The GLUT2 glucose transporter and the K-ATP-sensitive potassium channels have been implicated as an integral part of the glucose-sensing mechanism in the pancreatic islet b cells. The expression of GLUT2 and K-ATP channels in the hypothalamic region suggest that they are also involved in a sensing mechanism in this area. The hypothalamic glial cells, known as tanycytes a and b, are specialized ependymal cells that bridge the cerebrospinal fluid and the portal blood of the median eminence. We used immunocytochemistry, in situ hybridization and transport analyses to demonstrate the glucose transporters expressed in tanycytes. Confocal microscopy using specific antibodies against GLUT1 and GLUT2 indicated that both transporters are expressed in a and b tanycytes. In addition, primary cultures of mouse hypothalamic tanycytes were found to express both GLUT1 and GLUT2 transporters. Transport studies, including 2-deoxyglucose and fructose uptake in the presence or absence of inhibitors, indicated that these transporters are functional in cultured tanycytes. Finally, our analyses indicated that tanycytes express the K-ATP channel subunit Kir6.1 in vitro. As the expression of GLUT2 and K-ATP channel is linked to glucose-sensing mechanisms in pancreatic b cells, we postulate that tanycytes may be responsible, at least in part, for a mechanism that allows the hypothalamus to detect changes in glucose concentrations.

Methicillin-resistant Staphylococcus aureus (MRSA) has not been studied in child care centers. The prevalence of MRSA colonization was determined at two centers with an index patient. Two (3%) of 61 children at center X had MRSA; strains from both children and the index illness were pulsed-field gel electrophoresis type B. Nine (24%) of 40 children at center Y had MRSA; strains from 5 children and the index illness were type B, and strains from 4 children were type A. Ten of 11 colonized children were in classes with 2- and 3-year-old children. Colonization with MRSA was not associated with health care contact by subjects or by members of their households. MRSA in child day care centers indicates accelerated spread of MRSA in the community.

No abstract

We studied the epidemiology of invasive disease caused by Streptococcus pneumoniae in 1995 among 1.9 million residents of Dallas County, Texas. The sociodemographic characteristics and chronic medical conditions of 432 patients were identified through active, population-based surveillance and review of medical records. The incidence of disease was 22 cases per 100,000 person-years and was highest for children < 2 years of age (136 cases per 100,000 person-years) and for adults > or = 65 years of age (80 cases per 100,000 person-years). Twenty percent of isolates were nonsusceptible to penicillin; the highest rates of resistance were among the youngest and oldest age groups (28% and 22% of isolates, respectively). An increased incidence of disease was associated with low income (42 cases per 100,000 person-years) and black race (39 cases per 100,000 person-years). The frequency of most chronic medical conditions increased with age; smoking, heavy alcohol use, and infection due to human immunodeficiency virus were most common between 30 and 64 years of age. Of otherwise healthy patients 30-64 years of age, 47% were current smokers, an association requiring further investigation. Characterizing groups at risk for invasive pneumococcal disease could aid in the development of prevention programs and increase the benefits from wide use of effective vaccines.

To examine the changes in birth cohort prevalence rates and severity of congenital heart disease, we studied children with congenital heart disease born to blacks, whites, and Mexican-Americans in Dallas County from 1971 through 1984. Diagnoses were made by pediatric cardiologists' clinical evaluations, echocardiography, catheterization, surgery, or autopsy. During this study period, 2,509 of 379,561 liveborn infants were diagnosed, a prevalence rate of 6.6/1000. The rates for whites was significantly higher than for blacks or Mexican-Americans -7.2/1,000, 5.6/1,000, and 5.911,000, respectively. The rate for severe cases requiring cardiac catheterization or surgery or undergoing autopsy was 3.111,000 and did not differ among the three groups. The time trend for rates of congenital heart disease suggested an apparent increase in prevalence rate during the 1970s; however, the prevalence rate of severe forms remained relatively stable. This indicates that the apparent rise in prevalence could be accounted for by an increase in detection of mild cases. These findings were interpreted as reflecting a greater tendency for pediatricians to refer asymptomatic children with significant heart murmurs to a pediatric cardiologist. (Circulation 1990;81:137-142) C ongenital heart disease (CHD) is a leading cause of death during the first year of life. Malformations of the cardiovascular system are also associated with significant medical morbidity, which requires use of costly medical facilities. Children with CHD use 25-30% of the beds in most large pediatric intensive care units and, therefore, consume a large fraction of pediatric health care resources. To plan future health care needs, epidemiologic data are needed regarding changes in prevalence and severity of CHD. The surveillance systems for birth defects conducted by the Centers for Disease Control have indicated a more than twofold increase in the most common form of CHD, ventricular septal defect, between-1970 and 1977.1 To examine the changes in prevalence rates and severity of CHD, we gathered epidemiologic data on children with CHD who were born in a well-defined geographic area during a specific time period. The

Background: This study assessed the feasibility of a protocol-driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality. Results: There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0·025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0·010). The median (range) length of hospital stay was 9 (5-98) days for group 1 and 13 (8-106) days in group 2 (P = 0·012). Conclusion:Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay.

No abstract

Prevalence rates of specific cardiac defects vary among black, white and Mexican-American children, probably reflecting different genetic and environmental backgrounds. The timing of referral for pediatric cardiac care, however, was not related to ethnicity, median family income or household educational level.