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Infant sleep: resident recommendations and socioeconomic status differences in patient practices.

BACKGROUND: Although much research has focused on parental report of infant sleep position since the 1992 American Academy of Pediatrics (AAP) recommendation for non-prone placement, few studies have examined physician recommendations regarding infant sleep. This study examined differences between resident recommendations for infant sleep position and cosleeping (bed sharing) and parental report of practice. We also assessed socioeconomic differences in parent practice, awareness, and acceptability of AAP guidelines. METHODS: We conducted a telephone survey of parents of 2-, 4-, 8-, and 12-month-old infants from two family practice centers. All 27 residents at both centers completed a paper and pencil survey. RESULTS: Resident recommendations and parental practices differed significantly for both sleep positioning and cosleeping. Parents of 165 infants participated, revealing that higher socioeconomic families were more aware of compliant with, and more accepting of AAP recommendations for supine positioning. CONCLUSIONS: Parents consistently report that their physician or nurse is the primary source of information for infant sleep. Results of this study, however, indicate significant differences between physician recommendation and parental practice and acceptability of AAP guidelines. Physicians need to continue to discuss this information past the newborn period.

Child Rearing↗

[Aminopeptidases in the serum following myocardial infarct].

In 19 patients wiht myocardial infarction during 7 weeks after the onset of the infarction the serum activities of the leucine aminopeptidase (LAP) and of the alanine aminopeptidase (AAP) were determined. Here an increase of the LAP-values with a maximum in the 1st week was found. Apparantly a hypoxic lesion of the hepatocytes is to be regarded as cause for this. In patients with shock symptomatology as well as with heart decompensation the AAP-activities were on the average higher than in the cases with myocardial infarction without these alterations during the whole period of observation. In all myocardial infarctions the AAP-zymograms showed an additional anodic AAP-fraction as it was observed in previous investigations in cholestasis.

Aminopeptidases↗

Conclusion: The Equity Project.

As a result of the work completed during the meeting and summarized at the last session, 4 implementation groups have been established as the organizational framework for the American Academy of Pediatrics (AAP)-Royal College of Paediatrics and Child Health (RCPCH) Equity Project. This project will be the mechanism by which the RCPCH and the AAP will continue the endeavor that was initiated at this meeting. The Equity Project Implementation Groups will focus on Education and Training, Practice and Advocacy, Research and Public Policy, and Children's Rights. The goals and objectives of each group reflect the accomplishments of the conference participants. A call will go out to members of the AAP and the RCPCH to join these groups as the core of the operation of the project. Objectives will be prioritized and joint initiatives developed to focus on these priorities. The project thus will evolve as a broad-based effort to engage as many members of the AAP and the RCPCH as possible in project endeavors.

Child↗

[Protective action of seed oil of Hippophae rhamnoides L. (HR) against experimental liver injury in mice].

Protection by seed oil of HR against hepatic injury induced by CCl4, ethyl alcohol and acetaminophen (AAP) on mice was studied in this paper. It was found that seed oil of HR markedly inhibited MDA formation of liver induced by CCl4, AAP and ethyl alcohol, seed oil 4.75 g/kg could lower SGPT levels induced by CCl4 and AAP. It blocked also depletion of GSH damaged liver induced by AAP. The mechanism of heptoprotective actions of HR seed oil might be related to anti-lipid peroxidation.

Acetaminophen↗

[Clinical observation on effect of auricular acupoint pressing in treating sleep apnea syndrome].

OBJECTIVE: To study the clinical effect and mechanism of auricular acupoint pressing (AAP) in treating sleep apnea syndrome (SAS). METHODS: Forty-five patients with SAS were randomly divided in to the AAP group (30 patients) and the control group (15 patients) to observe the changes of clinical symptoms, apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and minimum blood oxygen saturation (mSaO2) in night before and after treatment by multiple channel polysomnography (PSG). RESULTS: Clinical symptoms were significantly alleviated in the AAP group after treatment, with improvement in various parameters monitored by PSG (P < 0.01), showing significantly reduced AHI, AI and HI and increased mSaO2 (P < 0.01). While in the control group, no improvement was found either in clinical symptom or in PSG parameters (P > 0.05). Comparison between the two groups showed significant difference (P < 0.01). CONCLUSION: AAP is an effective treatment of SAS, it provides a facilitate, economic and safe therapy for early prevention and treatment to SAS.

Acupressure↗

Qualitative and quantitative analysis of the effects of acetaminophen and N-acetylcysteine on the surface morphology of Hep3B hepatoma cells in vitro.

Acetaminophen (AAP) is harmful to the liver if consumed in excessive doses. Its toxicity can be counteracted by N-acetylcysteine (NAC). The authors studied cultures of Hep3B cells exposed to AAP or NAC or both, at 24 and 48 h, using the scanning electron microscope. Using morphometric software, they found that cultures exposed for 24 h to AAP or AAP + NAC suffered reduction in cell confluence. Exposure increased the incidence of rounding cells and of apoptotic and autoschizic appearances. Differences between control cultures cultivated without serum versus those exposed to xenobiotics were merely quantitative, not essential.

Acetaminophen↗

[Protective effects of shark hepatic stimulator substance against acute hepatic injury induced by acetaminophen in mice].

AIM: To investigate the protective effects of shark hepatic stimulator substance (sHSS) against acute hepatic injury induced by acetaminophen (AAP) in mice. METHODS: Acute hepatic injury model of Balb/c mice was induced by a single intraperitoneal injection of AAP (200 mg.kg-1, i.p.). Serum ALT and AST activities were analyzed. The changes of microstructure and ultrastructure of hepatocyte were observed under optical and electronic microscope. The hepatocyte apoptosis was analyzed by flow cytometer and the expression level of Fas mRNA was determined by RT-PCR. RESULTS: The activities of serum ALT and AST were significantly decreased and both necrosis and inflammatory infiltration were improved in the mice treated with sHSS 3.0 and 1.5 mg.kg-1. sHSS (3.0 mg.kg-1) prevented the ultrastructural changes of hepatocytes caused by AAP, decreased the percentage of apoptotic cells, and downregulated the expression level of Fas mRNA. CONCLUSION: sHSS protected hepatocytes from AAP-induced injury, which might be associated with its protection of the mitochondria and inhibition of apoptosis and expression of Fas mRNA in hepatocytes.

Acetaminophen↗

American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation.

The American Academy of Pediatrics (AAP) established diagnosis and treatment guidelines for pediculosis in 2002. Ideally, diagnosis should be based on the observation of a live louse. The presence of nits is also used by many people to positively diagnose an infestation, although a nit located farther from the scalp than 1 cm is unlikely to be viable. Other material on the scalp may be mistaken for nits, leading to misdiagnosis. Because lice are not associated with serious medical problems, the primary consideration of the AAP regarding treatment is the safety of pediculicides and other products used to treat head lice. From a pediatrician's perspective, no significant risk is acceptable. Over-the-counter (OTC) pyrethroid products (pyrethrin and permethrin) are commonly used by parents to treat their children and are generally considered safe for most people. Pyrethroids are not completely ovicidal, however, so a second application is required. Misuse and overuse of these products have contributed to the development of resistance. Prescription products include permethrin 5%, lindane, and malathion 0.5%. Resistance to permethrin 5% and lindane has been documented. In addition, lindane is associated with serious adverse events and should be used with caution only in a select population. Malathion 0.5% is about 98% ovicidal, and no resistance has been reported. Malathion is highly effective, but AAP guidelines note that the product is flammable and serious adverse effects can occur with ingestion. Very few cases of ingestion have occurred, and no reported cases of flammability, but children being treated with malathion should be carefully supervised, and this pediculicide should not be used unless treatment with OTC products has failed. AAP guidelines also state that no-nit policies in schools are detrimental, causing lost time in the classroom, inappropriate allocation of the school nurse's time for lice screening, and a response to infestations that is out of proportion to their medical significance. Accurate diagnosis, safe treatment options, and a common-sense approach to managing infestations in schools are recommended.

Animals↗

[Preservation of the autonomic nerve in rectal cancer surgery: anatomical factors in ligation of the inferior mesenteric artery].

OBJECTIVE: To evaluate the regional anatomy between the abdominal autonomic nerves including the abdominal aortic plexus (AAP) and the inferior mesenteric artery (IMA), and explore the safe ligation point on the IMA and the optimal dissection method to avoid autonomic nerve injuries. METHODS AND RESULTS: Dissections and observation were carried out on 16 fixed male cadavers. The AAP located in the thin fascia layer covering the surface of the aorta and its branches. No autonomic nerves were found in the area around the root of the IMA, and the point where the IMA and the left trunk of the AAP intersected was highly variable. The left trunk of the AAP adhered more closely to the IMA than to the aorta. CONCLUSIONS: In view of autonomic nerve preservation, the only safe site for ligation of the IMA is at its origin, and no other such sites are available along the IMA trunk and its branches. The IMA and the posterior fascia layer containing the autonomic nerves constitute the optimal surgical plane for IMA ligation, which should be performed following skeletonization of the IMA with careful preservation of the integrity of the posterior fascia layer.

Autonomic Pathways↗

[A membrane-bound alanine aminopeptidase from Acinetobacter calcoaceticus. 3. Inhibition of the enzyme].

The alanine aminopeptidase from Acinetobacter calcoaceticus is inhibited by SH-reagents like p-hydroxymercuribenzote, Ellman's reagent, N-bromosuccinimide, and metal chelating agents like 1,10-phenanthroline. The AAP is competitively inhibited by L-amino acids such as leucine, phenylalanine, and valine having hydrophobic side chains. Bacitracin (Ki = 2.0.10(-6) mol/l) inhibits AAP stronger than puromycin (Ki = 8.0.10(-6) mol/l). In contrast, the Aeromonas aminopeptidase (EC 3.4.11.10) is stronger inhibited by bestatin (Ki = 1.8.10(-8) mol/l) than the membrane-bound AAP from Acinetobacter calcoaceticus. However, the binding of bestatin by both membrane-bound enzymes. Acinetobacter-AAP and microsomal aminopeptidase M (EC 3.4.11.2), with Ki values of 8.10(-6) mol/l is in the same range.

Actinobacillus↗

[Tubular lesions in the nephrotic syndrome].

The problem of accompanying tubular lesions in nephrotic syndrome (NS) is not yet sufficiently clarified. The tubular changes were studied by the urine excretion of sensitive markers: beta 2-microglobulin (beta 2m), alaninaminopeptidase (AAP) and gammaglutamyltranspeptidase (gamma GTP). Beta 2m was determined by ELISA method and AAP and gamma GTP--electrophoretically. 75 patients were examined--37 patients with idiopathic nephrotic syndrome (INS), 27 patients with membranous glomerulonephritis (MGN), 11 patients with membranous-proliferative glomerulonephritis (MPGN). The most sensitive index AAP was elevated in the urine of 97,4% of the patients with nephrotic syndrome, beta 2m was elevated in 64,3% and gamma GTP--in 46,2% of the patients. There is a positive correlation between the excretion of APP and the quantity of proteinuria (r = 0,73, p less than 0,001). The comparison of the results of the patients with and without nephrotic syndrome established that in the patients with idiopathic nephrotic syndrome as well as in the patients with membranous glomerulonephritis the presence of nephrotic syndrome determines the higher excretion of AAP (p less than 0,02). The presence of nephrotic syndrome increases the frequency and the severity of the tubular impairment in glomerulonephritis. The tubular impairment is independent of the histologic type but is in positive correlation with the proteinuria.

Aminopeptidases↗

Localization of beta receptors in the anterior segment of the rat eye by a fluorescent analogue of propranolol.

A fluorescent analogue of propranolol, 9-AAP, was injected intravenously in order to detect beta-adrenergic receptors in the anterior segment of the albino rat eye. Specific 9-AAP fluorescence was noted along cell membranes of the ciliary epithelium and to lesser extent in the walls of blood vessels in the ciliary processes and episclera at the limbus. The iris showed maximum 9-AAP binding in the region of the sphincter muscle. These data suggest that 9-AAP may label beta receptors in the anterior segment of the rat eye.

Adrenergic beta-Antagonists↗

Interactions of beta adrenergic antagonists with isolated rat alveolar type II pneumocytes. II. Receptor-independent accumulation of beta adrenergic antagonists and other cationic amphiphilic drugs in lamellar bodies.

Accumulation of basic drugs by pulmonary tissue is well known. The cationic amphiphilic nature of many of these compounds suggests that they may be sequestered within an acidic and/or phospholipid-rich compartment. We described previously receptor-independent, concentrative, temperature- and pH-dependent sequestration of the beta adrenergic antagonists [125I]iodocyanopindolol and [125I]iodopindolol by intact rat type II pneumocytes in primary culture. The present study reveals that type II pneumocytes sequester [125I]iodocyanopindolol to an extent greater than other cell types (type II cells greater than polymorphonuclear leukocytes greater than S49) within 80-min incubations. Localization of fluorescence into large granular structures was observed after incubation of type II cells with 9-aminoacridine-propranolol (9-AAP). The distribution of fluorescence coincides with surfactant-containing lamellar bodies (LB) visualized with tannic acid/osmium staining. The large granule localization of 9-AAP fluorescence decreases with time in primary culture in parallel with changes in cell morphology and decreased numbers of LB. Comparison of patterns of fluorescence after incubation with 9-AAP, acridine orange and 9-aminoacridine (all 1 microM) indicates that localization is not a property of the acridine moiety, but requires the propranolol side-chain. Association of 9-AAP fluorescence with LB is inhibited completely by chlorpromazine (10 microM); the same concentration of propranolol or chlorquine produces less extensive, but detectable, inhibition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

Carcinogenicity testing of acetaminophen in F344 rats.

A study of acetaminophen (AAP) for possible carcinogenicity was conducted by administering the test chemical in pelleted diets to F344/DuCrj rats of each sex. Groups of 50 rats were administered AAP at one of two doses, either 0.45 or 0.9% for males and 0.65 or 1.3% for females. The rats were treated for 104 weeks, and then observed for 26 weeks. Control groups of 50 rats were fed basal diet throughout the study. Mean intakes of AAP by low- and high-dose rats were 195.4 and 402.1 in the males, and 335.7 and 688.0 mg/kg/day in the females, respectively. The survival rates at week 104 of each group were 86 to 90% in the males and 80 to 82% in the females. No pathologic or statistical evidence of induction of tumors by AAP was found. It is concluded that, under the conditions of this study, acetaminophen is not carcinogenic to F344/DuCrj rats of either sex.

Acetaminophen↗

[Myocardium in acute and chronic experimental alcoholic intoxication].

The myocardium of both heart ventricles in acute (AAP) and chronic (CAP) alcoholic poisoning was studied in 90 randombred rats. Functional-morphological changes typical of alcoholic cardiomyodystrophy were shown to develop in the heart in AAP and CAP. In AAP, alcoholic cardiomyodystrophy may lead to acute cardiac insufficiency and in CAP to progressive reduction of the contractile function of the heart and disturbances of conductivity in it. In AAP, however, the leading factor is the disturbance of bioenergetics as a result of toxic effect of ethanol and its metabolites on mitochondrial membranes under conditions of markedly disordered microcirculation. In CAP, along disordered microcirculation. In CAP, along with compensatory-adaptative processes in cardiomyocytes there increase the defects of the contractile apparatus, and diffuse fine-focal cardiosclerosis. This is the result of a long-term effect of ethanol and progressive hypoxia due to the affected vessels and disorders in lipid metabolism. Disorders in the function of sarcoplasmic reticulum may contribute to reduced contractile capacity of the heart.

Alcoholic Intoxication↗

[Early markers of nephrotoxicity: variation factors and reproducibility].

Epidemiological validity of early markers of nephrotoxicity currently used in occupational epidemiology has been poorly investigated. The aim of this study was to identify variation factors of these markers, to quantify their intra- and inter-individual variability and to evaluate the consequences of these results on study size and power. A cross-sectional survey was carried out in 1991 in a rotogravure plant including 168 male subjects (92 exposed to toluene and 76 controls). Blood and urine samples were taken twice: at study onset and one to five months later for 40% of the subjects. Creatinine and beta-2-microglobulin (beta 2M) were measured in both blood and urine; microalbumin (microALB), N-acetyl-beta-D-glucosaminidase (NAG), and alanine-aminopeptidase (AAP), in urine. Sources of physiological variation were reduced by standardization of collection and assay methods. Subjects completed a questionnaire to record information about their personal characteristics, alcohol, tobacco and drug consumption and their health. Statistical analysis of all subjects was adjusted for exposure status. Several factors were significantly related to the markers: age with beta 2M, NAG and AAP; smoking, alcohol drinking, and blood pressure with both microALB and NAG; urinary pH with beta 2M. These factors explained from 13 to 21% of the total variance of these markers. Short-term reproducibility, i.e. the correlation between the two measurements, was high for microALB (r = 0.75), moderate for NAG (r = 0.51), and low for beta 2M (r = 0.33) and AAP (r = 0.17). These results showed that confusion bias in the evaluation of exposure-marker association can be reduced by adjusting for several factors and that accuracy and study power can be improved by repeating measurements, especially for beta 2M and AAP.

Acetylglucosaminidase↗

Inhibition by suprofen and other non-narcotic analgesic drugs of the effects of prostaglandin precursor on isolated tissues and platelets.

Contractions caused by Slow Reacting Substance C(SRS-C) and by Arachidonic Acid hydroperoxide (AAP) in the guinea-pig ileum and by AAP in the rat fundus were studied in the presence of suprofen and of 3 reference compounds. The dose-related inhibitions were not due to antagonism of prostaglandins. Other agonists of gastrointestinal smooth muscle were not or only weakly antagonized. For the study of selective inhibition of AAP-induced contractions by non-narcotic analgesics, the rat fundus is the preferred preparation. In this model suprofen had an ED50 of 1.27 x 10(-7) M (0.033 mug/ml), being 1.5, 94 and 2, 020 times more potent than indomethacin, phenybutazone and acetylsalicylic acid, respectively. Suprofen also strongly inhibited malondialdehyde formation by guinea-pig platelets incubated with arachidonic acid. The reported effects point to inhibition by suprofen of prostaglandin biosynthesis. The antagonism of AAP-induced contractions in the rat fundus is a valuable test system for inhibitors of prostaglandin biosynthesis.

Analgesics↗

Childhood injury prevention counseling in primary care settings: a critical review of the literature.

OBJECTIVES: The American Academy of Pediatrics (AAP) believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report presents the results of a critical review of the scientific literature on the effectiveness of primary care-based counseling to prevent childhood unintentional injury. METHODS: A panel selected from the AAP Committee and the AAP Section on Injury and Poison Prevention searched the English-language scientific literature for all articles about childhood unintentional injury prevention counseling. A standardized format was developed to record data on each study. Two members of the panel independently reviewed each article. Articles that were original reports and in which unintentional injury prevention counseling took place in a primary care setting were included. Articles were encoded and analyzed by computer and then grouped by quality of evidence using the US Preventive Services Task Force (USPSTF) method of categorizing results of medical care evaluation. Articles were rated by strength of study design in order to compare studies within each USPSTF group. RESULTS: Twenty articles met the criteria for inclusion. Of these, 18 showed positive effects of injury prevention counseling including five randomized/controlled, 10 non-randomized/controlled, two multiple time series, and one descriptive study. In 15 of the positive studies, physicians performed the counseling. Positive outcomes as measured by increased knowledge, improved behavior, or decreased injury occurrence were reported for both motor vehicle and non-motor vehicle injuries. CONCLUSIONS: The literature review supports the recommendation of the AAP to include injury prevention counseling as part of routine health supervision. This recommendation has implications for health care reimbursement and care content.

Accident Prevention↗