Autoantibodies in mothers of children with neonatal liver disease.

Objectives: Neonatal lupus erythematosus (NLE) is associated with maternal anti-Ro/La autoantibodies. It is characterized by heart block and/or cutaneous skin lesions, and occasionally liver disease. This study was performed to determine whether idiopathic neonatal cholestasis (INC) represents NLE without its cardiac or cutaneous findings.

Changes in macromolecular allocation in nondividing algal symbionts allow for photosynthetic acclimation in the lichen Lobaria pulmonaria.

•   The lichen Lobaria pulmonaria survives large seasonal environmental changes through physiological acclimation to ambient conditions. •   We quantitated algal cell population, cell division and key macromolecular levels associated with photosynthesis and nitrogen metabolism in L. pulmonaria sampled from four seasons with contrasting environmental conditions in a deciduous forest.

Insulin lispro therapy in pregnancies complicated by type 1 diabetes: glycemic control and maternal and fetal outcomes.

Objective: To evaluate glycemic control and maternal and fetal outcomes of patients with type 1 diabetes treated with insulin lispro before and during pregnancy.

Methods: We undertook a retrospective review of medical records of 62 women with type 1 diabetes who were treated with insulin lispro before and during pregnancy in an outpatient center specializing in the care of patients with diabetes. Outcome measures included maternal glycemic control, hypoglycemic episodes, microvascular complications, duration of gestation, fetal birth weight, and major congenital malformations.

Outcomes associated with pediatric after-hours care by call centers: a multicenter study.

Objectives: To assess 1) parental opinion regarding appropriateness of triage, 2) utilization outcomes, and 3) the frequency of underreferral with subsequent hospitalization for children triaged by nurses at pediatric call centers.

Design/methods: From August 19 to October 1999, after-hours calls were randomly sampled from computerized records at 4 call centers at children's hospitals. Telephone surveys were conducted 3 to 7 days after the index calls.

Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic.

Objective: To decrease unnecessary antibiotic use for acute respiratory tract infections in adults in a point-of-service health care setting.

Design: Prospective, nonrandomized controlled trial.

Setting: An urban urgent care clinic associated with the major indigent care hospital in Denver, Colorado between October 2000 and April 2001.

The effectiveness of scalp cooling in preventing alopecia for patients receiving epirubicin and docetaxel.

The aim of this study was to establish the effectiveness of scalp cooling in preventing alopecia for patients with breast cancer who received the trial combination chemotherapy of Epirubicin and Docetaxel. Doubt remains about the general effectiveness of scalp cooling in preventing hair loss for patients receiving chemotherapy. There is very little information available about its specific effectiveness with combinations of Taxanes and Anthracycline drugs.

Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing.

Objective: The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result.

Methods: Two swabs were collected from children who were suspected of having S pyogenes pharyngitis.

Mechanical limitation of pulmonary blood flow facilitates heart transplantation in older infants with hypoplastic left heart syndrome.

Objectives: Progression of pulmonary vascular disease limits heart transplantation for hypoplastic left heart syndrome (HLHS) to early infancy. Our objective was to assess the impact of bilateral pulmonary artery banding (PAB) on the operative courses of HLHS infants transplanted at ages older than 4 months.

Methods: Courses of all HLHS patients in our center who remained listed to age >or=120 days before heart transplantation were assessed.

Lack of improvement in the treatment of hyperlipidemia among patients with type 2 diabetes.

Purpose: We investigated the adequacy of treatment of hyperlipidemia in patients with type 2 diabetes, and assessed the temporal trends in adherence to published guidelines.

Methods: We performed a post hoc analysis of 501 patients enrolled in the Appropriate Blood Pressure Control in Diabetes trial. All patients had fasting lipid profiles at baseline and during the 5 years (1993 to 1998) of the trial.

Risk factors for initial acquisition of Pseudomonas aeruginosa in children with cystic fibrosis identified by newborn screening.

The objective of this study was to identify risk factors for initial detection of Pseudomonas aeruginosa (P. aeruginosa) in children with cystic fibrosis (CF) identified by newborn screening. Life history data on 180 patients, collected prospectively in a follow-up study of infants and children diagnosed with CF, were examined for factors associated with the initial detection of P.

Variation in mortality risk factors with time after coronary artery bypass graft operation.

Background: Differences in mortality risk factor sets during different time periods (eg, short-term versus intermediate-term) after coronary artery bypass grafting have been reported. However, little is known about the time-varying effects of mortality risk factors after the operation.

Methods: We analyzed 11,815 veterans who had coronary artery bypass grafting at any of the 43 Veterans Affairs cardiac surgery centers from October 1997 to September 1999.

Comparison of two rapid Streptococcus pyogenes diagnostic tests with a rigorous culture standard.

Background: Comparisons of rapid antigen tests for the diagnosis of pharyngitis are often made between published studies but may not be reliable given differences in study design, sampling and reference standard definitions. Tests are rarely compared against each other in a single study.

Methods: The sensitivity and specificity of two rapid diagnostic tests were compared against a multiplate culture standard defined as the identification of on any of four culture plates.

Efficient transduction of liver and muscle after in utero injection of lentiviral vectors with different pseudotypes.

In this study we investigate the efficacy of lentiviral vectors of different pseudotypes for gene transfer to tissues of the preimmune fetus. BALB/c fetuses at 14-15 days' gestation received lentiviral vectors carrying the transgene lacZ under the control of the human cytomegalovirus (CMV) promoter by intramuscular (i.m.

Surgical options and results of repeated aortic root replacement for failed aortic allografts placed in childhood.

Objectives: This report reviews our experience with repeated aortic root replacement after failure of cryopreserved aortic allografts placed during childhood and compares replacement with aortic allografts, pulmonary autografts, and mechanical valved conduits in these patients.

Methods: This was a retrospective analysis of all such patients from 1986 through May 2001.

Results: There were 25 operations (11 aortic allografts, 9 pulmonary autografts, and 5 mechanical valved conduits) among 23 patients.

The ex-utero intrapartum treatment.

Advances in prenatal diagnosis, combined with a better understanding of the natural history of prenatally diagnosed anomalies, are providing increasing opportunities to consider fetal intervention in selected cases of life-threatening malformations. Accurate prenatal diagnosis can now accurately identify fetal pathophysiology that poses an immediate threat to the life of the newborn infant on separation from the placental circulation. In this circumstance, the ex-utero intrapartum treatment (EXIT) procedure, which maintains intrapartum uteroplacental support, can be life saving.

Engraftment of bone marrow and fetal liver cells after in utero transplantation in MDX mice.

Background/purpose: In utero hematopoietic stem cell transplantation (IUHSCTx) has been experimentally or clinically effective only in circumstances in which there is a survival advantage for donor cells. A survival advantage exists for normal muscle cells in muscular dystrophy. Because hematopoietic and mesenchymal stem cells may have the capacity to differentiate into muscle cells, the authors hypothesized that in utero bone marrow (BM) or fetal liver (FL) stem cell transplantation may be used to treat muscular dystrophy.

Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.

The accepted mode of pain management after total hip or knee arthroplasty is patient-controlled analgesia. This study evaluates the efficacy of lumbar paravertebral nerve block in diminishing postoperative pain when used as an adjunct to patient-controlled analgesia. A total of 115 arthroplasty patients received postoperatively a lumbar paravertebral nerve block (block, n = 57) or a sham procedure (control, n = 58).

Human mesenchymal stem cells: insights from a surrogate in vivo assay system.

Mesenchymal stem cells (MSC) are multipotent cells that have been isolated from the bone marrow of multiple species that can be induced to differentiate into at least bone, cartilage, and adipose tissue in vitro. Using a model of in utero cellular transplantation in which human MSC are transplanted into fetal lambs, we have shown that MSC can engraft in multiple tissues and persist for over one year. Furthermore, these cells can differentiate into cardiac and skeletal myocytes, bone marrow stromal cells, adipocytes, thymic epithelial cells, and chondrocytes.

Predictors of acute complications in children with type 1 diabetes.

Context: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors.

Objective: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications.

Multilineage differentiation of human MSC after in utero transplantation.

Prenatal transplantation of stem cells is an exciting frontier for the treatment of many congenital diseases. The fetus may be an ideal recipient for stem cells, as it is immunologically immature and has rapidly proliferating cellular compartments that may support the engraftment of transplanted cells. Mesenchymal stem cells (MSC), given their ability to differentiate among multiple lineages, could potentially be used to treat diseases such as osteogenesis imperfecta, muscular dystrophy, and a variety of others that can be diagnosed in utero.

Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with type 1 diabetes.

Aims: To determine if one method of short-acting insulin bolus administration is superior to other methods in managing a meal high in carbohydrates, calories and fat.

Methods: Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog) agreed to consume the same meal high in carbohydrates, calories and fat on four occasions 1 week apart. They received the same dose of bolus insulin on each of the four occasions randomly assigned and beginning 10 min prior to the meal as either a single bolus, two separate boluses of one-half the same total dose (the second after 90 min), the entire bolus given as a square-wave (over 2 h) or a dual-wave (70% as a bolus and 30% as a square-wave over 2 h).

The natural history of prenatally diagnosed conjoined twins.

Background/purpose: Accurate prenatal diagnosis of complex anatomic connections and associated anomalies has only been possible recently with the use of ultrasonography, echocardiography, and fetal magnetic resonance imaging (MRI). To assess the impact of improved antenatal diagnosis in the management and outcome of conjoined twins, the authors reviewed their experience with 14 cases.

Methods: A retrospective review of prenatally diagnosed conjoined twins referred to our institution from 1996 to present was conducted.

Risk factors for intermediate-term survival after coronary artery bypass grafting.

Background: Risk factors for short-term mortality after coronary artery bypass grafting are well established, but little is known about risk factors for intermediate-term mortality.

Methods: We analyzed the outcomes of 11,815 patients undergoing coronary artery bypass grafting in one of the 43 cardiac surgery programs of the Department of Veteran Affairs. Risk factors for intermediate- and short-term mortality were determined using Cox proportional hazards regression models.

Seasonal changes in temperature and light drive acclimation of photosynthetic physiology and macromolecular content in Lobaria pulmonaria.

Lobaria pulmonaria (L.) Hoffm. is an epiphytic lichen common to temperate deciduous forests where it copes with large changes in temperature and light levels through repeated annual cycles.

Comparison of measured astigmatic retinoscopies from different lid specula.

Purpose: We wanted to study the effects of different lid specula on retinoscopy readings in the pediatric population.

Methods: We prospectively enrolled 29 patients from the Eye Clinic at The Children's Hospital of Denver who were being examined under anesthesia and met the inclusion criteria for the study. Any patient with ocular pathology that could affect the pliability of the sclera of both eyes was excluded.