bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stentless versus Stented Bioprosthetic Aortic Valves
Authors: Cheng Davy , Pepper John , Martin Janet , Stanbridge Rex , Ferdinand Francis D. , Jamieson W. R. Eric , Stelzer Paul , Berg Geoffrey , Sani Guido 
Published: May 2009

Objective This meta-analysis sought to determine whether stentless bioprosthetic valves improve clinical and resource outcomes compared with stented valves in patients undergoing aortic valve replacement. Methods A comprehensive search was undertaken to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in patients undergoing aortic valve replacement available up to March 2008. The primary outcomes were clinical and resource outcomes in randomized controlled trial (RCT). Secondary outcomes clinical and resource outcomes in nonrandomized controlled trial (non-RCT). Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences and their 95% confidence intervals (CI) were analyzed as appropriate. Results Seventeen RCTs published in 23 articles involving 1317 patients, and 14 non-RCTs published in 18 articles involving 2485 patients were included in the meta-analysis. For the primary analysis of randomized trials, mortality for stentless versus stented valve groups did not differ at 30 days (OR 1.36, 95% CI 0.68–2.72), 1 year (OR 1.01, 95% CI 0.55–1.85), or 2 to 10 years follow-up (OR 0.82, 95% CI 0.50–1.33). Aggregate event rates for all-cause mortality at 30 days were 3.7% versus 2.9%, at 1 year were 5.5% versus 5.9% and at 2 to 10 years were 17% versus 19% for stentless versus stented valve groups, respectively. Stroke or neurologic complications did not differ between stentless (3.6%) and stented (4.0%) valve groups. Risk of prosthesis-patient mismatch was numerically lower in the stentless group (11.0% vs. 31.3%, OR 0.30, 95% CI 0.05–1.66), but this parameter was reported in few trials and did not reach statistical significance. Effective orifice area index was significantly greater for stentless aortic valve compared with stented valves at 30 days (WMD 0.12 cm2/m2), at 2 to 6 months (WMD 0.15 cm2/m2), and at 1 year (WMD 0.26 cm2/m2). Mean gradient at 1 month was significantly lower in the stentless valve group (WMD −6 mm Hg), at 2 to 6 month follow-up (WMD −4 mm Hg,), at 1 year follow-up (WMD −3 mm Hg) and up to 3 year follow-up (WMD −3 mm Hg) compared with the stented valve group. Although the left ventricular mass index was generally lower in the stentless group versus the stented valve group, the aggregate estimates of mean difference did not reach significance during any time period of follow-up (1 month, 2–6 months, 1 year, and 8 years). Conclusions Evidence from randomized trials shows that subcoronary stentless aortic valves improve hemodynamic parameters of effective orifice area index, mean gradient, and peak gradient over the short and long term. These improvements have not led to proven impact on patient morbidity, mortality, and resource-related outcomes; however, few trials reported on clinical outcomes beyond 1 year and definitive conclusions are not possible until sufficient evidence addresses longer-term effects.
Epicardial Ablation on the Beating Heart
Authors: Lee Anson M. , Aziz Abdulhameed , Sakamoto Shun-Ichiro , Schuessler Richard B. , Damiano Ralph J. 
Published: May 2009

Objective To perform a minimally invasive procedure for atrial fibrillation without cardiopulmonary bypass, it is necessary to create transmural lesions on the beating heart. Although bipolar radiofrequency clamps can isolate the pulmonary veins, they have difficulty in performing any other left atrial lesions, particularly those of the traditional Cox-Maze procedure. This study examined the performance of an internally cooled, bipolar radiofrequency device designed for such an application. Methods Eleven domestic pigs underwent median sternotomy. Five animals had eight atrial lesions created with the radiofrequency device at times of 20, 30, 40, and 50 seconds. In six other pigs, the device was compared with another technology that has been used clinically for epicardial, beating heart ablation, the Guidant Flex 4 microwave device. The tissue was stained with 2,3,5-triphenyltetrazoluim chloride, and the lesions were sectioned at 5-mm intervals. Lesion width, depth, and transmurality were evaluated. Results The radiofrequency device had a linear dose-response relationship. Lesions were wider and deeper with increasing ablation times. A total of 40%, 45%, 60%, and 67% of lesions were transmural at times of 20, 30, 40, and 50 seconds, respectively. Ninety-one percent of lesions in tissue up to 4-mm thick were transmural after 50 seconds. However, performance in thicker tissue was poor. Lesions created by the device were deeper and more likely to be transmural than the Flex 4. Conclusions This internally cooled, bipolar radiofrequency device can reliably create transmural lesions on tissue up to 4-mm thick and performs better than a microwave device.
Epidemiology of Pediatric Chronic Inflammatory Bowel Disease in Central and Western Slovenia, 1994–2005
Authors: Orel Rok , Kamhi Tina , Vidmar Gaj , Mamula Petar 
Published: May 2009

ABSTRACTBackground:The aim of this study was to determine the epidemiological and clinical characteristics of inflammatory bowel disease (IBD) in children in central and western Slovenia during a 12‐year period (1994–2005).Materials and Methods:The medical records of patients with newly diagnosed IBD during the period of 1994–2005 were retrospectively reviewed.Results:In the 12‐year study period, 137 children received new diagnoses of IBD, 60% had Crohn disease (CD), 28% had ulcerative colitis (UC), and 12% had indeterminate colitis (IC). The mean annual incidence of IBD for the whole 12‐year period was 4.03/100,000 children; for CD 2.42, for UC 1.14, and for IC 0.47. The annual incidence of IBD rose from 3.04 in the period 1994–1999 to 5.14 in the period 2000–2005. The incidences of CD, UC, and IC rose from 1.99, 0.77, and 0.28, respectively, in the first 6 years to 2.88, 1.57, and 0.69, respectively, in the second 6‐year period. The most common type of CD at presentation was inflammatory. Pancolitis was the most frequent form of UC. Almost half of the patients had a severe form of CD at its onset.Conclusions:The incidence of total pediatric IBD in central and western Slovenia is high and seems to be still rising. CD is the most prevalent form of IBD; its incidence is comparable with that reported in other central and western European countries. The incidences of UC and IC are rising more rapidly than the incidence of CD.
Oats Do Not Induce Systemic or Mucosal Autoantibody Response in Children With Coeliac Disease
Authors: Koskinen Outi , Villanen Mikko , Korponay‐Szabo Ilma , Lindfors Katri , Mäki Markku , Kaukinen Katri 
Published: May 2009

ABSTRACTObjectives:A gluten‐free diet omitting wheat, rye, and barley is the only effective treatment for coeliac disease. The necessity of excluding oats from the diet has remained controversial. We studied the toxicity of oats in children with coeliac disease during a 2‐year follow‐up by investigating jejunal transglutaminase 2 (TG2)‐targeted IgA‐class autoantibody deposits, a potentially more sensitive disease marker than serum antibodies or conventional histology.Patients and Methods:Twenty‐three coeliac children in remission were randomized to undergo oat or gluten challenge with wheat, rye, barley, and oats. When jejunal histological relapse was evident after gluten challenge, patients excluded wheat, rye, and barley but continued with oats. Mucosal morphology and TG2‐targeted autoantibody deposits were studied in jejunal biopsies taken at baseline and after 6 and 24 months. Furthermore, serum IgA‐class TG2 antibodies were measured.Results:At baseline, serum TG2 antibodies were negative in all 23 patients, but 7 of them had minor mucosal deposits. In the oats group, there was no significant change in the intensity of the deposits within 2 years. In contrast, during the gluten challenge, the intensity of the deposits clearly increased and decreased again when wheat, rye, and barley were excluded but consumption of oats was continued; this was in line with serum autoantibodies. The intensity of the mucosal deposits correlated well with both villous morphology and serum autoantibody levels.Conclusions:Consumption of oats does not induce TG2 autoantibody production at mucosal level in children with coeliac disease. Measurement of small‐intestinal mucosal autoantibody deposits is suitable for monitoring treatment in coeliac patients.
Bowel Habits and Toilet Training in a Diverse Population of Children
Authors: Wald Ellen R , Di Lorenzo Carlo , Cipriani Lynne , Colborn D Kathleen , Burgers Rosa , Wald Arnold 
Published: May 2009

ABSTRACTObjectives:To gather data concerning bowel habits and toilet training of developmentally normal children ages 5 to 8 years.Methods:A questionnaire containing information on age, race, and sex was completed anonymously by a parent in 9 pediatric practices. Recall information was elicited about onset and completion of toilet training, frequency and quality of stooling, size of bowel movements, and behavioral components of defecation.Results:Questionnaires were completed for 1142 children. When all of the children were considered together, toilet training started at a mean of 27.2 months and was completed at a mean of 32.5 months. It began and was completed nearly 3 months earlier for girls than for boys (P < 0.001). African American children started and completed toilet training at least 6 months earlier than white children (P < 0.001). Of the children, 95% defecated either daily or every other day. Straining at defecation and infrequent stooling were reported significantly more often for girls, whereas staining of underclothes and passage of large bowel movements were reported more often in boys. Approximately 10% of children fulfilled criteria for functional constipation.Conclusions:Most of the children between 5 and 8 years of age have a medium‐size bowel movement daily or every other day without straining or withholding. Although African American children toilet train at an earlier age than do white children, bowel habits appear to be similar. A sizeable subgroup of children presenting to primary care providers have a history that is consistent with constipation.
Pruritus Ani: An Approach to an Itching Condition
Authors: Stermer Edy , Sukhotnic Igor , Shaoul Ron 
Published: May 2009

ABSTRACTPruritus ani is frequently encountered in children by the primary care physician and the pediatrician. It is mainly due to an infection with pinworms, but fecal soiling, poor hygiene, local irritation, and dietary agents should also be considered. Treatment should be directed at the underlying etiology. Once these have been excluded, both general and specific measures must be initiated. There is almost no experience for local treatment modalities in children, and they cannot currently be recommended.
Safety of Rapid Intravenous Rehydration and Comparative Efficacy of 3 Oral Rehydration Solutions in the Treatment of Severely Malnourished Children With Dehydrating Cholera
Authors: Alam Nur H , Islam Sufia , Sattar Samima , Monira Shirajum , Desjeux Jehan‐François 
Published: May 2009

ABSTRACTObjectives:Assess the safety of rapid intravenous rehydration of severely malnourished children and compare the efficacy of 3 formulations of oral rehydration salts solutions.Patients and Methods:A group of 175 severely malnourished children of either sex (weight/length <70% of National Center for Health Statistics median), ages 6 to 36 months with cholera, were randomly assigned to receive 1 of 3 oral rehydration solutions (ORSs): glucose‐ORS (n = 58), glucose‐ORS plus 50 g/L of amylase‐resistant starch (n = 59), or rice‐ORS (n = 58). Severely dehydrated children at enrollment were administered 100 mL/kg of an intravenous solution for 4 to 6 hours before randomisation, and those with some dehydration were randomised on enrollment. The electrolytes of the 3 ORSs were identical. In acute and convalescence phases, treatment was similar other than the nature of the ORSs.Results:Intravenous fluid (mean) administered to 149 study children was 103 mL/kg (95% confidence interval [CI] 96–109), and all were rehydrated within 6 hours. None of them developed overhydration or heart failure. During the first 24 hours, stool output (31%; 95% CI 14%–42%; P = 0.004) and the ORS intake (26%; 95% CI 12%–37%; P = 0.002) of children receiving rice‐ORS were significantly less compared with children receiving glucose‐ORS. The mean duration of diarrhoea in all children (66 hours; 95% CI 62–71), and time to attain 80% of median weight/length (7.15 ± 2.81 days) were not different.Conclusions:Dehydration in severely malnourished children can safely be corrected within 6 hours. All study ORSs were equally efficient in correcting dehydration. Rice‐ORS significantly reduced the stool output and ORS intake, confirming previous reports.
Time Course of Bacterial Diversity in Stool Samples of Malnourished Children With Cholera Receiving Treatment
Authors: Monira Shirajum , Alam Nur Haque , Suau Antonia , Magne Fabien , Nair Gopinath Balakrish , Karmakar Polash Chandra , Rahman Motiur , Pochart Philippe , Desjeux Jehan‐Francois 
Published: May 2009

ABSTRACTBackground:Recent nutritional interventions have targeted colonic functions in patients with infectious diarrhea during rehydration and during recovery from malnutrition, with the assumption that the effects will be influenced by metabolism of complex carbohydrates by colonic bacteria. However, the diversity of colonic bacteria in patients with cholera is not known.Aim:To study the diversity of colonic bacteria in malnourished children with cholera before and during treatment with oral rehydration salt solutions containing 1 of these 3 substrates: glucose, rice, or amylase‐resistant starch.Patients and Methods:Serial fecal samples were collected from 30 malnourished children with cholera until completion of rehydration and partial nutritional recovery; 11 malnourished children without diarrhea; and 6 better nourished children. Polymerase chain reaction, using universal primers for 16S rDNA, was performed on chromosomal DNA extracted from the stool samples, and the products were separated by temporal temperature gradient gel electrophoresis.Results:The Vibrio cholerae band was detected in all children at enrollment and disappeared within 2 days. On day 2, a rapid and significant increase in the band numbers was observed, which was followed by a steady increase until day 28. After full recovery from cholera and partial recovery from malnutrition, the number of bands (11.5 ± 2.8) was lower than in healthy children (22.2 ± 1.3). On day 3, the number of bands was greater with rice or amylase‐resistant starch than with glucose (P < 0.05).Conclusions:Bacterial diversity was markedly but transiently altered in severely malnourished children with cholera receiving therapy.
Intestinal Microbiota During Infancy and Its Implications for Obesity
Authors: Reinhardt Christoph , Reigstad Christopher S , Bäckhed Fredrik 
Published: May 2009

ABSTRACTObesity is a worldwide epidemic, threatening both industrialized and developing countries, and is accompanied by a dramatic increase in obesity‐related disorders, including type 2 diabetes mellitus, hypertension, cardiovascular diseases, and nonalcoholic fatty liver disease. Recent studies have shown that the gut microbial community (microbiota) is an environmental factor that regulates obesity by increasing energy harvest from the diet and by regulating peripheral metabolism. However, there are no data on how obesogenic microbiotas are established and whether this process is determined during infancy. The sterile fetus is born into a microbial world and is immediately colonized by numerous species originating from the surrounding ecosystems, especially the maternal vaginal and fecal microflora. This initial microbiota develops into a complex ecosystem in a predictable fashion determined by internal (eg, oxygen depletion) and external (eg, mode of birth, impact of environment, diet, hospitalization, application of antibiotics) factors. We discuss how the gut microbiota regulates obesity and how environmental factors that affect the establishment of the gut microbiota during infancy may contribute to obesity later in life.
Impact of Hepatitis C Virus Infection on Children and Their Caregivers: Quality of Life, Cognitive, and Emotional Outcomes
Authors: Rodrigue James R , Balistreri William , Haber Barbara , Jonas Maureen M , Mohan Parvathi , Molleston Jean P , Murray Karen F , Narkewicz Michael R , Rosenthal Philip , Smith Lesley J , Schwarz Kathleen B , Robuck Patricia , Barton Bruce , González‐Peralta Regino P 
Published: May 2009

ABSTRACTObjective:Hepatitis C virus (HCV) infection is associated with decreased quality of life (QOL) and neurocognitive dysfunction in adults, but little is known about its impact on children and their caregivers.Patients and Methods:We studied the QOL, behavioral, emotional, and cognitive functioning of 114 treatment‐naïve children with HCV enrolled in a placebo‐controlled, randomized, multisite clinical trial evaluating peginterferon α‐2a alone or with ribavirin. Baseline assessment included measures of children's QOL, cognitive functioning, behavioral adaptation, and depression. Caregivers' QOL also was assessed.Results:Relative to published normative data, caregivers were more likely to believe that their children's health was poor and would likely worsen (t = 3.93; P < 0.0001), and reported higher concern about their children's health status (t = 6.63; P < 0.0001) and that this concern limited family activities (t = 2.45; P < 0.01); they also viewed their children as having more internalizing behavioral problems (t = 1.98; P < 0.05). Only 2 (2%) children had a score in the clinically depressed range. Children with HCV had worse cognitive functioning than the normative sample but significantly better functioning than children with attention‐deficit/hyperactivity disorder. Caregivers' QOL scores did not differ significantly from the normative sample, but infected mothers had lower QOL than noninfected caregivers. Caregivers were highly distressed about their children's medical circumstances.Conclusions:Although HCV infection, in its early stages, does not lead to global impairment in QOL, cognitive, behavioral, or emotional functioning in children, it is associated with higher caregiver stress and strain on the family system, and it may be associated with some cognitive changes in children.
Long‐term Outcome of Children With Biliary Atresia Who Were Not Transplanted After the Kasai Operation: >20‐year Experience at a Children's Hospital
Authors: Shinkai Masato , Ohhama Youkatsu , Take Hiroshi , Kitagawa Norihiko , Kudo Hironori , Mochizuki Kyoko , Hatata Tomoko 
Published: May 2009

ABSTRACTObjective:Sequential strategies combining the Kasai operation as a first‐line treatment and liver transplantation as a second‐line option, if necessary, have been accepted for patients with biliary atresia (BA). To understand the role of the Kasai operation in the treatment of BA, it is necessary to analyze the long‐term outcome of the operation alone and to evaluate the present status of survivors retaining their native livers.Materials and Methods:A retrospective chart review was carried out for a group of 80 patients who had undergone the Kasai operation between 1970 and 1986 at the Kanagawa Children's Medical Center.Results:The 5‐, 10‐, and 20‐year survival rates of patients with their native livers were 63%, 54%, and 44%, respectively. The survival rates varied significantly depending on the type of BA, age at initial Kasai operation, era of surgery, and surgical method. By age 20, nearly half of the adult survivors had already developed liver cirrhosis and its sequelae. Episodes of cholangitis and gastrointestinal bleeding occurred after 20 years of age in 37% and 17% of the adult patients, respectively, and 20% of the adult patients died of liver failure or underwent living‐related partial liver transplantation in their 20s. Five female patients gave birth to a total of 9 children, and 1 male patient fathered a child.Conclusions:Although increasing numbers of patients with BA survive 20 years or more after the Kasai operation, meticulous lifelong postoperative care should be continued for the survivors because of the possibility of hepatic deterioration.
Diagnostic Clues for Identification of Nonorganic vs Organic Causes of Food Refusal and Poor Feeding
Authors: Levy Yuval , Levy Anat , Zangen Tsili , Kornfeld Lia , Dalal Ilan , Samuel Eli , Boaz Mona , Ben David Nophar , Dunitz Marguerite , Levine Arie 
Published: May 2009

ABSTRACTObjectives:Food refusal, poor feeding, and somatic symptoms such as vomiting, gagging, irritability and failure to thrive (FTT) are commonly found in both infantile feeding disorders (IFD) and common treatable medical conditions. Present diagnostic classifications for diagnosing IFD are complex and difficult to apply in daily practice, leading to underdiagnosis and delay in diagnosis of IFD. We attempted to identify parental and infantile behaviour patterns or symptoms that could help distinguish between organic or behavioural causes for these symptoms.Methods:We screened 226 children with poor feeding. After exclusion criteria, we divided the remaining 151 into 2 groups. The nonorganic group (n = 83) included patients with onset of symptoms before age 2, persistent food aversion longer than 1 month, and a response to behavioural intervention. The second group consisted of children (n = 68) presenting with similar characteristics, who responded to medical or nutritional therapy in which a final diagnosis of gastro‐esophageal reflux disease, milk allergy, or idiopathic or nutritional FTT was made.Results:Poor intake, poor weight gain, or vomiting did not discriminate between organic and nonorganic causes. Factors indicating the presence of a behavioural cause included food refusal, food fixation, abnormal parental feeding practices, onset after a specific trigger, and presence of anticipatory gagging (P < 0.0001 for all).Conclusions:Integration of a few structured questions regarding infant behaviour, parental feeding practices, infant symptoms, and triggers for the onset of symptoms may help clinicians distinguish between organic and nonorganic causes for food refusal or low intake FTT.