of Speech and Language Disability in the Autism Spectrum
Authors: Manning Melanie A. , Cassidy Suzanne B. , Clericuzio Carol , Cherry Athena M. , Schwartz Stuart , Hudgins Louanne , Enns Gregory M. , Hoyme H. Eugene 
Published: August 2004

Objective. Cryptic subtelomeric chromosome rearrangements account for 6% to 10% of idiopathic mental retardation. As cytogenetic and molecular techniques have become more sophisticated, the number of genetic syndromes attributed to these microdeletions has increased. To date, 64 patients have been described in the literature with a more recently recognized microdeletion syndrome, del 22q13.3. The purpose of this study is to present 11 new cases of this recently described syndrome to delineate further the phenotype and to alert the clinician to another genetic condition that should be considered in the differential diagnosis of early hypotonia, delayed speech acquisition, and autistic behavior.
Methods. Eleven patients were evaluated in 3 academic institutions. Clinical features and results of cytogenetic testing were recorded and tabulated. Reasons for referral for genetic evaluation included developmental delay, severe expressive speech and language delay, and dysmorphic features.
Results. Age of presentation ranged from 5 months to 46 years. There were 10 female patients and 1 male patient. All of the patients exhibited delayed motor development, some degree of hypotonia, and severe expressive speech and language delay. Dysmorphic facial features included epicanthal folds, large cupped ears, underdeveloped philtrum, loss of cupid's bow, and full supraorbital ridges. Six patients exhibited autistic-like behaviors. Microscopically visible chromosome deletions were observed in 6 patients. In the remainder, the deletion was detected with the use of fluorescence in situ hybridization.
Conclusions. Hypotonia and developmental delay are nonspecific findings observed in many malformation and genetic syndromes. However, in association with severe speech and language delay and autistic-like behavior, this phenotype may be a significant indication to consider the 22q13 deletion syndrome as a potential cause.
Reduced Bone Density Among Children With Severe Hemophilia
Authors: Barnes Chris , Wong Patricia , Egan Brendan , Speller Tessa , Cameron Fergus , Jones Graeme , Ekert Henry , Monagle Paul 
Published: August 2004

Objective. Children with severe hemophilia are at risk for reduced bone mineral density (BMD) because of reduced weight-bearing exercise and hepatitis C infection. Reduced bone density in childhood is a risk factor for osteoporosis in later life.
Study Design. We performed a cross-sectional survey of bone density among 19 children with severe hemophilia, at the Royal Children’s Hospital. Results were correlated with findings of blinded objective evaluations of the joints of the lower limb and with hepatitis C status.
Results. The mean lumbar bone mineral apparent density for patients was reduced (0.102 g/cm3), compared with that for control subjects (0.113 g/cm3). The mean areal BMD z score was −0.92, which was significantly reduced, compared with that for control subjects. The difference in bone density was independent of body size. There was a statistically significant relationship between the lumbar BMD z scores and the maximal single joint evaluation scores, but there was no difference based on hepatitis C status.
Conclusions. Our results suggest that children with severe hemophilia have reduced BMD. Patients at risk are those with signs of hemophilic arthropathy. Because osteoporosis may complicate the future treatment of patients with hemophilia, screening of young patients for reduced bone density is recommended.
Association Between Patterns of Maternal Substance Use and Infant Birth Weight, Length, and Head Circumference
Authors: Shankaran Seetha , Das Abhik , Bauer Charles R. , Bada Henrietta S. , Lester Barry , Wright Linda L. , Smeriglio Vincent 
Published: August 2004

Objective. To determine the effects of patterns of drug use during term pregnancy on infant growth parameters at birth.
Methods. Histories of cocaine, opiate, alcohol, tobacco, and marijuana use during the 3-month period before pregnancy and the 3 trimesters of pregnancy were recorded at the infants’ 1-month visit. Patterns of use were categorized as consistently high, moderate, or low/none or increasing/decreasing, and effects on growth parameters were analyzed in multivariate linear regression analyses, with adjustment for clinical site, maternal age, prepregnancy weight, multidrug use, and socioeconomic status.
Results. A total of 241 cocaine-exposed women and 410 non–cocaine-exposed women participated in the study. In the cocaine-exposed group, 75% used alcohol, 90% used tobacco, and 53% used marijuana; in the non–cocaine-exposed group, 57% used alcohol, 34% used tobacco, and 19% used marijuana. Birth weight, birth length, and head circumference were significantly greater among infants born to women who used no drugs, compared with women with any cocaine, opiate, alcohol, tobacco, or marijuana use, and were greater among infants born to cocaine nonusers, compared with cocaine users. With adjustment for confounders, birth weight was significantly affected by cocaine (deficit of 250 g with consistently low pattern) and tobacco (deficits of 232 g with consistently high pattern, 173 g with consistently moderate pattern, 153 g with decreasing pattern, and 103 g with consistently low pattern). Head size was affected by cocaine (deficit of 0.98 cm with consistently moderate pattern) and tobacco (deficits of 0.72 cm with consistently high pattern and 0.89 cm with consistently moderate pattern). Birth length was affected by tobacco use only (deficits of 0.82 cm with consistently high pattern and 0.98 cm with decreasing use).
Conclusion. Patterns of tobacco use during pregnancy affect birth weight, length, and head circumference, whereas cocaine affects birth weight and head size, when adjustments are made for confounders, including multidrug use.
Polymorphism of Tumor Necrosis Factor-α and Risk and Severity of Bronchopulmonary Dysplasia Among Very Low Birth Weight Infants
Authors: Kazzi S. Nadya J. , Kim U. Olivia , Quasney Michael W. , Buhimschi Irina 
Published: August 2004

Background. Preterm infants with bronchopulmonary dysplasia (BPD) exhibit prolonged elevation of inflammatory indices in their tracheal aspirates. Tumor necrosis factor-α (TNF-α) is a central mediator of the inflammatory response. The adenine-containing alleles of TNF-α−308 and lymphotoxin-α+250 have been associated with increased levels of TNF-α, whereas the adenine allele of TNF-α−238 produces lower levels of TNF-α after stimulation. High levels of TNF-α may promote chronic inflammation by overwhelming counter-regulatory mechanisms and may lead to the development of BPD. Low levels of TNF-α may decrease the risk and/or severity of BPD.
Objective. To determine whether alleles of TNF-α play a role in the susceptibility and/or severity of BPD among very low birth weight infants.
Methods. Infants with birth weights of ≤1250 g were included. Genotypic analyses (polymerase chain reaction-restriction fragment length polymorphism assays) were performed with DNA extracted from whole-blood samples.
Results. Infants who developed BPD (fraction of inspired oxygen at postconceptional age of 36 weeks of &gt;0.21, n = 51) had a younger gestational age (mean ± SD: 27 ± 4 vs 29 ± 2 weeks) and lower birth weight (853 ± 184 vs 997 ± 193 g) than did infants without BPD (n = 69). The genotypic distributions of lymphotoxin-α+250 and TNF-α−308 were comparable among the groups of infants. However, the AA and GA TNF-α−238 genotypes were much less likely to occur among infants with BPD than among infants without BPD. The adenine allele of TNF-α−238 was absent among infants with severe BPD and occurred significantly less often among infants with moderate or severe BPD, compared with infants with mild BPD. The number of adenine alleles of TNF-α−238 was correlated inversely with the severity of BPD (r = −.341).
Conclusion. The adenine allele of TNF-α−238 may reduce the risk and severity of BPD.
Procalcitonin: A Marker of Severity of Acute Pyelonephritis Among Children
Authors: Pecile Paolo , Miorin Elisabetta , Romanello Carla , Falleti Edmondo , Valent Francesca , Giacomuzzi Francesco , Tenore Alfred 
Published: August 2004

Objective. Febrile urinary tract infection (UTI) is a common problem among children. The diagnosis and management of acute pyelonephritis is a challenge, particularly during infancy. The distinction between acute pyelonephritis and UTI without renal involvement is very important, because renal infection may cause parenchymal scarring and thus requires more aggressive investigation and follow-up monitoring. However, this distinction is not easy among children, because common clinical findings and laboratory parameters are nonspecific, especially among young children. In an attempt to differentiate acute pyelonephritis from febrile UTI without renal lesions in a group of 100 children, we measured serum levels of procalcitonin (PCT), a new marker of infection. The objective of the study was to determine the accuracy of PCT measurements, compared with C-reactive protein (CRP) measurements, in diagnosing acute renal involvement during febrile UTI and in predicting subsequent scars, as assessed with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.
Design. Serum CRP levels, erythrocyte sedimentation rates, leukocyte counts, and PCT levels were measured for 100 children, 1 month to 13 years of age, admitted for suspected febrile UTI (first episode). Renal parenchymal involvement was evaluated with DMSA scintigraphy within 5 days after admission. The DMSA study was repeated 6 months later if the initial results were abnormal.
Results. The mean PCT level was significantly higher in acute pyelonephritis than in UTI without renal lesions (4.48 ± 5.84 ng/mL vs 0.44 ± 0.30 ng/mL). In these 2 groups, the mean CRP levels were 106 ± 68.8 mg/L and 36.4 ± 26 mg/L, mean erythrocyte sedimentation rates were 79.1 ± 33 mm/hour and 58.5 ± 33 mm/hour, and leukocyte counts were 18 492 ± 6839 cells/mm3 and 16 741 ± 5302 cells/mm3, respectively. For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT measurements were 83.3% and 93.6%, respectively; CRP measurements had a sensitivity of 94.4% but a specificity of only 31.9%. Positive and negative predictive values for prediction of renal involvement with PCT measurements were 93.7% and 83% and those with CRP measurements were 61.4% and 83.3%, respectively. When inflammatory markers were correlated with the severity of the renal lesions, as assessed with DMSA scintigraphy, a highly significant correlation with both PCT and CRP levels was found. However, when the 2 parameters were correlated with renal scarring in follow-up scans, a significant positive association was found only for PCT levels.
Conclusions. Serum PCT levels may be a sensitive and specific measure for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement. Therefore, this measurement could be useful for the treatment of children with febrile UTIs, allowing prediction of patients at risk of permanent parenchymal renal lesions.
Amides, Fatty Acid
Authors: Opsahl Ross 
Published: August 2004

AbstractFatty acid amides, which contain a saturated or unsaturated alkyl chain derived from a fatty acid, can be divided into three categories. The first is primary monoamides in which R is a fatty alkyl or alkenyl chain of C5–C23and\documentclass{article}\usepackage{amssymb}\pagestyle{empty}\begin{document}${{\rm{R}}{^{{\prime}}}={\rm{R}}={\rm{H}}}$\end{document}. The second is substituted monoamides, including secondary, tertiary, and alkanolamides in which R is a fatty alkyl or alkenyl chain of C5–C23; R′ and R″ may be a hydrogen, fatty alkyl, aryl, or alkylene oxide condensation groups with at least one alkyl, aryl, or alkylene oxide group. The third category is bisamides where R groups are fatty alkyl or alkenyl chains. R′ and R″ may be hydrogen, fatty alkyl, aryl, or alkylene oxide condensation groups. Primary and secondary amides show strong hydrogen bonding which accounts for their high melting points and low solubilities in most solvents. With tertiary amides (disubstituted amides), hydrogen bonding is not possible, as exhibited by their increased solubility and lower melting points. Many fatty acid amides are essentially insoluble in water. Amides have a strong tendency to reduce friction on various surfaces by forming a layer on surfaces. This coating action may be attributed to their hydrophobic character and strong hydrogen bonding. Primary, secondary, and bisamides are widely used as lubricating or slip agents and alkanolamides are commonly used as surfactants Amides in general are stable to elevated processing temperatures, air oxidation, and dilute acids and bases. The dehydration of amides which produces nitriles is of great commercial value. The most widely used synthetic route for primary amides is the reaction of fatty acid with anhydrous ammonia. Most monosubstituted and disubstituted amides can be synthesized with or without solvents from fatty acids and alkylamines. Most bisamides are prepared by the reaction of the primary fatty amide and formaldehyde in the presence of an acid catalyst, or by the reaction of ethylene diamine with fatty acid. Some primary fatty amides available from various manufacturers under different trade names are coco fatty amide, stearamide, hydrogenated‐tallow fatty amide, docosanamide, octadecenamide, and 13‐docosenamide.. Many substituted fatty acid amides are commercially available, but other, specialty substituted amides are of lower commercial volume.
Growth Regulators, Animal
Authors: Beermann Donald H. 
Published: August 2004

AbstractThe growth of animals can be defined as an increase in mass of whole body, tissue(s), organ(s), or cell(s) with time. Improved understanding of the control of metabolic aspects of growth has provided the opportunity to regulate animal growth. Improvement of rate and efficiency of growth benefits the producer. Improvement in composition of meat animals benefits the producer through more efficient gain and greater value, and benefits the processor through less labor requirement for trimming and removal of fat. The consumer benefits by receiving a quality, desirable food at a cost reflective of efficient production.Four general classes of growth regulators are approved by the Food and Drug Administration (FDA) for use in food‐producing animals in the United States. These include naturally occurring and synthetic estrogens and androgens, ie, anabolic steroids; ionophores; antibiotics; and bovine somatotropin. Compounds in the first class, anabolic steroids, act as metabolism modifiers to alter nutrient partitioning toward greater rates of protein synthesis and deposition, thereby increasing the weight at which 25 to 30% lipid content in the body or carcass is achieved. Ionophores have highly selective antibiotic activity and appear to enhance feed conversion efficiency through effects on ruminal microbes. Antibiotics, administered at subtherapeutic doses, enhance growth through improving feed conversion efficiency and/or growth rate, with no consistent effect on body or carcass composition.Two other classes of growth regulators, ie, somatotropin or somatotropin secretogogues, and select synthetic phenethanolamines, have been investigated for the ability to alter growth; no compound in either class has yet been approved by the FDA for use in animals raised for meat. In 1993, the FDA approved administration of recombinant bovine somatotropin for increasing milk production in dairy cows.The U.S. Food and Drug Administration's Center for Veterinary Medicine thoroughly evaluates the proposed use of any compound, natural or synthetic, used in food‐producing animals for human food safety, safety to the animal of intended use, and safety to the environment.