bluuebunny/crossref_metadata_2025_split huggingface dataset:
Definition of mortality for trauma center performance evaluation: A comparative study*
Authors: Moore Lynne , Turgeon Alexis F. , Émond Marcel , Le Sage Natalie , Lavoie André 
Published: October 2011

Objective:
Mortality is widely used as a performance indicator to evaluate the quality of trauma care, but there is no consensus on the most appropriate definition. Our objective was to evaluate the influence of the definition of mortality in terms of the place (in-hospital or postdischarge) and time (30 days and 3, 6, and 12 months) of death on the results of trauma center performance evaluations according to the patients' ages.

Design:
Multicenter retrospective cohort study.

Setting:
Inclusive Canadian provincial trauma system.

Patients:
Adults admitted between 1999 and 2006 with a maximum abbreviated injury severity score ≥3 (n = 47,261).

Interventions:
None.

Measurements and Main Results:
Trauma registry data were linked to vital statistics data to obtain mortality up to 12 months postadmission. Observed mortality was compared to that expected according to provincial population mortality rates. Trauma center performance was evaluated with risk-adjusted mortality estimates. Agreement between performance results based on different definitions of mortality was evaluated with correlation coefficients; >.9 was considered acceptable. Analyses were stratified by predefined age categories (16–64, 65–84, and ≥85 yrs). A total of 3,338 patients (7%) died in-hospital, and 1,794 patients (4%) died postdischarge. Among patients 16–64 yrs old, 30-day hospital mortality represented 83% of all deaths and correlation coefficients across all definitions of mortality were >.9. In patients 65–84 yrs old, 30-day hospital mortality represented 52% of all deaths, observed mortality reached expected rates at around 6 months, and agreement across mortality definitions was low.

Conclusions:
We observed an important variation in performance evaluation results across definitions of mortality, specifically in patients aged ≥65 yrs. Half of the deaths among elders occurred later than 30 days following admission, including a significant number postdischarge. Results suggest that if performance evaluations include elderly patients, data on postdischarge mortality up to 6 months following admission are required.
Effect of Demyelinating Ulnar Nerve Injury on Strength and Fatigue
Authors: Allen Matti D , Doherty Timothy J 
Published: October 2011

Abstract

Objectives:
Conduction block (CB) from focal neuropathy is often associated with weakness and fatigue in affected muscles. Ulnar neuropathy at the elbow (UNE) provides an excellent model to examine the relationships between electrophysiologically defined CB and quantitative measurement of weakness and fatigue.

Methods:
Eight healthy control subjects (47 ± 14 years) and nine patients (53 ± 3 years) with clinical and electrophysiological features of UNE with CB were studied. All underwent bilateral, ulnar motor nerve conduction studies recording from the first dorsal interosseous muscle as well as quantitative measurement of strength and fatigue of the first dorsal interosseous with a custom dynamometer.

Results:
Strength and fatigue were similar in the dominant and nondominant hands of control subjects and unaffected limb in patients. Varying degrees of conduction block (14-62%, mean 36%) and conduction slowing (31 m/s ± 7) were observed in those with UNE. CB was associated with significant reductions in strength (42%) and fatigue (23%) on a timed fatigue task. The reductions in strength (r = 0.74) and fatigue (r = 0.60) were strongly correlated with the degree of CB.

Conclusions:
CB in UNE defined by electrophysiological criteria was strongly correlated with weakness and fatigue in the first dorsal interosseous. Fatigue may be simply related to the reduction in strength, but activity or frequency dependent CB may also contribute.
Inter‐ and Intraobserver Agreement in 24‐hour Combined Multiple Intraluminal Impedance and pH Measurement in Children
Authors: Pilic Denisa , Höfs Carolin , Weitmann Sandra , Nöh Frank , Fröhlich Thorsten , Skopnik Heino , Köhler Henrik , Wenzl Tobias G. , Schmidt‐Choudhury Anjona 
Published: October 2011

ABSTRACTObjectives:Assessment of intra‐ and interobserver agreement in multiple intraluminal impedance (MII) measurement between investigators from different institutions.Methods:Twenty‐four 18‐ to 24‐hour MII tracings were randomly chosen from 4 different institutions (6 per center). Software‐aided automatic analysis was performed. Each result was validated by 2 independent investigators from the 4 different centers (4 investigator combinations). For intraobserver agreement, 6 measurements were analyzed twice by the same investigator. Agreement between investigators was calculated using the Cohen kappa coefficient.Results:Interobserver agreement: 13 measurements showed a perfect agreement (kappa >0.8); 9 had a substantial (kappa 0.61–0.8), 1 a moderate (kappa coefficient 0.41 to 0.6), and 1 a fair agreement (kappa coefficient 0.11–0.4). Median kappa value was 0.83. Intraobserver agreement: 5 tracings showed perfect and 1 showed a substantial agreement. The median kappa value was 0.88.Conclusions:Most measurements showed substantial to perfect intra‐ and interobserver agreement. Still, we found a few outliers presumably caused by poorer signal quality in some tracings rather than being observer dependent. An improvement of analysis results may be achieved by using a standard analysis protocol, a standardized method for judging tracing quality, better training options for method users, and more interaction between investigators from different institutions.
Evaluation of Guidelines for Management of Familial Adenomatous Polyposis in a Multicenter Pediatric Cohort
Authors: Munck Anne , Gargouri Lamia , Alberti Corinne , Viala Jerome , Peuchmaur Michel , Lenaerts Catherine , Michaud Laurent , Lamireau Thierry , Mougenot Jean Francois , Dabadie Alain , Maurage Chantal , Lachaux Alain , Scaillon Michele , Languepin Jane , Spyckerelle Claire , Meyer Martine , Olschwang Sylvianne 
Published: October 2011

ABSTRACTObjective:To retrospectively assess, in a pediatric multicenter cohort, guidelines for the management of familial adenomatous polyposis (FAP).Methods:Ten centers from the French‐speaking Pediatric Gastroenterology Hepatology and Nutrition Group provided follow‐up data on patients up to 18 years of age. Clinical records, genetic test results, endoscopy with histopathology examination, and therapeutic modalities were reviewed.Results:A total of 70 children from 47 families were included. When initial consultation resulted from a surveillance program because of an affected family member, 12 of 59 children were already symptomatic. Among 11 patients whose initial consultation was based only on symptoms, families were unaware at the time of a familial FAP history for 7 children, whereas only 4 cases were sporadic. A panel of 27 different pathogenic adenomatous polyposis coli (APC) germ‐line mutations and large genomic deletions were identified in 43 families. Extracolonic manifestations were found in half of the patients. As part of the standard practice for initial screening, the entire cohort underwent colonoscopy, which revealed adenoma above an intact rectosigmoid in 8 cases. Prophylactic colectomy was performed in 42 cases; high‐grade dysplastic adenoma and 1 invasive carcinoma were detected in 6 children. For timing of surgery, indications were in accordance with recent international guidelines.Conclusions:Defining optimal screening and therapeutic modalities in pediatric FAP cohorts is a challenge. Specific advice for genetic screening, endoscopy surveillance, and type of surgery based on recent guidelines is recommended.
European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease
Authors: Husby S. , Koletzko S. , Korponay‐Szabó I.R. , Mearin M.L. , Phillips A. , Shamir R. , Troncone R. , Giersiepen K. , Branski D. , Catassi C. , Lelgeman M. , Mäki M. , Ribes‐Koninckx C. , Ventura A. , Zimmer K.P. ,   ESPGHAN Working Group on Coeliac Disease Diagnosis,   ESPGHAN Gastroenterology Committee
Published: October 2011

ABSTRACTObjective:Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)‐DQ2 and HLA‐DQ8; and CD‐specific antibody tests have improved.Methods:A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence‐based recommendations on CD‐specific antibody testing.Results:In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti‐tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA‐DQ2 and HLA‐DQ8 testing is valuable because CD is unlikely if both haplotypes are negative.Conclusions:The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.
Detection of Pepsinogen in the Neonatal Lung and Stomach by Immunohistochemistry
Authors: Elabiad Mohamad T. , Zhang Jie 
Published: October 2011

ABSTRACTObjective:Evaluate the hypothesis that the same pepsinogen C molecule produced in the stomach is also produced by the lung.Patients and Methods:Pulmonary and gastric tissues collected postmortem were immunohistochemically stained for pepsinogen C and pepsinogen A.Results:Sixteen patients with diverse causes of death were evaluated. Gestational age at birth ranged between 21 and 37 weeks. Pepsinogen A was detected in 12 of the 13 stomach sections, mainly in the chief cells, but not in any lung sections. Pepsinogen C was detected in all stomach sections in chief and mucus cells and in 9 of the 16 lung sections, mainly in type II pneumocytes. Pepsinogen C was not detected in the 3 lung cases with a gestational age <23 weeks.Conclusions:The same pepsinogen C molecule is produced in the stomach and in the lung. These findings potentially affect previous study results that used an enzymatic pepsin detection assay to evaluate for and associate gastroesophageal reflux disease with other morbidities.
Multicomponent School‐initiated Obesity Intervention in a High‐risk, Hispanic Elementary School
Authors: Klish William J. , Karavias Kellie E. , White Katie S. , Balch Angela J. , Fraley J. Kennard , Mikhail Carmen , Abrams Stephanie H. , Terrazas Norma L. , Smith E. O'Brian , Wong William W. 
Published: October 2011

ABSTRACTThe aim of the study was to determine the effectiveness of a school‐initiated cognitive and behavioral program to reduce childhood obesity. Height, weight, body mass index (BMI), and BMI z scores were obtained at the beginning and end of the school year at an intervention school (n = 1022) and at a control school (n = 692). The prevalence of overweight and obesity was 18.9% and 30.4% versus 19% and 30.2%, respectively, in the intervention and control schools. The incidence of overweight increased in the control school, but the incidence of obesity, weight, and BMI z scores increased significantly in the intervention school, suggesting that implementation of any school‐based obesity intervention programs requires careful planning to achieve goals.
Neutrophil Transintestinal Epithelial Migration to CXCR2 Ligands Is Regulated by Adenosine
Authors: Stadnyk Andrew W. , Carrigan Svetlana O. , Otley Anthony R. 
Published: October 2011

ABSTRACTObjectives:Polymorphonuclear leukocytes (PMN) feature prominently in the mucosa, including in crypt abscesses, of patients with inflammatory bowel disease, yet the mediators that are responsible for this migration are unknown. We discovered that CXCR2 chemokines (reportedly elevated in the mucosa) have reduced potency recruiting PMN across epithelial cell monolayers versus acellular filters, so the objective was to determine what molecules modify transepithelial PMN migration to CXCR2 chemokines.Methods:Transwells with T84 colon carcinoma monolayers or no epithelium were used with adolescent patient peripheral blood PMN and CXCL8 (interleukin‐8 [IL‐8], binds CXCR1 and CXCR2), CXCL5 (epithelial‐derived neutrophil chemoattractant‐78 [ENA‐78]), or CXCL1 (Gro‐α, both bind CXCR2) as chemoattractants.Results:IL‐8 was equally potent at recruiting PMN across filters and T84 monolayers growing on the filters. In contrast, ENA‐78 and Gro‐α were significantly less potent at recruiting PMN across monolayers than across bare filters. Blocking CXCR1 reduced PMN migration across monolayers to IL‐8. We ruled out superoxide radicals possibly enhancing migration to IL‐8 by using PMN from a patient with chronic granulomatous disease. PMN constitutively produce adenosine, so we added adenosine deaminase to the transwell assays and observed increased migration to ENA‐78 across T84 monolayers. The level of migration was further enhanced by pretreating PMN with adenosine before adding the cells to the assay in the presence of the deaminase.Conclusions:PMN migration mediated by CXCR2 through the epithelium is regulated by adenosine. Adenosine appears to reduce transepithelial migration by influencing β2 integrin use on the PMN.
Comparison of Quick Point‐of‐Care Test for Small‐bowel Hypolactasia With Biochemical Lactase Assay in Children
Authors: Rao Prithviraj , Rao Nagendra , Jordinson Matthew , Scott Camilla , Hinchcliffe Carol , Campbell David 
Published: October 2011

ABSTRACTAim:The aim of the present study was to compare the Biohit Lactose Intolerance Quick Test (BLIQT) to the criterion standard biochemical duodenal lactase (DL) activity assay in the paediatric population using standard statistical comparative tests.Methods:Using standard Olympus endoscopes, 2 postbulbar duodenal biopsies were taken from 38 prospective children (0–16 years) from June 2008–May 2009 at a single tertiary paediatric gastroenterology unit. The biopsies were used for the BLIQT and for biochemical disaccharides assay.Results:Thirty‐eight children (19 boys) of median age 5.45 years (0.3–14.8 years) underwent the combined BLIQT and disaccharidase testing. We subdivided the group into those who had biopsies with a larger endoscope (XQ, n = 26) and those who had a smaller endoscope (XP, n = 12) and thus a smaller biopsy forcep. When using a larger endoscope, the BLIQT showed a sensitivity of 100%, specificity of 86%, and positive and negative predictive value of 57.1% and 100%, respectively, on comparing it with DL. With a smaller endoscope, the BLIQT had a sensitivity of 100%, specificity of 80%, positive predictive value of 50%, and a negative predictive value of 100%.Conclusions:As in adult studies, the sensitivity and negative predictive value of the BLIQT was 100%. The specificity too appears to be high but variable, probably because of smaller biopsies obtained, and may warrant the need for 2 biopsies. The high sensitivity, specificity, and negative predictive value of the BLIQT for indicating hypolactasia make it an effective point‐of‐care test for paediatric hypolactasia.
Are Immunoglobulin A Anti‐gliadin Antibodies Helpful in Diagnosing Coeliac Disease in Children Younger Than 2 Years?
Authors: Foucher Barbara , Johanet Catherine , Jégo‐Desplat Sophie , Sanmarco Marielle , Dubucquoi Sylvain , Fily‐Nalewajk Sandrine , Olsson Nils‐Olivier , Lakomy Daniela , Escande Andrée , Chrétien Pascale , Fortenfant Françoise , Chevailler Alain , André Chantal , Goetz Joëlle , Humbel René‐Louis , Monier Jean‐Claude , Sibilia Jean , Taillefer Marie‐France , Abreu Isabelle , Fabien Nicole 
Published: October 2011

ABSTRACTThe usefulness of immumoglobulin (Ig) A antibodies to gliadin (AGA‐IgA) in addition to IgA anti‐endomysium and tissue transglutaminase antibodies was evaluated in 4122 children younger than 2 years with a suspicion of coeliac disease (CD). Eight percent (312/4122) displayed IgA anti‐endomysium and/or IgA anti‐tissue transglutaminase, whereas 2.1% (85/4122) displayed only AGA‐IgA. Clinical data were obtained for 62 of 85 children with isolated AGA‐IgA, and 33 children underwent a duodenal biopsy. Histologically proven CD was established for 5 patients, whereas 57 children were diagnosed to experience other diseases. The systematic detection of AGA‐IgA using native gliadin conferred no additional diagnostic benefit for the diagnosis of CD in children younger than 2 years of age, except for rare cases.
Monitoring of Anti‐transglutaminase Autoantibodies in Pediatric Celiac Disease Using a Sensitive Radiobinding Assay
Authors: Candon Sophie , Mauvais François‐Xavier , Garnier‐Lengliné Hélène , Chatenoud Lucienne , Schmitz Jacques 
Published: October 2011

ABSTRACTObjectives:The diagnosis of celiac disease (CD) is based on the histological identification of gluten‐sensitive enteropathy and detection of anti‐tissue transglutaminase antibodies (tTGA) and/or endomysial antibodies. Serial measurements of tTGA are now recommended as a follow‐up strategy to monitor compliance with a gluten‐free diet (GFD). We evaluated the performances of a quantitative radiobinding assay (RBA) of tTGA immunoglobulin A at diagnosis and during monitoring of GFD in pediatric CD.Methods:Eighty children with confirmed CD were selected. Levels of serum tTGA measured by RBA and a commercial enzyme‐linked immunosorbent assay (ELISA) were compared at diagnosis. The relation between RBA‐tTGA levels and histological damage was analyzed, as well as the time course of tTGA clearance during GFD.Results:Both RBA and ELISA showed high sensitivity and specificity for tTGA detection at diagnosis. There was no relation between RBA‐tTGA levels at diagnosis and severity of mucosal damage. Upon initiation of GFD, the rate of RBA‐tTGA positivity declined slower than that of endomysial antibodies positivity, with >50% of the children still tTGA positive at year 5; however, tTGA levels decreased rapidly during the first year of GFD and more slowly thereafter. Children who seroreverted had lower tTGA levels at diagnosis (2080±1554 cpm) than those who remained tTGA positive throughout follow‐up (3688±1435 cpm).Conclusions:The high sensitivity of RBA is likely responsible for higher tTGA positivity rates during GFD than previously reported with ELISA. A decreasing trend for tTGA levels may represent a better surrogate marker of compliance with GFD than absolute normal tTGA levels.
MYO5B Mutations in Patients With Microvillus Inclusion Disease Presenting With Transient Renal Fanconi Syndrome
Authors: Golachowska Magdalena R. , van Dael Carin M.L. , Keuning Hilda , Karrenbeld Arend , Hoekstra Dick , Gijsbers Carolien F.M. , Benninga Marc A. , Rings Edmond H.H.M. , van IJzendoorn Sven C.D. 
Published: October 2011

ABSTRACTBackground and Objective:Microvillus inclusion disease (MVID) is a rare congenital enteropathy associated with brush border atrophy and reduced expression of enzymes at the enterocytes' apical surface. MVID is associated with mutations in the MYO5B gene, which is expressed in all epithelial tissues. Whether organs other than the intestine are affected in MVID is unclear. We report 2 patients with MVID that developed renal Fanconi syndrome while receiving total parenteral nutrition. Renal Fanconi syndrome has been correlated to apical plasma membrane defects in kidney proximal tubular epithelial cells. The aim of the present study was to determine whether MYO5B mutations in these patients correlate with similar apical plasma membrane defects in renal tubular epithelial cells as observed in the intestine.Methods:Biopsies from kidney, duodenum, ileum, jejunum, and colon of 2 patients with MVID carrying MYO5B mutations and of age‐matched controls were fixed in paraffin and analyzed with immunohistochemistry and transmission electron microscopy.Results:Structural defects of the brush border and apical recycling endosome organization are observed in enterocytes of all of the segments of the small intestine and colon. MYO5B mutations in patients with MVID with renal Fanconi syndrome do not correlate with aberrant apical plasma membrane morphology or altered apical recycling endosome organization in renal tubular epithelial cells.Conclusions:MYO5B mutations have divergent effects on the apical membrane system in kidney and intestinal epithelial cells. Epithelial defects presented in MVID are therefore likely triggered by intestine‐specific factors, the identification of which may provide new targets and open avenues for the development of alternative therapeutic strategies to combat this devastating disease.
New Prebiotic Blend of Polydextrose and Galacto‐oligosaccharides Has a Bifidogenic Effect in Young Infants
Authors: Scalabrin Deolinda M.F. , Mitmesser Susan H. , Welling Gjalt W. , Harris Cheryl L. , Marunycz John D. , Walker D. Carey , Bos Nico A. , Tölkkö Satu , Salminen Seppo , Vanderhoof Jon A. 
Published: October 2011

ABSTRACTObjective:The aim of the study was to evaluate the effect of infant formula with polydextrose (PDX) and galacto‐oligosaccharides (GOS) on fecal microbiota and secretory IgA (sIgA).Materials and Methods:In the present double‐blind, randomized study, term infants received control (Enfamil Lipil) or the same formula with PDX/GOS (4 g/L, 1:1 ratio; PDX/GOS) for 60 days; a reference breast‐fed group was included. Formula intake, tolerance, and stool characteristics were collected via electronic diary and analyzed by repeated measures analysis of variance. Anthropometric measurements and stool samples were obtained at baseline and after 30 and 60 days of feeding. Fecal sIgA was measured by enzyme‐linked immunosorbent assay and fecal bacteria by fluorescent in situ hybridization and quantitative real‐time polymerase chain reaction (qPCR); both were analyzed by Wilcoxon rank sum test.Results:Two hundred thirty infants completed the study. Infants consuming PDX/GOS had softer stools than control at all times (P < 0.001). Using qPCR, counts in PDX/GOS were closer to the breast‐fed group, tended to be higher than control for total bifidobacteria (P = 0.069) and Bifidobacterium longum (P = 0.057) at 30 days, and were significantly higher for total bifidobacteria and B longum at 60 days and B infantis at 30 days (P = 0.002). No significant differences were detected between PDX/GOS and control in changes from baseline to 30 or 60 days for sIgA or total bifidobacteria by fluorescent in situ hybridization or qPCR; however, significantly higher changes from baseline were detected between PDX/GOS and control for B infantis at 30 days and B longum at 60 days (P ≤ 0.035).Conclusions:Infant formula with PDX/GOS produces soft stools and a bifidogenic effect closer to breast milk than formula without PDX/GOS.