Activity of mitogen-activated protein kinases in the esophageal epithelium of patients with Barrett's esophagus.

Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is associated with an increased risk of esophageal cancer. Mitogen-activated protein kinases may play an important role in the pathogenesis of this process. We aimed to evaluate mitogen-activated protein kinases activity in esophageal mucosa of patients with BE and find possible relationship between reflux type and BE. Twenty-four patients (mean age: 59 years) with gastroesophageal reflux disease symptoms and endoscopically suspected esophageal metaplasia (ESEM) were prospectively enrolled for testing by a multichannel intraluminal impedance monitoring along with a Bilitec 2000. Endoscopic biopsies were taken from methylene blue-positive pit patterns (sites suggesting specialized intestinal metaplasia [SIM]), from 2 cm above the Z-line and from cardial parts of the stomach. The biopsies were analyzed for extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38 activity by Western blot. Seventeen ESEMs had histologically proven metaplasia: eight patients had SIM and nine had gastric-type epithelia (GE). Biliary reflux was more evident in SIM (P = 0.019) but not in GE (P = 0.019); non-biliary reflux was typical for GE (P = 0.005) but not for SIM (P = 0.04). Strong activations of ERK and p38 were found predominantly in SIM, but not in normal esophageal mucosa (NE) (P = 0.01 and P < 0.001 respectively). Strong signals for active JNK and p38 were detected in GE, but not in NE (P = 0.006 and P = 0.02 respectively). ERK activity was significantly higher than p38 activity in ESEM patients only with GE (P = 0.02). The strong activation of ERK, but not JNK is indicative of SIM. The presence of bile in gastroesophageal refluxate is predisposing to SIM, but not to GE in esophageal mucosa.

The ghrelin-positive cells number is increased in duodenum in children with celiac disease.

Ghrelin is predominately produced in the stomach, but new findings indicate that the intestinal wall is an important source of the hormone. In patients with shortbowel syndrome, reduction in the intestinal tissue resulted in a decrease in the circulating ghrelin levels. Since in celiac disease (CD) intestinal mucosa atrophy is the main finding, alterations in duodenal ghrelin-positive cell population can be expected. The aim of the study was to evaluate the density of ghrelin-positive cells in the duodenum of CD children and its relationship with body mass index (BMI) and clinical presentation. The study included 31 consecutive patients with newly diagnosed CD [BMI SD scores (BMISDS) -0.926+/-1.496]. The control group consisted of 21 children (BMISDS -0.517+/-1.186], diagnosed with growth retardation, anemia or abdominal pain. All the patients underwent endoscopy with biopsy samples taken from distal duodenum. Immunohistochemistry was performed using rabbit anti- ghrelin (human) antiserum. The number of ghrelin-positive cells in the duodenum was significantly higher in children with CD than in controls (14.82+/-11.12 vs 5.69+/-5.02, p<0.0013). The density of ghrelin-positive cells in the duodenum did not correlate with age, pubertal status, BMISDS or clinical presentation. In the duodenum of CD children, the number of ghrelin-positive cells is increased compared with the control patients. The population of ghrelin-positive cells in the duodenum does not simply reflect an altered mucosal morphology or failure to thrive but is under the influence of other conditions.

Helicobacter pylori seroprevalence in children with sleep-disordered breathing.

OBJECTIVE: Chronic Helicobacter pylori (HP) infection is considered to be a factor involved in obstructive sleep apnea syndrome (OSAS). This cross-sectional study examined the seroprevalence of HP in children with sleep-disordered breathing (SDB) in respect to OSAS severity and in reference to other common pediatric medical conditions. METHODS: Overnight polysomnography with pH-metry (PSG) was performed at a Sleep Laboratory (in the years 2008-2011). OSAS severity was determined based on Obstructive Apnea Index (OAI). Subjects were classified into primary snoring group (OAI < 1/hours), mild - moderate OSAS (OAI: 1-5/hour), and severe OSAS (OAI: ≥5/hour). HP IgG was tested by an enzyme-linked immunosorbent assay in the SDB (n = 115) and reference (n = 387) groups [reference group consisted of 4 subgroups based on ICD-10 diagnoses encompassing conditions affecting the skin, respiratory system, food hypersensitivity, and gastrointestinal tract]. Analyses were performed by nonparametric statistical tests. RESULTS: HP seropositivity was 10.4% (12/115) in the SDB group and 11.6% (45/387) in the reference group. HP positive and negative subjects did not differ in PSG, acid gastro-esophageal reflux index nor in age, sex, nutritional status (BMI-z score), and hematological indices in the SDB group. Seropositivity was found in 16.7% of the primary snoring group, 10.2% of mild-moderate OSAS, and in 11.1% of severe OSAS (chi(2) p = 0.832). CONCLUSIONS: Children with SDB are not more predisposed to a chronic HP infection than children with other common chronic pediatric conditions. HP seropositivity does not influence OSAS severity but possible infection should none-the-less be considered on a case-by-case basis.

Correlations between leptin, body composition, bone mineral density, and bone metabolism in kidney transplant recipients.

INTRODUCTION: In kidney transplant recipients leptin levels are often elevated and bone mineral density (BMD) decreased. However, to date there are no about correlations between leptin and BMD in this population. It has been suggested that leptin is a predictor of BMD in postmenopausal women. Moreover, leptin acts as a marker of fat stores. We examined the relationships between leptinemia, some markers of nutritional status, BMD, and bone metabolism in kidney transplant recipients. We also assessed whether leptin was a significant and independent predictor of BMD in this population. METHODS: BMD and fat content (global, percentage, trunk) were measured using dual-energy X-ray absorptiometry in 27 kidney allograft recipients. Markers of bone turnover and leptin were studied using commercially available kits. RESULTS: Leptin correlated with the percentage of body fat, trunk fat, lean body mass, serum creatinine, and urea. Insulin growth factor binding protein 1 was negatively related to waist-hip ratio and global and trunk fat, whereas BMD of the lumbar spine was correlated with the daily dose of prednisone, azathioprine, cyclosporine trough levels, serum calcium, as well as osteoprotegerin level. CONCLUSIONS: Leptin levels are associated with graft function and body fat in kidney allograft recipients. Leptin is not related to nutritional status, BMD, or bone metabolism in kidney allograft recipients, but is associated with the current dosage of immunosuppressants and the serum calcium.

Correlations of new markers of bone formation and resorption in kidney transplant recipients.

Renal osteodystrophy is a common complication of chronic renal failure and renal replacement therapy. Successful kidney transplantation reverses many of these abnormalities, but the improvement is often incomplete. The evaluation of renal osteodystrophy in everyday practice is based on noninvasive measurements. Taking this into consideration the aim of the present study was to assess new markers of bone metabolism: serum CrossLaps degradation products of C-terminal telopeptides of type I collagen tartrate-resistant acid phosphatase (TRAP) and bone-specific alkaline phosphatase (bALP), as well as their correlations with bone mineral disease (BMD) in kidney transplant recipients. Twenty-six patients (aged 26 to 54 years) receiving a triple immunosuppressive regimen with stable graft function were enrolled in the study. Serum parathormone (PTH) osteocalcin type collagen C-terminal peptides (ICTP), and procollagen type I carboxyterminal extension peptide (PICP) concentrations were measured by radioimmunoassay (RIA), Serum CrossLaps, bALP, beta2-microglobulin, TRAP 5b by enzyme-linked immunoassay (ELISA), and deoxypyridinoline (DPD) in urine immunochemiluminescence. BMD, as measured by dual-energy X-ray absorptiometry (DEXA), correlated negatively with markers of bone formation (bALP, osteoclacin, and PICP) and resorption (TRAP, ICTP, and beta2-microglobulin). The only positive correlation was between urine DPD and BMD at the femoral neck. Interestingly, BMD correlated negatively with CsA concentration. TRAP 5b correlated positively with serum creatinine, ALP, bALP, osteocalcin, iPTH, ICTP, and serum beta2-microglobulin, and negatively with CsA concentration, and azathioprine and prednisone dose. DPD did not correlate with any parameters. Serum CrossLaps correlated with markers of both bone formation and resorption. Because TRAP and serum CrossLaps correlated with markers of both bone formation and or resorption, additional studies are needed to establish the value of these markers of bone resorption to assess renal osteodystrophy.

The influence of exogenous antioxidants and physical exercise on some parameters associated with production and removal of free radicals.

Metabolic processes generate chemically active forms of oxygen, among which a prominent role is played by the superoxide ion. Cells are equipped with defence systems against the effects of superoxide radicals, superoxide dismutase is the most important one. The organism depends on the delivery of exogenous antioxidants, like selenium, vitamins E and C. Physical exercise triggers the production of superoxide radicals, which can at least partly be responsible for muscular damage. This work has studied the effect of Protection Zellaktiv (Smith Kline Beecham, Fink Naturarznei GmbH), a preparation containing selenium, vitamins C, E, B2, niacin and beta-carotene on the activities of superoxide dismutase and catalase, levels of glutathione malondialdehyde selenium, iron, zinc, triglicerides, total cholesterol, HDL- and LDL-cholesterol, before and after physical exercise. Muscle status was monitored by the activities of lactic dehydrogenase and creatine kinase. Protecton Zellaktiv was administered orally for one month, the measurements were repeated and the results before and after treatment were compared. It was found that treatment diminished the levels of malondialdehyde and zinc in serum, as well as cholesterol and triglicerides. Physical exercise before treatment decreased the levels of reduced glutatione, zinc and triglycerides. As expected, the levels of selenium were increased by the preparation. Protecton Zellaktiv suppressed the production of malondialdehyde during physical exercise. The preparation had a beneficial effect on lipid levels and it is inferred that lipid peroxidation was suppressed.

The contribution of some constitutional factors to the development of cow's milk and gluten intolerance in children.

The role of some constitutional factors in the development of cow's milk and gluten intolerance among hospitalized children was the subject of analysis made by the authors. The patients were hospitalized at the Clinic of Infectious Diseases of Children during 1973-1982. The age of 45 children varied from 5 months to 5 years (gluten intolerance group) and of 50 children it amounted to from 2 months to 5 years (cow's milk intolerance group). In 34% of the family members of the children with milk intolerance and in 4.4% of the family members of the children with gluten intolerance the symptoms of this trait were found. Coeliac disease was observed in 13.3% of the family members of the gluten intolerance group of children and 10.8% psychic and/or diabetes disease among the members. It has been suggested that above illnesses of the family members occur more frequently compared to control group and this finding can speak for the participation of s constitutional (genetic?) factor in the development of this type of intolerance among the members of the family of affected children.

The contribution of some environmental factors to the development of cow's milk and gluten intolerance in children.

The analysis performed by the authors includes correlation between certain environmental factors i.e. the kind of food (natural, mixed, artificial), the role of infection and therapy applied (including antibiotic therapy), living conditions (residence place, the age of parents, number of siblings) and the body birth weight and the established food intolerance in children. The patients were hospitalized at the Clinic of Infectious Diseases of Children during 1978-1982. There were 45 children aged from 5 months to 5 years with gluten intolerance and 50 children aged from 2 months to 5 years with cow's milk intolerance. A close correlation between feeding and the development of food intolerance was stated. There had been found that 92% of children were given mixed cow milk already at the 2nd month of life and 46.6% were fed with this protein between the 2nd to the 3rd month of life. The former had cow milk allergy while the latter gluten intolerance. Due to longlasting diarrhea multiple antibiotic therapy was applied in the total group studied. Stool samples taken from the both groups revealed salmonella in 15.5% to 18.0%. Apart from this type of infection agent chemotherapy due to viral, parasitic and parenteral infections was used, too. The above presented findings confirmed significant role of the factors mentioned in the development and further progress of milk or gluten intolerance in the patients.

[Vaccination against hepatitis B in children with chronic hematologic diseases treated with immunosuppression]. / Szczepienia przeciw wirusowemu zapaleniu watroby typu B u dzieci z przewleklymi chorobami krwi leczonych immunosupresyjnie.

Prevention of hepatitis B infection is an important factor in the successful management of cancer and aplastic anaemia cases. Our result suggested that children with Hodgkin's disease and solid tumors vaccinated during early stage of immunosuppressive therapy are good responders to hepatitis B vaccine. Active immunisation with hepatitis B vaccine (Engerix B), was also effective in children with leukaemia after completing immunosuppressive therapy. Protective levels of antibodies remained 6 years after vaccination. Vaccination according to shortened schedule (0-10-20 days) was not effective in these children. Passive immunisation is indicated in children with chronic neoplastic haematological diseases during immunosuppressive therapy. In 6 children the lack of seroconversion after vaccination was due to immune disorders.

[Sodium cromoglycate in the treatment of food hypersensitivity in children under 3 years of age]. / Kromoglikan disodowy w leczeniu nadwrazliwosci pokarmowej u dzieci do 3. roku zycia.

Dietary elimination is a treatment of first choice in food hypersensitivity. Such therapy is not always enough to stop the disease and introduction of pharmacological treatment is necessary. In prevention and long term treatment antiallergic drugs are recommended. The aim of the study was to assess efficacy and safety of oral sodium cromoglycate in treatment of food hypersensitivity in the youngest children. In our study we examined: the group of 25 children aged 6 months-3 years treated with oral cromolyn sodium during the period 4-20 weeks and 29 children aged 6 months-3 years treated with ketotifen. Symptoms from skin, digestive and respiratory tract, behaviour status were evaluated for drugs efficacy. Cromolyn and ketotifen effected a significant decrease in total symptoms score. The treatment was well tolerated. No serious side effects were noted. The incidents of skin rash, disquiet during the night, diarrhoea and urticaria were only 8 percent. Sodium cromoglycate is safe and effective drug in treatment of food allergy in children; specially in symptoms from gastrointestinal tract and multi-organs allergy.

[Lymphocytic response of gastric and duodenal mucosa in Helicobacter pylori infection in children]. / Odpowiedz limfocytarna blony sluzowej zoladka i dwunastnicy w zakazeniu Helicobacter pylori u dzieci.

The authors evaluated morphologically gastric and duodenal mucosa in H. pylori infection in children. Fenotypic evaluation of T lymphocytes carried out in patients showed the increase in number of these cells in gastric antrum and corpus mucosa in comparison with controls according to the level of mucosal inflammation. B lymphocytes in inflamed gastric mucosa were dispersed as lamina propria infiltrates or in clusters (lymph nodules).

[Hyperplasia of pharyngeal lymphoid tissue in children]. / Przerost ukladu chlonnego gardla u dzieci.

40 children, aged 4-12, hospitalised in the III State Hospital of Children's Diseases and suffering from recurrent complaints of respiratory system with accompanying breathing disorders were subjected to clinical examination. In the analysed group 55% of children suffered from recurrent upper respiratory tract inflammations, 12.5% from recurrent otitis, 12.5%--increased neck nodules, 12.5% from hearing disorders, and 42.5% of children breathed by mouth. On the basis of allergic and immunological examinations, in 90.5% allergy was confirmed as the main cause of the complaints. In 7.5% of cases, above complaints were conditioned by accompanying infection. Increased total IgE level in serum was confirmed only in 37.5%. 17.5% of children showed peripheral blood eosinophilia. Some children were qualified for adenotomy and removed adenoid was examined histopatologically. Significant features of acute, subacute, and chronic inflammatory process leading to hypertrophy of the organ and causing obstruction in breathing were observed on the examination. Periodical dietetic treatment (the influence of nutritional allergy) and pharmacological treatment were recommended.

[The assessment of nutritional status in children with chronic hepatitis B treated with interferon alpha]. / Ocena stanu odzywienia dzieci z przewleklym zapaleniem watroby typu B podczas terapii interferonem alpha.

The aim of the study was an evaluation of nutrition status in children with chronic hepatitis B during IFN-alpha therapy. Observation was carried out in a group of 40 children in the age range of 1-14 years with clinically, diagnosed chronic hepatitis B. Respectful of age 2 subgroups were distinguished. I: 27 children up to 4 years old, II: 13 children in the age range of 4-14 years. The nutritional status was evaluated by anthropometric measurement (body mass, body length/height). Moreover Cole index was estimated at the beginning and completion of the treatment and in the time of the highest weight loss. None of the examined children has body mass deficiency before IFN-alpha treatment: Cole index was in normal range as well. Lack of appetite, connected with IFN-alpha administration, was observed in 42.5 children during therapy. Weight loss was observed in 65% of the examined children especially in the first 2 months of therapy. Return to the initial body mass value was observed within 3 months after IFN-alpha completion in 77% children; but in 2 children only 12 months after IFN-alpha therapy termination. 12 months after IFN-alpha completion Cole index lower than initial was observed in 42.5% of the examined children in spite of return of body mass to initial values. There was no observed unfavourable influence of IFN treatment on body height. 20-weeks IFN-alpha therapy in children with chronic hepatitis B often causes lack of appetite, which may lead to reversible disturbances in nutritional status. Correct dietetic proceeding is necessary to decrease the frequency and intensity of disturbances in nutritional status in this group of children.

[Thyroid function in children with diagnosed chronic hepatitis B treated with interferon alpha]. / Funkcja tarczycy u dzieci z rozpoznanym przewleklym zapaleniem watroby typu B leczonych IFN-alpha.

The aim of the study is to estimate thyroid function during interferon alpha therapy in children with chronic hepatitis B. 31 children aged 4-16 years were included in the study. Thyroid function was monitored by estimation of thyroid hormones (FT3, FT4, TSH) and antithyroid antibodies (TPO, ATG) concentration before and after therapy completion. In all children normal thyroid hormones and ATG concentration were found before and after therapy completion. Presence of TPO before IFN treatment in blood serum of 2 girls (6.45%) and in 4 children (12.9%) after IFN therapy were found. Clinical features of thyroid dysfunction were not observed in this group of children during IFN therapy.

[Mast cell of upper gastrointestinal tract mucosa and Helicobacter pylori infection in children]. / Komórka tuczna blony sluzowej górnego odcinka przewodu pokarmowego a zakazenie Helicobacter pylori u dzieci.

Using histological, immunohistochemical and electron microscopic examinations of gastric and duodenal mucosa the authors showed the increase in the number of mast cells with ultrastructural changes characteristic of their degranulation in H. pylori infected children. The damage of various intensification in glandular and covering epithelial cells and the inflammatory response were also proved. The results suggest the role of mastocytes in the inflammation of gastric and duodenal mucosa in H. pylori infected children.

[Densitometric evaluation of mineral deposits in children and young people with food sensitivity who were treated by diet therapy]. / Densytometryczna ocena zasobów mineralnych u dzieci i mlodziezy z nadwrazliwoscia pokarmowa leczonych dietetycznie.

Bone mineral content (BMC) and bone mineral density (BMD) of the whole skeleton were measured with dual energy x-ray absorptiometry (DEXA) using DPX-L bone densitometer (Lunar) in 240 caucasian subjects with food hypersensitivity, aged 2-18 years, fed milk-free diet (mean duration: 3.6 yrs). DEXA results were compared to the age and sex-matched reference population (n = 473) presenting normal consumption of milk and dairy products, Breast-feeding duration, social conditions and general physical activity did not differ in these groups. All subjects ranged between 3rd and 97th percentile for body weight and height and their nutritional status was similar in both groups, as assessed by means of anthropometric methods (BMI, skinfolds, midarm circumference). Mean values of total BMC and total BMD did not show significant differences between two groups of children, regarding to diet application. Although dietary calcium intake has a significant positive influence on the bone mineral content, our cross-sectional study suggests that the properly applied and controlled elimination diet should not disturb bone mass accumulation in children and adolescents with food allergy.

[Analysis of selected constitutional and environmental factors in patients with atopic dermatitis]. / Analiza wybranych czynników konstytucjonalnych i srodowiskowych u chorych z atopowym zapaleniem skóry.

In 156 children and adolescents with atopic dermatitis retrospective analysis was carried out for establishing the effect of constitutional and environmental factors on the process of development and clinical course of this disease. It was demonstrated that the type of feeding during infancy was related to the beginning of the first symptoms. The onset of atopic dermatitis was earliest and most frequent in children with a history of only brief breast-feeding (up to 2 months) or fed with cow milk formulas since birth. Breast-feeding during 2-6 months delayed the onset of atopic dermatitis by about 2 months in relation to the former group. The effect of environmental factors manifested itself also as exacerbation of skin changes after contact with house dust, animal hairs, feathers and other antigens (fish food, contact with plants). At the same time positive results were observed of point tests with these allergens. A significant effect of the constitutional factor on the development of atopic dermatitis included familial occurrence of atopic diseases (mostly atopic dermatitis). Only 12.8% of the studied children had no family history of atopy.

[Clinical aspects of gastro-esophageal reflux in children]. / Aspekty kliniczne odplywu zoladkowo-przelykowego u dzieci.

In 20 children hospitalized in the age range from 2 months to 7 years the clinical manifestations caused by radiologically demonstrated gastro-oesophageal reflux were analysed. The main symptoms were from the digestive tract and respiratory system. In this group of children this reflux was also the cause of deficient body weight and attacks of apnoea with cyanosis.

[Clinical characterization of "asthma-prurigo" syndrome with emphasis on risk factors]. / Charakterystyka kliniczna zespolu "asthma-prurigo" z uwzglednieniem czynników przyczynowych.

In a group of 228 patients with Asthma-Prurigo syndrome in 82.5% of patients the onset of skin lesions was earlier than the onset of asthma. It was found that the early onset of atopic dermatitis suggests the greater probability of subsequent asthma. In 88.6% of patients also other allergic diseases were diagnosed, and rhinitis allergica was observed most frequently. In the investigated group of patients urticaria chronica idiopathica or physical urticarias were not observed. Among 228 patients with Asthma-Prurigo syndrome, 74.6% of patients pointed to house dust as one of the most frequent causative factors. The house dust similarly to other inhalant allergens, somewhat more frequently had influence on the course of atopic dermatitis than on the course of asthma. Contrary to this observation according to patients food allergens (milk, eggs, fish, chocolate) aggravated or induced the relapses of skin lesions much more frequently than asthma. It was shown how often patients noticed adverse reactions due to penicillin and sulphonamides.

[Some clinical symptoms and allergens on asthma-prurigo syndrome]. / Niektóre objawy kliniczne oraz alergeny w zespole asthma-prurigo.

The group of 146 patients suffering from asthma-prurigo syndrome (85 adults and 64 children) have been inquired in many various clinical centers. It was established that in 79.6% of the patients the first symptoms of illness appeared already in infancy and only 28.2% of the patients had negative familiar anamnesis on the allergy. In 73.2% of the patients with asthma-prurigo syndrome the symptoms of atopic dermatitis persisted longer than asthma symptoms and in 89.9% of them asthma-prurigo symptoms accompanied other form of allergic diseases. The most important causal allergens provoking asthma-prurigo symptoms were: house dust (in 64.4% of the patients), chocolate (in 42.2%), cat epithelia (in 40.2%) and cow milk proteins (in 29.5% of the patients).