bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Bilirubin and Plasma Lipid Profiles of Premature Infants Dependent on the Lipid Emulsion Infused?
Authors: Rubin Moshe , Naor Nora , Sirota Lea , Moser Asher , Pakula Ronit , Harell Daniella , Sulkes Jacqueline , Davidson Shmuel , Lichtenberg Dov
Published: January 2024

The effect of a lipid emulsion containing longchain triglycerides (LCT) and supplemented with L‐carnitine on plasma lipids and bilirubin in premature neonates on total parenteral nutrition was compared to that of lipid emulsions containing either LCT or a mixture of LCT and medium‐chain triglycerides (MCT). In a double‐blind randomized study 49 premature neonates received one of the three fat emulsions, given intravenously, over 16–20 h daily for 6 days. Plasma carnitine levels increased significantly in the supplemented group only; the addition of carnitine did not seem to affect any of the parameters studied. Mean plasma triglycerides rose by 193 and 199% in the carnitine‐supplemented and the LCT groups, respectively, and by 314% in the MCT/LCT group. On the sixth day of the study free fatty acids were significantly higher in the MCT/LCT group than in the other two groups. Plasma phospholipids and free cholesterol increased (p < 0.05) progressively in all groups and were correlated (r = 0.74, p < 0.001). At the end of the 6‐day study all groups showed a similar decline in free and total bilirubin levels despite the significant increase in plasma lipids and free fatty acids resulting from the stepwise increase in lipid load. No correlation was found between free fatty acids and free bilirubin. Since hyperbilirubinemia and hypertriglyceridemia appear to be clinically independent factors, the infusion of lipids should not be withheld from jaundiced infants on total parenteral nutrition.
Reliability of Short‐term Esophageal pH Monitoring Versus 24‐Hour Study
Authors: Costantini A. Barabino M. , Ciccone M. O. , Pesce F. , Parodi B. , Gatti R.
Published: January 2024

The child's discomfort and the cost of overnight hospitalization are clear disadvantages of prolonged esophageal pH monitoring. The aim of this study was to verify the reliability of short recording versus 24‐h testing in a pediatric series with symptoms suggestive of gastro‐esophageal reflux (GER) disease. A 24‐h pH monitoring performed on 160 patients with either gastroenterological symptoms (n = 61), respiratory problems (n = 58), or emesis plus respiratory problems (n = 41) was reviewed. Regardless of clinical presentation, children were also classified according to age: <12 months (n = 39), 12–71 months (n = 81), and 72–168 months (n = 40). A diurnal fraction of 6 h, including at least 2 h after a meal, was compared to the entire 24‐h recording in all groups with respect to the reflux index (RI) (sum of the periods with pH <3.9 expressed as percentage of time) and reflux/h. RIs of > 10% were considered positive in patients < 1 year of age, whereas RIs of >5% were considered positive in other age groups. Negative predictive values of the short recording RI ranged from 71 to 90%. Positive predictive values ranged from 50 to 83%; it was unreliable for children <12 mos (50%) and patients with emesis plus respiratory problems (64%), who were, significantly, the youngest. Reflux/h values were not in agreement for the same groups. Absence of agreement was found if the absolute value of RI was considered. In conclusion, our data show that short‐term recordings may be used as an ambulatory screening test for GER in selected children, being unreliable for patients <1 year of age and for those presenting with both gastroenterological and respiratory symptoms.
Effectiveness of Nasogastric Rehydration in Hospitalized Children with Acute Diarrhea
Authors: Gremse David A.
Published: January 2024

The American Academy of Pediatrics recommends oral rehydration and early refeeding for management of infants with diarrhea and mild to moderate dehydration. However, intravenous rehydration is still widely used for treatment of infants hospitalized for dehydration. The administration of oral rehydration solution via continuous infusion through a nasogastric tube facilitates its delivery in hospitalized children. The purpose of this study is to compare intravenous and nasogastric rehydration in children hospitalized for mild to moderate dehydration. Infants who failed attempts at oral rehydration and were hospitalized for dehydration due to acute diarrheal illness were randomized to receive intravenous or nasogastric rehydration. Following rehydration, infants received soy formula and a maintenance oral electrolyte solution to replace ongoing stool losses, as directed by the attending physician. Patients were discharged from the hospital once oral feeding was tolerated, and the vomiting and diarrhea resolved. Twenty‐four patients, from 2 to 19 months of age, were enrolled in the study. Rehydration was successful in 11 of 12 patients in the nasogastric rehydration group and in all 12 patients who received intravenous rehydration. The degree of dehydration, severity of vomiting and diarrhea, and duration of rehydration were similar in both groups. The duration and cost of hospitalization were less for patients receiving nasogastric rehydration compared to those who were rehydrated intravenously. Rehydration by infusion of oral rehydration solution via a nasogastric tube is a safe and effective treatment for infants with mild to moderate dehydration. Rehydration with infusion of oral rehydration solution through a nasogastric tube should be considered for in‐patient management of infants with diarrhea.
Effect of Early Dietary Deficiency in Polyunsaturated Fatty Acids on Two Lectin Binding Sites in the Small Intestine of Postweanling Rats
Authors: Alessandri J‐M , Joannic J‐L , Delpal S. , Durand G.
Published: January 2024

This study was designed to determine whether dietary lipids influence the development of intestinal cell glycosylation, in relationship to diet‐induced changes in phospholipid fatty acid composition. The ability of two different lectins, wheat germ agglutinin (WGA) and Maackia amurensis agglutinin (MAA), to combine specifically with particular carbohydrate residues was used to investigate the surface characteristics of epithelial cells of rats fed different dietary lipids from birth to 6 weeks of age. Diets contained 5% (weight) peanut oil (PO), rich in n‐6 fatty acids; salmon oil (SO), rich in n‐3 fatty acids; hydrogenated palm oil (HPO), deficient in both n‐6 and n‐3 fatty acids or a PO and rapeseed oil (RO) mixture (PRO), the control diet. Pieces of jejunal and ileal villi were excised from postweanling rats and prepared for lectin histochemical study. Concurrently, epithelial cells were removed from jejunal and ileal segments for determining their phospholipid fatty acid compositions. Polyunsaturated fatty acid (PUFA) deficiency was evidenced in the HPO group by the appearance of eicosatrienoic acid (20:3n‐9) in both jejunal and ileal phospholipids, which paralleled the decrease in arachidonic acid content. Accretion of 18: ln‐9 and 20:3n‐9 in cell phospholipids of group HPO was not sufficient to match the unsaturation level in rats fed nonhydrogenated vegetable oils (PRO, PO) or fish oil (SO). The lectin histochemical study showed that WGA strongly labelled the brush border membrane microvilli whereas binding of MAA was specific to goblet cells and mucus. Regardless of the type of diet, WGA binding was weaker in the ileum than in the jejunum. In comparison to all other groups, WGA‐labelling of villi was less intense in the jejunum and disappeared almost completely in the ileum of HPO‐fed rats. Although SO‐ and PO‐fed rats had, respectively, very low and high ratios of n‐6 to n‐3 in their intestinal phospholipids, binding of WGA in both groups was not markedly different from that in the control (PRO). MAA‐labelling was very intense in jejunal and ileal villi of n‐3‐fed (SO) rats, whereas it was strongly attenuated in the n‐3− and n‐6 deficient (HPO) group. These results suggest that intestinal glycosyltransferase activities involved in cell differentiation were altered relative to the overall unsaturation index of dietary fatty acids. Alterations of epithelial glycosylation mainly resulted from a drop in total n‐6 and n‐3 fatty acids, although it may be speculated that there is a specific effect of n‐3 fatty acids.
Aminosyn PF or Trophamine
Authors: Forchielli M. Luisa , Gura Kathleen M. , Sandler Richard , Lo Clifford
Published: January 2024

Summary: Cholestasis often occurs in infants on total parenteral nutrition (TPN) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against cholestasis associated with total parenteral nutrition (CATPN). The development of cholestasis may also be caused by other risk factors such as prematurity, surgery, sepsis, and extracorporeal membrane oxygenation (ECMO). To evaluate the relative effectiveness of the pediatric amino acid formulations in reducing CATPN, the courses of 70 infants < 1 year of age who received TPN for at least 14 days were reviewed. Cholestasis was defined as a conjugated scrum bilirubin ≥ 2 mg/dl subsequent to the initiation of TPN; CATPN was considered present when other factors related to cholestasis were ruled out. Liver function tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholestasis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, while 15 (21.4%) developed cholestasis secondary to other factors. Of the 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosyn PF, and 2 had received both solutions. Aminosyn PF and Trophamine, along with other potential risk factors for CATPN such as antecedent surgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were analyzed by regression‐analysis methods. None was statistically significant except the length of TPN (p = 0.0063). In conclusion, we cannot support the view that Trophamine is more effective than Aminosyn PF in the prevention of CATPN.
Cyclical Vomiting Syndrome in Children
Authors: Abu‐Arafeh Ishaq , Russell George
Published: January 2024

Summary: We studied the prevalence and the characteristic features of cyclical vomiting syndrome (CVS) in the defined childhood population of the City of Aberdeen, in Scotland. Initial screening was done by questionnaire in 10% of all children between 5 and 15 years of age (2,165 children) attending schools in Aberdeen, followed by clinical interviews of symptomatic children. We invited for clinical interview 69 children (3.9%) with a history of unexplained vomiting; 46 (67%) attended. Of them, 34 fulfilled the criteria for the diagnosis of CVS (prevalence rate, 1.9%). Children with CVS had a mean age of 9.6 years and a mean age at onset of symptoms of 5.3 years (range, 1–13). The overall sex ratio was 1:1, although in younger children boys were more commonly affected than girls. Seven children (21%) also suffered from migraine, 10 (29%) from travel sickness, and 10 (29%) from atopic diseases. The attacks of vomiting occurred on average eight times per year, with a mean duration of 20 h. Travel was a frequent precipitating factor. Attacks were commonly associated with pallor, anorexia, and malaise and were often relieved by rest and sleep. The clinical features of CVS overlapped to a large extent with those of migraine, suggesting a common pathogenesis. Features common to both conditions included trigger factors, associated GI, sensory, and vasomotor symptoms, and factors that relieved attacks. There was also an association between CVS and headache, abdominal pain, atopic diseases, and travel sickness.
Normal Ranges of Continuous pH Monitoring in the Proximal Esophagus
Authors: Bagucka Beatrise , Badriul Hegar , Vandemaele Kris , Troch Elie , Vandenplas Yvan
Published: January 2024

Background

To determine normal ranges of gastroesophageal reflux (GER) in the proximal esophagus, measured with continuous pH monitoring. Normal ranges in the distal esophagus have been published. Because esophageal pH monitoring is frequently performed in children with atypical manifestations such as chronic respiratory disease, and because one of the possible pathophysiologic mechanisms may be (micro‐)aspiration, it may be relevant to establish normal ranges in the proximal esophagus.

Methods

Twenty‐four‐hour pH monitoring was performed in 200 children with suspected GER disease. The mean age of the patients was 4.5 months (range, 0.5–17.0 months). After initial analysis, patients were divided into three groups according to the reflux index (RI) in the distal esophagus, because it could be speculated that the amount of reflux reaching the proximal esophagus depends on the amount of reflux in the distal esophagus: Group I (n:120) children had a distal RI of less than 5% and were considered normal, group II (n:50) had a distal RI of 5% to 10% and was considered to have intermediate disease, and group III (n:30) had a distal RI of more than 10% and was regarded as pathologic. The following parameters are calculated: the RI, the total number of reflux episodes, the number of reflux episodes lasting more than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT).

Results

The median RI in the distal esophagus was 3.8 ± 0.34 (standard error of the mean [SEM]), and in the proximal esophagus, the RI was 1.2 ± 0.23. In group I patients, the RI in the proximal esophagus was 0.5% ± 0.09%, in group II the RI increased significantly to 2.75% ± 0.34% (P [group I compared with group II] < 0.01), and in group III the RI was 6.15% ± 0.96% (P [II‐III] < 0.01). The number of acid reflux episodes in group I was 17.0 ± 2.27, in group II the number increased to 62.5 ± 8.18 (P [I‐II] < 0.01), and in group III it reached 102.0 ± 23.9 (P [II‐III] < 0.05). Also the duration of the longest reflux episodes and the number of reflux episodes lasting more than 5 minutes increased from group I to group II, and from group II to group III. The ACT was shorter in the proximal esophagus (group I 0.3 ± 0.06 minutes; group II 0.48 ± 0.07 minutes, P [I‐II] = not significant [NS]; group III 0.56 ± 0.17 minutes P [II‐III] = NS) than in the distal esophagus (group I 0.49 ± 0.03 minutes, P [proximal ACT compared with distal ACT] < 0.05; Group II 0.76 ± 0.05 minutes, P [proximal‐distal] < 0.01; Group III 0.89 ± 0.09 minutes, P [proximal‐distal] = NS) suggesting more effective esophageal clearance in the proximal esophagus.

Conclusions

Protection of the proximal esophagus from acid reflux is significantly related to the incidence and duration of reflux measured in the distal esophagus. These normal ranges in the upper esophagus will be helpful in the interpretation of upper esophageal pH monitoring data.
Effect of a Water‐Soluble Fiber (Galactomannans)‐Enriched Formula on Gastric Emptying Time of Regurgitating Infants Evaluated Using an Ultrasound Technique
Authors: Fabiani Elisabetta , Bolli Valeria , Pieroni Giovanni , Corrado Giovanni , Carlucci Antonio , De Giacomo Costantino , Catassi Carlo
Published: January 2024

Background

Milk formulas enriched with water‐soluble fibers are a first‐line measure for infants with gastroesophageal reflux. However, it has been reported that these compounds could affect gastric emptying. The aim of this study was to evaluate the effects of these thickeners on gastric emptying time in infants with frequent regurgitation or vomiting.

Methods

Forty‐seven infants, aged 1 to 12 months, with uncomplicated gastroesophageal reflux underwent two ultrasound evaluations of gastric emptying time after receiving either a standard formula or a formula enriched with 0.4 g galactomannan per 100 ml diluted milk. Gastric emptying time was calculated by measuring the antrum area at baseline and at defined intervals over the next 3 hours.

Results

The gastric emptying time (mean ± SD) for the standard and the thickened formula was 136 ± 33 and 133 ± 34 minutes, respectively. There was no significant difference in the gastric emptying patterns of the two formulas. Gastric emptying time was longer after the standard formula in 15 of the 47 subjects, shorter in 15 of the 47, and the same in 17 of the 47.

Conclusions

The ingestion of a water‐soluble fiber‐enriched formula does not have any significant influence on the gastric emptying time of infants with frequent regurgitation or vomiting.
Evoked Potentials for the Evaluation of Latent Hepatic Encephalopathy in Pediatric Liver Transplant Candidates
Authors: Nora Daniel B. , Amaral Olavo B. , Busnello João V. , Quevedo João , Vieira Sandra , da Silveira Themis R. , Kapczinski Flávio
Published: January 2024

Background

Visual evoked potentials (VEPs) and brain stem auditory evoked potentials (BAEPs) have been proposed as tools in the diagnosis of subclinical hepatic encephalopathy (HE). However, little information exists to determine their usefulness in pediatric patients. This study was undertaken to evaluate both methods in the detection of subclinical HE in pediatric liver transplant candidates.

Methods

VEPs and BAEPs were recorded in 15 pediatric liver transplant candidates with no clinical signs of HE. The wave latencies found in these examinations were then compared with those in 16 healthy controls of similar age. Laboratory data on liver function and electroencephalographic data from the patients were also recorded to examine their correlation with the evoked potentials results.

Results

No differences were found in the BAEP results between patients and controls. However, in the VEPs, the liver transplant candidates had significantly prolonged N1 (N75) latencies when compared with controls; no significant delay was found in the other waves. In contrast, among the children with liver disease, higher BAEP peak latencies correlated positively with electroencephalographic abnormalities, but this correlation was not observed in VEPs.

Conclusions

Evoked potentials might be of use in detecting alterations related to HE in children. However, further studies are necessary to determine their sensitivity and specificity in this situation.
Helicobacter pylori Infection in Children of Texas
Authors: Opekun Antone R. , Gilger Mark A. , Denyes Susan M. , Nirken Milton H. , Philip Soman P. , Osato Michael S. , Malaty Hoda M. , Hicks John , Graham David Y.
Published: January 2024

Background

Acquisition of the Helicobacter pylori infection usually occurs in childhood. The prevalence of infection differs among ethnic groups and in adults is inversely related to the socioeconomic status of the individual's family during childhood. This study investigates the seroprevalence of H. pylori infection in children of different ethnic groups in relation to socioeconomic class and investigates the prevalence of acute H. pylori infection among children who have had recent onset of abdominal pain.

Methods

Serum samples were collected from 797 children, aged 6 months to 18 years, of various socioeconomic and ethnic backgrounds, at a large urban children's hospital. H. pylori status was determined by an anti‐H. pylori immunoglobulin (Ig)G enzyme‐linked immunosorbent assay (ELISA) validated for pediatric use. To determine the prevalence of acute H. pylori infection, children brought to the emergency center with abdominal symptoms without diarrhea and overt signs of acute abdomen were evaluated with both serology and the 13C‐urea breath test. Acute H. pylori was defined as a positive 13C‐urea breath test result and negative IgG serology for H. pylori.

Results

The overall seroprevalence of H. pylori was 12.2% and increased with age (e.g., 8.3% at 6–11.9 months and 17.9% at 13 years). The prevalence was inversely related to socioeconomic status (6.6%, moderate to high vs. 15%, low socioeconomic status). The difference in seroprevalence among blacks (16.8%), Hispanics (13.3%), and whites (8.3%;P < 0.01) could be accounted for by differences in socioeconomic status. Eighteen percent of children who were evaluated at the emergency center for recent‐onset abdominal pain had acute H. pylori infections.

Conclusions

Socioeconomic status, not ethnic group, is the more important risk factor for acquisition of H. pylori infection during childhood. Acute H. pylori infection was a relatively common cause of recent‐onset, nonsurgical abdominal pain.
Celiac Disease in Children and Adolescents with Type I Diabetes: Importance of Hypoglycemia
Authors: Mohn Angelika , Cerruto Marina , Iafusco Dario , Prisco Francesco , Tumini Stefano , Stoppoloni Ornella , Chiarelli Francesco
Published: January 2024

Background

Symptomatic hypoglycemia is an unavoidable problem in the treatment of type I diabetes. Celiac disease is associated with malabsorption and may therefore represent an important risk factor.

Methods

The frequency of symptomatic hypoglycemia in patients with type I diabetes and celiac disease (cases) was compared with those of patients who had diabetes without celiac disease (controls). For this purpose, each case was matched for age, sex, and duration of disease with one to two control patients. Indices of metabolic control (hemoglobin [Hb]A1c, frequency of hypoglycemia, and total insulin requirement) were retrieved for the 18 months before and after diagnosis of celiac disease.

Results

Eighteen patients (6 males and 12 females) had diagnosed celiac disease and were matched with 26 control patients (10 males and 16 females). There was no difference in age (11.0 years; range, 1.8–21.9 vs. 13.1 years; range, 2.3–22;P = 0.3) and duration of disease (8.4 years; range, 1.2–19.3 vs. 8.3 years; range, 1.1–18.7;P = 0.3) between the two groups. During the 6 months before and after diagnosis of celiac disease the cases had significantly more hypoglycemic episodes than the controls (means ± SD; 4.5 ± 4 vs. 2.0 ± 2.2 episodes/months, P = 0.01). This was reflected by a progressive reduction in insulin requirement over the 12 months before diagnosis reaching a nadir at time 0 (0.6 ± 0.2 vs. 0.9 ± 0.3, P = 0.05).

Conclusion

These data suggest that underlying celiac disease is associated with an increased risk of symptomatic hypoglycemia and that the introduction of a gluten‐free diet with normalization of the intestinal mucosa may reduce its frequency.
Assessment of Gliadin in Supposedly Gluten‐Free Foods Prepared and Purchased by Celiac Patients
Authors: Sdepanian Vera Lucia , Scaletsky Isabel Cristina Affonso , Fagundes‐Neto Ulysses , de Morais Mauro Batista
Published: January 2024

Background

The present study was designed to evaluate the presence of gliadin in homemade foods prepared by patients with celiac disease and/or their relatives, as well as in processed products consumed by such patients in São Paulo, Brazil, by enzyme immunoassay (EIA) and Western blot (WB) analysis.

Methods

One hundred ninety samples were analyzed: 108 homemade foods prepared in homes of patients with celiac disease, 81 processed products, and 1 positive control of homemade food. All samples were analyzed by EIA based on monoclonal antibodies to heat stable ω‐gliadins and related prolamins from wheat, rye, and barley. Samples were also analyzed using the WB technique.

Results

Only one (0.9%) of 108 homemade foods contained detectable amounts of gliadin, as determined by EIA. Twelve of 81 processed products contained gliadin by EIA, as follows: 5 of 61 without gluten listed in the ingredients, 2 of 11 malt extracts, 1 of 2 wheat starches, 1 of 2 types of beer, and all 3 positive control products. Gliadin content of these products was between 4 and 10 mg of gliadin/100 g of product, except for the wheat starch sample (28 mg of gliadin/100 g) and all 3 samples with gluten (>4000 mg of gliadin/100 g). The positive control of homemade food contained 152 mg of gliadin/100 g. One hundred three of 190 samples were analyzed by WB, and 21 of these were gliadin positive. A comparison of results obtained by EIA and WB showed no statistical differences between the methods.

Conclusions

The greater part of the foods prepared in homes of patients with celiac disease and most processed products supposed to be gluten‐free did not contain gliadin. Therefore, celiac patients adequately prepare gluten‐free homemade food and have the expertise to purchase processed gluten‐free food in São Paulo, Brazil.
Insulin‐Like Growth Factors and Leucine Kinetics During Exercise Training in Children With Cystic Fibrosis
Authors: Gulmans Vincent , van der Laag Johannes , Wattimena Darcos , van Doorn Jaap , Oostveen Dorothe , Berger Ruud , de Meer Kees
Published: January 2024

Background

Little is known about the metabolic effects of exercise training in children with cystic fibrosis. The hypothesis for the current study was that in patients with declining clinical status, exercise increases circulating insulin‐like growth factors (IGFs) and improves protein kinetics.

Methods

This was a prospective intervention study in 10 children with cystic fibrosis who participated in a structured isoenergetic exercise (cycling) training program for 3 months. Measurements of IGFs, protein kinetics (using intravenous [13C]‐1‐leucine tracer infusions) and nutritional balance studies were conducted at baseline and after 3 months.

Results

Standard deviation scores of plasma IGF‐I, IGF‐II, and IGF binding protein (BP)‐3 were all decreased at baseline (mean ± SE: −2.0 ± 0.2, −2.0 ± 0.2, −0.6 ± 0.2, respectively). IGF‐I and IGF‐II concentrations were significantly higher after exercise training (standard deviation scores −1.4 ± 0.3 and −1.3 ± 0.1, respectively; compared with baseline: one‐tailed t‐test P = 0.03 and 0.002). The standard deviation score of the IGF‐I/IGF BP‐3 ratio, an indicator of free IGF‐I in the circulation, normalized during exercise training (0.0 ± 0.6 vs. −1.3 ± 0.2 SD units at baseline, one‐tailed t‐test P = 0.04). There was no significant difference in protein intake and fasting protein breakdown, oxidation, and protein synthesis or in energy balance and fat absorption.

Conclusions

These results show that isoenergetic exercise training can be safely recommended to patients with cystic fibrosis. It provides a positive anabolic stimulus to IGF status but is not sufficient to adequately augment protein accretion in patients with diminished nutritional status.
Enteropathogenic Escherichia coli Strain RDEC‐1 Produces a Novel Electrogenic Factor Active on Rabbit Ileum In Vitro
Authors: Raimondi Francesco , Kaper James B. , Boedeker Edgar C. , Wolf Marcia K. , Guandalini Stefano , Fasano Alessio
Published: January 2024

Background

Attaching and effacing Escherichia coli demonstrate marked species specificity in inducing diarrhea, although its mechanism remains largely unclear. The purpose of this study was to investigate the existence of a soluble, species‐specific factor that induces diarrhea in an in vitro model.

Methods

Stripped rabbit ileum was mounted in Ussing chambers, and changes in potential difference and short‐circuit current were monitored after the addition of bacterial culture supernatant.

Results

The culture supernatant from rabbit‐specific strain RDEC‐1, but not from human‐specific enteropathogenic Escherichia coli strain E2348/69, induced an increase in potential difference and short‐circuit current in rabbit ileum mounted in Ussing chambers. This electrical signal was related to chloride ion secretion, was absent in colonic tissue, and was retained in the 30 to 100‐KDa fraction of the supernatant. Preliminary experiments failed to show an involvement of calcium or cyclic nucleotides as intracellular messengers. RDEC‐1 cured of a 42‐MDa plasmid lost the enterotoxicity whereas conjugation of the plasmid into the negative E. coli recipient HB101 resulted in the expression of toxicity.

Conclusions

The authors describe a novel, species‐specific factor that helps to explain RDEC‐1 diarrhea, which may be relevant to the pathogenesis of enteropathogenic Escherichia coli infection.
Wide Variety of Genotypes and Geographic Origins of Hepatitis B Virus in Belgian Children
Authors: Liu Hsin‐Fu , Sokal Etienne , Goubau Patrick
Published: January 2024

Background

Belgium is a country with low endemicity for hepatitis B virus (HBV) infection. Few data are available on genotypes or serotypes of HBV among infected children.

Methods

The S region of the hepatitis B virus genome was amplified and sequenced in 23 children treated with interferon‐α in Belgium. Nucleotide sequences were aligned and compared with other known sequences in a phylogenetic analysis.

Results

A high stability of the S gene was observed during treatment. Four genotypes were represented in this sample of Belgian patients (A, B, D, and E), reflecting the geographic diversity of origins.

Conclusions

In this series, the wide variety of geographic origins is confirmed by the molecular characteristics of HBV. In Belgium, HBV infection of children is currently essentially an imported infection.
Extensive and Partial Protein Hydrolysate Preterm Formulas: The Effect on Growth Rate, Protein Metabolism Indices, and Plasma Amino Acid Concentrations
Authors: Szajewska Hania , Albrecht Piotr , Stoińska Bogumila , Prochowska Anna , Gawecka Agnieszka , Laskowska–Klita Teresa
Published: January 2024

Background

The use of protein hydrolysate preterm formulas is restricted because data on their nutritional adequacy are scarce. The authors evaluated the rate of growth and indices of protein metabolism in low‐birth weight infants fed extensive and partial protein hydrolysate preterm formula followed for 12 weeks.

Methods

A total of 61 low‐birth weight infants were assigned randomly to receive extensive protein hydrolysate preterm formula (EH; n = 16), partial protein hydrolysate preterm formula (PH; n = 15), and standard preterm formula (SF; n = 15), or were fed their own mother's fortified breast milk (FBM; n = 15). The infants were investigated at study entry, and at 4, 8, and 12 weeks after study entry.

Results

There were no differences with respect to growth rate (weight gain, increments in length and head circumference), urea, albumin, prealbumin, transferrin, and plasma amino acid concentrations (except for tyrosine on a single occasion) according to the degree of hydrolysis. There were also no differences between groups fed hydrolyzed formulas and SF. However, several differences were found when EH and PH were compared with FBM. Weight gain from the entry to 12 weeks, serum urea at 12 weeks, and total plasma essential amino acids at 8 weeks were significantly higher in groups fed EH and PH than in those fed FBM. In addition, valine was significantly higher in groups fed PH (P < 0.05) than in the group fed FBM at 8 and 12 weeks, tyrosine was higher in EH and PH in comparison with FBM at 4 weeks, and in PH versus FBM at 12 weeks after study entry.

Conclusions

This study suggests that experimental EH and PH are at least nutritionally equivalent to SFs.
Parenteral Multivitamin Supplementation Induces Both Oxidant and Antioxidant Responses in the Liver of Newborn Guinea Pigs
Authors: Chessex Philippe , Lavoie Jean‐Claude , Laborie Sophie , Rouleau Thérèse
Published: January 2024

Background

The multivitamin solution is a major component of photo‐induced generation of peroxides in parenteral nutrition. The aim of this study was to determine whether the parenteral multivitamin preparation induces in the liver a peroxide‐induced oxidant challenge or an antioxidant protection associated with the antiradical components of the solution.

Methods

Newborn guinea pigs were infused with dextrose supplemented with peroxides (250 μmol/L H2O2 or 350 μmol/L tert‐butylhydroperoxide) or with a multivitamin preparation (MVP, 1% vol/vol). After 4 days, total glutathione and a free radical–sensitive eicosanoid marker (prostaglandin I2 [PGI2]/total prostaglandins) were measured in livers.

Results

There was a significant decrease in the PGI2/total prostaglandin ratio (mean ± SEM ) [dextrose: 0.068 ± 0.007 vs. (dextrose + H2O2: 0.048 ± 0.001, dextrose + TBH: 0.043 ± 0.001)] and glutathione concentrations decreased [dextrose: 55 ± 7 vs. (dextrose + H2O2: 37 ± 7, dextrose + TBH: 18 ± 7 nmol/mg protein)] after infusion of peroxides. Despite the peroxide load in the multivitamin solution, it did not alter the measured variables as prostanoid ratio remained at control concentrations (dextrose: 0.066 ± 0.008 vs. dextrose + MVP: 0.065 ± 0.006), as did glutathione levels (dextrose: 52 ± 6 vs. dextrose + MVP: 45 ± 7 nmol/mg prot).

Conclusion

In the liver of guinea pig pups, infused peroxides cause oxidation of membrane‐derived prostanoids. The decrease in glutathione in response to administration of peroxides suggests consumption rather than a response to a free radical attack. Despite the oxidant load associated with peroxides generated in MVP, the multivitamin preparation protected membranes as the prostanoid ratio, and glutathione levels remained at control levels.
Upper Gastrointestinal Mucosal Disease in Pediatric Crohn Disease and Ulcerative Colitis: A Blinded, Controlled Study
Authors: Tobin Jacinta M. , Sinha Bidisa , Ramani Pramila , Saleh Abdul R. H. , Murphy M. Stephen
Published: January 2024

Background

Upper gastrointestinal endoscopic biopsies often show histologic abnormalities in Crohn disease. Consequently, it has been proposed that routine endoscopy could help to distinguish Crohn disease from ulcerative colitis. Surprisingly, however, recent case reports and an uncontrolled study suggested that similar abnormalities may occur in ulcerative colitis. Therefore, a blinded, controlled study was performed.

Methods

Esophageal, gastric antral, and duodenal biopsies from children with Crohn disease (n = 28) and ulcerative colitis (n = 14) were compared with those from controls undergoing endoscopy for suspected reflux esophagitis (n = 22). Two pathologists, unaware of patient identity and diagnosis, agreed on a consensus report. Severity of inflammation was scored semiquantitatively. Helicobacter pylori colonization was an exclusion criterion.

Results

Inflammation was reported as follows: esophagitis: controls 91%; Crohn disease: 72%; ulcerative colitis: 50%; gastritis: controls: 27%; Crohn disease: 92% (P < 0.001); ulcerative colitis: 69%; duodenitis: controls: 9%; Crohn disease: 33%; ulcerative colitis: 23%. In Crohn disease, granulomas were noted in 40% of patients (P = 0.001). Duodenal cryptitis was noted in 26% of patients with Crohn disease but not ulcerative colitis. In one patient with ulcerative colitis, neutrophilic infiltration of gastric glands was seen. Abnormalities seen in Crohn disease and ulcerative colitis included gastroduodenal ulceration (Crohn disease, 7%; ulcerative colitis, 8%), villus atrophy (Crohn disease, 11%; ulcerative colitis, 15%), and increased intraepithelial lymphocytes (Crohn disease, 15%; ulcerative colitis, 31% [P < 0.05]). None of these abnormalities was noted in the controls.

Conclusion

Although the presence of granulomas can support a diagnosis of Crohn disease, severe inflammation and other abnormalities occur in the proximal gastrointestinal tract in Crohn disease and ulcerative colitis.
Higher Serum Eosinophil Cationic Protein Levels in Children with Cow's Milk Allergy
Authors: Hidvégi Edit , Cserháti Endre , Kereki Erzsébet , Arató András
Published: January 2024

Background

In the pathogenesis of cow's milk allergy, abnormal immunologically mediated reactions play a basic role. Eosinophil activation also participates in the development of several allergies. The purpose of this study was to characterize the degree of this activation by measuring the serum level of eosinophil cationic protein (sECP) and establishing whether it is a useful parameter in monitoring oral cow's milk allergy.

Methods

The sECP level of 35 patients with previously confirmed cow's milk allergy (mean age, 16 months) was evaluated using a fluoroimmunoassay before the cow's milk rechallenge test and at 2 hours and 24 hours after cow's milk challenge.

Results

Of the 35 children with previously confirmed cow's milk allergy, 10 had positive clinical reactions after the milk rechallenge test, whereas 25 children had no reaction. The median sECP level of all the patients before the challenge test was significantly higher (12.4 μg/L) than that of the control group (4.3 μg/L) (P < 0.05). Two hours after the challenge, the median sECP of all patients (9.4 μg/L) was lower than the starting values. The median sECP levels were higher in children with positive challenge test results at all time points. However, this difference was not statistically significant.

Conclusions

The normalization of sECP level may indicate the cessation of the cow's milk allergy. Therefore, the measurement of sECP may be helpful in determining the optimal time in which to repeat the challenge test, when the result will more likely be negative. The significant decrease of the sECP level 2 hours after the beginning of milk challenge test may be explained by the fact that this protein is excreted into the intestinal lumen.
Baterial Translocation in Humans
Authors: Lichtman Steven M.
Published: January 2024

Bacterial translocation is a phenomenon in which live bacteria cross the intestinal barrier. The definition may be broadened to include transmural passage of bacterial cell wall components such as lipopolysaccharide and peptidoglycan polysaccharide. After translocation, bacteria or their products reach the mesenteric lymph nodes. From there, it is possible that enteric bacteria, their cell wall components, or both may disseminate throughout the body, causing sepsis, shock, multisystem organ dysfunction, or death of the host. Bacterial translocation and its complications have been shown clearly to occur in animal models, but its existence and importance in humans has been difficult to ascertain. The purpose of this review is to evaluate the data from studies in humans on the occurrence of bacterial translocation and, more importantly, to evaluate its role as a cause of death in humans. Studies from trauma and intensive care centers often imply that bacterial translocation is a major contributor to sepsis, shock, and multisystem organ failure in humans. However, the data reviewed herein do not support that view clearly. Carefully designed studies are needed to determine the relevance of bacterial translocation in human disease.
Constipation in Very‐Low‐Birth‐Weight Children at 10 to 14 Years of Age
Authors: Cunningham Carin , Taylor H. Gerry , Minich Nori Mercuri , Hack Maureen
Published: January 2024

Background

The authors documented that very‐low‐birth‐weight children (less than 750‐g) when compared with 750‐to 1,499‐g birth‐weight and normal‐birth‐weight–matched controls have higher than normal rates of neurosensory and cognitive impairments at school age. In this population, the authors found a higher rate of constipation than expected among 19 of 59 (32%) less‐than‐750‐g‐birth‐weight children. The authors therefore wanted to evaluate in greater detail the problem of constipation and associated toileting problems in this population.

Methods

Nineteen less‐than‐750‐g‐birth‐weight children with constipation were matched to the next less than 750‐g‐birth‐weight child of comparable age, sex, and race who did not have constipation. A telephone questionnaire was administered to 15 of 19 parents of the less‐than‐750‐g‐birth‐weight children who had constipation.

Results

The 15 children with constipation had significantly higher rates of neurosensory impairment (7 [47%] vs. 1 [7%]) and lower mean WISC III IQ scores (72 ± 22 vs. 89 ± 13) when compared with birth‐weight‐matched controls without constipation (P < 0.05). The constipated children also had significantly higher rates of associated toileting problems, including encopresis (8[53%] vs. 1 [7%])and stool withholding (9 [60%] vs. 2 [13%];P < 0.05).

Conclusion

The higher incidence of constipation among less‐than‐750‐g‐birth‐weight children is associated with neurodevelopment impairment. Awareness of this problem and preventive intervention to ensure regular stools could possibly decrease the high rate of constipation and associated toileting problems.
Pancreatic Elastase 1 in Feces of Preterm and Term Infants
Authors: Nissler Karl , Von Katte Irene , Huebner Angela , Henker Jobst
Published: January 2024

Background

Determination of fecal pancreatic elastase 1 (E1) is a reliable and noninvasive test of exocrine pancreatic function. Adult reference values of greater than 200 μg E1/g feces do not seem to be applicable to early infancy because of immature pancreatic function. Because reference values for infants do not exist, the current study was aimed to define reference values for preterm and term infants up to 12 months of age.

Methods

The authors measured pancreatic E1 concentration in feces of 148 infants up to 12 months of age. Infants with known bowel or pancreatic disorders were excluded from the study.

Results

The authors found that 96.8% of all children had E1 concentrations greater than an adult lower limit after 2 weeks of life, independent of gestational age. Up to 48 hours after birth, none of the preterm infants had an E1 concentration of greater than 30 μg/g meconium, whereas 43% of the term infants had normal adult values.

Conclusions

The adult reference value for pancreatic E1 of greater than 200 μg/g feces can be applied to infants older than 2 weeks, independent of gestational age, birth weight, and the type of nutrition.
Controlled Ileal Release Budesonide in Pediatric Crohn Disease: Efficacy and Effect on Growth
Authors: Kundhal P. , Zachos M. , Holmes J. L. , Griffiths Anne M.
Published: January 2024

Background

Although the effectiveness of controlled ileal release (CIR) budesonide in children can be extrapolated from adult studies, there are currently no data available concerning the effects of CIR budesonide therapy on linear growth. In the absence of controlled, prospective pediatric clinical trials, we reviewed the outcomes, particularly linear growth, of children and adolescents given CIR budesonide to treat active intestinal inflammation and to maintain remission.

Methods

Thirty‐two children (20 males) aged 14.1 ± 2.7 years with Crohn disease of the distal ileum with or without right colon involvement were treated for active Crohn disease (baseline Pediatric Crohn Disease Activity Index, 34 ± 14) with 9 mg daily of CIR budesonide through the Hospital for Sick Children, University of Toronto, Inflammatory Bowel Diseases program.

Results

At first follow‐up visit 8.7 ± 6.0 weeks later, 19 of 32 (59%) were judged by the physician to have responded. In the subset of 22 patients who had laboratory tests repeated at the first follow‐up visit, their Pediatric Crohn Disease Activity Index fell from 33 ± 14 to 22 ± 16 (P = 0.001). The Pediatric Crohn Disease Activity Index score fell to less than 15 (cut‐off score remission) in 29%. Six prepubertal responders continued to receive 6 mg CIR budesonide for 6 to 13 months. Five of the 6 experienced only mild or no gastrointestinal symptoms and gained weight. Nevertheless, their mean height velocity was only 2.3 ± 1.0 cm/year, and none grew at a rate of more than 4cm/year whilst receiving CIR budesonide.

Conclusions

These data provide grade III evidence of modest effectiveness of CIR budesonide in children with active Crohn disease confined to the ileum with or without right colon involvement. The subnormal growth observed with continued therapy is concerning and may reflect either inadequately controlled intestinal inflammation or direct suppression of linear growth, as is observed with conventional corticosteroids. Randomized controlled pediatric trials of CIR budesonide must include parameters of linear growth as an outcome variable.
Intestinal Motility in an In Vivo Rat Model of Intestinal Ischemia–Reperfusion With Special Reference to the Effects of Nitric Oxide on the Motility Changes
Authors: Takahashi Atsushi , Tomomasa Takeshi , Kaneko Hiroaki , Watanabe Toshio , Tabata Masahiko , Morikawa Hiroaki , Tsuchida Yoshiaki , Kuwano Hiroyuki
Published: January 2024

Background

To clarify the relation between intestinal ischemia–reperfusion (IR) and dysmotility, the authors investigated changes in the motility pattern in the duodenum and jejunum in an in vivo rat model of IR when artery‐ (and vein‐) fed jejunum was clamped transiently. The authors also studied the effect of nitric oxide on the motility changes in this model by means of the administration of l ‐NAME (NG ‐nitro‐ l ‐arginine methyl ester) or S‐methylisothiourea sulfate (SMT).

Materials and Methods

A force transducer was sutured onto the serosal side of the duodenum or jejunum. After a 3‐to 4‐day recovery period, contractions were recorded during periods of preischemia, ischemia (60 minutes), and reperfusion (90 minutes). An intestinal IR was produced by clamping and releasing the mesenteric artery and vein with artery forceps.

Results

In the jejunum, there was a prolongation in the duration of contraction and there were decreases in the number of contractions (NC) during the IR. When treated with L‐NAME, no decrease in the NC was observed during the 45 to 90 minutes after reperfusion. S‐methylisothiourea sulfate did not affect the IR‐induced motility changes significantly. In the duodenum, there was a prolongation in the duration of contraction and a decrease in the NC and AC only during the reperfusion. l ‐NAME or S‐methylisothiourea sulfate inhibited the decreases in the NC during the reperfusion.

Conclusions

Intestinal IR causes motility changes in the ischemic site during the IR and in the nonischemic site during the reperfusion. The IR‐induced motility changes partly depend on nitric oxide production.
Clinical Relevance of Precore and Basal Core Promoter Variants of Hepatitis B Virus During Natural Hepatitis B e Antigen Seroconversion May Be Overstated
Authors: Fukuda Ryo , Mohammad Rumi , Hamamoto Sachiko , Ishimura Norihisa , Ishihara Shunnji , Akagi Shuji , Watanabe Makoto , Kinoshita Yoshikazu
Published: January 2024

Background

Clinical relevance of nucleotide changes in precore and basal core promoters in the hepatitis B virus genome during hepatitis B e antigen seroconversion may be overstated. The authors investigated the existence and changes in the relative proportion of variants to wild virus that occur with seroconversion.

Methods

Sera from 30 school‐aged long‐term hepatitis B virus carriers, including 11 tested before and after seroconversion during 1 to 8 years of follow‐up, were evaluated for variations in nucleotide sequences of the basal core promoter (T1762 and A1764), precore region (A1869), and carboxyl‐terminus of the X region of the hepatitis B virus genome using an amplification refractory mutation detection system with mutant‐specific primers.

Results

All variants were found to already exist before seroconversion at various wild‐type/mutant ratios. The positive rates of these variants were not changed with loss of hepatitis B e antigen. Although there was a relative increase in the concentration of these mutants in wild‐type/mutant mixed populations, most patients with only a wild‐type population maintained the same pattern after loss of hepatitis B e antigen.

Conclusions

Our results indicate that hepatitis B virus exists as a quasi species, and correlations of nucleotide sequences with clinical and serologic findings must be done with caution.