bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Following Aminosalicylate Therapy in Children Newly Diagnosed As Having Ulcerative Colitis
Authors: Zeisler Bella , Lerer Trudy , Markowitz James , Mack David , Griffiths Anne , Bousvaros Athos , Keljo David , Rosh Joel , Evans Jonathan , Kappelman Michael , Otley Anthony , Kay Marsha , Grossman Andrew , Saeed Shehzad , Carvalho Ryan , Oliva‐Hemker Maria , Faubion William , Sudel Boris , Pfefferkorn Marian , Ashai‐Khan Farhat , LeLeiko Neal , Hyams Jeffrey ,   Pediatric Inflammatory Bowel Disease Collaborative Research Group
Published: November 2012

ABSTRACTObjectives:Despite a paucity of published supporting data, 5‐aminosalicylate (5‐ASA) use in pediatric ulcerative colitis (UC) is common. The present study describes the use and outcome of a large multicenter inception cohort of children with UC treated with 5‐ASA.Methods:Data were obtained from the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry, a prospective North American observational study of children newly diagnosed as having inflammatory bowel disease ages 16 years or younger. Patient data are recorded at diagnosis, 30 days, and then quarterly. Patients are managed by physician dictate, not protocol. Disease activity is classified by physician global assessment. The primary outcome examined was corticosteroid (CS) free, inactive UC at 1 year following initiation of 5‐ASA within 30 days of diagnosis (with or without concomitant CS use) without the need for rescue therapy (immunomodulators, biologics, or colectomy).Results:Study subjects included 213 patients newly diagnosed as having UC who received oral 5‐ASA compounds (115 of whom also received CS) during the first 30 days after diagnosis, and no other oral therapies for the treatment of UC. Of these 213 patients, 86 (40%) were CS free and physician global assessment inactive at 1 year without rescue. Outcome was not associated with disease severity at diagnosis, demographic or laboratory factors examined, or initial dose of 5‐ASA used.Conclusions:Forty percent of children taking 5‐ASA as primary maintenance therapy at diagnosis are in CS‐free remission after 1 year of treatment. Further pediatric studies will be needed to address whether increased adherence and/or higher dosing schedules will improve outcomes.
Constipation in Children With Neurofibromatosis Type 1
Authors: Pedersen Cecilie E. , Krogh Klaus , Siggaard Charlotte , Joensson Iben M. , Haagerup Annette 
Published: November 2012

ABSTRACTBackground and Objectives:Neurofibromatosis type 1 (NF1) is a hereditary, heterogenic, and multiorganic disease. The NF1 phenotype shows great variability in expressivity and often includes symptoms from the central and peripheral nervous systems. Bowel symptoms have been reported, but gastrointestinal function in NF1 remains to be described in detail. In this first systematic study of bowel function in children with NF1, we aimed to investigate symptoms of constipation and test the hypotheses that children with NF1 have abnormally large rectum and prolonged colonic transit time (CTT).Methods:A total of 20 children with NF1 (age 8.2 ± 2.4 years) were evaluated with medical history; clinical examination; digital rectal examination; bowel and dietary diaries; Rome III criteria; measurement of rectal diameter by transabdominal ultrasound; and radiographic estimation of CTT. The control group for assessment of rectal diameter comprised 23 healthy children (mean age 9.1 ± 2.7 years).Results:A total of 6 children with NF1 (30%) were constipated according to Rome III criteria. Average rectal diameter was significantly larger than for healthy children (32.9 ± 7.2 mm vs 21.4 ± 5.9 mm, P < 0.0001). Median CTT in NF1 children was 53 hours (range 26–101). Compared with existing normative data, CTT was prolonged (>84 hours) in 3 (19%).Conclusions:Symptoms of constipation were surprisingly common in children with NF1. Correspondingly, rectal diameters were abnormally large and a higher proportion than expected had prolonged CTT. The underlying pathophysiology remains obscure, but we hypothesise that abnormalities of the enteric nervous system or disturbed cellular growth could be present.
Evolution of In Vitro Cow's Milk Protein–specific Inflammatory and Regulatory Cytokine Responses in Preterm Infants With Necrotising Enterocolitis
Authors: Abdelhamid Adel E. , Chuang Shu‐Ling , Hayes Peter , Fell John M.E. 
Published: November 2012

ABSTRACTBackground:We have previously reported evidence of in vitro sensitisation to cow's milk protein in peripheral blood mononuclear cells (PBMCs) in preterm infants with necrotising enterocolitis (NEC). In the present study, we document the changes in the PBMC responses to stimulation with mitogen (phytohaemagglutinin) and cow's milk proteins β‐lactoglobulin (β‐lg) and casein over time: from the acute presentation of NEC, to initial recovery (reinitiation of enteral feeds), to full recovery (full feeding).Methods:Of the 14 preterm infants recruited with acute NEC, 12 were followed until fully enterally fed (2 died during the acute phase). Cytokine secretion (interferon‐γ [IFN‐γ], interleukin 4, [IL‐4], IL‐10, and transforming growth factor‐β1 [TGF‐β1]) by PBMCs in response to stimulation by phytohaemagglutinin, β‐lg, and casein was measured by enzyme‐linked immunospot in the acute phase and subsequently at recovery and full recovery.Results:The high levels of cytokine secretion (IFN‐γ, IL‐4, IL‐10, and TGF‐β1) observed in response to β‐lg and casein in the acute phase increased by a further 50% to 100% at recovery (P < 0.005). At full recovery (full feeding), however, IFN‐γ, IL‐4, and IL‐10 secretion response had returned to, or below, acute‐phase levels, whereas the augmented TGF‐β1 response was maintained (P = 0.005 vs acute level). This response pattern was similar for casein, and did not appear to be influenced by the nature of the feed used following NEC (breast milk/formula/hydrolysed formula).Conclusions:The evolution of the cytokine response profile in parallel with the clinical recovery from NEC is consistent with a putative role for TGF‐β1 in regulation of inflammation, and possibly also oral tolerance.
Colon Manometry Proves That Perception of the Urge to Defecate Is Present in Children With Functional Constipation Who Deny Sensation
Authors: Firestone Baum Carrie , John Anub , Srinivasan Kavitha , Harrison Prince , Kolomensky Andrew , Monagas Javier , Cocjin Jose , Hyman Paul E. 
Published: November 2012

ABSTRACTBackground and Objective:Children with functional constipation often state an inability to sense an urge to defecate and/or inability to feel incontinence. We used colon manometry to assess whether there was a sensory abnormality in patients who denied sensation.Methods:A physician observed all of the colon manometries in the preceding 20 years, and included behavioral observations in the procedure reports. We reviewed the charts of these patients.Results:Of 150 subjects with normal manometry and a diagnosis of functional constipation, 56 volunteered that they had no urge to defecate or complained of abdominal pain. For all who denied sensation, the first high‐amplitude propagating colonic contraction (HAPC) was associated with retentive posturing and facial grimaces. When queried, all reported they felt nothing. The examiner explained the HAPC was causing pain, and informed the child that the pain would resolve if they defecated. With subsequent HAPCs, every patient acknowledged an urge to defecate and successfully defecated. Most agreed that a similar pain sensation was present daily, but was misinterpreted to be abdominal pain.Conclusions:Colon manometry may be useful not only for objective findings to discriminate neuromuscular disease from functional symptoms but also to understand psychological issues and aid in helping the child and family understand the maladaptive behaviors in functional constipation.
Psychosocial Outcomes for Children With Nonalcoholic Fatty Liver Disease Over Time and Compared With Obese Controls
Authors: Kerkar Nanda , D'Urso Christine , Van Nostrand Kelsey , Kochin Israel , Gault Allison , Suchy Frederick , Miloh Tamir , Arnon Ronen , Chu Jaime , Annunziato Rachel 
Published: November 2012

ABSTRACTObjectives:Children with nonalcoholic fatty liver disease (NAFLD) experience compromised quality of life (QOL) akin to those with other chronic disease. Our objectives were to examine the association between NAFLD and QOL as well as other psychosocial outcomes, to compare psychosocial outcomes to obese children without known NAFLD, and to determine whether present standard care for NAFLD results in weight loss and improvement in psychosocial outcomes longitudinally.Methods:Children with NAFLD between 8 and 18 years and obese control children without known NAFLD were consented to complete a brief psychosocial battery examining depression (Children's Depression Inventory), QOL (Pediatric Quality of Life Inventory; PedsQL), and effect of weight on self‐esteem (Body‐Esteem Scale for Adolescents and Adults) at baseline; and additionally for the NAFLD group after at least 6 months.Results:A total of 48 children with NAFLD and 40 obese control children were enrolled. The PedsQL scores were not significantly different but the CDI total score and subscales of negative mood, ineffectiveness, and negative self‐esteem as well as all of the 3 subscales of BESAA, appearance, attribution, and weight were worse in the NAFLD group compared with obese controls. The PedsQL scores also did not change after standard care in the 33 patients with NAFLD who completed the follow‐up evaluations, but the CDI score differed between those whose body mass index improved or not.Conclusions:Children with NAFLD have higher levels of depression than obese controls. Outcomes did not improve with standard care. Larger longitudinal studies and appropriate interventions are required in this area.
Abdominal Plain Film Before Gastrostomy Tube Placement to Predict Success of Percutaneous Endoscopic Procedure
Authors: Pruijsen J.M. , de Bruin A. , Sekema G. , Koetse H.A. , van Rheenen P.F. 
Published: November 2012

ABSTRACTObjectives:Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long‐term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status ≥III, indicating increased risk for peri‐ and postoperative morbidity. The success rate of endoscopic insertion is high, but variations in the anatomy may lead to failure of PEG placement and repeated exposure to anesthesia for surgical gastrostomy. We evaluated the efficiency of using abdominal plain film with gastric insufflation in the preparatory phase to predict a successful PEG insertion and avoid rescheduling.Methods:A single‐center cohort of candidates for PEG underwent abdominal plain film with gastric insufflation in the preparatory phase before tube insertion. The x‐ray film was considered normal when the stomach projected distal to the costal margin. Primary endpoint was the success rate of PEG insertion. Multivariate logistic regression analysis was used to identify factors associated with PEG insertion failure.Results:A total of 303 candidates for PEG underwent abdominal plain film (age range 0.3–18.1 years). PEG tube insertion succeeded in 287 cases (95%). In case of an abnormal abdominal film, the probability of successful PEG insertion dropped to 67% (95% confidence interval 46%–87%). In a multivariate logistic regression model, significant predictors for PEG insertion failure were spinal deformities (odds ratio [OR] 12.1), previous abdominal surgery (OR 8.5), neurological impairment (OR 4.1), and abnormal plain abdominal film (OR 10.3).Conclusions:Assessment of the gastric anatomy by abdominal plain film in PEG candidates with spinal deformities, previous abdominal surgery, or neurological impairment may help to identify children with a high likelihood of PEG insertion failure. This strategy enables the endoscopist to notify the surgeon in advance for a potential conversion and avoids repeated exposure to anesthesia.
Leonardo da Vinci Meets Celiac Disease
Authors: Zanchi Chiara , Ventura Giovanna , Di Leo Grazia , Orzes Nicoletta , Ronfani Luca , Not Tarcisio , Ventura Alessandro 
Published: November 2012

ABSTRACTBackground and Aim:Leonardo da Vinci's face symmetry derives from 3 equal craniofacial segments: trichion‐nasion (tn), which represents the superior third of the face, nasion‐subnasal (ns) that is the medium third of the face, and subnasal‐gnathion (sg) that is the length of the lower third of the face. It has been reported that adult subjects with celiac disease (CD) can be identified on the basis of a greater extension of the forehead in comparison to the medium third of the face, with a high tn/ns ratio. The aim of the present study was to investigate the correlation between facial asymmetry and CD in childhood and adulthood.Methods:We studied 126 biopsy‐proven patients with CD (76 children and 50 adults) and 102 healthy controls (43 children and 59 adults). Their faces were photographed; the pictures were edited using a software program to calculate the facial segments.Results:The tn length was significantly different between adult celiac and adult controls (7.43 ± 1.46 cm vs 6.38 ± 1.73 cm, P = 0.001). The cutoff of 6.5 cm tn, derived from receiver operating characteristic curve analysis, identified 43 of 50 patients (sensitivity 86%), but 34 of 59 controls were positive (specificity 54.2%). The positive predictive value was 56%; however, the tn/ns ratio was not significantly different between celiacs and controls. Neither the tn length nor the tn/ns ratio in celiacs correlated to the time of gluten exposure.Conclusions:Adults, but not children, with celiac disease show a forehead extension significantly greater than controls, but this test's specificity appears too low to be used in the screening of CD.
Increased Prevalence of Antibodies Against Dietary Proteins in Children and Young Adults With Cerebral Palsy
Authors: Stenberg Reidun , Dahle Charlotte , Magnuson Anders , Hellberg Dan , Tysk Curt 
Published: November 2012

ABSTRACTObjectives:Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case‐control study of IgG antibodies against other dietary antigens, AGA, anti‐tTG, and IgE antibodies against wheat and gluten.Methods:Sera from 99 cases with CP and 99 healthy, age‐ and sex‐matched controls were analysed with fluorescence enzyme‐linked immunosorbent assay for detection of IgG antibodies against β‐lactoglobulin, casein, egg white, IgG‐ and IgA‐AGA, IgA‐anti‐tTG, and IgE antibodies against gluten and wheat.Results:Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β‐lactoglobulin was 17.0 (95% confidence interval [CI] 2.3–128), against casein 11.0 (95% CI 2.6–46.8), and against egg white 7.0 (95% CI 1.6–30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA‐anti‐tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology.Conclusions:Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.
Sensory Processing Issues in Young Children Presenting to an Outpatient Feeding Clinic
Authors: Davis Ann M. , Bruce Amanda S. , Khasawneh Rima , Schulz Trina , Fox Catherine , Dunn Winifred 
Published: November 2012

ABSTRACTObjectives:The aim of the study was to describe the relation between sensory issues and medical complexity in a series of patients presenting to an outpatient multidisciplinary feeding team for evaluation, by a standardized measure of sensory‐processing abilities.Methods:A retrospective chart review of all of the patients seen from 2004 to 2009 on 2 key variables: medical diagnostic category and short sensory profile (SSP) score.Results:On the SSP, 67.6% of children scored in the clinical (“definite difference”) range. The most common diagnostic categories were developmental (n = 23), gastrointestinal (n = 16), and neurological (n = 13). Behavioral and cardiorespiratory medical diagnostic categories were significantly related to SSP total score and SSP definite difference score.Conclusions:Children who present for feeding evaluation do indeed tend to have clinically elevated scores regarding sensory processing, and these elevated scores are significantly related to certain medical diagnostic categories. Future research is needed to determine why these significant relations exist as well as their implications for treatment of feeding‐related issues.
A Residential Summer Camp Can Reduce Body Fat and Improve Health‐related Quality of Life in Obese Children
Authors: Wong William W. , Barlow Sarah E. , Mikhail Carmen , Wilson Theresa A. , Hernandez Paula M. , Shypailo Roman J. , Abrams Stephanie H. 
Published: November 2012

ABSTRACTIn an earlier report, we showed that a 2‐week, residential summer camp (Kamp K'aana) led to improved body weight, body mass index, body mass index z score, and self‐esteem among obese children. To assess whether improvements in body weight and self‐esteem translate into improvement in body fat and weight‐related quality of life, we measured the changes in body fat by bioimpedance and quality of life by Impact of Weight on Quality of Life instrument on 42 multiethnic obese children who took part in our Kamp K'aana program. Significant reduction in body fat was detected with significant improvements in the weight‐related quality of life scores.
Tolerability, Safety, and Efficacy of PEG 3350 as a 1‐day Bowel Preparation in Children
Authors: Walia Ritu , Steffen Rita , Feinberg Lisa , Worley Sarah , Mahajan Lori 
Published: November 2012

ABSTRACTObjective:The aim of the study was to evaluate the tolerability, safety, and efficacy of polyethylene glycol (PEG) 3350 without electrolytes as a 1‐day bowel preparation for colonoscopy in children.Methods:A prospective study of 45 children undergoing colonoscopy prescribed PEG 3350 without electrolytes mixed with a commercial electrolyte beverage was performed. Patients <45 kg received 136 g of PEG 3350 without electrolytes mixed in 32 ounces of Gatorade. Patients ≥45 kg were given 255 g of PEG 3350 without electrolytes in 64 ounces of Gatorade. A basic metabolic panel was performed at the time of the clinic visit and just before colonoscopy. Patients completed a survey related to bowel preparation. Endoscopists graded bowel preparation and noted the proximal extent of the examination.Results:A total of 44 patients (14 ± 3 years) completed the study. One patient was excluded due to protocol breach. All subjects reported the preparation was easy (61%) or tolerable (39%). Adverse events included nausea (34%), abdominal pain (23%), vomiting (16%), abdominal distension (20%), bloating (23%), and dizziness (7%). Although significant changes in serum glucose and CO2 were noted, no therapeutic interventions were indicated. Significant changes in sodium, potassium chloride, blood urea nitrogen, or creatinine did not occur. Colonic preparation was rated as excellent in 23%, good in 52%, fair in 23%, and poor in 2% of patients. Intubation of the ileum was successful in 100%.Conclusions:One‐day bowel preparation with high dose PEG 3350 mixed with commercial electrolyte solution is tolerable, safe, and effective in children before colonoscopy.
Markers of Antigen Presentation and Activation on Eosinophils and T Cells in the Esophageal Tissue of Patients With Eosinophilic Esophagitis
Authors: Le‐Carlson Minou , Seki Scott , Abarbanel David , Quiros Antonio , Cox Kenneth , Nadeau Kari C. 
Published: November 2012

ABSTRACTObjectives:Evidence suggests eosinophils may be acting as antigen‐presenting cells (APCs) by presenting antigen to T cells. We investigated the surface proteins of eosinophils and T cells in the esophageal biopsies of patients with eosinophilic esophagitis (EoE), patients with gastroesophageal reflux disease (GERD), and healthy controls (HCs).Methods:Subjects were categorized as EoE, GERD, or HC. In esophageal tissue, EG2+ eosinophils were stained for the APC markers, CD40 or CD80, via immunohistochemistry. CD3+ T cells were stained for costimulatory markers, CD40L or CD28, and for activation markers, CD69 or CD134, via immunofluorescence or immunohistochemistry.Results:Eosinophils stained with CD40 and CD80. The number of EG2+CD40+ cells was increased in EoE (mean 19.1 ± 14.8 cells/high‐power field [HPF], n = 11), compared with GERD (mean 0.13 ± 0.19 cells/HPF, n = 5, P < 0.01) and HC (mean 0.3 ± 0.7 cells/HPF, n = 5, P < 0.01). There was an elevation in EG2+CD80+ cells in EoE (mean 18.1 ± 16.2 cells/HPF, n = 10), GERD (mean 1.7 ± 2.8 cells/HPF, n = 6, P < 0.01), or HC (mean 0.8 ± 1.3 cells/HPF, n = 6, P < 0.01). CD3+ T cells stained with CD40L (not quantified). CD3+ T cells stained with CD28 at elevated levels in EoE (mean 14 ± 8.7 cells/HPF, n = 9) versus GERD (mean 3.3 ± 1.2 cells/HPF, n = 6, P < 0.05) or HC (mean 3.0 ± 3.2 cells/HPF, n = 7, P < 0.01). The number of CD3+CD69+ cells was highest in EoE (mean 14.8 ± 7.5 cells/HPF, n = 6) versus GERD (mean 0.8 ± 0.9 cells/HPF, n = 6, P < 0.001) or HC (mean 2.7 ± 2.5 cells/HPF, n = 6, P < 0.001).Conclusions:We show that esophageal eosinophils express CD40 and CD80, and T cells with CD40L, CD28, and CD69. The number of double‐stained cells was higher in EoE in comparison to control groups. These data support the hypothesis that eosinophils in EoE may act as APCs, activating T cells.
Cytokine Profile of Mature Milk From Smoking and Nonsmoking Mothers
Authors: Szlagatys‐Sidorkiewicz Agnieszka , Woś Ewa , Aleksandrowicz Ewa , Łuczak Grażyna , Zagierski Maciej , Martysiak‐Żurowska Dorota , Marek Krzysztof , Kamińska Barbara 
Published: November 2012

ABSTRACTWe verified whether smoking during lactation influences breast milk cytokine (interleukin [IL]‐1α, IL‐1β, IL‐6, IL‐8, IL‐10, and tumor necrosis factor‐α) levels 30 to 32 days after delivery. The study group comprised 24 postpartum women who declared smoking >5 cigarettes per day. The control group included 45 nonsmoking postpartum women. Compared with nonsmoking women, smokers were characterized by significantly higher breast milk concentrations of IL‐1α (P = 0.04), whereas no significant intergroup differences were observed in terms of remaining analyzed cytokines. Moreover, both groups were characterized by a similar fraction of women with detectable cytokine levels.