The comparative, long-term effect of the Salter osteotomy and Pemberton acetabuloplasty on pelvic height, scoliosis and functional outcome.

AIMS: This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. PATIENTS AND METHODS: We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. RESULTS: During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p < 0.001). The difference in the increase in pelvic height was insignificant at the most recent review (Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. CONCLUSION: In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145-50.

VEGF attenuated increase of outward delayed-rectifier potassium currents in hippocampal neurons induced by focal ischemia via PI3-K pathway.

We recently indicated that the vascular endothelial growth factor (VEGF) protects neurons against hypoxic death via enhancement of tyrosine phosphorylation of Kv1.2, an isoform of the delayed-rectifier potassium channels through activation of the phosphatidylinositol 3-kinase (PI3-K) signaling pathway. The present study investigated whether VEGF could attenuate ischemia-induced increase of the potassium currents in the hippocampal pyramidal neurons of rats after ischemic injury. Adult male Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (MCAO) to induce brain ischemia. The whole-cell patch-clamp technique was used to record the potassium currents of hippocampal neurons in brain slices from the ischemically injured brains of the rats 24h after MCAO. We detected that transient MCAO caused a significant increase of voltage-gated potassium currents (Kv) and outward delayed-rectifier potassium currents (IK), but not outward transient potassium currents (IA), in the ipsilateral hippocampus compared with the sham. Moreover, we found that VEGF could acutely, reversibly and voltage-dependently inhibit the ischemia-induced IK increase. This inhibitory effect of VEGF could be completely abolished by wortmannin, an inhibitor of PI3-K. Our data indicate that VEGF attenuates the ischemia-induced increase of IK via activation of the PI3-K signaling pathway.

5-HMF prevents against oxidative injury via APE/Ref-1.

Oxidative injury is involved in many diseases, including ischemic and neurodegenerative diseases. Antioxidant drugs can be used to relieve the oxidative injury caused by these diseases; however, there are very few antioxidant drugs available for clinical use. In this study, we found that 5-(hydroxymethyl)-2-furfural (5-HMF) protects against the oxidative damage induced by cerebral ischemia in rats or by hydrogen peroxide (H2O2) in PC12 cells. We demonstrated that 5-HMF performs this function via apurinic/apyrimidinic endonuclease/redox factor-1 (APE/Ref-1). APE/Ref-1 is a multifunctional protein involved in oxidative DNA damage repair through the base excision repair (BER) pathway and in the regulation of the DNA-binding activity of several transcription factors. The current study focused on the role of APE/Ref-1 in the antioxidative properties of 5-HMF. The results show that 5-HMF inhibited the reduction of APE/Ref-1 protein level caused by cerebral ischemia-reperfusion injury in rats or H2O2 treatment in PC12 cells. Treatment with an APE/Ref-1 inhibitor blocked 5-HMF-induced protection, suggesting that APE/Ref-1's DNA repair function contributes to antioxidation. In conclusion, this study suggests that APE/Ref-1 may be a potential target for antioxidant drugs.

Spring migratory birds (Aves) extend the northern occurrence of blacklegged tick (Acari:Ixodidae).

Birds that had migrated northward across Lake Superior were captured upon reaching landfall at Thunder Cape (48 degrees 18' N, 88 degrees 56' W) at the southwestern tip of the Sibley Peninsula, northwestern Ontario, from 9 May to 9 June 1995. Twenty-one of 530 birds examined (6 of 55 species) had a total of 34 ticks; 1 blue jay, Cyanocitta cristata, had a northern fowl mite, Ornithonyssus sylviarum (Canestrini & Fanzago). Four blacklegged tick, Ixodes scapularis Say, larvae were found on an American robin, Turdus migratorius, and 2 on a chipping sparrow, Spizella passerina. This tick was not found on small mammals at Thunder Cape. Twenty-six larvae and a nymph of the rabbit tick, Haemaphysalis leporispalustris (Packard) were found on 1 American robin, 2 Swainson's thrushes, Catharus ustulatus, 1 white-throated sparrow, Zonotrichia albicollis, 1 common yellowthroat, Geothlypis trichas, 1 blue jay, and 12 chipping sparrows. A nymph of H. chordeilis (Packard) occurred on 1 chipping sparrow. Results demonstrate that northward migrating birds transport larvae of I. scapularis to areas of Ontario where the tick does not appear to have become established in small mammal populations. Spring migrants may be more involved in the dispersal of I. scapularis larvae than previously thought. Cooler temperatures and shorter seasons experienced in the more northerly, continental parts of the established distribution of this tick may extend the life cycle, resulting in a predominance of larvae rather than nymphs being acquired by northward-bound birds in early spring. Consequently, the role of spring migrating birds in the northward spread of I. scapularis and of borreliosis should be reevaluated.

The development of ABO isohemagglutinins in Taiwanese.

To evaluate the developmental pattern of ABO isohemagglutinins in Taiwanese, 644 blood samples (349 males, 295 females), including cord blood, were collected from individuals with ages ranging from newborn to 83 years. Synthesis of anti-A and anti-B could be demonstrated in most Taiwanese infants by 2-4 months of age, increasing progressively to reach adult levels (titers of 1:32-1:256) at around 1 year of age. Peak levels were reached at between 3-10 years of age and then declined with advancing years, with individuals of 80 years of age and over showing reduced levels similar to those seen in 6- to 12-month-old infants. Sex and parity did not appear to influence ABO isohemagglutinin development.

Breast-feeding counseling by a 24-hour telephone hot-line.

A 24-hour telephone hot-line functioning as a counseling service and case registry was included in a multi-faceted breast-feeding promotion program. The mothers could speak directly to especially trained staff members in a municipal hospital. All the questions were answered according to an "Answering Book" which included the anticipated question and the optimum answer. A total of 201 calls, which included 340 problems, were recorded from January 1, 1993 to October 31, 1993. Almost all the calls were made by the mothers (99%), and more than half (57.7%) of the mothers were primiparous. Most of the calls (79.6%) were made between 8 AM to 4 PM. The questions were frequently raised when the baby was aged 8 to 14 days (23.4%). The most frequently asked questions were: (1) insufficient milk? (14.1%), (2) frequent and loose stools? (13.2%), (3) weaning? (10.3%), (4) drugs? (6.8%), (5) additional formula or water? (6.2%), and (6) maternal contraindication? (6.2%). Although the impact of this telephone consultation could not be properly evaluated, the incidence of breast-feeding during hospital stay increased from 50% to 73.4%, and breast-feeding for more than 1 month increased from 22.7% to 42.2% before and after the whole promotion program. It is recommended that health care professionals provide more help when the mother leaves the hospital. A nation-wide toll-free telephone operated by the Department of Health to increase the chance of successful breast-feeding is also recommended.

[Family environment of children with simple obesity].

Fifty obese children aged from 6 to 15 years and 50 non-obese controls paired on the basis of age and sex were evaluated by anthropometric measurements and a parents' questionnaire. Birth weight was comparable in obese and non-obese children. The majority (78%) of the cases in the study group were becoming obese during the age among 2 and 12 years. It was found that obese children were about five times as likely to have an obese parent as controls: 44% of the obese children had obese fathers and 12% had obese mothers. There also a significant difference in the chance of having an obese sibling between the obese and control groups. However, the difference of socioeconomic status between the two groups did not reach level of significance. The results indicated that there are likely to be more obese family members at home for every obese case identified in a weight control clinic. Identification, prevention, and control of childhood obesity in at-risk families are an important pediatric issue. Further research efforts are needed to unravel the multiple factors associated with childhood obesity.

Povidone-iodine in umbilical cord care interferes with neonatal screening for hypothyroidism.

Out of 1346 newborns screened for congenital hypothyroidism, 31 non-hypothyroid infants were summoned because of a thyroid stimulating hormone (TSH) level above 10 microU/ml. False-positive TSH levels were significantly more frequent in the babies treated with povidone-iodine (4.6%) than in those treated with either alcohol or triple dye (0.7%). CONCLUSION. Iodine containing solutions should be avoided in umbilical cord care of the newborn.

Effects of nebulized terbutaline on oxygen saturation in acute asthmatic children.

To evaluate the paradoxical effect of oxygen desaturation following beta-2 bronchodilator nebulization treatment in acute asthmatic children, a total of 47 patients, aged between 1.8 and 14 years, 27 males and 20 females, were studied. Twenty ml of nebulized normal saline (NS), followed by 10 mg (4 ml) of terbutaline sulphate solution (TSS) in 20 ml NS, were delivered by an ultrasonic nebulizer in 10 min to each patient through a connecting air tube placed in front of the nose and mouth. Oxygen saturation (SaO2) and pulse rate were monitored, using a pulse oximeter, before study and every two minutes until the end of the study. The clinical severity score and peak expiratory flow rate (PEFR) were checked before the study, at the end of inhalation of NS, and at the end of inhalation of TSS. SaO2 was increased both after nebulized NS and TSS when compared with the pre-study data (p < 0.05 and p < 0.0001, respectively). Twenty two cases (47%) during NS and 12 cases (25%) during TSS nebulization had SaO2 below the pre-study level. The mean decrease of SaO2 for the former was 1.62 +/- 0.95% (range: 1.00% to 4.26%), and 1.64 +/- 0.83% (range: 1.02% to 3.13%) for the latter (p > 0.9). No SaO2 decrease after nebulized TSS was observed in any of the seven severe asthmatic children with a prestudy SaO2 < or = 90%. The clinical severity score and PEFR were also significantly improved both after nebulized NS and TSS (p < 0.0001 and p < 0.001, respectively for NS, and both p < 0.0001 for TSS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory failure after nebulized terbutaline treatment in severely wheezy infants: report of three cases].

Subjective clinical observations have suggested that nebulized bronchodilators are helpful in the treatment of some wheezy infants. Although the role of beta 2-agonists in the management of acute asthma in infants and very young children remains controversial, the use of beta 2-adrenergic agents in this age group has been widespread. beta 2-agonists nebulization continues to be the first-line treatment for acute attack of asthma, irrespective of age, in some institutes, but their uses are not without side effect especially in young wheezy infants. We report three cases of respiratory failure occurred after treatment with nebulized beta 2 bronchodilator in infants with chronic lung disease and acute wheezing. All the 3 cases were victims of prematurity. Case 1 was a case of Wilson-Mikity syndrome; case 2 was a case of bronchopulmonary dysplasia; and case 3 was a case of repeatedly wheezing infant. All 3 cases had severely wheezy dyspnea with retraction before nebulized beta 2 bronchodilator treatment. Respiratory failure was found 5 to 10 minutes after the treatment. We suggest that it must be very careful in the treatment of severely wheezy infants with beta 2-agonist nebulization, especially in cases with histories of prematurity and chronic lung disease. It is necessary to carefully monitor the vital signs of the infants during beta 2 agonist nebulization.

[Parent-directed weight reduction program for obese children: model formulation and follow-up].

To investigate the effect of a parent-directed weight reduction program on childhood obesity, a prospective 12-month follow-up study was performed at an outpatient clinic in a district general hospital. Sixty obese children, who, together with their parents received a free of charge weight reduction program, were compared with 52 obese controls who refused the program. The program included knowledge of childhood obesity and ways to decrease calories and increase physical activity; emphasized family participation and behavior modification; and stressed parent direction and self-responsibility. Complete outcome information relating to weight and height changes and a compliance questionnaire was available for 70.5% of these children after 1 year. Twenty three (48.9%) of the 47 children in the treatment group showed a decrease in the percentage they were overweight, compared to only six (18.8%) of the 32 control children. The mean changes in percentage overweight showed a decrease of 2.3% for the treatment children and an increase of 3.1% for the control children. Of the 23 children who were more successful during therapy, two had normal weight, 5 were overweight and 16 remained obese. Child height was not changed after weight reduction in those children in the treatment group who were more successful. The degree of compliance was significantly correlated to the change in percentage overweight. A decrease in percentage overweight was not significantly predicted by sex, age, or severity of obesity of the children, nor by whether the children were excessive eaters or partook in insufficient physical activity prior to the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Weight-for-length index in evaluation of children's body weight status: a simple and accurate method].

This study examines the weight-for-length index (WLI)--weight/height/the WLI constant, where the WLI constant is the ratio between the 50th percentile weight and height for the age and sex--for its appropriateness in estimating the status of body weight among school children. The WLI constant has been calculated for practical use and rapid calculation. Using the known percentile data in the Taiwan area, this report shows evidence that the WLI constant has changed a little during the past 30 years. On theoretical grounds, it seems that the WLI is a valid index because it is independent of the progressing physical growth of children it Taiwan. Data were obtained for a sample of 5,214 healthy boys and 5,607 healthy girls ages 5 to 14, attending schools in Taipei, Taiwan. The WLI was found to be a satisfactory measure of relative weight as has been generally found for the body mass index (weight/height2) because it has little correlation with age (r = 0.07) and only a fair correlation with height (r = 0.26) for the whole sample of children. In an attempt to offer support for the findings, the relationship between WLI and the overweight index (actual weight/average weight for sex, age and height) were evaluated. The correlations between the WLI and the overweight index were excellent for each sex grouping (r = 0.91 for boys and 0.89 for girls). The results also suggest that the WLI appears to be a very accurate measure of obesity (sensitivity: 88.3-92.1%, specificity: 86.9-89.9%) for all the school children in this sample.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trial of corticosteroid and beta-2 bronchodilator in acute wheezing infants.

To evaluate the effect of a combination of corticosteroid and beta-2 bronchodilator on acute, young, wheezing patients, a total of 80 patients, ages below 36 months who were hospitalized for this condition during the period November 1988 to March 1990 were studied. They were divided into three groups. Group A consisted of 29 cases, under 12 months old, and treated with hydrocortisone and procaterol; Group B included 23 cases, between 12 and 36 months old, treated as in Group A; Group C, of 28 cases younger than 12 months, received neither drug. The clinical severity scores for Group B were significantly more improved than Group A on days 4 and 5 (p less than 0.05 and p less than 0.05, respectively), and better than that of Group C on days 3, 4, and 5 (p less than 0.05, 0.005, and 0.05, respectively). No significant difference was found between Group A and C from days 1 to 5. The previous wheezy coughing episodes were significantly more frequent in Group B than in Groups A and C (p less than 0.05). Two-thirds of the quick responders to hydrocortisone and procaterol were 12 months old or older. The personal and family allergic history, serum IgE level, and total eosinophil count could not be used as parameter to predict responsiveness to the combined therapy of hydrocortisone and procaterol.

[Dandy-Walker complex with multiple anomalies: report of one case].

A 3570 gram male newborn was born to a 29-year-old mother at the gestational age of 40 weeks with gross abnormalities of flexion contracture of third and fifth fingers and fourth toes bilaterally. After birth, cyanotic spell while feeding was found, and a series of examinations were done. The abnormalities were focused on brain echogram, computed tomogram and magnetic resonance imaging examination, which showed a large posterior fossa cyst, cerebellar hypoplasia complicated with multiple severe supratentorial anomalies, including marked ventricular dilatation, cerebral agyria, agenesis of corpus callosum, absence of thalamus and basal ganglion, and optic nerve atrophy. Clinically, the patient had neonatal seizure and high fever. The diagnosis of Dandy-Walker complex type A was made according to the new classification presented by Barkovick et al. in 1989.

[Artificial feeding practice in nursery: a new policy and maternal response].

While a single-bottle method is what mothers actually do in preparation of infant formula in their own home, in the hospital, each nursery makes its own rules about preparing formula. Early in 1988 a "self-service", artificial feeding practice was initiated in this 600-bed general hospital. Mothers who intended to bottle-feed were asked to purchase the powdered formula at their own expense. At feeding time, mothers prepare one bottle of formula at a time, and feed the infant immediately. Each mother's technique of formula preparation was observed by the nurses, and practical instructions were given if needed. Particular errors and hazards in the reconstitution of formula were emphasized with posters hung on the nursery wall and by the pamphlets distributed to the mothers. These practices avoid distribution of formula samples at the hospital, and provide repeated practice for mothers during their hospitalization. To explore the attitudes of mothers toward this new feeding practice, a questionnaire survey of 483 consecutive mothers who gave birth to healthy newborns was carried out. While 61.3% of the mothers thought that it was acceptable to purchase infant formula themselves, 85.1% thought preparing the formula themselves in hospital was acceptable. Furthermore, only 1.2% of the mothers said that this new practice was a great deal of trouble. Most mothers said that on-the-spot teaching by nurses was very helpful. Regarding overall attitudes, 5.4% and 2.1%, respectively, will not or may not return for the next delivery. After controlling for several socio-educational variables, only previous experience with bottle-feeding was associated with pro-and-con responses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Amniotic band disruption complex: report of one case in twins].

Amniotic band disruption complex is a congenital disorder with the principal features vary from simple digital band constrictions to major craniofacial and visceral defects. Early amniotic rupture results in multiply affected infants who are frequently aborted or stillborn, whereas later rupture results primarily in limb involvement. Here we report a case of amniotic band disruption complex, a male infant (twin A) weighing 2350 gm with Apgar scores of 9 and 10 at one and five minutes. The second, third and fourth fingers on the left hand appeared to have ring constrictions, the distal part of the fourth finger had been amputated distally. There were amputations and ring constrictions of the distal parts of the second, third and fifth digits on the right hand, the fourth finger had only proximal third. All of the toes on the left foot had been amputated distally. The fifth toe on the right foot were absent, and the others had been partly amputated. Left cleft lip and palate were present with sunken left nasal flare. This baby underwent the cranial ultrasound examination, which demonstrated on structural anomalies, and both of the twins had the karyotype of 46XY. No other abnormalities was noted in the infant. The 890 gm placenta was delivered spontaneously. Two umbilical cords were present, each with normal vessels. The examination of the placenta revealed it to be dichorionic and diamniotic, and numerous fibrous strings extending form the fetal surface.

[Nebulizing terbutaline therapy in children with acute asthma].

To evaluate the therapeutic effect of nebulized terbutaline in children with acute asthma, 21 children, aged 1 year and 7 months to 10 years, with acute asthma, were enrolled into this study, during the period from July to December 1989. Each patient received nebulized terbutaline (Bricanyl) 5 mg/dose over 10 minutes. The respiratory rate, pulse rate, blood pressure, peak expiratory flow rate and clinical severity score were recorded before, and at 10 minutes after treatment. Comparing with the data before treatment, respiratory rate, peak expiratory flow rate and clinical severity score at 10 minutes after treatment showed significant improvement (p value less than 0.05; less than 0.0005; less than 0.0001, respectively), but pulse rate and blood pressure did not differ significantly. It was concluded that administration of nebulized terbutaline, at a dose of 5 mg, was both safe and effective in treating acute asthma, and may be used as the first line measure in treating acute asthma in children.

[Hemolytic disease of the newborn caused by maternal irregular antibody anti-E: report of one case].

A 3390 gm male baby was born smoothly at 41 weeks' gestation to a 35-year-old, gravida 3, para 3, mother by spontaneous vaginal delivery at this hospital. The mother denied ever having received a blood transfusion. Her first two uneventful pregnancies had resulted in two healthy fullterm infants. Physical examination of the baby showed normal, until 15 hours of age, when apparent jaundice with serum total bilirubin concentration up to 21 mg/dl was noted. The blood types of both baby and mother were group A, Rh(D) positive. Compatibility testing for exchange blood transfusion with group A whole blood showed positive reaction due to the presence of an irregular antibody. Two exchange blood transfusions were performed in the same day with compatible blood. Thereafter, the patient's condition was much improved, he was discharged one week later. The irregular antibody--anti-E was identified in both baby and mother. The maternal RBC phenotyping was CCDee (R1R1), and the baby, CcDEe (R1R2).