bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactoferrin, amylase and mucin MUC5B and their relation to the oral microflora in hyposalivation of different origins
Authors: Almståhl A. , Wikström M. , Groenink J.
Published: March 2003

There are several reasons for hyposalivation, each affecting the salivary composition in different ways. The aim of this study was to analyze and compare lactoferrin, amylase and mucin MUC5B in stimulated whole saliva collected from subjects with hyposalivation of different origins and to relate the results to the presence of some microbial species associated with oral disorders. Albumin was determined as a marker of serum leakage. The characteristic feature for subjects with radiation‐induced hyposalivation was a large increase in lactoferrin, probably due to leakage through inflamed mucosal tissues, while it was a high albumin content for the group with primary Sjögren’s syndrome, probably due to disruption of the fragile mucosa. The saliva composition in subjects with hyposalivation of unknown origin or due to medicines was close to that in the healthy controls. All three hyposalivation groups tended to display a decrease in the concentrations of MUC5B and amylase. None of the microbial species analyzed (streptococci, mutans streptococci, Lactobacillus spp., Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Candida albicans, Staphylococcus aureus and enterics) correlated with concentration of MUC5B in saliva. The RT group, having the highest concentration of lactoferrin, had the lowest median number of F. nucleatum and was the only group in which median number of P. intermedia/P. nigrescens was zero.
Clonality of Fusobacterium nucleatum in root canal infections
Authors: Moraes S. R. , Siqueira J. F. , Rôças I. N. , Ferreira M. C. S. , Domingues R. M. C. P.
Published: March 2003

Fusobacterium nucleatum is a gram‐negative non‐spore‐forming, non‐motile, obligate anaerobic rod that is normally isolated from the oral cavity. Several studies have reported a significant heterogeneity within the F. nucleatum species. The aim of the present study was to analyze the clonal diversity of F. nucleatum strains isolated from intracanal infections and to evaluate the presence of Enterobacterial Repetitive Intergenic Consensus (ERIC)‐like sequences in the genome of F. nucleatum. Samples were collected from 13 single‐root teeth from adult patients, all having carious lesions, necrotic pulps and radiographic evidence of periradicular bone loss. F. nucleatum was isolated from two different patients (subjects 5 and 7) by culture. Amplification of 19 colonies from subject 5 and 15 colonies from subject 7 using ERIC primers resulted in four clonal types, two per subject. An intense amplicon of approximately 700 bp was generated by ERIC‐PCR for all F. nucleatum isolates and F. nucleatum ssp. polymorphum ATCC 10953. The amplification reaction using primer 1254 confirmed the results obtained with the ERIC primer. Our findings indicate that DNA fingerprints provided by ERIC‐ and Arbitrarily Primed (AP)‐PCR may constitute a powerful tool for investigating F. nucleatum clonal diversity.
Contrasting responses of human gingival and periodontal ligament fibroblasts to bacterial cell‐surface components through the CD14/Toll‐like receptor system
Authors: Hatakeyama J. , Tamai R. , Sugiyama A. , Akashi S. , Sugawara S. , Takada H.
Published: March 2003

We compared human periodontal ligament fibroblasts with human gingival fibroblasts isolated from the same donor to examine interleukin‐8 (IL‐8) responses of the cells to Salmonella lipopolysaccharide, a water‐soluble peptidoglycan from Staphylococcus epidermidis and the synthetic muramyldipeptide, with special reference to the possible involvement of the CD14/Toll‐like receptor (TLR) system of the cells in the responses. Human gingival fibroblasts expressed CD14 on their surfaces and strongly expressed CD14 mRNA, while human periodontal ligament fibroblasts showed considerably lower levels of expression in both respects. Both cells expressed mRNA of TLR‐related molecules, i.e. TLR2, TLR4, MD‐2 and MyD88, although human periodontal ligament fibroblasts expressed TLR2 more strongly than human gingival fibroblasts. Human gingival fibroblasts exhibited a stronger IL‐8 response than human periodontal ligament fibroblasts to lipopolysaccharide, while human periodontal ligament fibroblasts exhibited a response comparable to, or slightly stronger than, that of human gingival fibroblasts to S. epidermidis peptidoglycan and muramyldipeptide. The IL‐8 responses of both cells to lipopolysaccharide and S. epidermidis peptidoglycan were completely inhibited by antihuman CD14 monoclonal antibody (MAb). The responses of both cells to lipopolysaccaride were significantly inhibited by antihuman TLR4 MAb, while those to S. epidermidis peptidoglycan were inhibited by antihuman TLR2 MAb. In contrast, muramyldipeptide activated both types of cells in a TLR2‐ and TLR4‐independent manner, although the activities of muramyldipeptide on human gingival fibroblasts, but not human periodontal ligament fibroblasts, were significantly inhibited by anti‐CD14 MAb.
Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: Two cross‐sectional studies, five years apart
Authors: Fuat Kalyoncu A. , Toros Selçuk Z. , Enünlü Tayfun , Demir Ahmet U. , Ç öplü L. , Altay Şahin A. , Artvinli Mustafa
Published: March 2003

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the preceding 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6–13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months’ prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09–2.98 and 1.01–2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13–3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5‐year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.
Mononuclear cell reactivity to food allergens in neonates, children and adults
Authors: Miceli Sopo Stefano , Pesaresi Maria Assunta , Guerrini Barbara , Federico Gilda , Stabile Achille
Published: March 2003

A model of antigen‐specific T‐cell proliferative responses based on reciprocal patterns of responses to dietary and inhalant allergens has been suggested, the former being frequent in infancy but rare in adults, whereas the latter are preserved and expand between infancy and adulthood. We have evaluated the age‐related variations of mononuclear cell reactivity to food allergens. The cord blood mononuclear cells (CBMC) of 30 neonates without family history of atopy and the peripheral blood mononuclear cells (PBMC) of 20 healthy children and of 40 healthy adults were stimulated in vitro with β‐lactoglobulin (BLG) or ovalbumin (OVA) and the cultures were harvested after 7 days. Neonates, children and adults were compared for the percentages of positive responses and for the magnitude of response. Adult subjects showed significantly lower percentages of positive responses and reduced magnitude of response than those observed in neonates and children either in BLG or in OVA cultures. We have not observed a decrease of food allergen mononuclear cell reactivity between neonates and children for the frequency of positive responses. The magnitude of response of neonates was significantly lower than that of children in BLG cultures. Our results seem to confirm the loss of mononuclear cell reactivity to food allergens in adult age. However, other reports show conflicting data. We suggest that a rigorous standardization of the methodological steps of in vitro mononuclear cell stimulation with allergen is necessary.
Low‐dose budesonide improves exercise‐induced bronchospasm in schoolchildren
Authors: Jónasson Gunnar , Carlsen Kai‐håkon , Hultquist Christer
Published: March 2003

The aim of this study was to compare the clinical efficacy of low‐dose inhaled budesonide (once or twice daily) and placebo, administered via Turbuhaler®, on exercise‐induced bronchoconstriction (EIB) in children with mild asthma. Fifty‐seven steroid‐naive children (7–16 years old; 41 boys, 16 girls) with EIB participated in this sub‐population study according to the following inclusion criterion: a maximum fall in forced expiratory volume in 1 s (FEV1) ≥ 10% after a standardized treadmill test. Mean baseline FEV1 was 100.3% of predicted, and mean maximum fall in FEV1 after the standardized exercise test was 22%. The study was a double‐blind, randomized, parallel‐group design. After 2 weeks of run‐in, the children received inhaled budesonide 100 µg or 200 µg once daily in the morning, 100 µg twice daily, or placebo, for 12 weeks. After 12 weeks of treatment, the fall in FEV1 after the exercise test was significantly less in all three budesonide groups (7.2–7.8%) vs. placebo (16.7%). Daytime symptom scores were significantly lower in all three budesonide groups compared with placebo (p < 0.02). The three budesonide groups did not differ significantly, and no significant change in lung function was found in any group. Therefore children with mild asthma, but with significant EIB, improved their exercise tolerance and symptom control after 3 months of treatment with a low dose of inhaled budesonide given once or twice daily.
Egg allergy in infancy predicts respiratory allergic disease by 4 years of age
Authors: Tariq Syed M. , Matthews Sharon M. , Hakim Eluzai A. , Arshad Syed H.
Published: March 2003

Sensitization to hen’s egg early in life has been proposed as a predictor for respiratory allergic disease during childhood. However, symptomatic egg allergy in infancy has not been studied in this context. In 1989, a cohort of consecutive births was recruited. Data on family history of atopy and environmental factors were collected. At 4 years of age, 1218 children were seen of whom 981 were skin‐prick tested with a range of food and aero‐allergens. Of the 1218 children, 29 (2.4%) had suffered symptomatic egg allergy (20 during infancy). Egg allergy in infancy was associated with increased respiratory (asthma, rhinitis) allergic disease (odds ratio [OR] 5.0, 95% confidence intervals [CI] 1.1–22.3; p < 0.05) at 4 years of age, with a positive predictive value (PPV) of 55.0%. The addition of infantile eczema to egg allergy increased the PPV to 80% whereas the addition of family history of atopy had no effect. Egg allergy also increased aero‐allergen sensitization (OR 6.1, CI 1.1–37.5; PPV 61.1%; p < 0.05). As a predictor for respiratory allergic disease and aero‐allergen sensitization, it carried a high specificity but poor sensitivity. Hence, egg allergy in infancy, especially when coexisting with eczema, increases respiratory allergic symptoms and aero‐allergen sensitization in early childhood.
Increased bronchoalveolar lavage CD8 lymphocyte subset population in wheezy infants
Authors: Arnoux Bernard , Bousquet Jean , Rongier Monique , Scheinmann Pierre , De Blic Jacques
Published: March 2003

Episodes of wheezing are very common in infancy but, despite their high prevalence, their mechanism is still poorly understood. To better understand the airway inflammation of wheezing infants, we examined cells of the bronchoalveolar lavage (BAL), focusing on the phenotype of lymphocytes and macrophages by using cytofluorimetry. Twenty‐one wheezers (mean age 15.4 months) and seven non‐wheezers (mean age 24.1 months) were studied. BAL was collected at fiberoptic bronchoscopy. Total and differential cell counts were similar in both populations. Eosinophils were not detected in the BAL fluid. The cell‐surface markers CD2, CD3, CD4, CD7, CD8, CD19, and CD45 were studied for the lymphocyte sub‐population analysis. The cell‐surface markers CD14, CD54, CD62L, and human leucocyte antigen (HLA)‐DR were studied for the macrophage sub‐population analysis. A significant increase in the CD8+ lymphocyte population (p = 0.03) was observed in wheezers (median 43.1%, 25–75% percentile: 30.1–54.9%), as compared to non‐wheezers (median 29.3%, 25–75% percentile: 13.5–34.7%). A significantly (p = 0.04) decreased expression of HLA‐DR (mean fluorescence intensity [MFI]) was detected in the macrophage population of the wheezers (median MFI, 7,016; range 2135–7986), as compared to non‐wheezers (median MFI, 8,369; range: 6478–8860). The results of the present study suggest that viral infection may have induced a CD8+ response in BAL cells.
Cardiac failure in an infant with Chediak–Higashi syndrome: A hypothesis of the effect of diadenosine polyphosphates
Authors: Ganschow Rainer , Grabhorn Enke , Lemke Joachim , Lepler Rudolf
Published: March 2003

A 14‐week‐old boy with undiagnosed Chediak–Higashi syndrome developed fever with a high temperature and acute cardiac failure after having received a scheduled vaccination. We hypothesize that decreased concentrations and receptor binding of serum and tissue diadenosine polyphosphates, such as AP4A, AP5A, or AP6A, which are stored in various tissues and serve as extra‐cellular signaling molecules or are secreted by cells in response to physiologically stressful stimuli, lead to the observed severe tachyarrhythmia. Diadenosine polyphosphates normally have a negative chronotropic and inotropic effect. This is the first report of severe cardiac failure in a child with Chediak–Higashi syndrome and we suggest that cardiac arrhythmias should be considered in such children in the event of high fever. Our hypothesis requires further investigation in other patients.
Clostridium difficile, atopy and wheeze during the first year of life
Authors: Woodcock Ashley , Moradi Mohammad , Smillie Frazer I. , Murray Clare S. , Burnie James P. , Custovic Adnan
Published: March 2003

Differences have been suggested to occur in the composition of intestinal microflora from allergic and non‐allergic children. In this study we used a semi‐quantitative enzyme‐linked immunosorbent assay (ELISA) for the measurement of Clostridium difficile‐specific immunoglobulin G (IgG) (CDIgG). CDIgG was excellent in differentiating between adults with or without Cl. difficile colitis (absorbance levels, positive vs. negative controls: geometric mean (GM) 0.301, 95% CI: 0.289–0.314 vs. GM 0.167, 95% CI: 0.155–0.181; mean difference 1.8‐fold, 95% CI: 1.65–1.95; p < 0.0001). We used this technique to investigate whether there are any differences between atopic wheezy infants and non‐atopic non‐wheezy controls. In a prospective cohort study (n = 390) 10 patients were identified at 1 year of age (atopic, history of recurrent wheeze) and matched (gender, month of birth, exposure to Der p 1, Fel d 1 and Can f 1) with a control group of infants (non‐atopic, no history of wheeze). The patients had significantly higher Cl. difficile‐specific IgG absorbance levels (GM 0.298, 95% CI: 0.249–0.358) compared with controls (GM 0.235, 95% CI: 0.201–0.274; mean difference 1.27‐fold, 95% CI: 1.07–1.50; p = 0.01). These results suggest that there may be differences in the composition of intestinal microflora between allergic and non‐allergic infants at 1 year of age, with allergic children having higher Cl. difficile IgG antibody levels.
Reduced expression of CD69 and adhesion molecules of T lymphocytes in asthmatic children receiving immunotherapy
Authors: Huang Jing‐Long , Ou Liang‐Shiou , Tsao Ching‐Hsiung , Chen Li‐Chen , Kuo Ming‐Ling
Published: March 2003

T lymphocytes play a fundamental role in the initiation and regulation of chronic inflammatory responses in patients with asthma. CD69 is an early marker of T‐cell activation. The levels of intercellular adhesion molecule‐1 (ICAM‐1, CD54) and L‐selectin have been reported to increase in patients with allergic diseases and asthma. The present study was therefore undertaken to investigate the expression of CD69, CD54, and L‐selectin by T lymphocytes of children with asthma, before and after immunotherapy. Eighteen children newly diagnosed with asthma, 11 good and nine poor responders to immunotherapy, and 16 normal subjects, were enrolled in this study. The percentages of CD69+, CD54+, and CD62L+ cells in T lymphocytes were measured by using flow cytometry. The levels of CD69, CD54, and CD62L in serum and culture supernatants were determined by using enzyme‐linked immunosorbent assay (ELISA). The expression of CD69 and CD54 on CD3+ T lymphocytes was significantly higher in children with asthma than in control patients. All the patient groups expressed (spontaneously and following stimulation with phorbol myristate acetate and ionomycin together with mite‐extract proteins) greater amounts of CD69 and CD54 than did control subjects. With long‐term immunotherapy, the percentages of CD69+ and CD54+ T lymphocytes were significantly lower in patients with a good response to immunotherapy. Our results also showed significantly lower serum L‐selectin levels following immunotherapy. In conclusion, successful immunotherapy resulted in decreased expression and production of CD69 and CD54. These results may explain, in part, the clinical efficacy of immunotherapy.
Long‐term psychosocial adjustment following pediatric liver transplantation
Authors: Törnqvist J. , Van Broeck N. , Finkenauer C. , Rosati R. , Schwering K. ‐L. , Hayez J. ‐Y. , Janssen M. , Otte J. ‐B.
Published: March 2003

Abstract: This study assessed long‐term psychosocial adjustment to pediatric liver transplantation in 146 patients aged 4–25 yr, who had received a transplant 2–12 yr previously. Evaluations of psychosocial adjustment and related variables were based on the Harter Self‐Perception Profiles for children, Child Behavior Checklist (CBCL), and children’s school level. Up to the age of 8 yr, transplant children as a group did not perceive themselves as less competent than healthy peers. Gender effects were characterized by older girls perceiving significantly less scholastic cognitive competence than their healthy peers. Adolescent and young adult boys had significantly lower global self‐worth and lower perceived athletic competence than their healthy peers. In comparison to normative data of healthy children, CBCL parent‐reported scores revealed significant deficits in competences for all age groups. Only for the older boys, however, did these deficits reported by the parents reach a pathological level. The majority of transplant children also had significantly higher problem scores, but they remained within the normal range, except for the older boys whose internalizing problems reached a borderline level. Our results suggest that liver transplantation does not affect schooling in a substantial way. Regardless of statistically significant differences in psychosocial adjustment, the majority of the transplant children functioned on a normal level. For adolescent and young adult boys, however, the presence of problems and the lack of competences observed by parents and by the youngsters themselves reached borderline to pathological levels. Our findings stress the importance of psychological post‐transplant follow‐up with increased attention of caregivers to child and parental concerns about their long‐term psychosocial adjustment process.
The potential role of rapamycin in pediatric transplantation as observed from adult studies
Authors: Kahan Barry D.
Published: March 2003

Kahan BD. The potential role of rapamycin in pediatric transplantation as observed from adult studies.

Pediatr Transplantation 1999: 3: 175–180. © Munksgaard, 1999

Abstract: Although pediatric patient and renal graft survival rates have shown marked improvements during the past decade, the persistent toxicities of immunosuppressive drugs and chronic allograft attrition remain major obstacles in transplant therapy. Results in adult patients suggest that complete steroid withdrawal is possible in the majority of recipients under treatment with a cyclosporin A–rapamycin (CsA–RAPA) regimen. Furthermore, preliminary studies suggest that a marked reduction in the dose of CsA may be possible under the umbrella of RAPA coverage. The gain in immunosuppressive efficacy afforded by RAPA has not only been obtained without an increased morbidity owing to infectious or neoplastic causes, but also with the potential for reducing the incidence and/or progression of chronic rejection.
Heart transplantation in children: Indications*
Authors: Fricker F. Jay , Addonizio Linda , Bernstein Daniel , Boucek Mark , Boucek Robert , Canter Charles , Chinnock Richard , Chin Clifford , Kichuk Maryanne , Lamour Jacqueline , Pietra Bill , Morrow Robert , Rotundo Kathy , Shaddy Robert , Pahl Schuette Elfriede , Schowengerdt Kenneth O. , Sondheimer Henry , Webber Steve
Published: March 2003

Abstract: This review details the indications for heart transplantation in children. Contraindications have evolved from absolute to relative. Controversial issues remain and this paper represents a consensus of more than a dozen centers that have programs that remain active performing pediatric heart transplants.
The role of the graft endothelium in transplant rejection: Evidence that endothelial activation may serve as a clinical marker for the development of chronic rejection
Authors: Denton Mark D. , Davis Stacy F. , Baum Michelle A. , Melter Michael , Reinders Marlies E. J. , Exeni Andrea , Samsonov Dmitry V. , Fang Jim , Ganz Peter , Briscoe David M.
Published: March 2003

Abstract: In this review, we discuss the role of the allograft endothelium in the recruitment and activation of leukocytes during acute and chronic rejection. We discuss associations among endothelial activation responses, the expression of adhesion molecules, chemokines and chemokine receptors, and rejection; and we propose that endothelial vascular cellular adhesion molecule‐1 (VCAM‐1) may be used as a surrogate marker of acute rejection and allograft vasculopathy. In addition, we describe potential mechanistic interpretations of persistent endothelial cell (EC) expression of major histocompatibility complex (MHC) class II molecules in allorecognition. The graft endothelium may provide an antigen‐specific signal to transmigrating, previously activated, T cells and may induce B7 expression on locally transmigrating leukocytes to promote costimulation. Taken together, these functions of the EC provide it with a potent regulatory role in rejection and in the maintenance of T‐cell activation via the direct and/or the indirect pathways of allorecognition.
Pulmonary complications following liver transplantation in pediatric patients
Authors: Mack Cara L. , Millis J. Michael , Whitington Peter F. , Alonso Estella M.
Published: March 2003

Abstract: The purpose of this study was to define the incidence and type of pulmonary complications experienced by children after orthotopic liver transplantation (OLT). The radiological records of all patients receiving OLT during a 3‐yr period were reviewed to identify evidence of a pulmonary abnormality. Medical records were then reviewed to determine type, duration, therapy and outcome of pulmonary disorders. Potential risk factors for the development of persistent pleural effusions were also analyzed. One hundred and fifty‐one pediatric liver transplantations were performed on 113 patients during this period. Pneumonia developed in 27 patients, including 11 proven bacterial, six presumed bacterial, six viral and four fungal cases. All three deaths related to pulmonary complications were in this group. Three patients developed mild pulmonary hemorrhages, and three developed pulmonary calcifications, which did not impair lung function. Sixteen patients developed paralysis of the right hemidiaphragm, four required diaphragm plication. Pleural effusions developed in 86 patients, 38 persisted longer than 7 days. Patients with persistent effusions were more likely to develop allograft rejection than patients with no persistent effusion (p < 0.01) by χ2 analysis. Seven patients required tracheostomy placement. Of these, four were successfully decannulated, two died from non‐pulmonary complications and one is receiving home ventilator support. In conclusion, the majority of children experience at least one pulmonary complication after OLT, but mortality due to pulmonary disease is low in this population. Persistent pleural effusions may be a heralding sign of allograft rejection. Viral, bacterial and fungal pneumonia were the only pulmonary causes of death and only one patient in this series has had significant chronic lung disease.
Non‐adherence in pediatric liver transplant recipients − an assessment of risk factors and natural history
Authors: Lurie Susan , Shemesh Eyal , Sheiner Patricia A. , Emre Sukru , Tindle Helen L. , Melchionna Libera , Shneider Benjamin L.
Published: March 2003

Abstract: Despite the fact that non‐adherence to medical therapy is one of the major causes of late morbidity and mortality in pediatric liver transplant recipients, little is known of the risk factors involved in this behavior. Three cases of fatal non‐adherence are reported. Factors associated with non‐adherence were investigated by performing a retrospective chart review of a panel of 27 variables in an age‐matched cohort of 15 pediatric liver transplant recipients. The most striking differences between the severely non‐adherent group and the age‐matched cohort included history of substance abuse, child abuse (physical or sexual), not having two parents at home, having received public assistance, having been diagnosed with a psychiatric disorder, and history of school dropout. In addition it appeared that a pretransplant diagnosis of autoimmune hepatitis was associated with more significant medical sequelae related to non‐adherence. These findings are preliminary owing to the retrospective design of this study, but could be used as a starting point for a prospective study of this important phenomenon.
Management of hepatic venous obstruction after split‐liver transplantation
Authors: Mazariegos George V. , Garrido Victor , Jaskowski‐Phillips Susan , Towbin Richard , Pigula Frank , Reyes Jorge
Published: March 2003

Abstract:Stenosis of the hepatic vein anastomosis is an unusual but critical complication after liver transplantation. In pediatric liver transplantation, the scarcity of size‐matched donors has required the use of segmental liver allografts, either as reduced‐size or split‐liver grafts. This report illustrates the primary use of a hepatic vein stent to manage hepatic venous outflow obstruction in a pediatric split‐liver recipient, and reviews experience in the management of hepatic venous outflow obstruction after liver transplant using stent methods.
Interleukin‐1 receptor antagonist in ascites indicates acute graft rejection after pediatric liver transplantation
Authors: Ganschow R. , Baade B. , Hellwege H. H. , Broering D. C. , Rogiers X. , Burdelski M.
Published: March 2003

Abstract: Acute graft rejection is one of the most frequent complications after pediatric liver transplantation (LTx). In clinical practice, it is sometimes difficult to differentiate acute cellular graft rejection from other complications because clinical and chemical findings are often non‐specific. We therefore investigated the value of cytokine quantification in drained ascites, in addition to quantification of cytokine concentrations of serum, in 30 children in the first 2 weeks after orthotopic liver transplantation (OLT). Six of 30 patients showed acute graft rejection, with rising levels of alanine aminotransferase (ALT) and α‐glutathione‐S‐transferase (α‐GST) in serum up to 24 h prior to biopsy‐proven rejection. There were no significant elevations of interleukin‐2 receptor (IL‐2r) and interleukin‐6 (IL‐6) in serum and ascites. In contrast to these findings, the concentration in ascites of the interleukin‐1 receptor antagonist (IL‐1ra) increased 48 h before rejection was proven by liver biopsy (p < 0.01, in comparison with the non‐rejecting group, n = 24). The IL‐1ra concentration in ascites was up to 11‐fold higher than in serum during rejection (15.43 vs. 1.38 ng/mL). Two children with early infectious complication showed no significant increase in ascitic IL‐1ra concentration. We conclude from these data that quantification of IL‐1ra in ascites indicates the start of graft rejection after LTx. As long as abdominal drainage is performed, this non‐invasive procedure may be of additional value in differential diagnoses and early diagnosis of rejection.
Pediatric renal transplantation in Turkey:A review of 56 cases from a single center
Authors: Haberal M. , Bereket G. , Karakayalı H. , Arslan G. , Moray G. , Bilgin N.
Published: March 2003

Abstract:In order to assess certain aspects of pediatric kidney transplantation (Tx) in Turkey, we retrospectively analyzed the results of 56 of these pediatric procedures performed at our center. From January 1986 to January 1998, 56 pediatric renal Tx (29 males, 27 females; 0–17 yr of age) were carried out at Başkent University Hospital. All were first‐time Tx. Fifty‐one (91%) patients were on hemodialysis and four (7.3%) were on peritoneal dialysis prior to Tx. Pre‐emptive Tx was performed for only one patient. Living‐related donors (LRD) provided 47 (84%) of the transplanted organs and cadaver sources were utilized for nine (16%) patients. The mean cold ischemia time (CIT) for cadaveric donors (CD) was 38.6 h (range 23–56 h). Among living‐related graft (LRG) recipients, the average waiting time for Tx was 4 months for Tx performed after 1990 and 8 months for those prior to 1990 (p< 0.05). Median length of hospital stay for Tx was 17±1.1 and 18±1.4 days for LRG and cadaveric graft (CG) recipients, respectively. Fifteen of 47 (33%) LRG recipients and six of nine (67%) CG recipients received anti‐rejection treatment within 30 days following the Tx surgery. Graft failure developed in 16 (12 LRG, four CG) recipients. Two patients developed Kaposi's sarcoma, 17 and 3 months after Tx. There were total of six deaths (four with functioning grafts). The 1‐, 3‐, and 5‐yr graft survival rates were 93%, 75%, and 63%, respectively, and corresponding patient survival rates were 96%, 92%, and 77%. The social and educational status of 27 patients with functioning grafts were also evaluated. Our results showed that 56% of patients ended their education before high school and only three patients have been married. The high rate of school drop‐out and unemployment among pediatric renal transplant recipients in our population underline the need for a more intensive rehabilitation program.
First experience with basiliximab in pediatric liver graft recipients
Authors: Ganschow R. , Broering D. C. , Stuerenburg I. , Rogiers X. , Hellwege H. H. , Burdelski M.
Published: March 2003

Abstract:Several studies have shown a significant reduction of acute cellular graft rejection in adult liver and kidney graft recipients treated with monoclonal anti‐interleukin‐2 (IL‐2)‐receptor antibodies. The mechanism was inhibition of activated T‐helper cells by blocking the α‐chain (CD25) of the IL‐2 receptor. The pilot study described here evaluated the use of basiliximab in pediatric liver transplantation (LTx), which is the first report on its use in children. Fifty‐two liver‐transplanted children were analyzed in this study. A matched‐pair historical control group (n = 26) received cyclosporin A (CsA) and prednisolone, and patients in the basiliximab group (n = 26) were treated with low‐dose CsA and basiliximab (after reperfusion and on day 4 post‐transplant). The incidences were compared of acute graft rejections, infectious complications, and the adverse effects of immunosuppressive medication within the first 6 months post‐transplant. The incidence of acute rejection was significantly higher in the control group (61.5% vs. 11.5%, p = 0.0004). The frequency of infectious complications was similar (46.1% vs. 53.8%). Patients in the basiliximab group showed less arterial hypertension; however, the differences were not statistically significant (30.7% vs. 7.7%, p = 0.07). Nephrotoxicity, hepatotoxicity or neurotoxicity were only seen in the control group (7.7%; 3.8%; 3.8%, respectively). Hence, the use of basiliximab in combination with CsA and steroids in pediatric liver transplant recipients is safe and reduces the incidence of acute graft rejection. Further studies are needed to confirm our preliminary results and to analyze long‐term effects on post‐transplant lymphoproliferative disease, chronic rejection, and patient survival.
Recent advances and future prospects in intestinal and multi‐visceral transplantation
Authors: Pirenne Jacques , Coosemans Willy , Herman Jean , Van Damme‐Lombaerts Rita
Published: March 2003

Abstract: From an experimental procedure, intestinal transplantation (ITx) has evolved over the last 10 yr into a treatment option for patients suffering from short bowel syndrome and who develop life‐threatening complications from total parenteral nutrition (TPN) (e.g. liver dysfunction, line sepsis, shortage of venous access, etc.). One‐year survival rates are ≈ 70% and thus similar to lung Tx. However, the intestine remains the most challenging abdominal organ to transplant. This is because of the severe immune response (mostly rejection) that is produced, and therefore the need for profound immunosuppression with its attendant complications (sepsis, lymphoma, direct drug toxicity). Unlike other organs, graft loss as a result of acute rejection can occur late after transplantation (more than 1 yr post‐transplant). With regard to the actual immunosuppressive regimens, considerable experience in patient management is required to optimize outcome of those complex transplants, which are permanently at risk of rejection and infection. ITx remains an unfinished product, and the application of ITx to patients doing well on TPN warrants further research in the understanding of the rejection process, in the development of less toxic and more efficient immunosuppressive protocols, and in the development of immunomodulatory strategies, to better control rejection and thereby reduce the need for immunosuppression.
Induction of a transient graft vs. leukemia effect following unrelated cord blood transplantation
Authors: Haut Paul R. , Gonzalez‐Ryan Lydia , Wang Ling‐Jia , Olszewski Marie , Morgan Elaine , Kletzel Morris
Published: March 2003

Abstract: Umbilical cord blood (UCB) has become a frequent source of allogeneic hematopoietic stem cells for transplantation. Of theoretical concern is a potential decrease in the graft vs. leukemia (GvL) effect, given the lesser degree of graft vs. host disease (GvHD) with this donor source. We report a case of recurrent acute non‐lymphoblastic leukemia (ANLL) following stem cell transplantation with unrelated mismatched UCB, which responded to the induction of GvHD. The response was documented both morphologically and by evaluation of chimeric engraftment by molecular DNA techniques. In addition, WT‐1, a purported marker of minimal residual disease in acute leukemia, correlated with remission status in this patient. In summary, the GvL effect is seen with allogeneic UCB transplantation and has the potential to be induced along with GvHD.
Propagation of activated T lymphocytes from endomyocardial biopsy samples of cardiac allografts: Influence of the addition of recombinant interleukin‐4 to the culture environment
Authors: Webber Steven A. , Bentlejewski Carol , Boyle Gerard J. , Miller Susan A. , Law Yuk , Murali Srinivas , Pham Si , Park Andrew , Griffith Bartley P. , Duquesnoy Renee , Zeevi Adriana
Published: March 2003

Abstract: In vivo, activated T cells can be propagated from endomyocardial biopsy (EMB) samples of cardiac allografts in cultures containing recombinant interleukin‐2 (rIL‐2). However, T cells are sometimes not propagated in such cultures, even when rejection is present, and at other times the yield of lymphocytes is too small to allow further studies of these graft‐infiltrating cells. The current study investigated the effects of the addition of recombinant interleukin‐4 (rIL‐4) to the culture environment. Cultures were performed on 532 consecutive EMB samples from 120 adult and pediatric heart transplant recipients. Each sample was divided into multiple fragments. Half of the fragments were cultured in media containing 30 U/mL of rIL‐2 and the remaining half were cultured under identical conditions but with the addition of 200 U/mL of rIL‐4. After 14 days, cell counts were performed, the cell phenotypes were assessed by flow cytometry, and donor specificity and cytotoxicity were assessed using the primed lymphocyte test (PLT) and cell‐mediated lympholysis (CML) assay, respectively. Lymphocyte growth occured in 18% of grade 0–1a EMB in the presence of rIL‐2 and in 29% of grade 0–1a EMB in the presence of rIL‐2/rIL‐4 (p = 0.02). For higher‐grade EMB (equivalent to grade 1b), the proportion of positive cultures (≈ 39%) was similar in both conditions. For positive cultures, there was a 5‐fold increase in the number of cells in the rIL‐2/4 cultures compared to rIL‐2 alone (1.6 × 106 versus 3.4 × 105). Flow cytometry revealed an increase in the proportion of CD8+ cells in the rIL‐2/4 cultures (42% versus 23%, p = 0.004). Proliferative responses to donor antigens (as assessed by using the PLT) were comparable between the two groups, but donor‐specific cell‐mediated cytotoxicity was enhanced on addition of rIL‐4. Hence, addition of rIL‐4 enhances the propagation of donor‐specific T cells from heart biopsy samples, especially in the presence of minimal rejection. This will provide a greater quantity of material for further studies of graft‐infiltrating cells.
Lipid profile during rhGH therapy in pediatric renal transplant patients
Authors: Ghio L. , Damiani B. , Garavaglia R. , Oppizzi G. , Taioli E. , Edefonti A.
Published: March 2003

Abstract: To evaluate the effect of recombinant human growth hormone (rhGH) treatment on the lipid profile of pediatric renal transplant patients, we studied nine children treated with rhGH for 1 yr and a control group of 12 untreated patients matched in terms of age, renal transplant function and post‐transplant follow‐up. The levels of lipoprotein (a [Lp(a)], cholesterol, triglycerides, apolipoprotein A (APO A) and apolipoprotein B (APO B), and the APO B/APO A ratio, were determined at baseline and after 6 and 12 months of follow‐up. RhGH therapy had no effect on cholesterol, triglycerides or apolipoproteins. Mean serum Lp(a) levels increased from 6.7 ± 5.7 mg/dL at baseline to 11.8 ± 10.7 after 6 months (p = 0.018) and 13.6 ± 15.1 after 12 months of rhGH treatment (p = 0.04), but did not change in the control group. Lp(a) is a risk factor for cardiovascular morbidity, and increased Lp(a) levels may be a side‐effect of rhGH treatment in renal transplant patients. Although long‐term follow‐up of a large number of patients is needed to establish the duration and extent of the effects of rhGH treatment on Lp(a) levels in transplanted children, serum Lp(a) levels should be carefully monitored in those receiving rhGH therapy.
Effects of isolated small bowel transplantation on liver dysfunction caused by intestinal failure and long‐term total parenteral nutrition
Authors: Hasegawa Toshimichi , Sasaki Takashi , Kimura Takuya , Nakai Hiroshi , Sando Kinya , Wasa Masafumi , Takagi Yoji , Okada Akira , Mushiake Sohtarou , Harada Tokuzou
Published: March 2003

Abstract: It has not been fully determined whether isolated small bowel transplantation (ISBTx) can reverse liver dysfunction caused by intestinal failure requiring long‐term total parenteral nutrition (TPN). A boy with congenital microvillus inclusion disease presented with vomiting and severe diarrhea since the first day of life and had been managed by TPN since then. He suffered from catheter‐related sepsis several times. At 14 yr of age he developed progressive hepatosplenomegaly with thrombocytopenia and coagulopathy. He underwent ISBTx with an ileal graft from his blood‐identical grandmother at the age of 16 yr. Oral feeding was started on the 14th day after ISBTx and gradually increased. TPN was completely withdrawn after 5 months. Liver was palpated 5 cm below the costal margin before ISBTx, while it became non‐palpable 5 months after ISBTx. Serum liver enzyme levels and prothrombin time normalized in the 5 months following ISBTx. Liver biopsy showed marked steatosis, slight cholestasis, and mild bridging fibrosis before ISBTx. Although histological examination of liver biopsy revealed complete disappearance of steatosis 7 and 11 months after ISBTx, liver fibrosis remained unchanged. This clinical experience has shown that although steatosis and cholestasis are reversible after successful ISBTx and withdrawal of TPN, liver fibrosis may remain unchanged.
Clostridium difficile colitis associated with inflammatory pseudotumor in a liver transplant recipient
Authors: Lykavieris Panayotis , Fabre Monique , Pariente Daniele , Lezeau Yves‐Marie , Debray Dominique
Published: March 2003

Abstract: The aim of this report is to describe a rare complication of clostridium difficile (CD) disease, the occurrence of an inflammatory pseudotumor that caused intestinal obstruction in a liver transplant recipient. A 9‐month‐old girl underwent liver transplantation for biliary atresia. She was given tacrolimus as primary immunosuppressive therapy. Three months after liver transplantation, she presented with febrile protracted bloody diarrhea and failure to thrive. A diagnosis of post‐transplant lymphoproliferative disease associated with Epstein–Barr virus infection was initially made on histological examination of duodenal biopsies. Tacrolimus was discontinued. Despite treatment with anti‐CD20 monoclonal antibodies the child's condition deteriorated and she presented with intestinal occlusion. A mass at the ascending colon was seen on the computed tomography scan mimicking lymphoma and the child underwent surgical laparotomy. Histological examination of the mass showed typical pathological lesions of inflammatory pseudotumor and CD pseudomembranous colitis. Diagnosis of CD disease was confirmed upon the identification of CD toxin A in stools. She was successfully treated by metronidazole and γ‐globulin perfusions. Delayed diagnosis and anti‐CD20 monoclonal antibodies therapy (associated with hypogammaglobulinemia) possibly played a major role in the severity of CD pseudomembranous colitis and in the occurrence of an inflammatory pseudotumor.
End‐of‐life issues of children
Authors: Gowan Darla
Published: March 2003

Abstract: When working with children who have cancer or other life‐threatening illnesses, providers are frequently deal with end‐of‐life concerns. Children deserve the best of care at all times, and the end‐of‐life is no exception. Controversy surrounds the debate between use of hospice care or palliation with children. Laws and guidelines dictate how we can treat symptoms and expect reimbursement. This article will review some of the main issues and give ideas for caring for children who deal with life‐threatening illness.
Bone marrow transplantation: it's not just about blood anymore!
Authors: Horwitz Edwin M.
Published: March 2003

Abstract: Bone marrow transplantation is established as effective cell therapy for hematopoietic disorders. With the recognition that bone marrow also contains mesenchymal stem cells, with the potential to differentiate to a wide variety of mesenchymal tissues, bone marrow transplantation, in theory, may be used to treat many nonhematopoietic disorders as well. Here, we present an overview of the developments of clinically oriented marrow mesenchymal stem cell biology and it's early applications as adjunct cell therapy in conventional stem cell transplantation, and most importantly as stem cell therapy for nonhematopoietic disorders.
The expansion of maize root‐cap mucilage during hydration. 1. Kinetics
Authors: Sealey L. J. , McCully M. E. , Canny M. J.
Published: March 2003

The conventional view of root‐cap mucilage as an expanded blob of mucilage is characteristic only of root tips in contact with free water. In soil, the mucilage is almost always a dry coating over the tip to which soil particles adhere. The kinetics of expansion of root‐cap mucilage of Zea mays roots grown in field soil, in soil in pots, and axenically on agar, were determined when the mucilage was exposed to water. On the soil‐grown roots the increase in mucilage volume was linear with time, sometimes reaching a constant volume during the 6 h of measurement, but sometimes not. This linear expansion is interpreted as limited by the rate at which the condensed mucilage in the periplasmic and intercellular spaces of the root cap passes to the exterior of the cap, expanding as fast as it arrives outside in the water. The height of the plateau is interpreted as a measure of the amount of mucilage initially present in the interior spaces. Because of the greater availability of water in the axenic roots grown on 1% agar, the mucilage was already outside the root cap, and it expanded more rapidly. It reached a final volume about 10‐fold greater than that on the soil‐grown roots. The volume increase was curvilinear with time. An analysis of these curves suggested that this swelling on axenic roots was a diffusion of mucilage outwards from the flanks of the root cap, and the diffusivity of the mucilage was estimated as 4 × 10−8 cm2 s−1. The molecular radius derived from this diffusivity was 34 nm, and the estimated molecular weight was 1.6 × 108 Da.
Regulation of the ripening of tomato pericarp discs by GA3 and divalent cations
Authors: Ben‐Arie Ruth , Mignani Ilaria , Greve L. Carl , Huysamer Marius , Labavitch John M.
Published: March 2003

We have used a tomato (Lycopersicon esculentum Mill.) pericarp disc system to study the inhibition of ripening caused by diazocyclopentadiene (DACP), gibberellic acid (GA3) and calcium (CaCl2), and to compare their modes of action. Treatment of discs with 1‐aminocyclopropane carboxylic acid (ACC) accelerated their ripening while DACP treatment eliminated ripening in the absence or presence of a treatment with the ethylene precursor. Both GA3 and calcium retarded color development and tissue softening. Calcium delayed the onset of the climacteric rise in respiration and ethylene evolution, but GA3 had no consistent effect in this respect. The different modes of action of the two inhibitors were emphasized by the synergistic effect on inhibition of ripening obtained when both were simultaneously applied. Inhibition of color development and softening was also achieved by applying other divalent cations such as strontium and barium. However, no such effect was observed with manganese or with the monovalent cations potassium and sodium. We concluded that calcium inhibition of ripening is not specific and is not necessarily mediated by the calcium calmodulin complex.