bluuebunny/crossref_metadata_2025 huggingface dataset:
Who Is Performing Stapedectomy Surgery? Implications for Residency and Fellowship Training
Authors: Ruckenstein Michael J. , Staab Jeffrey P.
Published: March 2009

Objectives: To demonstrate that 1) recent graduates of training programs in otorhinolaryngology–head and neck surgery are less likely to recommend/perform stapedectomy than more senior otolaryngologists; and 2) when surgery is recommended, referral is most commonly made to an otologist/neurotologist.

Study Design: Survey of 500 regional otolaryngologists pertaining to their treatment of patients with hearing loss secondary to otosclerosis.

Methods: Otolaryngologists in community practice were provided with written surveys pertaining to their treatment of otosclerosis.

Results: Data were obtained from 179 general otolaryngologists treating adults and children in solo or group private practices in our geographic region. The majority (66%) diagnosed one to five new cases per year. Ten percent of surgeons graduating in the 1970s, 25% graduating in the 1980s, 50% graduating in the 1990s, and 90% of graduates in the 2000s never performed stapedectomy as part of their practices (P < .001). Similarly, a significant number of surgeons who formerly performed stapedectomies no longer do this surgery. A trend toward greater use of hearing aids for the treatment of otosclerosis was seen in more recent graduates (P < .08). When surgery was recommended, otologists/neurotologists received the majority of referrals (75%) from the practitioners surveyed.

Conclusions: Stapedectomy is performed and recommended less often by more recent graduates of otolaryngology training programs. Training requirements for both general otolaryngologists and neurotologists may need modification given current practice patterns for stapes surgery.
Oral Insulin Enhances Cell Proliferation and Decreases Enterocyte Apoptosis During Methotrexate‐induced Mucositis in the Rat
Authors: Sukhotnik Igor , Shehadeh Naim , Coran Arnold G , Mogilner Jorge G , Karry Rahel , Shamian Benhoor , Ure Benno M , Shamir Raanan
Published: March 2009

Objective:

Oral insulin (INS) has been shown to protect intestinal epithelial cells from injury caused by ischemia‐reperfusion and endotoxemia. In the present study, we tested whether oral insulin can protect gut epithelial cells from methotrexate (MTX)‐induced intestinal damage.

Materials and Methods:

Adult male Sprague‐Dawley rats were divided into 3 experimental groups. Control rats were treated with normal saline given intraperitoneally (CONTR), MTX rats were treated with a single dose (20 μg/kg) of MTX given intraperitoneally, and MTX‐INS rats were treated with oral insulin given in drinking water (1 U/mL) 72 hours after IP injection of a single dose of MTX (similar to MTX rats). Three days after either MTX or saline injection, rats were killed. Intestinal mucosal damage (Park injury score), mucosal structural changes, enterocyte proliferation, and enterocyte apoptosis were measured. Reverse transcription polymerase chain reaction was used to determine the level of bax and bcl‐2 mRNA expression.

Results:

MTX‐INS rats demonstrated a greater jejunal and ileal mucosal weight, ileal mucosal DNA, greater jejunal villus height, greater jejunal and ileal crypt depth, greater enterocyte proliferation index in ileum, and lower enterocyte apoptosis in ileum than did MTX‐nontreated animals. Treatment with insulin did not change the injury score grade in comparison with MTX animals. A significant decrease in cell apoptosis was observed in MTX‐INS rats (vs MTX) and also a decrease in a bax mRNA expression and decrease in a bax/bcl‐2 ratio.

Conclusions:

In a rat model of MTX‐induced mucositis, oral insulin supplementation does not prevent mucosal injury but improves intestinal recovery and enhances enterocyte survival.
Lactose and Lactase—Who Is Lactose Intolerant and Why?
Authors: Montgomery Robert K , Krasinski Stephen D , Hirschhorn Joel N , Grand Richard J
Published: March 2009

Lactase‐phlorizin hydrolase (LPH) is expressed only in the small intestine and is confined to absorptive enterocytes on the villi with a tightly controlled pattern of expression along the proximal to distal and crypt‐villus axes of the intestine. LPH expression is regulated mainly at the level of lactase (LCT) gene transcription that directs 2 phenotypes: a decline in LCT activity (LCT nonpersistence) in mid‐childhood in the majority of the world's population, and maintenance of the lactase levels found in infancy (LCT persistence) in people of northern European extraction and scattered populations elsewhere. The molecular mechanisms that regulate these phenotypes are not completely understood. A population genetic association of lactase persistence with 2 single nucleotide polymorphisms in the distal 5′‐flanking region of LCT (−13.9T and −22A) has been confirmed in northern Europeans, but this fails to explain lactase persistence found in some African groups. Any hypothesis for the control of lactase expression must reconcile the presence of high levels of activity in early life in all humans and the characteristic loss of activity found subsequently in many but not all people.
Body Mass Index and Elbow Range of Motion in a Healthy Pediatric Population: A Possible Mechanism of Overweight in Children
Authors: Golden Daniel W , Wojcicki Janet M , Jhee Jeffrey T , Gilpin Susan L , Sawyer Jeffrey R , Heyman Melvin B
Published: March 2009

Background:

Childhood overweight has become a serious health problem among children and adolescents in the United States. No previous study, to our knowledge, has analyzed the effect of body mass index (BMI) on range of motion and carrying angle of the elbow joint in a healthy pediatric population. The primary objective of this study was to determine the effect of BMI on orthopedic parameters of the elbow joint, including range of motion, flexion, extension, and carrying angle.

Study Participants and Methods:

Healthy children age 2 to 18 years (mean 12.0 ± 3.9 years) were recruited at an urban pediatric orthopedic clinic as pediatric orthopedic patients or as the siblings or friends of patients. Measures of range of motion (flexion and extension) and carrying angle of 226 elbows and of BMI from 113 study participants were analyzed.

Results:

BMI was negatively correlated with right and left elbow range of motion (r = −0.54, P < 0.01; r = −0.43, P < 0.01) and right and left elbow flexion (r = −0.59, P < 0.01; r = −0.50, P < 0.01). BMI had a positive correlation with right elbow extension (r = 0.20, P = 0.04). BMI did not correlate with left elbow extension or right or left carrying angle. After adjustment for age, sex, and ethnic group, BMI was associated with right (P < 0.01) and left (P < 0.01) elbow range of motion.

Conclusions:

These data demonstrate that increased BMI in children is negatively correlated with range of motion of the elbow joint. Further studies are needed to evaluate the consequences of impaired range of motion associated with overweight on activity levels and energy expenditure in growing children and adolescents.
Orthostatic Intolerance and Gastrointestinal Motility in Adolescents With Nausea and Abdominal Pain
Authors: Antiel Ryan M , Risma Justin M , Grothe Rayna M , Brands Chad K , Fischer Philip R
Published: March 2009

Objective:

To describe the relationships between gastric emptying, autonomic function, and postural tachycardia in adolescent patients with nausea and/or abdominal discomfort. It was hypothesized that patients with both gastrointestinal symptoms and symptoms of orthostatic intolerance are more likely to show abnormal tilt table results and delayed gastric emptying.

Patients and Methods:

A retrospective review was conducted of adolescent patients who came to a pediatric referral center because of nausea and dyspepsia and who subsequently underwent both autonomic reflex screening and gastric emptying testing. Patients with a heart rate change of 30 or more beats per minute on the heads‐up tilt table test were assigned to the postural orthostatic tachycardia syndrome (POTS) group (n = 21), and those with a heart rate change of fewer than 30 beats per minute on the heads‐up tilt table test were assigned to the non‐POTS group (n = 10).

Results:

There was no significant difference between the POTS and non‐POTS groups with regard to presenting symptoms (P > 0.05). Overall, 13 (42%) individuals had abnormal gastric emptying results (delayed in 6, accelerated in 7), but gastric emptying scores were similar between the POTS and non‐POTS groups. Furthermore, there was no correlation between an individual's gastric emptying results at 1, 2, and 4 hours and that person's heart rate change on HUT (r = −0.05, −0.15, and −0.19).

Conclusions:

Although altered gastric emptying and postural tachycardia are common in a referral population of adolescents with nausea and/or abdominal discomfort, the clinical presentation was not predictive of test results. Furthermore, delayed gastric emptying was not correlated with the current definition of postural tachycardia.
Peculiarities of Norovirus and Rotavirus Infections in Hospitalised Young Children
Authors: Narkeviciute Irena , Tamusauskaite Indre
Published: March 2009

Objectives:

To investigate the features of norovirus infection in hospitalised children under the age of 3 and to compare the results with those of rotavirus infection.

Patients and Methods:

Case notes were randomly selected and retrospectively analysed for 70 norovirus‐ and 70 rotavirus‐infected children. All of the children were treated in Vilnius University Children's Hospital in 2005. The norovirus antigen was assayed using enzyme‐linked immunosorbent assay, the rotavirus using immunochromatography diagnostic assay.

Results:

In young children, norovirus infection manifested as vomiting (94% of all cases), diarrhoea (81%), and fever (66%). It presented as gastroenteritis with fever (47%) or without fever (30%). However, 19% of cases were without diarrhoea. During rotavirus infection, fever was present in 97% of cases and 81% of them were >38°C. However, in norovirus infection, the percentages were 66% and 48%, respectively (P < 0.0001). Intensive diarrhoea (≥7 times/day) more frequently appeared in children with rotavirus infection than with norovirus (P < 0.0001). Repeated vomiting (≥4 times/day) has been more common for children with norovirus infection. As opposed to norovirus infection, which has 2 main syndromes (gastroenteritis with fever and without fever), rotavirus infection is dominated by just 1 clinical syndrome—gastroenteritis with fever (P < 0.0001).

Conclusions:

Norovirus infection in young children can present as gastroenteritis with or without fever. Norovirus and rotavirus infections had statistically significant differences in the presence and the degree of fever, and the intensity of diarrhoea and vomiting, as well as frequency of different syndromes.
Is Visceral Hypersensitivity Correlated With Symptom Severity in Children With Functional Gastrointestinal Disorders?
Authors: Castilloux Julie , Noble Angela , Faure Christophe
Published: March 2009

Background:

Abdominal pain related to irritable bowel syndrome (IBS) and functional abdominal pain (FAP) is frequent in children and can be of variable severity. Both IBS and FAP are associated with rectal hypersensitivity. We hypothesized that in children with IBS and FAP, the rectal sensory threshold for pain (RSTP) is associated with symptom severity.

Paitents and Methods:

A total of 47 patients (34 girls; median age, 14.2 years) with IBS (n = 29) and FAP (n = 18), according to the Rome II criteria, underwent a rectal barostat examination to determine their RSTP. Gastrointestinal symptom severity was assessed by validated questionnaires. During the rectal barostat exam, symptoms were documented using a visual analog scale and by measuring the area coloured on a human body diagram corresponding to painful sensations.

Results:

The median RSTP was 16 mmHg and was similar in IBS and FAP patients. Eighty‐three percent of the patients had rectal hypersensitivity (RSTP ≤ 30.8 mmHg, the 5th percentile of control children studied in our laboratory). Fifty‐one percent and 36%, respectively, reported missing school and social activities at least once per week. Increased frequency of pain, missed days of school, missed social activities, and pain during the barostat examination were not associated with lower RSTP values in either the whole group or in the subset of children with rectal hypersensitivity.

Conclusions:

Rectal hypersensitivity is not proportional to the severity of symptoms in children with IBS and FAP, indicating that symptom severity is influenced by other factors in addition to visceral hypersensitivity.
Regional Fat Distribution in Children Born Preterm Evaluated at School Age
Authors: Giannì Maria L , Mora Stefano , Roggero Paola , Amato Orsola , Piemontese Pasquina , Orsi Anna , Vegni Chiara , Puricelli Valeria , Mosca Fabio
Published: March 2009

Children born preterm may have aberrant adiposity. At school age, we evaluated body fat and fat distribution in 45 former preterm infants (birth weight ≤1800 g and gestational age <34 weeks) and 40 children born at term using dual‐energy x‐ray absorptiometry. Children born preterm exhibited lower total body fat mass and total body fat mass index compared with children born at term. Fat mass indexes in the limbs but not the trunk were lower in children born preterm than in children born at term. In conclusion, children born preterm, evaluated at school age, may be at risk for altered regional adiposity.
Seasonal Variation in the Presentation of Abdominal Pain
Authors: Saps M , Blank C , Khan S , Seshadri R , Marshall BM , Bass LM , Di Lorenzo C
Published: March 2009

Background:

Anxiety and depression, conditions frequently associated with childhood chronic abdominal pain (AP), are characterized by seasonal exacerbations. A seasonal pattern characterized by a higher frequency of consultations for AP during winter has been suspected but has never, to our knowledge, been demonstrated. We hypothesize the presence of a seasonal variation in AP consultations with a winter predominance.

Aims:

To determine the seasonal distribution of AP consultations among centers across time and geographic latitude.

Patients and Methods:

This was a retrospective cohort study. The number of outpatient consultations from primary care clinics and every pediatric specialty clinic that resulted in a diagnosis of AP and the total number of outpatient consultations (2001–2004) from 6 tertiary care institutions (Chicago, Pittsburgh, Wilmington, Pensacola, Orlando, Jacksonville) was determined. Rates of consultations were compared across time and between cities. Four time periods of interest, with 2‐ and 3‐month definitions, were arbitrarily selected. Seasonal rates across time were compared separately for each of the 2‐month (January–February vs June–July) and 3‐month periods (January–March vs June–August). Logistic regression models for each city were used to determine variations in the rate of outpatient AP cases by season or by year.

Results:

A total of 3,929,522 outpatient consultations and 73,591 AP consultations were analyzed. The rates of AP consultations were consistently higher in the winter months at all of the sites. The results differed between sites at northern and southern latitudes.

Conclusions:

There seems to be a seasonal variation in consultation patterns for AP at the tertiary care level. A possible role of daylight hours, climate, latitude, and stress is proposed.
Design of Predictive Models for Positive Outcomes of Upper and Lower Gastrointestinal Endoscopies in Children and Adolescents
Authors: Noble Angela J , Drouin Eric , Tamblyn Robyn
Published: March 2009

Objectives:

To develop models to accurately determine the outcomes of diagnostic endoscopies performed in children and adolescents without known gastrointestinal disease.

Materials and Methods:

Retrospective chart review of all endoscopies performed in children 2 to 18 years of age without known gastrointestinal disease from January 1 to December 31, 2000. The association between age, presenting symptoms, physical examination findings, laboratory investigations, and endoscopy outcomes was assessed. Predictive models for positive outcomes on endoscopy were estimated for upper and lower endoscopies separately by use of multiple logistic regression. Receiver operating curves were constructed to evaluate the performance of the models. A model with a sensitivity of 95% and specificity of 40% was considered clinically significant.

Results:

Positive findings on endoscopy were found in 191 (55%) of 346 and in 120 (59%) of 204 upper and lower endoscopies, respectively. Age above 13 years, vomiting, and hypoalbuminemia were significant predictors of positive upper endoscopies. Rectal bleeding, hypoalbuminemia, and elevated erythrocyte sedimentation rate were significant predictors of positive lower endoscopies. Extrapolating from the receiver operating curves, a sensitivity of 95% corresponded to a specificity of 10% for the upper endoscopy model and 30% for the lower endoscopy model.

Conclusions:

In our population of children and adolescents, several clinical characteristics were predictive of positive upper and lower endoscopy outcomes. Predictive models composed of these clinical variables were statistically, but not clinically, significant. The inclusion of additional clinical characteristics that could be assessed in prospective studies will likely improve the clinical significance of endoscopy outcome prediction.
20 Years of Scientific Training of Dutch Medical Students in an American Academic Division for Pediatric Gastroenterology and Nutrition: Impact on Career Development
Authors: Rings Edmond HHM , Escher Johanna C , Büller Hans A , Heymans Hugo SA
Published: March 2009

Objectives:

To evaluate the impact on career development of a program for scientific training of Dutch medical students in an American academic division for pediatric gastroenterology and nutrition.

Materials and Methods:

A survey was undertaken of medical students who were trained in the division of pediatric gastroenterology and nutrition at Tufts University and later at Children's Hospital, Harvard Medical School, Boston, MA. Characteristics of the students, the training period, the scientific output, and their career development were evaluated.

Results:

A questionnaire was sent to 54 students, of which 39 (72%) responded. The mean time of their rotation was 12.2 ± 12.1 months. Twenty‐five students published 33 scientific manuscripts. Fifteen students obtained a doctorate degree and 4 are involved in a doctorate program. Six theses were directly related to the scientific content of the rotation and were performed under the supervision of American mentors. A total of 59% of the students hold a position as medical specialist, which is a substantially higher percentage than the national average of all graduated medical doctors. Thirty‐five percent of them practice pediatrics (of whom 38% practice pediatric gastroenterology) and 22% practice gastroenterology. Seventy‐eight percent of the medical specialists hold an academic position.

Conclusions:

Dutch medical students who are scientifically trained in a US academic division for pediatric gastroenterology and nutrition—where specialists approached all of the students with a special program to involve them in biomedical research—have a great chance to establish a scientific career track and to become a medical specialist.
Validation of a Nutrition Risk Screening Tool for Children and Adolescents With Cystic Fibrosis Ages 2–20 Years
Authors: McDonald Catherine M
Published: March 2009

Objectives:

According to the 2002 Cystic Fibrosis (CF) Foundation nutrition consensus report, children with CF should grow normally. Cross‐sectional data from the foundation's patient registry concluded that a body mass index at or greater than the 50th percentile is associated with better lung function. A consistent, evidence‐based screening process can identify those individuals with CF having nutrition risk factors associated with a decrease in pulmonary function, target early intervention, and prevent further decline. A tool for screening nutrition risk is described to identify those children with CF who would benefit from more extensive nutrition intervention.

Methods:

The proposed screening tool is a risk‐based classification system with 3 categories: weight gain, height velocity, and body mass index. The CF Foundation recommendations regarding these parameters are incorporated, with risk points assigned when minimum body mass index, weight gain, and/or height gain standards are unmet.

Results:

An interrater measure of agreement determined a satisfactory level of reliability (κ = 0.85). Patient records (n = 85) were reviewed to determine nutrition status category (no risk or at risk) of this tool compared with the CF Foundation 2002 Nutrition Consensus, yielding sensitivity and specificity at 84% and 75%, respectively. A second comparison was made with combined, independent nutrition risk factors not included in the screening tool. The sensitivity and specificity of the screening tool compared with the combined risk factors were 86% and 78%, respectively.

Conclusions:

This tool for screening nutrition risk for CF is reliable and valid, with consistent, reproducible results, free from subject or observer bias.
Can Optimal Combinations of Local Foods Achieve the Nutrient Density of the F100 Catch‐up Diet for Severe Malnutrition?
Authors: Ferguson Elaine L , Briend André , Darmon Nicole
Published: March 2009

Objectives:

F100 is a fortified milk‐based food used as a standard therapy for severe malnutrition. Our aim was to assess whether optimal combinations of local foods in Ghana, Bangladesh, and Latin America could achieve the nutrient density levels of F100 and, if that was unachievable, to identify the key limiting nutrients.

Materials and Methods:

In all of the analyses, a published list of population‐specific foods (n = 59) and maximum food portions were used. The nutrient densities of individual foods were calculated to identify nutrient‐dense foods and potential limiting nutrients. The feasibility of formulating diets that achieved the nutrient density of F100, for each region individually and for all regions combined, was explored by the use of linear programming analysis (4 models), which minimized the total grams of food while respecting model constraints on diet energy and nutrients, phytate:zinc molar ratio, and maximum food portion sizes.

Results:

For vitamin E, riboflavin, zinc, and copper, fewer than 5 foods achieved the nutrient density of F100. All 4 linear programming model solutions were unfeasible, indicating that in all regions, community‐based home‐prepared rehabilitation diets for severely malnourished children will not achieve the nutrient densities of F100. In model solutions, the densities of vitamin E, riboflavin, zinc, copper, calcium, thiamin, and niacin were unachievable, indicating they are potential key problem nutrients.

Conclusions:

Optimal combinations of local foods are unlikely to achieve the nutrient density of F100, especially for vitamin E, riboflavin, thiamin, niacin, zinc, calcium, and copper. Before home‐prepared rehabilitation diets with nutrient densities lower than those of F100 are promoted, it is important to establish their clinical efficacy.
Sex, Psychosocial Factors, and Reported Symptoms Influence Referral for Esophagogastroduodenoscopy and Biopsy Results in Children With Chronic Abdominal Pain
Authors: Puzanovova Martina , Rudzinski Erin , Shirkey Kezia C , Cherry Rebecca , Acra Sari , Walker Lynn S
Published: March 2009

Objectives:

To identify symptoms and psychosocial factors that predicted referral for esophagogastroduodenoscopy (EGD) and discriminated between patients with positive versus negative biopsy findings.

Patients and Methods:

Children age 8 to 16 years old and parents completed validated questionnaires assessing gastrointestinal symptoms and psychosocial characteristics. Biopsy results of esophagus, stomach, and duodenum were reviewed.

Results:

From the total sample of 461 patients (mean age 11.87 years, 62% girls), 127 (28%) underwent EGD with biopsy (mean age 12.1 years, 57% girls). Upper abdominal gastrointestinal symptoms predicted EGD referral, and psychosocial characteristics did not. From the total of 127 patients who underwent EGD, complete biopsy results were available for 124 patients and were negative at all sites for 34.7% of patients (n = 43), equivocal for 20.2% (n = 25), and positive at 1 or more sites for 45.2% (n = 56). Boys were more likely than girls to have positive biopsy results (56.6% vs 36.6%, P < 0.03) because of the higher rate of positive esophageal biopsy results (47.2% vs 26.8%, P < 0.04). Among boys, vomiting (P < 0.02) and family stress (P < 0.04) predicted positive esophageal biopsy findings. Among girls, depressive symptoms predicted positive biopsy findings (P = 0.015).

Conclusions:

Upper abdominal symptoms, sex, stress, and depressive symptoms predict positive EGD biopsy findings in patients with chronic abdominal pain. Research on mechanisms linking these factors to mucosal damage in the gut is warranted.
Crypt Fission Peaks Early During Infancy and Crypt Hyperplasia Broadly Peaks During Infancy and Childhood in the Small Intestine of Humans
Authors: Cummins Adrian G , Catto‐Smith Anthony G , Cameron Donald J , Couper Richard T , Davidson Geoffrey P , Day Andrew S , Hammond Paul D , Moore David J , Thompson Fiona M
Published: March 2009

Background:

Postnatal growth of the small intestine occurs by crypt hyperplasia and by the less recognised mechanism of crypt fission. How the small intestine grows is largely extrapolated from animals and is poorly described in humans.

Aim:

To investigate crypt fission and crypt hyperplasia as mechanisms of intestinal growth in humans.

Patients and Methods:

Proximal intestinal samples were taken from 3 neonates at surgical anastomosis, and duodenal biopsies were taken at endoscopy from 16 infants (mean age 0.7, range 0.3–1.7 years), 14 children (mean age 7.9, range 2.4–16.2 years), and 39 adults. Morphometric measures of villous area, crypt length (measure of crypt hyperplasia), and percentage of bifid crypts (measure of crypt fission) were assessed by a microdissection technique.

Results:

Mean crypt fission rates in neonates, infants, children, and adults were 7.8%, 15%, 4.9%, and 1.7%, respectively. In particular, crypt fission peaked at 18% in 5 infants from 6 to 12 months of age. Mean crypt length was 123 μm in neonates, 287 μm in infants, 277 μm in children, and 209 μm in adults. Thus, crypt hyperplasia had a broad peak during infancy and childhood.

Conclusions:

We conclude that crypt fission was present predominantly during infancy, and crypt hyperplasia occurred during both infancy and childhood.
Association of Raised Liver Transaminases With Physical Inactivity, Increased Waist–Hip Ratio, and Other Metabolic Morbidities in Severely Obese Children
Authors: Lee Yung Seng , Kek Betty Lay Kee , Poh Larry Kok Seng , Saw Seang Mei , Loke Kah Yin
Published: March 2009

Objective:

To identify factors associated with raised alanine transaminase, aspartate transaminase, and γ‐glutaryl transferase in severely obese children

Patients and Methods:

In all, 201 children with early‐onset obesity and greater than 140% ideal weight for height were recruited. Anthropometric and body fat measurements, fasting blood tests, and oral glucose tolerance tests were performed.

Results:

The mean and standard deviation (SD) for age was 11.1 (3.0) years, for weight for height 170.5% (22.7%), and for percentage body fat was 40.7% (5.2%). Elevated liver transaminases were present in 53 subjects (26.4%), who were therefore at risk for nonalcoholic fatty liver disease, and was associated with male sex (odds ratio [OR] 2.144, 95% confidence interval [CI] 1.033–4.448), Chinese ethnicity (OR 2.062, 95% CI 1.038–4.096), reduced physical activity (OR 2.389, 95% CI 1.163–4.909), insulin resistance (P < 0.05), elevated triglyceride levels (P = 0.029), and increased waist–hip ratio (P = 0.005). Stepwise logistic regression analysis of the main factors as covariates revealed Chinese ethnicity, waist–hip ratio, reduced physical activity, and homeostasis model assessment index were significant predictors. Alanine transaminase/aspartate transaminase were not well correlated with percentage body fat and weight for height. Subjects with type 2 diabetes mellitus and impaired glucose tolerance were more likely to have raised hepatic transaminases (OR 6.176, 95% CI 1.326–28.754). The severity of metabolic syndrome correlated with increasing aspartate transaminase, alanine transaminase, and γ‐glutaryl transferase (P < 0.01).

Conclusions:

Insulin resistance, truncal adiposity, and physical inactivity are major determinants potentially modifiable to reduce risk of nonalcoholic fatty liver disease. Increasing physical activity levels were associated with decreasing insulin resistance and transaminases, despite lack of correlation with waist–hip ratio, which supports the direct benefit of regular physical activity in preventing nonalcoholic fatty liver disease.
Biliary Atresia: Swiss National Study, 1994–2004
Authors: Wildhaber Barbara E , Majno Pietro , Mayr Johannes , Zachariou Zacharias , Hohlfeld Judith , Schwoebel Marcus , Kistler Walter , Meuli Martin , Le Coultre Claude , Mentha Gilles , Belli Dominique , Chardot Christophe
Published: March 2009

Objectives:

To determine the epidemiology of biliary atresia (BA) in Switzerland, the outcome of the children from diagnosis, and the prognostic factors.

Patients and Methods:

The records of all patients with BA born in Switzerland between January 1994 and December 2004 were analyzed. Survival rates were calculated with the Kaplan‐Meier method, and prognostic factors evaluated with the log rank test. Median follow up was 58 months (range, 5–124).

Results:

BA was diagnosed in 48 children. Incidence was 1 in 17,800 live births (95% confidence interval 1/13,900–1/24,800), without significant regional, annual, or seasonal variation. Forty‐three children underwent a Kasai portoenterostomy (PE) in 5 different Swiss pediatric surgery units. Median age at Kasai PE was 68 days (range, 30–126). Four‐year survival with native liver after Kasai PE was 37.4%. Liver transplantation (LT) was needed in 31 in 48 children with BA, including 5 patients without previous Kasai PE. Four patients (8%, all born before 2001) died while waiting for LT, and 29 LT were performed in 27 patients (28 in Geneva and 1 in Paris). All of the transplanted patients are alive. Four‐year overall BA patient survival was 91.7%. Four‐year survival with native liver was 75% in patients who underwent Kasai PE before 46 days, 33% in patients operated on between 46 and 75 days, and 11% in patients operated on after 75 days (P = 0.02).

Conclusions:

Overall survival of patients with BA in Switzerland compares favorably with current international standards, whereas results of the Kasai operation could be improved to reduce the need for LTs in infancy and early childhood.
Intestinal Metabolism and Transport of Drugs in Children: The Effects of Age and Disease
Authors: Johnson Trevor N , Thomson Mike
Published: March 2009

The presence of cytochrome P450 enzymes in the small bowel results in the reduced bioavailability of several drugs. Recently, there has been much research on the interplay between these enzymes and transporter proteins such as P‐glycoprotein. Intestinal drug metabolism not only has an effect on drug disposition but also may have a role in protecting the host from xenobiotics. Although there is some information on how both the enzymes and transporters develop in the small bowel with age, there is little information regarding the clinical effects of these changes. In addition to developmental changes, the influence of gastrointestinal disease and nutrition are additional covariates in the intestinal metabolism of drugs.
Long‐term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic
Authors: Davies Yinka K , Cox Kathleen M , Abdullah Bisher A , Safta Anca , Terry Annie B , Cox Kenneth L
Published: March 2009

Background:

Primary sclerosing cholangitis is a rare chronic cholestatic condition of unknown etiology, frequently associated with inflammatory bowel disease and characterized by diffuse fibrosing and inflammatory destruction of the intra‐ and/or extrahepatic biliary duct system.

Patients and Methods:

The study involved 14 children with primary sclerosing cholangitis confirmed by either liver biopsy, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiogram. In each of the 14 cases, liver histology showed characteristic features consistent with primary sclerosing cholangitis. Eleven children had intrahepatic biliary beading and strictures (6 by endoscopic retrograde cholangiopancreatography; 5 by magnetic resonance cholangiogram). Biochemical tests of liver function including alanine aminotransferase, aspartate aminotransferase, and γ‐glutamyl transpeptidase and the erythrocyte sedimentation rate were elevated for a mean 17 ± 22 months before vancomycin treatment was initiated. All of the patients were shown to have inflammatory bowel disease histologically; 13 of those patients had clinical evidence of colitis. Oral vancomycin was given to all 14 patients.

Results:

All 14 patients showed improvement in their alanine aminotransferase (P = 0.007), γ‐glutamyl transpeptidase (P = 0.005), erythrocyte sedimentation rate (P = 0.008), and clinical symptoms with oral vancomycin treatment. There was less improvement noted in the patients with cirrhosis when compared with the patients without cirrhosis.

Conclusions:

Before this study, there has not been an effective long‐term treatment for sclerosing cholangitis to prevent the usual progression of this disease to cirrhosis. This study showed that oral vancomycin could be an effective long‐term treatment of sclerosing cholangitis in children, especially those without cirrhosis.
Celiac Disease
Authors: Polanco Isabel
Published: March 2009

Celiac disease is an immunologically mediated enteropathy of the small intestine, characterized by lifelong intolerance to the gliadin and related prolamines from wheat and other cereals, that occurs in genetically predisposed individuals. Symptoms result from structural damage to the mucosa of the small intestine, which may cause malabsorption with positive autoantibodies in the sera. Normal mucosal architecture is restored after the use of a gluten‐free diet and the normalization of the autoantibodies. Villous atrophy and high levels of autoantibodies reappear when gluten is reintroduced into the diet (gluten challenge).
Digestive, Hepatic, and Nutritional Manifestations in Latin American Children With HIV/AIDS
Authors: Velasco‐Benítez Carlos Alberto
Published: March 2009

The HIV/AIDS infection is increasing in Latin America and the Caribbean regions, according to the World Health Organization (WHO). In Latin America, most cases are in Brasil, Mexico, and Colombia. Some causes of the HIV/AIDS infection in Latin America are poverty, limitations on the access to antiretroviral drugs, poor response from governmental and health authorities, migration, and scantiness of research resources. In the pediatric population, perinatal transmission is the main contact mechanism. Several digestive, hepatic, and nutritional manifestations allow the classification of HIV infection in children, according to the Centers for Disease Control and Prevention. Improvement in knowledge of the epidemiology, pathogenesis, physiopathology; and management of HIV enteropathy and on nutritional care practices of infected HIV children is recommended.
Celiac Disease Pathogenesis: The Proinflammatory Cytokine Network
Authors: Garrote José Antonio , Gómez‐González Emma , Bernardo David , Arranz Eduardo , Chirdo Fernando
Published: March 2009

In susceptible individuals, the adaptive response, mediated by the activation of antigen‐specific T lymphocytes, drives a proinflammatory response, which ends in an immune‐mediated enteropathy characterized by villous atrophy, crypt hyperplasia, and recruitment of intraepithelial lymphocytes. In addition, some gluten peptides are able to induce an innate immune response in intestinal mucosa. The molecular mechanisms and the cells involved in the initial stages of the gluten–intestinal mucosa interaction are poorly understood to date. There is evidence of a direct toxic effect of gluten peptides in several biological models. However, the failure to control the inflammatory response may be one of the factors underlying gluten intolerance in these individuals. The cytokine network involved in celiac disease is characterized by abundant interferon‐γ in the intestinal mucosa. In addition, the production of interleukin (IL)‐15, IL‐18, and IL‐21 is linked to gluten intake, which can drive the inflammatory response probably sustained by IL‐18, IL‐21, and perhaps IL‐27 through STAT1 and STAT5 pathways, whereas neither IL‐12 nor IL‐23 plays a significant role in pathogenic mechanisms. Herein we describe the involvement of these activation pathways in the context of the pathogenesis of celiac disease.
Case of creeping disease treated with ivermectin
Authors: SENBA Yuko , TSUDA Kenshiro , MARUYAMA Haruhiko , KUROKAWA Ichiro , MIZUTANI Hitoshi , TANIGUCHI Yoshiki
Published: March 2009

We report a case of creeping disease treated successfully with ivermectin. A 46‐year‐old man presented with a 1‐month history of pruriginous linear erythema on his right thigh after a visit to Indonesia. Although he had no history of eating raw fish or meat, he walked along the river and in the jungle without wearing shoes. Creeping disease caused by animal hookworm was strongly suspected. The presence of parasite larvae was not confirmed in biopsied skin specimens. In enzyme‐linked immunosorbent assay, serum samples were negative for binding to hookworm antigens, including Ancylostoma canium, Necator americanus and Gnathostoma doloresi. He was treated with a single 12 mg oral dose (200 µg/kg) of ivermectin. The eruption and pruritus resolved within a few days after the administration and did not relapse.
Fluorescence navigation with indocyanine green for detecting sentinel nodes in extramammary Paget's disease and squamous cell carcinoma
Authors: TSUJINO Yoshio , MIZUMOTO Kazuo , MATSUZAKA Yuki , NIIHARA Hiroyuki , MORITA Eishin
Published: March 2009

The radioisotope navigation method, which has usually been used for identification of sentinel nodes, is less useful in locating sentinel nodes close to primary lesions in cases of extramammary Paget's disease because of overlapping radioactivity from the primary site. We applied fluorescence navigation with indocyanine green (ICG) in two patients with skin cancer to cover this defect. The use of a charge‐coupled device camera enabled real‐time visualization of dynamic lymph flow without skin incision. The inguinal skin over the identified sentinel node with a handheld gamma probe was in accordance with the point detected by ICG fluorescence in a patient with squamous cell carcinoma of the foot. Sentinel node biopsy using fluorescence navigation with ICG proved to be easy and reliable.
Case of cutaneous Scedosporium apiospermum infection successfully treated with voriconazole
Authors: MATSUMOTO Yuka , OH‐I Tsunao , NAGAI Ayako , OHYAMA Fuminori , OOISHI Tsuyoshi , TSUBOI Ryoji
Published: March 2009

We report a case of cutaneous infection due to Scedosporium apiospermum in a 75‐year‐old immunocompromised male patient who had received long‐term corticosteroid and immunosuppressant therapy for the treatment of nephrotic syndrome. The patient came to our department complaining of erythema with a number of pustules on the dorsal surface of the right hand. S. apiospermum was identified from a culture taken from the pus. After unsuccessful treatment with topical ketoconazole, oral itraconazole and oral terbinafine, the lesion quickly resolved with the daily administration of 400 mg voriconazole. No recurrence was observed despite discontinuation of voriconazole due to drug‐induced hepatitis. Voriconazole holds out the promise of an effective treatment for invasive Scedosporium infection.
Toll‐like receptor 4genetic diversity among pig populations
Authors: Palermo S. , Capra E. , Torremorell M. , Dolzan M. , Davoli R. , Haley C. S. , Giuffra E.
Published: March 2009

The transmembrane glycoprotein encoded by theToll‐like receptor 4gene (TLR4) acts as the transducing subunit of the lipopolysaccharide receptor complex of mammals, which is a major sensor of infections by Gram‐negative bacteria. As variation inTLR4may alter host immune response to lipopolysaccharide, the association betweenTLR4polymorphisms and immune traits of the respiratory and gut systems has important implications for livestock. Here, a sequence dataset from 259 animals belonging to commercial and traditional European pig populations, consisting of 4305 bp ofTLR4,including the full transcribed region, a portion of intron 2 and the putative promoter region, was used to explore genetic variation segregating at theTLR4locus. We identified 34 single nucleotide polymorphisms, 17 in the coding sequence and 17 in the non‐coding region. Five non‐synonymous mutations clustered within, or in close proximity to, the hypervariable domain of exon 3. In agreement with studies in other mammals, a major exon 3 haplotype segregated at high frequency in the whole sample of 259 pigs, while variants carrying non‐synonymous substitutions showed frequencies ranging between 0.6% and 8.7%. Although results on exon 3 provided suggestive evidence for purifying selection occurring at the porcineTLR4gene, the analysis of both coding and non‐coding regions highlighted the fact that demographic factors strongly influence the tests of departure from neutrality. The phylogenetic analysis ofTLR4identified three clusters of variation (ancestral, Asian, European), supporting the evidence of Asian introgression in European main breeds and the well documented history of pig breed domestication previously identified by mtDNA analysis.
Signet ring cells in fine needle aspiration cytology of breast carcinomas: review of the cytological findings in ten cases identified by histology
Authors: Kelten C. , Akbulut M. , Zekioglu O. , Kapkaç M. , Erhan Y. , Ozdemir N.
Published: March 2009

Objective:  To establish whether the presence of signet ring cells (SRCs) in histology sections of breast carcinoma cases was reflected by their presence in fine needle aspiration cytology (FNAC) smears, correlating to the histological type of breast carcinoma.

Methods:  We reviewed the FNAC findings of ten cases that had been diagnosed as primary breast carcinoma with SRCs on histological sections between 1998 and 2007. Slides and histological sections were obtained from the archives of Ege University Hospital.

Results:  FNA smears were reviewed for the following cytomorphological features: background, cellularity, architecture, nuclear pleomorphism and the presence of SRCs. The background was bloody in eight cases, necrotic in one, and clean in one. There was no mucinous material in any of the cases. Cellularity was prominent in five cases (hypercellular), moderate in three (cellular) and low in two (hypocellular). Loosely cohesive groups of tumour cells of varying size were observed in all cases. A plasmacytoid appearance to some of the tumour cells was seen in all cases and discohesive tumour cells were present in eight. Nuclear pleomorphism was high in six cases and moderate in four. SRCs were observed in seven of the ten cases. Two of these seven cases also had a tubular pattern and one had tumour giant cells.

Conclusions:  FNAC should be evaluated carefully regarding the presence of SRCs when cells with a plasmacytoid appearance are observed in either hyper‐ or hypocellular smears. The presence of single SRCs in FNACs with hypercellularity, high nuclear grade and tubular formation or tumour giant cells may be a clue in favour of ductal carcinoma. The presence of single SRCs in FNACs with hypocellularity and mild to moderate nuclear grade may be suggestive of lobular carcinoma. However, larger studies would be needed to establish the predictive value of the presence of SRCs on FNAC.
Distributional and demographic consequences of Pleistocene climate fluctuations for a marine demersal fish in the north‐eastern Atlantic
Authors: Larmuseau Maarten H. D. , Van Houdt Jeroen K. J. , Guelinckx Jef , Hellemans Bart , Volckaert Filip A. M.
Published: March 2009

Aim  The Pleistocene glaciations were the most significant historical event during the evolutionary life span of most extant species. However, little is known about the consequences of these climate changes for the distribution and demography of marine animals of the north‐eastern Atlantic. The present study focuses on the phylogeographic and demographic patterns of the sand goby, Pomatoschistus minutus (Teleostei: Gobiidae), a small marine demersal fish.

Location  North‐eastern Atlantic, Mediterranean, Irish, North and Baltic seas.

Methods  Analysis was carried out by sequencing the mtDNA cytochrome b gene of sand gobies from 12 localities throughout the species’ range, and using this information in combination with published data of allozyme markers and mtDNA control region sequences. Several phylogenetic methods and a network analysis were used to explore the phylogeographic pattern. The historical demography of P. minutus was studied through a mismatch analysis and a Bayesian skyline plot.

Results  Reciprocal monophyly was found between a Mediterranean Sea (MS) clade and an Atlantic Ocean (AO) clade, both with a Middle Pleistocene origin. The AO Clade contains two evolutionary significant units (ESUs): the Iberian Peninsula (IB) Group and the North Atlantic (NA) Group. These two groups diverged during Middle Pleistocene glacial cycles. For the NA Group there is evidence for geographic sorting of the ancestral haplotypes with recent radiations in the Baltic Sea, Irish Sea, North Sea and Bay of Biscay. The demographic histories of the Mediterranean Clade and the two Atlantic ESUs were influenced mainly by expansions dated as occurring during the Middle Pleistocene glaciations and post‐Eem, respectively.

Main conclusions  The pre‐LGM (Last Glacial Maximum) subdivision signals were not erased for P. minutus during the LGM. Middle Pleistocene glaciations yielded isolated and differently evolving sets of populations. In contrast to the case for most other taxa, only the northern Atlantic group contributed to the post‐glacial recolonization. The historical demography of Mediterranean sand gobies was influenced mainly by Middle Pleistocene glaciations, in contrast to that of the Atlantic populations, which was shaped by Late Pleistocene expansions.