bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Oral Diazepam Versus Midazolam, Administered With Intravenous Meperidine, as Premedication to Sedation for Pediatric Endoscopy
Authors: Martinez Jose L. , Sutters Kimberly A. , Waite Steven , Davis Judy , Medina Elizabeth , Montano Nancy , Merzel David , Marquez Carol 
Published: January 2024

ABSTRACTObjectivesThis study was performed to compare the effects of oral midazolam and oral diazepam, administered with intravenous (IV) meperidine, on pre‐procedural, procedural, and post‐procedural sedation and recovery in children undergoing diagnostic upper endoscopy. The costs of pre‐procedure sedation were compared for the two benzodiazepines.MethodsA randomized, double‐blind study was conducted in 154 children (mean age 96.73 ± 59.34 months, 53% male) undergoing endoscopy. Oral midazolam (0.5 mg/kg, maximum dose of 20 mg) or oral diazepam (0.3 mg/kg, maximum dose of 10 mg) was given before IV insertion, and with IV meperidine (2 mg/kg, maximum dose of 100 mg) given to all patients just before upper endoscopy. Further “rescue” midazolam doses (to a maximum cumulative dose of 5 mg) were given as needed to achieve a pre‐procedure sedation score of ≥2. All patients received intravenous propofol for procedural sedation. Patients were evaluated for the efficacy and safety of pre‐procedural sedation, sedation during upper endoscopy, and recovery following completion of the procedure.ResultsThere were no significant differences between study groups for level of pre‐procedural sedation, need for midazolam rescue in endoscopy, effectiveness of procedural sedation, occurrence of adverse events, and recovery parameters.ConclusionsOral midazolam and diazepam, in conjunction with IV administration of meperidine, provide comparable, effective, and safe premedication for children undergoing upper endoscopy. The cost of midazolam was substantially higher than diazepam.
Assessment of Three Methods of pH Probe Positioning in Preterm Infants
Authors: Emmerson Anthony JB , Chant Terri , May Judith , Vales Patricia 
Published: January 2024

ABSTRACTBackgroundIn the assessment of gastroesophageal reflux, correct placement of the pH catheter is crucial. This is particularly so in very low birth weight infants where a small error in positioning could give rise to a potentially large error in results. Accepted modes of assessing correct positioning can be problematic in this population of infants and alternative methods were investigated.MethodsA total of 26 preterm infants (<35 weeks gestation) were enrolled in this study. All infants were suspected of having GOR and pH monitoring was performed. Probe position was assessed using Strobel's formula, manometry and acid‐alkali interface and confirmed by chest x‐ray.ResultsThere was a highly significant positive correlation between the calculation of the pH probe position using Strobel's formula and the position on x‐ray and a significant positive correlation between the acid/alkali interface and x‐ray position. There was no correlation between manometry and x‐ray position and this method was also shown to be problematic in its' application.ConclusionThe data suggests that it is appropriate to use Strobel's formula as a method of accurate positioning of pH probes in preterm infants, thus avoiding the need for additional x‐rays. The acid/alkali interface, when obtainable, is a secondary, satisfactory method to confirm the position calculated by Strobel's formula.
Early Feeding Advancement in Very Low‐Birth‐Weight Infants With Intrauterine Growth Retardation and Increased Umbilical Artery Resistance
Authors: Mihatsch Walter Alexander , Pohlandt Frank , Franz Axel Rainer , Flock Felix 
Published: January 2024

ABSTRACTBackgroundTo investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low‐birth‐weight (VLBW, <1,500 g) infants.MethodsFrom July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles.ResultsFull enteral feeds were achieved at 15 days (range, 12–21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12–21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11–16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14–20 days) were not associated with early feeding intolerance.ConclusionVery low‐birth‐weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate‐for‐gestational‐age VLBW infants.
Water Load Test in Children
Authors: Sood Manu R. , Schwankovsky Lenore M. , Rowhani Anita , Zangen Tsili , Ziring David , Furtado Theresa , Hyman Paul E. 
Published: January 2024

ABSTRACTObjectiveThe purpose of this study was to estimate values for the water load test in healthy elementary school children.MethodsWe measured the volume of water consumed by 176 children (71 boys and 105 girls) using the water load test at school. Children completed a questionnaire, which included self‐efficacy and abdominal pain history. Then subjects drank water for 3 minutes or until full.ResultsChildren drank 630 ± 260 ml. Water consumption correlated with age, weight, and height. Children who believed they could drink a lot, drank more than those who thought they could not, P < 0.01.ConclusionThe water load test is a simple and inexpensive method to estimate onset of satiety and may be useful in future studies now that there are values for healthy children.
Comparison of Steatocrit and Fat Absorption in Persons With Cystic Fibrosis
Authors: Wagner Mary H. , Bowser Ellen K. , Sherman James M. , Francisco Mary Pat , Theriaque Douglas , Novak Donald A. 
Published: January 2024

ABSTRACTBackgroundExocrine pancreatic insufficiency is a common problem in persons with cystic fibrosis causing malabsorption and poor growth. The 72‐hour fecal fat study is the best qualitative measure of fat malabsorption used in clinical practice. This test has several drawbacks, which include cost and logistics. The steatocrit has been proposed as a rapid method to assess fat malabsorption.ObjectivesThe objective of this study was to determine whether the steatocrit is an accurate estimation of fat malabsorption in persons with cystic fibrosis.MethodsForty‐nine stool samples for steatocrit processing were obtained from 72‐hour fecal fat collections performed on twenty‐seven persons with cystic fibrosis. Stools were weighed and homogenized with sand and water. The emulsified specimen was pipetted into heparinized capillary tubes and centrifuged for 15 minutes. The length of the fatty layer was compared to the length of the solid layer plus the fatty layer in each tube to determine the steatocrit value. Four steatocrit mixtures were evaluated: (1) standard steatocrit, (2) dilute steatocrit, (3) acid steatocrit, (4) dilute acid steatocrit. Steatocrit values were compared with the coefficient of fat absorption determined from the 72‐hour fecal fat collection.ResultsThe correlation coefficient of the steatocrit and the coefficient of fat absorption ranged from ‐.045 to ‐.491. Only the coefficient of fat absorption and the acid steatocrit had a significant correlation (P = 0.033).ConclusionThe steatocrit is an imprecise measure of fat absorption and not clinically useful in estimating steatorrhea.
Small Bowel Intestinal Permeability in Australian Aboriginal Children
Authors: Kukuruzovic Renata H. , Brewster David R. 
Published: January 2024

ABSTRACTObjectiveTo show that the severity of diarrheal disease in Aboriginal children in tropical Australia is a consequence of underlying small intestinal mucosal damage.Study DesignA prospective study of 338 Aboriginal admissions compared to 37 non‐Aboriginal children, both diarrhea cases and controls. Intestinal permeability was measured by lactulose‐rhamnose (L/R) ratios on a timed 90‐minute blood test.ResultsFor diarrheal admissions, significantly more Aboriginal (vs. non‐Aboriginal children) had hypokalemia (70 vs. 10%), acidosis (65 vs. 29%), moderate to severe dehydration (52 vs. 19%) and a longer mean length of stay (mean 8.9 vs. 3.9 days). Mean L/R ratios (95% confidence intervals) in Aboriginal children (diarrhea vs. controls) were 16.5 (14.6–18.7) vs. 4.5 (3.8–5.3) compared to 7.7 (4.4–13.3) vs. 2.5 (1.8–3.4), respectively, in non‐Aboriginals. Abnormal permeability ratios (> 5.6) consistent with tropical‐environmental enteropathy syndrome were found in 36% (27/75) of Aboriginal controls compared to none of the non‐Aboriginal controls. On multiple regression, the factors associated with high L/R ratios were diarrheal severity (P < 0.001), acidosis (P = 0.007) and hypokalemia (P = 0.04).ConclusionsAn underlying tropical‐environmental enteropathy contributes to the severity of acute gastroenteritis in Aboriginal children. Diarrheal complications, such as acidosis, hypokalemia, and osmotic diarrhea are associated with high L/R ratios, reflecting greater small intestinal mucosal damage.
Whey Predominant, Whey Modified Infant Formula with Protein/energy Ratio of 1.8 g/100 kcal: Adequate and Safe for Term Infants From Birth to Four Months
Authors: Räihä N. C. R. , Fazzolari‐Nesci A. , Cajozzo C. , Puccio G. , Monestier A. , Moro G. , Minoli I. , Haschke‐Becher E. , Bachmann C. , Van't Hof M. , Fässler A.‐L. Carrié , Haschke F. 
Published: January 2024

ABSTRACTBackgroundProtein quality of breast milk is superior to that of formula proteins. To ensure that the protein intake is sufficient, starter formulas with conventional protein composition provide a protein/energy ratio of 2.2–2.5 g per 100 kcal to infants, which is much higher than that supplied with breast milk. Several studies have shown that formula‐fed infants have higher plasma or serum urea concentrations than breast‐fed infants do. We tested if feeding formulas with improved protein quality and a protein content corresponding to the minimum level that is consistent with international recommendations (1.8 g/100 kcal) allows patients to achieve normal growth and plasma urea concentrations.MethodsHealthy term infants were enrolled into the study and were either breast‐fed or randomly assigned to three formula‐fed groups. Formula‐fed infants received either a standard formula with a protein/energy ratio of 2.2 g/100 kcal, whereas the two other groups received formulas with a protein/energy ratio of 1.8g/100 kcal differing mainly by their source of protein. Subjects received breast milk or these formulas ad libitum as the sole source of energy from birth to four months of age in a controlled blind design (except for the breast‐fed group). Anthropometric measurements (body weight and length) were obtained at birth, at 30, 60, 90, and 120 days. Energy and protein intakes were calculated from three‐day dietary records. Blood was collected for biochemical measurements at 30, 60, and 120 days.ResultsNo differences were found between the four feeding groups for weight‐ and length‐gains or for body mass indices (BMI). No differences in energy intakes between the formula‐fed groups could be found, whereas protein intakes were less in infants fed the 1.8 g/100 kcal formulas. Plasma urea levels of the infants fed the 1.8 g/100 kcal formulas were closer to those found in the breast‐fed infants.ConclusionImprovement of the amino acid profile permits a whey predominant starter formula with 1.8 g protein per 100 kcal to meet the needs of normal term infants during the first four months of life.
Activated Duodenal Mucosal Eosinophils in Children With Dyspepsia: A Pilot Transmission Electron Microscopic Study
Authors: Friesen Craig A. , Andre Linda , Garola Robert , Hodge Charles , Roberts Charles 
Published: January 2024

ABSTRACTBackgroundActivated eosinophils can be identified by electron microscopy (EM) Previous studies have shown EM evidence of eosinophil activation in a variety of gastrointestinal conditions associated with inflammation. The purpose of this study was to evaluate the activation state by EM of duodenal mucosal eosinophils in children who presented with dyspepsia and to determine if eosinophils are activated in patients with normal eosinophil counts on routine histology.MethodsTwenty patients (ages 7–15 years) with dyspepsia were evaluated. All had normal gross endoscopies and Helicobacter pylori was excluded. Each patient had two endoscopic forceps biopsies taken from both the duodenal bulb (DB) and the second portion of the duodenum (DS) for routine histology to determine eosinophil counts. Two additional biopsies were taken from the adjacent mucosa of each site for EM evaluation. The eosinophil activation state was determined for each specimen and a degranulation index was calculated for DB specimens.ResultsOn routine histology, peak eosinophil counts were greater than or equal to 20 per hpf in three patients, 11 to 19 per hpf in 12 patients, and less than or equal to 10 per hpf in 5 patients. All patients showed evidence of EM activation on DB specimens and 95% showed activation on DS specimens. The mean degranulation index was 50.5 + 12.0% with 65% of specimens revealing moderate (20 – 60%) degranulation and 30% of specimens revealing extensive (greater than 60%) degranulation.ConclusionsEosinophils present in the duodenal mucosa of children with dyspepsia are activated in a significant proportion of patients, even in those with normal eosinophil counts. The degree of degranulation is similar to that seen in other conditions where eosinophils have a pathogenic role.
Protective Effect of Bilirubin in Ischemia‐Reperfusion Injury in the Rat Intestine
Authors: Hammerman C. , Goldschmidt D. , Caplan M. S. , Kaplan M. , Bromiker R. , Eidelman A. I. , Gartner L. M. , Hochman A. 
Published: January 2024

ABSTRACTBackgroundAlthough bilirubin, which crosses the blood–brain barrier, can cause irreversible brain damage, it also possesses antioxidant properties that may be protective against oxidative stress. Intestinal ischemia–reperfusion (IR) injury results in cell destruction, mediated via the generation of reactive oxygen species. Although increased serum bilirubin is correlated with increased antioxidant potential in the face of hyperoxia, evidence of bilirubin‐associated protective effect against IR injury remains nonspecific. We therefore sought to investigate whether hyperbilirubinemia would be protective against IR injury to the intestine.MethodsYoung adult rats were randomly assigned to one of three groups: 1) IR/control (n = 12); 2) IR/hyperbilirubinemia (n = 10), in which IR was generated while the rats were treated with a continuous infusion of bilirubin; and 3) hyperbilirubinemia controls (n = 10). Blood and intestinal tissue samples were obtained to determine serial thiobarbituric acid reducing substances (index of lipid peroxidation) and for xanthine oxidase/xanthine dehydrogenase and glutathione/glutathione disulfide ratios. Intestinal histopathology was graded from 1 (normal) to 4 (severe necrotic lesions).ResultsHistopathologic scoring and circulating and tissue thiobarbituric acid reducing substances were highest in the IR/control animals compared with either the IR/hyperbilirubinemics or the controls. All of these are consistent with the most severe injury in this group. Xanthine oxidase/xanthine dehydrogenase ratios were not significantly different among the groups.ConclusionHyperbilirubinemia ameliorates the extent of intestinal IR injury in our model and appears to act as an antioxidant. This study supports the concept that bilirubin possesses some beneficial properties in vivo, although no direct clinical conclusions can be drawn from these data.
Lactobacillus plantarum Reduces the In Vitro Secretory Response of Intestinal Epithelial Cells to Enteropathogenic Escherichia coli Infection
Authors: Michail Sonia , Abernathy Frank 
Published: January 2024

ABSTRACTObjectiveEnteropathogenic Escherichia coli (EPEC) is a Gram‐negative bacillus that causes diarrhea. Secretory responses of intestinal epithelial cells can be seen after EPEC infection. Probiotics, which are live bacteria that have proven benefit to the host, play a role in the treatment and prevention of the different enteric pathogens. The goals of the study were to determine whether the probiotic agent Lactobacillus plantarum (LBP) strain 299v alters the secretory changes seen in EPEC infection and, if so, what underlying mechanism is possible.MethodsCaco‐2 cell monolayers were rapidly infected with EPEC strain E2348/69 and immediately mounted in Ussing chambers. The monolayers were exposed to LBP before, after, and simultaneously with EPEC infection. Short circuit current (Isc) was measured in the Ussing chamber.ResultsEPEC infection caused an increase in short circuit current that was reduced by preincubation with LBP (P < 0.01). No direct bactericidal effect was observed, but LBP reduced the attachment of EPEC to Caco‐2 cells.ConclusionLBP can play an important role in reducing the secretory change in response to EPEC infection, possibly through inhibition of its binding. However, the presence of the probiotic agent before the infection is necessary. In this setting, its role is more preventive rather than therapeutic.
Histologic Activity of Childhood Chronic Hepatitis B Related to Viremia Levels, Genotypes, Mutations, and Epidemiologic Factors
Authors: Söderström Ann , Norkrans Gunnar , Conradi Nils , Krantz Marie , Horal Peter , Lindh Magnus 
Published: January 2024

ABSTRACTBackgroundDespite high viral load, children with chronic hepatitis B virus (HBV) infection may lack significant biochemical signs of liver dysfunction. Failure to develop abnormal liver chemistriesis is probably due to immunologic hyporeactivity. Despite the absence of biochemical abnormalities in these patients, there is still a risk for long‐term complications. The pathogenic importance of viral load and genetic variability is less well studied in children than in adults.MethodsWe evaluated viremia levels, genotypes, and mutations related to histologic evidence of liver damage in 71 HBV carriers, aged 2 to 18 years, all of non‐Swedish origin.ResultsNone of the of 22 children who were hepatitis B e antigen (HBeAg) negative had severe liver disease or had HBV DNA levels greater than 104.6 copies/mL (mean 103.2); 3 (14%) of them had increased alanine aminotransferase (ALT). The 49 HBeAg‐positive children had a mean HBV DNA level of 108.0 copies/mL, and increased ALT was seen in 28 (55%). Core promoter mutations (at nt 1764) or precore mutations (at codon 1, 2, or 28) were rare; they were seen in four and one HBeAg‐positive children, and in four and nine HBeAg‐negative children, respectively, without association to liver damage. C‐1858 was associated with more liver inflammation. Genotype did not significantly influence liver damage. Children with horizontal transmission had a faster rate of seroconversion and more inflammation of the liver.ConclusionsSevere HBeAg‐negative hepatitis with high HBV DNA levels and mutations in the core promoter or precore regions seems to be less common in children than in adults. C‐1858 strains may be more pathogenic, but this requires further study. Epidemiologic factors influence the course of infection.
Intestinal Transport of Insulin‐Like Growth Factor‐I (IGF‐I) in the Suckling Rat
Authors: Philipps Anthony F. , Kling Pamela J. , Grille James G. , Dvořák Bohuslav 
Published: January 2024

ABSTRACTObjectivesInsulin‐Like Growth Factor‐1 is a potent growth‐promoting peptide that is present in mammalian milk. Previous studies have suggested that milk‐borne IGF‐1 may be absorbed intact from the gastrointestinal tract of the suckling but the mechanism responsible for such transport is not well documented. The present study was designed to investigate in an in vivo suckling rat model whether or not intestinal absorption of IGF‐1 is a saturable phenomenon.MethodsSuckling rats (10–12 days postnatal age) were studied under anesthesia. A jejunal loop from each rat pup was isolated and injected intraluminally with 1–2 × 105 cpm of rh125I‐IGF‐I. Injections were performed in paired littermates either with or without a preceding injection of unlabeled IGF‐I of 20, 500, or 1000 ng/ml concentration. After flushing, the loops and livers were homogenized and counted in a gamma counter. In addition, homogenates of jejunum and liver were precipitated with trichloroacetic acid (TCA) and the precipitates also counted. In selected instances (jejunum), acid gel chromatography of homogenates was also performed.ResultsRetention of radioactivity was observed in all jejunal specimens, but the pre‐incubation of jejunal loops with unlabeled IGF‐1 was associated with a biphasic response, i.e. at low dose (20 ng/ml) pre‐incubation limited retention of radioactivity, but at a high dose (1000 ng/ml), retention was enhanced (P < 0.05). Linear regression analysis confirmed this inverse relationship. Liver radioactivity followed a similar pattern. Between 40 and 49% of the radioactivity in jejunal and liver homogenates was TCA precipitable. Chromatography of jejunal homogenates showed that approximately 40% of cpm migrated in a position identical with that of intact IGF‐1.ConclusionsThe intestinal uptake of IGF‐1 in the suckling is nonsaturable, confirming previous in vitro studies and suggesting that a nonreceptor‐dependent method of transepithelial transport is important in this process.
Evaluation of Dietary Fiber Intake in Belgian Children With Cystic Fibrosis: Is There a Link With Gastrointestinal Complaints?
Authors: Proesmans M. , De Boeck K. 
Published: January 2024

ABSTRACTBackgroundPancreatic enzyme replacement is the cornerstone of treating pancreatic insufficiency in patients with cystic fibrosis. Additionally, a high‐calorie/high‐fat diet is required to compensate for the increased energy requirement and the incomplete fat digestion. Even with adequate enzyme treatment, gastrointestinal problems, varying from simple constipation to inspissated stools, and distal intestinal obstruction syndrome (DIOS) may occur. Apart from residual fat malabsorption, a low fiber intake is suspected to be an underlying factor in gastrointestinal complaints.MethodsWe evaluated fiber intake in 40 patients with cystic fibrosis based on the dietary history method. Patients were classified according to gastrointestinal problems: group 1, no gastrointestinal complaints; group 2, nonspecific and mild gastrointestinal complaints; and group 3, documented DIOS.ResultsOverall fiber intake was adequate when compared with current recommendations. We could not show a relation between fiber intake and gastrointestinal complaints or DIOS. On the contrary, in patients with DIOS, fiber intake was higher, possibly as a therapeutic response to their gastrointestinal complaints.ConclusionOverall fiber intake is adequate in our cystic fibrosis population. We could show no relation between low fiber intake and gastrointestinal problems in our patients with cystic fibrosis.