bluuebunny/crossref_metadata_2025 huggingface dataset:
Water and Electrolyte Salvage in an Animal Model of Dehydration and Malnutrition
Authors: Islam Sufia , Abély Michel , Alam N. Hoque , Dossou Flore , Chowdhury A. K. Azad , Desjeux Jehan‐François
Published: January 2024

Background and aim

Recently, a new oral rehydration solution (ORS) called Resomal has been designed specifically for children with severe malnutrition. The aim of this study was to assess the effect of malnutrition on renal and intestinal responses to dehydration, and to compare intestinal water and electrolyte absorption from Resomal and from the standard World Health Organization‐Oral Rehydration Solution (WHO‐ORS).

Methods

Malnutrition was achieved in a rabbit model by feeding the animals daily for 30 days with half the amount of food that a well‐nourished group of control animals had consumed on the previous day. Dehydration was achieved by water deprivation for 46 hours in both control and malnourished rabbits. At 46 hours, dehydration was assessed by changes in body weight, urinary volume and osmolarity, and blood urea nitrogen concentration. At that time active colonic and jejunal mucosal electrolyte transport in Ussing chambers was also measured. Small intestinal absorption of water, sodium, and potassium was measured in vivo during intestinal perfusion of the two ORSs and in vitro by measurement of mucosal electrogenic glucose‐stimulated sodium absorption across intestinal patches.

Results

Compared to controls (C), well‐nourished but dehydrated (C+D) animals lost 12% of their body weight, with an 87% reduction in urine volume, a 110% increase in urine osmolality, and a 94% increase in blood urea nitrogen. In the colon of C+D animals, short‐circuit current (Isc) and net sodium transepithelial flux (JNa+ net) were increased. Almost identical results were obtained in malnourished and dehydrated (M+D) animals. In the jejunum, net in vivo absorption of water (JWater), sodium (JNa+), and potassium (JK+) were increased during standard ORS infusion in both dehydrated groups. During Resomal infusion, water absorption was the same as seen with WHO‐ORS, but sodium absorption was reduced, and potassium absorption was increased in both well‐nourished and malnourished dehydrated animals. In vitro, compared to controls, the glucose‐stimulated short‐circuit current (ΔIsc), JNa+ net and G were increased in both dehydrated groups.

Conclusion

During experimental dehydration, the kidney and large intestine salvage water and electrolytes, thus reducing the consequences of dehydration. These findings indicate that jejunal water absorption from Resomal and WHO‐ORS is increased during dehydration, but Resomal allows for less sodium and more potassium to be absorbed, both in well‐nourished and malnourished dehydrated rabbits.
Vitamin E Treatment in Pediatric Obesity‐Related Liver Disease: A Randomized Study
Authors: Vajro Pietro , Mandato Claudia , Franzese Adriana , Ciccimarra Edmondo , Lucariello Stefania , Savoia Marcella , Capuano Grazia , Migliaro Fiorella
Published: January 2024

Objective

A beneficial role of antioxidants in hepatopathic obese individuals has hitherto been inferred only from uncontrolled pilot studies. The authors compared the effect of vitamin E and weight loss on transaminase values and on ultrasonographic bright liver in a controlled group of children with obesity‐related liver dysfunction.

Methods

Twenty‐eight children with obesity‐related hypertransaminasemia and bright liver were randomly allocated to two single‐blind groups: group 1 (n = 14) treated with a low‐calorie diet associated with oral placebo for 5 months, and group 2 (n = 14) treated with a low‐calorie diet associated with oral vitamin E (400 mg/d × 2 months, 100 mg/d × 3 months). Transaminase values and ultrasonographic liver brightness along with weight loss and vitamin E levels were monitored.

Results

Variations in transaminase levels and percentage of patients with normalized transaminase values were comparable in the two groups. The disappearance of bright liver was observed only in patients who lost weight and was twice as common in patients from group 1. Two subgroups of patients with complete normalization of transaminase values emerged as a consequence of controlled adherence to diet alone (n = 6; significant decrease of percent overweight:P = 0.0019 ) and to vitamin E alone (n = 7; unmodified percent overweight and significant increase of vitamin E/cholesterol ratio:P < 0.0001). Changes in treatment‐induced alanine aminotransferase levels in these two subgroups were comparable at month 2, whereas values at month 5 were significantly lower in the subgroup adherent to diet alone (P = 0.04). In the subgroup adherent to vitamin E alone, after 2 months washout, transaminase remained stable in 5 patients and increased in 2; bright liver persisted in all.

Conclusions

Oral vitamin E warrants consideration in obesity‐related liver dysfunction for children unable to adhere to low‐calorie diets.
Functional Fecal Retention With Encopresis in Childhood
Authors: Loening‐Baucke Vera
Published: January 2024

Objectives

The most common cause of encopresis in children is functional fecal retention (FFR). An international working team suggested that FFR be defined by the following criteria: a history of >12 weeks of passage of <2 large‐diameter bowel movements (BMs) per week, retentive posturing, and accompanying symptoms, such as fecal soiling. These criteria are usually referred to as the ROME II criteria. The aims of this study were to evaluate how well the ROME II criteria identify children with encopresis; to compare these patients to those identified as having FFR by historical symptoms or physical examination; to determine whether 1‐year treatment outcome varied depending on which definition for FFR was used; and to suggest improvements to the ROME II criteria, if necessary.

Methods

Data were reviewed from the history and physical examination of 213 children with encopresis. One‐year outcomes identified were failure, successful treatment, or full recovery.

Results

Only 88 (41%) of the patients with encopresis fit the ROME II criteria for FFR, whereas 181 (85%) had symptoms of FFR by history or physical examination. Thirty‐two (15%) patients did not fit criteria for FFR, but only 6 (3%) appeared to have nonretentive fecal soiling. Rates of successful treatment (50%) and recovery (39%) were not significantly different in the two groups.

Conclusions

The ROME II criteria for FFR are too restrictive and do not identify many children with encopresis who have symptoms of FFR. The author suggests that the ROME II criteria for FFR could be improved by including the following additional items: a history of BMs that obstruct the toilet, a history of chronic abdominal pain relieved by enemas or laxatives, and the presence of an abdominal fecal mass or rectal fecal mass.
Lewis Antigen Expression in Gastric Mucosa of Children: Relationship With Helicobacter pylori Infection
Authors: Nogueira Ana Margarida , Marques Terezinha , Soares Paula Cristina M. , David Leonor , Reis Celso A. , Serpa Jacinta , Queiroz Dulciene M. , Rocha Gifone A. , Rocha Andréia C.
Published: January 2024

Objective

Lewis epithelial antigen expression has a role in Helicobacter pylori adherence, presumably mainly in cag A‐positive strains. The authors investigated whether Lewis antigen expression in children's gastric mucosa was associated with H. pylori infection, cag A status, patient age, or presence of duodenal ulcer (DU).

Methods

The expression of Lewis A (Lea), B (Leb), X (Lex), and Y (Ley) was detected by immunohistochemistry in the antral and oxyntic mucosae of 70 children. Children were divided in four age groups (<4 years; 4–8 years; 9–12 years; and 13–18 years).

Results

Forty‐seven of the 70 children had H. pylori and 17 had DU. The cag A status was determined by polymerase chain reaction in 34 patients. Lea and Leb were expressed in 64% and 44% of the patients, respectively; Lex and Ley were expressed in the glands in all of the patients and in the superficial epithelium. Leb expression was more common among patients without H. pylori (15/23, 65%) than in those with H. pylori (16/47, 34%) (P = 0.03). In noninfected patients, Leb and superficial Ley expression were associated with increased age. Leb expression was more common in patients with chronic gastritis than in those with DU. Lex superficial expression was significantly associated with DU in patients with H. pylori.

Conclusion

In children, the expression of Leb and Ley in the superficial gastric epithelium depends on age. Other receptors, such as Lex, may have a role in H. pylori colonization, especially in patients with DU. Studies assessing the expression of Lewis antigens in children may contribute to an understanding of the mechanisms of acquisition of H. pylori infection.
Gastric Histopathology, Iron Status and Iron Deficiency Anemia in Children with Helicobacter pylori Infection
Authors: Baysoy Gökhan , Ertem Deniz , Ademoğlu Evin , Kotiloğlu Esin , Keskin Sabiha , Pehlivanoğlu Ender
Published: January 2024

Objectives

Helicobacter pylori has been established as a major cause of gastritis and peptic ulcer disease in adults and children. H. pylori infection may also have a role in the development of some extragastrointestinal diseases, including iron deficiency anemia. The aim of this study is to investigate H. pylori‐related changes in gastric physiology and histology and the relationship of these changes to iron deficiency anemia in children.

Methods

Fifty‐two patients with gastrointestinal complaints were studied. Hematologic parameters, 3‐day vitamin C and iron consumption, serum gastrin levels, and gastric juice ascorbic acid levels were compared in patients with and without H. pylori infection. Dietary intake of vitamin C and iron, serum gastrin, gastric juice ascorbic acid content, and gastric histology were compared in patients with H. pylori infection and anemia and in patients with H pylori infection and no anemia. The CagA status of the H. pylori organisms was evaluated.

Results

Twenty‐eight of 52 patients had H. pylori. Thirty‐one patients had iron deficiency anemia. H. pylori infection was associated with low serum iron levels. H. pylori gastritis was associated with a decrease in the gastric juice ascorbic acid level. Infection with CagA‐positive strains was associated with a greater decrease in gastric juice ascorbic acid than infection with CagA‐negative strains. However, the gastric juice ascorbic acid levels of patients with H. pylori and anemia were not different from those of non‐anemic patients with H. pylori. Among patients with H. pylori infection, pangastritis was twice as common in those with anemia than in those without anemia.

Conclusions

H. pylori infection was associated with a decrease in gastric juice ascorbic acid concentration, and this effect was more pronounced in patients with the CagA‐positive strain. Pangastritis was more common in patients whose H. pylori. infection was accompanied by anemia.
Low‐Dose Immunosuppression Reduces the Incidence of Post‐transplant Lymphoproliferative Disease in Pediatric Liver Graft Recipients
Authors: Ganschow Rainer , Schulz Tania , Meyer Thomas , Broering Dieter C. , Burdelski Martin
Published: January 2024

Objectives

In pediatric solid organ transplantation, the Epstein‐Barr virus (EBV)‐related lymphoproliferative disorders (PTLD) still play a major role in post‐transplant morbidity and mortality. The aim of the study was to determine the incidence of PTLD in pediatric patients with liver transplant who receive low‐dose immunosuppression protocols.

Methods

All pediatric patients (n = 269) received a dual immunosuppression therapy consisting of cyclosporine A (initial trough levels, 170–200 μg/L; trough levels for maintenance immunosuppression after 1 year, 80–100 μg/L) and prednisolone (starting dose, 60 mg/m2). Steroids were reduced to 30 mg/m2 after 1 week, followed by a weekly tapering to 5 mg/m2. Seventy‐seven of 269 patients were switched to tacrolimus therapy. The authors evaluated the significance of EBV‐DNA monitoring by quantitative polymerase chain reaction in identifying patients at risk for PTLD.

Results

Patient survival was 90.3%; graft survival was 85.9%. Eight patients lost their grafts because of chronic rejection. The incidence of PTLD was low (0.7%), although a significant EBV viral load was found in 42.4% of the patients. One third of the patients with a viral load of 3,000 genomes/105 cells or greater had clinical signs of EBV infection.

Conclusions

The authors conclude that low‐dose immunosuppressive protocols significantly reduce the incidence of PTLD. In patients treated with that regimen, the monitoring of EBV viral load seems not to be helpful. It can be assumed that low‐dose immunosuppression does not suppress EBV‐specific cytotoxic CD8+ T cells, thus allowing the host to control EBV infection without the risk of PTLD. Our low‐dose immunosuppression protocol did not increase the risk of chronic rejection.
Irreversible Intestinal Failure
Authors: Goulet Olivier , Ruemmele Frank , Lacaille Florence , Colomb Virginie
Published: January 2024

Intestinal failure (IF) can be defined as the reduction of functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for maintenance in adults or growth in children. In developed countries, IF mainly includes individuals with the congenital or early onset of conditions requiring protracted or indefinite parenteral nutrition (PN). Short bowel syndrome was the first commonly recognized cause of protracted IF. The normal physiologic process of intestinal adaptation after extensive resection usually allows for recovery of sufficient intestinal function within weeks to months. During this time, patients can be sustained on parenteral nutrition. Only a few children have permanent intestinal insufficiency and life‐long dependency on PN. Non‐transplant surgery including small bowel tapering and lengthening may allow weaning from PN in some cases. Hormonal therapy with recombinant human growth hormone has produced poor results while therapy with glucagon‐like peptide‐2 holds promise. Congenital diseases of enterocyte development such as microvillus inclusion disease or intestinal epithelial dysplasia cause permanent IF for which no curative medical treatment is currently available. Severe and extensive motility disorders such as total or subtotal intestinal aganglionosis (long segment Hirschsprung disease) or chronic intestinal pseudo‐obstruction syndrome may also cause permanent IF. PN and home‐PN remain are the mainstays of therapy regardless of the cause of IF. Some patients develop complications while receiving long‐term PN for IF especially catheter related complications (thrombosis, sepsis) and liver disease. These patients may be candidates for intestinal transplantation. This review discusses the causes of irreversible IF and emphasizes the specific medico‐surgical strategies for prevention and treatment of these conditions at several stages of IF.
Administration of Oral Probiotic Bacteria to Pregnant Women Causes Temporary Infantile Colonization
Authors: Schultz Michael , Göttl Claudia , Young Rose J. , Iwen Peter , Vanderhoof Jon A.
Published: January 2024

Background

It is difficult to permanently change the composition of the complex intestinal microflora of the adult. Orally administered probiotic bacteria produce only temporary colonization of the intestine in patients with a fully developed gut microflora. The gastrointestinal tract of a healthy fetus is sterile. During the birth process and rapidly thereafter, microbes from the mother and the surrounding environment colonize the gastrointestinal tract until a dense, complex microflora develops. Probiotic bacteria have been shown to beneficially influence the intestinal and systemic immune system and mediate protection against nosocomial infections affecting the neonate.

Objectives

The purpose of this study was to determine whether oral administration of the probiotic micro‐organism Lactobacillus rhamnosus strain GG (L. GG) to the pregnant woman leads to colonization of the newborn infant.

Methods

The authors identified six women who were taking L. GG during late pregnancy. None of the children received L. GG after birth, and their mothers discontinued its consumption at the time of delivery. L. GG concentration in fecal samples was determined by colony morphology and molecular analysis.

Results

In all four children delivered vaginally and in one of two children delivered by cesarean section, L. GG was present in fecal samples at 1 and 6 months of age. Three children remained colonized for at least 12 months, and in two children L. GG was detected in fecal samples at 24 months of age. Three mothers were tested 1 month post partum and no L. GG was present in fecal samples. No L. GG was found in one of these women 24 months post partum. There was no L. GG detectable in stools of the siblings of two children at the 2‐year and 3‐years after birth of the index child. L. GG was not isolated from the stools of children whose mothers were not taking L. GG.

Conclusions

Temporary colonization of an infant with L. GG may be possible by colonizing the pregnant mother before delivery. Colonization is stable for as long as 6 months, and in unexplained circumstances may persist for as long as 24 months.
Impact of Sedation and Anesthesia on the Rectoanal Inhibitory Reflex in Children
Authors: Pfefferkorn Marian D. , Croffie Joseph M. , Corkins Mark R. , Gupta Sandeep K. , Fitzgerald Joseph F.
Published: January 2024

Objective

The study objective was to determine whether the rectoanal inhibitory reflex (RAIR) can be elicited during limited anorectal manometry (ARM) performed under general anesthesia (GA).

Methods

In this retrospective study, patients with intractable constipation who underwent ARM under GA from November 1999 to March 2002 were evaluated. Rectal biopsy specimens were examined for the presence of ganglion cells.

Results

Eighty consecutive patients aged 5 months to 16 years were evaluated. Three patients with Hirschsprung disease were excluded from analysis. Ganglion cells were found in rectal biopsy specimens from 76 patients. RAIR was positive in 69 (90%) and negative in 8 (10%). Forty‐five patients received preoperative medications: midazolam (n = 36), midazolam + atropine (n = 3), atropine (n = 1), midazolam + glycopyrrolate (n = 3), and glycopyrrolate (n = 2). Different combinations of general anesthetic medications were used. Ten patients received neuromuscular blockers. The use of preoperative midazolam or atropine did not affect the presence or absence of RAIR; however, the proportion of patients with negative RAIR was higher in those receiving glycopyrrolate (P = 0.007) than in those receiving other medications. There was no significant difference in the effect of the general anesthetic agents or neuromuscular blockers used on the presence or absence of RAIR.

Conclusions

The rectoanal inhibitory reflex in children can be elicited even when anorectal manometry is performed under general anesthesia. Glycopyrrolate, an anticholinergic, appears to inhibit the demonstration of the RAIR.
Energy Intake, Metabolic Balance and Growth in Preterm Infants Fed Formulas With Different Nonprotein Energy Supplements
Authors: Romera Gerardo , Figueras Josep , Rodríguez‐Miguélez José Manuel , Ortega Josep , Jiménez Rafael
Published: January 2024

Objective:

To study metabolic and energy balances, growth and composition of increased body mass in healthy preterm infants fed control formula or control formula with three different nonprotein energy supplements.

Patients and Methods:

Growing preterm infants (birth weight < 1,500 g and gestational age < 31 weeks) were fed standard preterm formula (control group) or the same formula enriched with three different nonprotein energy supplements. An energy supplement of 23 kcal/kg/day was achieved by adding medium‐chain triglyceride and dextrinomaltose in three different caloric ratios: 33:66 in group A, 66:33 in group B, and 85:15 in group C. Energy balance was determined by open‐circuit continuous (5–6 hours) measurements of energy expenditure, with simultaneous measurement of 24‐hour urinary nitrogen excretion. Metabolic balance was determined by measurements of energy intake, energy oxidation, and energy output in urine and stool. The composition of body mass accretion was determined as the accretion of fat and protein in the total weight gain.

Results:

The fat accretion (4.9, 5.9, 6.2, and 3.8 g/kg/day in groups A, B, C and D, respectively) correlated directly with fat intake. Infants receiving standard energy intake had a fat percentage of weight gain significantly lower (28%) than that of the high‐energy intake groups (31%, 40%, and 38% in groups A, B, and C, respectively). This difference corresponded to the results obtained from skinfold thickness measurements.

Conclusions:

Excess nonprotein energy is stored as fat regardless of its source (fat or carbohydrate). High caloric and medium‐chain triglyceride intake in otherwise healthy growing preterm infants does not promote nitrogen retention.
Longevity of Balloon‐stabalized Skin‐level Gastrostomy Devive
Authors: Michaud Laurent , Guimber Dominique , Blain‐Stregloff Anne‐Sophie , Ganga‐Zandzou Serge , Gottrand Frédéric , Turck Dominique
Published: January 2024

Objective:

The gastrostomy button is increasingly used in patients requiring long‐term enteral feeding. No data are available addressing the longevity of balloon‐type gastrostomy buttons. The aim of this study was to evaluate the longevity of balloon‐type gastrostomy buttons in children and the cause of the button removal.

Patients and methods:

During a period of 2.5 years, 165 gastrostomy (Mic‐Key®, Medical Innovations Corporation, Draper, Utah, U.S.A.) buttons were inserted in 84 children. In all patients, the button replaced a standard tube gastrostomy. The first button was usually inserted under general anesthesia at least 2 months after the insertion of a surgical gastrostomy tube. Additional replacement was performed without sedation.

Results:

Mean longevity of balloon‐type gastrostomy buttons was 5 months (range, 14 days–14 months). Causes of button removal were: inner balloon rupture (n = 101, 61%); leak around button or deflation of the balloon (n = 23, 14%); accidental removal (n = 20, 12%); device damage (n = 5), and obstruction (n = 3). When considering the subgroup with inner balloon rupture, the longevity of the button was 6 months (range, 1–13 months). No correlation was found between duration of gastrostomy button and underlying disease, age of the patient, or the use of antisecretory drugs.

Conclusion:

Although the Mic‐Key button has the advantage of an easy insertion, its major limitation is the high frequency of inner balloon rupture, which was the primary main reason for removal.
Plasma Oxytocin in Children with Recurrent Abdominal Pain
Authors: Alfvén Gösta
Published: January 2024

Objective:

The main objective of this work was to study plasma oxytocin concentration of children with psychosomatic recurrent abdominal pain and children with organic abdominal disease producing pain. Another objective was to study plasma oxytocin in children with psychosomatic recurrent pain over time and its relationship to other associated symptoms such as somatic pains and appetite.

Design:

The concentration of oxytocin in plasma (fasting morning sample) was measured by radioimmunoassay in 48 children with abdominal pain, 32 of whom had psychosomatic recurrent abdominal pain according to previously defined criteria. Oxytocin levels were assessed in a separate group of 15 children with inflammatory bowel disease with abdominal pain and in a control group of 79 healthy school children.

Results:

Plasma oxytocin concentration was significantly lower in children with recurrent abdominal pain of psychosomatic origin (P < 0.0001) and in the group of children with inflammatory bowel disease (P < 0.001) compared to controls. There was no difference between oxytocin levels of children with psychosomatic abdominal pain and those with inflammatory bowel disease. When repeated after one year, children with psychosomatic abdominal pain had an increase in mean plasma oxytocin level (P < 0.05). No relationship was found between specific symptoms and plasma oxytocin.

Conclusions:

Plasma oxytocin level is low in patients with abdominal pain of psychosomatic origin and inflammatory bowel disease. Measurement of plasma oxytocin may be of some help in the differential diagnosis of recurrent abdominal pain, but does not differentiate between psychosomatic abdominal pain and pain associated with inflammatory bowel disease.
Cholestatic and Metabolic Liver Diseases: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Authors: Thompson Richard J. , Azevedo Ramiro Anthero , Galoppo Cristina , Lewindon Peter , McKiernan Patrick
Published: January 2024

Research

To understand the mechanisms of drug‐induced cholestasis.

Which conditions are best treated by liver replacement therapy or bone marrow transplant, and how does one monitor the function of such cells?

Intervention

To develop common diagnostic pathways for cholestatic or metabolic liver disease.

International network for rare diagnosis.

What are the minimal skills needed to care for biliary atresia.

Education

Dissemination of practically useful research findings.

International framework for re‐education.
Intestinal Failure and Small Bowel Transplantation, Including Clinical Nutrition: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Authors: Kocoshis Samuel A. , Beath Sue V. , Booth Ian W. , Garcia Oliva Carlos A. , Goulet Olivier , Kaufman Stuart S. , Lai Hong Shiee , Luque Carlos , Ohtsuka Yoshikazu
Published: January 2024

Research

Epidemiology and natural history of short bowel syndrome and intestinal failure.

Basic and translational research in intestinal failure.

Basic and translational research in small bowel transplantation.

Intervention

Decreasing the incidence of intestinal failure.

Reducing the economic impact of intestinal failure.

Reducing the economic impact of intestinal transplantation.

Education

Education of patients and families in the principles of intestinal rehabilitation.

Education of primary practitioners, house officers and medical students in basic nutrition and nutritional rehabilitation.

Education of a cadre of highly specialized nurses, nutritionists and physicians in the subtleties of medical and surgical therapy of patients with intestinal failure.
Pediatric Surgery of the Digestive Tract: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Authors: Langer Jacob C. , Carpaneto Eduardo , Defago Victor , Le Coultre Claude , Tam Paul
Published: January 2024

Research

Molecular biology, embryology, and genetics of Hirschsprung disease and intestinal neuronal dysplasia.

Etiology and prevention of necrotizing enterocolitis.

Intervention

Providing evidence‐based guidelines for the use of minimal access surgery in pediatric gastrointestinal disorders through clinical trials.

Improving results of surgery for biliary atresia.

Comparison of medical and surgical approaches to children with gastroesophageal reflux.

Education

Improving surgical care for children with gastrointestinal disease in developing nations.

Improving communication between pediatric gastroenterologists and pediatric surgeons.
Persistent and Chronic Diarrhea and Malabsorption: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Authors: Bhutta Zulfiqar A. , Ghishan Fayez , Lindley Keith , Memon Iqbal A. , Mittal Santosh , Rhoads J. Marc
Published: January 2024

Research

Assessment of mucosal immunopathology and molecular and cellular biology of persistent diarrhea in representative populations in developing countries.

Studies of small bowel microbiology in PD, especially in at‐risk populations e.g., malnourished children and HIV endemic areas.

Evaluation of the link of micronutrient deficiencies with PD and their relationship with intestinal repair mechanisms.

Intervention

Improved facility‐based approaches and algorithms for the nutritional management of PD and malnutrition.

Diagnosis and management of PD in public health system and primary care (including domiciliary) settings.

Scaling‐up environmental control measures and safe water and hygiene strategies.

Education

Continuing medical education strategies to educate medical students and physicians in the recognition, management and prevention of PD.

Education of nursing and paramedical personnel in the recognition and management of PD in ambulatory and health system settings.

Community and public health education strategies for increased awareness of the prevention of PD and optimal management of acute and prolonged diarrheal episodes.
Lack of Effect of Oral 4‐Phenylbutyrate on Serum Alpha‐1‐Antitrypsin in Patients with α‐1‐Antitrypsin Deficiency: A Preliminary Study
Authors: Teckman Jeffrey H.
Published: January 2024

Objective:

In homozygotes with ZZ genotype alpha‐1‐antitrypsin (α1AT) deficiency, mutant α1ATZ protein (α1ATZ) accumulates in hepatocytes, rather than being secreted into the blood. Homozygous individuals experience emphysema as a result of reduced levels of circulating α1AT in the lung with which to inhibit connective tissue breakdown. Homozygotes may also experience liver disease from the accumulation of α1ATZ within hepatocytes, which causes liver damage. A previous study indicated that the compound 4‐phenylbutyrate (4‐PBA) mediated a significant increase in release of α1ATZ from cells in tissue culture and in a mouse model of α1AT deficiency. The authors hypothesized that 4‐PBA could be used to treat both the liver and lung disease of humans with α1AT deficiency.

Methods:

In this preliminary, open label study the authors evaluated the effect of 14 days of oral 4‐PBA therapy on α1AT blood levels in 10 patients with α1AT deficiency.

Results:

There was no significant increase in α1AT blood level associated with 4‐PBA administration. Symptomatic and metabolic side effects were significant.

Conclusion:

4‐PBA did not increase α1AT blood levels in humans with α1AT deficiency in this preliminary trial.
Neutrophil and Small Intestinal Lymphocyte Migration After Salmonella typhimurium Infection: Impact of Fermentable Fiber
Authors: Milo Laura A. , Correa‐Matos Nancy J. , Donovan Sharon M. , Tappenden Kelly A.
Published: January 2024

Objectives:

Formula‐fed infants have more episodes of acute diarrhea and intestinal infection than do breast‐fed infants. Nutrient additions to infant formula that could confer some of the immune benefits of breast milk to formula‐fed infants are currently under investigation. This study examined the impact of enteral formulas supplemented with fermentable substrates on small intestinal lymphocyte and neutrophil migration in piglets infected with Salmonella typhimurium. Small intestinal proin‐flammatory cytokine messenger RNA abundance and in vitro lipopolysaccharide‐stimulated interleukin‐6 release in whole blood were assessed.

Methods:

Piglets were randomized to receive sow milk replacer formula supplemented with methylcellulose (control), soy polysaccharides (SPS) or fructooligosaccharides (FOS). On day 7, half of the piglets were infected with S. typhimurium. Intestinal lymphocyte, neutrophil and whole blood samples were obtained on day 14.

Results:

After infection, there was decreased lymphocyte migration in the control group but not in the SPS and FOS groups. The SPS group had greater neutrophil migration compared with the control and FOS groups, regardless of infection. Small intestinal abundance of proinflammatory cytokine messenger RNA was not significantly changed by either infection or diet. Blood from the FOS group challenged with lipopolysaccharide for 2 hours exhibited decreased interleukin‐6 production compared with blood from the control and SPS groups, regardless of infection.

Conclusions:

Supplementation of enteral formulas with SPS maintains the migratory function of small intestinal lymphocytes while increasing that of neutrophils.
Assessment of Phospholipid Malabsorption by Quantification of Fecal Phospholipid
Authors: Chen Alice , Innis Sheila
Published: January 2024

Objectives:

The standard methods for quantifying fat absorption involve extraction of fat from fecal samples with heptane, ether and ethanol. These solvents do not quantitatively recover phospholipids. Malabsorption of dietary and biliary phosphatidylcholine could potentially result in choline deficiency. Therefore, the authors developed a method extracting and quantifying fecal phospholipids.

Methods:

Fecal samples were collected for 72 hours from 18 children with cystic fibrosis and 10 control children. Fat was extracted first with hexane/diethyl ether/ethanol and then with chloroform/methanol. Total fat was quantitated gravimetrically. Phospholipids in extracted fat were separated and quantified using high‐performance liquid chromatography with evaporative light‐scattering detection (HPLC‐ELSD). Phospholipid quantification was validated with a phosphomolybdate colorimetric assay.

Results:

The combination of solvent systems used in this study significantly improved total fat (p < 0.05) and phospholipid (p < 0.001) extraction compared with either hexane/diethyl ether/ethanol or chloroform/methanol alone. Fecal phospholipid measured by HPLC‐ELSD was significantly correlated with lipid‐soluble phosphorous using the phosphomolybdate assay (r = 0.75, p < 0.001). This method also allows quantification of fecal phosphatidylcholine and lysophosphatidylcholine.

Conclusions:

Hexane/diethyl ether/ethanol followed by chloroform/methanol extraction of fecal samples and quantification of phospholipids using HPLC‐ELSD is a new method for investigating phospholipid malabsorption.
Communication modality matters: Co‐rumination via in‐person versus digital modalities has different prospective associations with depression and friendship quality
Authors: Battaglini Ashley M. , Rnic Katerina , Jopling Ellen , Tracy Alison , LeMoult Joelle
Published: January 2024

Introduction

Co‐rumination is an interpersonal emotion regulation strategy in which negative feelings and problems are discussed perseveratively with another person. Although co‐rumination is salient in adolescence, research to date has focused on co‐rumination occurring in person and has not kept pace with the surge in digital communication that begins in adolescence. This study examined the degree, associations among, and consequences (i.e., depressive symptoms, and friendship quality) of adolescents' co‐rumination via in‐person, text, social media, and phone modalities.

Methods

Adolescents (n = 109; 51 girls, 57 boys, 1 nonbinary; Mage = 12.83 years) residing in Canada, completed self‐report questionnaires on co‐rumination, depressive symptoms, and friendship quality for up to 2 years.

Results

Adolescents engaged in co‐rumination across all modalities, particularly in‐person. Findings indicated a negative association between in‐person co‐rumination at baseline and in‐person co‐rumination over time. Whereas less text co‐rumination was associated with increased depressive symptoms over time, greater phone co‐rumination was associated with increased depressive symptoms over time. Although greater in‐person co‐rumination was positively associated with friendship quality concurrently, it was negatively associated with friendship quality prospectively.

Conclusions

Taken together, co‐rumination outcomes may vary depending on communication modality. Implications for adolescents' mental and social wellbeing are discussed.
Netrin‐1 protects blood–brain barrier (BBB) integrity after cerebral ischemia‐reperfusion by activating the Kruppel‐like factor 2 (KLF2)/occludin pathway
Authors: Li Yuanxiao , Liu Changyun , Chen Zhiting , Lin Hanbin , Li Xiaofeng
Published: January 2024

Ischemia/reperfusion (I/R)‐induced neural damage and neuroinflammation have been associated with pathological progression during stroke. Netrin‐1 is an important member of the family of laminin‐related secreted proteins, which plays an important role in governing axon elongation. However, it is unknown whether Netrin‐1 possesses a beneficial role in stroke. Here, we employed the middle cerebral artery occlusion (MCAO) model to study the function of Netrin‐1 in alleviating brain injuries. Our results demonstrate that Netrin‐1 rescued poststroke neurological deficits and inhibited production of the inflammatory cytokines such as interleukin 6 (IL‐6) and endothelial chemokine (C‐X‐C motif) ligand 1 (Cxcl1). Importantly, Netrin‐1 protected against MCAO‐induced dysfunction of the blood–brain barrier (BBB) in mice and a reduction in the expression of the tight junction (TJ) protein occludin. Additionally, we report that Netrin‐1 could ameliorate oxygen‐glucose deprivation/reoxygenation (OGD/R)‐induced injury and prevent aggravation in endothelial monolayer permeability in bEnd.3 human brain microvascular endothelial cells (HBMVECs). Mechanistically, Netrin‐1 ameliorated OGD/R‐induced decrease in occludin and Kruppel‐like factor 2 (KLF2) in HBMVECs. Notably, silencing of KLF2 abolished the beneficial effects of Netrin‐1 in protecting endothelial permeability and occludin expression, suggesting that these effects are mediated by KLF2. In conclusion, our findings suggest that Netrin‐1 could constitute a novel therapeutic strategy for ischemic stroke.
Camphor tree bark extract as green corrosion inhibitor of LCS in 0.5 M H2SO4 with and without salt effect
Authors: El Nemr Ahmed , Elhebshi Abdualah , Ashour Ibrahim , El‐Deab Mohamed S. , Barghout Nehal A. , Eddy Nnabuk Okon , Ragab Safaa
Published: January 2024

This work tested the ethanol extract of camphor tree Cinnamomum camphora bark (CTBEE) as a green corrosion inhibitor of low carbon steel (LCS) in 0.5 M H2SO4 with and without the synergistic effect of 4000 ppm NaCl or 800 ppm of KI. The corrosion protection of LCS was significantly increased in the presence of CTBEE‐KI and CBWE‐NaCl blends compared with CTBEE alone, according to data performed by electrochemical impedance spectroscopy (EIS) and electrochemical polarization (EP) analyses. The formation of a film by the blends blocks the LCS surface area, preventing corrosive gradients from reaching its surface. Inhibition efficiency (IE%) of 81% and 89% were obtained in the presence of 800 ppm CTBEE‐4000 ppm NaCl and CTBEE‐800 ppm KI, respectively, compared with IE of 65% in the presence of 800 ppm CTBEE only. A maximum IE% of 89% and 97% were reached after 72 h of immersion in the presence of CTBEE‐NaCl and CTBEE‐KI, respectively. Potentiodynamic experiments indicate that the blends act as mixed‐type inhibitors. The inhibition efficiency of CTBEE, CTBEE‐KI, and CTBEE‐NaCl remained effectively high during the testing period of immersion time, which proved the excellent stability of CTBEE in the corrosive acidic media.
Micro aneurysm detection using optimizedresidual‐basedtemporal attentionConvolutional Neural NetworkwithInception‐V3transfer learning
Authors: Alotaibi Nouf Saeed
Published: January 2024

In this manuscript micro aneurysm detection using residual‐based temporal attention Convolutional Neural Network (CNN) with Inception‐V3 transfer learning optimized with equilibrium optimization algorithm (MA‐RTCNN‐Inception V3‐EOA) is proposed. The proposed research work contains four phases: (1) pre‐processing, (2) segmentation, (3) post‐processing, and (4) classification. At first, guided box filtering for contrast enhancement and background exclusion of input image. The proposed MA‐RTCNN‐Inception V3‐EOA based classification framework is implemented in MATLAB using several performances evaluating metrics like precision, sensitivity, f‐measure, specificity, accuracy, classification error rate, and Matthews's correlation coefficient and RoC analysis. The experimental outcome demonstrates that the proposed method provides 23.56%, 14.99%, and 21.37% higher accuracy and 31.26%, 57.69%, and 21.14% minimum classification error rate compared to existing methods, such as diabetic retinopathy identification utilizing prognosis of micro aneurysm and early diagnosis for non‐proliferative diabetic retinopathy depending on deep learning approaches (DRD‐CNN‐NPDR), a magnified adaptive feature pyramid network for automatic micro aneurysms identification (MAFPN‐AMD‐MAFP‐Net) respectively.

Research Highlights

Micro aneurysm detection using residual‐based temporal attention Convolutional Neural Network (CNN) is proposed.

To get rid of the retina background, guided box filtering is applied.

COAT is used for segmenting the images into smaller parts

RTCNN is used for accurate micro aneurysms disease classification.

RT‐CNN algorithm successfully identifies the micro aneurysms using EOA.
“Can you help me think this through?” How pediatric hospitalists learn from informal peer consultation
Authors: O'Neill Laura B. , Bhansali Priti , Goldman Ellen
Published: January 2024

Informal peer consultation (IPC), also called curbside consultation, is a common practice in medicine. Research has shown that physicians use IPC but how this learning occurs during the process has not been studied. This basic qualitative study describes how pediatric hospitalists learn during IPC, framed by Kolb's (2015) Experiential Learning Theory of Growth and Development. Eleven pediatric hospitalists were interviewed. Deidentified transcripts were coded for key themes using inductive methods. The main prompt for informal peer consultation was the perception of uncertainty. Three themes describe the learning process: “Eliciting Perspectives,” “Thinking Aloud Together,” and “Experiencing Validation. A fourth theme, “Acknowledging Value,” described the importance of IPC for modeling how to manage uncertainty with patients' caregivers and medical trainees. By describing the learning process, the results have implications for physicians who engage in IPC and may inform faculty‐level professional development initiatives to improve the IPC process.
Rates of diabetic ketoacidosis with empagliflozin use during hospitalization for acute heart failure
Authors: Huang Cheng‐Wei , Lee Janet S. , Lee Ming‐Sum
Published: January 2024

There is concern that sodium‐glucose cotransporter‐2 inhibitors during hospitalization for acute heart failure (aHF) may precipitate diabetic ketoacidosis (DKA). A retrospective study of all hospitalization encounters for aHF defined by a primary HF International Classification of Diseases (ICD)‐10 code in 15 Kaiser Permanente Southern California medical centers hospitalized between January 1, 2021 and August 31, 2023 was performed to describe rates of DKA with empagliflozin use. DKA was defined by the presence of either a DKA ICD‐10 code or ketoacidosis lab criteria (bicarbonate <18 mmol/L and urine ketone 1+ or more or elevated serum beta‐hydroxybutyrate within 12 h) during hospitalization. Among 21,630 hospital encounters (15,518 patients) for aHF, 1678 (8%) had empagliflozin use. There were 2 (0.1%) probable DKA cases in empagliflozin encounters and 15 (0.1%) in nonexposed encounters. These rates were similar when stratified by diabetes status and ejection fraction. Empagliflozin may be safe during aHF hospitalization.
高血糖と循環不全により救急搬送された脊椎の気腫性骨髄炎の1例(Emphysematous osteomyelitis of the spine with concomitant hyperglycemia and circulatory failure: a case report)
Authors: 透 野田 , 忠幸 平井 , 正樹 岡島
Published: January 2024

70歳代の女性。先行する腰痛と意識障害，循環不全にて救急搬送された。著明な高血糖と脱水の所見があり，また，画像検査および血液検査，尿検査にて腰椎の気腫性骨髄炎と尿路感染，血小板減少の所見を認めた。尿路感染に起因する気腫性骨髄炎により糖尿病性ケトアシドーシスと高血糖高浸透圧状態，感染性の播種性血管内凝固を発症したものと診断し，集学的治療を行った。感染に対しては来院時より抗生剤投与が行われ，また，入院3日目に腰椎の椎弓切除ならびに椎間板の掻把が行われた。血液，尿，椎間板のいずれからもEscherichia coliが検出された。入院61日目の時点で，全身状態は安定したが椎体の感染に対して加療が継続されている。気腫性骨髄炎は稀な疾患であるが死亡率も高く，適切な全身管理ならびに抗生剤投与，必要時の迅速な外科的介入が必要である。
Cerebral Blood Flow Patterns in Patients With Low‐Flow Carotid Artery Stenosis, a 4D‐PCMRI Assessment
Authors: Zarrinkoob Laleh , Myrnäs Sanne , Wåhlin Anders , Eklund Anders , Malm Jan
Published: January 2024

Background

Compromised cerebral blood flow can contribute to future ischemic events in patients with symptomatic carotid artery disease. However, there is limited knowledge of the effects on cerebral hemodynamics resulting from a reduced internal carotid artery (ICA) blood flow rate (BFR).

Purpose

Investigate how reduced ICA‐BFR, relates to BFR in the cerebral arteries.

Study Type

Prospective.

Subjects

Thirty‐eight patients, age 72 ± 6 years (11 female).

Field Strength/Sequence

3‐Tesla, four‐dimensional phase‐contrast magnetic resonance imaging (4D‐PCMRI).

Assessment

Patients with ischemic stroke or transient ischemic attack were evaluated regarding the degree of stenosis. 4D‐PCMRI was used to measure cerebral BFR in 38 patients with symptomatic carotid stenosis (≥50%). BFR in the cerebral arteries was assessed in two subgroups based on symptomatic ICA‐BFR: reduced ICA‐flow (<160 mL/minutes) and preserved ICA‐flow (≥160 mL/minutes). BFR laterality was defined as a difference in the paired ipsilateral‐contralateral arteries.

Statistical Tests

Patients were grouped based on ICA‐BFR (reduced vs. preserved). Statistical tests (independent sample t‐test/paired t‐test) were used to compare groups and hemispheres. Significance was determined at P < 0.05.

Results

The degree of stenosis was not significantly different, 80% (95% confidence interval [CI] = 73%–87%) in the reduced ICA‐flow vs. 72% (CI = 66%–76%) in the preserved ICA‐flow; P = 0.09. In the reduced ICA‐flow group, a significantly reduced BFR was found in the ipsilateral middle cerebral artery and anterior cerebral artery (A1), while significantly increased in the contralateral A1. Retrograde BFR was found in the posterior communicating artery and ophthalmic artery. Significant BFR laterality was present in all paired arteries in the reduced ICA‐flow group, contrasting the preserved ICA‐flow group (P = 0.14–0.93).

Data Conclusions

4D‐PCMRI revealed compromised cerebral BFR due to carotid stenosis, not possible to detect by solely analyzing the degree of stenosis. In patients with reduced ICA‐flow, collaterals were not sufficient to maintain symmetrical BFR distribution to the two hemispheres.

Evidence Level

2

Technical Efficacy

Stage 3