bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumor necrosis factor‐α and transforming growth factor‐β reflect severity of liver damage in primary biliary cirrhosis
Authors: NEUMAN MANUELA , ANGULO PAUL , MALKIEWICZ IZABELLA , JORGENSEN ROBERTA , SHEAR NEIL , DICKSON E ROLLAND , HABER JULIA , KATZ GADY , LINDOR KEITH 
Published: March 2003

AbstractBackground and Aims The pathogenesis of primary biliary cirrhosis (PBC) is unknown. The role of cytokines such as tumor necrosis factor‐α (TNF‐α) and transforming growth factor‐β (ΤGF‐β), and the effect of ursodeoxycholic acid (UDCA) in modifying the cytokine environment in patients with PBC has remained largely unstudied. Our aims were to determine: (i) the relationship between serum levels of TNF‐α and TGF‐β and the severity of PBC; and (ii) the effects of UDCA therapy on TNF‐α and TGF‐β levels in patients with PBC.Methods We studied 90 patients who had been treated with UDCA (53 patients) or placebo (37 patients) for 2 years as part of a randomized, double‐blind, controlled trial. Patients were divided into histological stage I/II or stage III/IV disease. Serum TNF‐α and TGF‐β levels were quantified by enzyme‐linked immunoabsorbent assay.Results Baseline levels of TNF‐α were significantly greater in patients with stage III/IV compared to stage I/II disease. After 2 years of treatment with UDCA, patients showed a significantly greater decrease in TNF‐α levels and progression risk score compared to placebo‐treated patients. TNF‐α and TGF‐β levels were significantly reduced compared to baseline levels in the UDCA‐treated group after 2 years, while there was no significant change in the levels of placebo‐treated patients.Conclusions Serum TNF‐α and TGF‐β levels may reflect severity of disease in patients with PBC. The beneficial effects of UDCA therapy may be explained by lowering serum levels of these two cytokines.
Genetic testing for HFE hemochromatosis in Australia: The value of testing relatives of simple heterozygotes
Authors: CAVANAUGH JULEEN A , WILSON SUSAN R , BASSETT MARK L 
Published: March 2003

Abstract
Background
: It is unclear whether screening of relatives of C282Y and H63D heterozygotes (other than compound heterozygotes) for hemochromatosis will detect sufficient numbers of cases to justify introduction of this screening strategy.
Methods
: Conditional probabilities were determined using published Australian allele frequencies and penetrance data to determine the detection rate of hemochromatosis by testing the siblings and offspring of heterozygotes (subjects with only one HFE mutation).
Results
: The number of individuals who are at risk of developing increased body iron stores because of HFE mutations is substantially higher (1 in 80) than previously estimated. In addition, 33% of the Australian population are heterozygous for either C282Y or H63D. Based on population estimates, the relative risk to the offspring of C282Y and H63D heterozygotes of developing increased iron stores is 4.1 and 1.5, respectively, while the relative risk to each sibling is 2.3 and 1, respectively. The risk of developing clinical features of hemochromatosis or hepatic fibrosis is likely to be substantially lower.
Conclusions
: Although the detection rate from testing the families of unaffected heterozygotes is low, this can be justified as a clinically useful screening strategy. At the present time this strategy should be restricted to first‐degree relatives of heterozygotes. Further studies are recommended to determine if cascade genetic screening is a cost‐effective alternative to general population screening.© 2002 Blackwell Publishing Asia Pty Ltd
Endoscopic hemostasis of a bleeding marginal ulcer: Hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation
Authors: Lee Yi‐Chia , Wang Hsiu‐Po , Yang Chang‐Shiu , Yang Tzeng‐Huey , Chen Jiann‐Hwa , Lin Chun‐Che , Tsai Chiang‐Yen , Chang Li‐Ying , Huang Shih‐Pei , Wu Ming‐Shiang , Lin Jaw‐Town 
Published: March 2003

Abstract
Background and Aims:
Endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation have been proven effective in the hemostasis of bleeding peptic ulcers. However, the hemostatic efficacy has not been investigated in bleeding marginal ulcers. The aim of this study is to investigate the hemostatic efficacy of endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation in bleeding marginal ulcers.
Methods:
From November 1997 to July 2000, 50 patients with active marginal ulcer bleeding underwent either hemoclipping (20 patients) or dual therapy (30 patients) for hemostasis. The demographic data, clinicopathological characteristics, endoscopic findings, initial hemostatic rates, rebleeding rates, amount of blood transfusion, the need of surgery, and mortality rates were collected and analyzed.
Results:
Marginal ulcers were located at the anastomotic site (64%), saddle portion (22%), efferent loop (10%), or at the afferent loop (4%). The bleeding stigmata were classified into spurting artery (32%), oozing vessel (38%), visible vessel (20%), and blood clot adhesion (10%). The overall therapeutic results in 50 patients were initial hemostasis (100%), rebleeding rate (22%), need for surgery (4%), and hospital mortality rate (4%). There was no significant difference in demographic data and clinicopathological characteristics between the two modes of treatments, whereas recurrent bleeding developed in 5% in the hemoclipping group and 33% in the dual therapy group. No complication related to the procedure occurred in either mode of therapy. The hospital mortality rates were 0 and 6.7%, respectively.
Conclusion:
Endoscopy is effective in achieving initial hemostasis from bleeding marginal ulcers. However, the rebleeding rate remains high and repeated endoscopy may be needed to arrest the hemorrhage.© 2002 Blackwell Publishing Asia Pty Ltd
Cholangiocarcinoma in liver cirrhosis
Authors: HUI CHEE‐KIN , YUEN MAN‐FUNG , TSO WAI‐KUEN , NG IRENE OI‐LIN , CHAN ANNIE ON‐ON , LAI CHING‐LUNG 
Published: March 2003

AbstractBackground and Aim: Hepatocellular carcinoma (HCC) is usually associated with chronic liver diseases and liver cirrhosis, while conversely, cholangiocarcinoma (CC) usually occurs in a non‐cirrhotic liver. The purpose of the present study was to evaluate CC in liver cirrhosis.Methods: Between January 1998 and December 1999, 26 patients with CC were retrospectively reviewed. The occurrence of CC in chronic hepatitis B infection‐related liver cirrhosis, portal vein thrombosis (PVT) and survival were analyzed.Results: Twenty‐six patients with CC (19 with a non‐cirrhotic liver and seven with chronic hepatitis B infection‐related liver cirrhosis) were included in the present study. All cases of CC in the cirrhotic group were incidentally discovered during routine screening for HCC. The mean age (± SD) was 58.8 ± 14 years in the cirrhotic group and 73.2 ± 15.9 years (P = 0.001) in the non‐cirrhotic group. When compared to the cirrhotic group, the non‐cirrhotic group had a higher median level of albumin (42 compared to 30 g/L, P = 0.005), bilirubin (117.5 compared to 18 µmol/L, P = 0.01), alkaline phosphatase (291.5 compared to 100 U/L, P = 0.001) and gamma glutamyl transpeptidases (215.5 compared to 31 U/L, P = 0.001). In contrast, the cirrhotic group had a higher median prothrombin time (PT) compared to the non‐cirrhotic group (18.2 compared to 12 s, P = 0.05). In the non‐cirrhotic group, only one patient (5.3%) showed evidence of PVT on a computerized tomography and Doppler ultrasound, while in the cirrhotic group six patients (85.7%) had PVT (P < 0.001). The median survival period in the cirrhotic group was six months (range 2–24 months) compared to 16 months (range 6–41 months) in the non‐cirrhotic group (P = 0.036).Conclusion: CC in cirrhotic liver presented at a younger age and patients who developed CC were prone to PVT. The survival period was also shorter in comparison to that of non‐cirrhotic liver patients.
Paediatricians: Referral rates and speech pathology waiting lists
Authors: KEATING D , SYRMIS M , HAMILTON L , McMAHON S 
Published: March 2003

Objective:This study aimed to examine paediatricians’ training in and understanding of communication development and disabilities and their attitudes to speech pathology waiting lists and management practices. The relationship between these factors and referral rates was also investigated.Methodology:A total of 229 paediatricians registered with the Australian College of Paediatrics participated in the study in November 1996. They answered 15 multiple‐choice questions designed to collect demographic information and data pertaining to their training and understanding of communication development and disabilities. The survey also obtained data on referral rates to public and private speech pathology services and on paediatricians’ perceptions of speech pathology waiting lists and possible management strategies.Results:Referral rate to public and private speech pathology services was found to be associated with the quality of paediatricians’ training in and knowledge of communication development and disabilities. Paediatricians who had regular contact with speech pathologists were also more likely to make more referrals. Waiting lists had a negative influence on referral rate. Treatment rather than assessment waiting lists were preferred. Paediatricians believed the best solution to speech pathology waiting lists was an increase in staffing levels particularly in community health centres. Respondents reported that 1–4 months was an acceptable time to wait for speech pathology care and indicated the order of importance of factors for prioritising children.Conclusions:The results have important implications for developing best practice models for improving referral processes and access to speech pathology services for children with communication disabilities.
Gentamicin dosage intervals in neonates: Longer dosage interval—less toxicity
Authors: DAVIES MW , CARTWRIGHT DW 
Published: March 2003

Objectives:The aim of this study was to determine the incidence of toxic trough serum gentamicin levels in neonates in the first week of life, with different dosage intervals.Methods:This was a retrospective study of neonates born between 01.07.95 and 31.12.95, who received gentamicin. Data were collected on birth weight, gestation, gentamicin dose, the trough level of gentamicin, serum creatinine and urine output. A trough serum gentamicin level of ≥1.5 mg/L was considered toxic.Results:One hundred and seventy infants met the study criteria. All 21 infants in group one (24–29 weeks) received gentamicin with a dosage interval of 24 h. Sixteen (76%) infants had toxic trough serum gentamicin levels. In group two (30–34 weeks) 8 infants had gentamicin q12hly and all (100%) had toxic trough serum gentamicin levels. Fourteen infants had gentamicin every 18 h and 13 (93%) had toxic trough serum gentamicin levels. Sixty‐one infants had gentamicin q24hly and 25 (41%) had toxic trough serum gentamicin levels. The differences in proportions with toxic levels were statistically significant. In group three (≥35 weeks) 29 infants had gentamicin q12hly and 25 (86%) had toxic trough serum gentamicin levels. Six infants had gentamicin every 18 h and 2 (33%) had toxic trough serum gentamicin levels. Thirty‐one infants had gentamicin q24hly and 4 (13%) had toxic trough serum gentamicin levels. The differences in proportions comparing infants having gentamicin q12hly with those having it q24hly were statistically significant.Conclusions:A starting gentamicin dosage interval of 12 h in infants of any gestational age, or a starting dosage interval of 24 h for infants of less than 30 weeks gestational age, leads to most having toxic trough serum gentamicin levels. In infants of 30 weeks gestational age or greater, most have safe non‐toxic trough serum gentamicin levels if started on a dosage interval of 24 h.
Low dose oral anticoagulation therapy in Chinese children with congenital heart disease
Authors: CHEUNG YF , LEUNG MP 
Published: March 2003

Objectives:This study aims to evaluate the efficacy of a low dose warfarin regimen for Chinese children requiring anticoagulation therapy and its safety when monitored on an outpatient basis. Current recommendations are based on extrapolations from the adult experience and a high target international normalised ratio (INR) is adopted amongst the Western countries.Methodology:This is a 10‐year retrospective study from January 1986 to June 1996. Effectiveness of warfarin therapy was monitored by the prothrombin time, standardised and expressed as the INR. A target INR of 1.5–2.5 was adopted for children with cardiac diseases requiring anticoagulation therapy for primary and secondary prophylaxis against thromboembolism. From the clinical records, demographic data, induction warfarin dosage, changes of dosages and related events on follow‐up, frequency of outpatient visits, complications and serial INR results were reviewed.Results:Thirty‐five patients (23 boys, 12 girls) were included with a mean age at initiation of warfarin therapy of 8.4±5.8 years. Amongst these, 66% (n=23) were after isolated valvar replacement, 28% (n=10) after Fontan operation with or without valvar replacement and 6% (n=2) after deep vein thrombosis. Regression estimate of the induction dose was 0.05–0.13 mg kg−1 in order to achieve the target INR range after 2 days of warfarin therapy. The daily maintenance warfarin dose was correlated with the bodyweight [dose (mg day−1)=0.04×bodyweight (kg)+0.87, r=0.63, P<0.0001]. Young children required significantly higher daily warfarin maintenance dose when adjusted for bodyweight [dose (mg kg day−1)=antilog10{−0.02×age (years)−0.80}, r=−0.74, P<0.0001]. The mean maintenance warfarin dosage was significantly lower in patients after the Fontan operation, with or without valvar replacement, in the absence of apparent liver dysfunction. The total period of follow‐up was 159 patient‐years. No serious bleeding complications or embolic phenomena were documented. One patient died of thrombosis of the mitral valve prosthesis. The overall incidence of thrombosis was 0.6 per 100 patient‐years.Conclusions:A low dose warfarin regimen to maintain a target INR of 1.5–2.5 provides adequate protection in Chinese children against thromboembolism whilst allowing safe outpatient monitoring of the anticoagulation status.
Incidence of invasive pneumococcal disease in Sydney children, 1991–96
Authors: Liddle JLM , Mcintyre PB , Davis CWC 
Published: March 2003

Objective: Few data are available on invasive disease due to Streptococcus pneumoniae in representative Australian childhood populations. This study aimed to determine the age‐specific incidence of invasive pneumococcal disease in Sydney children. Methodology: Population‐based prospective study where isolates of Streptococcus pneumoniae from normally sterile sites were identified through an established laboratory surveillance network. Isolates came from children aged under 15 years living within the boundaries of Central, Eastern, Southern, Western and South‐western Sydney Area Health Services from 1 July 1991 to 30 June 1996. Results: Invasive pneumococcal disease was identified in 320 children during a 5‐year period, of whom 193 (60%) were under 2 years of age. The incidence per 100 000 children was 12.7 per 100 000 (95% CI: 11.4–14.2/100 000) under 15 years; 31.7 (95% CI 28.1–35.7) under 5 years, and 45.5 (95% CI 38.9–53.3) under 2 years. The incidence of pneumococcal meningitis in children aged under 2 years was 10.5 per 100 000 (95% CI: 7.4–14.5/100 000). Conclusions: The incidence of childhood invasive pneumococcal disease in Sydney was stable during 1991–96 and comparable to rates reported from other industrialized countries. There was no evidence of any change in pneumococcal disease incidence with reduction in invasive Haemophilus influenzae type b (Hib) disease following introduction of Hib immunization.
A 12‐month profile of community paediatric consultations in the Barwon region
Authors: Hewson PH , Anderson PK , Dinning AH , Jenner BM , McKellar WJD , Weymouth RD , Gollan And Ra 
Published: March 2003

Objective: To determine the profile of all consultations carried out in paediatricians’ offices in the Barwon region over a 12‐month period. Methodology: The age, sex, category, diagnosis, and outcome of all non‐hospital‐based paediatric consultations carried out in the Barwon region were documented prospectively on a day by day basis. Relevant demographic data and information on Barwon children treated elsewhere were also collected. The frequency of different categories of illness, systems involved and groups of diagnoses was determined. Results: A total of 14 711 consultations was carried out in the region with 10% of the childhood population having contact with the paediatricians during the year; 3135 new patients or problems were seen with 34.8% of all consultations involving behavioural problems and 76% of these relating to ADHD. The most frequent medical diagnostic group was CNS/disability being 16% of all consultations. At least 50% of the medical consultations involved chronic illness. Conclusions: Behavioural difficulty, chronic disability, and learning problems represent a significant part of the workload of community‐based general paediatricians. Appropriate exposure during paediatric training should be given to these issues along with more sophisticated training in the medical, social and psychological complications of chronic illness and its effect on clients and families.
Low rates of hospitalization for asthma among Aboriginal children compared to non‐Aboriginal children of the Top End of the Northern Territory
Authors: Whybourne AM , Lesnikowski CL , Ruben AR , Walker AC 
Published: March 2003

Objective: To determine the hospitalization rates from asthma for Aboriginal and Torres Strait Islander (ATSI) and non‐Aboriginal (non‐ATSI) children in the ‘top end’ of the Northern Territory and to determine the proportion of hospitalizations due to asthma. Methodology: A retrospective review was undertaken of separation data from the Royal Darwin Hospital for the period July 1991 to June 1997. All children aged 1–9 years residing in the Darwin urban or rural district were included, with asthma identified by the International Classification of Diseases Version 9 codes 493.0–493.9. Results: The overall average annual hospitalization rate per 1000 population with a principal diagnosis of asthma for ATSI children from rural areas (ATSI‐rural) was 2.6, 4.7 for ATSI children from urban areas (ATSI‐urban) and 5.5 for non‐ATSI children. These hospitalization rates were significantly different between ATSI and non‐ATSI children (rate ratio 0.72, 95% CI 0.59–0.86). On stratification for residence, the rates were significantly different between ATSI‐rural and non‐ATSI children (rate ratio 0.61, 95% CI 0.47–0.80) but not different between rural and urban dwelling ATSI children (rate ratio 0.76, 95% CI 0.54–1.07) or between ATSI‐urban children and non‐ATSI children (rate ratio 0.81, 95% CI 0.63–1.03). Asthma was diagnosed in 6.5% of ATSI admissions (4.0% for ATSI‐rural and 13.8% for ATSI‐urban) and 12.7% of non‐ATSI admissions. Conclusions: The hospitalization rate for ATSI children with asthma was significantly lower than for non‐ATSI children. Asthma plays a far less significant role in the spectrum of disease affecting hospitalized ATSI children compared to non‐ATSI children. There are significant differences in disease frequency between urban and rural resident ATSI children but less marked differences between urban resident ATSI children and non‐ATSI children. Further study is required if the underlying causes behind these differences are to be determined.
Intellectual disability in Western Australia
Authors: Bower C , Leonard H , Petterson B 
Published: March 2003

Objective: To investigate the prevalence of intellectual disability in Western Australia (WA), its causes, prevention, and trends over time. Methodology: Data from an administrative database of intellectual disability in WA were used to report on the trends in intellectual disability in childhood. Results: The prevalence of intellectual disability was 8.3 per 1000 live births in 1980–90. For half the cases, there was no known cause for the intellectual disability. Down syndrome accounted for 14 to 15% of all cases. Since the introduction of newborn screening, no WA‐born child participating in the screening program has been diagnosed with intellectual disability as a result of either phenylketonuria or congenital hypothyroidism. The rate of autism spectrum disorders rose from three to six per 10 000 in the 1980–83 WA birth cohort to 10–13 per 10 000 for the 1989–92 cohort. Conclusions: Recent linkage of this administrative database to the WA Maternal and Child Health Research Data Base provides a unique opportunity for more detailed investigation of intellectual disability and its risk factors in a large, well‐ascertained population of children.
Epilepsy and associated psychopathology in young people with intellectual disability
Authors: LEWIS JN , TONGE BJ , MOWAT DR , EINFELD Sl , SIDDONS HM , REES VW 
Published: March 2003

Objective: This study aimed to investigate the role of epilepsy in psychopathology among an epidemiological sample of young people with intellectual disability (ID). The study also compared behavioural and emotional problems in young people on medication to control their epilepsy with those not on medication, and young people with epilepsy who were having current seizure activity with those with no current seizure activity. Methodology: An epidemiological cohort of 392 participants, representative of the general Australian population of young people with ID, were used in the study. One hundred and fifteen individuals from this cohort were identified as suffering from epilepsy. The Developmental Behaviour Checklist was used to measure symptoms of behavioural and emotional disturbance. Results: Results confirmed that young people with ID and epilepsy did not differ from controls without epilepsy on measures of psychopathology. Furthermore, those with epilepsy on medication had no difference in levels of problem behaviours than epileptics not on medication. Conclusions: The results suggest that epilepsy has little or no influence on problem behaviours for young people with ID. Our attempt to understand the pathogenesis of behaviour problems in persons with ID may be better directed towards understanding genetic mechanisms than epilepsy pathologies.