bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Supplementation of Preterm Formula With Long Chain Polyunsaturated Fatty Acids on Mineral Balance in Preterm Infants
Authors: Martinez Francisco Eulógio , Sieber Vanessa Moura , Jorge Salim Moysés , Ferlin Maria Lúcia Silveira , Mussi‐Pinhata Marisa Márcia 
Published: January 2024

ABSTRACTBackgroundIncorporation of long chain polyunsaturated fatty acids (LCP) into formulas may interfere with mineral metabolism. We investigate mineral balance in preterm infants who were fed a formula with LCP.MethodsInfants were randomized in a double‐blind manner, 20 infants in each group, to receive a formula with LCP (F+LCP) or without LCP (F) for 30 days. Plasma levels (at the beginning and after 30 days) and nutritional balance (after 1 week) for Ca, P, Mg, Zn, and Cu were obtained for all infants.ResultsGroups were similar regarding birth weight, gestational age, weight, and corrected age at study start. During the 30‐day study period, the groups had comparable milk intake and reached similar and satisfactory weight gains and longitudinal growth. Within each group, there was no change in plasma mineral concentrations over the course of the study, and there were no differences at each time point between groups. All values were within the normal range for age. No differences in mineral balance were detected between the F and F+LCP groups, with both groups demonstrating comparable intake, net retention, and fecal losses of each mineral.ConclusionsAdding a content of LCP blend similar to that of human milk to a preterm formula caused no disturbance in Ca, P, Mg, Zn, or Cu nutritional balance.
Patient Web‐Resource Interest and Internet Readiness in Pediatric Inflammatory Bowel Disease
Authors: Cawdron R. , Issenman R. M. 
Published: January 2024

ABSTRACTObjectiveThe internet has been touted as a cost‐effective method of providing valuable patient education and support resources. However, little is known of the level of internet interest in or access to web‐based resources of most chronically ill populations generally, and pediatric populations in particular. Web‐based patient resources could be especially applicable to the pediatric inflammatory bowel disease (IBD) population given the potential appeal of an anonymous forum for this group.MethodsTertiary‐care clinic patients aged 8–18 years and diagnosed with IBD were surveyed by mail. χ2 and/or analysis of variance were used to compare demographic data from nonresponders and responders and for subgroup analyses.ResultsOf 162 eligible patients, 63 (38.9%) completed the survey. Responders did not differ significantly from nonresponders by age, sex, or distribution of disease. Overall, 98.4% of those surveyed had internet access, with 61.9% having access at school. Ninety‐five percent had used the internet, while 91% expressed interest in visiting a pediatric IBD website for general IBD information (83%), for support (73%), to pose questions (78%) or read (73%) or respond (60%) to questions, or to chat with others (46%). Despite expressed interest, far fewer had ever used the internet as an IBD information (52.4%) or support (9.5%) resource. Similarly, although 15.8% anticipated visiting a pediatric IBD site weekly, only 1.5% had done so in the week of the survey.ConclusionsReported levels of interest in web‐based patient resources are high among pediatric IBD patients, yet use may be infrequent.
Effects of Serum From Children with Newly Diagnosed Crohn Disease on Primary Cultures of Rat Osteoblasts
Authors: Varghese Samuel , Wyzga Nancy , Griffiths Anne M. , Sylvester Francisco A. 
Published: January 2024

ABSTRACTObjectivesWe propose that Crohn disease (CD) decreases bone formation via circulating inflammatory mediators. We therefore examined the effects of serum from newly diagnosed, untreated children with CD on osteoblasts in culture and the role of interleukin‐6 (IL‐6), a cytokine present in excess in active CD that also has direct effects on bone.MethodsBone mineral density was measured by dual x‐ray absorptiometry. Primary cultures of rat osteoblasts were treated with serum from patients with CD and healthy controls. We measured expression of osteoblast proliferation, viability, differentiation markers, and mineralized nodule formation. Neutralizing antibodies were used to inhibit the effects of IL‐6 present in serum.ResultsWe studied 24 children with CD (14 male) and 31 controls (15 male). Spine bone mineral density was lower in patients with CD (Z score, −0.8 ± 0.9 vs. 0.0 ± 1.0 for controls;P < 0.05). Nodule formation was markedly decreased in osteoblasts treated with CD serum. However, CD serum did not affect osteoblast proliferation or viability. Expression of proteins characteristic of mature osteoblasts—osteocalcin and alkaline phosphatase—was reduced. Unlike our results in a model of intact bone, neutralization of IL‐6 did not inhibit the effects of CD serum. Addition of IL‐6 to control serum to match serum concentrations in CD had no effect either.ConclusionsCD serum affects osteoblast function and probably differentiation in vitro, suggesting a mechanism by which CD may affect bone formation. IL‐6 by itself is not sufficient to cause these effects and probably needs a cofactor present in intact bone.
Visceral Pain‐Associated Disability Syndrome: A Descriptive Analysis
Authors: Hyman Paul E. , Bursch Brenda , Sood Manu , Schwankovsky Lenore , Cocjin Jose , Zeltzer Lonnie K. 
Published: January 2024

ABSTRACTObjectivePain‐associated disability syndrome (PADS) is a recently defined term that describes patients with chronic pain whose restriction in daily activities appears disproportionately severe for the observable pathology. The aim of this study is to describe the features of a group of pediatric patients with abdominal symptoms fitting this diagnosis.MethodsTo identify factors associated with visceral PADS, we reviewed the records of 40 patients (18 males; age range, 7–21 years) with gastrointestinal symptoms severe enough to prevent school attendance or eating for 2 months or more. These patients, in whom pain was neither feigned nor self‐induced, met the diagnostic criteria for visceral PADS, including failure of usual treatments and lack of a satisfactory organic explanation for the severity of the pain.ResultsThe dominant symptom was abdominal pain in 30 patients, regurgitation in 5 patients, nausea in 3 patients, and chest pain in 2 patients. All patients complained of pain or discomfort, and all met symptom‐based criteria for one or more functional gastrointestinal disorder. Disordered sleep was a problem for 39 patients. Factors associated with PADS included learning disabilities, unrealistic goals in a perfectionist, high‐achieving child, early pain experiences, passive or dependent coping style, marital problems in the home, and chronic illness in a parent. All patients had at least two associated factors, and a majority had four or more associated factors. Possible triggering events included an acute febrile illness in 20 patients, school change in 11 patients, trauma in 2 patients, death of a loved one in 2 patients, and sexual abuse in 2 patients. Before diagnosis, all patients underwent extensive negative evaluations. Nearly all patients had mental health evaluations that ruled out eating disorder and psychosis. Medical management had failed, and surgeries worsened symptoms. In a majority of patients, we identified a comorbid psychiatric disorder.ConclusionsEvaluation of preteens and teens unable to go to school or eat because of unexplained incapacitating symptoms should include queries about factors associated with PADS. To treat PADS, medical and mental health clinicians must recognize pain as having both nociceptive and affective components and address treatment collaboratively. Invasive procedures and surgery reinforce the cycle of arousal and pain and are to be avoided. Age for the onset of PADS in the preteen and early teen years suggests that developmental issues play a role.
The Spectrum of Fatty Liver in Obese Children and The Relationship of Serum Aminotransferases to Severity of Steatosis
Authors: Fishbein Mark H. , Miner Michelle , Mogren Chris , Chalekson Jennifer 
Published: January 2024

ABSTRACTObjectivesNon‐alcoholic fatty liver disease is an emerging diagnosis in the pediatric population. Previously, ultrasonography and serum aminotransferases have been used to estimate prevalence of the disorder. A lack of concordance has been noted between these two diagnostic tests. To better understand the spectrum of fatty liver in obese children and the relationship of serum aminotransferases to the severity of steatosis, hepatic MRI was used to quantitate fat content.MethodsTwenty‐two children, ages 6 to 18 years, with obesity (BMI > 95th percentile for age) and hepatomegaly (liver edge more than 2 cm below the right costal margin) underwent hepatic MRI for fat quantitation. Hepatic MRI was performed using a modification of the Dixon method that used a fast gradient echo sequence rather than traditional spin echo. Scan times were sufficiently brief to allow completion within a single breath hold. Serum aminotransferases were obtained within one month of MRI.ResultsTwenty‐one of 22 subjects had an elevated hepatic fat fraction. Seven of 7 subjects with a fat fraction of ≤18% had a normal serum ALT. Twelve of 13 subjects with fat fraction of >18% had an elevated serum ALT. Hepatic fat fraction correlated with serum ALT but did not correlate with age, BMI, or serum AST.ConclusionThe spectrum of fatty liver is larger than detected by screening for abnormal serum aminotransferases alone. Abnormalities in serum ALT occur exclusively in more severe cases of fatty liver.
Glycine Conjugation of Para‐Aminobenzoic Acid (PABA): A Pilot Study of A Novel Prognostic Test in Acute Liver Failure in Children
Authors: Lebel Sylvie , Nakamachi Yoshiko , Hemming Alan , Verjee Zul , Phillips M. James , Furuya Katryn N. 
Published: January 2024

ABSTRACTBackgroundFulminant hepatic failure (FHF) is associated with high mortality; few patients survive without liver transplantation. It is important to have a sensitive, specific early predictor of outcome to distinguish potential survivors (S) from nonsurvivors (NS).ObjectiveBecause we had previously shown that glycine conjugation of para‐aminobenzoic acid (PABA) quantitatively reflects liver function in children with chronic liver disease, in this pilot study we wanted to determine whether the measurement of the glycine conjugates of PABA could distinguish S from NS in FHF in comparison with standard prognostic indices.MethodsTwenty‐four patients were studied: acute severe hepatitis (n = 7), subfulminant hepatic failure (n = 7), and FHF (n = 10). Assessment of King's College criteria, measurement of factor V and VII levels, PABA testing, and transjugular liver biopsies were performed in almost all patients within 48 hours of admission. Serum PABA and its glycine conjugates (para‐aminohippurate (PAHA) and para‐acetamidohippurate (PAAHA)) were measured thirty minutes after oral administration by high‐pressure liquid chromatography. Poor prognostic categories as previously established in the literature were defined as factor V < 0.20U/ml, factor VII < 0.08 U/ml, % necrosis >70%, hippurate ratio = 0%, and PAHA = 0M.ResultsThe measurement of PAHA was the best predictor of a poor outcome in patients with acute liver failure with a sensitivity of 92%, and negative predictive value (NPV) of 92% compared with a sensitivity of 54% and a NPV of 63% with King's College criteria.ConclusionMeasurement of serum PAHA is the best early prognostic marker of death in children who suffer from FHF.
The Clinical Spectrum of Duodenal Polyps in Pediatrics
Authors: Attard T. M. , Abraham S. C. , Cuffari C. 
Published: January 2024

ABSTRACTObjectivesThe aim of this retrospective study was to determine the prevalence, clinical presentation, and histologic subclassification of duodenal polyps identified on endoscopy (EGD) in pediatric patients.MethodsWe performed an 18‐year retrospective study of all pediatric patients (< 21 years) with duodenal polyps diagnosed between 1983 and 2001 at The Johns Hopkins Children's Center. Our analysis includes a formal histologic evaluation of duodenal polyps either biopsied using cold‐forceps or removed by snare cautery.ResultsDuodenal polyps were reported in 22 of 5766 EGDs (0.4%) performed in 16 (M:F; 1:1) patients with a mean (SD) age of 14.1 (5.1) years. Polyps were equal in both the Caucasian and African American population (adjusted ratio 1.2:1). The histologic subtypes included Adenomatous (42%), Brunner's gland hyperplastic (33%), hamartomatous (17%), and heterotopic gastric gland polyps (8%). The most frequent indication for EGD was surveillance in patients with polyposis syndromes; most of these patients were asymptomatic at the time of their EGD. In comparison, the most frequent indication for an EGD in patients without polyposis syndromes was abdominal pain and vomiting.ConclusionsDuodenal polyps are most frequently encountered in children with polyposis syndromes, most of whom are asymptomatic. In nonsyndromic patients, the most common histologic subtype is Brunner's gland hyperplastic polyp and presenting symptoms include abdominal pain and vomiting.
Homocysteine Prevents Total Parenteral Nutrition (TPN)–Induced Cholestasis Without Changes in Hepatic Oxidative Stress in the Rat
Authors: Belli Dominique C. , Albrecht Robert , La Scala Giorgio C. , Desjeux Jehan‐François , Pelissier Marie‐Agnes 
Published: January 2024

ABSTRACTBackgroundThe role of oxidative stress in total parenteral nutrition (TPN)–associated cholestasis with liver glutathione depletion was recently shown. The aims of this study were to test the appearance of cholestasis and oxidative stress during TPN, and the hypothesis that reducing oxidative stress with a precursor of glutathione (GSH), homocysteine, would restore bile flow.MethodsThree groups of rats (weight, 179–278 g) were studied: 1) D/aa group received dextrose and amino acids (3.4 g/d); 2) D/aa/L group received the same amount of amino acids, and lipids were added on an equicaloric basis (50 kcal/d) with a lowered amount of dextrose; and 3) a control group, which received dextrose perfusion and had free access to chow. A subgroup of D/aa/L rats (n = 6) received a TPN solution containing homocysteine. After 5 days of TPN, bile was collected during 2 hours. In liver homogenates, GSH, thiobarbituric acid reactive substances (TBARS), and carbonyl content of proteins (Prot‐CO) were measured to test the level of oxidative stress and hepatic lipid and protein oxidation.ResultsAfter TPN, bile flow was significantly lower in the D/aa group than in the control group. Addition of lipids further decreased bile flow. Addition of homocysteine to TPN with lipids significantly increased bile flow. Aspartate aminotransferase increased significantly in both TPN groups compared with the control group. γ‐Glutamyl transpeptidase was not different among TPN groups. An increased hepatic lipid oxidation was demonstrated by TBARS level in both TPN groups when compared with the control group. However, the liver GSH contents were not different. Protein oxidation was also significantly increased by TPN. The addition of homocysteine to TPN solution increased bile flow without liver injury or changes of lipid and protein oxidation.DiscussionThis study shows that TPN administered to rats induces a decrease of bile flow and an oxidative stress but that the two changes are not directly correlated. Addition of lipids further impairs bile flow but does not increase the occurrence of liver injury. Consequently, it seems more likely that TPN primarily induces a cholestatic effect that in turn induces an oxidative stress rather than inducing an oxidative stress that leads to cholestasis. However, an association of both mechanisms is not totally excluded.
Bile in the Esophagus: A Factor in the Pathogenesis of Reflux Esophagitis in Children
Authors: Orel Rok , Markovic Sasa 
Published: January 2024

ABSTRACTObjectivesBile reflux has been postulated to be an important factor contributing to gastroesophageal reflux disease in adults. The purpose of this study was to investigate its role in children.MethodsSixty‐five children with symptoms of gastroesophageal reflux disease were classified on the basis of the endoscopic grade of reflux esophagitis: no esophagitis (n = 26), mild to moderate esophagitis (n = 26), and severe esophagitis (n = 13). Simultaneous 24‐hour esophageal pH and bilirubin monitoring with Bilitec 2000 was performed.ResultsBoth bile and acid reflux increased with the severity of esophagitis. The differences between all groups were significant for the percentage of total (P < 0.0005), upright (P < 0.05), and supine time (P < 0.0005) bilirubin absorbance ≥ 0.14, as well as for the percentage of total and supine time pH < 4, and DeMeester score (P < 0.0005). Combined pathologic acid and bile reflux was found in 11% of children with mild esophagitis and in 70% of children with severe esophagitis, while isolated bile reflux was found in 31% and 7.5%, respectively. Combined pH and bilirubin monitoring, compared with ph‐monitoring alone, increased the sensitivity from 56% to 79%, and the accuracy from 69% to 83%.ConclusionsBoth bile and acid reflux increase stepwise with the severity of esophagitis.Combined acid and bile reflux is associated with severe esophagitis. Isolated acid or bile reflux is usually present in mild esophagitis.Simultaneous esophageal pH and bilirubin monitoring has a higher sensitivity, as well as predictive values and accuracy than ph monitoring alone.
Urinary NOx:Creatinine Ratios During Gluten Challenge in Children With Celiac Disease
Authors: Koster‐Kamphuis L. , van Straaten E. A. , Kors W. A. , De Schrijver J. E. A. R. , Bovee‐Oudenhoven I. M. Y. , van der Meer R. , Forget P‐Ph. 
Published: January 2024

ABSTRACTObjectivesCeliac disease is a gluten‐induced small bowel enteropathy. Inflammation is known to be associated with enhanced nitric oxide (NO) production. An increase in urinary nitrate and nitrite (NOx) reflects increased NO production. The urinary NOx:creatinine ratio can be used as an indicator of the endogenous NO production. The aim of the study was to determine whether the urinary NOx:creatinine ratio of celiac disease patients increases during gluten challenge.MethodsThe authors studied 20 patients with unconfirmed celiac disease who had been following a gluten‐free diet for at least 1 year. These patients underwent an 80‐day gluten challenge. Urinary samples were obtained before and 10, 20, 40, and 80 days after starting the gluten challenge. The Griess reagent method was used for measuring urinary NOx.ResultsGluten challenge confirmed the diagnosis of celiac disease in 15 of 20 patients. The NOx:creatinine ratios (mmol:mmol) of the biopsy‐confirmed celiac disease patients were significantly higher than those of the unconfirmed celiac disease patients (0.67 vs. 0.17 on day 10; 0.78 vs. 0.15 on day 20; 0.85 vs. 0.25 on day 40; and 0.85 vs. 0.17 on day 80).ConclusionsGluten challenge resulted in an increased urinary NOx:creatinine ratio in patients with biopsy‐confirmed celiac disease. The NOx:creatinine ratio could be useful for the serial evaluation of disease activity.
Lactobacillus plantarum Inhibits the Intestinal Epithelial Migration of Neutrophils Induced by Enteropathogenic Escherichia coli
Authors: Michail Sonia , Abernathy Frank 
Published: January 2024

ABSTRACTBackgroundLactobacillus plantarum is a Gram‐positive bacillus known for its effect as a probiotic agent. The goal of the study was to determine whether L. plantarum is capable of inhibiting the transepithelial neutrophil migration induced by enteropathogenic Escherichia coli (EPEC).MethodsCultured intestinal epithelial T‐84 cell monolayers were rapidly infected with EPEC. L. plantarum or culture supernatants were added to the monolayers before and after the infection. Indium‐labeled neutrophils were added to the basolateral side of inverted monolayers. After 150‐minute incubation, radioactivity of the neutrophils that migrated in the physiologic direction was assayed, and the number of migrating neutrophils was calculated. L. plantarum was also added to the monolayers before and after EPEC infection, and the number of adherent EPEC was determined by plate counting.ResultsEPEC‐induced neutrophil migration and EPEC binding to monolayers were inhibited by viable L. plantarum but only when added to the monolayers before EPEC. Culture supernatants failed to inhibit the neutrophil migration.ConclusionsThese results suggest that L. plantarum is beneficial in inhibiting neutrophil migration induced by EPEC, but only when preincubated with host epithelia. Rather than an indirect effect through a secreted substance produced by the probiotic agent, its effect is direct and requires the presence of the bacterium.
Increased Prevalence of Autoimmune Diseases in First‐Degree Relatives of Patients With Celiac Disease
Authors: Cataldo Francesco , Marino Vincenzo 
Published: January 2024

ABSTRACTBackgroundThe prevalence of autoimmune disorders is increased in patients with celiac disease (CD), and it is unknown whether their first‐degree relatives also have a high risk of autoimmune disorders.MethodsTo assess the prevalence of autoimmune diseases in first‐degree relatives of CD patients, the authors looked for autoimmune disorders in 225 first‐degree relatives of 66 children with CD (group A) and in 232 first‐degree relatives of 68 healthy children (group B). For both groups, serologic screening for CD was performed through antiendomysium (EMA) and tissue transglutaminase autoantibodies (tTGAA). EMA‐ and tTGAA‐positive subjects were offered an intestinal biopsy. The age at onset of autoimmune diseases was also recorded in group A.ResultsThe prevalence of autoimmune disorders was significantly (P = 0.028) higher in group A (11 of 225, 4.8%) than in group B (2 of 232, 0.86%). In relatives of CD patients, the prevalence increased with age (χ2 for trend, 43.5;P < 0.0001). Serologic screening for CD was only positive in group A (15 of 225 subjects). An intestinal biopsy was performed in 13 of these 15 relatives (2 refused biopsy). Eleven of 13 had flat mucosa, with subclinical or silent forms of CD. The prevalence of autoimmune diseases in the EMA‐ and tTGAA‐positive relatives of CD patients was significantly higher (3 of 15, 20%;P = 0.028; odds ratio, 6.3; 95% CI, 1/0.21–1/0.11, 4.9–7.6) than in those who were EMA and tTGAA negative (8/210, 3.8%).ConclusionsThe first‐degree relatives of CD patients have an increased risk of autoimmune diseases, most likely connected with unrecognized subclinical or silent forms of CD.
Rectal Manometry in Patients With Isolated Sacral Agenesis
Authors: Morera Claudio , Nurko Samuel 
Published: January 2024

ABSTRACTObjective:The authors evaluated rectal manometry of children with sacral root abnormalities secondary to isolated sacral agenesis.Methods:The anorectal manometric recordings of seven patients with isolated sacral agenesis (four with partial agenesis and three with complete agenesis) were retrospectively evaluated and compared with tracings from healthy control subjects. Characteristics of the internal anal sphincter (IAS), the rectoanal inhibitory reflex (RAIR), voluntary external anal squeeze pressure, and threshold of rectal sensation to distension were analyzed. Characteristics of the patients' neurologic function with attention to urinary and fecal continence were obtained by chart review.Results:All seven patients had urinary and fecal incontinence. IAS resting pressure was the same in patients and control subjects. In the three patients with total sacral agenesis, IAS relaxation was more complete and lasted longer after balloon distention of the rectum. These patients also had significantly lower voluntary external anal squeeze pressure and blunted sensation of rectal distension.Conclusions:Abnormal parasympathetic innervation associated with sacral agenesis is associated with changes in anorectal function. Manometric findings suggest that there is modulation of the RAIR by extrinsic innervation, which may explain the fecal incontinence in these patients.