bluuebunny/crossref_metadata_2025 huggingface dataset:
α‐SMA Overexpression Associated With Increased Liver Fibrosis in Infants With Biliary Atresia
Authors: Dong Rui , Luo Yi , Zheng Shan
Published: November 2012

Objective:

The mechanisms responsible for increased collagen production and hepatic fibrosis in biliary atresia (BA) remain largely unknown. We evaluated α‐smooth muscle actin (α‐SMA) expression in liver and the porta hepatis in infants with BA.

Methods:

Immunohistochemical staining for α‐SMA and CD68 in the BA liver and porta hepatis was performed. A semiquantitative 3‐grade staging system was employed to estimate liver fibrosis. The densities of CD68 in BA liver and the levels of direct bilirubin were assessed in relation to α‐SMA expression.

Results:

α‐SMA was found to be overexpressed in epithelial cells and in periductular collagen fibers. The expression in infants with BA was higher than that in the control group (P < 0.05). The amount of α‐SMA in BA was positively correlated with liver fibrosis scores (r = 0.549, P = 0.022). The levels of α‐SMA in the liver of BA were negatively related with improvements in direct bilirubin levels, 3 months postoperatively (r = −0.653, P = 0.029). The correlation between the α‐SMA and CD‐68 expression was not significantly different (r = 0.444, P = 0.057).

Conclusions:

The expression of α‐SMA in BA liver is higher than that in contro1 group. α‐SMA expression is negatively correlated with the reduction of direct bilirubin, 3 months postoperatively, probably due to fibrosis or cirrhosis affecting the entire biliary system.
Intestinal Failure in Children
Authors: D'Antiga Lorenzo , Goulet Olivier
Published: November 2012

Intestinal failure (IF) is a condition in which severe intestinal malabsorption mandates artificial nutrition through a parenteral route. Causes of severe protracted IF include short bowel syndrome, congenital diseases of enterocyte development, and severe motility disorders (total or subtotal aganglionosis or chronic intestinal pseudo‐obstruction syndrome). IF can result in nutritional failure, defined as the long‐term failure to nourish a child by natural or artificial means. Today, IF‐associated liver disease is the most common cause of parenteral nutrition (PN) failure, but catheter‐related sepsis and extensive vascular thrombosis may also jeopardize the health of those receiving PN. For a child with nutritional failure, intestinal transplantation, often in the form of a composite visceral graft, offers the only chance for long‐term survival. The management of IF requires a multidisciplinary approach. There have been a number of recent advances in both medical and surgical treatments of IF. In particular, new intestinal lengthening techniques and the use of PN formulas rich in fish oil both have resulted in decreased rates of severe complications of IF and its treatments. In addition, better awareness of the risks and benefits of intestinal transplantation have resulted in better patient selection, and ultimately in improved patient survival, hence restricting the indication to transplantation only to patients with nutritional failure and no other chance to survive.
Cow's Milk Elimination
Authors: Kagalwalla Amir F. , Amsden Katie , Shah Ameesh , Ritz Sally , Manuel‐Rubio Maria , Dunne Katherine , Nelson Suzanne P. , Wershil Barry K. , Melin‐Aldana Hector
Published: November 2012

Objectives:

Cow's‐milk protein is one of the food antigens responsible for causing eosinophilic esophageal inflammation in a majority of children. We describe our experience with treating eosinophilic esophagitis (EoE) in children by eliminating only cow's milk from their diets.

Methods:

This retrospective study assessed the short‐term clinical and histological response to eliminating cow's‐milk protein from the diet of children with EoE. Only patients undergoing a subsequent upper endoscopy to assess their histological response were included in this analysis.

Results:

We identified 17 (12 boys and 5 girls) children with EoE who excluded only cow's milk from their diet. Remission was induced in 11 of 17 (65%) patients; within the remission group, 7 (41%) achieved complete histological remission and 4 patients (24%) were in significant histological remission. The mean peak pre‐ and posttreatment counts for those in remission were 76 ± 40 and 2 ± 4 (P < 0.01), respectively.

Conclusions:

Elimination of cow's milk–induced clinical and histological remission in 65% (95% confidence interval 42%–88%) of children with EoE in whom it was attempted. This approach offers distinct advantages over other dietary treatment approaches for the initial management of children with EoE. The role of eliminating cow's milk alone for the treatment of EoE warrants further prospective study.
Congenital Anomalies and Childhood Celiac Disease in Sweden
Authors: Wingren Carl Johan , Agardh Daniel , Merlo Juan
Published: November 2012

Previously, chromosomal anomalies and, to a lesser extent, other congenital anomalies have been associated with an increased risk of celiac disease (CD). We investigated these associations using a systematic approach. We identified all of the singleton children (792,401) born in Sweden between 1987 and 1993, and obtained cases of CD using the Swedish National Inpatient Registry. We applied Cox regression models as well as sibling designs to study the association between congenital anomalies and childhood CD. We observed that anomalies of face, neck, ear, heart, digestive tract, or chromosomes were associated with CD.
Vitamin and Mineral Status in Patients With Inflammatory Bowel Disease
Authors: Alkhouri Razan H. , Hashmi Humaira , Baker Robert D. , Gelfond Daniel , Baker Susan S.
Published: November 2012

Objectives:

Patients with inflammatory bowel disease (IBD) are at risk for vitamin and mineral deficiencies because of long‐term inflammation in the gut mucosa and decreased oral intake. The aim of the study is to investigate the prevalence of vitamin and zinc deficiencies in patients with newly diagnosed IBD compared with a control group.

Methods:

This is a retrospective chart review of all of the patients diagnosed as having IBD from 2006 to 2010, ages 1 to 18 years. Patients who had fat‐ and water‐soluble vitamins (A, E, D 25‐OH, folate, and B12) and zinc levels obtained at time of diagnosis were included in the study. A total of 61 patients with IBD and 61 age‐ and sex‐matched controls were included.

Results:

None of the 61 patients with IBD had folate or vitamin B12 deficiency. Vitamin D deficiency was found in 62% of the patients, vitamin A deficiency in 16%, vitamin E deficiency in 5%, and zinc deficiency in 40%. The control group had vitamin D and E and zinc deficiency in 75%, 8%, and 19% patients, respectively.

Conclusions:

We conclude that vitamin B12 and folate deficiencies are rare in children with newly diagnosed IBD in the United States and we question whether routine monitoring is warranted. Vitamin A and zinc deficiency are common in patients with newly diagnosed IBD and levels should be assessed at the time of diagnosis so that enteral repletion can commence. Vitamin D deficiency is common in all of the children in the Buffalo, NY, area, and routine screening for this deficiency is warranted.
Outcome Following Aminosalicylate Therapy in Children Newly Diagnosed As Having Ulcerative Colitis
Authors: Zeisler Bella , Lerer Trudy , Markowitz James , Mack David , Griffiths Anne , Bousvaros Athos , Keljo David , Rosh Joel , Evans Jonathan , Kappelman Michael , Otley Anthony , Kay Marsha , Grossman Andrew , Saeed Shehzad , Carvalho Ryan , Oliva‐Hemker Maria , Faubion William , Sudel Boris , Pfefferkorn Marian , Ashai‐Khan Farhat , LeLeiko Neal , Hyams Jeffrey ,   Pediatric Inflammatory Bowel Disease Collaborative Research Group
Published: November 2012

Objectives:

Despite a paucity of published supporting data, 5‐aminosalicylate (5‐ASA) use in pediatric ulcerative colitis (UC) is common. The present study describes the use and outcome of a large multicenter inception cohort of children with UC treated with 5‐ASA.

Methods:

Data were obtained from the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry, a prospective North American observational study of children newly diagnosed as having inflammatory bowel disease ages 16 years or younger. Patient data are recorded at diagnosis, 30 days, and then quarterly. Patients are managed by physician dictate, not protocol. Disease activity is classified by physician global assessment. The primary outcome examined was corticosteroid (CS) free, inactive UC at 1 year following initiation of 5‐ASA within 30 days of diagnosis (with or without concomitant CS use) without the need for rescue therapy (immunomodulators, biologics, or colectomy).

Results:

Study subjects included 213 patients newly diagnosed as having UC who received oral 5‐ASA compounds (115 of whom also received CS) during the first 30 days after diagnosis, and no other oral therapies for the treatment of UC. Of these 213 patients, 86 (40%) were CS free and physician global assessment inactive at 1 year without rescue. Outcome was not associated with disease severity at diagnosis, demographic or laboratory factors examined, or initial dose of 5‐ASA used.

Conclusions:

Forty percent of children taking 5‐ASA as primary maintenance therapy at diagnosis are in CS‐free remission after 1 year of treatment. Further pediatric studies will be needed to address whether increased adherence and/or higher dosing schedules will improve outcomes.
Constipation in Children With Neurofibromatosis Type 1
Authors: Pedersen Cecilie E. , Krogh Klaus , Siggaard Charlotte , Joensson Iben M. , Haagerup Annette
Published: November 2012

Background and Objectives:

Neurofibromatosis type 1 (NF1) is a hereditary, heterogenic, and multiorganic disease. The NF1 phenotype shows great variability in expressivity and often includes symptoms from the central and peripheral nervous systems. Bowel symptoms have been reported, but gastrointestinal function in NF1 remains to be described in detail. In this first systematic study of bowel function in children with NF1, we aimed to investigate symptoms of constipation and test the hypotheses that children with NF1 have abnormally large rectum and prolonged colonic transit time (CTT).

Methods:

A total of 20 children with NF1 (age 8.2 ± 2.4 years) were evaluated with medical history; clinical examination; digital rectal examination; bowel and dietary diaries; Rome III criteria; measurement of rectal diameter by transabdominal ultrasound; and radiographic estimation of CTT. The control group for assessment of rectal diameter comprised 23 healthy children (mean age 9.1 ± 2.7 years).

Results:

A total of 6 children with NF1 (30%) were constipated according to Rome III criteria. Average rectal diameter was significantly larger than for healthy children (32.9 ± 7.2 mm vs 21.4 ± 5.9 mm, P < 0.0001). Median CTT in NF1 children was 53 hours (range 26–101). Compared with existing normative data, CTT was prolonged (>84 hours) in 3 (19%).

Conclusions:

Symptoms of constipation were surprisingly common in children with NF1. Correspondingly, rectal diameters were abnormally large and a higher proportion than expected had prolonged CTT. The underlying pathophysiology remains obscure, but we hypothesise that abnormalities of the enteric nervous system or disturbed cellular growth could be present.
Evolution of In Vitro Cow's Milk Protein–specific Inflammatory and Regulatory Cytokine Responses in Preterm Infants With Necrotising Enterocolitis
Authors: Abdelhamid Adel E. , Chuang Shu‐Ling , Hayes Peter , Fell John M.E.
Published: November 2012

Background:

We have previously reported evidence of in vitro sensitisation to cow's milk protein in peripheral blood mononuclear cells (PBMCs) in preterm infants with necrotising enterocolitis (NEC). In the present study, we document the changes in the PBMC responses to stimulation with mitogen (phytohaemagglutinin) and cow's milk proteins β‐lactoglobulin (β‐lg) and casein over time: from the acute presentation of NEC, to initial recovery (reinitiation of enteral feeds), to full recovery (full feeding).

Methods:

Of the 14 preterm infants recruited with acute NEC, 12 were followed until fully enterally fed (2 died during the acute phase). Cytokine secretion (interferon‐γ [IFN‐γ], interleukin 4, [IL‐4], IL‐10, and transforming growth factor‐β1 [TGF‐β1]) by PBMCs in response to stimulation by phytohaemagglutinin, β‐lg, and casein was measured by enzyme‐linked immunospot in the acute phase and subsequently at recovery and full recovery.

Results:

The high levels of cytokine secretion (IFN‐γ, IL‐4, IL‐10, and TGF‐β1) observed in response to β‐lg and casein in the acute phase increased by a further 50% to 100% at recovery (P < 0.005). At full recovery (full feeding), however, IFN‐γ, IL‐4, and IL‐10 secretion response had returned to, or below, acute‐phase levels, whereas the augmented TGF‐β1 response was maintained (P = 0.005 vs acute level). This response pattern was similar for casein, and did not appear to be influenced by the nature of the feed used following NEC (breast milk/formula/hydrolysed formula).

Conclusions:

The evolution of the cytokine response profile in parallel with the clinical recovery from NEC is consistent with a putative role for TGF‐β1 in regulation of inflammation, and possibly also oral tolerance.
Colon Manometry Proves That Perception of the Urge to Defecate Is Present in Children With Functional Constipation Who Deny Sensation
Authors: Firestone Baum Carrie , John Anub , Srinivasan Kavitha , Harrison Prince , Kolomensky Andrew , Monagas Javier , Cocjin Jose , Hyman Paul E.
Published: November 2012

Background and Objective:

Children with functional constipation often state an inability to sense an urge to defecate and/or inability to feel incontinence. We used colon manometry to assess whether there was a sensory abnormality in patients who denied sensation.

Methods:

A physician observed all of the colon manometries in the preceding 20 years, and included behavioral observations in the procedure reports. We reviewed the charts of these patients.

Results:

Of 150 subjects with normal manometry and a diagnosis of functional constipation, 56 volunteered that they had no urge to defecate or complained of abdominal pain. For all who denied sensation, the first high‐amplitude propagating colonic contraction (HAPC) was associated with retentive posturing and facial grimaces. When queried, all reported they felt nothing. The examiner explained the HAPC was causing pain, and informed the child that the pain would resolve if they defecated. With subsequent HAPCs, every patient acknowledged an urge to defecate and successfully defecated. Most agreed that a similar pain sensation was present daily, but was misinterpreted to be abdominal pain.

Conclusions:

Colon manometry may be useful not only for objective findings to discriminate neuromuscular disease from functional symptoms but also to understand psychological issues and aid in helping the child and family understand the maladaptive behaviors in functional constipation.
Psychosocial Outcomes for Children With Nonalcoholic Fatty Liver Disease Over Time and Compared With Obese Controls
Authors: Kerkar Nanda , D'Urso Christine , Van Nostrand Kelsey , Kochin Israel , Gault Allison , Suchy Frederick , Miloh Tamir , Arnon Ronen , Chu Jaime , Annunziato Rachel
Published: November 2012

Objectives:

Children with nonalcoholic fatty liver disease (NAFLD) experience compromised quality of life (QOL) akin to those with other chronic disease. Our objectives were to examine the association between NAFLD and QOL as well as other psychosocial outcomes, to compare psychosocial outcomes to obese children without known NAFLD, and to determine whether present standard care for NAFLD results in weight loss and improvement in psychosocial outcomes longitudinally.

Methods:

Children with NAFLD between 8 and 18 years and obese control children without known NAFLD were consented to complete a brief psychosocial battery examining depression (Children's Depression Inventory), QOL (Pediatric Quality of Life Inventory; PedsQL), and effect of weight on self‐esteem (Body‐Esteem Scale for Adolescents and Adults) at baseline; and additionally for the NAFLD group after at least 6 months.

Results:

A total of 48 children with NAFLD and 40 obese control children were enrolled. The PedsQL scores were not significantly different but the CDI total score and subscales of negative mood, ineffectiveness, and negative self‐esteem as well as all of the 3 subscales of BESAA, appearance, attribution, and weight were worse in the NAFLD group compared with obese controls. The PedsQL scores also did not change after standard care in the 33 patients with NAFLD who completed the follow‐up evaluations, but the CDI score differed between those whose body mass index improved or not.

Conclusions:

Children with NAFLD have higher levels of depression than obese controls. Outcomes did not improve with standard care. Larger longitudinal studies and appropriate interventions are required in this area.
Abdominal Plain Film Before Gastrostomy Tube Placement to Predict Success of Percutaneous Endoscopic Procedure
Authors: Pruijsen J.M. , de Bruin A. , Sekema G. , Koetse H.A. , van Rheenen P.F.
Published: November 2012

Objectives:

Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long‐term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status ≥III, indicating increased risk for peri‐ and postoperative morbidity. The success rate of endoscopic insertion is high, but variations in the anatomy may lead to failure of PEG placement and repeated exposure to anesthesia for surgical gastrostomy. We evaluated the efficiency of using abdominal plain film with gastric insufflation in the preparatory phase to predict a successful PEG insertion and avoid rescheduling.

Methods:

A single‐center cohort of candidates for PEG underwent abdominal plain film with gastric insufflation in the preparatory phase before tube insertion. The x‐ray film was considered normal when the stomach projected distal to the costal margin. Primary endpoint was the success rate of PEG insertion. Multivariate logistic regression analysis was used to identify factors associated with PEG insertion failure.

Results:

A total of 303 candidates for PEG underwent abdominal plain film (age range 0.3–18.1 years). PEG tube insertion succeeded in 287 cases (95%). In case of an abnormal abdominal film, the probability of successful PEG insertion dropped to 67% (95% confidence interval 46%–87%). In a multivariate logistic regression model, significant predictors for PEG insertion failure were spinal deformities (odds ratio [OR] 12.1), previous abdominal surgery (OR 8.5), neurological impairment (OR 4.1), and abnormal plain abdominal film (OR 10.3).

Conclusions:

Assessment of the gastric anatomy by abdominal plain film in PEG candidates with spinal deformities, previous abdominal surgery, or neurological impairment may help to identify children with a high likelihood of PEG insertion failure. This strategy enables the endoscopist to notify the surgeon in advance for a potential conversion and avoids repeated exposure to anesthesia.
Leonardo da Vinci Meets Celiac Disease
Authors: Zanchi Chiara , Ventura Giovanna , Di Leo Grazia , Orzes Nicoletta , Ronfani Luca , Not Tarcisio , Ventura Alessandro
Published: November 2012

Background and Aim:

Leonardo da Vinci's face symmetry derives from 3 equal craniofacial segments: trichion‐nasion (tn), which represents the superior third of the face, nasion‐subnasal (ns) that is the medium third of the face, and subnasal‐gnathion (sg) that is the length of the lower third of the face. It has been reported that adult subjects with celiac disease (CD) can be identified on the basis of a greater extension of the forehead in comparison to the medium third of the face, with a high tn/ns ratio. The aim of the present study was to investigate the correlation between facial asymmetry and CD in childhood and adulthood.

Methods:

We studied 126 biopsy‐proven patients with CD (76 children and 50 adults) and 102 healthy controls (43 children and 59 adults). Their faces were photographed; the pictures were edited using a software program to calculate the facial segments.

Results:

The tn length was significantly different between adult celiac and adult controls (7.43 ± 1.46 cm vs 6.38 ± 1.73 cm, P = 0.001). The cutoff of 6.5 cm tn, derived from receiver operating characteristic curve analysis, identified 43 of 50 patients (sensitivity 86%), but 34 of 59 controls were positive (specificity 54.2%). The positive predictive value was 56%; however, the tn/ns ratio was not significantly different between celiacs and controls. Neither the tn length nor the tn/ns ratio in celiacs correlated to the time of gluten exposure.

Conclusions:

Adults, but not children, with celiac disease show a forehead extension significantly greater than controls, but this test's specificity appears too low to be used in the screening of CD.
Increased Prevalence of Antibodies Against Dietary Proteins in Children and Young Adults With Cerebral Palsy
Authors: Stenberg Reidun , Dahle Charlotte , Magnuson Anders , Hellberg Dan , Tysk Curt
Published: November 2012

Objectives:

Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case‐control study of IgG antibodies against other dietary antigens, AGA, anti‐tTG, and IgE antibodies against wheat and gluten.

Methods:

Sera from 99 cases with CP and 99 healthy, age‐ and sex‐matched controls were analysed with fluorescence enzyme‐linked immunosorbent assay for detection of IgG antibodies against β‐lactoglobulin, casein, egg white, IgG‐ and IgA‐AGA, IgA‐anti‐tTG, and IgE antibodies against gluten and wheat.

Results:

Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β‐lactoglobulin was 17.0 (95% confidence interval [CI] 2.3–128), against casein 11.0 (95% CI 2.6–46.8), and against egg white 7.0 (95% CI 1.6–30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA‐anti‐tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology.

Conclusions:

Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.
Sensory Processing Issues in Young Children Presenting to an Outpatient Feeding Clinic
Authors: Davis Ann M. , Bruce Amanda S. , Khasawneh Rima , Schulz Trina , Fox Catherine , Dunn Winifred
Published: November 2012

Objectives:

The aim of the study was to describe the relation between sensory issues and medical complexity in a series of patients presenting to an outpatient multidisciplinary feeding team for evaluation, by a standardized measure of sensory‐processing abilities.

Methods:

A retrospective chart review of all of the patients seen from 2004 to 2009 on 2 key variables: medical diagnostic category and short sensory profile (SSP) score.

Results:

On the SSP, 67.6% of children scored in the clinical (“definite difference”) range. The most common diagnostic categories were developmental (n = 23), gastrointestinal (n = 16), and neurological (n = 13). Behavioral and cardiorespiratory medical diagnostic categories were significantly related to SSP total score and SSP definite difference score.

Conclusions:

Children who present for feeding evaluation do indeed tend to have clinically elevated scores regarding sensory processing, and these elevated scores are significantly related to certain medical diagnostic categories. Future research is needed to determine why these significant relations exist as well as their implications for treatment of feeding‐related issues.
A Residential Summer Camp Can Reduce Body Fat and Improve Health‐related Quality of Life in Obese Children
Authors: Wong William W. , Barlow Sarah E. , Mikhail Carmen , Wilson Theresa A. , Hernandez Paula M. , Shypailo Roman J. , Abrams Stephanie H.
Published: November 2012

In an earlier report, we showed that a 2‐week, residential summer camp (Kamp K'aana) led to improved body weight, body mass index, body mass index z score, and self‐esteem among obese children. To assess whether improvements in body weight and self‐esteem translate into improvement in body fat and weight‐related quality of life, we measured the changes in body fat by bioimpedance and quality of life by Impact of Weight on Quality of Life instrument on 42 multiethnic obese children who took part in our Kamp K'aana program. Significant reduction in body fat was detected with significant improvements in the weight‐related quality of life scores.
Tolerability, Safety, and Efficacy of PEG 3350 as a 1‐day Bowel Preparation in Children
Authors: Walia Ritu , Steffen Rita , Feinberg Lisa , Worley Sarah , Mahajan Lori
Published: November 2012

Objective:

The aim of the study was to evaluate the tolerability, safety, and efficacy of polyethylene glycol (PEG) 3350 without electrolytes as a 1‐day bowel preparation for colonoscopy in children.

Methods:

A prospective study of 45 children undergoing colonoscopy prescribed PEG 3350 without electrolytes mixed with a commercial electrolyte beverage was performed. Patients <45 kg received 136 g of PEG 3350 without electrolytes mixed in 32 ounces of Gatorade. Patients ≥45 kg were given 255 g of PEG 3350 without electrolytes in 64 ounces of Gatorade. A basic metabolic panel was performed at the time of the clinic visit and just before colonoscopy. Patients completed a survey related to bowel preparation. Endoscopists graded bowel preparation and noted the proximal extent of the examination.

Results:

A total of 44 patients (14 ± 3 years) completed the study. One patient was excluded due to protocol breach. All subjects reported the preparation was easy (61%) or tolerable (39%). Adverse events included nausea (34%), abdominal pain (23%), vomiting (16%), abdominal distension (20%), bloating (23%), and dizziness (7%). Although significant changes in serum glucose and CO2 were noted, no therapeutic interventions were indicated. Significant changes in sodium, potassium chloride, blood urea nitrogen, or creatinine did not occur. Colonic preparation was rated as excellent in 23%, good in 52%, fair in 23%, and poor in 2% of patients. Intubation of the ileum was successful in 100%.

Conclusions:

One‐day bowel preparation with high dose PEG 3350 mixed with commercial electrolyte solution is tolerable, safe, and effective in children before colonoscopy.
Markers of Antigen Presentation and Activation on Eosinophils and T Cells in the Esophageal Tissue of Patients With Eosinophilic Esophagitis
Authors: Le‐Carlson Minou , Seki Scott , Abarbanel David , Quiros Antonio , Cox Kenneth , Nadeau Kari C.
Published: November 2012

Objectives:

Evidence suggests eosinophils may be acting as antigen‐presenting cells (APCs) by presenting antigen to T cells. We investigated the surface proteins of eosinophils and T cells in the esophageal biopsies of patients with eosinophilic esophagitis (EoE), patients with gastroesophageal reflux disease (GERD), and healthy controls (HCs).

Methods:

Subjects were categorized as EoE, GERD, or HC. In esophageal tissue, EG2+ eosinophils were stained for the APC markers, CD40 or CD80, via immunohistochemistry. CD3+ T cells were stained for costimulatory markers, CD40L or CD28, and for activation markers, CD69 or CD134, via immunofluorescence or immunohistochemistry.

Results:

Eosinophils stained with CD40 and CD80. The number of EG2+CD40+ cells was increased in EoE (mean 19.1 ± 14.8 cells/high‐power field [HPF], n = 11), compared with GERD (mean 0.13 ± 0.19 cells/HPF, n = 5, P < 0.01) and HC (mean 0.3 ± 0.7 cells/HPF, n = 5, P < 0.01). There was an elevation in EG2+CD80+ cells in EoE (mean 18.1 ± 16.2 cells/HPF, n = 10), GERD (mean 1.7 ± 2.8 cells/HPF, n = 6, P < 0.01), or HC (mean 0.8 ± 1.3 cells/HPF, n = 6, P < 0.01). CD3+ T cells stained with CD40L (not quantified). CD3+ T cells stained with CD28 at elevated levels in EoE (mean 14 ± 8.7 cells/HPF, n = 9) versus GERD (mean 3.3 ± 1.2 cells/HPF, n = 6, P < 0.05) or HC (mean 3.0 ± 3.2 cells/HPF, n = 7, P < 0.01). The number of CD3+CD69+ cells was highest in EoE (mean 14.8 ± 7.5 cells/HPF, n = 6) versus GERD (mean 0.8 ± 0.9 cells/HPF, n = 6, P < 0.001) or HC (mean 2.7 ± 2.5 cells/HPF, n = 6, P < 0.001).

Conclusions:

We show that esophageal eosinophils express CD40 and CD80, and T cells with CD40L, CD28, and CD69. The number of double‐stained cells was higher in EoE in comparison to control groups. These data support the hypothesis that eosinophils in EoE may act as APCs, activating T cells.
Cytokine Profile of Mature Milk From Smoking and Nonsmoking Mothers
Authors: Szlagatys‐Sidorkiewicz Agnieszka , Woś Ewa , Aleksandrowicz Ewa , Łuczak Grażyna , Zagierski Maciej , Martysiak‐Żurowska Dorota , Marek Krzysztof , Kamińska Barbara
Published: November 2012

We verified whether smoking during lactation influences breast milk cytokine (interleukin [IL]‐1α, IL‐1β, IL‐6, IL‐8, IL‐10, and tumor necrosis factor‐α) levels 30 to 32 days after delivery. The study group comprised 24 postpartum women who declared smoking >5 cigarettes per day. The control group included 45 nonsmoking postpartum women. Compared with nonsmoking women, smokers were characterized by significantly higher breast milk concentrations of IL‐1α (P = 0.04), whereas no significant intergroup differences were observed in terms of remaining analyzed cytokines. Moreover, both groups were characterized by a similar fraction of women with detectable cytokine levels.
Monotonous Diets Protect Against Acute Colitis in Mice
Authors: Nagy‐Szakal Dorottya , Mir Sabina A.V. , Ross Matthew C. , Tatevian Nina , Petrosino Joseph F. , Kellermayer Richard
Published: November 2012

Objectives:

Multiple characteristics of industrialization have been proposed to contribute to the global emergence of inflammatory bowel diseases (IBDs: Crohn disease and ulcerative colitis). Major changes in eating habits during the last decades and the effectiveness of exclusive enteral nutrition in the treatment of Crohn disease indicate the etiologic importance of dietary intake in IBDs. A uniform characteristic of nutrition in developing countries (where the incidence of IBD is low) and exclusive enteral nutrition is their consistent nature for prolonged periods; however, the potentially beneficial effect of dietary monotony in respect to mammalian intestinal inflammation has not been examined.

Methods:

The association between alternating (2 different complete chows) and persistent regular diets, and dextran sulfate sodium colitis susceptibility in C57BL/6J mice was studied. Colonic mucosal microbiota changes were investigated by high‐throughput pyrosequencing of the 16S rRNA gene.

Results:

The severity of colitis increased upon dietary alternation compared with consistent control feeding. The microbiota of the alternating nutritional group clustered discretely from both control groups.

Conclusions:

Our findings highlight that monotonous dietary intake may decrease mammalian vulnerability against colitis in association with microbiota separation. The epidemiologic and therapeutic implications of our results are also discussed.
Seasonal Patterns of Abdominal Pain Consultations Among Adults and Children
Authors: Saps Miguel , Hudgens Stacie , Mody Reema , Lasch Karen , Harikrishnan Venkatesh , Baum Charles
Published: November 2012

Background and Aim:

Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children.

Methods:

The number of outpatient consultations among children (5–17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases‐9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month × 1000) by season in children and adults. Seasons were defined as follows: winter (December–February), spring (March–May), summer (June–August), and fall (September–November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted.

Results:

A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population.

Conclusions:

Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ.
Allogeneic Hematopoietic Stem Cell Transplantation May Restore Gluten Tolerance in Patients With Celiac Disease
Authors: Ciccocioppo Rachele , Bernardo Maria Ester , Russo Maria Luisa , Vanoli Alessandro , Franco Carla , Martinetti Myriam , Catenacci Laura , Giorgiani Giovanna , Zecca Marco , Piralla Antonio , Baldanti Fausto , Locatelli Franco , Corazza Gino Roberto
Published: November 2012

We report on 2 patients affected by both celiac disease (CD) and β‐thalassemia major who underwent successful myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for the latter condition. After HSCT, the introduction of a gluten‐containing diet did not cause the reappearance of clinical, serological, and histological markers of CD in up to 5 years of follow‐up. After transplantation, in both patients, dendritic cells and regulatory FoxP3+T cells showed a recovery of normal values and no proliferative T‐cell response upon gliadin stimulation was found. These data suggest that allogeneic HSCT may lead to induction of gluten tolerance in patients with CD.
Long‐term Outcomes After Surgery on Pediatric Patients With Crohn Disease
Authors: Piekkala Maija , Pakarinen Mikko , Ashorn Merja , Rintala Risto , Kolho Kaija‐Leena
Published: November 2012

Objective:

Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long‐term functional outcomes and quality of life (QoL) are unclear.

Methods:

In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre.

Results:

In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow‐up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re‐resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients.

Conclusions:

Surgery for pediatric‐onset CD is risky even under expert care. Disease relapses and bowel re‐resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.
Diffuse Esophageal Spasm in Children Referred for Manometry
Authors: Rosen John M. , Lavenbarg Teri , Cocjin Jose , Hyman Paul E.
Published: November 2012

Diffuse esophageal spasm (DES) causes chest pain and/or dysphagia in adults. We reviewed charts of 278 subjects 0 to 18 years of age after esophageal manometry to describe the frequency and characteristics of DES in children. Patient diagnoses included normal motility (61%), nonspecific esophageal motility disorder (20%), DES (13%, n = 36), and achalasia (4%). Of patients with DES, the most common chief complaint was food refusal in subjects younger than 5 years (14/24, 58%) and chest pain in subjects older than 5 years (4/12, 33%). Comorbid medical conditions, often multiple, existed in 33 subjects. DES should be considered when young children present with food refusal.
Levels of Serum Ceruloplasmin Associate With Pediatric Nonalcoholic Fatty Liver Disease
Authors: Nobili Valerio , Siotto Mariacristina , Bedogni Giorgio , Ravà Lucilla , Pietrobattista Andrea , Panera Nadia , Alisi Anna , Squitti Rosanna
Published: November 2012

Objectives:

Nonalcoholic fatty liver disease (NAFLD) in adolescents and children is rapidly becoming one of the most common causes of chronic liver disease worldwide. NAFLD varies from simple fatty liver to nonalcoholic steatohepatitis (NASH) with possible fibrosis. Several studies suggest that oxidative stress plays a central role in several metabolic abnormalities and cellular damage that characterize NAFLD. We investigated whether transition metals and their related proteins were related to NAFLD symptoms and their underlying processes.

Methods:

We measured copper, iron, ceruloplasmin (Cp) concentration and activity, transferrin (Tf), ferroxidase activity, and ferritin, and we calculated Tf saturation and Cp to Tf ratio (Cp/Tf) as an index of the activity of the antioxidant Cp‐Tf system in 100 children with biopsy‐proven NAFLD. Pediatric patients were grouped by nonalcoholic fatty liver disease score (NAS) ≥ 5 (30 subjects) and NAS < 5 (70).

Results:

Cp distinguished children with NAS ≥ 5 from those with NAS < 5 with an accuracy of 82%. Specifically, a receiver operator characteristics curve showed that a cutoff of 28.6 mg/dL separated NAS ≥ 5 from NAS < 5 with a specificity of 92% and a sensitivity of 76%. The Cp/Tf ratio, as well as copper concentration and Cp activity, decreased in the NAS ≥ 5 group, pointing out an imbalance in metal regulation. Either copper or Cp concentrations were lower in subjects having ballooning.

Conclusions:

Serum antioxidant capacity owing to Cp failure is strongly associated with NAFLD‐related damage. Further studies are, however, required to clarify the role of Cp in NAFLD pathogenesis and to evaluate its potential application as diagnostic marker.
Increased Procoagulant Function of Microparticles in Pediatric Inflammatory Bowel Disease
Authors: Deutschmann Andrea , Schlagenhauf Axel , Leschnik Bettina , Hoffmann Karl Martin , Hauer Almuthe , Muntean Wolfgang
Published: November 2012

Objectives:

Patients with inflammatory bowel disease (IBD) have a higher risk for venous thromboembolism compared with non‐IBD subjects. The pathogenic mechanisms of the thrombotic events are not fully understood. We investigated levels of circulating microparticles and their influence on thrombin generation in pediatric patients with IBD during active and quiescent disease compared with healthy controls.

Methods:

Plasma samples were collected from 33 pediatric patients with Crohn disease (CD), 20 pediatric patients with ulcerative colitis (UC), and 60 healthy controls. Microparticles' procoagulant activity was measured by enzyme‐linked immunosorbent assay, and the dependency of thrombin generation on microparticles‐derived tissue factor was determined by means of calibrated automated thrombography.

Results:

The procoagulant function of microparticles was significantly increased in patients with active and inactive CD, and active UC compared with controls. Endogenous thrombin potential was significantly higher in patients with CD and UC compared with controls. A minor influence of microparticles on thrombin generation was only observed for patients with active UC.

Conclusions:

Our study shows increased procoagulant function of microparticles in pediatric patients with active and quiescent CD and active UC compared with controls, but demonstrates that they are not a major cause for the higher thrombin generation in pediatric patients with IBD.
Association of Inflammatory Bowel Disease With Familial Mediterranean Fever in Turkish Children
Authors: Beşer Ömer F. , Kasapçopur Özgür , Çokuğraş Fügen Çullu , Kutlu Tufan , Arsoy Nil , Erkan Tülay
Published: November 2012

Background and Aims:

Inflammatory bowel disease (IBD) and familial Mediterranean fever (FMF) share common clinical and biological features. The prevalence of other inflammatory diseases, including IBD, is increased in FMF. We investigated the presence of IBD accompanying FMF in patients who were being followed up with a diagnosis of FMF and the relation of IBD with the MEFV gene mutation.

Methods:

A total of 78 children with FMF were enrolled in the study. The patients were included in the study independent of the presence of complaints. Colonoscopy for IBD was performed if any of the following was present: blood mixed with mucus in the stool; chronic diarrhea (loose and frequent stools lasting >4 weeks); abdominal pain incompatible with FMF (localized in a certain part of the abdomen, not occurring during attacks, >3 days); and positive IgA and IgG anti‐Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies. MEFV gene mutations were analyzed in patients diagnosed as having IBD and FMF.

Results:

Of the 78 patients with a diagnosis of FMF, colonoscopy was performed and biopsy samples were taken in 20 patients (25.6%) who had abdominal pain incompatible with FMF, chronic diarrhea, bloody stools, and/or positive perinuclear anti‐neutrophil cytoplasmic antibody or anti‐Saccharomyces cerevisiae antibody. Histopathological examination resulted in a diagnosis of IBD in 12 of the 78 patients (15.4%). MEFV gene mutations were present in all 12 patients diagnosed as having IBD. We observed M694 V mutations in 5 of 12 patients (41.7%), M680I mutations in 3 (25%), K695R mutations in 3 (25%), and E148Q mutations in 1 (8.3%).

Conclusions:

We found that the number of patients with FMF was higher than the number with IBD in the general population. When IBD accompanied FMF, the most common mutation was M694 V; however, the high rate (25%) of K695R mutation in our patients with FMF and IBD was not observed in previous studies.
Adhesion of mussel foot proteins to different substrate surfaces
Authors: Lu Qingye , Danner Eric , Waite J. Herbert , Israelachvili Jacob N. , Zeng Hongbo , Hwang Dong Soo
Published: November 2012

Mussel foot proteins (mfps) have been investigated as a source of inspiration for the design of underwater coatings and adhesives. Recent analysis of various mfps by a surface forces apparatus (SFA) revealed that mfp-1 functions as a coating, whereas mfp-3 and mfp-5 resemble adhesive primers on mica surfaces. To further refine and elaborate the surface properties of mfps, the force–distance profiles of the interactions between thin mfp (i.e. mfp-1, mfp-3 or mfp-5) films and four different surface chemistries, namely mica, silicon dioxide, polymethylmethacrylate and polystyrene, were measured by an SFA. The results indicate that the adhesion was exquisitely dependent on the mfp tested, the substrate surface chemistry and the contact time. Such studies are essential for understanding the adhesive versatility of mfps and related/similar adhesion proteins, and for translating this versatility into a new generation of coatings and (including
in vivo
) adhesive materials.
With that diet, you will go far: trait-based analysis reveals a link between rapid range expansion and a nitrogen-favoured diet
Authors: Betzholtz Per-Eric , Pettersson Lars B. , Ryrholm Nils , Franzén Markus
Published: November 2012

Recent global change has had a substantial influence on the distribution of organisms, and many species are currently expanding their ranges. To evaluate the underlying processes, long-term data with good geographic resolution are essential. One important but generally overlooked data source is offered by the taxon-specific national catalogues of first provincial records that are kept in many countries. Here, we use such data to quantify trait-based influences on range expansion in Swedish butterflies and moths between 1973 and 2010. Of 282 species meeting pre-defined quality criteria, 170 expanded their northern range margin, with a mean expansion rate of 2.7 km per year. The analyses demonstrate that habitat and diet generalists, forest species and species active during warm conditions have expanded their ranges more rapidly than other species. Notably, range expansion in diet specialists was positively related to a nitrogen-favoured larval diet, an effect not found among oligo- or polyphagous species. In contrast to the general view, this shows that specialist species can undergo rapid range expansion. We suggest that increased areas of nitrogen-rich habitat, and increased availability of a nitrogen-favoured diet, are among the most important drivers of range expansions, potentially having far-reaching consequences for a wide variety of organisms.
Aeromonas australiensis sp. nov., isolated from irrigation water
Authors: Aravena-Román Max , Beaz-Hidalgo Roxana , Inglis Timothy J. J. , Riley Thomas V. , Martínez-Murcia Antonio J. , Chang Barbara J. , Figueras Maria Jose
Published: November 2012

A Gram-negative, facultatively anaerobic bacillus, designated strain 266T, was isolated from an irrigation water system in the south-west of Western Australia. Analysis of the 16S rRNA gene sequence confirmed that strain 266T belonged to the genus

Aeromonas

, with the nearest species being

Aeromonas fluvialis

(99.6 % similarity to the type strain, with 6 nucleotide differences) followed by

Aeromonas veronii

and

Aeromonas allosaccharophila

(both 99.5 %). Analysis of gyrB and rpoD sequences suggested that strain 266T formed a phylogenetic line independent of other species in the genus. This was confirmed using the concatenated sequences of six housekeeping genes (gyrB, rpoD, recA, dnaJ, gyrA and dnaX) that also indicated that

A. veronii

and

A. allosaccharophila

were the nearest relatives. DNA–DNA reassociation experiments and phenotypic analysis further supported the conclusion that strain 266T represents a novel species, for which the name Aeromonas australiensis sp. nov. is proposed, with type strain 266T ( = CECT 8023T  = LMG 2670T).