bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotoxicity in humans exposed to arsenic, lithium, and boron in drinking water in the Bolivian Andes—A cross sectional study
Authors: Tirado Noemi , Mamani Josué , De Loma Jessica , Ascui Franz , Broberg Karin , Gardon Jacques
Published: February 2024

Elevated concentrations of arsenic, lithium and boron in drinking water have already been reported in Bolivia. Arsenic is known to cause genotoxicity but that caused by lithium and boron is less well known. The aim of the present cross‐sectional study was to evaluate potential genotoxic effects of exposure to arsenic, while considering exposure to lithium and boron and genetic susceptibility. Women (n = 230) were recruited in villages located around Lake Poopó. Exposure to arsenic was determined as the sum of concentrations of arsenic metabolites inorganic arsenic, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) in urine. Exposure to lithium and boron was determined based on their concentrations in urine. Genetic susceptibility was determined by GSTM1 (glutathione S‐transferase‐mu‐1) and GSTT1 (glutathione S‐transferase‐theta‐1) null genotypes and AS3MT (Arsenite Methyltransferase) rs3740393. Genotoxicity was measured in peripheral blood leukocytes using the comet assay. The geometric means of arsenic, lithium, and boron concentrations were 68, 897, and 3972 μg/L, respectively. GSTM1 and GSTT1 null carriers had more DNA strand breaks than gene carriers (p = .008, p = .005). We found no correlation between urinary arsenic and DNA strand breaks (rS = .03, p = .64), and only a weak non‐significant positive association in the adjusted multivariate analysis (β = .09 [−.03; .22], p = .14). Surprisingly, increasing concentrations of lithium in urine were negatively correlated with DNA strand breaks (rS = −.24, p = .0006), and the association persisted in multivariate analysis after adjusting for arsenic (β = −.22 [−.36; −.08], p = .003). We found no association between boron and DNA strand breaks. The apparent protective effect of lithium merits further investigation.
Data sharing in modeling and simulation of biomechanical systems in interdisciplinary environments
Authors: Villota‐Narvaez Yesid , Bleiler Christian , Röhrle Oliver
Published: February 2024

All digital objects that result from the modeling and simulation field are valid sets of research data. In general, research data are the result of intense intellectual activity that is worth communicating. This communication is an essential research practice that, whether with the aim of understanding, critiquing or further developing results, smoothly leads to collaboration, which not only involves discussions, and sharing institutional resources, but also the sharing of data and information at several stages of the research process. Data sharing is intended to improve and facilitate collaboration but quickly introduces challenges like reproducibility, reusability, interoperability, and standardization. These challenges are deeply rooted in an apparent reproducibility standard, about which there is a debate worth considering before emphasizing how the modeling and simulation workflow commonly occurs. Although that workflow is almost natural for practitioners, the sharing practices still require special attention because the principles (known as FAIR principles) that guide research practices towards data sharing also guide the requirements for machine actionable results. The FAIR principles, however, do not address the actual implementation of the data sharing process. This implementation requires careful consideration of characteristics of the sharing platforms for benefiting the most of the data sharing activity. This article serves as an invitation to integrate data sharing practices into the established routines of researchers and elaborates on the perspectives, and guidelines surrounding data sharing implementation.
Trends by age and sex and projections of disease prevalence from studying hypertensive heart disease in China over the past three decades
Authors: Su Yao , He Honghong , Yang Jingtao , Liu Ya , Jiang Weiwei , Li Chen , Wei Yang , Cheng Jun , Chen Yiguo
Published: February 2024

Background

Hypertensive heart disease (HHD) is a common cause of cardiovascular disease and mortality worldwide, and its burden is increasing with aging populations.

Objectives

This study aimed to estimate the prevalence and mortality rates of HHD in mainland China and Taiwan Province using data from the Global Burden of Disease Study 2019 (GBD 2019), and forecast the development trend of HHD from 2020 to 2024.

Methods

We obtained data on number of cases, deaths, crude prevalence rate, crude death rate, age‐standardized prevalence rate (ASPR), and age‐standardized death rate (ASDR) for mainland China and Taiwan Province from 1990 to 2019 from the GBD 2019. Joinpoint software was used to estimate average annual percentage change (AAPC) with 95% confidence intervals, and the number of HHD cases in China from 2022 to 2024 was predicted by the exponential smoothing method.

Results

Between 1990 and 2019, HHD cases and deaths increased in mainland China, but the ASPR and ASDR decreased by 5.96% and 48.72%, respectively. In Taiwan Province, ASPR and ASDR decreased by 7.66% and 52.14%, respectively. The number of HHD cases and death rates varied by region, age, and sex, with a higher number of cases in mainland China than in Taiwan Province. By 2024, the number of HHD cases in mainland China was projected to be over 9.6 million cases, and in Taiwan Province, it was projected to surpass 120,000 cases.

Conclusion

The differences in HHD cases between mainland China and Taiwan Province in terms of age and sex indicated the need for effective prevention and control measures, especially targeting the elderly population. These findings can inform policymakers and health professionals in the development of targeted prevention and treatment strategies and resource allocation for HHD in China.
Boosting CsSnI3‐based near‐infrared perovskite light‐emitting diodes performance via solvent coordination engineering
Authors: Li Yuqing , Guan Xiang , Meng Yuanyuan , Chen Jingfu , Lin Junpeng , Chen Xi , Liu Chia‐Yun , Zhao Yaping , Zhang Qin , Tian Chengbo , Lu Jianxun , Wei Zhanhua
Published: February 2024

Due to their unique photoelectric properties, nontoxic tin‐based perovskites are emerging candidates for efficient near‐infrared LEDs. However, the facile oxidation of Sn2+ and the rapid crystallization rate of tin‐based perovskites result in suboptimal film quality, leading to inferior efficiencies of tin‐based perovskite light‐emitting diodes (Pero‐LEDs). In this study, we investigate the influence of commonly used solvents on the quality of the CsSnI3 films. Remarkably, DMSO exhibits a stronger interaction with SnI2, forming a stable intermediate phase of SnI2·3DMSO. This intermediate effectively inhibits the oxidation of Sn2+ and slows down the crystallization rate, bringing in lower defect state density and higher photoluminescence quantum yield of the prepared perovskite films. Consequently, the corresponding Pero‐LEDs achieve a maximum external quantum efficiency (EQE) of 5.6%, among the most efficient near‐infrared Pero‐LEDs. In addition, the device processes ultra‐low efficiency roll‐off and high reproducibility. Our research underscores the crucial role of solvent‐perovskite coordination in determining film quality. These findings offer valuable guidance for screening solvents to prepare highly efficient and stable tin‐based perovskites.
Dietary Fiber in Weaning Cereals: A Study of the Effect on Stool Characteristics and Absorption of Energy, Nitrogen, and Minerals in Healthy Infants
Authors: Davidsson Lena , Mackenzie Jill , Kastenmayer Peter , Rose Anne , Golden Barbara E. , Aggett Peter J. , Hurrell Richard F.
Published: February 2024

We evaluated the effect of increased dietary fiber (DF) content in weaning cereals based on wheat/soy (8.0 and 1.8% DF) and wheat/milk (5.3 and 2.0% DF) in healthy, formula‐fed infants 7‐17 weeks old. The study had a cross‐over design, each infant acting as his or her own control. Stool characteristics and anthropometry were monitored over 4‐week periods in groups of 34 (wheat/soy) and 23 (wheat/milk) infants. Absorption of zinc (Zn) and calcium (Ca) was studied by measuring the fecal excretion of stable isotopes during 72 h (70Zn and 42Ca) in a subgroup of the infants consuming wheat/soy cereals. Iron (Fe) bioavailability was evaluated by analysis of the incorporation of 58Fe into erythrocytes 14 days after administration. Fractional absorption (X ± SD: 8.0 versus 1.8% DF) was 45.3 ± 27.5 versus 41.2 ± 19.4% of 70Zn and 63.4 ± 15.8 versus 64.4 ± 10.6% of 42Ca. Bioavailability of 58Fe varied between 1.0% and 5.4% (8.0% DF) and from <0.9% to 9.1% (1.8% DF). No significant difference in energy (95.3 ± 2.0% versus 95.7 ± 1.2%) or nitrogen (92.6 ± 2.3% versus 93.0 ± 1.6%) apparent absorption from the total diet was found during consumption of cereal with 8.0 and 1.8% DF. The intake of cereal decreased with higher DF content in the wheat/soy product: 34 ± 23 g/d (8.0% DF) versus 42 ± 23 g/d (1.8% DF), p < 0.01. While consuming the 8.0% DF product, 11 infants were reported to have “gritty stools”; no other differences were observed between different groups in stool characteristics or anthropometry. These results demonstrate no negative effect on the absorption of energy and nutrients with higher dietery fiber intake in primarily formula‐fed infants. The impact of increased dietary fiber levels remains unknown in less well‐nourished infants.
Effects of Native and Hydrolyzed Whey Protein on Intestinal Repair of Severely Starved Rats at Weaning
Authors: Boza Julio , Jiménez Jesús , Baró Luis , Martínez Olga , Suárez M. Dolores , Gil Angel
Published: February 2024

The aim of this study was to evaluate the effect of two sources of dietary nitrogen (isolated whey protein and hydrolyzed whey protein) on the intestinal repair of malnourished rats at weaning. The malnutrition was achieved by a 3 days' starvation period. Normally fed male Wistar rats were used as controls. Intestinal repair was studied after a refeeding period of 4 days. The parameters studied included nitrogen balance, lactase, sucrase, isomaltase, and maltase activities of the jejunum; liver acetylcholinesterase and glutamate dehydrogenase activities; and the serum amino acid profile. In addition, tests of intestinal permeability to macromolecules were performed by measurement of ovalbumin and β‐lactoglobulin in serum. Both diets led to the recovery of the severely starved rats, in terms of the values of all the parameters evaluated. The serum β‐lactoglobulin was the only exception, because its concentration was significantly lower in the normally fed animals. This study suggests that the intestinal mucosal barrier is not completely repaired, even after a 4‐day refeeding period, to the point of being suitable to accept an increase in the uptake of antigens.
Randomised Trial of Effect of Delayed Intravenous Lipid Administration on Chronic Lung Disease in Preterm Neonates
Authors: Alwaidh M. H. , Bowden L. , Shaw B. , Ryan S. W.
Published: February 2024

A recent sevenfold increase in the annual incidence of chronic neonatal lung disease (CNLD) on an intensive care unit was attributed to the early administration of intravenous lipid (IVL) in ventilated preterm neonates. When logistic regression was used to eliminate other confounding variables, early delivery of IVL was independently associated with an eight‐fold increase in the likelihood of CNLD. Consequently, we designed a prospective study to detect a halving of the incidence of CNLD by delaying IVL administration from 5 days (as is routine practice) to 14 days. Sixty‐four parenterally fed preterm neonates weighing <1,500 g at birth were randomised to receive IVL either on day 5 or day 14. Analysis was by intention to treat, since several infants in the latter group required no parenteral nutrition by day 14. Our results showed that the relative risk (95% confidence interval) of CNLD at 28 postnatal days was 1.15 (0.81‐1.62); at 36 weeks postconception, it was 1.08 (0.59‐1.99). A study population of >2,000 would be required to determine whether these relative risks were significantly different from 1.
Development of Iron Status and Response to Iron Medication in Pubertal Boys
Authors: Anttila Raija , Siimes Martti A.
Published: February 2024

During male puberty, rapid growth of body mass and the rise in hemoglobin concentration require much iron. The increasing need for iron may carry a risk of iron deficiency. Criteria for iron deficiency in adolescence are difficult to assess, as indicated by prevalences ranging from 0.5 to 30% in five recent studies from developed countries. We followed 60 prepubertal or early pubertal boys, testing them at 6‐month intervals for 24 months and relating hemoglobin levels and other iron parameters to age, pubertal development, and response to iron medication. A significant increase in mean hemoglobin was first seen at genital stage G4. In early puberty, in contrast, between stages G1 and G3, ferritin decreased. Mean transferrin increased slightly during the study. The prevalence of iron deficiency increased both with age and with advancing puberty. However, the early decline in ferritin may be a physiologic response to guarantee increasing intestinal absorption. After iron medication, we observed improvements in the levels of our parameters of iron status, which showed that hemoglobin levels had been limited by iron deficiency. In pubertal boys, evaluation of iron deficiency should not be based on laboratory parameters alone; age, pubertal development, and growth should also be taken into account.
Cryptogenic Hepatitis Masking the Diagnosis of Ornithine Transcarbamylase Deficiency
Authors: Zammarchi Enrico , Donati Maria Alice , Filippi Luca , Resti Massimo
Published: February 2024

We describe three children with transaminase elevations and hepatic insufficiency who were given the diagnosis of cryptogenic hepatitis after the more common viral and metabolic diseases of the liver had been excluded. However, further laboratory investigations showed hyperammonemia, low blood urea levels, elevated plasma glutamine levels, and low citrulline levels. Urinary excretion of orotic acid was higher than normal, with absent urinary homocitrulline and normal fractional tubular reabsorption of lysine, ornithine, and arginine. These findings suggest the diagnosis of ornithine transcarbamylase deficiency. We emphasize the importance of investigating possible urea cycle disorders by determining ammonia plasma levels, both at baseline and after a protein load; urinary and plasma amino acids; and urinary orotic acid in all patients with liver disease of indeterminate etiology.
Absorption of Macronutrients from a Calorie‐Dense Diet in Malnourished Children during Acute Shigellosis
Authors: Mazumder Ramendra N. , Kabir Iqbal , Rahman M. Mujibur , Khatun Makduma , Mahalanabis Dilip
Published: February 2024

A metabolic balance study was performed to determine the absorption of macronutrients and energy from different food items in 23 malnourished children aged 12 to 48 months with clinically severe acute dysentery due to shigellosis. In a 72‐h balance period, the absorption of carbohydrate, protein, fat, and total energy was determined. All the children received a standard hospital diet; 12 children in the test group were offered an additional calorie‐dense milk (5.0 kJ/ml with a protein‐energy ratio of 11.0), and 11 children in the control group, on the other hand, received a milk formula with an energy of 2.5 kJ/ml with a protein‐energy ratio of 11.0. The intakes (g/kg/day) of protein, fat, carbohydrate, and energy between test and control groups were 4.25 versus 2.32 (p = 0.01), 7.63 versus 3.00 (p = 0.01), 21.09 versus 11.14 (p = 0.01), and 711 kJ/kg/day versus 338 kJ/kg/day (p = 0.01), respectively. The coefficients of absorption of protein, fat, carbohydrate, and energy between test and control groups were 61 versus 67% (p = 0.45), 69 versus 82% (p = 0.11), 77 versus 86% (p = 0.13), and 72 versus 82% (p = 0.13), respectively. The losses (g/kg/day) of protein, fat, carbohydrate, and energy between the two groups were 1.61 versus 0.76 (p = 0.00), 2.44 versus 0.55 (p = 0.00), 5.0 versus 1.6 (p = 0.00), and 204 kJ/kg/day versus 60 kJ/kg/day, respectively. The results of this study indicate that during the acute stage of shigellosis (with a substantially enhanced total intake of protein, fat, carbohydrate, and energy), by adding calorie‐dense meals in malnourished children younger than 5 years, the absorption of macronutrients is not significantly different from that with the usual diet but suboptimal dietary energy intake, as is the case under ordinary treatment conditions.
IgA Antigliadin Antibodies as a Screening Method for Nonovert Celiac Disease in Children with Insulin‐Dependent Diabetes Mellitus
Authors: Calero P. , Ribes‐Koninckx C. , Albiach V. , Carles C. , Ferrer J.
Published: February 2024

One hundred forty‐one children with insulindependent diabetes mellitus were screened for serum immunoglobulin A (IgA) antigliadin antibodies by means of an enzyme‐linked immunosorbent assay (ELISA) method. None of them had gastrointestinal symptoms, and no major nutritional disturbances were detected except for a girl with moderate growth delay. Twelve patients with positive IgA antigliadin antibodies on two or more consecutive measurements underwent a small intestinal biopsy; four of them had a subtotal villous atrophy, and celiac disease was diagnosed; in another patient, a partial villous atrophy was observed. Children suffering from both diabetes and celiac disease showed an onset of diabetes at a younger age than did nonceliac patients. Prevalence of celiac disease in the screened population is 2.85%, which is higher than in the general population of the Comunidad Valenciana (one in 2,500 live births).
Facilitating Effect of Amino Acids on Fructose and Sorbitol Absorption in Children
Authors: Hoekstra J. Hans , van den Aker Janet H. L.
Published: February 2024

The facilitating effect of glucose on free fructose absorption has been suggested to be due to a sucrase‐related transport mechanism. In contrast, the conditions influencing the absorption of sorbitol have hardly been investigated. As amino acids promote transcellular water flow, we investigated their effects on the absorption of fructose and sorbitol. We studied 15 healthy children using breath hydrogen tests following the ingestion of fructose and sorbitol, alone and in combination with glucose or amino acids. Similarly, the effect of acarbose pretreatment on sucrose and fructose‐glucose absorption was investigated. The inhibition of sucrase isomaltase by acarbose impedes the absorption of sucrose but not of the fructose‐glucose mixture. Fructose absorption is enhanced by glucose and by the amino acids L‐alanine, L‐glutamine, L‐phenylalanine, and L‐proline. Similarly, the absorption of sorbitol is facilitated by glucose and L‐alanine. These results are not in concordance with a sucrase‐related fructose‐transport system and suggest another mechanism for glucose‐induced enhancement of fructose (and sorbitol) absorption. We hypothesize that the absorption of fructose and sorbitol may be stimulated by the increased water flux induced by active absorption of glucose as well as amino acids.
Congenital Glucose‐Galactose Malabsorption in Arab Children
Authors: Abdullah Assad M. A. , El‐Mouzan Mohamed I. , Shiekh Omer Karrar El , Mazyad Abdullah Al
Published: February 2024

Eight children with chronic diarrhea from glucose‐galactose malabsorption from eight different families are presented. Six children are Saudi Arabs and two are of the other Arab nationalities. The mean age of the children at the time of presentation was 10.6 months. They were first seen for chronic watery diarrhea, present since birth, and failure to thrive. Laboratory investigations, including small‐bowel biopsy, histology, and small‐bowel enzyme assay, confirmed the diagnosis of glucose‐galactose malabsorption. One child had a renal stone at the first visit, and another was discovered to have one on follow‐up. All the children responded clinically to fructose‐based formula, and they are thriving at follow‐up.
Incidence of Gastroesophageal Reflux with Whey‐ and Casein‐Based Formulas in Infants and in Children with Severe Neurological Impairment
Authors: Khoshoo Vikram , Zembo Michelle , King Andrew , Dhar Monica , Reifen Ram , Pencharz Paul
Published: February 2024

Ten exclusively gastrostomy‐fed, neurologically impaired children (4.5‐14.5 years old) with gastroesophageal reflux were randomly assigned to receive feedings with either a casein‐ or a whey‐based formula for 48 h each and then crossed over to the other formula. One 24‐h pH probe study each was performed while being fed casein‐ and whey‐based formula, respectively. There was a significant reduction in episodes and duration of gastroesophageal reflux while consuming the whey‐based formula (p < 0.05). Whey‐based feedings should be considered an additional tool in conjunction with other antireflux measures to treat gastroesophageal reflux more effectively in children with severe neurological impairment. A similar study was also conducted involving 14 infants (3‐12 months old) with documented gastroesophageal reflux using 24‐h pH probe monitoring while consuming a casein‐based formula. The formula was changed to a whey‐based formula and the pH probe study repeated within 3‐5 days. Four infants showed improvement and the rest showed either deterioration (1/14) or comparable results (9/14). The reduction in the mean number of episodes or duration of gastroesophageal reflux with the whey‐formula was not significantly different from that with the casein‐based formula (p > 0.05). Based on these findings, generalized recommendations for the use of whey‐based formula in infants with gastroesophageal reflux cannot be made.
Biliary Lipid Composition and Bile Acid Profiles During and After Enteral Fast of Total Parenteral Nutrition in the Rabbit
Authors: Das John B. , Poulos Nicholas D. , Ansari G. Ghaus
Published: February 2024

Feeding and fasting influence biliary lipid composition. With total parenteral nutrition (TPN), it is possible to study the effects of a long‐term “enteral fast” on biliary lipid composition without the metabolic illeffects on nutrient deprivation. We compared the lipid and bile acid (BA) contents of hepatic and gallbladder biles in rabbits on completion of a 14‐day regimen of TPN with those in rabbits returned to oral feeds for 6 weeks after a similar spell of TPN. Chow‐fed rabbits served as controls. With TPN, plasma phospholipid and cholesterol levels were elevated. Basal bile flow and the secretion of bile acids and phospholipids were decreased in the TPN and post‐TPN groups, while the cholesterol secretion rate was essentially unchanged. During TPN, the molar percent of cholesterol (relative to bile acids and phospholipid) in hepatic bile was increased. Biliary glycolithocholic acid (GLCA; as a percent of total conjugated BA) in hepatic bile increased from 1.7% (0.9% SEM) in the chow‐fed to 8.5% (1.5% SEM) during TPN. In TPN and post‐TPN groups, the gallbladder was enlarged to more than twice normal (chow‐fed) size, and contained a dark, mucoid bile (biliary sludge). In this bile, (a) there was a 2.5‐fold increase in bile acid concentration; and (b) the molar percent of cholesterol decreased while that of bile acids increased. TPN produced a state of functional cholestasis, which extended into the post‐TPN period. Gallbladder distension was the common denominator of the hepatobiliary dysfunction in the TPN and post‐TPN rabbits. With sequestration of bile acids in the gallbladder during and after TPN, the circulating bile acid pool was constricted, and the enterohepatic circulation impaired. As cholesterol secretion was low at all times, cholesterol supersaturation did not occur. The molar percent of cholesterol in gallbladder bile decreased, while that of bile acids increased; this suggests absorption of cholesterol by gallbladder mucosa. The increase in biliary GLCA probably resulted from bacterial biotransformation of glycochenodeoxycholic acid to lithocholic acid and its increased absorption from the cecum during TPN.
Vitamin A Concentration in the Liver Decreases with Age in Patients with Cystic Fibrosis
Authors: Lindblad Anders , Diczfalusy Uif , Hultcrantz Rolf , Thorell Anders , Strandvik Birgitta
Published: February 2024

Background:

Vitamin A deficiency is a common manifestation in cystic fibrosis (CF), but high levels of vitamin A in the liver have also been described. High levels of vitamin A in the liver are toxic, while normal levels might be protective against liver damage. In order to investigate whether liver damage in patients with CF is related to vitamin A content of the liver, vitamin A status was investigated in 15 patients with CF aged 8 to 34 years.

Methods:

Liver biopsy was performed on clinical indication and the vitamin A concentration in the liver was determined as retinylpalmitate. Serum levels of retinol and retinol‐binding protein were investigated on the morning of the biopsy. Eight patients had morphologic signs of cirrhosis. Eight patinets had been on treatment with ursodeoxycholic acid for 1 to 3 years. All but three patients had been on vitamin A supplementation for years.

Results:

Five patients had serum concentrations of retinol below the reference range and seven patients had decreased serum levels of retinol‐binding protein. There was a strong correlation between serum levels of retinol and retinol‐binding protein (rs = 0.90, p = 0.01), but no correlations with age, Shwachamn score, or genotype. Six of the patients had vitamin A concentrations in the liver <40 μg/g wet weight, and the concentrations decreased significantly with age (rs = 0.77, p = 0.01), without correlation to clinical score or liver disease. There was no indication of hypervitaminosis, although younger patients had been or were being treated with vitamin A in fat‐water emulsion.

Conclusions:

Our results indicate that the risk of vitamin a deficiency in cystic fibrosis increases with age. The data do not support the view that patients are at risk for hypervitaminosis by long‐term supplementation with vitamin A. No correlation was found between the severity of liver disease and the vitamin A content in the liver.
Fecal α1‐Antitrypsin in Newborn Infants
Authors: Keller Klaus‐Michael , Knobel Richard , Ewe Klaus
Published: February 2024

Background:

Fecal α1‐antitrypsin is used as a marker for intestinal protein loss reflecting increased intestinal permeability. Exact data of fecal α1‐antitrypsin in newborn infants are not available.

Methods:

30 healthy mature neonates and three infants with impaired gastrointestinal passage due to stenoses and atresia respectively, were investigated during the first days of life. The amniotic fluid of 13 and the serum of 17 infants was available. α1‐antitrypsin was determined using the radial immunodiffusion method.

Results:

Normal newborns showed mean fecal α1‐antitrypsin levels (±SD) of 2061 ± 817 mg/dl (day 1), 1186 ± 720 mg/dl (day 2), 308 ± 380 (day 3), 35 ± 27 (day 5), and 27 ± 21 mg/dl (day 6). Two infants with esophageal atresia presented a much lower pattern, and one with annular pancreas had a fecal α1‐antitrypsin pattern comparable with that of normal babies. Serum α1‐antitrypsin was normal (275 ± 52 mg/dl), and amniotic fluid contained 20 ± 12 mg/dl α1‐antitrypsin.

Conclusions:

The pattern of neonatal fecal α1‐antitrypsin content appears to reflect the meconium clearance of the gut rather than intestinal permeability and “gut closure.” We hypothesize that the origin of increased fecal α1‐antitrypsin is the result of accumulated secretions from bile, the pancreas, and the duodenum, but α1‐antitrypsin originating from swallowed amniotic fluid during pregnancy may play an additional role.
Omeprazole for Severe Reflux Esophagitis in Children
Authors: De Giacomo Costantino , Bawa Paola , Franceschi Massimo , Luinetti Ombretta , Fiocca Roberto
Published: February 2024

Background:

Severe esophagitis is a rare complication of gastroesophageal reflux in children. In adults, omeprazole therapy of severe erosive esophagitis has become the gold standard short‐term treatment of the disease. In children, data on its use are limited, and problems about the dosage are unresolved. The aim of this study was to evaluate the efficacy of a simplified, body‐weight‐based daily dosage of omeprazole in children with severe esophagitis.

Methods:

Ten children (median age 75.6 months; range 25‐109 months) with severe esophagitis were prospectively investigated. All patients were evaluated by endoscopy, histology, and 24‐h pH‐metry study before and after 3 months of omeprazole. The starting dose of omeprazole was 20 mg as a single daily dose in children weighing less than 30 kg, and 40 mg daily for those weighing over 30 kg.

Results:

A significant improvement in all the children was demonstrated after 3 months of treatment by clinical, endoscopic, and pH‐metry assessment. However, histologic study failed to show significant improvement of both inflammatory and hyperplastic findings. Relapse occurred in six of 10 patients after discontinuation of therapy.

Conclusions:

Omeprazole is effective in the short‐term treatment of severe oesophagitis in children. The daily dose of the drug could be easily based on the body weight. The persistence of histologic features of esophagitis in spite of clinical and endoscopic healing could be an indicator of poor outcome.
Liprotein(a) Phenotypes in Japanese Children: A Cohort Study
Authors: Arisaka Osamu , Fujiwara Sachi , Miyake Noriko , Mokuno Hiroshi , Yabuta Keijiro
Published: February 2024

Background:

Elevated serum lipoprotein(a) [Lp(a)] concentrations have been demonstrated to be associated with cardiovascular diseases due to premature atherosclerosis. However, the association of Lp(a) phenotypes with the development of these diseases remains largely unexplored.

Methods:

We analyzed the population‐based frequencies of serum Lp(a) phenotypes in 269 Japanese children aged 8‐13 years in one community. According to the different apolipoprotein(a) [apo(a)] electrophoretic mobilities, Lp(a) was classified into seven single‐band and respective double‐band phenotypes. Each individual expressed a single (homozygotic) or a double band (heterozygotic).

Results:

The serum Lp(a) concentration frequency distribution was skewed toward lower levels with a mean ± SD of 15.5 ± 18.0 mg/dl and a median of 11.0 mg/dl. The Lp(a) phenotype frequencies revealed that the frequency of double‐band phenotype expression (55%) was higher than that of single bands (44%) and that the frequency of phenotypes representative of low molecular weight apo(a) was very low (2%). The mean serum Lp(a) concentration of the double‐band‐expressing subjects was higher than that of subjects with the single‐band phenotype (20.1 ± 19.9 vs. 10.5 ± 15.9 mg/dl, p < 0.01).

Conclusions:

These findings of Lp(a) phenotypes in children seemed to differ from those in Japanese adults in another study; contrary to expectation, the predominant Lp(a) phenotypes found in children were those frequently associated with cardiovascular diseases in adults. Thus, it is speculated that children whose Lp(a) phenotypes remain unchanged during the transition to adulthood may show an increased susceptibility to cardiovascular disease, although the nutritional effects on the Lp(a) phenotypes cannot be neglected.
Indices of Body Fat Distribution in Spanish Children Aged 4.0 to 14.9 Years
Authors: Moreno Luis A. , Fleta Jesús , Mur Lilianne , Feja Cristina , Sarría Antonio , Bueno Manuel
Published: February 2024

Background

Reference values for the main indices of body fat distribution in children are not available.

Methods

The study population comprised 1638 Caucasian children and adolescents: 848 boys and 790 girls, with ages ranging from 4.0 to 14.9 years, and living in the central part of Spain (Provincia de Zaragoza). The waist‐to‐hip circumference ratio and the triceps‐to‐subscapular skinfold thickness ratio were measured.

Results

In boys, mean waist‐to‐hip circumference ratio ranges from 0.834, at 13.5 years, to 0.896 at 4.5 years. In girls, waist‐to‐hip circumference ratio ranges from 0.756, at 14.5 years, to 0.877, at 4.5 years. We observed a decrease of waist‐to‐hip circumference ratio with age, especially in girls. In boys, triceps‐to‐subscapular skinfold thickness ratio ranges from 1.360, at age 14.5, to 1.704, at age 5.5. In girls, triceps‐to‐subscapular skinfold thickness ratio ranges from 1.468, at age 13.5, to 1.727, at age 9.5. We observed a decrease with age only in boys.

Conclusions

We present reference values for the main indices of body fat distribution, which could be useful in clinical practice. However, research is needed that will compare these indices with data on body fat distribution obtained by a gold standard method, such as computed tomography or magnetic resonance imaging.
Activated Eosinophils in Esophagitis in Children: A Transmission Electron Microscopic Study
Authors: Justinich Christopher J. , Ricci Andrew , Kalafus Dolores A. , Treem William R. , Hyams Jeffrey S. , Kreutzer Donald L.
Published: February 2024

Background

Esophagitis in infants and children is often characterized by eosinophilic inflammation. The underlying pathophysiologic mechanisms leading to this type of inflammation, and the role of eosinophils in the clinical expression of esophagitis, are unknown. The purpose of this study was to demonstrate the ultrastructural activation state of eosinophils in esophagitis in infants and children.

Methods

Standard transmission electron microscopy was used to examine endoscopic esophageal biopsy material from patients with and without esophagitis, as defined by standard histologic criteria.

Results

Twelve esophagitis and three control cases were studied. In patients with esophagitis, electron microscopy revealed numerous eosinophils throughout the mucosa and invariably demonstrated signs of activation, including inversion of coreto‐matrix densities and lucency of granule core protein. Eosinophils in an activated state were seen in active diapedesis through vascular endothelium into the mucosa. Eosinophils were sometimes seen in proximity to lymphocytes. Biopsies of control patients did not demonstrate eosinophils.

Conclusions

Eosinophils present in esophagitis are activated by electron microscopic criteria, and can been seen in an activated state entering into the mucosa. This suggests that eosinophils play an active role in the pathophysiology of this disorder, and that proinflammatory factors are present that selectively recruit and activate eosinophils in esophagitis in children.
Percutaneous Endoscopic Gastrostomy in Children and Adolescents
Authors: Behrens Rolf , Lang Thomas , Muschweck Herbert , Richter Thomas , Hofbeck Michael
Published: February 2024

Background:

Long‐term nasogastric tube feeding is often associated with irritation of the hypopharynx or dislocation of the tube. These pitfalls may be circumvented by percutaneous endoscopic gastrostomy. Although frequently used in adults, there is limited experience with the procedure in children.

Methods:

A series of 139 patients (aged 3 weeks to 36.5 years, mean age, 4.4 years; weight 3.1‐60 kg, mean weight, 15 kg) underwent placement of a percutaneous endoscopic gastrostomy because of central dysphagia (n = 103); general dystrophy caused by chronic renal failure, congenital heart disease, neoplasms, or cystic fibrosis (n = 26); requirement for special diets (n = 7); malnutrition related to respiratory insufficiency (n = 2); and gastric volvulus (n = 1).

Results:

The percutaneous endoscopic gastrostomy was placed either in the stomach (n = 122) or in the duodenum (n = 15). In two patients a direct percutaneous endoscopic jejunostomy was performed, because duodenal placement proved impossible. Percutaneous endoscopic gastrostomies were placed using intravenous sedation (midazolam, etomidate, or diazepam). None of the patients required general or inhalation anesthesia. We observed 19 complications including: dislocation of the duodenal part into the stomach (n = 5); inflammation at the insertion site (n = 3); perforation of the stomach (n = 2), which healed under conservative treatment; disconnection of the retention disk (n = 4); occlusion of the tube (n = 4), and chronic vomiting (n = 1). Mean lifetime of a percutaneous endoscopic gastrostomy was more than 1 year.

Conclusions:

Percutaneous endoscopic gastrostomy provides a major improvement for children requiring long‐term tube feeding. High efficacy and low rates of complication suggest that percutaneous endoscopic gastrostomy should be considered more often, even in infants.
The Technetium White Cell Scan as an Initial Imaging Investigation for Evaluating Suspected Childhood Inflammatory Bowel Disease
Authors: Shah D. B. , Cosgrove M. , Rees J. I. S. , Jenkins H. R.
Published: February 2024

Background:

The technetium white cell scan (WCS) may be a useful investigation for patients with inflammatory bowel disease (IBD). In a retrospective study we assessed the use of the WCS as an initial imaging investigation in evaluating children with suspected IBD.

Methods:

Over a 3‐year period, 60 WCS were performed on 55 patients (25 boys, median age 12.1 years, age range 1.5‐18 years) with known or suspected IBD. There were two clinical groups: those with previously diagnosed IBD (histologically and radiologically) and in clinical relapse (13 patients), and newly presenting patients with suspected IBD (42 patients).

Results:

Eighteen scans were performed on the 13 patients presenting with relapse. Seventeen were positive and one patient, subsequently shown to have an inactive stricture, had a negative scan. Seven of the 42 newly presenting patients had abnormal scans, confirmed to be due to IBD by a combination of histology and barium examinations. Of the remaining 35 scans, three were abnormal and 32 were normal. None of these patients were subsequently proven to have IBD. These results show that in detecting active IBD, a positive WCS has a 100% sensitivity (24/24) and a 91% specificity (32/35) in the diagnosis of IBD.

Conclusions:

Our results show that the WCS is very useful as an initial imaging investigation in evaluating patients with suspected IBD to select patients for further investigation.
Use of Barbiturates in the Treatment of Cyclic Vomiting During Childhood
Authors: Gokhale Ranjana , Huttenlocher Peter R. , Brady Lynda , Kirschner Barbara S.
Published: February 2024

Background:

Cyclic vomiting is an uncommon disorder that can be described as recurrent, self‐limiting, fairly uniform episodes of intractable nausea and vomiting with no identifiable organic cause, separated by symptom‐free intervals. There is no established therapeutic regimen for this disorder.

Methods:

Fourteen children referred to the Pediatric Gastroenterology Clinic were diagnosed with cyclic vomiting from May 1984 to January 1995. Vomiting, the predominant symptom, was present in all children and was severe enough to require hospitalization in 11. Associated symptoms included abdominal pain, headache, nausea, aura, and fever. Diagnostic studies were done to rule out organic causes as indicated in individual patients. Daily phenobarbital was prescribed in all 14 patients. The dose ranged from 30 to 120 mg/hs (mean 2 mg · kg‐1 · day‐1), with a median dose of 60 mg/hs. Prior therapy with propranolol (3 patients) and butalbital (2 patients) had been ineffective.

Results:

Eleven patients had complete resolution of their symptoms, and 3 patients had marked improvement in their symptoms with infrequent attacks of reduced severity. The only side effects associated with long‐term phenobarbital therapy were behavioral in nature, namely hyperactivity and disruptive behavior at school.

Conclusions:

The results of our series of 14 patients, all of whom received barbiturates, support the usefulness of this therapeutic approach. Hence we feel that daily low‐dose phenobarbital therapy is a safe and effective therapy in preventing episodes of cyclic vomiting in children.
Prooxidant Effects of Maternal Smoking and Formula in Newborn Infants
Authors: Schwarz Kathleen B. , Cox Jeanne M. , Sharma Savitri , Clement Liliana , Witter Frank , Abbey Helen , Sehnert Shelley S. , Risby Terence H.
Published: February 2024

Background:

The purpose of this study was to use the breath ethane test to determine if either maternal cigarette smoking, formula, and/or deficiency of the antioxidant nutrients vitamins A and E was associated with oxidant stress in newborn infants. The rationale for this study was: (1) our observation that cigarette smoking was a source of oxidant stress in pregnant women, suggesting that it could be a source of oxidant stress for infants exposed in utero; (2) formula was predicted to be prooxidant compared to colostrum, which contains several compounds with antioxidant activity in vitro; and (3) deficiencies of vitamins A and E have been shown to promote oxidant stress in experimental animals.

Methods:

Breath ethane, a volatile alkane produced by peroxide of n‐3 fatty acids, was utilized as an index of oxidant stress status. Forty‐five healthy full‐term infants of the women mentioned above were studied at 18‐24 h of age, after four to six feedings of breast milk (colostrum) or caseinbased infant formula. Relationships between infant breath ethane, maternal smoking, mode of infant nutrition, and serum concentrations of the antioxidant vitamins A and E of infants were examined.

Results:

The breath ethane of the entire group of infants whose mothers smoked (n = 19) was increased compared to values of infants whose mothers did not smoke (n = 26): 97 ± 16 versus 43 ± 9 pmol/kg/min, p < 0.03. When infants of mothers who smoked were eliminated from the analysis in order to study effects of nutrition alone, formula appeared to be prooxidant compared to breast milk. Breath ethane of formula‐fed infants (n = 16) was 62 ± 13 versus 13 ± 4 pmol/kg/min for breast‐fed infants (n = 10), p < 0.04. For the group as a whole, there was no correlation between infant breath ethane and serum concentrations of vitamins A and E.

Conclusions:

Exposure to maternal smoking in utero is prooxidant in newborn infants. Formula also has a prooxidant effect compared to colostrum in newborn infants not exposed to maternal smoking in utero. Further investigations will be necessary to explore the clinical consequences of these observations.
Modified Cow's Milk Formula with Reduced Renal Acid Load Preventing Incipient Late Metabolic Acidosis in Premature Infants
Authors: Kalhoff H. , Diekmann L. , Hettrich B. , Rudloff S. , Stock G. J. , Manz F.
Published: February 2024

Background:

Premature infants receiving alimentation with cow's milk formulas are at a considerably high risk of developing incipient late metabolic acidosis, an early stage in the development of manifest late metabolic acidosis. Is it possible to reduce this risk by modification of the composition of a standard formula?

Methods:

The mineral composition of a cow's milk preterm formula A was modified (formula B) with the aim of reducing the alimentary load to that of human milk. 160 premature infants were fed either mother's milk (n = 50) or the modified formula B (enriched with sodium and potassium) (n = 110), and their urine pH was tested twice a week. Randomly collected subgroups of infants were studied in detail for nutrient balances. The results were compared with earlier observations of 282 premature infants fed either mother's milk (n = 28) or the standard formula A (n = 254).

Results:

Incipient late metabolic acidosis was observed in nine of 78 premature infants receiving mother's milk, 53 of 254 premature infants receiving the standard formula A, and only one of 110 premature infants fed the modified formula B. Net acid excretion was 0.58 mmol/kg/day in 11 premature infants receiving alimentation with the modified formula B compared with 1.73 mmol/kg/day in 23 premature infants fed formula A. This reduction was mainly due to an increased alkali excess (sodium + potassium‐chloride) in intake and urine.

Conclusions:

Reduction of renal acid load with the modified formula B had a preventive effect on the rate of development of incipient late metabolic acidosis in premature infants.
Growth and Nutrient Intake in Three‐ to Twelve‐Month‐Old Infants Fed Human Milk or Formulas with Varying Protein Concentrations
Authors: KarlslandÅkeson Pia M. , Axelsson Irene E. M. , Räihä Niels C. R.
Published: February 2024

Background:

Results on growth and nutrient intake in infants in the second half of infancy fed human milk or formulas with varying protein concentrations in combination with supplementary foods have not previously been reported.

Methods:

Seventy‐one healthy infants were studied from 3 to 12 months of age. They were exclusively breast‐fed until 3 months and were then randomly assigned to one of three feeding groups, F13, F15, or F18, indicating formulas with 13, 15 or 18 g/l of protein, respectively. Formula was gradually introduced when breast‐feeding was terminated. Infants fed breast milk only were included in the breast‐fed group, and those with breast milk and formula were included in the mixed‐fed group. The same supplementary foods were provided to all infants.

Results:

There were no differences in growth between the feeding groups. Total protein intake exceeded minimum recommendations in all groups at all ages and was higher at 6 months in F18 than in F13 (2.3 vs. 1.9 g/kg per day;p < 0.01), whereas formula protein intake was higher at all ages in F18 compared with F13. Intake of protein from supplementary foods increased, but that from formula decreased between 6 and 12 months in all groups.

Conclusions:

Intake of breast milk or infant formula with 13 g/l of protein along with high‐protein supplementary foods provided enough protein with no adverse effect on growth. Infants fed formulas with higher protein concentrations had similar growth, despite higher intakes of formula protein.
Bile Salt‐Stimulated Lipase and Digestion of Non‐Breast Milk Fat
Authors: McClean Patricia , Harding Marilyn , Coward W. Andy , Prentice Ann , Austin Steve , Weaver Lawrence T.
Published: February 2024

Background:

13Carbon (13C)‐lipid breath tests are an effective, noninvasive way of repeatedly measuring fat digestion. The purpose of this study was to assess the contribution of bile salt‐stimulated lipase (BSSL) in human milk to the digestion of non‐breast‐milk fat in Gambian infants.

Methods:

Twelve Gambian infants (aged 3‐8 months) were studied on 4 days.13 C‐Trioctanoin (7.5 mg/kg, digested by BSSL preduodenal and pancreatic lipases) and 13C‐cholesteryl octanoate (25 mg/kg, digested by BSSL and pancreatic lipases) were used as substrates. The percentage dose recovery(PDR) of 13C in breath during 5 hours was compared after ingestion of each substrate with fresh, expressed breast milk (FBM) or heated, expressed breast milk (HBM). Gas isotope ratio‐mass spectrometry was used to measure13 C enrichment, and breast milk samples were analysed for esterase activity.

Results:

Heating breast milk significantly decreased esterase activity (mean± SD values: FBM = 12.2 ± 2.9 IU/ml; HBM = 0.5 ± 0.3 IU/ml), and there was no difference in the volumes of milk ingested on each test day (approximately 50 ml). The PDR of 13C was comparable to that previously described in healthy English infants and was not increased by BSSL. The mean ± SD PDR of 13C from trioctanoin was 36.3 ± 8.4% for FBM and 34.6 ± 6.3% for HBM (NS). From cholesteryl octanoate, the mean ± SD PDR of 13C was 24.3 ± 8.7% for FBM and 27.1± 7.5% for HBM (NS).

Conclusions:

Bile salt‐stimulated lipase may enhance fat digestion in younger or malnourished infants who have a greater degree of pancreatic enzyme deficiency. However, this study suggests that it does not increase the digestion of non‐breast‐milk fat in healthy, well‐nourished infants aged 3 to 8 months from an underprivileged background, who typically ingest frequent small quantities of breast milk.