Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years

Objective : Childhood obesity is an emerging problem in Asia. Sequential monitoring of the growth of an individual can detect a change in body fatness, provided there are ethnically appropriate growth references.
Methodology : A territory wide cross-sectional growth survey of Hong Kong on 24 709 individuals from the age of newborn to 18 years was performed in 1993. Weight-for-age and weight-for-height percentile charts were prepared separately for boys and girls.
Results : There was an average increase of 8.5 kg and 5.1 kg in the 18 year old boys and girls, respectively, compared to those surveyed 30 years ago. The percentile curves between 6 and 18 years were similar to those of Singapore. Weight-for-height percentile curves were close to those of America in the prepubertal years.
Conclusions : These Hong Kong growth standards for weight-for-age and weight-for-height are important tools for the assessment of nutritional status of an individual and for monitoring changes in nutritional status of the population.     

Cell-lineage antigens of the stem cell-megakaryocyte-platelet lineage are associated with the platelet IIb-IIIa glycoprotein complex

The stem cell-platelet lineage is uniquely defined by platelet cell- lineage antigens. These antigens are present on all stem cells measured by the spleen colony assay and become restricted to the platelet cell lineage as differentiation proceeds. In this study, anti-platelet serum (APS) has been used to identify cells in the bone marrow that express platelet cell-lineage antigens and to identify platelet cell surface molecules expressing these antigens. Anti-platelet IgG extensively absorbed with brain, thymus, and peritoneal cells bound selectively to stem cells, megakaryocyte progenitor cells (Mk-CFC), and megakaryocytes in CBA mouse bone marrow and to blood platelets. No other hemopoietic cell type, tissue, cell line, or tumor cell bound significant amounts of antibody against platelet cell-lineage antigens as determined by ability to absorb the anti-stem cell activity in APS. Studies with lactoperoxidase-labeled platelets showed that two major iodinated proteins of Mr = 114,000 and 138,000 were immunoprecipitated with APS and with antiserum that had been extensively absorbed. These proteins correspond to the platelet IIb-IIIa glycoprotein complex, which is known to express receptors for collagen and fibrinogen, molecules known to influence hemopoietic cell proliferation and tumor cell growth. A panel of six monoclonal antibodies against human IIb-IIIa inhibited spleen colony formation by 17% to 100%, J15 and A5.15 also being cytotoxic for granulocyte-macrophage progenitor cells and Mk-CFC. Other platelet monoclonal antibodies did not inhibit spleen colony formation. Although APS inhibited fibrinogen binding to platelets and platelet aggregation, these activities were greatly reduced with absorbed antiserum. Furthermore, fibrinogen treatment of bone marrow did not block the anti-stem cell activity in APS. Thus the evidence is consistent with expression of platelet cell-lineage antigens on the platelet IIb-IIIa glycoprotein complex at a site removed from the fibrinogen binding site.     

Chronic illness perception in adolescence: Implications for the doctor-patient relationship

To describe the inter-relationship of chronic illness severity as perceived by adolescents with both psychosocial well-being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.

Methods:

The psychological well-being of 48 adolescents with either cystic fibrosis (CF) or insulin-dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.

Results:

There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.

Conclusions:

For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well-being. Physicians do not accurately infer their patients' perception of illness severity.     

Characterisation of renal chloride channel, CLCN5, mutations in hypercalciuric nephrolithiasis (kidney stones) disorders

Mutations of the renal-specific chloride channel (CLCN5) gene, which is located on chromosome Xp11.22, are associated with hypercalciuric nephrolithiasis (kidney stones) in the Northern European and Japanese populations. CLCN5 encodes a 746 amino acid channel (CLC-5) that has approximately 12 transmembrane domains, and heterologous expression of wild-type CLC-5 in Xenopus oocytes has yielded outwardly rectifying chloride currents that were markedly reduced or abolished by these mutations. In order to assess further the structural and functional relationships of this recently cloned chloride channel, additional CLCN5 mutations have been identified in five unrelated families with this disorder. Three of these mutations were missense (G57V, G512R and E527D), one was a nonsense (R648Stop) and one was an insertion (30:H insertion). In addition, two of the mutations (30:H insertion and E527D) were demonstrated to be de novo, and the G57V and E527D mutations were identified in families of Afro-American and Indian origin, respectively. The G57V and 30:H insertion mutations represent the first CLCN5 mutations to be identified in the N-terminus region, and the R648Stop mutation, which has been observed previously in an unrelated family, suggests that this codon may be particularly prone to mutations. Heterologous expression of the mutations resulted in a marked reduction or abolition of the chloride currents, thereby establishing their functional importance. These results help to elucidate further the structure-function relationships of this renal chloride channel.      

Poliomyelitis-like illness after acute asthma

Two children had pain in one arm, followed by weakness and wasting, after an acute exacerbation of bronchial asthma. Similar cases in which a poliomyelitis-like illness was associated with acute asthma have been reported, but the relationship between the two remains conjectural.     

Growth hormone replacement in patients with Langerhan's cell histiocytosis

OBJECTIVES: To assess the impact of growth hormone on growth and the underlying disease in children with growth hormone deficiency as a result of Langerhan's cell histiocytosis. STUDY DESIGN: Retrospective analysis of data from the Kabi (Pharmacia & Upjohn) international growth database (KIGS) for 82 children with Langerhan's cell histiocytosis treated with recombinant growth hormone. RESULTS: At the start of treatment the median (10-90th centile) age was 9.0 (5.2 to 14.7) years, with a median height standard deviation score (SDS) of -2.0 (-3.5 to -0.9). The median pretreatment height velocity (measured in cm/year) was 3.6 (0.9 to 6.4); this increased to 8.8 (3.8 to 12.0) in the first year of treatment with growth hormone, and then remained significantly greater than the pretreatment height velocity at 7.3 (4.4 to 9.7) and 7.1 (4.1 to 9.3) cm/year in the second and third years, respectively. The median height SDS increased from -2.0 to -0.8 (-2.3 to 0.6) by the end of three years of treatment. There was no increase in the recurrence rate of the underlying disease and no adverse event could be directly attributed to growth hormone treatment, apart from one case of benign intracranial hypertension that resolved on stopping treatment with growth hormone. CONCLUSIONS: Growth hormone replacement treatment for patients with Langerhan's cell histiocytosis with growth hormone deficiency is beneficial and safe.     

The effects of X-ray contrast media on bacterial growth

Six widely used X-ray contrast media (XRC) were tested against nine commonly isolated organisms to determine the practicality of using XRC to outline body spaces prior to obtaining specimens for culture and to assess the feasibility of using XRC in divided doses to reduce cost. Preparations of Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Candida albicans, Streptococcus pyogenes and Streptococcus milleri in two approximate concentrations of 10⁴ and 10⁸ colony forming units/mL (cfu/mL) were inoculated into the following XRC: Conray 280, Hexabrix 320, lopamiro 370, Omnipaque 350, Ultravist 300 and Optiray 320 each in two concentrations. Sampling was performed in triplicate at 0, 2, 4 and 20 h with the 20 h counts made after exposure at both 22°C and 4°C. There were 16 significant interactions, predominantly with the Gram-negative organisms. Conray 280 produced the greatest number of effects. Most effects were bacteriostatic. Organisms were most susceptible at low concentration and after prolonged contact with XRC. No effect was seen with dilute XRC. All weekly sterility checks were negative. Non-ionic XRC have no significant effect on the growth of Gram-positive organisms and little effect on Gram-negative organisms if processing is performed promptly. Using standard aseptic technique, no contamination of XRC occurred, suggesting multi-dosing may be a safe and cost-effective method of XRC utilization.     

Pulmonary vascular resistance in complete atrioventricular septal defect. A comparison between children with and without Down's syndrome

Invasive data obtained in children with complete atrioventricular septal defect over the last three years are presented to determine the age at which pulmonary vascular obstructive disease develops. Comparisons were made between children with (n = 21) and without Down's syndrome (n= 12). The investigation was restricted to patients less than one year of age at initial catheterization. Patients with complicated associated heart defects were excluded. Patients with Down's syndrome had a higher ratio of pulmonary to systemic vascular resistance than children without Down's syndrome in the basal situation. This difference almost disappeared after 100% oxygen had been given to patients with elevated pulmonary vascular resistance, indicating that hypoxia and/or hypoventilation is of importance, especially in children with Down's syndrome. Fixed elevated pulmonary vascular resistance was found in 11% of Down patients under one year, with the youngest patient being 5.5 months old. One child without Down's syndrome may have had fixed elevated pulmonary vascular resistance. It is concluded that all children with complete atrioventricular septal defect should be evaluated and operated on at a very young age.