bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bovine Colostrum Ameliorates Diarrhea in Infection with Diarrheagenic Escherichia coli, Shiga Toxin‐Producing E. coli, and E. coli Expressing Intimin and Hemolysin
Authors: Huppertz Hans‐Iko , Rutkowski Stefan , Busch Dirk H. , Eisebit Reinhard , Lissner Reinhard , Karch Helge 
Published: February 2024

ABSTRACTBackground:Diarrheagenic Escherichia coli may cause serious extraintestinal complications, but there is no specific treatment.Methods:Patients with diarrhea caused by diarrheagenic E. coli, specifically Shiga toxin‐producing E. coli and E. coli‐expressing intimin and enterohemorrhagic E. coli‐hemolysin were treated by administration of pooled bovine colostrum, rich in antibodies to Shiga toxin and enterohemorrhagic E. coli‐hemolysin, in a placebo‐controlled, double‐blind study. Symptom resolution and fecal excretion of infecting strains were assessed.Results:No side effects were attributable to colostrum. Stool frequencies in the group treated with bovine colostrum were significantly reduced compared with those in the placebo group. No effect of therapy on the carriage of the pathogens or on complications of the infection could be demonstrated.Conclusions:Bovine colostrum is well tolerated and diminishes frequency of loose stools in children with E. coli‐associated diarrhea. A prospective study should be conducted among a larger number of children with Shiga toxin‐producing E. coli identified early in illness, to determine the effectiveness of colostrum therapy.
Noninvasive Assessment of Essential Fatty Acid Status in Preterm Infants by Buccal Mucosal Cell Phospholipid Analysis
Authors: Koletzko Berthold , Knoppke Birgit , von Schenck Ursula , Demmelmair Hans , Damli Aynur 
Published: February 2024

ABSTRACTBackground:The dietary supply of long‐chain polyunsaturated fatty acids is receiving increased attention since a linkage to infant growth and development has been reported. To avoid repeated blood collections for determination of long‐chain polyunsaturated fatty acid status, the authors developed and evaluated a noninvasive method for analysis of buccal mucosal cell phospholipids.Methods:Oral mucosal cells were gently collected with a soft cotton swab, buccal cell lipids separated by thin‐layer chromatography, and fatty acid methyl esters of the phospholipid fraction prepared. Subsequently, the fatty acid methyl esters were analyzed by high‐resolution gas chromatography.Results:The method allowed reliable analysis from very small amounts of oral mucosal cells, and results were well reproducible. The intraindividual coefficients of variation in four samples of three subjects were less than 5% for both arachidonic and docosahexaenoic acid. Fatty acid composition was not altered by consumption of milk formula before and after sample collection. The method was applied in a clinical trial with preterm infants fed human breast milk or assigned by double‐blind randomization to preterm formula with or without arachidonic and docosahexaenoic acid. Buccal mucosal cells were collected in infants less than 14 days of age and at the postconceptional ages of 52 weeks and 64 weeks. Dietary long‐chain polyunsaturated fatty acids showed a lasting influence on buccal cell phospholipid composition. In the course of the study, arachidonic and docosahexaenoic acid decreased significantly in the nonenriched formula group, whereas stable or rising values were observed in the groups receiving breast milk or enriched formula.Conclusions:Buccal mucosal cell phospholipids are feasible for use as a noninvasive marker for long‐chain polyunsaturated fatty acid status in preterm infants and yield reliable results. Dietary long‐chain polyunsaturated fatty acids have a lasting influence on fatty acid composition of buccal cells in preterm babies.
Quality of Life in Inflammatory Bowel Disease: Background and Definitions
Authors: Ferry George D. 
Published: February 2024

ABSTRACTDefining and measuring quality of life is a relatively new dimension of health care for many clinicians. The traditional method of evaluating clinical status and response to treatment has been to look at disease‐specific symptoms, global assessments (e.g., impressions of the good, better, or worse condition of a patient), days missed at school, and a variety of disease activity scores. These impressions and techniques may or may not reflect how patients are functioning day to day and how they feel about the illness. To address these issues, health‐related quality of life questionnaires have been developed to measure the functional effect of an illness and its treatment on a patient, as perceived by the patient. There are four broad domains that are considered part of a health‐related quality‐of‐life questionnaire: 1) physical and occupational function, 2) psychologic state, 3) social interaction, and 4) somatic sensation. In the case of children, the perception of parents or caretakers may be added to complete the picture. Significant social and psychiatric problems have been described in children with IBD, including absenteeism from school, depression, suicide, and major disruption of family patterns. To understand fully the impact of inflammatory bowel disease and its treatment on patient and family function requires one or more quality‐of‐life instruments that are sensitive to the full range of symptoms, growth and development, and response (including side effects) to many new therapies.
Social Implications of Childhood Crohn's Disease
Authors: Moody Gill , Eaden Jayne A. , Mayberry John F. 
Published: February 2024

ABSTRACTBackground:Children with Crohn's disease may have an impaired quality of life.Methods:A validated questionnaire was mailed to the parents of all child members of Crohn's in Childhood Research Association (CICRA) (age range, 5‐17 years). It investigated aspects of the quality of life of children with Crohn's disease. Sixty‐four questionnaires were returned together with another 35 from those outside the defined age range. Patients in the latter group were not included in the analysis.Results:Of the children investigated, 60% had significant absences from school, with a mean of 3 ± 2.8 months' absence in the previous year. Most (53%) thought that their teachers knew nothing about Crohn's disease, and 50% thought that teachers were unsympathetic. Of the 24 who had taken examinations 80% thought they had underachieved because of ill health. Sixty‐seven percent of children were unable to participate in sports on a regular basis, 60% felt unable to leave the house, and 50% were unable to play with their friends. Information about Crohn's disease had predominantly come from doctors (89%), information booklets (83%), and nursing staff (42%). The commonest questions asked by the children were: what is Crohn's disease (50%), why me (64%), will it affect my schooling (52%), and will it affect my chances of getting a job (67%).Conclusion:Children with Crohn's disease have a significantly impaired quality of life. They fear everyday childhood activities and fear for their future. These children need sympathetic management, and effort should be concentrated on improving their day‐to‐day existence to enable them to lead as normal a life as possible.
Behavior and Gastroesophageal Reflux in the Premature Neonate
Authors: Snel Antonie , Barnett Christopher P. , Cresp Trevor L. , Haslam Ross R. , Davidson Geoffery P. , Malbert Charles H. , Dent John , Omari Taher I. 
Published: February 2024

ABSTRACTBackground:The belief that behavioral observations assist in the clinical diagnosis of gastroesophageal reflux (GER) disease in premature neonates has not been formally tested. The purpose of this study was to determine whether esophageal acidification was associated with a recognizable pattern of behavioral changes in these infants.Methods:The behavior of 14 healthy premature infants was recorded by a video camera while esophageal pH was simultaneously monitored. For each of 20 acid GER episodes recorded, a 10‐minute video epoch, encompassing the onset of acid GER and lasting at least 4 minutes after the onset of GER, was examined. Two independent observers each scored reflux‐associated epochs of “general” infant behavior and behavior previously shown to be indicative of reflux in normal term infants.Results:The occurrence of esophageal acidification due to reflux did not significantly alter scores for general behavior. Infants frequently demonstrated reflux‐specific behavior, including discomfort, head retraction, and mouthing; however, none of these behavioral patterns was temporally associated with the occurrence of acid GER.Conclusions:These data indicate that reflux‐specific behavioral criteria, established in older term infants, may be inappropriate as diagnostic criteria for GER in premature neonates and may lead to the unnecessary use of antireflux therapy.
Duodenojejunitis: Is It Idiopathic or Is It Henoch–Schönlein Purpura Without the Purpura?
Authors: Gunasekaran T. S. , Berman James , Gonzalez Miguel 
Published: February 2024

ABSTRACTBackground:Henoch–Schönlein purpura is a small‐vessel vasculitic disease that most often affects the skin. Gastrointestinal manifestations have been well described, including duodenojejunal inflammation (DJI).Methods:Four children with DJI and clinical features of HSP are described, in whom the rash was either not present or appeared atypically late in the illness.Results:The characteristic rash did not develop in three children, and it developed much later in one. The patients (three boys and one girl) were aged between 7 and 9 years (mean, 7.5 years). Growth characteristics were normal. In all patients, pain occurred acutely with colicky abdominal pain in the spring or fall of the year, and all stools were positive for occult blood. No infectious cause was identified. Upper gastrointestinal endoscopic examinations demonstrated significant visual and histologic duodenitis in a pattern consistent with previous reports in children with known HSP. Factor XIII activity was absent. Immunoglobulin A levels were increased in three of four children. All children made a prompt recovery with the administration of intravenous glucocorticoids. In one child, the characteristic rash of HSP developed 18 weeks after the initial examination.Conclusion:Duodenojejunal inflammation may be the primary manifestation of HSP, even in the absence of the characteristic rash.
Normal Immune Responses to Ingested Foods
Authors: Husby Steffen , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTThis is a short review of the literature with a bias toward the author's work. Small amounts of dietary antigens are taken up into the circulation. B‐cell responses to foods (antibodies and antibody‐secreting cells) occur as a physiological event locally and in the circulation in all three major immunoglobulin classes. A low levels of IgE is also a normal phenomenon. IgA anti‐gliadin antibodies represent an exception. Antibody titers in general tend to decline with age. T‐cell responses specific for foods are low in the circulation of healthy subjects. T‐cell cytokines are more frequently produced in the gastrointestinal mucosa compared with the circulation. Results indicate that the phenomenon of oral tolerance takes place in humans. Oral tolerance within the T cell system may represent an important regulatory mechanism for normal immunity.
Evaluation of IgE‐Mediated Food Hypersensitivities
Authors: Bock S. Allan , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTDuring the past 25 years the diagnostic assessment of IgE‐associated food hypersensitivity has improved substantially. The double‐blind placebo‐controlled food challenge has become the “gold‐standard” against which all other diagnostic approaches can be measured. Having a standard which gives a correct answer almost all of the time, has enabled us to move to more accurate diagnoses in both the clinic and the laboratory. Food allergy has gone from being a medical mystery to being a clear component of allergy evaluation. Histories are obtained from patients which may be used to design food challenges. The role of skin testing and its interpretation has moved from the fringe to having a central role in eliminating foods incriminated as causes of immediate‐onset allergic reactions. The material used for skin testing for foods has improved and we have learned when we must use fresh substances to supplement the commercial extracts. Recently the CAP radioallergosorbent test has shown promise in raising the probability of food reactions to the point that for a few foods in specific individuals, challenges may not be needed. Progress in this area will continue. We have been able to clarify which foods have a high probability of producing symptoms and which foods and which constellation of complaints are unlikely to be confirmed. These patterns of food allergic reactions have now been reproduced in many research centers throughout the world giving us confidence in their validity.
Food‐Induced Malabsorption Syndromes
Authors: Savilahti Erkki , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTA syndrome of chronic diarrhea, vomiting, and failure to thrive was described 35 years ago. The syndrome was caused by damage in the jejunum after ingestion of cow's milk. Symptoms appeared in young infants shortly after introduction of cow's milk formula. Patients had moderate steatorrhea, decreased absorption of D‐xylose, and, often, iron‐deficiency anemia and hypoproteinemia. They had strong IgA and IgG antibodies to cow's milk. IgE antibodies to cow's milk were negative, as a rule. Indicators of cell‐mediated immune reaction to cow's milk proteins were often positive. Patients were tolerant to cow's milk by the age of 3 years. Malabsorption was due to damage to the jejunal mucosa: Varying villus atrophy was associated with inflammation in surface epithelium and lamina propria. The epithelial cell renewal rate increased. Surface epithelial cells decreased in height, with short, furry microvilli and large aggregates of lysozymes. The number of intraepithelial lymphocytes was markedly increased, but normalized during cow's milk elimination. Most of these lymphocytes had α/β T‐cell receptors, and many were cytotoxic. Some specimens had an increase in γ/δ T‐cell receptor‐bearing cells. In the lamina propria, CD4+ cells predominated, and some of them were activated. IgA‐ and IgM‐containing cells were markedly increased during cow's milk exposure, but IgE cells were not abnormal. The density of eosinophils was moderately increased. Secretion of interferon‐γ by cells isolated from patients' intestines was markedly increased. Morphologic and immunologic findings suggest that T‐cell‐mediated reaction to proteins in cow's milk is present in the small intestines of patients with this syndrome and causes this enteropathy.
Dietary Aspects of Food Allergy Prevention in Infants and Children
Authors: Zeiger Robert S. , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTFood allergy occurs in approximately 4% to 6% of children, has increased in prevalence during the past decade, and thus represents a major burden to our young. The natural history of food allergy documents that allergies to cow's milk, egg, and soy frequently remit whereas allergies to peanut, nuts, and fish typically persist to adulthood, although exceptions exist. Food allergen avoidance subsequent to sensitization and manifestation of symptoms appears to hasten tolerance; however, the immunologic mechanism responsible for tolerance to one food group and not another is poorly understood. Identification and characterization of allergens and determination of B‐ and T‐cell epitopes has provided an opportunity to better define these mechanisms. Identifying and developing effective strategies to prevent food and other allergic diseases represents a high priority for medicine at this time because of the unbridled increase in the prevalence and morbidity attributed to them. Immunologic engineering holds the greatest promise for allergy prevention in the not too distant future, but environmental strategies that promote food avoidance provide an avenue for prevention at present. Such efforts rely actively on reducing the food allergenic load and exposure of atopy‐prone infants and children.
Toxaphenes and Chlorinated Naphthalenes in Adipose Tissue of Children
Authors: Witt K. , Niessen K. H. 
Published: February 2024

ABSTRACTBackground:Chlorinated hydrocarbons are ingested by humans in food and accumulate in adipose tissue. At the University Kinderklinik, Mannheim, previously unknown substances have been found in children (e.g., the pesticide toxaphene and chlorinated naphthalenes). These substances have been widely used for industrial purposes in the past. Samples from West and East Germany; Saratov, Russia; and Almaty, Kazakhstan were examined to determine whether these substances are ubiquitous.Methods:After Soxhlet extraction, the extracts were cleaned up using a liquid chromatographic technique. Measurement was performed by gas chromatography–mass spectrometry using negative chemical ionization in the single‐ion–monitoring mode.Result:In specimens from all cities, toxaphene congeners Parlar 26 and Parlar 50 and six chlorinated naphthalenes were traced. Highest median load of toxaphene was 1.97 μg/kg for Parlar 26 and 2.36 μg/kg for Parlar 50 in Stralsund, East Germany. For chlorinated naphthalenes, the median was highest in Mannheim, West Germany, with 12.0 μg/kg.Conclusion:These findings show that monitoring these toxic substances remains necessary. Even though the use and as a consequence the amount of chlorinated hydrocarbons were reduced, these substances have by no means disappeared from the environment.
Long‐term Outcome of Chronic Hepatitis B in Adolescents or Young Adults in Follow‐up From Childhood
Authors: Fujisawa Tomoo , Komatsu Haruki , Inui Ayano , Sogo Tsuyoshi , Miyagawa Yoshihiro , Fujitsuka Satoshi , Sekine Isao , Kosugi Takeshi , Inui Michio 
Published: February 2024

ABSTRACTBackground:It has not yet been defined whether children with chronic hepatitis B are likely to develop severe liver disease in the future. The purpose of this study was to evaluate the evolution of chronic hepatitis B acquired in childhood.Method:Fifty‐two children in the age range of 0 to 15 years who were positive for hepatitis B surface antigen and hepatitis B e antigen in serum for at least 6 months were enrolled in this study. In the majority of the 52 children, hepatitis B virus infection was acquired by perinatal transmission. All 52 showed abnormal liver function test findings for more than 6 months before enrollment, and the subjects were followed up longitudinally for 3 to 22 years (mean, 11 years). They are now more than 15 years of age (15–27 years old).Results:During the follow‐up period, 26 (50%) children had spontaneous seroconversion to anti‐hepatitis B e. Serum levels of alanine aminotransferase normalized in these 26 children. In one child of these children, hepatocellular carcinoma developed at the age of 21 years, 16 years after seroconversion, although his liver function profiles remained normal. The other 26 children remained hepatitis B e antigen positive, most with unchanged biochemical features. Sixteen (62%) children among these 26 children were treated with interferon‐α. Eleven (69%) children had seroconversion to anti‐hepatitis B e within the first year after the cessation of therapy. Hepatocellular carcinoma developed in 1 of these 11 children at the age of 16 years, 6 years after interferon therapy. Thus, hepatocellular carcinoma developed in two children in an anti‐hepatitis B e positive phase.Conclusion:All children carrying hepatitis B surface antigen should be observed carefully to monitor the possible development of hepatocellular carcinoma, especially in the anti‐hepatitis B e–positive phase after spontaneous seroconversion or even after interferon treatment.
Parietal Cell Antibodies and Helicobacter pylori in Children
Authors: Kolho Kaija–Leena , Jusufovic Jasminka , Miettinen Aaro , Savilahti Erkki , Rautelin Hilpi 
Published: February 2024

ABSTRACTBackground:Gastric autoantibodies are common in Helicobacter pylori–infected adults, and the presence of these antibodies is associated with atrophic gastritis. The role of H. pylori in the autoimmune type of atrophic gastritis is unresolved, and it is not known at what stage the autoantibodies appear in serum during H. pylori infection. Therefore, we screened children with and without H. pylori infection for gastric parietal cell antibodies.Methods:Seventy‐one children with H. pylori infection verified by examination of gastric biopsy specimens (mean age, 9.4 years), 8 children with positive serology but negative histology for H. pylori (mean age, 11.6 years), and 130 children with negative serology for H. pylori (mean age, 7.7 years) were screened for the presence of gastric parietal cell antibodies in serum by indirect immunofluorescence. In addition, 61 children with celiac disease (mean age, 7.1 years) were screened for gastric parietal cell antibodies and H. pylori antibodies.Results:None of the children with H. pylori infection had gastric parietal cell antibodies in serum. Only three positive parietal cell antibody reactions were found: a 14‐year‐old boy with positive serology for H. pylori but no other signs of infection (titer 5000), a 14‐year‐old girl with tuberculosis (titer 1250, seronegative for H. pylori) and a 10‐year‐old girl with insulin‐dependent diabetes mellitus (titer 6250, seronegative for H. pylori).Conclusions:Although gastric autoantibodies are often found in adults with chronic H. pylori gastritis, it seems that H. pylori–infected children are not positive for gastric parietal cell antibodies. It remains to be studied in which H. pylori infections and at what stages gastric autoantibodies appear.
A Prospective Trial of Lansoprazole Triple Therapy for Pediatric Helicobacter pylori Infection
Authors: Shashidhar Harohalli , Peters John , Lin Chuan‐Hao , Rabah Rajah , Thomas Ronald , Tolia Vasundhara 
Published: February 2024

ABSTRACTBackground:Triple therapy with a proton‐pump inhibitor and two antibiotics is widely used in the treatment of Helicobacter pylori infection in adults. Experience with such therapy in the pediatric population is limited. This was a prospective, nonrandomized, open‐label trial to evaluate safety and efficacy of a combination of lansoprazole, clarithromycin, and amoxicillin in symptomatic children with H. pylori infection.Methods:Children with H. pylori gastritis diagnosed by endoscopy performed for persistent nausea, vomiting, recurrent abdominal pain, and diarrhea with consistent histology were treated with the regimen of 0.45 mg/kg per day lansoprazole divided into two doses (maximum dose, 15 mg twice daily), amoxicillin 40 mg/kg per day in two doses (maximum dose, 1.0 g twice daily), and 250 mg clarithromycin twice daily (<10 years old) or 500 mg twice daily (>10 years old) for 2 weeks. Pre‐and posttreatment endoscopic biopsy specimens were graded for the severity of gastritis and H. pylori density by a blinded pathologist. A questionnaire for assessing the severity of symptoms at the time of initial and second endoscopy were completed by patient and/or parent.Results:Thirty‐two children (age range, 1–25 years; mean age, 11 years; 19 females, 13 males) were treated with this regimen during an 18‐month period. H. pylori organisms with varying grades of gastritis were present in tissue specimens of all patients. Only 28 children had follow‐up endoscopy, which showed eradication of H. pylori in 15 (54%) children. Histologic symptoms of gastritis improved after therapy in the whole group. Overall, symptoms of vomiting, abdominal pain, diarrhea, anorexia, and halitosis significantly improved (P < 0.05). Minor adverse effects of therapy occurred in 25% of patients.Conclusions:Symptoms, histologic, and endoscopic findings improved after triple therapy in children with H. pylori gastritis; however, eradication of bacteria was achieved in only 56% of children.