bluuebunny/crossref_metadata_2025 huggingface dataset:
Food‐Induced Malabsorption Syndromes
Authors: Savilahti Erkki , Simpson Hugh A. , Anderson John A.
Published: February 2024

A syndrome of chronic diarrhea, vomiting, and failure to thrive was described 35 years ago. The syndrome was caused by damage in the jejunum after ingestion of cow's milk. Symptoms appeared in young infants shortly after introduction of cow's milk formula. Patients had moderate steatorrhea, decreased absorption of D‐xylose, and, often, iron‐deficiency anemia and hypoproteinemia. They had strong IgA and IgG antibodies to cow's milk. IgE antibodies to cow's milk were negative, as a rule. Indicators of cell‐mediated immune reaction to cow's milk proteins were often positive. Patients were tolerant to cow's milk by the age of 3 years. Malabsorption was due to damage to the jejunal mucosa: Varying villus atrophy was associated with inflammation in surface epithelium and lamina propria. The epithelial cell renewal rate increased. Surface epithelial cells decreased in height, with short, furry microvilli and large aggregates of lysozymes. The number of intraepithelial lymphocytes was markedly increased, but normalized during cow's milk elimination. Most of these lymphocytes had α/β T‐cell receptors, and many were cytotoxic. Some specimens had an increase in γ/δ T‐cell receptor‐bearing cells. In the lamina propria, CD4+ cells predominated, and some of them were activated. IgA‐ and IgM‐containing cells were markedly increased during cow's milk exposure, but IgE cells were not abnormal. The density of eosinophils was moderately increased. Secretion of interferon‐γ by cells isolated from patients' intestines was markedly increased. Morphologic and immunologic findings suggest that T‐cell‐mediated reaction to proteins in cow's milk is present in the small intestines of patients with this syndrome and causes this enteropathy.
Dietary Aspects of Food Allergy Prevention in Infants and Children
Authors: Zeiger Robert S. , Simpson Hugh A. , Anderson John A.
Published: February 2024

Food allergy occurs in approximately 4% to 6% of children, has increased in prevalence during the past decade, and thus represents a major burden to our young. The natural history of food allergy documents that allergies to cow's milk, egg, and soy frequently remit whereas allergies to peanut, nuts, and fish typically persist to adulthood, although exceptions exist. Food allergen avoidance subsequent to sensitization and manifestation of symptoms appears to hasten tolerance; however, the immunologic mechanism responsible for tolerance to one food group and not another is poorly understood. Identification and characterization of allergens and determination of B‐ and T‐cell epitopes has provided an opportunity to better define these mechanisms. Identifying and developing effective strategies to prevent food and other allergic diseases represents a high priority for medicine at this time because of the unbridled increase in the prevalence and morbidity attributed to them. Immunologic engineering holds the greatest promise for allergy prevention in the not too distant future, but environmental strategies that promote food avoidance provide an avenue for prevention at present. Such efforts rely actively on reducing the food allergenic load and exposure of atopy‐prone infants and children.
Toxaphenes and Chlorinated Naphthalenes in Adipose Tissue of Children
Authors: Witt K. , Niessen K. H.
Published: February 2024

Background:

Chlorinated hydrocarbons are ingested by humans in food and accumulate in adipose tissue. At the University Kinderklinik, Mannheim, previously unknown substances have been found in children (e.g., the pesticide toxaphene and chlorinated naphthalenes). These substances have been widely used for industrial purposes in the past. Samples from West and East Germany; Saratov, Russia; and Almaty, Kazakhstan were examined to determine whether these substances are ubiquitous.

Methods:

After Soxhlet extraction, the extracts were cleaned up using a liquid chromatographic technique. Measurement was performed by gas chromatography–mass spectrometry using negative chemical ionization in the single‐ion–monitoring mode.

Result:

In specimens from all cities, toxaphene congeners Parlar 26 and Parlar 50 and six chlorinated naphthalenes were traced. Highest median load of toxaphene was 1.97 μg/kg for Parlar 26 and 2.36 μg/kg for Parlar 50 in Stralsund, East Germany. For chlorinated naphthalenes, the median was highest in Mannheim, West Germany, with 12.0 μg/kg.

Conclusion:

These findings show that monitoring these toxic substances remains necessary. Even though the use and as a consequence the amount of chlorinated hydrocarbons were reduced, these substances have by no means disappeared from the environment.
Long‐term Outcome of Chronic Hepatitis B in Adolescents or Young Adults in Follow‐up From Childhood
Authors: Fujisawa Tomoo , Komatsu Haruki , Inui Ayano , Sogo Tsuyoshi , Miyagawa Yoshihiro , Fujitsuka Satoshi , Sekine Isao , Kosugi Takeshi , Inui Michio
Published: February 2024

Background:

It has not yet been defined whether children with chronic hepatitis B are likely to develop severe liver disease in the future. The purpose of this study was to evaluate the evolution of chronic hepatitis B acquired in childhood.

Method:

Fifty‐two children in the age range of 0 to 15 years who were positive for hepatitis B surface antigen and hepatitis B e antigen in serum for at least 6 months were enrolled in this study. In the majority of the 52 children, hepatitis B virus infection was acquired by perinatal transmission. All 52 showed abnormal liver function test findings for more than 6 months before enrollment, and the subjects were followed up longitudinally for 3 to 22 years (mean, 11 years). They are now more than 15 years of age (15–27 years old).

Results:

During the follow‐up period, 26 (50%) children had spontaneous seroconversion to anti‐hepatitis B e. Serum levels of alanine aminotransferase normalized in these 26 children. In one child of these children, hepatocellular carcinoma developed at the age of 21 years, 16 years after seroconversion, although his liver function profiles remained normal. The other 26 children remained hepatitis B e antigen positive, most with unchanged biochemical features. Sixteen (62%) children among these 26 children were treated with interferon‐α. Eleven (69%) children had seroconversion to anti‐hepatitis B e within the first year after the cessation of therapy. Hepatocellular carcinoma developed in 1 of these 11 children at the age of 16 years, 6 years after interferon therapy. Thus, hepatocellular carcinoma developed in two children in an anti‐hepatitis B e positive phase.

Conclusion:

All children carrying hepatitis B surface antigen should be observed carefully to monitor the possible development of hepatocellular carcinoma, especially in the anti‐hepatitis B e–positive phase after spontaneous seroconversion or even after interferon treatment.
Parietal Cell Antibodies and Helicobacter pylori in Children
Authors: Kolho Kaija–Leena , Jusufovic Jasminka , Miettinen Aaro , Savilahti Erkki , Rautelin Hilpi
Published: February 2024

Background:

Gastric autoantibodies are common in Helicobacter pylori–infected adults, and the presence of these antibodies is associated with atrophic gastritis. The role of H. pylori in the autoimmune type of atrophic gastritis is unresolved, and it is not known at what stage the autoantibodies appear in serum during H. pylori infection. Therefore, we screened children with and without H. pylori infection for gastric parietal cell antibodies.

Methods:

Seventy‐one children with H. pylori infection verified by examination of gastric biopsy specimens (mean age, 9.4 years), 8 children with positive serology but negative histology for H. pylori (mean age, 11.6 years), and 130 children with negative serology for H. pylori (mean age, 7.7 years) were screened for the presence of gastric parietal cell antibodies in serum by indirect immunofluorescence. In addition, 61 children with celiac disease (mean age, 7.1 years) were screened for gastric parietal cell antibodies and H. pylori antibodies.

Results:

None of the children with H. pylori infection had gastric parietal cell antibodies in serum. Only three positive parietal cell antibody reactions were found: a 14‐year‐old boy with positive serology for H. pylori but no other signs of infection (titer 5000), a 14‐year‐old girl with tuberculosis (titer 1250, seronegative for H. pylori) and a 10‐year‐old girl with insulin‐dependent diabetes mellitus (titer 6250, seronegative for H. pylori).

Conclusions:

Although gastric autoantibodies are often found in adults with chronic H. pylori gastritis, it seems that H. pylori–infected children are not positive for gastric parietal cell antibodies. It remains to be studied in which H. pylori infections and at what stages gastric autoantibodies appear.
A Prospective Trial of Lansoprazole Triple Therapy for Pediatric Helicobacter pylori Infection
Authors: Shashidhar Harohalli , Peters John , Lin Chuan‐Hao , Rabah Rajah , Thomas Ronald , Tolia Vasundhara
Published: February 2024

Background:

Triple therapy with a proton‐pump inhibitor and two antibiotics is widely used in the treatment of Helicobacter pylori infection in adults. Experience with such therapy in the pediatric population is limited. This was a prospective, nonrandomized, open‐label trial to evaluate safety and efficacy of a combination of lansoprazole, clarithromycin, and amoxicillin in symptomatic children with H. pylori infection.

Methods:

Children with H. pylori gastritis diagnosed by endoscopy performed for persistent nausea, vomiting, recurrent abdominal pain, and diarrhea with consistent histology were treated with the regimen of 0.45 mg/kg per day lansoprazole divided into two doses (maximum dose, 15 mg twice daily), amoxicillin 40 mg/kg per day in two doses (maximum dose, 1.0 g twice daily), and 250 mg clarithromycin twice daily (<10 years old) or 500 mg twice daily (>10 years old) for 2 weeks. Pre‐and posttreatment endoscopic biopsy specimens were graded for the severity of gastritis and H. pylori density by a blinded pathologist. A questionnaire for assessing the severity of symptoms at the time of initial and second endoscopy were completed by patient and/or parent.

Results:

Thirty‐two children (age range, 1–25 years; mean age, 11 years; 19 females, 13 males) were treated with this regimen during an 18‐month period. H. pylori organisms with varying grades of gastritis were present in tissue specimens of all patients. Only 28 children had follow‐up endoscopy, which showed eradication of H. pylori in 15 (54%) children. Histologic symptoms of gastritis improved after therapy in the whole group. Overall, symptoms of vomiting, abdominal pain, diarrhea, anorexia, and halitosis significantly improved (P < 0.05). Minor adverse effects of therapy occurred in 25% of patients.

Conclusions:

Symptoms, histologic, and endoscopic findings improved after triple therapy in children with H. pylori gastritis; however, eradication of bacteria was achieved in only 56% of children.
Stability of Insulin‐Like Growth Factor I in the Gastrointestinal Lumen in Neonatal Pigs
Authors: Shen Wei‐Hua , Xu Ruo‐Jun
Published: February 2024

Background:

Insulin‐like growth factor (IGF)‐I is present in the milk of various species. A prerequisite for any biological activity of milk‐borne IGF‐I in the suckling young is to survive the gastrointestinal luminal digestion. In the present study, the stability of IGF‐I was examined in the gastrointestinal lumen in neonatal pigs.

Methods:

Iodine‐labeled IGF‐I was incubated in the gastrointestinal luminal fluids of 3‐day‐old suckling and 45‐day‐old weaned pigs at 37°C for 20 minutes. Degradation of the peptide was analyzed by trichloroacetic acid (TCA) precipitation, liquid chromatography, and receptor binding assay.

Results:

IGF‐I remained unchanged in the gastric fluids of suckling and weaned pigs when determined by TCA precipitation. IGF‐I degraded 3%, 18%, and 37% in the luminal fluids of the proximal, mid and distal small intestine in suckling piglets compared with 53%, 62%, and 54% in weaned pigs. The results were supported by the chromatography and receptor binding analysis. Porcine colostrum had a capacity to protect IGF‐I from gastrointestinal luminal digestion in weaned pigs.

Conclusion:

Milk‐borne IGF‐I is stable in the gastrointestinal lumen in suckling pigs and may play a role in regulating postnatal development in the suckling young.
Assessment of Nutritional Status and Body Composition in Children Using Physical Anthropometry and Bioelectrical Impedance: Influence of Diurnal Variations
Authors: Rodríguez Gerardo , Moreno Luis A. , Sarría Antonio , Fleta Jesús , Bueno Manuel
Published: February 2024

Background:

To observe whether there are diurnal variations when assessing children's body composition, using physical anthropometric and bioelectrical impedance (BI) methods.

Methods:

In 32 children (18 females and 14 males) aged between 7.1 and 14.9 years, weight, height, arm circumference (AC), four skinfolds, and total body impedance (Z) were measured at 8 A.M., 12 noon, 4 P.M., and 8 P.M. on the same day. Body mass index (BMI), skinfolds sum (SS), total body water (TBW), fat‐free mass (FFM), and fat mass (FM) were also calculated at these times.

Results:

Height at 8 P.M. was 1.156 ± 0.54 cm less than at 8 A.M. (P < 0.001) and BMI increased 0.434 ± 0.29 kg/m2 at 8 P.M. (P < 0.001). Weight, SS and AC underwent no significant changes in the course of the day. Z was 5.83% less at 8 P.M. than at 8 A.M. (P < 0.001), yielding a TBW and FFM increase at 8 P.M. of 0.855 ± 1.061 and 1.173 ± 1.47 kg, respectively (P < 0.001).

Conclusions:

In children there is a diurnal decrease in height, impedance and FM, and an increase in BMI, TBW, and FFM. These factors must be taken into account when using such methods for assessing nutritional status in childhood.
Risk of Inadequate Bone Mineralization in Diseases Involving Long‐Term Suppression of Dairy Products
Authors: Infante Dámaso , Tormo Ramón
Published: February 2024

Background:

Eighty percent of peak bone mass should be achieved from birth through adolescence. An adequate calcium intake is essential, and it is advisable that 60% of the recommended calcium allowance be dairy calcium. This study was conducted to exaine bone mineral content (BMC) in patients with diseases that usually involve long‐term suppression of dairy products.

Methods:

Thirty patients, aged 2 to 14 years (mean, 7 years), 10 with late‐onset, genetically induced lactose intolerance, 7 with cow's milk protein allergy, 3 with short‐bowel syndrome, and 10 with hypercholesterolemia were involved in the study. They were receiving various dietary regimens for periods longer than 2 years: 14 patients received special formulas for children (lactose‐free cow's milk formula, highly hydrolyzed cow's milk protein formula, soy protein isolate formula), 4 patients received liquid soy beverages, 6 patients received skim milk (1% fat), and 6 patients had exclusion of dairy products. Bone mineral density (BMD) was assessed by dual‐energy x‐ray absorptiometry.

Results:

Nine patients had osteoporosis, 6 had osteopenia, and 15 had results within normal ranges. Overall, the group had a standard deviation score of −1.3 (osteopenia). The statistical correlation between the BMD value and the percentage intake of recommended daily allowance (RDA) of dairy (or substitute) calcium (in milligrams per day) was highly significant (P < 0.0001, r = 0.89).

Conclusions:

All patients with diseases involving total or partial withdrawal from milk products for a prolonged period are a group at potential risk of defective bone mineralization and should be monitored through BMD assessment.
Monitoring of 25‐OH Vitamin D Levels in Children With Cystic Fibrosis
Authors: Grey Vijaylaxmi , Lands Larry , Pall Harpreet , Drury Donna
Published: February 2024

Background:

Patients with cystic fibrosis are at risk for malabsorption of fat‐soluble vitamins, and those with low 25‐OH vitamin D levels have a higher risk of low bone mineral density and long‐term skeletal complications. It is currently recommended that vitamins A and E be monitored yearly; however, no recommendations exist for 25‐OH vitamin D. Because all three vitamins are fat‐soluble, the hypothesis in the current study was that low levels of vitamins A and E could identify patients at risk for low 25‐OH vitamin D, so that 25‐OH vitamin D measurements could be obtained in only selected circumstances.

Methods:

Forty (21 girls) patients with CF, age 10.5 ± 3.9 (SD) years, were assessed in a cross‐sectional survey for ideal weight for height (percentage of predicted), spirometry (percentage of predicted FEV1, 33/40 patients), and serum levels of vitamins A, E, 25‐OH vitamin D, and cholesterol (37/40 patients).

Results:

Nine (22.5%) of 40 patients were malnourished (percentage of predicted ideal weight for height <85%), 7 (21.2%) of 33 had moderate to severe lung disease (FEV1 <60%), 4 (10%) of 40 had low levels of vitamin A, 3 (7.5%) of 40 had low vitamin E levels, 4 (10.8%) of 37 low vitamin E/cholesterol levels, and 4 (10%) of 40 had marginal or low levels of 25‐OH vitamin D (<40 mmol/l). The patients with low 25‐OH vitamin D were older, with no child < 12 years of age having a 25‐OH vitamin D level less than 40 mmol/l. They also had lower vitamin E and vitamin E/cholesterol levels than those with normal 25‐OH vitamin D levels. The groups did not differ in percentage of predicted ideal weight for height, lung function, or vitamin A levels. The best positive predictor for 25‐OH vitamin D less than 40 mmol/l was low vitamin E (66.7%), with a negative predictive value of 94.6%. 25‐OH vitamin D levels correlated with vitamin E/cholesterol levels (r = 0.41, P < 0.01) and weakly with vitamin E levels (r = 0.28, P < 0.08), but not with vitamin A levels.

Conclusions:

These results suggest that children aged less than 12 years and older children with normal vitamin E levels are especially unlikely to have low 25‐OH vitamin D levels, and this measure can therefore be omitted. In contrast, those children with low vitamin E levels may warrant monitoring.
Liver Disease Does Not Affect Lipolysis as Measured With the 13C‐Mixed Triacylglycerol Breath Test in Children With Cystic Fibrosis
Authors: Ling Simon C. , Amarri Sergio , Slater Christine , Hollman Anne S. , Preston Tom , Weaver Lawrence T.
Published: February 2024

Background:

Liver disease associated with cystic fibrosis may not only limit the solubilisation and absorption of the products of fat digestion, but also may depress the activity of pancreatic lipase. The purpose of this study was to measure the effect of liver disease on triacylglycerol lipolysis using the 13C‐mixed triacylglycerol breath test.

Methods:

Forty children with cystic fibrosis took 13C‐mixed triacylglycerol with a standard breakfast and the child's normal pancreatic enzyme replacement therapy. Breath samples were collected before and every 30 minutes after ingestion for 6 hours. The cumulative percentage dose of 13C recovered at 6 hours was calculated from sequential measurements of 13C enrichment of breath CO2, measured by isotope ratio mass spectrometry. Liver abnormalities and portal hypertension were defined by ultrasound scan and clinical examination.

Results:

Twenty‐four children had liver abnormalities, including 5 with portal hypertension. No difference was found between cumulative percentage dose of 13C recovered at 6 hours in 16 children with no liver abnormality (mean, 21.4% ± 11.1%), 19 children with liver abnormalities (22.2% ± 10.0%) and 5 children with portal hypertension (20.9% ± 7.1%).

Conclusion:

Intestinal lipolysis is not reduced in cystic fibrosis liver disease when measured using the 13C mixed triacylglycerol breath test. These findings affirm the test's use as an indirect measure of fat digestion that is not affected by inadequate intraluminal bile salts or liver disease.
Thickening Infant Formula With Digestible and Indigestible Carbohydrate: Availability of Calcium, Iron, and Zinc In Vitro
Authors: Bosscher Douwina , Van Caillie‐Bertrand Micheline , Van Dyck Kristien , Robberecht Harry , Van Cauwenbergh Rudy , Deelstra Hendrik
Published: February 2024

Background:

Regurgitation is common in infants and is usually due to gastroesophageal reflux. Often parental reassurance and dietary management by feeding thickened formulas are the only therapeutic steps necessary. Adding fibers may interfere with the absorption of micronutrients.

Methods:

A continuous‐flow dialysis in vitro method with a preliminary intraluminal digestive phase, modified to simulate the conditions of infants less than 6 months of age and children from 6 months of age on, was used to study the availability of calcium, iron, and zinc from thickened and nonthickened first‐and second‐age infant formulas. Pooled mature human milk was used as the reference standard. The elemental content of the samples and dialysate fractions of calcium, iron, and zinc after digestion was determined by atomic absorption spectrometry.

Results:

In human milk, calcium, iron, and zinc were highly available for absorptive processes. Availability of calcium, iron, and zinc from nonthickened first‐and second‐age infant formulas tends to be significantly better than in the corresponding products thickened with locust bean gum. Thickening infant formulas with pregelatinized rice starch, however, does not affect the availability of calcium, iron, and zinc.

Conclusions:

It appears that human milk provides optimal conditions for the availability of calcium, iron, and zinc. Availability of calcium, iron, and zinc seems to lower when infant formulas are thickened with indigestible carbohydrates, whereas it does not by adding digestible carbohydrates.
Complications of Removing Percutaneous Endoscopic Gastrostomy Tubes in Children
Authors: Kobak Gregory E. , McClenathan Daniel T. , Schurman Scott J.
Published: February 2024

Background:

Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children.

Methods:

The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis.

Results:

Fifty‐four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2‐antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean ± SE of 20.6 ± 3.6 months, range 11–31 months vs. 11.1 ± 1.3 months, range 1–35 months;P < 0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups.

Conclusions:

These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.
Dyspepsia in Children and Adolescents: A Prospective Study
Authors: Hyams Jeffrey S. , Davis Patricia , Sylvester Francisco A. , Zeiter Donna K. , Justinich Christopher J. , Lerer Trudy
Published: February 2024

Background:

Dyspepsia is poorly characterized in the pediatric population. The goal of the current study was to describe the clinical constellation and natural history of dyspepsia in children and adolescents seen in a pediatric gastroenterology practice.

Methods:

A standardized questionnaire was administered by a pediatric gastroenterologist to all subjects 5 or more years of age (and their parents or guardians) treated in a referral pediatric gastroenterology practice for 1 month or more of abdominal pain or discomfort, nausea, or vomiting. Subjects with dyspepsia and dyspepsia subtypes (ulcer‐like, dysmotility‐like) were identified by using previously defined adult criteria. Evaluation and treatment were performed at the discretion of the attending pediatric gastroenterologist.

Results:

During a 1‐year period, 257 patients were screened with 127 subjects fulfilling criteria for dyspepsia (59% girls, 85% white; median age, 11.7 years; median duration of symptoms, 8 months). Symptoms were ulcer‐like in 26% and dysmotility‐like (nausea predominance) in 15% of subjects. In those with dyspepsia, irritable bowel syndrome and gastroesophageal reflux were noted in 24% and 43%, respectively. Esophagogastroduodenoscopy and biopsy were performed in 56 subjects with 21 (38%) having mucosal inflammation (Helicobacter pylori in 5). The remaining 35 subjects (62%) were considered to have functional dyspepsia. Duration of symptoms less than 1 year and vomiting were risk factors for mucosal inflammation. Follow‐up at 6 months to 2 years revealed 70% of subjects were either asymptomatic or much improved regardless of the cause of dyspepsia.

Conclusion:

Most children and adolescents with dyspepsia do not have serious disease. In our referral population H. pylori infection was unusual, and no peptic ulceration was found. Most subjects with functional dyspepsia have improvement of symptoms over time.
Portosystemic Shunting in Children During the Era of Endoscopic Therapy: Improved Postoperative Growth Parameters
Authors: Kato Tomoaki , Romero Rene , Koutouby Raghad , Mittal Naveen K. , Thompson John F. , Schleien Charles L. , Tzakis Andreas G.
Published: February 2024

Background:

Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy.

Methods:

Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997.

Results:

Twelve children (age range, 1–16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow‐up was 35 months (range, 24–48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre‐existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight‐for‐age z score in nine prepubertal patients improved from −1.16 SD to +0.15 SD (P = 0.023), and mean height‐for‐age z score from −1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery.

Conclusions:

Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension.
Transmission of Hepatitis C Virus From Infected Mother to Offspring During Subsequent Pregnancies
Authors: Resti Massimo , Bortolotti Flavia , Azzari Chiara , Giacchino Raffaella , Zancan Lucia , Gussetti Nadia , Vierucci Alberto
Published: February 2024

Background

Several studies have demonstrated that hepatitis C virus (HCV) may be transmitted from mother to offspring. To date, however, little is known about the risk of vertical transmission during subsequent pregnancies. The purpose of this study was to evaluate the risk of vertical HCV transmission in offspring in subsequent pregnancies of HCV infected women.

Methods

In a multicenter study, two groups of index cases were selected. Group 1 included 75 children investigated for HCV infection during prospective studies of vertical transmission. Group 2 included children born to HCV‐infected mothers and found to be HCV infected, independent of studies on vertical transmission. All children in the index cases had one or more siblings. Anti‐HCV, HCV‐RNA (determined by polymerase chain reaction), and HCV genotype were evaluated in all the infected children, their mothers, and siblings.

Results

The results indicate that a mother who has already delivered an HCV‐infected baby is not at greater risk of infecting her second child. Duration of maternal infection does not seem to be a risk factor in offspring infection, because HCV infection is equally distributed among first‐born infants and infants of subsequent births. Because clustering of HCV infection among siblings appeared to be rare in this study, data also indirectly confirm that the risk of horizontal transmission of HCV among siblings is low.

Conclusion

For practical purposes, the current observations indicate that mothers who have already delivered an HCV‐infected child can be advised that this event does not increase the probability of infecting the second child.
Contribution of Villous Atrophy to Reduced Intestinal Maltase in Infants With Malnutrition
Authors: Nichols Buford L. , Nichols Veda N. , Putman Margaret , Avery Stephen E. , Fraley J. Kennard , Quaroni Andrea , Shiner Margot , Sterchi Erwin E. , Carrazza Francisco R.
Published: February 2024

Background

It has been known for many years that small intestinal maltase activities are reduced in malnourished infants and in other patients with villous atrophy. The recent availability of human maltase‐glucoamylase cDNA provides the opportunity to test the hypothesis that villous atrophy accounts for the reduced maltase enzyme activity in malnourished infants.

Methods

Mucosal biopsy specimens obtained for clinical evaluation of malnourished infants with poor responses to refeeding were examined by quantitative methods for enzyme activity and mRNA levels.

Results

Maltase activity and maltase‐glucoamylase mRNA were reduced (approximately 45% of normal). When maltase‐glucoamylase message was normalized to villin message, a structural protein expressed only in enterocytes, a preservation of maltase messages in surviving enterocytes was documented. The luminal glucose transporter–villin message was also preserved.

Conclusions

The loss of maltase‐glucoamylase message paralleled the reduction in villin message and degree of villous atrophy. The reduced maltase‐glucoamylase message also paralleled sucrase‐isomaltase message, previously found to be decreased in proportion to villous atrophy of malnourished infants. The data directly demonstrate, for the first time, that the terminal steps of starch 1‐4 starch digestion and sucrase‐isomaltase 1‐6 starch digestion are decreased in malnourished infants, secondary to villous atrophy. These data in prior and present reports suggest that mechanisms underlying the chronic villous atrophy of malnutrition should be a priority for investigations in malnourished infants with slower than expected weight gain during refeeding.
Evaluation of the Use of Botulinum Toxin in Children With Achalasia
Authors: Hurwitz Melissa , Bahar Ron J. , Ament Marvin E. , Tolia Vasundhara , Molleston Jean , Reinstein L. Julio , Walton J. Mark , Erhart Nora , Wasserman Dror , Justinich Christopher , Vargas Jorge
Published: February 2024

Background

Achalasia is rare in children. Recently, injection of botulinum toxin into the lower esophageal sphincter has been studied as an alternative to esophageal pneumatic dilatation or surgical myotomy as treatment for achalasia. In the current study, the effects of botulinum toxin were investigated in the largest known series of children with achalasia.

Methods

Treatment for achalasia was assessed in 23 pediatric patients who received botulinum toxin from June 1995 through November 1998. Those who continued to receive botulinum toxin and did not subsequently undergo pneumatic dilatation or surgery were considered repeat responders. Results were compared with those of published studies evaluating the use of botulinum toxin in adults with achalasia.

Results

Nineteen patients initially responded to botulinum toxin. Mean duration of effect was 4.2 months ± 4.0 (SD). At the end of the study period, three were repeat responders, three experienced dysphagia but did not receive pneumatic dilatation or surgery, three underwent pneumatic dilatation, eight underwent surgery, three underwent pneumatic dilatation with subsequent surgery, and three awaited surgery. Meta‐analysis shows that, in the current study group, the data point expressing time of follow‐up evaluation versus percentage of patients needing one injection session without additional procedures (botulinum toxin injection, pneumatic dilatation, or surgery) falls within the curve for those in studies on adult patients receiving botulinum toxin for achalasia.

Conclusions

Botulinum toxin effectively initiates the resolution of symptoms associated with achalasia in children. However, one half of patients are expected to need an additional procedure approximately 7 months after one injection session. The authors recommend that botulinum toxin be used only for children with achalasia who are poor candidates for either pneumatic dilatation or surgery.
Milk‐Borne Insulin With Trypsin Inhibitor in Milk Induces Pancreatic Amylase Development at the Onset of Weaning in Rats
Authors: Kinouchi Toshi , Koizumi Kyoko , Kuwata Tamotsu , Yajima Takaji
Published: February 2024

Background

The physiologic significance of milk‐borne hormones and growth factors for internal organs of suckling animals is poorly understood. In this study the significance of milk‐borne insulin was evaluated, as well as its combination with trypsin inhibitor, and its role in the development of pancreatic digestive capacity at the time of weaning was investigated.

Methods

Experiments were performed using insulin‐deficient milk formula (standard formula), insulin (20 ng/ml) formula, or insulin with trypsin inhibitor (1 U/ml) formula by a rat artificial‐rearing technique.

Results

In 17‐day‐old rats administered standard formula, the plasma insulin level was as low as that in 14‐day‐old rats. When insulin‐trypsin inhibitor formula was administered to rat pups, the plasma insulin level was significantly higher than those in rats given standard or insulin formula. In rats artificially reared on standard formula, the usual developmental increases in pancreatic amylase activity and plasma insulin concentration at the beginning of weaning did not occur. Insulin formula elevated the pups' plasma insulin concentration and amylase activity at the onset of weaning but not to the levels observed in mother‐reared rats. In rats reared on insulin‐trypsin inhibitor formula, the developmental increases in the plasma insulin concentration and amylase activity observed in mother‐reared rats were induced.

Conclusions

The present study demonstrates the necessity of milk‐borne insulin for the development of pancreatic amylase during the weaning period.
Effect of Type of Early Infant Feeding on Fatty Acid Composition of Plasma Lipid Classes in Full‐Term Infants During the Second 6 Months of Life
Authors: Decsi Tamás , Kelemen Barbara , Minda Hajnalka , Burus István , Kohn Gerhard
Published: February 2024

Background

Previously, the authors found significantly higher arachidonic and docosahexaenoic acid values in plasma lipids in 2‐month‐old full‐term infants fed human milk than in those receiving formula. This is the report of data obtained in full‐term infants during the second half of the first year of life.

Methods

Healthy, full‐term infants fed human milk (n = 12) or formula without preformed long‐chain polyunsaturated fatty acids (n = 12) were investigated. Fatty acid composition of plasma lipid classes was determined by high‐resolution capillary gas–liquid chromatography.

Results

Linoleic acid acid values in plasma phospholipids (18.5 [3.94] vs. 20.79 [4.34]) and γ‐linolenic acid values in plasma cholesteryl esters (0.17 [0.09] vs. 0.27 [0.20]) and triacylglycerols (0.27 [0.18] vs. 0.46 [0.27]) were significantly (P < 0.05) lower in breast‐fed infants than in those receiving formula. Data are percentage weight by weight shown as median (range from 1st to 3rd quartile) for breast‐fed vs. formula fed infants, respectively. In contrast, arachidonic acid values in plasma phospholipids (10.05 [2.90] vs. 7.03 [1.87];P < 0.01), cholesteryl esters (7.54 [3.58] vs. 4.09 [1.81];P < 0.05), and triacylglycerols (1.28 [0.84] vs. 0.80 [0.39];P < 0.05), as well as docosahexaenoic acid values in plasma phospholipids (1.92 [0.36] vs. 1.02 [0.31];P < 0.001), cholesteryl esters (0.39 [0.13] vs. 0.15 [0.13];P < 0.001), and triacylglycerols (0.17 [0.17] vs. 0.09 [0.04];P < 0.01) were significantly higher in infants fed human milk than in those receiving formula.

Conclusion

Healthy, full‐term infants fed formula without preformed dietary long‐chain polyunsaturated fatty acids are unable to match the arachidonic and docosahexaenoic acid status of breast‐fed infants even during the second half of the first year of life.
Deep Learning Radiomic Analysis of MRI Combined with Clinical Characteristics Diagnoses Placenta Accreta Spectrum and its Subtypes
Authors: Zheng Changye , Zhong Jian , Wang Ya , Cao Kangyang , Zhang Chang , Yue Peiyan , Xu Xiaoyang , Yang Yang , Liu Qinghua , Zou Yujian , Huang Bingsheng
Published: February 2024

Background

Different placenta accreta spectrum (PAS) subtypes pose varying surgical risks to the parturient. Machine learning model has the potential to diagnose PAS disorder.

Purpose

To develop a cascaded deep semantic‐radiomic‐clinical (DRC) model for diagnosing PAS and its subtypes based on T2‐weighted MRI.

Study Type

Retrospective.

Population

361 pregnant women (mean age: 33.10 ± 4.37 years), suspected of PAS, divided into segment training cohort (N = 40), internal training cohort (N = 139), internal testing cohort (N = 60), and external testing cohort (N = 122).

Field Strength/Sequence

Coronal T2‐weighted sequence at 1.5 T and 3.0 T.

Assessment

Clinical characteristics such as history of uterine surgery and the presence of placenta previa, complete placenta previa and dangerous placenta previa were extracted from clinical records. The DRC model (incorporating radiomics, deep semantic features, and clinical characteristics), a cumulative radiological score method performed by radiologists, and other models (including a radiomics and clinical, the clinical, radiomics and deep learning models) were developed for PAS disorder diagnosing (existence of PAS and its subtypes).

Statistical Tests

AUC, ACC, Student's t‐test, the Mann–Whitney U test, chi‐squared test, dice coefficient, intraclass correlation coefficients, least absolute shrinkage and selection operator regression, receiver operating characteristic curve, calibration curve with the Hosmer–Lemeshow test, decision curve analysis, DeLong test, and McNemar test. P < 0.05 indicated a significant difference.

Results

In PAS diagnosis, the DRC‐1 outperformed than other models (AUC = 0.850 and 0.841 in internal and external testing cohorts, respectively). In PAS subtype classification (abnormal adherent placenta and abnormal invasive placenta), DRC‐2 model performed similarly with radiologists (P = 0.773 and 0.579 in the internal testing cohort and P = 0.429 and 0.874 in the external testing cohort, respectively).

Data Conclusion

The DRC model offers efficiency and high diagnostic sensitivity in diagnosis, aiding in surgical planning.

Level of Evidence

3

Technical Efficacy

Stage 2
Stimulation of small phytoplankton drives enhanced sinking particle formation in a subtropical ocean eddy
Authors: Liu Haoran , Browning Thomas J. , Laws Edward A. , Huang Yibin , Wang Lei , Shang Yiwei , Xing Xiaogang , Zhou Kuanbo , Jiang Zong‐Pei , Liu Xin , Huang Bangqin , Dai Minhan
Published: February 2024

Nutrient transfer into the sunlit surface ocean by cyclonic eddies is potentially crucial for sustaining primary productivity in the stratified subtropical gyres. However, the nature of productivity enhancements, including the flow of matter to higher trophic levels and its impact on carbon fluxes, remain poorly resolved. Here, we report a detailed assessment of the biogeochemical response to a cyclonic eddy in the subtropical Northwest Pacific via a combination of ship‐based and autonomous platforms. Primary production was enhanced twofold within the eddy core relative to reference sites outside, whereas phytoplankton biomass even decreased. Pico‐phytoplankton (< 2 μm) dominated (> 80%) both phytoplankton biomass and primary production inside and outside the eddy. The stimulated primary production in the eddy core was accompanied by an approximately twofold increase in mesozooplankton abundance, an approximately threefold increase in particle formation in the deep chlorophyll maximum layer, as well as significantly enhanced surface oceanic CO2 uptake and net community production. We suggest these observations carry important implications for understanding carbon export in the subtropical ocean and highlight the need to include such subtropical eddy features in ocean carbon budget analyses.
Influence of zinc (Zn) powder on the microhardness characteristic and microstructure properties of stainless steel SS304 hybrid joint using low power microwave heating
Authors: Tayier W. , Janasekaran S. , Tai V. C.
Published: February 2024

Microwave hybrid heating (MHH) process is a unique and novel approach of joint materials. Several lightweight materials (medium and high melting point) such as nickel, copper and aluminum have been successfully joined in the past research. However, small dimensions and low melting point of light weight materials such as zinc (Zn) metal or zinc (Zn) powder were always being a challenging mere for creating bond via any joining techniques. The sheets of stainless steel SS304 (17 mm×7.9 mm×0.2 mm) have been fabricated and joined at lap joint by using novel Microwave hybrid heating technique with mini heat chamber of 2.45 GHz of frequency and 200 W–360 W of microwave power, using pure zinc powder (99.9 %) as an interface material. Epoxy rate and exposure time have been varied from 10 % to 20 % and 2 min to 4 min, respectively. A developed heat chamber has been set in domestic microwave oven properly as proposed. To evaluate the microstructure correlation and microhardness at joint interface, the field emission scanning electron microscopy (FESEM – EDS), x‐ray diffraction (XRD) and Vickers hardness were used. For the experimental studies, it had found an excellent bonding was produced at interface layer between the upper and lower sections with good penetration rate of 360 W of microwave power, 4 min of exposure time and 20 % of epoxy rate as the 183.1 HV 0.05 of excellent microhardness and the intermetallic phase of iron‐zinc (FeZn11), nickel‐zinc (NiZn) and nickel‐zinc (NiZn3) were observed at interface layer.
Low‐velocity impact response of 3D carbon fiber reinforced polymer auxetic lattice structures
Authors: Zhang Minglonghai , Li Keda , Ho Mabel Mei Po , Etemadi Ehsan , Hu Hong
Published: February 2024

In this paper, low‐velocity impact properties and impact damage responses of a novel type of 3D hybrid auxetic structures made from carbon fiber‐reinforced polymer (CFRP) laminates were investigated experimentally and numerically. The structures were first fabricated with three different rib's width ratios t1/t0, and then impacted with three different impact energies of 30, 40, and 50 J using a drop tower impact system equipped with a cylindrical impactor. The finite element (FE) models were built in ABAQUS/Explicit, and the Hashin criteria were applied to predict the failure of the structures. The contact force histories, energy histories, displacements, and failure modes were compared between the experiment and FE simulation at all three impact energy levels. The failure morphologies and mechanisms were obtained and studied. The impact testing results suggest that the 3D auxetic structure with a higher t1/t0 ratio can lead to higher peak contact force and sustain higher impact energy. The failure of the structure starts from the middle area and propagates to the upper and lower areas. This research provides a better understanding of the impact responses and failure modes of the 3D auxetic lattice structure, which can promote the potential applications of the auxetic materials.

Highlights

Drop weight low‐velocity impact responses of 3D novel hybrid auxetic lattice structures are investigated through both experiment and finite element simulation.

The effects of structural parameters on the impact performance of the 3D auxetic structures at different impact energy levels are analyzed.

The failure morphologies and mechanisms of the 3D auxetic structures are studied.
Gradual error detection technique for non-destructive assessment of density and tensile strength in fused filament fabrication processes
Authors: Raths Max , Bauer Lukas , Kuettner Andreas , Fischer Samuel , Laumer Tobias
Published: February 2024

Fused filament fabrication (FFF) is a widely used additive manufacturing process for producing functional components and prototypes. The FFF process involves depositing melted material layer-by-layer to build up 3D physical parts. The quality of the final product depends on several factors, including the component density and tensile strength, which are typically determined through destructive testing methods. X-ray microtomography (XCT) can be used to investigate the pore sizes and distribution. These approaches are time-consuming, costly, and wasteful, making it unsuitable for high-volume manufacturing. In this paper, a new method for non-destructive determination of component density and estimation of the tensile strength in FFF processes is proposed. This method involves the use of gradual error detection by sensors and convolutional neural networks. To validate this approach, a series of experiments has been conducted. Component density and tensile strength of the printed specimens with varying extrusion factor were measured using traditional destructive testing methods and XCT. The cumulative error detection method was used to predict the same properties without destroying the specimens. The predicted values were then compared with the measured values, and it was observed that the method accurately predicted the component density and tensile strength of the tested parts. This approach has several advantages over traditional destructive testing methods. The method is faster, cheaper, and more environmentally friendly since it does not require the destruction of the product. Moreover, it facilitates the testing of each individual part instead of assuming the same properties for components from one series. Additionally, it can provide real-time feedback on the quality of the product during the manufacturing process, allowing for adjustments to be made as needed. The advancement of this approach points toward a future trend in non-destructive testing methodologies, potentially revolutionizing quality assurance processes not only for consumer goods but various industries such as electronics or automotive industry. Moreover, its broader applications extend beyond FFF to encompass other additive manufacturing techniques such as selective laser sintering (SLS), or electron beam melting (EBM). A comparison between the old destructive testing methods and this innovative non-destructive approach underscores the possible fundamental change toward more efficient and sustainable manufacturing practices. This approach has the potential to significantly reduce the time and cost associated with traditional destructive testing methods while ensuring the quality of FFF-manufactured products.