bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in Density of Jejunal IgA2 Cells during Infancy without Change in IgA1 Cells
Authors: Hacsek Gabor , Savilahti Erkki 
Published: February 2024

SummaryTo determine any association between densities of cells containing IgA, IgA1, IgA2, IgG, and IgM in the lamina propria of the jejunum and the age of the individual, we restudied 65 specimens from 65 patients in the age range 66 days to 4 years. Indications for jejunal biopsy were minor symptoms; none of the patients had any gastrointestinal disease, and the specimens showed normal morphology. We used murine anti‐human monoclonal antibodies to IgA, IgA1, IgA2, IgG, and IgM and an indirect immunoperoxidase method and found a significant increase with advancing age in the densities of cells containing IgA, IgA2, and IgG, whereas the densities of IgA1‐ and IgM‐positive cells did not change with age. Densities of IgA2 and IgG cells in children over 1 year were significantly greater than in infants under 9 months (upper vs. lower quartile of the study group, p < 0.05 in both comparisons). In the jejunum, an increase in IgA2 cells was responsible for the increase in total IgA production for the age range studied.
Nutritional Status in Untreated Children with Acute Leukemia as Compared with Children without Malignancy
Authors: Uderzo Cornelio , Rovelli Attilio , Bonomi Massimo , Barzaghi Anna , Strada Simona , Balduzzi Adriana , Pirovano Letizia , Masera Giuseppe 
Published: February 2024

SummaryWe evaluated the nutritional status of 173 consecutive children with newly diagnosed leukemia compared with that of 307 children with benign acute diseases. Nutritional status was assessed by anthropometric measurements including weight, height, weight for height, midarm circumference (MAC) and triceps skinfold (TSF), and by biochemical indices, in particular prealbumin (TBPA) and retinol‐binding protein (RBP). On admission, no significant differences were found between groups in weight, height, weight for height, MAC, and TSF values. TBPA and RBP, lower than normal in most cases, were not significantly different in the two groups. Furthermore, no differences were observed when children with high‐risk leukemia were compared with those at standard risk. In conclusion, children with newly diagnosed leukemia do not seem to present significant nutritional depletion, and their nutritional status is similar to that of children admitted for other nonmalignant acute diseases. However, nutritional indices should be monitored in children with high‐risk leukemia because treatment intensity is likely to result in a malnutritional status later, which might be prevented by early adequate nutritional support.
Growth Hormone Insensitivity in Children with Biliary Atresia
Authors: Bucuvalas John C. , Horn Jo Ann , Slusher Joyce , Alfaro Mary Pat , Chernausek Steven D. 
Published: February 2024

SummaryMalnutrition is a critical predictor of mortality and morbidity in children with biliary atresia who undergo orthotopic liver transplantation. Growth hormone (GH) enhances nitrogen retention in patients with chronic obstructive lung disease, sepsis, and in fasted adult volunteers. The goal of this study was to assess the acute response to recombinant human GH (rhGH) treatment in children with biliary atresia to determine whether GH therapy was likely to improve pretransplant nutritional status. Five children, aged 10‐32 months, with biliary atresia and persistent cholestasis despite surgical attempts to reestablish bile flow, were studied. All five children had portal hypertension, conjugated hyperbilirubinemia, and decreased serum albumin concentrations. Length, weight, and growth velocity were decreased in all five children. Despite adequate energy and protein intake, fat stores were depleted in all five subjects, and somatic protein stores were diminished in all except one child. Baseline serum concentrations of insulin‐like growth factor‐1 (IGF‐1) and IGF‐binding protein‐3 (IGFBP‐3) were low (8.4 ± 2 ng/ml and 0.2 ± 0.1 mg/l respectively). In the four children who completed the study, serum IGF‐I and IGFBP‐3 levels did not change after treatment with rhGH (0.1 mg/kg/day) for 4 days. Our findings indicate that children with biliary atresia awaiting liver transplantation are insensitive to GH and that treatment with GH is unlikely to promote anabolism. A rationale exists for examining the effect of treatment with IGF‐I, which mediates the anabolic effects of GH.
Gastroesophageal Reflux in Infants: Evaluation of a New Intraluminal Impedance Technique
Authors: Skopnik Heino , Silny Jiri , Heiber Oliver , Schulz Jürgen , Rau Günter , Heimann Gerhard 
Published: February 2024

SummaryIn this study, pH metry was simultaneously applied with a new technique, the intraluminal multiple electrical impedance (IMP) procedure, for measuring gastrointestinal motility for gastroesophageal reflux (GER) detection. Seventeen infants with clinical symptoms of GER disease such as recurrent apnea, aspiration pneumonia, wheezing, and failure to thrive were investigated during two feeding periods. A single catheter combining a pH electrode with seven electrodes for impedance measurements over a distance of 8.5 cm was used for the investigation. In all patients, 185 acid episodes were detected by pH metry. In 106 of these 185 acid episodes, a unique pattern in the IMP readings was noted, indicated by a retrograde esophageal volume flow. These episodes were regarded as acid GER episodes. Seventy‐one of the 185 acid episodes occurred during the clearance process of a preceding acid GER characterized by typical IMP readings of an anterograde bolus transport. Eight of 185 acid episodes were missed in the IMP readings for technical reasons. The IMP pattern described as characteristic for a GER was observed in 490 other episodes not detected by pH metry. More than 75% of all GER detected by IMP reached the pharyngeal space; 73% of all GER occurred during feeding and the first 2 postprandial hours and 27% occurred during the remaining time until the next feeding. Even during the latter period, 34% of GER were detected by IMP only; they were missed by pH metry. Volume clearance indicated by IMP was always completed earlier than acidity clearance. The results show that IMP technique facilitates the detection of all GER, whereas pH metry is confined to the measurement of acid GER. Therefore, this technique might improve the evaluation of GER disease and detection of GER in conditions with gastric hypoacidity.
Intussusception: A 9‐Year Survey (1986‐1995)
Authors: Eshel G. , Barr J. , Heyman E. , Tauber T. , Klin B. , Vinograd I. , Starinsky R. , Lahat E. 
Published: February 2024

Background:Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel.Methods:A retrospective chart review of a 9‐year period (1985‐1995) was carried out at a university medical center. Data extracted included age, sex, ethnic origin, presenting symptoms and signs, the type of enema (barium or air), and the success rate of non‐surgical reduction of the intussusception.Results:Ninety patients suffering from intestinal obstruction due to acute intussusception were admitted. The triad of intermittent screaming attacks, lethargy, and vomiting was observed in 37.5% of study subjects. The majority of patients were admitted during the warmer months of the year. The average age of the patients was 7.8 ± 3.7 months; 70% of them were between the ages of 4 and 9 months and 92.5% under 1 year of age. The female‐to‐male ratio was 1:2.1. Air enema was superior to the barium enema in achieving reduction (p < 0.01). The incidence in the Jewish population was similar to that observed in other surveys, and twice that found in the Arab population in our region (p < 0.05).Conclusions:The overall clinical presentation of acute intussusception found in our study does not differ from other studies. The lower incidence of acute intussusception found in the Arab population can be explained by ethnic, genetic, or nutritional factors.
The Platelet‐Activating Factor Receptor Antagonist WEB 2170 Prevents Neonatal Necrotizing Enterocolitis in Rats
Authors: Caplan Michael S. , Hedlund Erik , Adler Luba , Lickerman Matthew , Hsueh Wei 
Published: February 2024

Background:To evaluate the role of platelet‐activating factor (PAF) in a neonatal rat model of necrotizing enterocolitis (NEC).Methods:NEC was reproduced in newborn rats following exposure to formula feeding, asphyxia, and bacterial colonization. The role of endogenous PAF in neonatal NEC was studied by pretreating animals with PAF receptor antagonists (WEB 2170 and WEB 2086) and by measuring intestinal PAF content in animals with NEC, WEB‐treated animals, and controls.Results:We found that WEB 2170 (dosed using 10 mg/kg in a.m. and 30 mg/kg in p.m.) markedly reduced the incidence of NEC (3/17 vs. 14/18 control; p < 0.001) and death (6/17 vs. 17/18 control; p < 0.001) compared with saline‐treated animals. Although lower WEB 2170 doses prevented NEC, neither fourfold higher dosing with WEB 2170 nor similar dosing with WEB 2086 affected the incidence of disease in this study. PAF content in intestine was elevated in NEC animals (270 ± 80 pg/g) compared with WEB 2170‐treated animals (0 pg/g) and maternally fed controls (70 ± 50 pg/g).Conclusions:The data support the role of PAF in the final common pathway of neonatal NEC.
Antibody Pattern in Childhood Celiac Disease
Authors: Bottaro Gaetano , Volta Umberto , Spina Massimo , Rotolo Novella , Sciacca Agata , Musumeci Salvatore 
Published: February 2024

Background:We carried out a study of the antibody pattern in 50 celiac children [34 females (F) and 16 males (M); F/M, 2.1], ages 7 months‐15 years, compared with that in 25 control subjects (13 females and 12 males) of the same age.Methods:IgA and IgG antigliadin antibodies (AGA) were determined with an enzyme‐linked immunosorbent assay technique. IgA anti‐R1‐reticulin antibodies (ARA) and IgA antiendomysium antibodies (EmA) were determined with the fluorescein isothiocyanate‐conjugate‐labeled anti‐human immunoglobulin technique. To compare sensitivity and specificity, EmA were identified using monkey esophagus and human umbilical cord as substrates.Results:While AGA (IgA and IgG) showed a high sensitivity but a low specificity, ARA showed a high specificity but a low sensitivity. Data on EmA showed a high sensitivity and specificity with both tissue sections, with monkey esophagus being more sensitive (96%) and umbilical cord more specific (100%).Conclusions:Our results confirm the importance of celiac disease‐related antibodies in identifying celiac children. Moreover, the easy availability of human umbilical cord indicates that it would be proper to use this tissue as substrate, instead of monkey esophagus, for EmA search in the future.
Cost‐Benefit Analysis of Interferon Therapy in Children with Chronic Active Hepatitis B
Authors: Louis‐Jacques Otto , Olson Allan D. 
Published: February 2024

Background:α‐Interferon is widely accepted for treatment of adults with chronic hepatitis B, but its use remains limited in children, partly because of questions regarding its cost effectiveness. The aim of this study was to evaluate the cost effectiveness of α‐interferon for children with chronic active hepatitis B.Methods:We estimated the cost per year of life saved by α‐interferon therapy for three cohorts of patients with chronic active hepatitis B treated at 2, 12, or 25 years of age. We assumed that only patients with active viral replication would be treated and that α‐interferon would prevent cirrhosis and hepatocellular carcinoma in a portion of the population treated. We calculated costs per year of life saved. Medical costs and years of life saved were discounted at 5% per year.Results:With a 30% response rate to α‐interferon, there was a net savings in both money and lives in the children's group with a minimal cost per year of life saved for adolescents ($510) and adults ($934). Years of life saved per person were greater for children (1.0) than adults (0.5). With a 6% response rate, estimated costs per year of life saved for children ($5,700) were one‐fourth of those of adults ($22,100).Conclusions:α‐interferon therapy for patients with chronic active hepatitis B is cost effective. α‐Interferon is more cost effective in toddlers than adults because of the smaller dose required and the greater increase in life expectancy of children.
Effect of Ursodeoxycholic Acid Therapy on Hepatic Function in Children with Intrahepatic Cholestatic Liver Disease
Authors: Narkewicz Michael R. , Smith Debra , Gregory Christopher , Lear James L. , Osberg Iris , Sokol Ronald J. 
Published: February 2024

ABSTRACTBackground:Ursodeoxycholic acid (UDCA) has been shown to improve pruritus, alanine aminotransferase (ALT), and cholesterol levels in children with intrahepatic cholestatic liver disease. However, the effect of UDCA on quantitative tests of hepatic function in children is uncertain.Methods:A 2.5‐year, open label, crossover study, was designed to determine the effect of UDCA (15‐20 mg/kg per day for 12 months, off for 6 months, and on again for 12 months) on clinical symptoms, biochemical test results, galactose and caffeine elimination half‐lives (t½), and quantitative hepatic scintigraphy in 13 subjects aged 13.1 ± 2.1 years (10 of whom completed the entire study), with intrahepatic cholestasis.Results:Pruritus improved with UDCA in the 6 patients with pruritus on entry into the study. At 12 months, there was a significant decline in ALT,γ‐glutamyl transpeptidase, and plasma levels of copper and manganese, with no further decline in these levels at 24 months. There were no changes in bilirubin or cholylglycine levels. After therapy was discontinued at 12 months, UDCA was restarted within 1 month in 9 of 12 patients in response to a doubling of ALT (n = 6) or worsening pruritus (n = 3). Galactose t½ increased after 12 months, with no further increases after 24 months of UDCA therapy, whereas caffeine t½ did not change. There were no significant changes in hepatic scintigraphy throughout the study.Conclusions:These data suggest that although UDCA therapy improves pruritus and results in a reduction in ALT and γ‐glutamyl transpeptidase, UDCA therapy did not improve quantitative measures of hepatic function in children with intrahepatic cholestasis.
Impact of Gastroesophageal Reflux on Growth and Hospital Stay in Premature Infants
Authors: Frakaloss Geri , Burke Georgine , Sanders Marilyn R. 
Published: February 2024

ABSTRACTBackground:Gastroesophageal reflux (GER) is associated with failure to thrive in term infants with severe GER; however, this association has not been shown in premature infants. A retrospective case‐control study of growth velocities, caloric intake, and length of hospital stay in premature infants with GER was conducted to determine the impact of GER on their growth.Methods:Twenty‐three patients with clinically significant GER were identified from a database containing records for all infants admitted to the University of Connecticut Health Center Neonatal Intensive Care Unit. Patients and control subjects (n = 23) were matched for gestational age, birth weight, gender, and severity of bronchopulmonary dysplasia. Each infant's average weekly weight gain and average weekly caloric intake were calculated, using daily bedside nursing flow sheets. Comparisons were also made of the number of days it took each infant to achieve full oral feedings, number of days from full oral feedings to discharge, and length of hospital stay.Results:There were no significant differences between patients and control subjects for each week in average weekly weight gain, caloric intake, grams gained per calorie given, or weekly increments gained in length and head circumference. There were, however, significant differences in time required to achieve full oral feedings (32 ± 13 days versus 19 ± 12 days; p< 0.0008) and length of hospital stay (99 ± 27 days versus 70± 31 days; p < 0.002) as well as postmenstrual age (PMA) at discharge (43 ± 3 weeks versus 39 ± 3 weeks, p < 0.001).Conclusions:GER did not have a significant impact on caloric intake, effective use of calories, or growth velocities in the study population. It is more likely that the constant monitoring of weight gain and caloric intake while in the intensive care environment protects against the failure to thrive often seen in older infants with GER. Premature infants with GER had a significantly increased length of hospital stay. More aggressive medical management and consideration of alternative feeding strategies may help facilitate discharge for premature infants diagnosed with GER.
T‐Cells and HLA‐Class II Expression in the Large Intestine of Infants in the Early Postnatal Period
Authors: Örmälä Timo , Rintala Risto , Savilahti Erkki 
Published: February 2024

ABSTRACTBackground:There is only limited knowledge of the development of the immune responses of the gut in very young infants after exposure to bacterial and food antigens at birth.Methods:In this study, 49 large intestinal biopsy specimens, which were judged to have normal morphology, were taken from 49 young infants. Eleven patients had Hirschsprung's disease (group 1) and 38 had miscellaneous conditions (group 2). The densities of T cells, their subsets expressing surface antigens CD8 and CD4, and T‐cell receptors α/β or γ/δ were measured, as well as densities of mononuclear and epithelial cells expressing HLA‐class II antigens.Results:T‐cell densities in groups 1 and 2 were similar. Patients with Hirschsprung's disease had significantly more HLA‐DR (p = 0.006) and HLA‐DP‐expressing cells (p = 0.003) in the lamina propria than did the patients in group 2. In group 1, HLA‐DR‐ (r = 0.58; p= 0.46) and HLA‐DP‐expressing cells (r = 0.66; p = 0.03) showed a significant positive regression with age in the lamina propria, whereas in group 2, HLA‐DR+ cells in the lamina propria showed marked(r = ‐0.9; p = 0.006) negative regression during the first 1.5 months of life. In contrast to results in previous reports, in the current results, HLA‐D region antigens were present in the epithelium in a considerable proportion (up to one fourth) of specimens from the large intestine in both groups. CD3+ (r = ‐0.59; p = 0.006) and CD4+ (r = ‐0.64; p = 0.002) cells showed a strong negative regression with age in the lamina propria during the first 2.5 months; and thereafter, there was a weak, insignificant rise in the numbers of these cells. The distribution of CD4+, CD8+, and TCR α/β orγ/δ T cells of the epithelium of the young infants did not differ significantly from that in the epithelium of adults.Conclusions:These results show that several significant changes occur in the mucosal immune system during the first few weeks of life.
Histologic Evaluation of Endoscopic Versus Suction Biopsies of Small Intestinal Mucosae in Children with and Without Celiac Disease
Authors: Branski David , Faber Joseph , Freier Serem , Gottschalk‐Sabag Shoshana , Shiner Margot 
Published: February 2024

ABSTRACTBackground:Concern over the adequacy of histologic diagnosis of endoscopic duodenal biopsies in children prompted this comparative study on the histologic quality of endoscopic versus capsule biopsies. We found this problem addressed in only six previous reports.Methods:Blind examinations of the histologic sections of 48 duodenal biopsies obtained by gastrointestinal endoscopy in children aged 2‐18 years were compared to 52 biopsies obtained by the small bowel suction method (from children aged 1‐16 years).Results:Although 87.5% of endoscopic biopsies and 94.2% of capsule biopsies were adequate for histologic diagnosis, fragmentation or squashing was seen in 83.3% of endoscopic biopsies and only in 25% of capsule biopsies.Conclusions:Biopsies obtained by suction are of better quality than those obtained by endoscopy. If endoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a minimum of four biopsies should be obtained with forceps of a diameter greater than 2 mm. Adequate histologic criteria for diagnosis should include at least one full‐thickness mucosal specimen more than 3 mm in length, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the specimens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient.
Intestinal, Pancreatic and Hepatic Involvement in Carbohydrate‐Deficient Glycoprotein Syndrome Type I
Authors: Kristianson Bengt , Borulf Stefan , Conradi Nils , Erlanson‐Albertsson Charlotte , Ryd Walter , Stibler Helena 
Published: February 2024

ABSTRACTBackground:Children with carbohydrate‐deficient glycoprotein syndrome type I during infancy have gastrointestinal symptoms and growth impairment, the cause of which is largely unknown.Methods:Seven children were investigated with small intestinal biopsy, liver biopsy, duodenal intubation with determination of lipolytic and proteolytic activity, and test meal. Weight, length‐height, and head circumference were recorded regularly.Results:Growth was affected from early infancy, with an initial low rate of weight gain followed by impaired linear growth. Vomiting and diarrhea were dominant symptoms. Four of seven children had abnormal findings in light microscopic examination of small intestinal biopsy specimens, with short villi and increased inflammatory cells in the stroma, that did not respond to elimination of such food proteins as cow's milk or gluten. Electron microscopic study showed dilatation of smooth endoplasmic reticulum and abnormal inclusions containing lipids. The liver was abnormal in all. Besides steatosis and fibrosis or cirrhosis, there was a remarkable increase of inflammatory cells in portal zones. Activity of lipolytic enzymes in duodenal juice was low, except in one child, who no longer had growth problems or symptoms. Two of six had abnormal proteinolytic activity in duodenal juice. Digestion of triglycerides and absorption were within normal limits, as was the absorption of glucose and xylose.Conclusions:Inflammation of small intestine and liver may be the cause of gastrointestinal symptoms. In all likelihood, the growth failure was because of low caloric intake and increased losses related to vomiting. Growth and gastrointestinal symptoms improved spontaneously as time elapsed