bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient Elastography Is a Useful Noninvasive Tool for the Evaluation of Fibrosis in Paediatric Chronic Liver Disease
Authors: Fitzpatrick Emer , Quaglia Alberto , Vimalesvaran Sunitha , Basso Maria Sole , Dhawan Anil 
Published: November 2012

ABSTRACTBackground:Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error, and risks including bleeding. The aim of the present study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort.Methods:Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepatohistopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared with biopsy score.Results:During the study period, 104 children (62 boys) were enrolled (median age 13.6 years). Diagnosis was autoimmune liver disease in 27; nonalcoholic fatty liver disease in 37; posttransplant in 16; hepatitis B/C in 8; Wilson disease in 5; and the remainder, miscellaneous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (≥F2) (P < 0.001), severe fibrosis (≥F3) (P < 0.001), and cirrhosis (F4) (P = 0.003). The area under the receiver operating characteristic curve for the prediction of ≥F2, ≥F3, and F4 using TE was 0.78, 0.79, and 0.96, respectively. TE performed best in children with autoimmune liver disease and in those posttransplant.Conclusions:The present study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus, TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of noninvasively monitoring liver disease progression in children.
Comparison of Diagnostic Methods for Pancreatic Insufficiency in Infants With Cystic Fibrosis
Authors: Tardelli Amanda C.S. , Camargos Paulo A.M. , Penna Francisco J. , Sarkis Pauliane F.B. , Guimarães Elizabet V. 
Published: November 2012

ABSTRACTObjective:The objective of the present study is to compare daily weight gain and laboratory analysis (72‐hour fecal fat and steatocrit) with fecal elastase‐1 (EL‐1) when diagnosing pancreatic insufficiency (PI) in infants with cystic fibrosis (CF).Methods:A total of 39 infants with CF, diagnosed consecutively by newborn screening at 2 referral centers, were included in the study. Daily weight gain and results of laboratory analysis of stool samples were compared using the κ coefficient and the receiver operator characteristic (ROC) curve.Results:Using the criterion of low daily weight gain, the frequency of PI was 92.3%; using the 72‐hour fecal fat, steatocrit, and fecal EL‐1 tests, the frequency was 42.3%, 86.2%, and 84.6%, respectively. EL‐1 was used as the reference test. It was observed that the criteria of low daily weight gain (<50th percentile) and abnormal steatocrit, used together, showed the highest sensitivity (91.3%) and specificity (83.3%) for the diagnosis of PI.Conclusions:When fecal EL‐1 analysis is not immediately available, low daily weight gain associated with abnormal steatocrit can be adopted as a criterion for initiating pancreatic enzyme replacement therapy in infants with CF; however, EL‐1 testing should be performed later for confirmation of PI.
Oral Microbial Profile Discriminates Breast‐fed From Formula‐fed Infants
Authors: Holgerson Pernilla L. , Vestman Nelly R. , Claesson Rolf , Öhman Carina , Domellöf Magnus , Tanner Anne C.R. , Hernell Olle , Johansson Ingegerd 
Published: November 2012

ABSTRACTObjectives:Little is known about the effect of diet on the oral microbiota of infants, although diet is known to affect the gut microbiota. The aims of the present study were to compare the oral microbiota in breast‐fed and formula‐fed infants, and investigate growth inhibition of streptococci by infant‐isolated lactobacilli.Methods:A total of 207 mothers consented to participation of their 3‐month‐old infants. A total of 146 (70.5%) infants were exclusively and 38 (18.4%) partially breast‐fed, and 23 (11.1%) were exclusively formula‐fed. Saliva from all of their infants was cultured for Lactobacillus species, with isolate identifications from 21 infants. Lactobacillus isolates were tested for their ability to suppress Streptococcus mutans and S sanguinis. Oral swabs from 73 infants were analysed by the Human Oral Microbe Identification Microarray (HOMIM) and by quantitative polymerase chain reaction for Lactobacillus gasseri.Results:Lactobacilli were cultured from 27.8% of exclusively and partially breast‐fed infants, but not from formula‐fed infants. The prevalence of 14 HOMIM‐detected taxa, and total salivary lactobacilli counts differed by feeding method. Multivariate modelling of HOMIM‐detected bacteria and possible confounders clustered samples from breast‐fed infants separately from formula‐fed infants. The microbiota of breast‐fed infants differed based on vaginal or C‐section delivery. Isolates of L plantarum, L gasseri, and L vaginalis inhibited growth of the cariogenic S mutans and the commensal S sanguinis: L plantarum >L gasseri >L vaginalis.Conclusions:The microbiota of the mouth differs between 3‐month‐old breast‐fed and formula‐fed infants. Possible mechanisms for microbial differences observed include species suppression by lactobacilli indigenous to breast milk.
Benign Hepatic Nodular Lesions After Treatment for Childhood Cancer
Authors: Masetti R. , Colecchia A. , Rondelli R. , Martoni A. , Vendemini F. , Biagi C. , Prete A. , Festi D. , Lima M. , Pession A. 
Published: November 2012

ABSTRACTBackground:Benign nodular hepatic regenerating lesions such as focal nodular hyperplasia (FNH) have been reported as rare complications of the antineoplastic therapy received during infancy. Little is known about the risk factors associated with the onset of these lesions and their diagnostic management.Methods:We have analyzed a series of benign hepatic nodular lesions occurring in children previously treated for malignant tumors in our institution in a period of 11 years. An extensive description of the imaging presentation of the lesions has been provided to facilitate the differential diagnosis, and a risk factor analysis has been conducted.Results:A total of 14 diagnoses (10 FNH and 4 hemangiomas) of benign nodular hepatic lesions have been found. Hematopoietic stem cell transplantation is the most important statistically independent risk factor associated with the development of these lesions, especially for FNH. No malignant transformation of nodules has been recorded during a median follow‐up time of 4 years.Conclusions:In our experience, FNH is the most frequent benign nodular hepatic lesions occurring after treatment for childhood cancer. Hematopoietic stem cell transplantation is the most important risk factor to be taken in account. After a secure diagnosis of these benign lesions, only a close imaging follow‐up is recommended.
Serum Retinol‐binding Protein 4 Is Independently Associated With Pediatric NAFLD and Fasting Triglyceride Level
Authors: Huang Shu‐Ching , Yang Yao‐Jong 
Published: November 2012

ABSTRACTObjectives:Nonalcoholic fatty liver disease (NAFLD) is identified as a major liver disease in children. The present study aimed to identify the prevalence and predictors of pediatric NAFLD and the correlation between serum retinol‐binding protein 4 (RBP4) levels and metabolic characteristics in children.Methods:A total of 748 schoolchildren, ages 6 to 12 years, were enrolled in 2009. The body weight and height were measured in the morning before intake. Laboratory tests included overnight fasting serum lipids, insulin, liver enzymes, and RBP4 levels. Hepatic steatosis was determined by ultrasound in 219 volunteers.Results:The rates of NAFLD were 3% in the normal‐weight, 25% in the overweight, and 76% in the obese children. Twenty (22%) of obese children had abnormal alanine aminotransferase (ALT) levels. In children with NAFLD, younger age and higher body mass index (BMI), insulin/homeostasis model of assessment, and male sex rate were associated with abnormal liver function. Stepwise increments in BMI, insulin, homeostasis model of assessment, and ALT were found in children with normal livers to simple steatosis, and to steatosis with abnormal ALT. Multiple logistic regression analysis confirmed that serum RBP4 levels (P = 0.048), ALT (P = 0.048), and BMI (P < 0.001) were independently predictors of pediatric NAFLD. Moreover, multiple linear regression analysis revealed that only serum triglycerides levels were positively related to RBP4 levels (P < 0.001).Conclusions:Higher RBP4 and ALT levels as well as BMI are independently associated with pediatric NAFLD in Taiwan. In addition, an increment in RBP4 levels was positively correlated to hypertriglyceridemia in children.
Frequency of Celiac Disease in Attention‐deficit/Hyperactivity Disorder
Authors: Güngör Serdal , Celiloğlu Özgü Suna , Özcan Özlem Özel , Raif Sabiha Güngör , Selimoğlu Mukadder Ayşe 
Published: November 2012

ABSTRACTObjective:Although it is well known that celiac disease (CD) is associated with neurologic disorders, association with psychiatric problems is not well defined. In this report, we aimed to detect CD prevalence in patients with attention‐deficit hyperactivity disorder (ADHD).Methods:A total of 362 patients between the ages 5 and 15 years with the diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM‐IV‐TR) diagnostic criteria and 390 sex‐ and age‐matched healthy children were included in the present study. Serum levels of tissue transglutaminase (tTg) immunoglobulin (Ig) A and IgG were studied in both groups. Serum IgA levels were also studied in patients with positive tTG IgG for the exclusion of selective IgA deficiency. Endoscopic duodenal biopsy was provided in seropositive patients, whose parents approved the procedure. Biopsy samples were evaluated according to Marsh‐Oberhuber classification.Results:tTg IgA was positive in 4 patients with ADHD (1.1%). Endoscopic duodenal biopsy was suggestive of CD in one of them (0.27%). tTg IgA was positive in 3 of control group patients (0.8%). Duodenal biopsy of the only patient from control group, who underwent upper gastrointestinal endoscopy, revealed normal intestinal mucosa.Conclusions:The seropositivity rates for CD were found similar in ADHD and control groups. Thus, neither routine screening for CD nor empirical recommendation of gluten‐free diet seems necessary in children with ADHD.
Conceptual Framework for Health‐related Quality of Life Assessment in Acute Gastroenteritis
Authors: Johnston Bradley C. , Donen Rachel , Pooni Amrita , Pond Julia , Xie Feng , Giglia Lucy , Kam April , Bhamber Amanpaul , Bami Karan , Patel Yashesh , Guyatt Gordon H. 
Published: November 2012

ABSTRACTBackground and Objectives:To date, most trials in pediatric acute gastroenteritis have evaluated short‐term clinical disease activity (eg, duration of diarrhea or vomiting, level of dehydration), laboratory outcomes (eg, rotavirus, norovirus), or a composite of these outcomes. Measuring health‐related quality of life may also be important in evaluating the effect of interventions for acute gastroenteritis in children. The objectives of this study were to conduct individual interviews and, when possible, focus group discussions, with parents of children with acute gastroenteritis; to determine how parent and child quality of life is negatively affected by acute gastroenteritis; and, from the perspective of parents and children, to develop a conceptual framework for quality of life instrument specific to pediatric acute gastroenteritis.Methods:We conducted interviews and focus groups with parents of children (3 months–5 years of age) given a diagnosis of gastroenteritis in a hospital emergency department. Interviews and focus groups were conducted to determine the effect of gastroenteritis on quality of life in parents and children (as perceived by the parents).Results:Interviews and focus groups involving 25 parents suggested a conceptual framework that, for children, includes 2 domains (physical and emotional function) and 14 subdomains. For parents, our framework includes 3 domains (physical, emotional, and social function) with physical function including 4 subdomains, emotional function including 7 subdomains, and social function including 2 subdomains. The framework has been used to develop a preliminary quality of life questionnaire for parents and children.Conclusions:Acute gastroenteritis has an important adverse effect on health‐related quality in both children and parents involving physical symptoms and restrictions in physical function and disturbed emotional function. Upon further research on the psychometric properties of the proposed questionnaires, future trials of effectiveness should consider measuring patient important outcomes such as health‐related quality of life.
Parents' Information Needs in Tumor Necrosis Factor‐α Inhibitor Treatment Decisions
Authors: Lipstein Ellen A. , Lovell Daniel J. , Denson Lee A. , Moser David W. , Saeed Shehzad A. , Dodds Cassandra M. , Britto Maria T. 
Published: November 2012

ABSTRACTObjective:The aim of the study was to describe parents' experiences and the information used when making decisions about tumor necrosis factor‐α inhibitor (TNFαi) treatment.Methods:We interviewed parents of children with Crohn disease (CD) or juvenile idiopathic arthritis who had experience deciding about TNFαi treatment. Interview questions focused on information used to make decisions and factors that influenced decision making. We used thematic analysis for all coding and analysis. Coding structure was developed by a multidisciplinary team review of the initial interviews. Two coders then coded the remaining interviews, compared coding, and resolved disagreements through discussion. Data were analyzed by thematic grouping and then compared between diseases.Results:We interviewed 35 parents. For nearly all parents the decision about TNFαi treatment was the most challenging medical decision they had made; however, parents of children with CD experienced more stress and anxiety than did other parents. Both groups of parents sought information from multiple sources including health care providers, the Internet, and social contacts. They looked for information related to treatment effectiveness, adverse effects, and other individuals' treatment experiences. In CD, information was used to help make the decision, whereas in juvenile idiopathic arthritis it was used to confirm the decision.Conclusions:The decision‐making experience, and associated information seeking, leaves some parents with long‐lasting concerns and worry about TNFαi treatment. Providing parents with structured decision‐making support may lead to more effective and efficient decision making, decreased psychosocial distress, and, ultimately, improved outcomes for their children.
Blood Lead Concentration Is Not Altered by High‐Dose Vitamin D Supplementation in Children and Young Adults With HIV
Authors: Groleau Veronique , Herold Rachel A. , Schall Joan I. , Wagner Julia L. , Dougherty Kelly A. , Zemel Babette S. , Rutstein Richard M. , Stallings Virginia A. 
Published: November 2012

ABSTRACTObjectives:Optimal vitamin D status is known to have beneficial health effects and vitamin D supplements are commonly used. It has been suggested that vitamin D supplementation may increase blood lead in children and adults with previous lead exposure. The objective was to determine the safety regarding lead toxicity during 12 weeks of high‐dose vitamin D3 supplementation in children and young adults with human immunodeficiency virus (HIV).Methods:Subjects with HIV (8–24 years) were randomized to vitamin D3 supplementation of 4000 or 7000 IU/day and followed at 6 and 12 weeks for changes in serum 25‐hydroxy vitamin D (25D) and whole‐blood lead concentration. This was a secondary analysis of a larger study of vitamin D3 supplementation in children and adolescents with HIV.Results:In 44 subjects (75% African American), the baseline mean ± standard deviation serum 25D was 48.3 ± 18.6 nmol/L. Fifty percent of subjects had baseline serum 25D <50.0 nmol/L. Serum 25D increased significantly with D3 supplementation during the 12 weeks. No subject had a whole‐blood lead >5.0 μg/dL at baseline or during subsequent visits. Whole‐blood lead and 25D were not correlated at baseline, and were negatively correlated after 12 weeks of supplementation (P = 0.014). Whole‐blood lead did not differ between those receiving 4000 and 7000 IU of vitamin D3.Conclusions:High‐dose vitamin D3 supplementation and the concomitant increased serum 25D did not result in increased whole‐blood lead concentration in this sample of children and young adults living in a northeastern urban city.
Tolerability of Curcumin in Pediatric Inflammatory Bowel Disease
Authors: Suskind David L. , Wahbeh Ghassan , Burpee Tyler , Cohen Morty , Christie Dennis , Weber Wendy 
Published: November 2012

ABSTRACTBackground:Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation in the absence of a recognized etiology. The primary therapies are medications that possess anti‐inflammatory or immunosuppressive effects. Given the high use of complementary alternative medicines in pediatric IBD, a prospective tolerability study of curcumin, an herbal therapy with known anti‐inflammatory effects, was conducted to assess possible dosage in children with IBD.Methods:Prospectively, patients with Crohn disease or ulcerative colitis in remission or with mild disease (Pediatric Crohn's Disease Activity Index [PCDAI] <30 or Pediatric Ulcerative Colitis Activity Index [PUCAI] score <34) were enrolled in a tolerability study. All patients received curcumin in addition to their standard therapy. Patients initially received 500 mg twice per day for 3 weeks. Using the forced‐dose titration design, doses were increased up to 1 g twice per day at week 3 for a total of 3 weeks and then titrated again to 2 g twice per day at week 6 for 3 weeks. Validated measures of disease activity, using the PUCAI and PCDAI, and the Monitoring of Side Effect System score were obtained at weeks 3, 6, and 9.Results:All patients tolerated curcumin well, with the only symptom that was consistently reported during all 3 visits being an increase in gassiness, which occurred in only 2 patients. Three patients saw improvement in PUCAI/PCDAI score.Conclusions:This pilot study suggests that curcumin may be used as an adjunctive therapy for individuals seeking a combination of conventional medicine and alternative medicine.
Autoantibodies and Autoimmune Disease During Treatment of Children With Chronic Hepatitis C
Authors: Molleston Jean P. , Mellman William , Narkewicz Michael R. , Balistreri William F. , Gonzalez‐Peralta Regino P. , Jonas Maureen M. , Lobritto Steven J. , Mohan Parvathi , Murray Karen F. , Njoku Dolores , Rosenthal Philip , Barton Bruce A. , Talor Monica V. , Cheng Irene , Schwarz Kathleen B. , Haber Barbara A. ,   PEDS‐C Clinical Research Network
Published: November 2012

ABSTRACTObjectives:Autoantibodies were studied in a well‐characterized cohort of children with chronic hepatitis C during treatment with pegylated interferon and ribavirin to assess the relation with treatment and development of autoimmune disease.Methods:A total of 114 children (5–17 years), screened for the presence of high‐titer autoantibodies, were randomized to pegylated interferon with or without ribavirin. Anti‐nuclear, anti‐liver‐kidney‐microsomal, anti‐thyroglobulin, anti‐thyroid peroxidase, insulin, anti‐glutamic acid decarboxylase (GAD) antibodies were measured after trial completion using frozen sera.Results:At baseline, 19% had autoantibodies: anti‐nuclear antibodies (8%), anti‐liver‐kidney‐microsomal antibodies (4%), and glutamic acid decarboxylase antibodies (4%). At 24 and 72 weeks (24 weeks after treatment completion), 23% and 26% had autoantibodies (P = 0.50, 0.48 compared with baseline). One child developed diabetes and 2 hypothyroidism during treatment; none developed autoimmune hepatitis. At 24 weeks, the incidence of flu‐like symptoms, gastrointestinal symptoms, and headaches was 42%, 8% and 19% in those with autoantibodies versus 52%, 17%, and 26% in those without (P = 0.18, 0.36, and 0.20, respectively). In children with negative hepatitis C virus polymerase chain reaction at 24 weeks, there was no difference in the rate of early virologic response/sustained virologic response, respectively, in those with autoantibodies 76%/69% vs 58%/65% in those without (P = 0.48).Conclusions:Despite screening, we found autoantibodies commonly at baseline, during treatment for chronic hepatitis C and after. The presence of antibodies did not correlate with viral response, adverse effects, or autoimmune hepatitis. Neither screening nor archived samples assayed for thyroid and diabetes‐related antibodies identified the 3 subjects who developed overt autoimmune disease, diabetes (1), and hypothyroidism (2).
Methodological Approaches for Dietary Intake Assessment in Formula‐fed Infants
Authors: Luque Veronica , Escribano Joaquin , Mendez‐Riera Georgina , Schiess Sonia , Koletzko Berthold , Verduci Elvira , Stolarczyk Anna , Martin Françoise , Closa‐Monasterolo Ricardo 
Published: November 2012

ABSTRACTBackground and Objective:The estimation of dietary intake remains a challenge in human nutritional studies. In infants, the use of food diaries (FDs) is a suitable method already validated; however, this method is not exempt from error. In formula‐fed infants, dilution of powdered formulas may produce errors. Our aim was to develop and validate standard operating procedures (SOPs) for the assessment of dietary intake in formula‐fed infants, attending potential sources of error.Methods:We analysed sources of error in a random subsample of 3‐day FDs from 100 infants enrolled in the European Childhood Obesity Project. Calculations to estimate intakes were standardised and included in a software tool (SOPsystem). An evaluation of a simulated FD was performed by 9 trained nutritionists and 23 nutrition students (n = 225 and n = 575 bottle evaluations, respectively) to compare the results obtained when using or not the SOPsystem. Correct answers (%), coefficients of variation, and the time spent (minutes) to assess the simulated FD were analysed.Results:Overall, 60% of the FDs contained reports of incorrect volumes, and 37% reported incorrect formula dilutions. When the SOPsystem was used, correct answers in the simulated FD were more frequent (P < 0.001) and the mean coefficient of variation and the time spent were lower (P < 0.005 and P < 0.01, respectively).Conclusions:The development and implementation of SOPs with a software tool that identifies specific sources of error in record‐keeping achieved a harmonised and improved process for assessing dietary intakes in formula‐fed infants, minimising errors in calculations and reducing the work time invested.
Human Leukocyte Antigen DQ2.2 and Celiac Disease
Authors: Mubarak Amani , Spierings Eric , Wolters Victorien , van Hoogstraten Ingrid , Kneepkens C.M. Frank , Houwen Roderick 
Published: November 2012

ABSTRACTPatients with celiac disease (CD) lacking both human leukocyte antigen (HLA)‐DQ2.5 in cis (DQA1*05:01, DQB1*02:01) or trans (DQA1*05:05, DQB1*02:02) configuration and HLA‐DQ8 (DQA1*03:01, DQB1*03:02) are considered to be rare. Therefore, absence of these genotypes is commonly used to exclude the diagnosis of CD. To investigate whether this approach is justified, the HLA‐distribution in 155 children with CD was studied. A total of 139 (89.7%) patients carried HLA‐DQ2.5. Of the remaining patients, 7 (4.5%) carried HLA‐DQ8. Interestingly, the 9 (5.8%) patients lacking HLA‐DQ2.5 and HLA‐DQ8 carried HLA‐DQA1*02:01 and ‐DQB1*02:02 (HLA‐DQ2.2). Therefore, HLA‐DQ2.2 should be included as an important HLA‐type related to CD.