We have validated our clinical scoring system as an accurate way of determining an infant's risk of skull fracture. Whereas a clinical score of 4 or greater maximizes the trade-off between sensitivity and specificity for identifying skull fracture, a clinical score of 3 or greater may be preferable for detecting intracranial injury.
The ELL gene was first identified by its involvement with MLL in the translocation (11;19)(q23;p13.1) in acute myeloid leukemia. To date, nine other MLL partner genes have been cloned, but their precise functions have yet to be determined. To characterize the functions of ELL further, we have cloned the murine homologue of ELL and have found that the gene is highly conserved at the nucleotide and amino acid level. The open reading frame of the murine homologue contains 602 aa, slightly smaller than the 621 aa in the human gene. With Northern blot analysis, a 3.4-kb transcript is detected in all tissues examined with greatest levels of expression in the liver. Unlike human ELL, only a single transcript can be detected with either murine coding sequence or 3 untranslated region probes. To examine the spatial and temporal pattern of expression in murine development, in situ hybridization studies were performed with sense and antisense riboprobes from the 3 untranslated region of murine Ell. Ell is expressed diffusely by embryonic day 7.5 (E7.5). In addition, high levels of expression can be detected in maternally derived decidual tissue. At E14.5, Ell is expressed diffusely throughout the embryo. However by E16.5, specific expression in the liver and gastrointestinal tract becomes prominent and remains so in both neonates and adults. To determine the subcellular localization of ELL, we developed a polyclonal antiserum to ELL that was used for immunofluorescence studies in COS-7, HeLa, NIH 3T3, and A7r5 cells. The ELL protein was localized to the nucleus but excluded from nucleoli in all cell lines examined. Recently, the gene product of ELL was found to function as an RNA polymerase II elongation factor, an activity that is consistent with our immunofluorescence data. Thus, these studies extend our understanding of the normal functions of ELL and provide additional insight into its aberrant function when fused to MLL in acute myeloid leukemia.We first identified the ELL gene as a partner gene of MLL in the translocation (11;19)(q23;p13.1), a recurring cytogenetic abnormality in de novo and therapy-related acute myeloid leukemia (1). Previously, we found that the MLL gene is involved in over 20 different cytogenetic aberrations that affect chromosome band 11q23 (2). The majority of these events are reciprocal translocations, and less commonly, some are insertions or inversions, which result in the juxtaposition of the MLL gene with sequences located on other chromosomes. The critical feature of these chromosomal rearrangements is the generation of an in frame chimeric fusion transcript consisting of 5Ј MLL and 3Ј sequences of the gene on the partner chromosome.Nine other genes at 11q23 partner chromosomal breakpoints have been cloned. These include AF-4 in the t(4;11)(q21;q23) (3), ENL in the t(11;19)(q23;p13.3) (4), AF-9 in the t(9;11)(p22;q23) (5), AF-6 in the t(6;11)(q27;q23) (6), AF-1p in the t(1;11)(p32;q23) (7), AF-X in the t(X;11)(q13;q23) (8), AF-1q in the t(1;11)(q21;23) (9), AF-10 in the t(10;11)(p...
The urinary tract is a common site of infection in the pediatric population. Unlike the generally benign course of urinary tract infection (UTI) in the adult population, UTI in the pediatric population is well recognized as a cause of acute morbidity and chronic medical conditions, such as hypertension and renal insufficiency in adulthood. As a result, it is crucial to have a clear understanding of the pathogenesis of UTI, risk factors, indications for diagnostic tests, and the appropriate uses of antimicrobial agents in the management of children with UTI. Classification A UTI is defined as colonization of a pathogen occurring anywhere along the urinary tract: kidney, ureter, bladder, and urethra. Traditionally, UTIs have been classified by the site of infection (ie, pyelonephritis [kidney], cystitis [bladder], urethra [urethritis]) and by severity (ie, complicated versus uncomplicated). A complicated UTI describes infections in urinary tracts with structural or functional abnormalities or the presence of foreign objects, such as an indwelling urethral catheter. This model does not necessarily reflect clinical management, however. In children, a simpler and more practical approach is to categorize UTI as a first infection versus recurrent infection. Recurrent infections can be further subdivided into (1) unresolved bacteriuria, (2) bacterial persistence, and (3) reinfection (Fig. 1). The initial UTI documented by a proper urine culture is the first infection. Infections of the urinary tract generally resolve with adequate treatment in most
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