bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biliary Lipid Composition and Bile Acid Profiles During and After Enteral Fast of Total Parenteral Nutrition in the Rabbit
Authors: Das John B. , Poulos Nicholas D. , Ansari G. Ghaus 
Published: February 2024

SummaryFeeding and fasting influence biliary lipid composition. With total parenteral nutrition (TPN), it is possible to study the effects of a long‐term “enteral fast” on biliary lipid composition without the metabolic illeffects on nutrient deprivation. We compared the lipid and bile acid (BA) contents of hepatic and gallbladder biles in rabbits on completion of a 14‐day regimen of TPN with those in rabbits returned to oral feeds for 6 weeks after a similar spell of TPN. Chow‐fed rabbits served as controls. With TPN, plasma phospholipid and cholesterol levels were elevated. Basal bile flow and the secretion of bile acids and phospholipids were decreased in the TPN and post‐TPN groups, while the cholesterol secretion rate was essentially unchanged. During TPN, the molar percent of cholesterol (relative to bile acids and phospholipid) in hepatic bile was increased. Biliary glycolithocholic acid (GLCA; as a percent of total conjugated BA) in hepatic bile increased from 1.7% (0.9% SEM) in the chow‐fed to 8.5% (1.5% SEM) during TPN. In TPN and post‐TPN groups, the gallbladder was enlarged to more than twice normal (chow‐fed) size, and contained a dark, mucoid bile (biliary sludge). In this bile, (a) there was a 2.5‐fold increase in bile acid concentration; and (b) the molar percent of cholesterol decreased while that of bile acids increased. TPN produced a state of functional cholestasis, which extended into the post‐TPN period. Gallbladder distension was the common denominator of the hepatobiliary dysfunction in the TPN and post‐TPN rabbits. With sequestration of bile acids in the gallbladder during and after TPN, the circulating bile acid pool was constricted, and the enterohepatic circulation impaired. As cholesterol secretion was low at all times, cholesterol supersaturation did not occur. The molar percent of cholesterol in gallbladder bile decreased, while that of bile acids increased; this suggests absorption of cholesterol by gallbladder mucosa. The increase in biliary GLCA probably resulted from bacterial biotransformation of glycochenodeoxycholic acid to lithocholic acid and its increased absorption from the cecum during TPN.
Vitamin A Concentration in the Liver Decreases with Age in Patients with Cystic Fibrosis
Authors: Lindblad Anders , Diczfalusy Uif , Hultcrantz Rolf , Thorell Anders , Strandvik Birgitta 
Published: February 2024

Background:Vitamin A deficiency is a common manifestation in cystic fibrosis (CF), but high levels of vitamin A in the liver have also been described. High levels of vitamin A in the liver are toxic, while normal levels might be protective against liver damage. In order to investigate whether liver damage in patients with CF is related to vitamin A content of the liver, vitamin A status was investigated in 15 patients with CF aged 8 to 34 years.Methods:Liver biopsy was performed on clinical indication and the vitamin A concentration in the liver was determined as retinylpalmitate. Serum levels of retinol and retinol‐binding protein were investigated on the morning of the biopsy. Eight patients had morphologic signs of cirrhosis. Eight patinets had been on treatment with ursodeoxycholic acid for 1 to 3 years. All but three patients had been on vitamin A supplementation for years.Results:Five patients had serum concentrations of retinol below the reference range and seven patients had decreased serum levels of retinol‐binding protein. There was a strong correlation between serum levels of retinol and retinol‐binding protein (rs = 0.90, p = 0.01), but no correlations with age, Shwachamn score, or genotype. Six of the patients had vitamin A concentrations in the liver <40 μg/g wet weight, and the concentrations decreased significantly with age (rs = 0.77, p = 0.01), without correlation to clinical score or liver disease. There was no indication of hypervitaminosis, although younger patients had been or were being treated with vitamin A in fat‐water emulsion.Conclusions:Our results indicate that the risk of vitamin a deficiency in cystic fibrosis increases with age. The data do not support the view that patients are at risk for hypervitaminosis by long‐term supplementation with vitamin A. No correlation was found between the severity of liver disease and the vitamin A content in the liver.
Fecal α1‐Antitrypsin in Newborn Infants
Authors: Keller Klaus‐Michael , Knobel Richard , Ewe Klaus 
Published: February 2024

Background:Fecal α1‐antitrypsin is used as a marker for intestinal protein loss reflecting increased intestinal permeability. Exact data of fecal α1‐antitrypsin in newborn infants are not available.Methods:30 healthy mature neonates and three infants with impaired gastrointestinal passage due to stenoses and atresia respectively, were investigated during the first days of life. The amniotic fluid of 13 and the serum of 17 infants was available. α1‐antitrypsin was determined using the radial immunodiffusion method.Results:Normal newborns showed mean fecal α1‐antitrypsin levels (±SD) of 2061 ± 817 mg/dl (day 1), 1186 ± 720 mg/dl (day 2), 308 ± 380 (day 3), 35 ± 27 (day 5), and 27 ± 21 mg/dl (day 6). Two infants with esophageal atresia presented a much lower pattern, and one with annular pancreas had a fecal α1‐antitrypsin pattern comparable with that of normal babies. Serum α1‐antitrypsin was normal (275 ± 52 mg/dl), and amniotic fluid contained 20 ± 12 mg/dl α1‐antitrypsin.Conclusions:The pattern of neonatal fecal α1‐antitrypsin content appears to reflect the meconium clearance of the gut rather than intestinal permeability and “gut closure.” We hypothesize that the origin of increased fecal α1‐antitrypsin is the result of accumulated secretions from bile, the pancreas, and the duodenum, but α1‐antitrypsin originating from swallowed amniotic fluid during pregnancy may play an additional role.
Omeprazole for Severe Reflux Esophagitis in Children
Authors: De Giacomo Costantino , Bawa Paola , Franceschi Massimo , Luinetti Ombretta , Fiocca Roberto 
Published: February 2024

Background:Severe esophagitis is a rare complication of gastroesophageal reflux in children. In adults, omeprazole therapy of severe erosive esophagitis has become the gold standard short‐term treatment of the disease. In children, data on its use are limited, and problems about the dosage are unresolved. The aim of this study was to evaluate the efficacy of a simplified, body‐weight‐based daily dosage of omeprazole in children with severe esophagitis.Methods:Ten children (median age 75.6 months; range 25‐109 months) with severe esophagitis were prospectively investigated. All patients were evaluated by endoscopy, histology, and 24‐h pH‐metry study before and after 3 months of omeprazole. The starting dose of omeprazole was 20 mg as a single daily dose in children weighing less than 30 kg, and 40 mg daily for those weighing over 30 kg.Results:A significant improvement in all the children was demonstrated after 3 months of treatment by clinical, endoscopic, and pH‐metry assessment. However, histologic study failed to show significant improvement of both inflammatory and hyperplastic findings. Relapse occurred in six of 10 patients after discontinuation of therapy.Conclusions:Omeprazole is effective in the short‐term treatment of severe oesophagitis in children. The daily dose of the drug could be easily based on the body weight. The persistence of histologic features of esophagitis in spite of clinical and endoscopic healing could be an indicator of poor outcome.
Liprotein(a) Phenotypes in Japanese Children: A Cohort Study
Authors: Arisaka Osamu , Fujiwara Sachi , Miyake Noriko , Mokuno Hiroshi , Yabuta Keijiro 
Published: February 2024

Background:Elevated serum lipoprotein(a) [Lp(a)] concentrations have been demonstrated to be associated with cardiovascular diseases due to premature atherosclerosis. However, the association of Lp(a) phenotypes with the development of these diseases remains largely unexplored.Methods:We analyzed the population‐based frequencies of serum Lp(a) phenotypes in 269 Japanese children aged 8‐13 years in one community. According to the different apolipoprotein(a) [apo(a)] electrophoretic mobilities, Lp(a) was classified into seven single‐band and respective double‐band phenotypes. Each individual expressed a single (homozygotic) or a double band (heterozygotic).Results:The serum Lp(a) concentration frequency distribution was skewed toward lower levels with a mean ± SD of 15.5 ± 18.0 mg/dl and a median of 11.0 mg/dl. The Lp(a) phenotype frequencies revealed that the frequency of double‐band phenotype expression (55%) was higher than that of single bands (44%) and that the frequency of phenotypes representative of low molecular weight apo(a) was very low (2%). The mean serum Lp(a) concentration of the double‐band‐expressing subjects was higher than that of subjects with the single‐band phenotype (20.1 ± 19.9 vs. 10.5 ± 15.9 mg/dl, p < 0.01).Conclusions:These findings of Lp(a) phenotypes in children seemed to differ from those in Japanese adults in another study; contrary to expectation, the predominant Lp(a) phenotypes found in children were those frequently associated with cardiovascular diseases in adults. Thus, it is speculated that children whose Lp(a) phenotypes remain unchanged during the transition to adulthood may show an increased susceptibility to cardiovascular disease, although the nutritional effects on the Lp(a) phenotypes cannot be neglected.
Indices of Body Fat Distribution in Spanish Children Aged 4.0 to 14.9 Years
Authors: Moreno Luis A. , Fleta Jesús , Mur Lilianne , Feja Cristina , Sarría Antonio , Bueno Manuel 
Published: February 2024

BackgroundReference values for the main indices of body fat distribution in children are not available.MethodsThe study population comprised 1638 Caucasian children and adolescents: 848 boys and 790 girls, with ages ranging from 4.0 to 14.9 years, and living in the central part of Spain (Provincia de Zaragoza). The waist‐to‐hip circumference ratio and the triceps‐to‐subscapular skinfold thickness ratio were measured.ResultsIn boys, mean waist‐to‐hip circumference ratio ranges from 0.834, at 13.5 years, to 0.896 at 4.5 years. In girls, waist‐to‐hip circumference ratio ranges from 0.756, at 14.5 years, to 0.877, at 4.5 years. We observed a decrease of waist‐to‐hip circumference ratio with age, especially in girls. In boys, triceps‐to‐subscapular skinfold thickness ratio ranges from 1.360, at age 14.5, to 1.704, at age 5.5. In girls, triceps‐to‐subscapular skinfold thickness ratio ranges from 1.468, at age 13.5, to 1.727, at age 9.5. We observed a decrease with age only in boys.ConclusionsWe present reference values for the main indices of body fat distribution, which could be useful in clinical practice. However, research is needed that will compare these indices with data on body fat distribution obtained by a gold standard method, such as computed tomography or magnetic resonance imaging.
Activated Eosinophils in Esophagitis in Children: A Transmission Electron Microscopic Study
Authors: Justinich Christopher J. , Ricci Andrew , Kalafus Dolores A. , Treem William R. , Hyams Jeffrey S. , Kreutzer Donald L. 
Published: February 2024

BackgroundEsophagitis in infants and children is often characterized by eosinophilic inflammation. The underlying pathophysiologic mechanisms leading to this type of inflammation, and the role of eosinophils in the clinical expression of esophagitis, are unknown. The purpose of this study was to demonstrate the ultrastructural activation state of eosinophils in esophagitis in infants and children.MethodsStandard transmission electron microscopy was used to examine endoscopic esophageal biopsy material from patients with and without esophagitis, as defined by standard histologic criteria.ResultsTwelve esophagitis and three control cases were studied. In patients with esophagitis, electron microscopy revealed numerous eosinophils throughout the mucosa and invariably demonstrated signs of activation, including inversion of coreto‐matrix densities and lucency of granule core protein. Eosinophils in an activated state were seen in active diapedesis through vascular endothelium into the mucosa. Eosinophils were sometimes seen in proximity to lymphocytes. Biopsies of control patients did not demonstrate eosinophils.ConclusionsEosinophils present in esophagitis are activated by electron microscopic criteria, and can been seen in an activated state entering into the mucosa. This suggests that eosinophils play an active role in the pathophysiology of this disorder, and that proinflammatory factors are present that selectively recruit and activate eosinophils in esophagitis in children.
Percutaneous Endoscopic Gastrostomy in Children and Adolescents
Authors: Behrens Rolf , Lang Thomas , Muschweck Herbert , Richter Thomas , Hofbeck Michael 
Published: February 2024

Background:Long‐term nasogastric tube feeding is often associated with irritation of the hypopharynx or dislocation of the tube. These pitfalls may be circumvented by percutaneous endoscopic gastrostomy. Although frequently used in adults, there is limited experience with the procedure in children.Methods:A series of 139 patients (aged 3 weeks to 36.5 years, mean age, 4.4 years; weight 3.1‐60 kg, mean weight, 15 kg) underwent placement of a percutaneous endoscopic gastrostomy because of central dysphagia (n = 103); general dystrophy caused by chronic renal failure, congenital heart disease, neoplasms, or cystic fibrosis (n = 26); requirement for special diets (n = 7); malnutrition related to respiratory insufficiency (n = 2); and gastric volvulus (n = 1).Results:The percutaneous endoscopic gastrostomy was placed either in the stomach (n = 122) or in the duodenum (n = 15). In two patients a direct percutaneous endoscopic jejunostomy was performed, because duodenal placement proved impossible. Percutaneous endoscopic gastrostomies were placed using intravenous sedation (midazolam, etomidate, or diazepam). None of the patients required general or inhalation anesthesia. We observed 19 complications including: dislocation of the duodenal part into the stomach (n = 5); inflammation at the insertion site (n = 3); perforation of the stomach (n = 2), which healed under conservative treatment; disconnection of the retention disk (n = 4); occlusion of the tube (n = 4), and chronic vomiting (n = 1). Mean lifetime of a percutaneous endoscopic gastrostomy was more than 1 year.Conclusions:Percutaneous endoscopic gastrostomy provides a major improvement for children requiring long‐term tube feeding. High efficacy and low rates of complication suggest that percutaneous endoscopic gastrostomy should be considered more often, even in infants.
The Technetium White Cell Scan as an Initial Imaging Investigation for Evaluating Suspected Childhood Inflammatory Bowel Disease
Authors: Shah D. B. , Cosgrove M. , Rees J. I. S. , Jenkins H. R. 
Published: February 2024

Background:The technetium white cell scan (WCS) may be a useful investigation for patients with inflammatory bowel disease (IBD). In a retrospective study we assessed the use of the WCS as an initial imaging investigation in evaluating children with suspected IBD.Methods:Over a 3‐year period, 60 WCS were performed on 55 patients (25 boys, median age 12.1 years, age range 1.5‐18 years) with known or suspected IBD. There were two clinical groups: those with previously diagnosed IBD (histologically and radiologically) and in clinical relapse (13 patients), and newly presenting patients with suspected IBD (42 patients).Results:Eighteen scans were performed on the 13 patients presenting with relapse. Seventeen were positive and one patient, subsequently shown to have an inactive stricture, had a negative scan. Seven of the 42 newly presenting patients had abnormal scans, confirmed to be due to IBD by a combination of histology and barium examinations. Of the remaining 35 scans, three were abnormal and 32 were normal. None of these patients were subsequently proven to have IBD. These results show that in detecting active IBD, a positive WCS has a 100% sensitivity (24/24) and a 91% specificity (32/35) in the diagnosis of IBD.Conclusions:Our results show that the WCS is very useful as an initial imaging investigation in evaluating patients with suspected IBD to select patients for further investigation.
Use of Barbiturates in the Treatment of Cyclic Vomiting During Childhood
Authors: Gokhale Ranjana , Huttenlocher Peter R. , Brady Lynda , Kirschner Barbara S. 
Published: February 2024

Background:Cyclic vomiting is an uncommon disorder that can be described as recurrent, self‐limiting, fairly uniform episodes of intractable nausea and vomiting with no identifiable organic cause, separated by symptom‐free intervals. There is no established therapeutic regimen for this disorder.Methods:Fourteen children referred to the Pediatric Gastroenterology Clinic were diagnosed with cyclic vomiting from May 1984 to January 1995. Vomiting, the predominant symptom, was present in all children and was severe enough to require hospitalization in 11. Associated symptoms included abdominal pain, headache, nausea, aura, and fever. Diagnostic studies were done to rule out organic causes as indicated in individual patients. Daily phenobarbital was prescribed in all 14 patients. The dose ranged from 30 to 120 mg/hs (mean 2 mg · kg‐1 · day‐1), with a median dose of 60 mg/hs. Prior therapy with propranolol (3 patients) and butalbital (2 patients) had been ineffective.Results:Eleven patients had complete resolution of their symptoms, and 3 patients had marked improvement in their symptoms with infrequent attacks of reduced severity. The only side effects associated with long‐term phenobarbital therapy were behavioral in nature, namely hyperactivity and disruptive behavior at school.Conclusions:The results of our series of 14 patients, all of whom received barbiturates, support the usefulness of this therapeutic approach. Hence we feel that daily low‐dose phenobarbital therapy is a safe and effective therapy in preventing episodes of cyclic vomiting in children.
Prooxidant Effects of Maternal Smoking and Formula in Newborn Infants
Authors: Schwarz Kathleen B. , Cox Jeanne M. , Sharma Savitri , Clement Liliana , Witter Frank , Abbey Helen , Sehnert Shelley S. , Risby Terence H. 
Published: February 2024

Background:The purpose of this study was to use the breath ethane test to determine if either maternal cigarette smoking, formula, and/or deficiency of the antioxidant nutrients vitamins A and E was associated with oxidant stress in newborn infants. The rationale for this study was: (1) our observation that cigarette smoking was a source of oxidant stress in pregnant women, suggesting that it could be a source of oxidant stress for infants exposed in utero; (2) formula was predicted to be prooxidant compared to colostrum, which contains several compounds with antioxidant activity in vitro; and (3) deficiencies of vitamins A and E have been shown to promote oxidant stress in experimental animals.Methods:Breath ethane, a volatile alkane produced by peroxide of n‐3 fatty acids, was utilized as an index of oxidant stress status. Forty‐five healthy full‐term infants of the women mentioned above were studied at 18‐24 h of age, after four to six feedings of breast milk (colostrum) or caseinbased infant formula. Relationships between infant breath ethane, maternal smoking, mode of infant nutrition, and serum concentrations of the antioxidant vitamins A and E of infants were examined.Results:The breath ethane of the entire group of infants whose mothers smoked (n = 19) was increased compared to values of infants whose mothers did not smoke (n = 26): 97 ± 16 versus 43 ± 9 pmol/kg/min, p < 0.03. When infants of mothers who smoked were eliminated from the analysis in order to study effects of nutrition alone, formula appeared to be prooxidant compared to breast milk. Breath ethane of formula‐fed infants (n = 16) was 62 ± 13 versus 13 ± 4 pmol/kg/min for breast‐fed infants (n = 10), p < 0.04. For the group as a whole, there was no correlation between infant breath ethane and serum concentrations of vitamins A and E.Conclusions:Exposure to maternal smoking in utero is prooxidant in newborn infants. Formula also has a prooxidant effect compared to colostrum in newborn infants not exposed to maternal smoking in utero. Further investigations will be necessary to explore the clinical consequences of these observations.
Modified Cow's Milk Formula with Reduced Renal Acid Load Preventing Incipient Late Metabolic Acidosis in Premature Infants
Authors: Kalhoff H. , Diekmann L. , Hettrich B. , Rudloff S. , Stock G. J. , Manz F. 
Published: February 2024

Background:Premature infants receiving alimentation with cow's milk formulas are at a considerably high risk of developing incipient late metabolic acidosis, an early stage in the development of manifest late metabolic acidosis. Is it possible to reduce this risk by modification of the composition of a standard formula?Methods:The mineral composition of a cow's milk preterm formula A was modified (formula B) with the aim of reducing the alimentary load to that of human milk. 160 premature infants were fed either mother's milk (n = 50) or the modified formula B (enriched with sodium and potassium) (n = 110), and their urine pH was tested twice a week. Randomly collected subgroups of infants were studied in detail for nutrient balances. The results were compared with earlier observations of 282 premature infants fed either mother's milk (n = 28) or the standard formula A (n = 254).Results:Incipient late metabolic acidosis was observed in nine of 78 premature infants receiving mother's milk, 53 of 254 premature infants receiving the standard formula A, and only one of 110 premature infants fed the modified formula B. Net acid excretion was 0.58 mmol/kg/day in 11 premature infants receiving alimentation with the modified formula B compared with 1.73 mmol/kg/day in 23 premature infants fed formula A. This reduction was mainly due to an increased alkali excess (sodium + potassium‐chloride) in intake and urine.Conclusions:Reduction of renal acid load with the modified formula B had a preventive effect on the rate of development of incipient late metabolic acidosis in premature infants.
Growth and Nutrient Intake in Three‐ to Twelve‐Month‐Old Infants Fed Human Milk or Formulas with Varying Protein Concentrations
Authors: KarlslandÅkeson Pia M. , Axelsson Irene E. M. , Räihä Niels C. R. 
Published: February 2024

ABSTRACTBackground:Results on growth and nutrient intake in infants in the second half of infancy fed human milk or formulas with varying protein concentrations in combination with supplementary foods have not previously been reported.Methods:Seventy‐one healthy infants were studied from 3 to 12 months of age. They were exclusively breast‐fed until 3 months and were then randomly assigned to one of three feeding groups, F13, F15, or F18, indicating formulas with 13, 15 or 18 g/l of protein, respectively. Formula was gradually introduced when breast‐feeding was terminated. Infants fed breast milk only were included in the breast‐fed group, and those with breast milk and formula were included in the mixed‐fed group. The same supplementary foods were provided to all infants.Results:There were no differences in growth between the feeding groups. Total protein intake exceeded minimum recommendations in all groups at all ages and was higher at 6 months in F18 than in F13 (2.3 vs. 1.9 g/kg per day;p < 0.01), whereas formula protein intake was higher at all ages in F18 compared with F13. Intake of protein from supplementary foods increased, but that from formula decreased between 6 and 12 months in all groups.Conclusions:Intake of breast milk or infant formula with 13 g/l of protein along with high‐protein supplementary foods provided enough protein with no adverse effect on growth. Infants fed formulas with higher protein concentrations had similar growth, despite higher intakes of formula protein.