bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous Endoscopic Gastrostomy and Gastrojejunostomy in Psychomotor Retarded Subjects: A Follow‐Up Covering 106 Patient Years
Authors: Mathus‐Vliegen E. M. H. , Koning H. , Taminiau J. A. J. M. , Moorman‐Voestermans C. G. M. 
Published: January 2024

ABSTRACTBackgroundWhether psychomotor retarded persons should be treated by percutaneous endoscopic gastrostomy (PEG) or by surgical gastrostomy combined with an antireflux procedure is controversial. Therefore, the authors investigated the feasibility of a PEG and enteral feeding in these patients.MethodsPatients referred from specialized institutions for a PEG placement were assessed extensively by a multidisciplinary team. When considered eligible, age and general condition determined the choice of treatment under general anesthesia (group 1) or conscious sedation (group 2). Patients were followed up after 1 and 7 days, 4 and 12 weeks, and thereafter every 6 to 12 weeks. Data were collected prospectively over a period of 5 years until gastrostomy removal, death, or arrival at the censory date, 6 months after PEG placement. The endpoints were 1) to evaluate the procedure and its complications; 2) to discover barriers that impeded adequate nutrition; and 3) to explore the appropriateness of the choice of PEG or percutaneous endoscopic gastrojejunostomy (PEJ).ResultsThe procedure was successful in 95% of patients, in every patient in group 1 (35/35; median age, 4.1 years) and in 20 of 23 patients (87%) in group 2 (median age, 22.0 years). There were no procedure‐related deaths and no 30‐day mortality. Major complications changed from procedure‐related problems in the short term (5.4%) to tube‐related problems in the long‐term (24.1%). Nausea and vomiting interfered with adequate feeding mainly in young children, but dietary adjustments alleviated the symptoms and ensured an adequate intake. The choice of a PEG was incorrect in four patients: surgery was needed twice and two PEGs had to be converted into a PEJ. All seven primarily indicated PEJs seemed justified and of temporary need in five.ConclusionsIn severely disabled patients, a PEG and adequate enteral nutrition is feasible in the setting of a multidisciplinary approach and protocol‐wise follow‐up. Yet, anatomic deformities and restricted pulmonary function rendered the procedure more difficult. In cases with obvious aspiration or gastroesophageal reflux, a PEJ combined with acid suppression and prokinetic drugs may be tried before surgery.
Effect of Insulinlike Growth Factor‐1 Treatment in Children With Cystic Fibrosis
Authors: Bucuvalas John C. , Chernausek Steven D. , Alfaro Mary Pat , Krug Susan K. , Ritschel Wolfgang , Wilmott Robert W. 
Published: January 2024

ABSTRACTObjectivesMalnutrition is common in cystic fibrosis (CF) and adversely affects survival. Because insulinlike growth factor‐1 (IGF‐1) has insulinlike effects in terms of carbohydrate metabolism and is growth promoting, the authors hypothesized that its use would increase linear growth rate and decrease insulin requirements in children with CF.MethodsThe authors used a double‐blind placebo‐controlled crossover design. Seven prepubertal children aged 9.6 to 13 years (5 boys and 2 girls) were treated with placebo or IGF‐1 for 6 months. After a 6‐month washout period, patients received the alternative therapy for 6 months. The primary outcome measure was linear growth rate. Secondary outcome measures were changes in body mass index, body composition determined by dual energy x‐ray absorptiometry, forced expiratory volume (FEV 1 ), and the blood glucose/insulin ratio.ResultsThe mean height z score at baseline was −1.5 ± 0.8. At entry, the mean serum IGF‐1 level was 124 ± 25 ng/mL (normal range, 110–771 ng/mL). With treatment, mean serum IGF‐1 levels increased twofold to threefold for all patients. The half‐life for IGF‐1 was 10.3 hours. We observed no significant difference in linear growth rate, weight gain, rate of accretion of lean body mass, or mean FEV 1 during treatment with IGF‐1 compared with placebo. The glucose/insulin ratio, an indirect index of insulin sensitivity, was significantly increased with IGF‐1 treatment compared with placebo (P < 0.02). No adverse events related to IGF‐1 were detected.ConclusionsTreatment with IGF‐1 for 6 months did not promote linear growth in prepubertal children with CF. However, the glucose/insulin ratio was increased without changing blood glucose levels with IGF‐1 treatment suggesting increased insulin sensitivity.
Effect of IGF‐Rich Colostrum on Bowel Adaptation in Neonatal Piglets With Short Bowel Syndrome
Authors: Heemskerk V. H. , van Heurn L. W. E. , Farla P. , Buurman W. A. , Piersma F. , ter Riet G. , Heineman E. 
Published: January 2024

ABSTRACTBackgroundInsulin‐like growth factor 1 (IGF‐1), a polypeptide growth factor with mitogenic effects on intestinal epithelial crypt cells occurs naturally in high concentrations in colostrum. The hypothesis for this study was that colostrum rich in IGF‐1 could promote small bowel adaptation in neonatal piglets with short bowel syndrome.MethodsTwenty‐four piglets, aged 7 days, underwent 75% small bowel resection and were fed 525 kJ · kg −1 · d −1 (125 kcal) of colostrum‐based formula (Rs + ) or placebo formula (Rs − ). Immunoglobulin G (IgG) accounted for 35% of the protein and was compensated with casein and whey protein in the control feed. The piglets were weighed daily and killed 28 days after surgery. Bowel samples were taken at surgery and at death.ResultsRelative body‐weight increase did not differ between the Rs + and Rs − group (84% ± 9% vs. 90% ± 12%, P = 0.83). There was a significant relative increase in crypt depth in the Rs − compared with the Rs + group (201% ± 15% vs. 147% ± 17%, P = 0.02) and total protein (mg/cm bowel) (482 ± 51 vs. 278 ± 46, P = 0.008). Increase in villus length, DNA/RNA content, and mitotic index did not differ between groups.ConclusionColostrum supplement rich in IGF‐1 has no benefits over protein‐enriched feed with respect to growth and bowel adaptation in neonatal piglets with short bowel syndrome.
An Analysis of Published Trials of Interferon Monotherapy in Children With Chronic Hepatitis C
Authors: Jacobson Karen R. , Murray Karen , Zellos Aglaia , Schwarz Kathleen B. 
Published: January 2024

ABSTRACTBackgroundAlthough no therapeutic regimen has received Food and Drug Administration approval for treating children with chronic hepatitis C viral infection (CHC), there have been a number of pediatric interferon‐α (IFN‐α) trials. The purpose of this study was to perform a critical review of these trials to determine 1) end‐of‐treatment (ETR) and sustained‐response (SR) rates, 2) predictors of response to therapy, and 3) safety of and tolerance to IFN‐α in children with CHC.MethodsRelevant studies in the English‐language medical literature and abstracts (January 1990 through November 2000) were identified by searching for manuscripts that contained the key words “children,” “hepatitis C,” and “interferon.” Trials were considered eligible for inclusion in this analysis if criteria for treatment included positive serum polymerase chain reaction for hepatitis C virus RNA (HCV PCR).ResultsTwenty published manuscripts of the use of IFN‐α in children with CHC were found, of which 12 met our inclusion criteria. Twenty‐two abstracts, of which seven met our inclusion criteria, were identified. In the 19 included trials, 366 treated and 105 untreated children were observed; five countries were represented. Average ETR was 54% (0%–91%) and average SR was 36% (0%–73%). The SR in children with genotype 1 was 27% versus 70% for nongenotype 1 (P = 0.001). Five of 105 (5%) untreated controls exhibited spontaneous viral clearance.ConclusionsTo date, there is no published large‐scale, multicenter, prospective, placebo‐controlled randomized trial of the use of IFN‐α in children with CHC. The data in this review suggest that IFN‐α in children with CHC does have reasonable efficacy and safety. This review highlights the need for a more systematic design of future pediatric CHC trials. Ideally, such trials would be large scale, prospective, and controlled, and would include HCV genotype and viral load, histology, quality of life measures, and systematic recording of adverse events and of effects of therapy on growth and development.
Serum Biotinidase Activity in Children With Chronic Liver Disease and Its Clinical Significance
Authors: Pabuçcuoğlu Aysun , Aydoğdu Sema , Baş Meral 
Published: January 2024

ABSTRACTBackgroundBiotinidase is the enzyme responsible for liberating the vitamin biotin from biocytin and dietary protein–bound vitamin. Individuals lacking biotinidase activity become biotin deficient. Because the liver is the major source of plasma biotinidase, chronic liver diseases can lead to decreased serum biotinidase activity and biotin deficiency. The aim of this study is to determine serum biotinidase activity values in children with chronic liver disease and to investigate the relation among enzyme activity, certain liver function tests, and degree of liver damage.MethodIn this study, using a spectrophotometric method, biotinidase activity was determined in sera from 62 children with chronic liver diseases (median age, 9.73 years; range, 8 months to 18 years) and from 27 healthy controls. Diagnoses of the patient group were as follows: noncirrhotic chronic hepatitis B virus infection (n = 12), metabolic liver diseases (n = 16), autoimmune hepatitis (n = 6), intrahepatic and extrahepatic cholestasis (n = 14), fulminant hepatitis (n = 5), cryptogenic cirrhosis n = 5), prehepatic portal hypertension (n = 4). Meanwhile, serum albumin, total bilirubin, alkaline phosphatase, alanine aminotransferase, and γ‐glutamyltransferase concentrations and prothrombine time were determined for each patient and the results were correlated with serum biotinidase activity.ResultsThere was significant difference between mean enzyme activity of the controls (7.6 ± 1.2 nmol · min −1 · mL −1 ) and of all patients with chronic liver disease (6.3 ± 2.5 nmol · min −1 · mL −1 ) (P < 0.05). Serum biotinidase activity in patients with noncirrhotic chronic liver diseases (chronic viral hepatitis, prehepatic portal hypertension, glycogen storage disease, Gaucher disease) was within the normal ranges. However, serum biotinidase activity in patients with cirrhosis and Wilson disease was significantly less than that of the control group (P < 0.05). The lowest enzyme activities were detected in patients with fulminant hepatitis.ConclusionIn this study, serum biotinidase activity was significantly lower in patients with cirrhosis, particularly in the patients with decompensated cirrhosis and fulminant hepatitis who exhibited no clinical symptoms related to biotin deficiency. The decreased serum biotinidase activity in chronic liver diseases was associated with severe impairment of hepatocellular function.
Children's Knowledge, Anticipatory Anxiety, Procedural Distress, and Recall of Esophagogastroduodenoscopy
Authors: Claar Robyn Lewis , Walker Lynn S. , Barnard John A. 
Published: January 2024

ABSTRACTBackgroundThis study evaluates the relations among children's knowledge of esophagogastroduodenoscopy (EGD) and anticipatory anxiety, procedural distress, and the nature of postprocedural recall and evaluations.MethodsOne hundred patients, aged 8 to 17 years, completed self‐report measures of knowledge and anxiety before EGD. Parents completed a self‐report measure assessing how they prepared their children. Nurses and trained observers completed observational ratings of distress. Children's recall and evaluation of the procedure were assessed by self‐report 1 hour after the procedure and by telephone that evening.ResultsMost children knew about the major components of EGD. Children with greater knowledge experienced less distress and reported that they would be less anxious and upset when undergoing future EGDs. Children with greater anticipatory anxiety exhibited more procedural distress. Children's distress varied by the phase of the procedure. Children who were more distressed during intravenous line insertion experienced greater distress during esophageal intubation and the endoscopic examination. Approximately 20% of patients reported at least some memory of the procedure even at the end of the day. Children with greater recall reported greater aversion and a more negative attitude toward future EGDs.ConclusionsThis study provides information about children's distress during EGD and the effects of conscious sedation on patients' memories and attitudes toward future procedures. The study indicates that preparation before EGD may reduce patient distress.
Modeling 13C Breath Curves to Determine Site and Extent of Starch Digestion and Fermentation in Infants
Authors: Christian Martin T. , Amarri Sergio , Franchini Fabio , Preston Tom , Morrison Douglas J. , Dodson Brian , Edwards Christine A. , Weaver Lawrence T. 
Published: January 2024

ABSTRACTBackgroundThe colon salvages energy from starch, especially when the capacity of the small intestine to digest it is limited. The aim of this study was to determine the site and relative extent of starch digestion and fermentation in infants.MethodsThirteen infants (10 male and 3 female infants), median age 11.8 months (range, 7.6–22.7 months), were fed a starchy breakfast containing 13C‐labeled wheat flour after an overnight fast. Duplicate breath samples were obtained before breakfast and every 30 minutes for 12 hours. Breath 13CO2 enrichment was measured using isotope ratio mass spectrometry, and results were expressed as percentage dose recovered (PDR) for each 30 minutes. The PDR data were analyzed and mathematically modeled assuming either a constant estimate of CO2 production rate or adjusted for physical activity.ResultsMean ± SD cumulative 13C PDR (cPDR) at 12 hours was 21.3% ± 8.4% for unadjusted data and 26.5% ± 11.6% for adjusted data. A composite model of two curves fit significantly better than a single curve. Modeling allowed estimation of cPDRs of small intestine (17.5% ± 6.5% and 22.7% ± 9.3% for unadjusted and adjusted data, respectively) and colon (4.6% ± 2.9% and 6.3% ± 5.4%).ConclusionsModeling of 13CO2 enrichment curves after ingestion of 13C‐enriched wheat flour is an attractive means to estimate the contribution of the upper and lower gut to starch digestion and fermentation.
Omeprozole Therapy in Pediatric Patients After Liver and Intestinal Transplantation
Authors: Kaufman Stuart S. , Lyden Elizabeth Ruby , Brown Cindy R. , Davis Carolyn K. , Andersen Deborah A. , Olsen Keith M. , Bergman Kimberly L. , Horslen Simon P. , Sudan Debra L. , Fox Ira J. , Shaw Byers W. , Langnas Alan N. 
Published: January 2024

ABSTRACTBackgroundProton pump inhibitors such as omeprazole are increasingly used to prevent stress‐related gastric bleeding in critically ill patients. In this investigation, the acid‐suppressive potency of omeprazole was assessed in one at‐risk group, pediatric patients undergoing liver or intestinal transplantation, or both.MethodsTwenty‐two patients ranging in age from 0.9 to 108 months (23.8 ± 6.5) underwent isolated liver (n = 10) or intestinal (11 with composite liver allografts) transplantation. Omeprazole was delivered in bicarbonate suspension through a nasogastric tube. Therapy was started after surgery at 0.5 mg/kg every 12 hours. Gastric pH monitoring was performed approximately 2 days later.ResultsFor the entire group, mean gastric pH equaled 6.1 ± 0.3, the same in recipients of isolated liver and intestinal allografts. Twelve of the 22 patients demonstrated a discontinuous omeprazole effect, that is, dissipation of acid reduction before the next dose. Five of the 12 patients with discontinuous omeprazole effect had mean gastric pH of less than 5 (3.9 ± 0.4). In 4 of these 5, the omeprazole dosing interval was shortened to every 8 or every 6 hours, resulting in an increase in mean pH to 6.6 ± 0.2 (P < 0.01). In the remaining 10 of 22 patients, acid suppression was uninterrupted until the next dose. No patient experienced bleeding attributable to gastric erosion.ConclusionOmeprazole suspended in sodium bicarbonate is an effective acid‐suppressing agent in pediatric recipients of liver or intestinal transplant, or both. A dosage of 0.5 mg/kg every 12 hours is sufficient for most patients, but dosing every 6 to 8 hours is required to assure maximal acid suppression in all.
Infliximab as a Novel Therapy for Pediatric Ulcerative Colitis
Authors: Mamula Petar , Markowitz Jonathan E. , Brown Kurt A. , Hurd Linda B. , Piccoli David A. , Baldassano Robert N. 
Published: January 2024

ABSTRACTObjectivesThe role of infliximab (anti–tumor necrosis factor α antibody) therapy in ulcerative colitis (UC) is not well defined. There are only two reports published describing its use in UC. The authors describe their experience with open‐label use of infliximab in children with moderate to severe UC.MethodsThe authors collected data on all consecutive pediatric patients with UC who received infliximab at The Children's Hospital of Philadelphia until July 2001. The primary measured outcome was clinical response at 2 days and 2 weeks after infliximab infusion, as measured by the Lichtiger colitis activity index (LCAI) score and the Physician Global Assessment (PGA). Tolerance of the infusions and adverse events were recorded.ResultsNine patients qualified for clinical response analysis. The median Lichtiger colitis activity index score decreased from 11 before the infusion to 1 at 2 days and 2 weeks after the infusion, respectively (P = 0.01 for 2 days and 2 weeks). Seven of nine (77%) patients had decreased activity of their disease measured by the Physician Global Assessment. Corticosteroid therapy was discontinued in six (66%) patients. An infusion reaction developed (generalized pruritus and facial flushing) in two patients and an elevated anti‐nuclear antibody (ANA) titer of 1:1280 developed in one patient.ConclusionInfliximab is associated with short‐term clinical improvement in children and adolescents with moderate to severe UC.
Effects of Nutritional Rehabilitation on Intestinal Function and on CD4 Cell Number in Children With HIV
Authors: Guarino Alfredo , Spagnuolo Maria Immacolata , Giacomet Vania , Canani Roberto Berni , Bruzzese Eugenia , Giaquinto Carlo , Roggero Paola , Plebani Anna , Gattinara Guido Castelli 
Published: January 2024

ABSTRACTBackgroundA complex interplay of malnutrition, intestinal dysfunction, and immune impairment increases the progression of human immunodeficiency virus (HIV) disease in children. The authors tested the hypothesis that nutritional support improves intestinal and immune functions in children infected with human immunodeficiency virus (HIV).MethodsA questionnaire was circulated through reference centers for pediatric HIV infection to evaluate the effects of nutritional rehabilitation, total parenteral nutrition (TPN) and enteral nutrition (EN), in children. Information included changes in body weight, CD4 cell numbers, and intestinal absorption—as judged by the xylose load—before and after clinical nutritional support and the outcome of children.ResultsSixty‐two children underwent nutritional support: 46 received TPN and 16 received EN. All but three had full‐blown acquired immunodeficiency syndrome, and all were severely malnourished. Baseline clinical conditions were worse in children receiving TPN than in those receiving EN. Intestinal dysfunction was detected in all children who received xylose oral load. A significant increase in CD4 cell count, xylose levels, and body weight followed EN. A similar pattern was observed after TPN, but none of the parameters significantly changed. Twenty‐seven children who received TPN and three who received EN eventually died. Fourteen who received TPN and eight who received EN were shifted to oral feeding, and five who received TPN and five who received EN continued with clinical nutritional support at the end of the observation period.ConclusionsNutritional intervention may restore intestinal absorption and increase CD4 cell numbers. The efficacy of nutritional intervention is enhanced if provided before a terminal stage of HIV infection. These data provide evidence of a close association among nutritional condition, intestinal absorption, and immune impairment.
Treatment of Childhood Encopresis: A Randomized Trial Comparing Three Treatment Protocols
Authors: Borowitz Stephen M. , Cox Daniel J. , Sutphen James L. , Kovatchev Boris 
Published: January 2024

ABSTRACTObjectivesTo compare short‐ and long‐term effectiveness of three additive treatment protocols in children experiencing chronic encopresis.MethodsChildren, 6 to 15 years of age, who experienced at least weekly fecal soiling for 6 months or longer were eligible for the study. Children were randomly assigned to a group that received intensive medical therapy (IMT), a group that received intensive medical therapy plus a behavior management program called enhanced toilet training (ETT), or a group that received intensive medical therapy with enhanced toilet training and external anal sphincter electromyographic biofeedback (BF). Data concerning toileting habits were collected for 14 consecutive days before an initial visit, and at 3, 6, and 12 months after initiation of therapy. All data were collected using a computerized voice‐mail system that telephoned the families each day. At 12 months, children were classified as significantly improved (reduction in soiling, P < 0.001) or cured (<one fecal accident in 2 weeks).ResultsEighty‐seven children participated in the study, 72 boys and 15 girls. Mean age at enrollment was 8.6 ± 2.0 years, and mean duration of symptoms was 58.2 ± 38.5 months. At 12 months, the cure rates for the IMM, ETT, and BF groups were 36, 48, and 39, respectively (not significant). The improvement rates for these three groups were 45, 78, and 54, respectively (P < 0.05). These results were very stable over time (r > 0.90, P < 0.001 in each case). Response to treatment during the first 2 weeks of therapy was highly predictive of outcome at 3, 6, and 12 months (P < 0.0001). Children in the ETT group used less laxative medication (P < 0.04) and required fewer treatment contacts (P = 0.08) than children in the IMM group. All three treatments resulted in significant increases in daily bowel movements passed in the toilet and self‐initiated toileting, and resulted in decreases in average daily soiling at 3, 6, and 12 months (P < 0.05).ConclusionsEnhanced toilet training is somewhat more effective in treating childhood encopresis than either intensive medical therapy or anal sphincter biofeedback therapy. Although similar total cure rates at 1 year can be expected with these three forms of therapy, enhanced toilet training results in statistically significant decreases in the daily frequency of soiling for the greatest number of children.