bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐Term Persistence of Hepatitis B Virus DNA in the Serum of Children with Chronic Hepatitis B after Hepatitis B e Antigen to Antibody Seroconversion
Authors: Bortolotti Flavia , Wirth Stefan , Crivellaro Carlo , Alberti Alfredo , Martine Ursula , de Moliner Lorena
Published: February 2024

To evaluate the prevalence and duration of viremia in relation to the features of liver disease, we investigated hepatitis B virus (HBV) DNA by the polymerase chain reaction in the serum of 39 children with chronic hepatitis B, after hepatitis B e antigen to antibody seroconversion. During a mean observation period of 8.2 ± 3.8 years after seroconversion, all patients were asymptomatic; 36 had persistently normal alanine aminotransferase levels, and three had occasional mild alterations. Liver histology, checked in 21 patients, showed persistent hepatitis in nine, fibrosis in 10, and cirrhosis in two cases. HBV DNA was always undetectable by dot blot hybridization. Five children eventually cleared hepatitis B surface antigen, including one with cirrhosis who developed liver cancer at 19 years. HBV DNA was detected by polymerase chain reaction in 87% of children within 5 years of follow‐up, in 58% of cases 6‐10 years after seroconversion (p < 0.001), and in 50% of patients investigated later. Long‐term viremia was found in two patients (40%) who cleared HBsAg, including the one who developed liver cancer. The chances of clearing viremia during follow‐up were higher in children with acute hepatitis at the onset of illness (86%) than in those with asymptomatic onset (37%; p < 0.05). Our results show that low levels of HBV viremia, probably reflecting low levels of virus replication, persist for several years in children with chronic hepatitis B after hepatitis B e antigen to antibody seroconversion and remission of liver disease, even after the clearance of hepatitis B surface antigen. Persistent replication could support mild biochemical alterations and inflammatory liver lesions. It could allow late reactivation of liver disease and may play a role in the development of carcinoma.
Twenty‐Four Hour Ambulatory Gastric and Duodenal pH Profiles in Cystic Fibrosis: Effect of Duodenal Hyperacidity on Pancreatic EnzymeFunction and Fat Absorption
Authors: Barraclough M. , Taylor C. J.
Published: February 2024

Overt steatorrhoea remains a problem for some patients with cystic fibrosis (CF) despite supraphysiological dosages of pancreatic enzymes. As pancreatin release and enzyme function is influenced by duodenal pH, we have used 24‐h ambulatory pH measurements to assess the extent and duration of postprandial hyperacidity. Readings were obtained from the stomach and proximal duodenum in 16 CF patients (aged 6 months to 12 years) using a dual‐channel antimony electrode. The fasting gastric and duodenal pH values were normal in all patients (mean pH values of 1.3, and 6.8, respectively). There was, however, a marked drop in duodenal pH in the first postprandial hour, which became more pronounced with successive meals. The total time that duodenal pH was <5 varied from 15 to 90% of the recording (mean 57%). Overnight the duodenal pH returned to normal levels. A subgroup of five patients were studied before and after treatment with omeprazole, a potent inhibitor of gastric acid secretion. There were significant improvements in both weight gain and fat absorption. This study supports the hypothesis that the postprandial duodenal pH is excessively acid in patients with CF and may be an important element in the continuing fat malabsorption experienced by some patients. This malabsorption may limit the efficacy of the newer high‐lipase pancreatic enzyme supplements and lead to delayed enzyme release, a possible factor in the recent reports of proximal colonic strictures.
How Valid Are Clinical Signs of Dehydration in Infants?
Authors: Duggan Christopher , Refat Mamdouh , Hashem Mohamed , Wolff Mark , Fayad Ibrahim , Santosham Mathuram
Published: February 2024

Our objective was to determine the ability of several clinical signs of dehydration to distinguish among degrees of dehydration in infants with acute diarrhea. The design was a prospective cohort study in a pediatric referral hospital in Cairo, Egypt. Infant boys, 3‐18 months old, with a history of acute diarrhea (5 or more watery stools per day for no more than 7 days) were eligible, except those with frank protein‐energy malnutrition, serious nongastrointestinal illness, or being exclusively breast‐fed. Several clinical signs of dehydration were assessed upon study entry. Subjects were then rehydrated with an oral rehydration solution and fed a standardized diet until diarrhea ceased (no watery or loose stools for 16 h). The main outcome measure was percent body weight gain at rehydration and at resolution of illness. Data from 135 subjects were available for analysis. Average (SD) rehydration phase duration was 5.2 (2.1) h, and average (SD) duration of illness was 54.5 (38) h. Multiple regression analysis selected prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa as the clinical signs that correlated best with percent dehydration (R2for model 0.244, p < 0.001). Mean weight gain for the two assessment systems was 3.6‐3.9% for mild, 4.9‐5.3% for moderate, and 9.5‐9.8% for severe dehydration. The most valid clinical signs of dehydration include prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa. Children with clinical signs of mild or moderate dehydration have fluid deficits on the order of 3 or 5% body weight, respectively.
Breast‐Feeding and Growth Factors in Preterm Newborn Infants
Authors: Díaz‐Gómez N. Marta , Domenech Eduardo , Barroso Flora
Published: February 2024

Background:

We analyzed the role that nutrition and the insulin‐like growth factors IGF‐I and IGFBP‐3 play on neonatal growth.

Methods:

Full‐term and preterm infants with 1 and 3 weeks of postnatal life (n = 54 and n = 33, respectively) were studied. Anthropmetric variables, daily intake of energy and nutrients, and serum levels of IGF‐I and IGFBP‐3 were measured.

Results:

At the first week after birth, preterm infants had lower IGF‐I levels than did those in the control group. At the third week of postnatal life, serum IGF‐I and IGFBP‐3 levels showed a significant increase. Preterm infants born before 33 gestational weeks showed lower IGF‐I (p < 0.02) and IGFBP‐3 (p < 0.02) levels than those born between 33 and 37 gestational weeks. Preterm infants fed with human milk supplemented with a formula showed higher serum IGF‐I levels than those fed exclusively with a milk formula (mean ± SEM 48.2 ± 9.5 μg/L vs. 25.4 ± 4.4 μg/L, p < 0.05). IGF‐I and IGFBP‐3 were correlated between themselves and with energy and protein intake. Multiple regression analysis confirmed that energy intake and serum IGFBP‐3 levels were the most predictable variables with regard to IGF‐I levels at neonatal period.

Conclusions:

These feedings suggest that IGF‐I levels during the neonatal periods are influenced by the maturity stage of the newborn, energy intake, and the type of lactation.
Five‐Year Follow‐Up of High‐Risk Infants with Family History of Allergy Who Were Exclusively Breast‐Fed or Fed Partial Whey Hydrolysate, Soy, and Conventional Cow's Milk Formulas
Authors: Chandra Ranjit Kumar
Published: February 2024

Background:

Allergy is a common cause of illness. The effect of feeding different infant formulas on the incidence of atopic disease and food allergy was assessed in a prospective randomized double‐blind study of high‐risk infants with a family history of atopy.

Methods:

216 high‐risk infants whose mothers had elected not to breast‐feed were randomized to receive exclusively a partial whey hydrolysate formula or a conventional cow's milk formula or a soy formula until 6 months of age. Seventy‐two high risk infants breast‐fed for ≥ 4 months were also studied.

Results:

Follow‐up until 5 years of age showed a significant lowering in the cumulative incidence of atopic disease in the breast‐fed (odds ratio 0.422 [0.200‐0.891]) and the whey hydrolysate (odds ratio 0.322 [0.159‐0.653) groups, compared with the conventional cow's milk group. Soy formula was not effective (odds ratio 0.759 [0.384‐1.501]). The occurrence of both eczema and asthma was lowest in the breast‐fed and whey hydrolysate groups and was comparable in the cow's milk and soy groups. Similar significant differences were noted in the 18‐60 month period prevalence of eczema and asthma. Eczema was less severe in the whey hydrolysate group compared with the other groups. Double‐blind placebo‐controlled food challenges showed a lower prevalence of food allergy in the whey hydrolysate group compared with the other formula groups.

Conclusions:

Exclusive breast‐feeding or feeding with a partial whey hydrolysate formula is associated with lower incidence of atopic disease and food allergy. This is a cost‐effective approach to the prevention of allergic disease in children.
Lactobacillus reuteri as a Therapeutic Agent in Acute Diarrhea in Young Children
Authors: Shornikova Aino‐Vieno , Casas Ivan A. , Isolauri Erika , Mykkänen Hannu , Vesikari Timo
Published: February 2024

Background:

Certain strains of lactobacilli may promote recovery from acute diarrhea. Lactobacillus reuteri is of human origin and is a natural colonizer of gastrointestinal tract. In this trial, exogenously administered L. reuteri was studied as a therapeutic agent in acute diarrhea.

Methods:

Forty patients between 6 and 36 months of age hospitalized with acute diarrhea (75% rotavirus) were studied. After parental consent, the patients were randomized to one of two treatment groups to receive either 1010 to 1011 colony‐forming units of L. reuteri or a matching placebo daily for the length of hospitalization or up to 5 days. The clinical outcome of diarrhea and colonization of L. reuteri were evaluated.

Results:

The mean (SD) duration of watery diarrhea after treatment was 1.7 (1.6) days in the L. reuteri group and 2.9 (2.3) days in the placebo group (p = 0.07). On the second day of treatment only 26% of patients receiving L. reuteri had watery diarrhea, compared with 81% of those receving placebo (p = 0.0005). Cultures of lactobacilli from stool samples demonstrated that administration of L. reuteri resulted in colonization of the gastrointestinal tract. Lactobacillus reuteri accounted for >75% of the total lactobacilli found in children fed with this product.

Conclusions:

Lactobacillus reuteri is effective as a therapeutic agent in acute rotavirus diarrhea in children. Further studies are warranted to confirm the present finding and to explore the full therapeutic potential of L. reuteri in acute viral diarrhea.
The Estimated Incidence of Cystic Fibrosis in Japan
Authors: Yamashiro Y. , Shimizu T. , Oguchi S. , Shioya T. , Nagata S. , Ohtsuka Y.
Published: February 2024

Background:

It is believed that the incidence of cystic fibrosis (CF) among Asiatic races, including the Japanese, is very rare. This epidemiological study was carried out to investigate the incidence of CF in Japan.

Methods:

We collected literature describing CF cases among pure Japanese and found 124 cases reported as CF during the 43 years from 1951, when the first case was reported, to 1993. Only 104 cases (57 male and 47 female patients) of 124 cases met our diagnostic criteria.

Results:

A simple calculation based on the number of reported CF cases and of live births after 1980 suggested that the incidence of CF is about 1 in 350,000 in the Japanese population. Twenty‐nine (27.9% of the total) of 30 patients diagnosed in the neonatal period presented symptoms of meconium ileus, an incidence higher than that reported for the white population.

Conclusions:

Our study results suggest that the incidence of CF in the Japanese population is even rarer than had been estimated before and that there is a genetic difference between northern European and Japanese populations.
Gastric Emptying Time is Faster in Cystic Fibrosis
Authors: Collins Clare E. , Francis J. Lynn , Thomas P. , Henry Richard L. , O'Loughlin Edward V.
Published: February 2024

Background:

The high energy requirements in cystic fibrosis (CF) increase the likelihood of malnutrition. Delayed mouth‐to‐cecum transit times have been reported and raise the possibility that abnormalities of gastric function in CF contribute to reduced food intake. The aims of this project were to document solid‐phase gastric emptying times in young people with CF and age‐ and sex‐matched healthy controls, and to investigate whether delayed gastric emptying contributes to suboptimal energy intakes.

Methods:

Nineteen subjects with CF, mean age 12.6 years (11 girls and 8 boys), and 17 control subjects, mean age 12.8 years (9 girls and 8 boys), were studied. Energy intake was assessed by means of a 4‐day weighed food record. Fecal fat excretion was determined from a 3‐day stool collection. Gastric emptying was assessed with a standard test meal of pancakes labeled with 99mTc‐macroalbumin aggregates. The half emptying time of solids from the stomach was recorded.

Results:

The mean solid‐phase gastric emptying time was significantly faster in the CF subjects compared with normal, healthy, age‐ and sex‐matched control subjects (53 min vs. 72.2 min, p<0.05). Energy intakes, measured as the percentage of the recommended energy intake for age and sex, were greater in the CF subjects than in the control subjects (115% vs. 89%, p<0.01), whereas the mean% FFE for the CF subjects was 9.9%. CF subjects with longer gastric emptying times also had lower relative energy intakes (r = ‐0.50, p<0.05).

Conclusion:

Gastric emptying time in healthy subjects with CF is rapid. Faster solid‐phase gastric emptying times may be secondary to high‐fat, high‐energy intakes and may represent a survival advantage.
Nonsyndromic Paucity of Interlobular Bile Ducts: Clinical and Laboratory Findings of 10 Cases
Authors: Koçak Nurten , Gürakan Figen , Yüce Aysel , Çağlar Melda , Kale Gülsev , Göğüş Safiye
Published: February 2024

Background:

Reports concerning nonsyndromic paucity of the interlobular bile ducts are not common.

Methods:

The clinical, biochemical, and histological features of ten such children were described.

Results:

All presented with jaundice, starting in the first month in seven and in the fourth, seventeenth, and thirtieth month in the others. Acholic stools were present intermittently in seven and persistently in three patients. Pruritus was a prominent symptom in five. Liver function tests were abnormal in all but one. Liver biopsies were performed at ages of 20 days to 3 years (median 5 months). In addition to a paucity of interlobular bile ducts, histology revealed intracellular cholestasis in all, portal fibrosis in four, and regenerative nodules in two patients. Complications of fat‐soluble vitamin deficiency occurred in seven. Therapy consisted of supplementation of those vitamins and administration of cholestyramine, phenobarbital, prednisolone, or ursodeoxycholic acid. While one child had a successful orthotopic liver transplantation, three died. Consanguinity rate was 80% among the parents, and five of the patients had siblings with similar symptoms.

Conclusions:

Prognosis of these patients is variable. Differentiation from other forms of cholestasis is important especially to avoid surgery.
Endoscopic Sclerotherapy for Esophageal Varices in Children with Extrahepatic Portal Venous Obstruction: A Follow‐Up Study
Authors: Yachha S. K. , Sharma B. C. , Kumar M. , Khanduri A.
Published: February 2024

Background:

Results of treatment with endoscopic sclerotherapy for esophageal varices in children extrahepatic portal venous obstruction are limited.

Methods:

A prospective study was undertaken of fifty children (mean age, 7.4 ± 3.8 years; range, 4 months to 14 years) with esophageal variceal bleeding caused by extrahepatic portal venous obstruction (EHPVO) treated by repeated intravariceal endoscopic sclerotherapy (EST) at intervals of 2‐3 weeks until eradication (no varices on endoscopy).

Results:

Eradication of varices was achieved in 44 children (88%) with a mean of eight sessions per child. In six other cases, variceal grade decreased by 50% from the initial grades. Bleeding episodes at presentation were controlled in all of the children with first ET>. Over a mean follow‐up period of 19 months (range, 12‐36 months), a total of 15 episodes of rebleeding occurred in 13 children (26%) before the third session of EST and all were controlled with EST. Risk of rebleeding in children with eradicated varices (n = 44) significantly decreased from 0.2 episodes per month to nil after eradication. None of the children without eradicated varices had rebleeding. Thus, EST was successful in controlling rebleeding in all of the cases. Recurrence of varices was observed in five children (10%). None of our children either required surgery for EST failure or died.

Conclusions:

EST is a safe and effective nonsurgical mode of therapy in controlling esophageal variceal bleeding in children with EHPVO. Significant variceal bleeding did not occur during the relatively short follow‐up in this series.
Colonoscopy or Sigmoidoscopy as the Initial Evaluation of Pediatric Patients with Colitis: A Survey of Physician Behavior and a Cost Analysis
Authors: Deutsch David E. , Olson Allan D.
Published: February 2024

Background:

Pediatric patients presenting with colitis, suggestive of inflammatory bowel disease, undergo evaluation with either flexible sigmoidoscopy or colonoscopy. Our objectives were to assess current practice behavior in the evaluation of pediatric patients with colitis and to determine whether flexible sigmoidoscopy or colonoscopy was more cost‐effective as the initial evaluation.

Methods:

Practice behavior and procedure charges were assessed using a nationwide survey, and costs for diagnostic strategies were compared using a decision analysis program.

Results:

The vast majority of survey respondents would proceed with colonoscopy if colitis suggestive of Crohn's disease was noted in the rectosigmoid area (81%) or if ulcerative colitis extended proximal to the rectosigmoid area (70%). If colonoscopy would follow if flexible sigmoidoscopy suggested either ulcerative colitis or Crohn's disease (67%), then colonoscopy would result in a savings of 23%. If the evaluation was predetermined to be limited to flexible sigmoidoscopy (16%), then flexible sigmoidoscopy was the cost‐effective strategy with savings of 29%. If colonoscopy would follow flexible sigmoidoscopy for Crohn's colitis only (13%), there was no clear cost advantage.

Conclusions:

The most cost‐effective strategy depends on the physician's need to know the disease location. Our survey results indicate that most physicians chose to establish the extent of disease in both ulcerative colitis and in Crohn's disease; thus initial colonoscopy would be the more cost‐effective strategy. When knowledge of disease distribution is not essential for patient care, flexible sigmoidoscopy can lead to substantial cost savings.
NADPH‐Diaphorase in Antral Gastritis of Childhood
Authors: Sbarbati Andrea , Bertini Marina , Peng Ze‐Chun , Tonolli Elisabetta , Osculati Francesco
Published: February 2024

Background:

Nitric oxide has an important role in the pathophysiology of the gastric mucosa. However, to date, it is not clear if nitric oxide plays a cytoprotective or cytotoxic role in the pathogenesis of mucosal lesion.

Methods:

We have used the NADPH‐diaphorase histochemistry that selectively stains cells containing nitric oxide synthase, the enzyme that catalyzes the production of nitric oxide on the antral gastric mucosa of children with antral gastritis.

Results:

In the lamina propria of the mucosa, the presence of the enzymatic activity was found in perivascular round cells and nerve fibers. In the epithelium, focal positivity to NADPH‐diaphorase was found in superficial cells, mainly located in the extrusive zones. The epithelial cells in the pits and glands were negative, in the mucous layer, Helicobacter pylori were also stained by NADPH‐diaphorase. A single H. pylori‐infected child who was also examined after eradication of the H. pylori showed during the control examination absence of microorganisms and reduction of the NADPH‐diaphorase‐positive cells in the mucosa.

Conclusions:

Our results demonstrate that, in gastric mucosa, endogenous and exogenous structures express a NADPH‐diaphorase activity.
Small Bowel and Fecal Microbiology in Children Suffering from Persistent Diarrhea in Bangladesh
Authors: Bardhan Pradip K. , Albert M. John , Alam Nur H. , Faruque Shah M. , Neogi Prodyot K. B. , Mahalanabis Dilip
Published: February 2024

Background:

The etiology of persistent diarrhea in children is multifactorial. The objective of the current study was to ascertain the role of microorganisms in the etiology and pathogenesis of persistent diarrhea in a group of children in Bangladesh.

Methods:

Enteric pathogens and total aerobic microflora were studied in the duodenal aspirates of 100 children with persistent diarrhea and compared with those in aspirates of 30 children with acute diarrhea, and those in aspirates of 15 healthy control children. The enteric pathogens in the stools of these children and in stools of an additional 38 patients with persistent diarrhea and 12 with acute diarrhea were also studied.

Results:

Approximately two thirds of the patients with acute diarrhea and persistent diarrhea, and half of the control subjects had more than 105 organisms per milliliter of duodenal fluid. Significantly, more patients with persistent diarrhea had a greater variety of flora than did patients with acute diarrhea and control subjects. The predominant organisms in patients with acute diarrhea and in those with persistent diarrhea were Gram‐negative rods, whereas those in control subjects were Gram‐positive cocci. Significantly more acute diarrhea patients and persistent diarrhea patients had enteric pathogens isolated from stool than did control subjects. DiarrheagenicEscherichia coli, as a whole, were present in significantly more persistent diarrhea patients than in acute diarrhea patients and control subjects. Among diarrheagenic E. coli, enteroaggregative E. coli were significantly associated only with persistent diarrhea. Other organisms significantly associated with persistent diarrhea wereAeromonas spp. and Klebsiella spp. Some patients in the acute diarrhea and the persistent diarrhea groups had the same pathogens isolated from both the duodenal fluid and stool.

Conclusions:

In accordance with results of other studies, an association between enteroaggregative E. coli and persistent diarrhea was found in the present study. This suggests that therapy directed against enteroaggregativeE. coli can be evaluated for management of some cases of persistent diarrhea.
Dientamoeba fragilis Masquerading as Allergic Colitis
Authors: Cuffari Carmello , Oligny Luc , Seidman Ernest G.
Published: February 2024

Background:

Dientamoeba fragilis is a rare cause of chronic infectious diarrhea and colitis in children.

Methods:

Review of the clinical manifestations, diagnostic methods, and clinical course of D. fragilis infection in our hospital.

Results:

Eleven pediatric patients are discussed, seven of whom had a history of recent travel. Clinical manifestations of infectious diarrhea included anorexia, intermittent vomiting, abdominal pain, and diarrhea, ranging from 1 to 100 weeks in duration. Peripheral eosinophilia was present in seven patients. One patient with well‐documented bovine protein allergy had intermittent episodes of diarrhea and abdominal pain, despite an appropriate elimination diet. Eosinophilic colitis documented by colonoscopy, was due toD. fragilis. Metronidazole was effective in treating five patients, and iodoquinol was effective in treating four others.

Conclusions:

D. fragilis should be included in the differential diagnosis of chronic diarrhea and eosinophilic colitis. The identification of this pathogen requires clinical awareness of epidemiologic risk factors and presenting complaints, as well as the laboratory staining procedures essential to its proper identification.
Addition of Rice Cereal to Formula Does Not Impair Mineral Bioavailability
Authors: Lifschitz Carlos H. , Abrams Steven A.
Published: February 2024

Background:

The effect of adding rice cereal to formula on calcium and iron bioavailability was studied.

Methods:

Fourteen healthy infants were studied at 2‐week intervals to assess the absorption of calcium and iron from formula or formula mixed with rice cereal. Infants were randomly assigned to initiate the study either on a lactose‐containing formula (F) or the same formula mixed with 6.5 g/dl of rice cereal (F + R). Calcium and iron absorption were determined using a multiple tracer approach in which calcium and iron isotopes were given orally mixed with either F or F + R and a different tracer of calcium given intravenously. Nine infants underwent calcium and iron studies and five underwent calcium studies only. A tracer amount of 46Ca was administered intravenously. Calcium absorption was determined as the ratio of the recovered oral versus intravenous tracer in the urine during the 24 hr after tracer administration. Iron incorporation into red blood cells (RBCs) was determined from the enrichment of the iron isotopes in the RBCs at 14 days after dosing.

Results:

Mean (±SD) percent absorption of calcium from F was 58% (±13) and from F + R 57% (±18). Absorption of iron from F was 5.8%(±7) and from F + R 6.3% (±4) (p = 0.06). Analyses of variance for repeated measures indicated no significant correlation between amount of calories, calcium, or iron ingested, and calcium or iron absorbed.

Conclusions:

Adding rice cereal to formula does not impair bioavailability of calcium or iron from infant formulas. Because of the increased total calcium and iron in the mixture of formula and cereal, the overall amount of minerals absorbed from F + R may be greater than from formula alone.
Pediatric Duodenal Biopsies: Mucosal Morphology and Glycohydrolase Expression Do Not Change Along the Duodenum
Authors: Van Berrs Erik H. , Einerhand Alexandra W. C. , Taminiau Jan A. J. M. , Heymans Hugo S. A. , Dekker Jan , Büller Hans A.
Published: February 2024

Background:

Duodenal mucosal biopsies are routinely taken for diagnosis in children with complaints of the upper gastrointestinal tract. Surprisingly, little is known about the usefulness of proximal duodenal versus distal duodenal biopsies for routine diagnostic purposes. This study evaluated the comparability of proximal and distal duodenal biopsies with respect to mucosal morphology as well as glycohydrolase expression as an indicator of intestinal epithelial function.

Methods:

Specimens obtained in duodenal endoscopic biopsies from 64 children, ranging in age from 3 months to 18 years with normal or affected mucosa, were studied. Biopsies were performed in anatomically defined regions in the bulbus duodeni (the very proximal part of the duodenum) and distally of the papilla of Vater (distal of the pancreatic duct). Biopsy specimens were paraformaldehyde‐fixed for histologic examination and immunohistochemical evaluation or were homogenized to isolate RNA. Crypt/villus morphology was assessed as is routinely determined by pathologists. In addition, several aspects of lactase and sucrase‐isomaltase expression as paradigms of intestinal brush border enzymes were assessed: localization at the cellular level, semiquantitative immunohistochemistry, and quantitative measurement of the messenger RNA levels of the respective brush border glycohydrolases.

Results:

As anticipated, there was a wide interpatient variation in mucosal morphology and expression of lactase and sucrase‐isomaltase. Nonetheless, the consistent finding was that in each patient, measurements of morphology and lactase and sucrase‐isomaltase gene expression were very similar between samples obtained in the proximal and distal biopsies.

Conclusions:

Biopsies performed in either location in the duodenum are equally suitable for diagnostic workup of patients suspected of mucosal abnormalities affecting morphology or small intestinal brush border glycohydrolase activities.
Discrepancies Between Males and Females with Cystic Fibrosis in Dietary Intake and Pancreatic Enzyme Use
Authors: Collins Clare E. , O'Loughlin Edward V. , Henry Richard
Published: February 2024

Background:

Length of survival of females with cystic fibrosis is worse than it is in males. Results of current research have shown an important correlation among dietary intake, nutritional status, lung function, and survival. The purpose of this study was to explore gender differences in dietary intake and pancreatic enzyme replacement therapy in males and females with cystic fibrosis.

Methods:

The study was a cross‐sectional measurement of clinical characteristics, energy, and fat intakes in males and females attending the cystic fibrosis outpatients clinics of the John Hunter Hospital, Newcastle, Australia. Twenty‐nine subjects, (17 females and 12 males), completed 4‐day weighed food records to measure total energy intake and the contribution of macronutrients and to document use of pancreatic enzyme replacement therapy. Energy intake was assessed as the percentage of the recommended energy intake for age and sex.

Results:

Females with cystic fibrosis had significantly lower energy and fat intakes than males, whereas the females used significantly more pancreatic enzyme replacement therapy. There were no significant differences in clinical characteristics between groups.

Conclusion:

The results support the possibility that gender differences in the energy and fat intakes of older patients may contribute to differential median survival time of males and females with cystic fibrosis.
Glutathione Peroxidase is Not a Functional Marker of Selenium Status in the Neonatal Period
Authors: Daniels Lynne A. , Gibson Robert A. , Simmer Karen
Published: February 2024

Background:

The antioxidant enzyme glutathione peroxidase is a selenoprotein that, in adults with low selenium intakes, has a strong linear relationship with blood selenium and hence is used as a functional indicator of selenium status. Our aim was to evaluate glutathione peroxidase as a functional marker of selenium status in preterm infants.

Methods:

Erythrocyte glutathione peroxidase activity and plasma and erythrocyte selenium were measured between days 1‐5 and then weekly until discharge in 63 preterm infants with mean ± standard error birth weight and gestation of 1572 ± 60g and 30.7 ± 0.3 weeks. A healthy reference group of term infants (n = 46) was assessed at day 5 and at 6 weeks.

Results:

In preterm infants, over the first 3 months, the association of glutathione peroxidase activity with erythrocyte selenium was weak and inconsistent and nonexistent with selenium intake or plasma selenium. No correlations between any of these indicators were evident for term infants. In preterm infants, plasma and erythrocyte selenium declined over the first 6 weeks (p< 0.01), while glutathione peroxidase activity increased (p < 0.05). In term infants, plasma selenium increased (p < 0.001), but there was no change in erythrocyte selenium or glutathione peroxidase activity. For preterm infants, glutathione peroxidase activities at weeks 4 and 6 were associated with maximum inspired oxygen concentration, ventilator pressure, and days of ventialtion.

Conclusions:

This data is consistent with animal and in vitro evidence that glutathione peroxidase may be confounded by oxygen. We conclude that erythrocyte glutathione peroxidase activity is not a reliable functional marker of preterm selenium status in the neonatal period.
Gastroesophageal Reflux and Nissen Fundoplication Following Percutaneous Endoscopic Gastrostomy in Children
Authors: Sulaeman Eva , Udall John N. , Brown Raynorda F. , Mannick Elizabeth E. , Loe William A. , Hill Charles B. , Schmidt‐Sommerfeld Eberhard
Published: February 2024

Background:

Abnormal gastroesophageal reflux after percutaneous endoscopic gastrostomy is a serious problem in neurologically impaired children. Protective fundoplication has been advocated. Whether esophageal pH monitoring before percutaneous endoscopic gastrostomy will predict later problems with gastroesophageal reflux is unclear.

Methods:

Eighty‐five mostly neurologically impaired pediatric patients who underwent percutaneous endoscopic gastrostomy were studied retrospectively regarding complications, success of nutritional rehabilitation, and the incidence of pathologic gastroesophageal reflux. Follow‐up period was 1 to 4 years. Twenty‐four‐hour esophageal pH monitoring was performed in 46 patients before percutaneous endoscopic gastrostomy.

Results:

There were no deaths. Two major complications occurred that required surgical intervention, and 14 minor complications occurred related to the procedure. Z‐scores for weight increased significantly after percutaneous endoscopic gastrostomy. pH probe results were normal in 22 patients (group 1). Five required medical treatment for gastroesophageal reflux after percutaneous endoscopic gastrostomy, but only 1 (5%) later required Nissen fundoplication. pH probe results were abnormal in 24 patients (group 2). Nineteen required medical therapy for gastroesophageal reflux, and 7 (29%) later needed fundoplication (p < 0.05, incidence of fundoplication group 1 vs. group 2). Improvement in z‐scores was similar in patients requiring and not requiring fundoplication.

Conclusions:

Percutaneous endoscopic gastrostomy is a safe and effective technique for long‐term nutritional support in children. Abnormal gastroesophageal reflux is common. Normal findings in an esophageal pH study before percutaneous endoscopic gastrostomy may be predictive of a favourable outcome with respect to gastroesophageal reflux. This is in contrast to patients with abnormal results in pH studies before percutaneous endoscopic gastrostomy of whom a relatively large percentage may later require fundoplication. Improved nutritional status after percutaneous endoscopic gastrostomy does not appear to have an impact on the severity of gastroesophageal reflux.
Lipid Digestion in Cystic Fibrosis: Comparison of Conventional and High‐Lipase Enzyme Therapy Using the Mixed‐Triglyceride Breath Test
Authors: De Boeck Kris , Delbeke Inge , Eggermont Ephrem , Veereman‐Wauters Genevieve , Ghoos Yvo
Published: February 2024

Background:

Fat maldigestion occurs in most patients with cystic fibrosis. Conventional pancreatic enzyme replacement therapy partially corrects this defect. In this study, the mixed‐triglyceride breath test was used to evaluate whether high‐lipase enzymes are equivalent to conventional enzymes in improving fat maldigestion in children with cystic fibrosis.

Methods:

Fat digestion was studied in 11 patients with a mean age of 10.5 years. The mean intake of conventional enzyme capsules a day was 19. Four 13C mixed‐triglyceride tests were performed on separate days and in random order. One test was taken without enzyme substitution, one with three capsules of 8,000 FIP units Creon (pancreatinum, Kali‐chemie Pharma, Hannover, Germany) and one with one capsule of 25,000 FIP units. The fourth test was made with13 C octanoic acid to study gastric emptying time.

Results:

Without enzyme intake, the mean cumulative percentage of 13C dose exhaled after 6 hours was 7.2 ± 3.7%. This increased to 14.4 ± 4% with intake of conventional pancreatinum and to 14.3 ± 5.1% with intake of high‐lipase pancreatinum (p = 0.0008 for both; pairedt‐test). There was no difference between both treatments. Also, the time course of 13C exhalation measured by percentage of13 CO2 exhaled per hour did not differ between enzyme treatments.

Conclusions:

The 13C mixed‐triglyceride test is noninvasive and documents improved lipid digestion with pancreatic enzyme replacement therapy. If the lipase dose is kept constant, results obtained with high‐lipase preparations are equivalent to those obtained with conventional preparations.
Butyrate and Glucose Metabolism in Isolated Colonocytes in the Developing Rat Colon
Authors: Krishnan Selvi , Ramakrishna B. S.
Published: February 2024

Background:

The newborn colon is devoid of microflora, in that bacterial colonization is established after birth. Short chain fatty acids, products of bacterial fermentation, are the major energy source for colonocytes. Because it is not known whether colonocytes in the newborn can metabolize butyrate, this was examined in newborn and infant rat colon.

Methods:

Isolated colonocytes from rats of different perinatal ages were incubated with 14C‐labeled butyrate or glucose in vitro. Complete oxidation was estimated by the production of 14C‐labeled carbon dioxide, whereas intermediate metabolites were measured enzymatically.

Results:

Oxidation of butyrate (in micromoles per hour per milligram of protein) was highest in newborns (5.83 ± 1.76), declining to 1.32 ± 0.28 at day 10 and to 0.34 ± 0.04 in adult rats. Glucose oxidation was also highest at birth (0.39 ± 0.23), with a minor increase at approximately day 20 (weaning period) before decreasing to adult levels (0.05 ± 0). Butyrate oxidation was substantially higher than was glucose oxidation in all age groups. Production of metabolic intermediates paralleled substrate oxidation. Acetoacetate production was 4.35 ± 2.68, 2.07 ± 1.29, and 0.27 ± 0.09 nmol/hr per milligram of protein in newborns, at postnatal day 10, and in adults, respectively. The corresponding values forβ‐hydroxybutyrate were 3.62 ± 3.35, 0.2 ± 0.07, and 0.09± 0.03 nmol/hr per milligram of protein; and L‐lactate production was 0.54 ± 0.52, 0.06 ± 0.04, and 0.02 ± 0 μmol/hr per milligram of protein respectively.

Conclusions:

Neonatal rat colon epithelial cells resemble adult colonocytes in their preference for butyrate as a metabolic substrate, indicating a constitutive expression of this property.
The Effect of Intestinal Permeability on Pancreatic Enzyme‐Induced Enteropathy in the Rat
Authors: Lloyd‐Still John D. , Uhing Michael R. , Arango Valerie , Fusaro Aldo , Kimura Robert E.
Published: February 2024

Background:

Fibrosing colonopathy in cystic fibrosis occurs in children 2 to 7 years old and is associated with excess doses of high and regular strength lipase pancreatic enzymes, given for more than 6 months. A rat model was developed to study the effects of excessive doses of pancreatic enzymes equivalent to those producing fibrosing colonopathy in cystic fibrosis patients.

Methods:

Five groups of animals were studied after administration of different combinations of pancreatic enzymes, oleic acid, and reserpine.

Results:

Pancreatic enzymes alone produced minimal damage to the intestine and none to the liver. Excessive doses of pancreatic enzymes in combination with agents that increased intestinal permeability (oleic acid, reserpine) were associated with intestinal eosinophilia and necrosis of the jejunoileal muscle layer and inflammatory nodules in the liver, which increased with duration of insult.

Conclusions:

Increased intestinal permeability potentiates damage to the intestine caused by excessive pancreatic enzyme dosage. It is a characteristic of cystic fibrosis that may increase vulnerability to fibrosing colonopathy.
Association of Insulin‐Dependent Diabetes Mellitus and Celiac Disease: A Study Based on Serologic Markers
Authors: Vitoria Juan C. , Castaño Luis , Itxaso Rica , Bilbao J. Ramón , Arrieta Arantza , García‐Masdevall María D.
Published: February 2024

Background:

The association of celiac disease and insulin‐dependent diabetes mellitus has been known for some time. In an attempt to clarify this association, the prevalence of celiac disease among diabetic children was determined, and the risk of insulin‐dependent diabetes mellitus was defined in pediatric patients with celiac disease.

Methods:

Ninety‐three children with diabetes were analyzed for the presence of celiac disease‐related markers (antigliadin and antiendomysial antibodies) and characteristic alterations in the intestinal mucosa. In another group, 93 children with celiac disease were screened for pancreatic autoantibodies and pancreatic β‐cell function.

Results:

Among children with insulin‐dependent diabetes mellitus, a 6.45% prevalence of celiac disease was observed, a value significantly higher than that found among healthy controls. In contrast, only three celiac disease patients showed potential autoimmunity toward the pancreatic β cell, a proportion not significantly different from that in the general population. Additionally, no alteration of glucose metabolism was observed in the antibody‐positive patients.

Conclusion:

The increased risk of celiac disease among patients with diabetes requires a long follow‐up to determine the presence of celiac disease markers among patients with diabetes, to avoid potential malignant disease derived from untreated celiac disease. In contrast, there is no evidence to support an increased risk of insulin‐dependent diabetes mellitus among children with celiac disease. In accordance with the accepted influence of diet in the development of autoimmune diabetes, a hypothetical mechanism of protection against insulin‐dependent diabetes mellitus that is mediated by environmental factors related to restricted diet is suggested in this population.
Polyamines in Human and Rat Milk Influence Intestinal Cell Growth In Vitro
Authors: Capano Guglielmo , Bloch Kurt J. , Carter Edward A. , Dascoli Julie A. , Schoenfeld David , Harmatz Paul R.
Published: February 2024

Background:

Polyamines are required for intestinal growth and development. In this study, we examined whether milk can supply the polyamines needed for growth of IEC‐6 cells, a line on non‐transformed rat intestinal crypt cells.

Methods:

Human, bovine, and rat milk, and cow's milk‐based infant formula were studied. Human, bovine, and rat milk were defatted and sterilized by filtration. IEC‐6 cells were stabilized in Dulbecco's modified Eagle's medium(DMEM) containing 0.5% fetal bovine serum, 5 mM L‐glutamine, 100 U/mL penicillin and 100 µg/mL streptomycin for 24 h at 37°C. Thereafter, to initiate active growth, cells were placed in fresh DMEM containing 5% FBS(plus the other ingredients) supplemented with 5% (vol/vol) milk or infant formula. In some experiments, cells were also treated with difluoromethylornithine (2.5 mM) (DFMO), an inhibitor of polyamine synthesis, or dialyzed milk plus DFMO. After 44 hours of culture, cells were pulsed with3 H‐thymidine (3H‐TdR) for 4 hours, harvested and the radioactivity incorporated into DNA was measured.

Results:

Human and rat milk stimulated proliferation of IEC‐6 cells (p < 0.05 compared to controls); addition of DFMO did not reverse the stimulatory effect. Bovine milk and the infant formula did not stimulate proliferation or prevent the growth inhibition induced by DFMO. After dialysis, human milk had less ability to reverse the DFMO inhibition (p < 0.05).

Conclusions:

These experiments suggest that both human and rat milk, but neither bovine milk nor the infant formula, contain sufficient bioactive polyamines to sustain cell growth during inhibition of polyamine synthesis.
Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain
Authors: Opp Joachim , Schürmann Mia , Jenke Andreas , Job Barbara
Published: February 2024

Objectives

Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP.

Methods

Conversation analyses of physician‐patient‐encounters and graphical expression of AP‐based pain were performed.

Results

Twenty‐two interactions were recorded and analyzed. Fifteen children were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life.

Conclusion

Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.
Stable Efficient Dye‐Sensitized Solar Cell Using Waste Polyvinyl Chloride (PVC) Derived Porous Carbon as Counter Electrode
Authors: Singh Longjam Surdash , Kumar Satish , Kumar Sandeep , Kumar Sushant , Yadav Tarun , Singh Pramod K. , Dhapola Pawan Singh
Published: February 2024

At the time, the world critically requires renewable energy. The challenge is figuring out how to meet expanding global energy consumption. Dye‐sensitized solar cells (DSCs) have attracted a lot of interest due to their high energy conversion efficiency, low cost, environmental friendliness, and easy production procedure. First, the study prepares standard cell platinum, which is the most expensive and in low supply. By replacing PVC‐derived porous carbon for expensive platinum in the DSScs counter electrode. The standard efficiency of platinum counter electrode comes out to be 1.94 and efficiency of PVC derived porous carbon electrode comes out to be 0.46.
Improvement of the thalamocortical white matter network in people with stable treated relapsing–remitting multiple sclerosis over time
Authors: Alshehri Abdulaziz , Koussis Nikitas , Al‐iedani Oun , Khormi Ibrahim , Lea Rodney , Ramadan Saadallah , Lechner‐Scott Jeannette
Published: February 2024

Advanced imaging techniques (tractography) enable the mapping of white matter (WM) pathways and the understanding of brain connectivity patterns. We combined tractography with a network‐based approach to examine WM microstructure on a network level in people with relapsing–remitting multiple sclerosis (pw‐RRMS) and healthy controls (HCs) over 2 years. Seventy‐six pw‐RRMS matched with 43 HCs underwent clinical assessments and 3T MRI scans at baseline (BL) and 2‐year follow‐up (2‐YFU). Probabilistic tractography was performed, accounting for the effect of lesions, producing connectomes of 25 million streamlines. Network differences in fibre density across pw‐RRMS and HCs at BL and 2‐YFU were quantified using network‐based statistics (NBS). Longitudinal network differences in fibre density were quantified using NBS in pw‐RRMS, and were tested for correlations with disability, cognition and fatigue scores. Widespread network reductions in fibre density were found in pw‐RRMS compared with HCs at BL in cortical regions, with more reductions detected at 2‐YFU. Pw‐RRMS had reduced fibre density at BL in the thalamocortical network compared to 2‐YFU. This effect appeared after correction for age, was robust across different thresholds, and did not correlate with lesion volume or disease duration. Pw‐RRMS demonstrated a robust and long‐distance improvement in the thalamocortical WM network, regardless of age, disease burden, duration or therapy, suggesting a potential locus of neuroplasticity in MS. This network's role over the disease's lifespan and its potential implications in prognosis and treatment warrants further investigation.
Delay‐adaptive control of first‐order hyperbolic partial integro‐differential equations
Authors: Wang Shanshan , Qi Jie , Krstic Miroslav
Published: February 2024

We develop a delay‐adaptive controller for a class of first‐order hyperbolic partial integro‐differential equations with an unknown input delay. By employing a transport PDE to represent delayed actuator states, the system is transformed into a transport partial differential equation with unknown propagation speed cascaded with a PIDE. A parameter update law is designed using a Lyapunov argument and the infinite‐dimensional backstepping technique to establish global stability results. Subsequently, the effectiveness of the proposed approach was validated through numerical simulations.