Objectives.Acute otitis media (OM) is the most common indication for the use of antibiotics among children.Otoscopy alone is an imprecise method for the diagnosis of OM,which may lead to inappropriate antibiotic use.W...Objectives.Acute otitis media (OM) is the most common indication for the use of antibiotics among children.Otoscopy alone is an imprecise method for the diagnosis of OM,which may lead to inappropriate antibiotic use.We sought to determine whether tympanometry, as an adjunct to otoscopy, would significantly change physician prescribing behavior and whether physicians overprescribe antibiotics for OM, using independently graded tympanometry results as a standard.Methods.A randomized, clinical trial was conducted among children 6 to 35 months of age who presented to a pediatric emergency department with either fever or upper respiratory infection symptoms.Children were randomized into 2 groups, in which the attending physician evaluated tympanometry results (Tymp Aware) or the attending physician was blinded to the tympanometry findings (Tymp Unaware).Tympanometry curves were graded independently by using a modified version of the Jerger scale.Results.Of the 698 patients enrolled, tympanometry was performed successfully for 99.3%.Antibiotics were prescribed for OM for 27.9%of all patients.No statistically significant difference in antibiotic prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp Unaware group (26.8%)-was found.Of all patients for whom antibiotics were prescribed for OM, 14%had normal curves for both ears and 40%had some tympanographic movement bilaterally.Conclusions.Tympanometry did not seem to change diagnoses or prescribing behavior in the group of physicians studied.Antibiotics were commonly prescribed for presumed OM in the absence of effusions documented with tympanometry.展开更多
IGF-I and IGF-II are ubiquitously expressed growth factors that have profoun d effects on the growth and differentiation of many cell types and tissues, incl uding cells of the CNS. In biologic fluids, most IGFs are b...IGF-I and IGF-II are ubiquitously expressed growth factors that have profoun d effects on the growth and differentiation of many cell types and tissues, incl uding cells of the CNS. In biologic fluids, most IGFs are bound to one of six IG F binding proteins (IGFBPs 1-6). Increasing evidence strongly supports a role f or IGF-I in CNS development, as it promotes neuronal proliferation and survival . However, little is known about IGF-I and its homolog IGF-II and their carrie r proteins, IGFBPs, during the neonatal period in which brain size increases dra matically, myelination takes place, and neurons show limited capacity to prolife rate. Herein, we have determined the concentrations of IGF-I, IGF-II, IGFBP-I , and IGFBP-3 in cerebral spinal fluid (CSF) samples that were collected from children who were 1 wk to 18 y of age. The concentrations of IGF-I, IGFBP-I, and IGFBP-3 in CS F from children < 6mo of age were significantly higher than in older children, w hereas IGF-II was higher in the older group. This is in contrast to what is obs erved in the peripheral circulation, where IGF-I and IGFBP-3 are low at birth and rise rapidly during the first year, reaching peak levels during puberty. Hig her concentrations of IGF-I, IGFBP-I, and IGFBP-3 in the CSF of very young ch ildren suggest that these proteins might participate in the active processes of myelination and synapse formation in the developing nervous system. We propose t hat IGF-I and certain IGFBPs are likely necessary for normal CNS development du ring critical stages of neonatal brain growth and development.展开更多
文摘Objectives.Acute otitis media (OM) is the most common indication for the use of antibiotics among children.Otoscopy alone is an imprecise method for the diagnosis of OM,which may lead to inappropriate antibiotic use.We sought to determine whether tympanometry, as an adjunct to otoscopy, would significantly change physician prescribing behavior and whether physicians overprescribe antibiotics for OM, using independently graded tympanometry results as a standard.Methods.A randomized, clinical trial was conducted among children 6 to 35 months of age who presented to a pediatric emergency department with either fever or upper respiratory infection symptoms.Children were randomized into 2 groups, in which the attending physician evaluated tympanometry results (Tymp Aware) or the attending physician was blinded to the tympanometry findings (Tymp Unaware).Tympanometry curves were graded independently by using a modified version of the Jerger scale.Results.Of the 698 patients enrolled, tympanometry was performed successfully for 99.3%.Antibiotics were prescribed for OM for 27.9%of all patients.No statistically significant difference in antibiotic prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp Unaware group (26.8%)-was found.Of all patients for whom antibiotics were prescribed for OM, 14%had normal curves for both ears and 40%had some tympanographic movement bilaterally.Conclusions.Tympanometry did not seem to change diagnoses or prescribing behavior in the group of physicians studied.Antibiotics were commonly prescribed for presumed OM in the absence of effusions documented with tympanometry.
文摘IGF-I and IGF-II are ubiquitously expressed growth factors that have profoun d effects on the growth and differentiation of many cell types and tissues, incl uding cells of the CNS. In biologic fluids, most IGFs are bound to one of six IG F binding proteins (IGFBPs 1-6). Increasing evidence strongly supports a role f or IGF-I in CNS development, as it promotes neuronal proliferation and survival . However, little is known about IGF-I and its homolog IGF-II and their carrie r proteins, IGFBPs, during the neonatal period in which brain size increases dra matically, myelination takes place, and neurons show limited capacity to prolife rate. Herein, we have determined the concentrations of IGF-I, IGF-II, IGFBP-I , and IGFBP-3 in cerebral spinal fluid (CSF) samples that were collected from children who were 1 wk to 18 y of age. The concentrations of IGF-I, IGFBP-I, and IGFBP-3 in CS F from children < 6mo of age were significantly higher than in older children, w hereas IGF-II was higher in the older group. This is in contrast to what is obs erved in the peripheral circulation, where IGF-I and IGFBP-3 are low at birth and rise rapidly during the first year, reaching peak levels during puberty. Hig her concentrations of IGF-I, IGFBP-I, and IGFBP-3 in the CSF of very young ch ildren suggest that these proteins might participate in the active processes of myelination and synapse formation in the developing nervous system. We propose t hat IGF-I and certain IGFBPs are likely necessary for normal CNS development du ring critical stages of neonatal brain growth and development.
