bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methoxycarbonyl-etomidate
Authors: Cotten Joseph F. , Husain S Shaukat , Forman Stuart A. , Miller Keith W. , Kelly Elizabeth W. , Nguyen Hieu H. , Raines Douglas E. 
Published: July 2009

Background
Etomidate is a rapidly acting sedative-hypnotic that provides hemodynamic stability. It causes prolonged suppression of adrenocortical steroid synthesis; therefore, its clinical utility and safety are limited. The authors describe the results of studies to define the pharmacology of (R)-3-methoxy-3-oxopropyl1-(1-phenylethyl)-1H-imidazole-5-carboxylate (MOC-etomidate), the first etomidate analogue designed to be susceptible to ultra-rapid metabolism.

Methods
The gamma-aminobutyric acid type A receptor activities of MOC-etomidate and etomidate were compared by using electrophysiological techniques in human alpha1beta2gamma2l receptors. MOC-etomidate's hypnotic concentration was determined in tadpoles by using a loss of righting reflex assay. Its in vitro metabolic half-life was measured in human liver S9 fraction, and the resulting metabolite was provisionally identified by using high-performance liquid chromatography/mass spectrometry techniques. The hypnotic and hemodynamic actions of MOC-etomidate, etomidate, and propofol were defined in rats. The abilities of MOC-etomidate and etomidate to inhibit corticosterone production were assessed in rats.

Results
MOC-etomidate potently enhanced gamma-aminobutyric acid type A receptor function and produced loss of righting reflex in tadpoles. Metabolism in human liver S9 fraction was first-order, with an in vitro half-life of 4.4 min versus more than 40 min for etomidate. MOC-etomidate's only detectable metabolite was a carboxylic acid. In rats, MOC-etomidate produced rapid loss of righting reflex that was extremely brief and caused minimal hemodynamic changes. Unlike etomidate, MOC-etomidate produced no adrenocortical suppression 30 min after administration.

Conclusions
MOC-etomidate is an etomidate analogue that retains etomidate's important favorable pharmacological properties. However, it is rapidly metabolized, ultra-short-acting, and does not produce prolonged adrenocortical suppression after bolus administration.
Performance Improvement System and Postoperative Corneal Injuries
Authors: Martin David P. , Weingarten Toby N. , Gunn Paul W. , Lee KunMoo , Mahr Michael A. , Schroeder Darrell R. , Sprung Juraj 
Published: July 2009

Background
The authors' department conducted a performance improvement initiative aimed to reduce the rate of perioperative corneal injuries. This study reports the effects of the initiative and examines the risk factors for corneal injury.

Method
The rate of corneal injuries during nonophthalmologic procedures under anesthesia was compared between the two time periods: preinitiative baseline (August 1, 2005-December 31, 2005) and initiative period (January 1, 2006-April 30, 2007). To examine the risk factors for corneal injury, a nested case-control study with a 2:1 matched-set design was separately performed and included cases between January 1, 2006 and July 31, 2008.

Results
During the baseline period, the corneal injury rate was 1.51 per 1,000, and it decreased to 0.79 per 1,000 during the performance initiative (P = 0.008). Independent risk factors were longer anesthetics (odds ratio = 1.2, 95% confidence interval (CI) 1.1-1.3 per 30 min), lower American Society of Anesthesiologists physical status (odds ratio 0.5, 95% CI 0.3-0.8 for American Society of Anesthesiologists physical status 3-4 vs. 1-2), and student nurse anesthetist as a primary anesthesia provider (odds ratio 2.6, 95% CI 1.3-5.0).

Conclusion
Corneal injury rate in our institution was significantly reduced and remains at low levels long after initiation of perioperative eye care improvement initiative. The higher rate of corneal injuries among student nurse anesthetists highlights the importance of standardizing education and supervision among all anesthesia providers. We believe that our model of performance improvement initiative can be used to improve other perioperative outcomes.
Celiac Disease Revealed in 3% of Swedish 12‐year‐olds Born During an Epidemic
Authors: Myléus Anna , Ivarsson Anneli , Webb Charlotta , Danielsson Lars , Hernell Olle , Högberg Lotta , Karlsson Eva , Lagerqvist Carina , Norström Fredrik , Rosén Anna , Sandström Olof , Stenhammar Lars , Stenlund Hans , Wall Stig , Carlsson Annelie 
Published: July 2009

ABSTRACTObjective:Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12‐year‐olds born during the epidemic (1993), including both symptomatic and screening detected cases.Patients and Methods:All sixth‐grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)‐IgA (Celikey), and serum‐IgA, and some for tTG‐IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease.Results:Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7–11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17–23). The total prevalence was 29/1000 (95% CI 25–33).Conclusions:The celiac disease prevalence of 29/1000 (3%)—with two thirds of cases undiagnosed before screening—is 3‐fold higher than the usually suggested prevalence of 1%. When these 12‐year‐olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast‐feeding, which might have contributed to this unexpectedly high prevalence.
Flexible Upper Videoendoscopy Through a Modified Endoscopy Mask in Infants and Young Children
Authors: Somri Mostafa , Gaitini Louis , Yanovski Boris , Tome Riad , Resnikov Igor , Karsh Karam , Shaoul Ron 
Published: July 2009

ABSTRACTEsophagogastroduodenoscopy (EGD) is considered an essential diagnostic and therapeutic procedure in the pediatric population. Although generally safe, EGD has the potential for airway complications. We routinely use general anesthesia to carry out EGD in patients younger than 10 years. In the past, these patients received oxygen either through a nasal cannula or were intubated; both modalities have drawbacks and may be associated with complications. Here we report our experience using a modified endoscopy mask, devised primarily for bronchoscopy, for upper endoscopy in children under general anesthesia.Results:Two hundred forty children (122 boys and 118 girls) participated in the study. Age range was 7 to 135 months (mean 60.7 ± 34.4 months). All patients maintained a stable hemodynamic status throughout the procedure. Ventilation was satisfactory in 230 patients. It was difficult in 9 patients, and external airway maneuvers had to be applied. Ventilation was impossible in only 1 patient (10 months old), and endotracheal intubation was performed. There were no procedure‐related complications.Conclusion:The modified endoscopy mask is efficient and safe and should be recommended for routine use for upper endoscopy under general anesthesia in children older than 6 months.
Defining Eosinophilic Colitis in Children: Insights From a Retrospective Case Series
Authors: Behjati Sam , Zilbauer Matthias , Heuschkel Robert , Phillips Alan , Salvestrini Camilla , Torrente Franco , Bates Alan W 
Published: July 2009

ABSTRACTObjectives:Although it is a well‐described syndrome in infants, eosinophilic colitis is a loosely defined and poorly understood diagnosis in older children. The aims of this case series were to characterise colonic eosinophilia in children and to determine whether it represents a distinct clinicopathological condition.Methods:We retrospectively reviewed symptomatic children older than 12 months with the principal diagnosis of colonic eosinophilia who presented between January 2000 and February 2007 (n = 38) and a further 10 children whose colonic biopsies were reported as histologically normal. The eosinophil density in all available gastrointestinal biopsies (n = 620) of these children was determined using a validated quantitative morphometric method. Patients were subdivided according to mean colonic eosinophil levels into 3 groups (marked, moderate, or minimal colonic eosinophilia). The following patient information was obtained and compared among patient groups: symptoms prompting endoscopy, atopic history, outcome, serum C‐reactive protein and total immunoglobulin E (IgE) levels, erythrocyte sedimentation rate, blood eosinophil count, and endoscopic findings.Results:In all 3 patient groups, there was a colonic gradient of decreasing eosinophil density from caecum to rectum. Upper gastrointestinal tract biopsies did not exhibit eosinophilia. Although a significant association (P = 0.03) between abnormal total IgE levels and moderate or severe colonic eosinophilia was found, there was no significant difference (P > 0.05) in other patient characteristics. Furthermore, follow‐up data did not show a consistent relation between eosinophil density and progression of symptoms.Conclusions:We find no association between “eosinophilic colitis,” defined as a histologically demonstrated marked colonic eosinophilia, and symptoms, history of atopy, inflammatory markers, or clinical outcome.
Gastrostomy Placement Improves Height and Weight Gain in Girls With Rett Syndrome
Authors: Motil Kathleen J , Morrissey Matthew , Caeg Erwin , Barrish Judy O , Glaze Daniel G 
Published: July 2009

ABSTRACTBackground:Growth failure and undernutrition complicate the clinical course of girls with Rett syndrome (RTT). These abnormalities are, in part, the consequence of oral motor dysfunction and inadequate dietary intake.Objective:To determine whether gastrostomy placement for nutritional therapy alters the natural history of growth failure and undernutrition in RTT.Hypothesis:We hypothesized that gastrostomy placement for nutritional therapy reverses the decline in height, weight, and body mass index (BMI) z scores in RTT.Methods:Standard stadiometric and anthropometric measures were obtained to derive height, weight, and BMI z scores and estimates of fat‐free mass (FFM) and body fat in a cohort of girls (n = 92) with RTT before and after gastrostomy placement. Methyl‐CpG‐binding protein 2 (MECP2) mutations and the presence or absence of a fundoplication were recorded.Results:The differences in height (n = 73), weight (n = 81), and BMI (n = 81) z score slopes before and after gastrostomy placement were 1.31 + 2.06 (P < 0.001), 2.38 ± 3.18 (P < 0.001), and 3.25 ± 3.32 (P < 0.001), respectively. FFM and body fat (n = 43) increased after gastrostomy by 41 ± 27 g/cm height (P < 0.001) and 7.5% ± 5.7% body weight (P < 0.001), respectively. The differences in height, weight, and BMI z score slopes were similar regardless of the age at which the gastrostomy was placed. The differences in height, weight, and BMI z score slopes, as well as the change in FFM and body fat deposition after gastrostomy placement, did not differ between those who did or did not have a fundoplication and among the classes of MECP2 mutations.Conclusion:Gastrostomy placement for aggressive nutritional therapy favorably altered the natural history of growth failure and undernutrition in RTT, but did not restore height and weight z scores to birth values, regardless of the age at which surgery occurred and in the presence or absence of a fundoplication.
Headache in Pediatric Patients With Celiac Disease and Its Prevalence as a Diagnostic Clue
Authors: Lionetti Elena , Francavilla Ruggiero , Maiuri Luigi , Ruggieri Martino , Spina Massimo , Pavone Piero , Francavilla Teresa , Magistà Anna Maria , Pavone Lorenzo 
Published: July 2009

ABSTRACTObjectives:To establish the prevalence of headache in children with celiac disease (CD), the response to a gluten‐free diet, and the prevalence of CD in children affected by headache.Methods:This hospital‐based study included 2 steps. In the retrospective part, 354 children with CD answered a questionnaire investigating the presence of headache before and after the gluten‐free diet. The same questionnaire was administered to 200 healthy children matched for sex and age. In the prospective part, 79 children affected by headache were screened for CD by antitransglutaminase IgA. Diagnosis of CD was confirmed by duodenal biopsy; before starting a gluten‐free diet patients underwent a brain positron emission tomography study. After 6 months of follow‐up children were reevaluated for the presence of headache.Results:Overall, 88 patients with CD complained of headaches before the diagnosis of CD as compared with 16 in the control group (24.8% vs 8%, P < 0.001). After the institution of a gluten‐free diet, the headaches significantly improved in 68 children (77.3%), of whom 24 (27.3%) were headache‐free during the study period. Four of 79 (5%) headache patients were found to have CD compared with 0.6% of the general population (P = 0.005). The brain positron emission tomography studies did not show any anomalies. During the follow‐up, headaches improved in all 4 children with CD.Conclusions:We recorded—in our geographical area—a high frequency of headaches in patients with CD and vice versa with a beneficial effect of a gluten‐free diet. Screening for CD could be advised in the diagnostic work‐up of patients with headache.
Prebiotics Improve Gastric Motility and Gastric Electrical Activity in Preterm Newborns
Authors: Indrio Flavia , Riezzo Giuseppe , Raimondi Francesco , Francavilla Ruggiero , Montagna Osvaldo , Valenzano Maria Luigia , Cavallo Luciano , Boehm Günther 
Published: July 2009

ABSTRACTThe aim of this double‐blind, randomized, placebo‐controlled study was to evaluate the effect of a prebiotic mixture on gastric motility in preterm newborns. After a feeding period of 15 days, gastric electrical activity was measured by electrogastrography, and the gastric emptying time was studied by ultrasound technique. No difference was seen in the daily increase of body weight, and no adverse events have been reported. The percentage of time in which propagation was detected in the electrogastrography signal was twice in newborns receiving formula with prebiotics with respect to placebo, and the gastric half‐emptying time was 30% faster in the prebiotic group than the placebo group. Prebiotic oligosaccharides can modulate the electrical activity and the gastric emptying and may improve the intestinal tolerance of enteral feeding in preterm infants.
Risk of Capsule Endoscope Retention in Pediatric Patients: A Large Single‐center Experience and Review of the Literature
Authors: Atay Orhan , Mahajan Lori , Kay Marsha , Mohr Franziska , Kaplan Barbara , Wyllie Robert 
Published: July 2009

ABSTRACTObjectives:Capsule retention is a potential complication of capsule endoscopy (CE). The aims of our study were to determine the incidence of capsule retention in pediatric patients undergoing CE and to identify potential risk factors for capsule retention.Materials and Methods:We performed an institutional review board–approved retrospective chart review of pediatric patients undergoing CE studies at a single center. Data collected included patient age, sex, prior diagnosis of inflammatory bowel disease (IBD), CE indication, prior small bowel series results, study result, and complications.Results:Two hundred seven CE procedures were performed in pediatric patients during the study period. Capsule retention occurred in 3 (1.4%) of the 207 studies. All 3 patients had known Crohn disease (CD). The risk of capsule retention in pediatric patients with known IBD was 5.2% (3/58). The risk of capsule retention for patients with suspected IBD and all other indications was 0%. If small bowel disease was identified on upper gastrointestinal series in patients with known CD, then the risk of capsule retention was 37.5% (3/8). Only 7 patients with known IBD had a body mass index (BMI) below the 5th percentile. Of these 7 patients, 3 (43%) had capsule retention.Conclusions:Red flags for potential CE retention identified in our study include known IBD (5.2% retention risk), previous small bowel follow‐through demonstrating small bowel CD (37.5% retention risk), and BMI <5th percentile with known IBD (43% retention risk). Caution is advised in these pediatric patients before capsule ingestion.
Randomized Controlled Trial of Feeding a Concentrated Formula to Infants Born to Women Infected by Human Immunodeficiency Virus
Authors: Winter Harland S , Oleske James M , Hughes Michael D , McKinney Ross E , Elgie Carol , Powell Christine , Purdue Lynette , Puga Ana M , Jimenez Eleanor , Scott Gwendolyn B , Cruz Maria Leticia Santos , Moye Jack ,   Pediatric AIDS Clinical Trials Group Protocol 247 Study Team
Published: July 2009

ABSTRACTObjective:We tested the hypothesis that concentrated formula (CF) begun within the first 2 weeks of life increases growth in infants born to human immunodeficiency virus (HIV)–infected mothers.Materials and Methods:HIV‐exposed infants from the United States, the Bahamas, and Brazil were randomized in a double‐blind, controlled trial to receive either a CF (87 kcal/100 mL [26 kcal/oz]) or a standard formula (SF; 67 kcal/100 mL [20 kcal/oz]) for 8 weeks. This article presents results for infants who were not determined to be HIV infected based on testing at 4 weeks. Primary outcomes were safety, tolerability, and growth in weight and length.Results:Two thousand ninety‐seven infants were enrolled, of whom 1998 were uninfected and had study formula dispensed. At weeks 4 and 8, uninfected infants receiving CF showed higher energy intake than those who were receiving SF (P < 0.001). By week 8, uninfected infants assigned to CF weighed more than infants receiving SF. There were no consistent differences in measures of tolerability, and rates of discontinuation or perceived formula intolerance were similar between treatment groups.Conclusions:A CF is well tolerated and results in increased weight gain compared with SF. Until the HIV status of an infant is reliably determined, early introduction of a CF in HIV‐exposed children may have beneficial effects on growth. The role of early nutritional intervention remains to be determined for individuals living in countries with endemic malnutrition for whom formula feeding is a viable option.
Moving From Tube to Oral Feeding in Medically Fragile Nonverbal Toddlers
Authors: Davis Ann McGrath , Bruce Amanda Schurle , Mangiaracina Cathy , Schulz Trina , Hyman Paul 
Published: July 2009

ABSTRACTThe current article describes a 14‐week outpatient protocol for transitioning from gastrostomy tube to oral feeding in toddlers with medical complications. The team ensured that eating skills were mastered before treating patients for 8 weeks with continuous gastrojejunal drip tube feedings and low‐dose tricyclic antidepressant and/or gabapentin. We prescribed 6 weeks of megestrol for hunger provocation while withdrawing tube feedings. A chart review after treatment demonstrated 9 subjects were eating exclusively orally and 1 was eating 50% orally.
Infliximab Therapy in Children With Concurrent Perianal Crohn Disease: Observations From REACH
Authors: Crandall Wallace , Hyams Jeffrey , Kugathasan Subra , Griffiths Anne , Zrubek Julie , Olson Allan , Liu Grace , Heuschkel Robert , Markowitz James , Cohen Stanley , Winter Harland , Veereman‐Wauters Gigi , Ferry George , Baldassano Robert N 
Published: July 2009

ABSTRACTObjective:Post hoc analyses evaluated the effect of infliximab upon concurrent perianal Crohn disease (CD) in a subpopulation of 31 patients from REACH, a randomized trial of 112 children with moderately to severely active luminal CD.Materials and Methods:The Pediatric Crohn Disease Activity Index perirectal subscore was used to assess perianal symptom activity and therapeutic response. Patients with no symptoms or asymptomatic tags received a score of 0; those with “1–2 indolent fistula, scant drainage, no tenderness” received a score of 5; and those with “active fistula, drainage, tenderness or abscess” received a score of 10. Initial perirectal subscores of 10 or 5 decreasing to 0 were considered complete response. Subscores of 10 decreasing to 5 were considered partial response. All patients were followed for efficacy and safety through week 54.Results:Twenty‐two patients with baseline perianal disease were randomized at week 10 following a 3‐dose infliximab induction regimen. At week 2, 40.9% (9/22) of patients with signs and symptoms of perianal disease at baseline attained response (4 partial and 5 complete). At week 54, 72.7% (16/22) of patients with signs and symptoms of perianal disease attained response (1 partial and 15 complete). Nine patients developed perianal signs and symptoms during treatment; 7 had complete response and 2 had no response at week 54. The incidence of adverse events for patients with perianal symptoms at baseline and for those in the overall REACH population was similar (95.7% vs 94.6%).Conclusions:Infliximab rapidly reduced concurrent perianal disease signs and symptoms in this REACH cohort.
Molecular and Chromosomal Evidence for Allopolyploidy in Soybean
Authors: Gill Navdeep , Findley Seth , Walling Jason G. , Hans Christian , Ma Jianxin , Doyle Jeff , Stacey Gary , Jackson Scott A. 
Published: July 2009

AbstractRecent studies have documented that the soybean (Glycine max) genome has undergone two rounds of large-scale genome and/or segmental duplication. To shed light on the timing and nature of these duplication events, we characterized and analyzed two subfamilies of high-copy centromeric satellite repeats, CentGm-1 and CentGm-2, using a combination of computational and molecular cytogenetic approaches. These two subfamilies of satellite repeats mark distinct subsets of soybean centromeres and, in at least one case, a pair of homologs, suggesting their origins from an allopolyploid event. The satellite monomers of each subfamily are arranged in large tandem arrays, and intermingled monomers of the two subfamilies were not detected by fluorescence in situ hybridization on extended DNA fibers nor at the sequence level. This indicates that there has been little recombination and homogenization of satellite DNA between these two sets of centromeres. These satellite repeats are also present in Glycine soja, the proposed wild progenitor of soybean, but could not be detected in any other relatives of soybean examined in this study, suggesting the rapid divergence of the centromeric satellite DNA within the Glycine genus. Together, these observations provide direct evidence, at molecular and chromosomal levels, in support of the hypothesis that the soybean genome has experienced a recent allopolyploidization event.