bluuebunny/crossref_metadata_2025 huggingface dataset:
Induced Growth and Maturation of the Gastrointestinal Tract After Phaseolus vulgaris Lectin Exposure in Suckling Rats
Authors: Linderoth Ann , Biernat Marzena , Prykhodko Olena , Kornilovska Iryna , Pusztai Arpad , Pierzynowski Stefan G , Björn Weström R
Published: July 2005

Objectives:

In mammals, the postnatal development of the gastrointestinal tract is characterized by vast structural and functional changes. Using a suckling rat model, we investigated whether red kidney bean lectin, phytohemagglutinin (PHA), a potent gut mitogen in adult rats, can accelerate the growth and maturation of the gastrointestinal tract.

Methods:

At either 10 or 14 days of age, suckling rats were daily gavage fed with PHA (0.05 mg/g body weight) or saline for 3 days. At 1 or 3 days after this treatment, gastrointestinal organ growth, intestinal morphology, disaccharidase pattern, macromolecular absorption capacity, and pancreatic enzyme contents were studied.

Results:

After PHA exposure, increased small intestinal growth and number of crypt cells were observed, whereas the proportion of enterocytes with supranuclear vacuoles in the distal intestine was decreased. The macromolecular absorption of the markers bovine immunoglobulin (Ig)G and bovine serum albumin and plasma levels of maternal IgG decreased, and intestinal disaccharidases switched toward an adult‐like pattern. The pancreas weight and pancreatic protein and trypsin contents increased. These changes were partly reversible when the PHA treatment began at 10 days of age, but they persisted when the treatment began at 14 days of age.

Conclusions:

PHA induced enhanced growth and precocious functional maturation of the gastrointestinal tract in suckling rats. The effects persisted if the PHA treatment started at 14 days of age, but not before, suggesting an age dependent mechanism. These findings may lead to a better understanding of gastrointestinal maturation and constitute a basis for the treatment of mammals having an immature gut.
Acidic Oligosaccharides from Pectin Hydrolysate as New Component for Infant Formulae: Effect on Intestinal Flora, Stool Characteristics, and pH
Authors: Fanaro S , Jelinek J , Stahl B , Boehm G , Kock R , Vigi V
Published: July 2005

Objectives:

To come even closer to the functional composition of human milk, acidic oligosaccharides (AOS) from pectin were added to well known neutral prebiotics (galacto‐oligosaccharides (GOS) and long‐chain fructo‐oligosaccharides (FOS)). The effect of AOS and GOS/FOS/AOS on intestinal flora, stool characteristics as well as acceptance and tolerance was investigated.

Methods:

Human milk contains 75% to 85% neutral and 15% to 25% acidic oligosaccharides. In this prospective, randomized, double blind study, a mixture of 80% neutral oligosaccharides (from long‐chain galacto‐ and long‐chain fructo‐oligosaccharides) with 20% acidic oligosaccharides derived from pectin hydrolysis was investigated. Forty‐six term infants were fed a standard formula supplemented with either maltodextrin as control (n = 15), or with 0.2 g acidic oligosaccharides (n = 16), or with the latter plus 0.6 g neutral oligosaccharides (mixture of galacto‐ and fructo‐oligosaccharides; n = 15). Fecal flora using plating technique and pH were measured. Stool characteristics and possible side effects (crying, vomiting, and regurgitation) were recorded.

Results:

There was no difference in the bifidobacteria counts between the control and the group supplemented with acidic oligosaccharides alone (8.75 ± 0.50 vs. 8.58 ± 0.94 log colony forming units [CFU]/g stool). In infants fed the combination of acidic and neutral oligosaccharides, bifidobacteria were increased (9.61 ± 0.70 log CFU/g stool; P < 0.01). The same pattern was observed with lactobacilli. Stool consistency was softest in infants fed the complete oligosaccharide mixture, but also in those fed formula supplemented with acidic oligosaccharides alone, the stool consistency was significantly softer compared with the control group. Fecal pH increased in the controls, remained constant in acidic oligosaccharides alone, and decreased in the complete mixture of oligosaccharides group.

Conclusion:

There was no difference in growth, crying, vomiting, and regurgitation patterns between the groups. In summary, acidic oligosaccharides from pectin hydrolysate are well tolerated as ingredient in infant formulae but do not affect intestinal microecology.
The local mean decomposition and its application to EEG perception data
Authors: Smith Jonathan S
Published: July 2005

This paper describes the local mean decomposition (LMD), a new iterative approach to demodulating amplitude and frequency modulated signals. The new method decomposes such signals into a set of functions, each of which is the product of an envelope signal and a frequency modulated signal from which a time-varying instantaneous frequency can be derived. The LMD method can be used to analyse a wide variety of natural signals such as electrocardiograms, functional magnetic resonance imaging data, and earthquake data. The paper presents the results of applying LMD to a set of scalp electroencephalogram (EEG) visual perception data. The LMD instantaneous frequency and energy structure of the EEG is examined, and compared with results obtained using the spectrogram. The nature of visual perception is investigated by measuring the degree of EEG instantaneous phase concentration that occurs following stimulus onset over multiple trials. The analysis suggests that there is a statistically significant difference between the theta phase concentrations of the perception and no perception EEG data.
The basic elliptic equations in an equilateral triangle
Authors: Dassios G , Fokas A.S
Published: July 2005

In his deep and prolific investigations of heat diffusion, Lamé was led to the investigation of the eigenvalues and eigenfunctions of the Laplace operator in an equilateral triangle. In particular, he derived explicit results for the Dirichlet and Neumann cases using an ingenious change of variables. The relevant eigenfunctions are a complicated infinite series in terms of his variables.

Here we first show that boundary-value problems with simple boundary conditions, such as the Dirichlet and the Neumann problems, can be solved in an elementary manner. In particular, the unknown Neumann and Dirichlet boundary values can be expressed in terms of a Fourier series for the Dirichlet and the Neumann problems, respectively. Our analysis is based on the so-called global relation, which is an algebraic equation coupling the Dirichlet and the Neumann spectral values on the perimeter of the triangle.

As Lamé correctly pointed out, infinite series are inadequate for expressing the solution of more complicated problems such as mixed boundary-value problems. In this paper we show, further utilizing the global relation, that such problems can be solved in terms ofgeneralized Fourier integrals.
Attractor minimal sets for non-autonomous delay functional differential equations with applications for neural networks
Authors: Novo Sylvia , Obaya Rafael , Sanz Ana M
Published: July 2005

The dynamics of a class of non-autonomous, convex (or concave) and monotone delay functional differential systems is studied. In particular, we provide an attractivity result when two completely strongly ordered minimal subsets
K
1
≪

C

K
2
exist. As an application of our results, sufficient conditions for the existence of global or partial attractors for non-autonomous delayed Hopfield-type neural networks are obtained.
The role of mutation accumulation in HIV progression
Authors: Galvani Alison P
Published: July 2005

The onset of AIDS is characterized by the collapse of the immune system after a prolonged asymptomatic period. The mechanistic basis of this disease progression has remained obscure, hindering the development of effective therapies. Here I present a mechanism that underlies the deterioration of the immune system during HIV infection. The elevated turnover of lymphocytes throughout the asymptomatic period is postulated to result in the accumulation of deleterious mutations, which impairs immunological function, replicative ability and viability of lymphocytes. This mutational meltdown is proposed to occur throughout the hierarchy of lymphocyte progenitors, resulting in the deterioration of lymphocyte regeneration and an ensuing rise in viral loads. A mathematical model is used to illustrate this mechanism of progressive immunological deterioration. Mutation accumulation may explain not only the decline in CD4+T cells, but also the functional deterioration of CD4+T cells, CD8+T cells and B cells, and the exhaustion of lymphocyte regeneration.
Introduction: The fundamental constants of physics, precision measurements and the base units of the SI
Authors: Quinn Terry , Burnett Keith
Published: July 2005

This is a short introductory note to the texts of lectures presented at a Royal Society Discussion meeting held on 14–15 Febrary 2005 and now published in this issue of
Philosophical Transactions A
. It contains a brief resumé of the papers in the order they were presented at the meeting. This issue contains the texts of all of the presentations except those of Christophe Salomon, on cold atom clocks and tests of fundamental theory, and Francis Everitt, on Gravity Probe B, which were, unfortunately, not available.
TV Weather Forecast or Look through the Window? Expert and Consumer Expectations about Macroeconomic Conditions
Authors: Roos Michael W. M.
Published: July 2005

This paper investigates the empirical relation between consumer and expert expectations about macroeconomic conditions in Germany. Using data from the EU Consumer Confidence Survey and the ZEW business expectations, static models and error‐correction models are estimated explaining consumer expectations as functions of expert expectations, consumer retrospections, and lagged consumer expectations. It's found that consumer expectations are only weakly related to expert expectations, but strongly influenced by consumers' retrospections. Consumers primarily extrapolate perceptions about current economic conditions in the future. However, during national election campaigns, the relation between consumer and expert expectations is stronger.
Mucosal immunity and allergic responses: lack of regulation and/or lack of microbial stimulation?
Authors: Prioult Guénolée , Nagler‐Anderson Cathryn
Published: July 2005

Summary:  Allergic hyperreactivity is defined as an exaggerated immune response [typically immunoglobulin E (IgE) but also non‐IgE mediated] toward harmless antigenic stimuli. The prevalence of allergic disease has increased dramatically during the last 20 years, especially in developed countries. Both genetic and environmental factors contribute to susceptibility to allergy. Evidence has emerged supporting the hypothesis that a reduction in antigenic stimulation brought about by widespread vaccination, improvements in standards of hygiene, and extensive use of antibiotics has contributed to the dysregulation of T‐helper 2 cell (Th2) type responsiveness that typifies allergy. Regulation of the inherently Th2‐biased mucosal immune response is crucial both to the maintenance of homeostasis at this strategic defensive barrier and to the prevention of allergic disease. The ability of Th1 responses to counter‐regulate Th2 reactivity is well characterized. More recently, interest has centered on regulatory T cells, which can suppress both Th1 and Th2 cells through the secretion of immunosuppressive cytokines such as interleukin‐10 and transforming growth factor‐β. In this review, we discuss the basic cellular mechanisms of allergic diseases at mucosal surfaces, focusing on allergic responses to food, before examining newer work that suggests the induction of allergic hyperreactivity is due to a deficient immunoregulatory network, a lack of microbial stimulation, or both.
Hospital admissions for ‘drug‐induced’ disorders in England: a study using the Hospital Episodes Statistics (HES) database
Authors: Waller Patrick , Shaw Mary , Ho Davidson , Shakir Saad , Ebrahim Shah
Published: July 2005

Aims

To review Hospital Episode Statistics (HES) data for England coded as being ‘drug induced’ during 1996–2000 and to consider their potential utility for assessing the public health burden of adverse drug reactions (ADRs) and studying drug safety.

Methods

ICD‐10 codes including the words ‘drug‐induced’ or ‘due to’ a medicine or which are recognized to be invariably caused by a drug were extracted along with external cause codes indicating that a drug was implicated (i.e. Y40‐59 in ICD‐10). We also calculated the proportions of patients with each ‘drug‐induced’ code for whom an external cause code had been applied.

Results

During the 5‐year study period there were almost 53.8 million hospital admissions in England, of which 44 411 (0.083%) were coded as ‘drug‐induced’ and 168 958 (0.314%) were associated with a relevant external cause code. The numbers of patients with ‘drug‐induced’ codes used were generally stable during the study period (range 7454–8860 per year) but the application of external cause codes increased in each year and by 40% overall (from 24 786 in 1996 to 34 843 in 2000). The overall proportion of ‘drug‐induced’ codes associated with a relevant external cause code was quite low (12–15%) but there was considerable variation between codes.

Conclusions

Comparisons with published studies indicate that HES data grossly underestimate the burden of drug‐induced disorders as a cause of hospital admission. There are likely to be multiple underlying reasons including under‐recognition, under‐recording and limitations of the coding system. The potential of these data for identifying previously unrecognized serious ADRs is limited by constraints on the availability of detailed data regarding individual cases.
Parents’ perspectives on coping with Duchenne muscular dystrophy
Authors: Webb C. L.
Published: July 2005

Background  The author, who has a grown son with Duchenne Muscular Dystrophy (DMD), has personally experienced a lack of available information for parents about coping with DMD. Therefore, as a longtime personal goal, she developed this study to address that lack of information.

Methods  Fifteen semi‐structured interviews were conducted with 23 parents (n = 7 with both parents; n = 1 with two sisters; n = 6 with mothers only; n = 1 with father only). The purpose of the interviews was to examine the strategies parents use to cope when their sons have DMD. The interviews were conducted in 12 states, taped and transcribed.

Results  Grounded theory analysis of the interview data indicated the willingness of these parents to share information to empower others like themselves.

Conclusions  Parents want to be heard and valued as experts on DMD by medical and other professionals who interact with their sons. In addition, they want to proactively participate in their sons’ lives and to encourage other parents to do the same.
Development of a measure of the health‐related quality of life of children in public care
Authors: Upton P. , Maddocks A. , Eiser C. , Barnes P. M. , Williams J.
Published: July 2005

Objectives  To validate PedsQLTM for children in public care and develop an ‘in‐care’ module.

Design and setting  Questionnaire development and validation. Questionnaires were completed in placement. A total of 69 children in public care (aged 8–18 years) and their carers were recruited through routine paediatric assessments, and 662 children not in public care were recruited from local schools.

Measures  Self‐ and proxy‐report versions of PedsQLTM generic module and the ‘in‐care’ module.

Results  Cronbach's alpha for the generic module ranged from 0.66 to 0.88 and from 0.74 to 0.90 for self‐ and proxy‐report respectively. Lower scores were reported for children in care compared with peers living at home for proxy‐ and self‐report. Proxy‐ and self‐report correlation ranged from 0.43 to 0.60 (P < 0.001).

Cronbach's alpha for the in‐care module was 0.87 and 0.91 for self‐ and proxy‐report respectively. Proxy‐ and self‐report scores showed significant correlation with generic module scores. The highest correlations were seen with sub‐scales measuring Psychosocial Functioning (e.g. Emotional Functioning: Pearson's r = 0.67 and 0.59, P < 0.001 for self‐ and proxy‐report respectively). Proxy‐ and self‐report correlation was 0.45 (P < 0.001).

Conclusions  We found PedsQLTM generic module and the newly developed ‘in‐care’ module to have excellent internal reliability for self‐ and proxy‐report. Validity was established for both measures and significant correlation found between child and proxy ratings. Although further testing of the measures is recommended, both have potential value in assessing the success of placements and could provide a reliable and valid tool for individual patient analysis in clinical practice and for research with this group.
Three‐year follow‐up of a family support service cohort of children with behavioural problems and their parents
Authors: Anderson L. , Vostanis P. , O'Reilly M.
Published: July 2005

Background  The aim of this study was to establish the medium‐term (three‐year) psychosocial outcome of children with behavioural problems and their parents, who had received an intervention from a family support service.

Methods  Forty families were traced at the three‐year follow‐up and agreed to participate. Pre‐ and post‐intervention and follow‐up measures were the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Strengths and Difficulties Questionnaire (SDQ).

Results  The primary HoNOSCA outcome items (i.e. those initially targeted by the parenting intervention) of aggression/antisocial behaviour and family relationships were not found to have changed significantly from the baseline (but had not sustained the sort‐term improvement following the intervention). Deterioration was found in other HoNOSCA items such as overactivity, self‐harm, scholastic/language skills, emotional, and poor school attendance. When we compared pre‐intervention with follow‐up SDQ scores, there was no significant change on any scales, i.e. these had returned to the level reported at the time of the original referral to the family support service.

Conclusions  Following the intervention from a family support service, children and families reported a significant improvement in most outcome measures, predominantly child behaviour and family relationships. However, these improvements were either not sustained or there were additional difficulties at three‐year follow‐up. These could be related to various external and developmental factors. This lack of sustainable treatment effects for children with behavioural problems is consistent with previous research findings on parenting programmes.
Developmental differences in understanding the causes, controllability and chronicity of disabilities
Authors: Smith L. A. , Williams J. M.
Published: July 2005

Objective  The present study explored typically developing children's (n = 77) understanding of the causes, controllability and chronicity of disabilities.

Design  Children in each of four age groups (4–5 years, 6–7 years, 9–10 years and 11–12 years) were interviewed to explore their ideas about children with physical disabilities (minor: missing thumb; major: wheel‐chair bound), sensory disabilities (blindness and hearing loss), learning disabilities (non‐specific and Down syndrome) and emotional/behavioural difficulties (attention deficit hyperactivity disorder and lack of social skills).

Results  Significant age differences were found in children's understandings of the causes, controllability and chronicity of disabilities. Furthermore, children showed a greater understanding of salient disabilities.

Conclusions  Findings are discussed in terms of developmental changes and the role of experience in shaping children's understanding of disabilities.
Tubular and glomerular function in children after renal transplantation
Authors: Dagan Amit , Eisenstein Bella , Bar‐Nathan Nathan , Cleper Roxana , Krause Irit , Smolkin Vladislav , Davidovits Miriam
Published: July 2005

Abstract:  Glomerular and tubular function of transplanted kidneys were assessed in 46 children aged 15.7 ± 4.6 yr, 4.2 ± 2.8 yr after renal transplantation. There were 34 cadaveric, and 12 living‐related donors. Twelve patients (26%) had acute episodes (acute tubular necrosis, rejection, or urinary tract infection) during follow‐up. All patients were on triple immunosuppression. The mean serum creatinine was 1.5 ± 0.6 mg/dL. Creatinine clearance (Ccreat) calculated from a 24‐h urine collection was 48.0 ± 19.7 mL/min/1.73 m2, and that estimated from the Schwartz formula, 61.0 ± 22.5 mL/min/1.73 m2. A positive correlation was found between the calculated and estimated clearances. Mean urine concentrating ability was 487 ± 184 mOsmol/kg, with a value lower than 400 mOsmol/kg in 35% of patients. There was a positive correlation between urine osmolality and estimated Ccreat. Metabolic acidosis (bicarbonate <22 mmol/L) was found in 41% of patients, with relatively alkaline urine and high chloride level. Fractional excretion (FE) of sodium was above 1% in 68% of patients (mean 1.66 ± 1.06%), and FEMg was above 3% (mean 10.9 ± 5.2%) in 93% of patients. Tubular reabsorption of phosphate (TP)/glomerular filtration rate (GFR) was 3.2 ± 0.8 mg/dL glomerular filtrate (GF). FEK, FEUA, and Ca/creatinine in urine were normal. There were no functional group differences between the cadaveric and living‐related kidneys. Significant group differences were found in those with acute episodes and those with a normal course. Estimated Ccreat was 54 ± 20 vs. 67 ± 20 mL/min/1.73 m2 in the acute episodes and the normal course groups, respectively. Also, the FENA, FEUA, and FEMg were higher in the acute episodes group −2.3 ± 1.6, 10.6 ± 4.4, and 14.8 ± 6.5%, respectively, compared with the normal course group −1.4 ± 0.6, 8.2 ± 2.8, and 9.6 ± 4.0%, respectively. There were no between‐group differences in plasma bicarbonate, FEK, TP/GFR, and urine osmolality. We believe that most, if not all tubular dysfunctions in the transplanted kidney are secondary to renal failure and interstitial damage from acute episodes and nephrotoxic drugs. These dysfunctions are similar to those in chronic renal failure, where interstitial fibrosis plays a role in kidney function deterioration.
Development of growth and body mass index after pediatric renal transplantation
Authors: Vester Udo , Schaefer Antonia , Kranz Birgitta , Wingen Anne‐Margret , Nadalin Silvio , Paul Andreas , Malagò Massimo , Broelsch Christoph E. , Hoyer Peter F.
Published: July 2005

Abstract:  Suboptimal final height and marked weight gain after renal transplantation (RTx) are common and may result in obesity. Steroid free immunosuppression has been advocated to improve growth and limit weight gain. We evaluated retrospectively the evolution of growth and body mass index (BMI) after renal transplantation to study risk factors for weight gain under steroid based treatment. Sixty‐four pediatric patients (age 9.9 ± 5.0 yr) were included in the study. To allow comparison between different age groups, standard deviation scores (SDS) for height and BMI for height age were calculated at time of transplantation and 3, 6, 9, 12, 24, 36, 48 and 60 months later. Induction immunosuppression consisted of basiliximab, cyclosporine and prednisone. Growth retardation at time of RTx was obvious with a SDS for height of −2.20 ± 1.34. Height during the first year improved to an SDS of −2.0 ± 1.27 (p < 0.01) but did further not increase in year 2 and 3. More than 40% of all patients remained 2 SDS below normal mean. SDS BMI for height age at transplantation was −0.19 ± 0.98 and increased significantly during the first 3 months after transplantation to +0.64 ± 1.07 (p < 0.01). Thereafter, BMI remained stable but did not decline to pretransplant values. A SDS BMI for height age of more than 2 SDS was observed in 2, 6, 9 and 11% of children at RTx and 1, 2 and 3 yr later respectively. BMI gain over 3 yr was significantly enhanced in children whose parents (especially the mother) were overweight. No influence of gender, BMI at RTx, dialysis modality prior to RTx or rejection episodes could be detected. We conclude that after RTx children exhibit some improvement in growth but height remains suboptimal. The BMI does increase significantly during the first months after RTx and does not return to baseline values under steroid‐based immunosuppression. Obesity (>2 SDS above normal) does not occur more often than in the normal population. The most predictive parameter of inappropriate weight gain during 3 yr is the BMI of the mother. We would speculate that steroids may play a major role in weight gain in the early phase after RTx. However, genetic or environmental factors predict the long‐term weight development.
Successful bone marrow transplantation for life threatening xanthogranuloma disseminatum in neurofibromatosis type‐1
Authors: Savaşan Süreyya , Smith Laurie , Scheer Carolyn , Dansey Roger , Abella Esteban
Published: July 2005

Abstract:  A 2‐yr and 9‐month‐old female patient with neurofibromatosis type‐1 presented with hepatomegaly, anemia, thrombocytopenia, and croupy cough and diagnosed with xanthogranuloma disseminatum (XD). She failed chemotherapy consisting of steroids, 6‐mercaptopurine and methotrexate. A partial response to HLH‐94 therapy that included etoposide and cyclosporine A was initially observed. However, she continued to have significant organ dysfunction without further improvement at 6 months of therapy. She then received matched unrelated donor bone marrow transplantation (BMT) following carmustine, etoposide, cytarabine and melphelan conditioning with complete resolution of symptoms. BMT is an option in therapy‐resistant, life threatening XD cases.
Risk factors for post‐transplant lymphoproliferative disorder in pediatric patients: A case‐control study
Authors: Allen Upton D. , Farkas Gabrielle , Hébert Diane , Weitzman Sheila , Stephens Derek , Petric Martin , Tellier Raymond , Ngan Bo , Fecteau Annie , West Lori , Wasfy Samia
Published: July 2005

Abstract:  Post‐transplant Lymphoproliferative Disorder (PTLD) because of the Epstein–Barr Virus (EBV) is a major concern after pediatric transplantation. The group at greatest risk is EBV‐seronegative recipients who receive EBV‐seropositive organs. Additional risk factors remain to be determined, including those among EBV‐seropositive recipients. In this case‐control study, PTLD cases were biopsy‐proven over a period of 4 yr (1997–2000, inclusive). Each case was matched with 2 controls, based on the type of organ transplanted and the period of transplantation (±1 yr). Variables compared between cases and controls included those relating to the clinical and virologic profiles and immunosuppressive therapy. Twenty‐two cases of PTLD were diagnosed during the study period. PTLD cases occurred at a median of 22.8 months post‐transplantation (range 1–131). The median age of cases was 26.2 months (range 6.1–194) compared with 47.4 months (range 0.8–202.2) for controls (p = 0.93). Cases had a higher mean baseline EBV load compared with controls (3.1 log10 (s.d. ± 1.0) vs. 1.6 log10/106 PBMCs (s.d. ± 1.4), with every 1 log increase in viral load resulting in a three times increase in the likelihood of PTLD (p < 0.007). Close to one in four cases of PTLD were EBV‐seropositive pretransplantation. These seropositive recipients tended to be older patients with a trend to a worse outcome compared with their seronegative counterparts. The occurrence of PTLD was not associated with the use of any specific immunosuppressants. A significant proportion of PTLD cases occurred among EBV‐seropositive transplant recipients, with a tendency towards an unfavorable outcome. Besides EBV‐seronegative recipients who receive seropositive organs, some EBV‐seropositive pediatric patients are at risk of PTLD. Additional studies are warranted to further define the factors associated with PTLD in EBV‐seropositive transplant recipients.
Glomerular and tubular function following orthotopic liver transplantation in children
Authors: McLin Valérie A. , Girardin Eric , LeCoultre Claude , Mentha Gilles , Belli Dominique C.
Published: July 2005

Abstract: Since its advent, cyclosporine nephrotoxicity has been a major concern to pediatricians attending to liver transplant recipients. The aims of this study were to examine glomerular and tubular function after orthotopic liver transplantation (OLT) in children, their correlation to CsA, and how they differed according to the underlying disease.

Patients and methods: Glomerular and tubular function was examined in 28 patients aged 7 months to 14 yr at the time of transplantation (mean 4.0 ± 3.6), retrospectively examining creatinine clearance, tubular phosphate reabsorption (TRP), calcium/creatinine ratio, sodium excretion fraction, and protein/creatinine ratio. The group with metabolic disease and an underlying tubulopathy was compared with the group with liver disease only. The effect of CsA trough levels and cumulated dose on these indices was examined, as was the effect of antihypertensives on creatinine clearance. Both glomerular and tubular functions improved significantly following liver transplantation. In patients on CsA (n = 21), CrCl decreased significantly at 1 month post‐OLT (42.6 ± 26.6 mL/min/1.73 m2) when compared with pretransplantation, and 3, 12 and 60 months post‐OLT (p < 0.05). It improved between 12 and 60 months post‐OLT (p < 0.05). It was correlated with cyclosporine trough levels (p < 0.03), and with total dose of CsA at 12 months. This was not true for patients on tacrolimus (n = 7). Overall pretransplant TRP was below normal (73.7% ± 19.6), which was significantly lower than the values at years 2, 3, and 5 post‐OLT (p < 0.05), owing mainly to the metabolic group which recovered normal proximal tubular function by the end of the second week post‐OLT. Calcium/creatinine ratio was significantly worse in the group with liver disease only (p < 0.01). Protein/creatinine ratio normalized rapidly in both groups. Urinary sodium excretion fraction (FENa) was very abnormal in the early postoperative phase, normalizing thereafter in both groups. Kidney function improved after liver transplantation in patients with and without pre‐existing kidney dysfunction. Overall, creatinine clearance was correlated to CsA trough levels suggesting CsA did not have an irreversible ‘sclerosing’ effect in the medium term. Combined antihypertensive therapy using nifedipine and enalapril may be the optimal choice for patients requiring medical management of their hypertension, although the observed effect on creatinine clearance did not reach statistical significance in this study. Tubular dysfunction is frequent in both groups of patients, pre‐ and post‐transplant, and may contribute to bone mineral density as well as to metabolic disturbances in this population.
Successful recovery of aplastic anemia following orthotopic liver transplantation for non‐A‐E acute liver failure
Authors: Rajwal S. R. , Davison S. M. , Stringer M. D. , Kinsey S. E. , McClean P.
Published: July 2005

Abstract:  This report describes a teenager who developed aplastic anemia (AA) because of non‐A‐E acute liver failure (ALF) requiring orthotopic liver transplantation (OLT). His AA did not recover spontaneously and he required treatment with ATG 9 months post‐OLT. Bone marrow recovery occurred 4 months after immunotherapy and coincided with further intensification of immunusuppression required to treat early chronic rejection of the liver graft. Three years post‐OLT he remains well with good bone marrow and liver function. Intensification of immunosuppression can lead to successful resolution of AA associated with non‐A‐E ALF.
Bone mineral density in pediatric and adolescent renal transplant patients: How to evaluate
Authors: Gökşen Damla , Darcan Şükran , Kara Pelin , Mir Sevgi , Çoker Mahmut , Kabasakal Caner
Published: July 2005

Abstract:  Reduced bone mass is a common complication of renal transplantation in adults but only few data are present for pediatric transplant patients. Bone mineral status of pediatric renal transplant patients ages ranging from 7.5 to 17.6 years (mean age 14.9 ± 2.3) who were at least 6 months postrenal transplantation was examined. Bone mineral density (BMD) of lumbar vertebrea and femoral neck was determined by dual energy X‐ray absorptiometry (DEXA) and z‐scores according to age, puberty, height and bone age were compared to sex and ethnic specific reference data. z‐scores were calculated for both areal and volumetric bone density. BMD L1‐4 z‐scores were more than 2 SD below the mean according to chronological age in 12 patients (63%), pubertal status in six patients (31.5%), bone age in five patients (26.3%) and height in five patients (26.3%). The BMD femoral neck z‐scores were more than 2 SD below the mean according to age in 10 patients (55.5%), puberty in five patients (27.7%), bone age in three (16.6%) patients and height in five (26.3%) patients. Correction of the vertebrae and femoral neck for bone size yielded osteoporotic values for seven patients (36.8%) for lumbar BMD and for four patients (22%) for femoral neck BMD. The use of aBMD in growth‐retarded children has some restrictions in determining z‐scores. Deficits in spinal bone density still persisted after correcting for height, puberty, bone age and volume. In renal transplant patients who have short stature it is reasonable to give values corrected for height, puberty, bone age and bone size and interpret each of these values for each patient.
Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation
Authors: Heffron Thomas G. , Welch David , Pillen Todd , Fasola Carlos , Redd Doug , Smallwood Gregory A. , Martinez Enrique , Atkinson George , Guy Mark , Nam Changwoo , Henry Stuart , Romero Rene
Published: July 2005

Abstract:  The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5–6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds.
Idiopathic intracranial hypertension following kidney transplantation: A case report and review of the literature
Authors: Chamberlain Christine E. , FitzGibbon Edmond , Wassermann Eric M. , Butman John A. , Kettl David , Hale Doug , Kirk Allan D. , Mannon Roslyn B.
Published: July 2005

Abstract:  A pediatric kidney transplant recipient receiving tacrolimus for immunosuppression experienced symptoms consistent with idiopathic intracranial hypertension. The diagnosis of idiopathic intracranial hypertension and possible secondary causes of intracranial hypertension are reviewed in association with the patient's clinical course. Treatment options for the reversal of intracranial hypertension are summarized. Because of the complexity of associated conditions in kidney transplant recipients, symptoms of persistent headaches, visual changes and nausea and vomiting should be promptly investigated by fundoscopic examination in the setting of immunosuppression therapy to prevent vision loss.
Heart transplantation in children: Clinical outcome during the early postoperative period
Authors: Azeka Estela , Auler José O. C. , Marcial Miguel B. , Fumagalli Fabio , Ramires José A. F.
Published: July 2005

Abstract:  As improved understanding of transplant‐related death should improve survival, we report a single center's experience with pediatric heart transplantation including potential risk factors and causes of death during the early postoperative period. This prospective longitudinal study involved 51 pediatric patients ranging in age from 12 days to 15.1 yr (median: 3 yr). The following pretransplant risk factors were evaluated: diagnosis, age at transplantation, recipient sex, weight and blood type, blood type match, donor/recipient sex match, weight ratio, ischemic time, recipient's status, requirement for mechanical ventilation or circulatory support, dialysis, or inotropic support at transplantation. We also determined the actuarial survival, clinical outcomes, and causes of death in this population. Survival was 86% during the early postoperative period (≤30 days), 79.3% at 1 yr, and 76.8% at 3 yr. Seven patients died during the early postoperative period (primary graft failure, rejection, and infection). However, there was no difference in the frequency of any of the risk factors analyzed between these patients and those who did not experience early death. There was a correlation between the duration of intubation after transplantation and pretransplant risk factors (diagnosis, recipient status, requirement for dialysis, inotropic and mechanical ventilation support). Our findings indicate that promising short‐term results can be obtained with pediatric transplantation. Although we identified no specific risk factors in this study for death, improved rejection surveillance and treatment strategies remain important goals in pediatric heart transplantation. Retransplantation had high mortality during the perioperative period.
Four‐year data after pediatric renal transplantation: A randomized trial of tacrolimus vs. cyclosporin microemulsion
Authors: Filler Guido , Webb Nicholas J. A. , Milford David V. , Watson Alan R. , Gellermann Jutta , Tyden Gunnar , Grenda Ryszard , Vondrak Karel , Hughes David , Offner Gisela , Griebel Martin , Brekke Inge B. , McGraw Mary , Balzar Egon , Friman Styrbjörn , Trompeter Richard
Published: July 2005

Abstract:  This study was undertaken to compare the efficacy and safety of tacrolimus (Tac) with cyclosporin microemulsion (CyA) in pediatric renal recipients. A 6‐month, randomized, prospective, open, parallel group study with an open extension phase was conducted in 18 centers from nine European countries. In total, 196 pediatric patients (<18 yr) were randomly assigned (1:1) to receive either Tac (n = 103) or CyA (n = 93) administered concomitantly with azathioprine and corticosteroids. The primary endpoint was incidence and time to first acute rejection (intent‐to‐treat). Baseline characteristics were comparable between treatment groups. Excluding deceased patients (n = 9) and patients lost to follow‐up (n = 31, mostly transferred to adult care), 95% of 2‐yr data (159 of 167 possible patients), 87% of 3‐yr data (142 of 163) and 73% of 4‐yr data (114 of 156) were retrieved. At 1 yr Tac therapy resulted in a significantly lower incidence of acute rejection (36.9%) compared with CyA (59.1%, p = 0.003). The incidence of corticosteroid‐resistant rejection was also significantly lower with Tac (7.8% vs. 25.8%, p = 0.001). At 4 yr, patient survival was similar (94% vs. 92%, p = 0.86) but graft survival significantly favored Tac (86% vs. 69%; p = 0.025, log‐rank test), respectively. At 1 yr, the mean glomerular filtration rate (GFR) (Schwartz formula, ml/min/1.73 m2) was 64.9 ± 20.7 (n = 84) vs. 57.8 ± 21.9 (n = 77, p = 0.0355), at 2 yr 64.9 ± 19.8 (n = 71) vs. 51.7 ± 20.3 (n = 66, p = 0.0002), at 3 yr 66.7 ± 26.4 (n = 81) vs. 53.0 ± 23.3 (n = 55, p = 0.0022), and at 4 yr 71.5 ± 22.9 (n = 51) vs. 53.0 ± 21.6 (n = 44, p = 0.0001) for Tac vs. CyA, respectively. Cholesterol remained significantly higher with CyA throughout follow‐up. Three patients in each arm developed post‐transplant lymphoproliferative disease. Incidence of insulin‐dependent diabetes mellitus was not different. Tac was significantly more effective than CyA in preventing acute rejection in pediatric renal recipients. Renal function and graft survival were also superior with Tac. Glomerular filtration rate appears to be an useful surrogate marker for long‐term outcome.
Mycophenolate mofetil suspension in pediatric renal transplantation: Three‐year data from the tricontinental trial
Authors: Höcker Britta , Weber Lutz T. , Bunchman Timothy , Rashford Michelle , Tönshoff Burkhard ,   the Tricontinental MMF Suspension Study Group
Published: July 2005

Abstract:  Mycophenolate mofetil (MMF) is widely used to prevent acute rejection in adult solid organ transplant recipients, but data in children and adolescents are scarce. This prospective, multicenter, open‐labeled, single‐arm study investigated the efficacy and safety of an MMF‐based immunosuppressive regimen in 100 pediatric renal transplant recipients over a 3‐yr period of time. Three age groups were formed (<6 yr, n = 33; 6 to <12 yr, n = 34; 12–18 yr, n = 33). Basic immunosuppression consisted of MMF (600 mg/m2 b.i.d), cyclosporin A microemulsion and corticosteroids. Seventy‐three percent of patients were given anti‐lymphocyte antibody induction therapy, of whom 74% received anti‐thymocyte globulin. Patient and graft survival 3 yr after transplantation amounted to 98 and 95%, respectively. Twenty‐five percent of all patients suffered a biopsy‐proven acute rejection episode in the first 6 month post‐transplant. Children undergoing induction therapy exhibited a numerically lower rejection rate (21 vs. 37%, p = 0.11). Three years after transplantation, the acute rejection rate added up to 30% (26% with induction therapy vs. 41% without induction therapy, p = 0.21). The number of patients with acute rejection was lowest in the youngest age group (18%), in comparison with 39% in the 6 to <12 yr and 33% in the 12–18 yr age group, respectively. For the entire patient population, the rate of patients who withdrew prematurely because of adverse events was low (12%). The present study shows that MMF therapy in pediatric renal transplant recipients leads to an excellent patient and graft survival 3 yr post‐transplant with an acceptable safety profile.
Duct‐to‐duct biliary reconstruction in pediatric living donor liver transplantation
Authors: Okajima Hideaki , Inomata Yukihiro , Asonuma Katsuhiro , Ueno Mikako , Ishiko Takatoshi , Takeichi Takayuki , Kodera Atsushi , Yoshimoto Kazuhiko , Ohya Yuki
Published: July 2005

Abstract:  The results of duct‐to‐duct biliary reconstruction in six pediatric patients who received a living donor liver transplant aged from 2 months to 11 yr old are reported. The graft was either entire or a part of the left lateral segments. The orifice of the bile duct of the graft was anastomosed to the recipients’ hepatic duct in an end‐to‐end fashion by interrupted suture using 6–0 absorbable material. A transanastomotic external stent tube (4 Fr) was passed through the stump of the recipients’ cystic duct. Mean time for reconstruction was 24 min. All the recipients survived the operation and reinitiated oral intake on postoperative day 3. There were no early biliary complications. One 5‐yr‐old boy suffered from an anastomotic stenosis 9 months after transplantation. He underwent re‐anastomosis by Roux‐en Y (R‐Y) procedure and recovered uneventfully. Duct‐to‐duct anastomosis in pediatric living donor liver transplantation has benefits while the complication rate is comparable to R‐Y reconstruction.
Heart transplantation: Literature review 2003–2004
Authors: Feingold Brian , Webber Steven A.
Published: July 2005

Abstract:  The rapid expansion of the volume of peer reviewed publications in recent years, including a large increase in the number of new biomedical journals, makes it difficult for the practicing clinician to stay up to date with the medical literature. This is the first review in a new series that will provide succinct summaries of the recent medical literature in the field of pediatric transplantation. In this review, we summarize important articles in the field of pediatric heart transplantation that have been published over the last 2 years (2003, 2004). The review is intended to be comprehensive but not exhaustive.
Low Foraging Success of Semipalmated Sandpipers at the Edges of Groups
Authors: Beauchamp G.
Published: July 2005

Variation in foraging success in relation to spatial position in a group is little known in species that feed on mobile prey that can hide or flee upon disturbance by foragers. I examined the foraging success of individuals located either at the edge or at the centre of flocks of semipalmated sandpipers (Calidris pusilla) feeding on a burrowing amphipod (Corophium volutator) during migration stopover in the Bay of Fundy, Canada. The rates of pecking, prey capture and success were lower for individuals foraging at the edge than at the centre of flocks. Edge birds spent more time running and more time flying than centre birds. Edge birds moved away from the centre of the flock and made frequent short flights towards the centre. In contrast, centre birds rarely moved in a specific direction and flew mostly to relocate elsewhere with the whole flock. Sandpiper flocks foraged over a large area in a relatively short amount of time. In addition, amphipod density is high in this habitat. It thus appears unlikely that prey depletion or low food availability at the edges of groups could explain the spatial variation in foraging success. Low foraging success at the edges of flocks thus arose mainly because of time costs related to flock expansion and retraction. The effect of mutual interference among foragers and of predation risk by falcons is discussed with respect to flock expansion and retraction.
Physiological Costs of Mate Guarding in the Japanese Beetle (Popillia japonica Newman)
Authors: Saeki Yoriko , Kruse Kipp C. , Switzer Paul V.
Published: July 2005

Males of many insects directly defend their mates from rival males (i.e. mate guard) as a way to avoid sperm competition and thus increase their reproductive success. However, mate guarding may have associated costs for these males. We examined costs of mate guarding in Japanese beetles (Popillia japonica), a pest species which exhibits post‐copulatory mate guarding during which the guarding male cannot feed. In this species, food provides both energy and water for thermoregulation. Consequently, we focused on possible thermoregulatory and energetic costs of their mate guarding. In a field study, we found that guarding males had significantly higher thoracic temperatures than non‐guarding males, indicating a difference in their ability and/or need to thermoregulate. Paired males had significantly lower water levels than single males in the morning and evening, but not in the afternoon. In the laboratory, we found that mate‐guarding duration was significantly shorter at higher ambient temperature than at lower temperature, and males that had been starved guarded for less time than males that had not been starved. Our results suggest that because guarding males are unable to feed, they suffer energetic and thermoregulatory costs that appear to limit the amount of time that they can guard a female.