Readmissions of children with diabetes mellitus to a children's hospital.

The characteristics of children with diabetes readmitted to Children's Hospital during a 5-year period, 1984 to 1989, were compared with those characteristics of new-onset patients admitted for stabilization and education and to outpatients in the Children's Hospital diabetes program to determine which characteristics were associated with patients who were readmitted. Changes in the frequency of readmissions were examined to determine whether the introduction of a diabetes team and a program that emphasizes the importance of ensuring that patients at risk of readmission consistently received insulin injections resulted in a reduction of readmissions. Readmissions occurred more frequently in patients who were black (71% compared with 38% of new-onset patients and 31% of outpatients) (P less than .001), from one-parent homes (56% compared with 27% of new-onset patients and 24% of outpatients) (P less than .001), and without third-party insurance (45% compared with 18% of new-onset patients and 15% of outpatients) (P less than .001). Readmissions were very common at 14 to 15 years of age (39% of readmissions vs 18% of outpatients) and very uncommon in children younger than age 9 (6% of readmissions vs 27% of outpatients) (P less than .001). Fewer readmissions for ketoacidosis occurred in the summer than in any other season (P less than .05). Readmissions fell by 47% over the 5-year period while new-onset patients increased by 85%. The reduction in frequency of readmissions was due to fewer readmissions for ketoacidosis and fewer readmissions in blacks, in patients from one-parent homes, and in patients without third-party insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of bcl-2 gene expression in lymphoid cell lines containing normal #18 or t(14;18) chromosomes.

The bcl-2 (B cell lymphoma/leukemia-2) gene at band 18q21 is involved in t(14;18) chromosomal translocations in most follicular lymphomas and occasional other human B cell malignancies, where it becomes juxtaposed to the transcriptionally active immunoglobulin (Ig) locus at 14q32. Regulation of bcl-2 gene expression was investigated in neoplastic lymphoid cell lines containing normal #18 chromosomes or a t(14;18) translocation with regard to steady-state mRNA levels, RNA stability, transcription rates, and DNA methylation. High steady-state levels of bcl-2 mRNA, and proportionally high rates of bcl-2 transcription (measured in isolated nuclei), were found in B cell lines containing t(14;18) translocations. The half-life of bcl-2 mRNA (approximately 2-3 hr) was similar in all cell lines examined, including a t(14;18)-containing follicular lymphoma cell line, which has a translocated and rearranged bcl-2 gene that produces bcl-2/Ig fusion transcripts. However, in the presence of cycloheximide (inhibitor of protein synthesis), the half-life of some of the bcl-2/Ig mRNAs produced by these cells was prolonged, indicating that in some circumstances mRNA stability may contribute to deregulated bcl-2 expression. Despite stabilizing some bcl-2 mRNAs, the overall effect of treating cell lines with cycloheximide was a reduction in the levels of accumulated bcl-2 mRNAs through inhibition of bcl-2 gene transcription. These latter data provide indirect evidence that short-lived transacting factor(s) regulate transcription of the human bcl-2 gene in lymphoid cells with or without a t(14;18) translocation. No clear correlation was discovered between bcl-2 gene methylation and transcription.