bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of CD40 Ligand on CD4+ T-Cells and Platelets Correlated to the Coronary Artery Lesion and Disease Progress in Kawasaki Disease
Authors: Wang Chih-Lu , Wu Yu-Tsun , Liu Chieh-An , Lin Mei-Wei , Lee Chia-Jung , Huang Li-Tung , Yang Kuender D. 
Published: August 2004

Objective.Kawasaki disease (KD) is an acute febrile vasculitic syndrome in children. CD40 ligand (CD40L) has been implicated in certain types of vasculitis. We proposed that CD40L expression might be correlated with coronary artery lesions in KD.Methods.Blood samples were collected from 43 patients with KD before intravenous immunoglobulin (IVIG) treatment and 3 days afterward. Forty-three age-matched febrile children with various diseases were studied in parallel as controls. CD40L expression on T-cells and platelets were detected by flow cytometry, and soluble CD40L (sCD40L) levels were measured by enzyme-linked immunosorbent assay.Results.We found that CD40L expression on CD4+ T-cells was significantly higher in patients with KD than in the febrile control (FC) group (28.69 ± 1.17% vs 4.37 ± 0.36%). CD40L expression decreased significantly 3 days after IVIG administration (28.69 ± 1.17% vs 13.53 ± 0.55%). CD40L expression on platelets from patients with KD was also significantly higher than in the FC group (8.20 ± 0.41% vs 1.26 ± 0.12%) and decreased after IVIG therapy. sCD40L levels were also significantly higher in KD patients with those of FC (9.69 ± 0.45 ng/mL vs 2.25 ± 0.19 ng/mL) but were not affected by IVIG treatment 3 days afterward (9.69 ± 0.45 ng/mL vs 9.03 ± 0.32 ng/mL). More interesting, we found that in KD patients, CD40L expression on CD4+ T-cells and platelets but not on CD8+ T-cells or sCD40L was correlated with the occurrence of coronary artery lesions.Conclusions.CD40L might play a role in the immunopathogenesis of KD. IVIG therapy might downregulate CD40L expression, resulting in decrease of CD40L-mediated vascular damage in KD. This implicates that modulation of CD40L expression may benefit to treat KD vasculitis.
Effect of Exercise on Immunologic Factors in Breast Milk
Authors: Lovelady Cheryl A. , Hunter Christie P. , Geigerman Cissy 
Published: August 2004

Objective. Although it is well documented that breast milk provides optimal nutrition and immune benefits to the infant, factors that influence the immunologic composition of breast milk are less understood. A recent study reported that immunoglobulin A (IgA) levels in breast milk are lower after exercise compared with resting concentrations. However, the women exercised until exhaustion. The effect of moderate exercise on immunologic components in breast milk has not been reported. Therefore, the purpose of this study was to 1) compare the levels of immunologic compounds in breast milk of exercising women with the milk of sedentary women and 2) determine whether 30 minutes of moderate exercise affects immunologic properties of breast milk.
Methods. Exclusively lactating women were studied at 3 months’ postpartum. Women in the exercise group (EG; n = 29) reported exercising aerobically at least 30 minutes/d for 3 days/wk, and women in the sedentary group (SG; n = 24) had exercised once a week or less during the previous 6 weeks. Cardiovascular fitness levels and concentrations of IgA, lactoferrin, and lysozyme in milk were measured. A subsample of the EG (n = 17) participated in a 30-minute exercise session at 75% of maximum heart rate and a rest session of 30 minutes of sitting rest on 2 separate days. Breast milk samples were collected before and 10 and 60 minutes after exercise and rest sessions. IgA, lactoferrin, and lysozyme concentrations were measured.
Results. Women in the EG had a higher level of cardiovascular fitness than women in the SG (39.7 ± 1.0 vs 32.4 ± 1.0 mL O2/kg/min). Milk concentrations of IgA, lactoferrin, or lysozyme were not significantly different between groups. In addition, there were no significant differences in the concentrations of IgA, lactoferrin, or lysozyme after moderate exercise compared with sitting rest.
Conclusion. Moderate exercise during lactation improves cardiovascular fitness without affecting levels of IgA, lactoferrin, or lysozyme in breast milk.
Temperament and Physical Performance in Children With Osteogenesis Imperfecta
Authors: Suskauer Stacy J. , Cintas Holly L. , Marini Joan C. , Gerber Lynn H. 
Published: August 2004

Objective.Children with osteogenesis imperfecta (OI) must participate in therapy to achieve motor performance objectives. Their behavioral style may influence motor performance. For this reason, the temperament of children with types III or IV OI was assessed prospectively to 1) compare their temperament with that of nondisabled children, 2) investigate the relationship between temperament and gross motor performance, and 3) examine relationships among temperament, parental overprotection and coping, physical activity, muscle strength, and motor performance.Methods.Age-appropriate Carey Temperament Scales, Brief Assessment of Motor Function (BAMF), and the Vulnerable Child/Overprotecting Parents Scale were completed for 35 children 1 to 12 years old. Additional measures included the Childhood Health Assessment Questionnaire, Parent Daily Hassles Scale, manual muscle testing, Pediatric Activity Record, and a Summed Severity Score. Spearman correlations and multiple regression were used to identify and predict significant relationships.Results.Temperament of children with OI differed from age-based norms in only 1 domain: activity. Motor performance (BAMF) correlated significantly with 3 domains of temperament: persistence (r = −.48), approach (r = −.34), and activity (r = .40). Activity was also related to the ratio of head circumference to body length (r = −.45) and the number of fractures in the preceding year (r = −.35). Parents’ reports of their daily hassles significantly correlated with several domains of the child’s temperament. No significant relationships were identified between parental overprotection and temperament or motor performance.Conclusions.The temperament of children with types III and IV OI does not differ from that of their nondisabled peers, with the exception of lower activity scores. Although it is considered a biological attribute, the expression of temperament, specifically activity, may be influenced by learned behaviors. Because gross motor performance is related to activity, persistence, and approach/avoidance, knowledge of an individual’s temperament may enhance the child’s ability to benefit from interventions to improve motor skill and activity levels.
Tobacco Counseling at Well-Child and Tobacco-Influenced Illness Visits: Opportunities for Improvement
Authors: Tanski Susanne E. , Klein Jonathan D. , Winickoff Jonathan P. , Auinger Peggy , Weitzman Michael 
Published: August 2004

Objective. To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM).Methods. Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (≤18 years) that included clinician-reported counseling for tobacco use/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed.Results. Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13–18 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5–33.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician’s assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002–2.50; and odds ratio: 3.0; 95% confidence interval: 1.5–6.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty.Conclusions. Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.
Infectious Disease Hospitalizations Among American Indian and Alaska Native Infants
Authors: Holman Robert C. , Curns Aaron T. , Cheek James E. , Singleton Rosalyn J. , Anderson Larry J. , Pinner Robert W. 
Published: August 2004

Objective. To describe the burden and trends in hospitalizations associated with infectious diseases among American Indian and Alaska Native (AI/AN) infants.Methods. First-listed infectious disease hospitalizations and hospitalization rates among AI/AN infants and infants in the general US population from 1988–1999 were analyzed by using Indian Health Service/tribal hospital discharge data and the National Hospital Discharge Survey data, respectively.Results. Infectious disease hospitalizations accounted for 53% of all AI/AN infant hospitalizations and approximately 43% of all US infant hospitalizations during 1988–1999. The annual hospitalization rate for infectious diseases among AI/AN infants declined from 27 486 per 100 000 infants in 1988 to 14 178 per 100 000 infants in 1999. However, the rates for AI/AN infants within the Alaska, Southwest, and Northern Plains regions remained higher than that for the general US infant population at the end of the study period. Lower respiratory tract infection hospitalizations accounted for almost 75% of AI/AN infant infectious disease hospitalizations, and the lower respiratory tract infection hospitalization rate for AI/AN infants was twice that for US infants.Conclusions. Although infectious disease hospitalization rates for AI/AN infants have declined, AI/AN infants continue to have a higher infectious disease burden than the general US infant population.
Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns
Authors: Koppel Robert I. , Druschel Charlotte M. , Carter Tonia , Goldberg Barry E. , Mehta Prabhu N. , Talwar Rohit , Bierman Fredrick Z. 
Published: August 2004

Objective. To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM).Methods. Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation ≤95% at &gt;24 hours). Data regarding true and false positives as well as negatives were collected and analyzed.Results. Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return ×2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).Conclusions. This screening test is simple, noninvasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.
Does Gatekeeping Control Costs for Privately Insured Children? Findings From the 1996 Medical Expenditure Panel Survey
Authors: Pati Susmita , Shea Steven , Rabinowitz Daniel , Carrasquillo Olveen 
Published: August 2004

Objective. Gatekeeping requirements were widely adopted by health insurers in an attempt to control costs in the mid-1990s, but empirical evidence demonstrating decreased health expenditures for children enrolled in such plans is lacking.Methods. We analyzed data from 3254 children with private health insurance sampled in the 1996 Medical Expenditure Panel Survey (MEPS) to compare total per capita health expenditures among gatekeeping versus indemnity plan enrollees. This sample represents 40.4 million privately insured American children. Total expenditures were defined as payments from all sources, including third-party and out-of-pocket payments, but excluding administrative costs. MEPS data are based on information provided by patients, health care providers, and hospitals. Gatekeeping plans included all children enrolled in health maintenance organizations or other plans requiring a primary care gatekeeper. All others were considered indemnity plan enrollees.Results. Mean total per capita annual expenditures for children in gatekeeping versus indemnity plans differed by &lt;1% ($887 vs $881, respectively). Third-party payments by gatekeeping plans on behalf of their beneficiaries were $636 versus $595 by indemnity plans. Out-of-pocket payments were on average $62 less for gatekeeping enrollees than for indemnity enrollees. After multivariate adjustment, mean per capita expenditures were approximately 4% lower for gatekeeping enrollees than for indemnity enrollees.Conclusion. In 1996, total per capita annual health expenditures for children in gatekeeping plans were approximately $8 less than for those in indemnity plans. These data indicate that gatekeeping is not an effective cost-containment method for children.
Soluble E-Selectin, Soluble L-Selectin and Soluble ICAM-1 in Bronchopulmonary Dysplasia, and Changes With Dexamethasone
Authors: Ballabh Praveen , Kumari Jaishree , Krauss Alfred N. , Shin Junghee J. , Jain Ajey , Auld Peter A. M. , Lesser Martin L. , Cunningham-Rundles Susanna 
Published: August 2004

Objective. To evaluate longitudinal change in arterial blood plasma levels of soluble adhesion molecules in infants of &lt;30 weeks’ gestation with respiratory distress syndrome (RDS) and to look for differences in these levels in neonates who subsequently developed bronchopulmonary dysplasia (BPD) compared with those neonates who did not, and also to investigate the effect of dexamethasone treatment on levels of soluble adhesion molecules in plasma.
Methods. We measured plasma concentrations of soluble L-selectin (sL-selectin), soluble E-selectin (sE-selectin), and soluble intercellular adhesion molecule-1 on days 1, 3, 7, 14, 21, and 28 of life and before and 2 to 3 days after initiating a 6-day course of dexamethasone treatment. Infants with RDS were followed until discharge and were classified as non-BPD and either 1) BPD day 28 reflecting oxygen requirement on day 28 but not at 36 corrected weeks or 2) BPD 36 weeks reflecting oxygen requirement at 36 (corrected) weeks’ gestation. The classification of presence or absence of BPD by oxygen requirement was supported by and was consistent with radiologic findings of BPD for all infants. The difference between BPD day 28 and BPD 36 weeks was supported by more extensive radiologic effects in the latter.
Results. The arterial plasma level of sL-selectin in infants who had RDS and did not develop BPD was significantly decreased compared with term healthy infants, as was the level of sE-selectin. Compared with infants who had RDS and did not develop BPD, sL-selectin levels were even further decreased in infants who had RDS and did develop BPD both at birth and throughout the first 4 weeks of life (day 1 through day 28). Infants with BPD also showed increasing levels of sE-selectin during this period of time, whereas infants without BPD did not. Levels of soluble intercellular adhesion molecule-1 in infants without BPD were not different from infants with BPD initially but increased in infants with BPD compared with infants without BPD, significant on day 28 in both groups. Dexamethasone treatment increased concentration of sL-selectin and decreased concentration of sE-selectin.
Conclusions. Low sL-selectin may be an early indicator of enhanced risk for BPD. Low levels of sL-selectin and increasing levels of sE-selectin may be risk factors for BPD. The effects of dexamethasone treatment include significant modulation of adhesion molecules.
Pulmonary Outcome at 1 Year Corrected Age in Premature Infants Treated at Birth With Recombinant Human CuZn Superoxide Dismutase
Authors: Davis Jonathan M. , Parad Richard B. , Michele Theresa , Allred Elizabeth , Price Anita , Rosenfeld Warren ,   for the North American Recombinant Human CuZnSOD Study Group
Published: August 2004

Objective. To examine whether treatment of premature infants with intratracheal recombinant human CuZn superoxide dismutase (r-h CuZnSOD) reduces bronchopulmonary dysplasia and improves pulmonary outcome at 1 year corrected age.Design. Three hundred two premature infants (600–1200 g birth weight) treated with exogenous surfactant at birth for respiratory distress syndrome were randomized to receive either intratracheal r-h CuZnSOD (5 mg/kg in 2 mL/kg saline) or placebo every 48 hours (as long as intubation was required) for up to 1 month of age. Short-term, as well as longer-term pulmonary outcome was assessed.Results. There were no differences between groups in the incidence of death or the development of bronchopulmonary dysplasia (oxygen requirement with an Edwards chest radiograph score of ≥3) at 28 days of life or 36 weeks’ postmenstrual age. r-h CuZnSOD was well-tolerated and not associated with significant increases in any adverse event. At a median of 1 year corrected age, health assessments and physical examinations were performed on 209 (80%) surviving infants, with complete data available on 189 infants. Thirty-seven percent of placebo-treated infants had repeated episodes of wheezing or other respiratory illness severe enough to require treatment with asthma medications such as bronchodilators and/or corticosteroids compared with 24% of r-h CuZnSOD-treated infants, a 36% reduction. In infants &lt;27 weeks’ gestation, 42% treated with placebo received asthma medications compared with 19% of r-h CuZnSOD-treated infants, a 55% decrease. Infants &lt;27 weeks’ gestation who received r-h CuZnSOD also had a 55% decrease in emergency department visits and a 44% decrease in subsequent hospitalizations. Growth measurements and the results of physical examinations were comparable between groups.Conclusions. These data indicate that treatment at birth with r-h CuZnSOD may reduce early pulmonary injury, resulting in improved clinical status when measured at 1 year corrected age. r-h CuZnSOD appears to be a safe and effective therapy that improves pulmonary outcome in high-risk premature infants.
Clinical Effects ofl-Carnitine Supplementation on Apnea and Growth in Very Low Birth Weight Infants
Authors: Whitfield Jonathan , Smith Twyala , Sollohub Heather , Sweetman Lawrence , Roe Charles R. 
Published: August 2004

Objective. Systemic carnitine deficiency may present with apnea, hypotonia, and poor growth. Premature infants often manifest these symptoms and are at risk of developing carnitine deficiency because of immaturity of the biosynthetic pathway, lack of sufficient predelivery transplacental transport, and lack of sufficient exogenous supplementation. This study was undertaken to examine the effect of carnitine supplementation in premature infants.Methods. Eighty preterm infants &lt;1500 g were enrolled in a prospective, double-blind, placebo-controlled study of carnitine supplementation within 96 hours of delivery. Growth, length of hospital stay, and frequency and severity of apnea were the primary outcome measures.Results. Weight gain and change in length, fronto-occipital head circumference, mid arm circumference, and triceps skinfold thickness were similar between the carnitine-supplemented and placebo groups. The amount and severity of apnea and the overall length of hospitalization were also similar between the 2 groups. The carnitine levels in the supplemented group were significantly higher than in the placebo group at 4 and 8 weeks after study entry.Conclusion. Although preterm infants &lt;1500 g have low carnitine levels, routine supplementation with carnitine has no demonstrable effect on growth, apnea, or length of hospitalization and thus seems to be unnecessary.
Chronic Lung Disease of Prematurity and Intrauterine Growth Retardation: A Population-Based Study
Authors: Lal Mithilesh K. , Manktelow Bradley N. , Draper Elizabeth S. , Field David J. 
Published: August 2004

Objective. To determine the risk of chronic lung disease (CLD) in small for gestational age (SGA) preterm infants in comparison to appropriately grown and large for gestational age (LGA) infants.Methods. Observational study derived from a geographically defined population (Trent Health Region, United Kingdom). All preterm infants of ≤32 completed weeks’ gestation born to Trent resident mothers admitted to neonatal units between 1995 and 1999 (inclusive) were included. Birth weight percentiles were created for the whole population, and infants were classified as SGA infants (if &lt;10th percentile), appropriately grown (if between 25th and 75th percentiles—reference group), and LGA infants (if ≥90th centile). Both mortality and CLD rates (using both 28 days’ and 36 weeks’ postmenstrual age [PMA] definitions) were determined for these groups of infants.Results. Four thousand fifty-one preterm infants ≤32 weeks’ gestation were identified. SGA infants showed higher mortality before 28 days’ postnatal age and 36 weeks’ PMA as compared with reference group infants (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.49–2.72; and OR: 2.00, 95% CI: 1.49–2.69), respectively.SGA infants showed a significantly greater risk of developing CLD, both at 28 days’ and 36 weeks’ PMA as compared with the reference group infants (OR: 1.34, 95% CI: 1.03–1.74; and OR: 1.87, 95% CI: 1.39–2.51), respectively. LGA infants showed a trend toward a reduced incidence of CLD in comparison to the reference group, which was statistically significant for the 36 weeks’ definition (OR: 0.76–28 weeks, 95% CI: 0.57–1.01; and OR: 0.55–36 weeks, 95% CI: 0.37–0.81).Conclusions. Fetal growth seems to influence mortality in general and morbidity, attributable to CLD, in particular in preterm infants. SGA preterm infants are at higher risk of death before 28 days’ and 36 weeks’ PMA and CLD by both definitions. LGA infants show reduced risk of CLD.