bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age at Time of Hepatitis Be Antibody Seroconversion in Childhood Chronic Hepatitis B Infection and Mutant Viral Strain Detection Rates
Authors: Ando Toshihiro , Sugiyama Kohachiro , Goto Kenji , Miyake Yoshishige , Li Rou , Kawabe Yoshikazu , Wada Yoshiro 
Published: February 2024

ABSTRACTBackground:Investigations of adult patients have demonstrated that with seroconversion, changes occur from wild‐type strains of the infecting virus to mutant strains. However, to date, there have been few reports and insufficient investigation of this issue in children.Methods:The presence or absence of nucleotide base and amino acid sequence mutations in a portion of the X region containing the core promoter region, the pre‐C region, and the C region of HBV genomic DNA were investigated using a polymerase chain reaction‐direct sequencing method on serum samples collected from 14 children who were hepatitis Be antibody (HBeAb)‐positive carriers. Samples from three children who were HBe antigen (HBeAg)‐positive carriers served as the control subjects.Results:When patients were grouped based on whether they had had documented seroconversion before age 6 or at age 6 or older, differences in mutant viral detection rates involving the core promoter region and the pre‐C region were apparent. Specifically, a mutant strain showing a G‐to‐A substitution at nucleotide 83 in the pre‐C region, or a mutant strain showing an A‐to‐T substitution at nucleotide 1762 and a G‐to‐A substitution at nucleotide 1764, was detected in only two of eight cases (25%) from the HBeAb‐positive carriers with documented seroconversion before age 6. In contrast, these findings were present in six of six patients (100%) with documented serocon‐version at age 6 or older.Conclusions:The results of the present study suggest that the mechanism of onset of HBeAb seroconversion differs between children aged less than 6 years and those who are aged 6 or more.
Intestinal Absorption and Permeability in Paediatric Short‐Bowel Syndrome: A Pilot Study
Authors: D'Antiga Lorenzo , Dhawan Anil , Davenport Mark , Mieli‐Vergani Giorgina , Bjarnason Ingvar 
Published: February 2024

ABSTRACTBackground:Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short‐bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status of intestinal mucosa of these patients.Methods:Six children with short‐bowel syndrome‐median age, 12 months, and median small bowel length at birth, 30 cm‐had a sugar test with 3‐o‐methyl‐D‐glucose, D‐xylose, D‐rhamnose, and melibiose approximately 2 months after operation. The melibiose/L‐rhamnose ratio was used as an index of permeability, and percentages of 3‐o‐methyl‐D‐glucose and D‐xylose absorbed were used as indices of absorption. Parenteral nutrition requirement, bowel length, liver disease, recent sepsis, and bacterial overgrowth were recorded.Results:Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver disease. All subjects had malabsorption of 3‐o‐methyl‐D‐glucose, and five of six had malabsorption of D‐xylose and L‐rhamnose. The absorption of 3‐o‐methyl‐D‐glucose correlated with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D‐xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time.Conclusions:Increased permeability was observed in three of six patients with short‐bowel syndrome associated with a recent episode of sepsis and severe liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple points during the disease course whether the test can be helpful in the management of these patients.
Quality of Life in Children with Crohn's Disease: A Pilot Study
Authors: Akobeng Anthony K. , Suresh‐Babu Mirajkar V. , Firth David , Miller Victor , Mir Pervaiz , Thomas Adrian G. 
Published: February 2024

ABSTRACTBackground:Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88‐item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation.Methods:The questionnaire covered six domains of health‐related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects.Results:Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16.Conclusions:In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health‐related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health‐related quality of life.
Quality of Life of Parents and Siblings of Children with Inflammatory Bowel Disease
Authors: Akobeng Anthony K. , Miller Victor , Firth David , Suresh‐Babu Mirajkar V. , Mir Pervaiz , Thomas Adrian G. 
Published: February 2024

ABSTRACTBackground:Few investigators have reported on the quality of life of family members of children with inflammatory bowel disease. Psychological symptoms have been reported in parents and siblings, but the problems that which give rise to these symptoms are seldom examined. In this pilot study, some of the issues that affect the quality of life of parents and siblings of children with inflammatory bowel disease were examined.Methods:Focus group meetings were held separately with 20 parents and 7 siblings of children with inflammatory bowel disease. The participants were encouraged to identify voluntarily problems related to the disease that affected their lives, and the discussions were taped recorded. Each participants subsequently wrote down the three most important concerns.Results:Thirteen (65%) parents were very concerned about the effect of the disease on the child's future (jobs, marriage, independence) and 11 (55%) were worried about problems the ill child was encountering at school. Other issues of most concern to parents included side effects of medication (n = 7), limited job prospects (n = 3), persistent feelings of guilt (n = 3), and restricted family lifestyle (n = 1). Most siblings (57%) were concerned about their parents' keeping information about the illness from them, and three (43%) of them were also concerned about others bullying the ill child at school. Other issues of concern to siblings included fear about the disease and treatment (n = 3), parents overprotecting the ill child, and feelings of jealousy (n = 1).Conclusion:Families of children with inflammatory bowel disease experience many problems that may affect their quality of life. Resources should be made available to help families with these concerns.
Assessment of Quality of Life in the Younger Child: The Use of an Animated Computer Program
Authors: Büller Hans 
Published: February 2024

ABSTRACTBackground:In the past, quality of life was primarily assessed using objective measurements of the condition of the patient. Today, most quality‐of‐life measurements include several aspects regarding the patient's opinions and feelings. There has been an extensive development of quality‐of‐life instruments particularly in adults, including those for people with inflammatory bowel disease (IBD). However, only a few instruments, mostly questionnaires, have been developed for the pediatric population. It has been noted, even in young patients with IBD, that there is reduced self‐esteem and more anxiety and depression. Altogether, these are important aspects for early measurement of psychosocial functioning and possibly intervention during the treatment of children with IBD.Methods:For the current study, an instrument was developed for young children aged 5 years or more in which a computer‐based animated program was used to measure quality of life in children with inflammatory bowel disease. The instrument was designed to be similar for boys and girls with no reference to racial identity. In addition, it was culturally acceptable for all Dutch children. The program was in the form of a story of a bear and a clown playing in an attic of an old house where they come across many objects with which they play and where many adventures occur. All 35 questions were interwoven in this story.Results:The animated computer program was well accepted and easily used by 16 children between the ages of 5 and 12 in a small pilot study. In those older than 11 years, another approach is probably necessary, using an age‐appropriate animated program.Conclusions:The computer program can easily be used in an outpatient setting and thus ensures that quality‐of‐life measurement will become a routine part of a medical visit.
Zinc Homeostasis in Healthy Infants Fed a Casein Hydrolysate Formula
Authors: Krebs Nancy F. , Reidinger Carol J. , Miller Leland V. , Borschel Marlene W. 
Published: February 2024

ABSTRACTBackground:The results of earlier, nonquantitative studies suggested that absorption of zinc from a semielemental (casein hydrolysate) formula was inferior to absorption from a cow's milk–based formula. The objective of this study was to compare fractional, total and net zinc absorption, and fecal excretion of endogenous zinc in the same healthy young infants when fed a casein hydrolysate versus cow's milk–based formula.Methods:Fractional absorption of zinc and fecal excretion of endogenous zinc were determined from measurement of cumulative fecal excretion of unabsorbed tracer and by an isotope dilution technique, respectively, after oral administration of a 70Zn tracer with all formula feedings for 1 day. Six infants were assigned randomly to receive the test or control formula, and the other formula was administered 2 to 5 weeks later.Results:Mean (±SD) fractional absorption of zinc from the casein hydrolysate formula (0.47 ± 0.17) was double that from the cow's milk–based formula (0.22 ± 0.04;P = 0.01) with a correspondingly greater total zinc absorption (3.23 ± 1.67 mg Zn/day vs. 1.55 ± 0.55 mg Zn/day;P = 0.05). Because the excretion of endogenous zinc in the feces did not differ between formulas (0.90 ± 0.44 mg Zn/day vs. 0.91 ± 0.29 mg Zn/day), net absorption of zinc was also higher with the casein hydrolysate formula (2.33 ± 1.65 mg Zn/day vs. 0.81 ± 0.67 mg Zn/day;P = 0.02).Conclusions:Retention of zinc appeared to be adequate to meet the needs for growth during feeding with cow's milk–based formula and was more than adequate during short‐term feeding with the casein hydrolysate formula.
Human Colostrum and Serum Contain Antibodies Reactive to the Intimin‐Binding Region of the Enteropathogenic Escherichia coli Translocated Intimin Receptor
Authors: Sanches Marcela Imperio , Keller Rogeria , Hartland Elizabeth L. , Figueiredo Dayse M. M. , Batchelor Miranda , Martinez Marina B. , Dougan Gordon , Careiro–Sampaio Magda M. S. , Frankel Gad , Trabulsi Luiz R. 
Published: February 2024

ABSTRACTBackground:In Brazil, enteropathogenic Escherichia coli (EPEC) diarrhoea is endemic in young infants. A characteristic feature of EPEC adhesion to host cells is intimate attachment leading to the formation of distinctive “attaching and effacing” (A/E) lesions on mammalian cells. Two genes directly involved in intimate adhesion, eae and tir, encode the adhesion molecule intimin and its translocated receptor Tir, respectively. The intimin‐binding domain of Tir was recently mapped to the middle part of the polypeptide (Tir‐M), and the amino (Tir‐N) and carboxy (Tir‐C) termini were found to be located within infected host cells. Recently, it was shown that colostrum samples from mothers living in Sao Paulo contain IgA‐class antibodies reactive with a number of proteins associated with EPEC virulence. It has also been shown that patients infected with verocytotoxin‐producing E. coli O157 can produce antibodies to Tir. In the current study antibody responses to the different Tir domains were analyzed in sera and colostrum samples collected in an EPEC‐endemic area of Brazil.Methods:Recombinant Tir, Tir‐N, Tir‐M, and Tir‐C were expressed as His‐tagged protein in E. coli BL21a and purified on nickel columns. Western blot analysis was used to investigate colostrum IgA‐and serum IgG‐class antibodies reactive with the Tir fragments.Results:Anti‐Tir IgG antibodies were detected in the serum of children, with (63%) or without (50%) diarrhoea. Anti‐Tir IgA‐class antibodies were detected in all the colostrum pools tested. With the use of both serum IgG‐and colostrum IgA‐class antibodies, an immunodominant domain of the Tir‐polypeptide, Tir M, was identified.Conclusion:The intimin‐binding region of Tir (Tir‐M) is the immunodominant region of the polypeptide in humans. Both serum IgG‐class and colostrum IgA‐class antibodies reacted predominantly with the Tir‐M domain.
Mucosal Immunity and Gastrointestinal Antigen Processing
Authors: Mayer Lloyd , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTThe intestine is the largest lymphoid organ in the body by virtue of lymphocyte numbers and quantity of immunoglobulin produced. This is largely related to the enormous antigen load to which these cells are exposed on a daily basis. However, despite this, the mucosa‐associated lymphoid tissue appears to be regulated by unique mechanisms, and this is reflected in specific phenomena (oral tolerance, controlled or physiologic inflammation) as well as unusual lymphoid populations (intra‐epithelial lymphocytes) that respond to alternative pathways of activation. This, coupled with the existence of novel antigen‐presenting cells (intestinal epithelial cells) sets the scene for distinct immune responses. It is these distinct regulatory factors that support immunosuppression or tolerance rather than active immunity at a site juxtaposed to the external environment. This review defines these novel interactions and suggests how alteration in normal function may result in allergic or inflammatory responses. A clearer understanding of mucosal immunoregulation may lead to new therapeutic approaches for these diseases.
Milk‐Induced Reflux in Infants Less Than One Year of Age
Authors: Cavataio Francesca , Carroccio Antonio , Iacono Giuseppe , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTCow's milk allergy (CMA) and gastroesophageal reflux are considered to be among the most common disturbances in infants less than 1 year of age. In recent years, the relationship existing between these two entities has been investigated and some important conclusions have been reached: In just under half the cases of GER in infants less than 1 one year of age there is an association with CMA; in a high proportion of cases, GER is not only CMA‐associated but also CMA‐induced; the frequency of this association should induce pediatricians to screen for possible concomitant CMA in all infants with GER less than 1 year old; with the exception of some patients with mild typical CMA manifestations (diarrhea, dermatitis, or rhinitis), the symptoms of GER associated with CMA are the same as those observed in primary GER; immunologic tests are useful in a suspected association between GER and CMA; and subjects with GER secondary to CMA show a typical pH‐monitoring tracing pattern, characterized by a progressive, slow decrease in esophageal pH between feedings. This article reviews the main features of the two diseases, stressing the aspects in common between them and comments on all the listed points.
Food Protein‐Induced Enterocolitis Syndrome: Clinical Perspectives
Authors: Sicherer Scott H. , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTFood Protein‐Induced Enterocolitis Syndrome (FPIES) is a symptom complex of severe vomiting and diarrhea caused by non‐IgE‐mediated allergy to cow's milk and/or soy in infants. Symptoms typically begin in the first month of life in association with failure to thrive and may progress to acidemia and methemoglobinemia. Symptoms resolve after the causal protein (usually sensitivity to both cow's milk and soy) is removed from the diet. Symptoms recur approximately 2 hours after reintroduction of the protein along with a coincident elevation of the peripheral blood polymorphonuclear leukocyte count. The sensitivity is usually outgrown by 3 years of age. The purpose of this review is to delineate the characteristic clinical features, diagnosis and management of FPIES. Furthermore, infantile FPIES will be discussed in relation to clinical syndromes that share features with it (“atypical FPIES”) and other food‐allergic disorders affecting the gastrointestinal tract.
Magnetic Resonance Imaging to Distinguish the Type and Severity of Pediatric Inflammatory Bowel Diseases
Authors: Durno Carol A. , Sherman Philip , Williams Tara , Shuckett Bruce , Dupuis Annie , Griffiths Anne M. 
Published: February 2024

ABSTRACTBackground:The distinction between ulcerative colitis and Crohn's disease is important, because treatment options and clinical course may vary. Magnetic resonance imaging (MRI) allows noninvasive transmural assessment of the intestine and may facilitate differentiation of ulcerative colitis from Crohn's disease. The objective of this prospective study was to determine whether MRI differentiates Crohn's disease from ulcerative colitis in children as effectively as colonoscopy with mucosal biopsies.Methods:Fifteen patients underwent colonoscopy with biopsies followed by abdominal MRI. The MRI diagnosis, determined by two radiologists independently completing a standardized form was compared with the gastroenterologic diagnosis.Results:After colonoscopy and review of histology, Crohn's disease was diagnosed in nine patients, ulcerative colitis in five, and indeterminate colitis in one, who was excluded from study. Agreement of the MRI diagnosis with the gastroenterologic diagnosis was 4 of 4 (100%) for ulcerative colitis, 4 of 10 (40%) for Crohn's disease considering both radiologists, and 5 of 10 (50%) for Crohn's disease for each radiologist individually. Percentage of enhancement by MRI did not correlate with the severity of inflammation determined at endoscopy among the patients with Crohn's disease (r = −0.3, P = 0.366). There was agreement on severity of inflammation in three of four patients with ulcerative colitis.Conclusions:Current MRI interpretation of inflammatory bowel disease did not adequately recognize Crohn's disease in children. Therefore, colonoscopy with biopsy remains the most accurate tool for determining the type and severity of inflammatory bowel disease in children and adolescents.
Transpyloric Enteral Nutrition Reduces the Complication Rate and Cost in the Critically Ill Child
Authors: de Lucas Carmen , Moreno María , López–Herce Jesús , Ruiz Fernando , Pérez–Palencia Mercedes , Carrillo Angel 
Published: February 2024

ABSTRACTBackground:Studies in adults have shown that transpyloric enteral nutrition (TEN) is useful in certain patients who cannot tolerate oral or gastric feeding. This study was conducted to compare TEN with parenteral nutrition (PN) in critically ill pediatric patients.Methods:A retrospective descriptive study conducted in the pediatric intensive care unit of a tertiary pediatric referral center. All patients in the pediatric intensive care unit (PICU) receiving PN and/or TEN from January 1993 through December 1996 were included in the study.Results:Two hundred forty patients (14.6% of all patients admitted to the PICU) received PN and/or TEN (168 exclusively PN, 21 exclusively TEN, and 51 a combined regimen). The number of patients receiving PN and duration of PN declined significantly from 1993 (65 patients, 703 days) through 1996 (48 patients, 395 days). This was mirrored by the increase in the number of patients receiving TEN and duration of TEN. The incidence of complications (hyperglycemia, hypertriglyceridemia, and cholestasis) was higher in the PN group. There was no difference in the incidence of hospital‐acquired infection or mortality between the two groups. The cost of TEN was lower than that of PN, with an estimated annual saving of $5,422.Conclusions:Transpyloric enteral nutrition is a suitable method of nutritional support for critically ill pediatric patients. It has fewer complications and a lower cost than PN.
Celiac Disease and Human Leukocyte Antigen Genotype: Accuracy of Diagnosis in Self‐Diagnosed Individuals, Dosage Effect, and Sibling Risk
Authors: Lewis Cathryn , Book Linda , Black Jeff , Sawitzke Allen , Cannon‐Albright Lisa , Zone John , Neuhausen Susan 
Published: February 2024

ABSTRACTBackground:Celiac disease is an autoimmune disorder of the small intestine characterized by intolerance to gluten. Traditionally, diagnosis is made by intestinal biopsy. Testing for immunoglobulin (Ig) A endomysial antibodies in the serum also is used for diagnosis. Biopsy and serology revert to normal with adherence to a gluten‐free diet. Often, after an index case is diagnosed, siblings with symptoms adhere to a gluten‐free diet without biopsy or serologic confirmation. More than 90% of patients with celiac disease have the human leukocyte antigen (HLA) DQA1*0501‐DQB1*0201 genotype. Non‐HLA genes also have been implicated.Methods:One hundred ninety‐five individuals with confirmed or suspected celiac disease were identified in 73 families affected by the disease. IgA endomysial antibody testing was performed for all symptomatic family members who did not have biopsy‐confirmed diagnoses. DNA samples were genotyped at D6S276 and the HLA class II loci DQA and DQB.Results:At the time sampling was begun in families, 88 of 177 (49.7%) individuals were self‐diagnosed and adhering to a gluten‐free diet. Ninety percent (91/101) of confirmed cases (biopsy or serology) had at least 1 copy of the DQA1*0501‐DQB1*0201 genotype, whereas only 67% (46/69) of cases self‐diagnosed (adherence to gluten‐free diet without confirmation) had at least 1 copy. Of confirmed cases, 61% carried two copies of DQB*0201. It is estimated that the HLA association and other unlinked genes contribute approximately equally to the sibling risk of celiac disease.Conclusions:A dosage effect of DQB1*0201 may be associated with an increased risk of celiac disease. Self‐diagnosis of celiac disease is as common as confirmed diagnosis in families in the United States. Diagnosis of celiac disease on the basis of clinical response to gluten restriction is inaccurate. With long‐term adherence to a gluten‐free diet, serologic test results are likely to be negative. Based on HLA genotype, approximately one third of self‐diagnosed individuals are unlikely to have celiac disease. However, it is not possible to determine which individuals consuming a gluten‐free diet have the disease. Therefore, before starting a gluten‐free diet, serologic screening and biopsy confirmation are necessary.