Objectives
Hepatic steatosis has become a considerable concern in the pediatric population. The objective of this study was to evaluate the feasibility of using ultrasound Nakagami imaging to produce ...a parametric image for analyzing the echo amplitude distribution to assess pediatric hepatic steatosis.
Methods
A total of 68 pediatric participants were enrolled in healthy control (
n
= 26) and study groups (
n
= 42). Raw data from ultrasound imaging were acquired for each participant analysis using AmCAD-US, a software approved by the US Food and Drug Administration for ultrasound Nakagami imaging. The Nakagami parameters were compared with the hepatic steatosis index (HSI) and the steatosis grade (G0: HSI < 30; G1: 30 ≤ HSI < 36; G2: 36 ≤ HSI < 41.6; G3: 41.6 ≤ HSI < 43; G4: HSI ≥ 43) using correlation analysis, one-way analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis.
Results
The Nakagami parameter increased from 0.53 ± 0.13 to 0.82 ± 0.05 with increasing severity of hepatic steatosis from G0 to G4 and were significantly different between the different grades of hepatic steatosis (
p
< .05). The areas under the ROC curves were 0.96, 0.92, 0.85, and 0.82 for diagnosing hepatic steatosis ≥ G1, ≥ G2, ≥ G3, and ≥ G4, respectively.
Conclusions
The Nakagami parameter value quantifies changes in the echo amplitude distribution of ultrasound backscattered signals caused by fatty infiltration, providing a novel, noninvasive, and effective data analysis technique to detect pediatric hepatic steatosis.
Key Points
•
Ultrasound Nakagami imaging enabled quantification of the echo amplitude distribution for tissue characterization
.
•
The Nakagami parameter increased with the increasing severity of pediatric hepatic steatosis
.
•
The Nakagami parameter demonstrated promising diagnostic performance in evaluating pediatric hepatic steatosis
.
Abstract
Serum indices based on creatinine and cystatin C, including creatinine/cystatin C ratio (Cr/CysC), ratio and difference of estimated glomerular filtration rate (eGFR) based on cystatin C and ...creatinine (eGFRcys/eGFRcre and eGFR
Diff
), and serum creatinine × eGFRcys, are recently identified serum markers for sarcopenia. We aimed to evaluate the association between these serum indices and mortality in patients with chronic kidney disease (CKD). A single-center retrospective cohort study included 1141 adult patients with stage 1–5 CKD between 2016 and 2018. Basic characteristics, comorbidities, laboratory parameters, and serum creatinine and cystatin C values were obtained. Patients were followed up until death, dialysis, transfer to another hospital, or end of the study. The median age (interquartile range) of our participants was 71 (62–81) years. During a median follow-up of 39 months, 116 (10.2%) patients died. Compared to the survivor group, Cr/CysC, eGFRcys/eGFRcre, eGFR
Diff
, and Cr × eGFRcys were all lower in the non-survivors (
p
< 0.001 for all). The receiver operating characteristic curves of serum indices for predicting mortality showed that all four indices had significant discriminative power. Based on the Cox proportional hazard models, lower values of four serum indices, both as continuous and categorical variables, independently predicted mortality. Our findings suggest that low serum indices of Cr/CysC, eGFRcys/eGFRcre, eGFRDiff, and Cr × eGFRcys are independent indicators of mortality in patients with non-dialysis CKD.
Acute diarrhea is a major cause of childhood morbidity and an economic burden for families. The aim of this study is to explore the effect of probiotics on clinical symptoms, intestinal microbiota, ...and inflammatory markers during childhood diarrhea.
Children (
= 81) aged six months to six years (mean age 2.31 years) hospitalized for acute diarrhea were randomized to receive probiotics (
variety
;
= 42) or no probiotics (
= 39) orally twice daily for seven days. Feces samples were also collected to evaluate microbial content using a traditional agar plate and next-generation sequencing. Immunoglobulin A (IgA), lactoferrin, and calprotectin were determined by enzyme-linked immunosorbent assay (ELISA) and compared in different groups. Other clinical symptoms or signs, including fever, vomiting, diarrhea, abdominal pain, bloated abdomen, daily intake, appetite, and body weight were also assessed.
Data were collected from 81 individuals across three different time points. Total fecal IgA levels in fecal extracts of the probiotics group were higher than those in the control group, reaching statistical significance (
0.05). Concentrations of fecal lactoferrin and calprotectin were significantly downregulated in patients with probiotic
variety
(Lc) consumption compared to those of the control (
0.05). Probiotic Lc administration may be beneficial for gut-microbiota modulation, as shown by the data collected at one week after enrollment. Counts of
and
species were elevated in stool culture of the probiotic group. Appetite and oral intake, body-weight gain, abdominal pain, bloating, as well as bowel habits (diarrhea) were much better in children receiving probiotics compared with those in the control group.
Fecal IgA increased during acute diarrhea under Lc treatment; in contrast, fecal lactoferrin and calprotectin were downregulated during acute diarrhea under Lc treatment. Probiotic Lc may be a useful supplement for application in children during acute diarrhea to reduce clinical severity and intestinal inflammatory reaction.
While we think of neurons as having a fixed identity, many show spectacular plasticity.1–10 Metamorphosis drives massive changes in the fly brain;11,12 neurons that persist into adulthood often ...change in response to the steroid hormone ecdysone.13,14 Besides driving remodeling,11–14 ecdysone signaling can also alter the differentiation status of neurons.7,15 The three sequentially born subtypes of mushroom body (MB) Kenyon cells (γ, followed by α′/β′, and finally α/β)16 serve as a model of temporal fating.17–21 γ neurons are also used as a model of remodeling during metamorphosis. As γ neurons are the only functional Kenyon cells in the larval brain, they serve the function of all three adult subtypes. Correspondingly, larval γ neurons have a similar morphology to α′/β′ and α/β neurons—their axons project dorsally and medially. During metamorphosis, γ neurons remodel to form a single medial projection. Both temporal fate changes and defects in remodeling therefore alter γ-neuron morphology in similar ways. Mamo, a broad-complex, tramtrack, and bric-à-brac/poxvirus and zinc finger (BTB/POZ) transcription factor critical for temporal specification of α′/β′ neurons,18,19 was recently described as essential for γ remodeling.22 In a previous study, we noticed a change in the number of adult Kenyon cells expressing γ-specific markers when mamo was manipulated.18 These data implied a role for Mamo in γ-neuron fate specification, yet mamo is not expressed in γ neurons until pupariation,18,22 well past γ specification. This indicates that mamo has a later role in ensuring that γ neurons express the correct Kenyon cell subtype-specific genes in the adult brain.
•Drosophila mushroom body γ neurons undergo two rounds of terminal differentiation•Ecdysone signaling via EcR-B1 partially de-differentiates larval γ neurons•Mamo is necessary to respecify the adult γ-neuron molecular identity•Mamo can promote γ-neuron identity even if the initial fating step was deficient
Mushroom body γ neurons remodel during metamorphosis in response to the hormone ecdysone. Here, Lai et al. reveal that ecdysone also promotes differentiation state changes in γ neurons. Ecdysone signaling partially de-differentiates the larval γ neurons and induces a transcription factor, Mamo. Mamo is essential to confer adult γ-neuron identity.
Muscle wasting is highly prevalent in patients with chronic kidney disease (CKD). However, the assessment of skeletal muscle mass and strength in clinical settings is not commonly available. We aimed ...to evaluate the feasibility of serum creatinine/cystatin C (Cr/CysC) ratio in the assessment of muscle wasting.
In 272 patients with CKD aged 66.5 ± 15.1 years, skeletal muscle mass and handgrip strength (HGS) were assessed. Skeletal muscle index (SMI) was calculated as skeletal muscle mass/height2. Low muscle mass was defined as SMI below the sex-specific 10th percentile of study population and low handgrip strength as less than 26 Kg for men and 18 Kg for women.
The Cr/CysC ratio was significantly lower in both the low SMI and low HGS groups. Moreover, the Cr/CysC ratio correlated with SMI (r = .306, p < .001) and HGS (r = .341, p < .001). After adjusting for confounding factors, age, sex, waist circumference, body fat mass, and Cr/CysC ratio were independently associated with SMI, whereas age, sex, diabetes, hemoglobin, estimated glomerular filtration rate, urine protein/creatinine ratio, SMI, and Cr/CysC ratio were independently associated with HGS.
Cr/CysC ratio appears to be a promising surrogate marker for detecting muscle wasting in patients with CKD. Further studies are needed to extend our findings.
Sarcopenia is highly prevalent in patients undergoing chronic hemodialysis (HD). This study investigated the relationship among serum indoxyl sulfate (IS) levels, muscle mass, and strength in HD ...patients. A total of 108 HD patients were enrolled. Skeletal muscle mass and handgrip strength (HGS) were assessed, using bioimpedance analysis and a hand-held dynamometer, respectively. Skeletal muscle index (SMI) was defined as skeletal muscle mass/height
2
(kg/m
2
). Serum IS, p-cresol sulfate (PCS), and trimethylamine N-oxide (TMAO) levels were determined using liquid chromatography–mass spectrometry. Patients were classified into two groups based on median serum IS values. HGS measurement was repeated after 2 years. Patients in the high IS group had longer HD duration and higher serum TMAO levels than those in the low IS group. Log-normalized IS level was negatively correlated with SMI (
r
= − 0.227;
p
= 0.018), but PCS and TMAO levels were not. Among 78 patients who completed 2-year follow-up, those in the high IS group (
n
= 41) showed greater absolute (− 2.48 kg versus − 0.25 kg,
p
= 0.035) and relative HGS loss (− 9.1% versus 1.4%,
p
= 0.036) than those in the low IS group, after adjustment for potential confounders. Indoxyl sulfate (IS) may play a significant role in uremic sarcopenia. Further large-scale studies are needed to confirm our preliminary findings.
Helicobacter pylori infection can cause gastritis, gastric or duodenal ulcers, mucosa-associated lymphoid tissue lymphoma, gastric cancer, and extra-gastrointestinal manifestations. Ideal treatment ...should be guided by antibiotic susceptibility testing. However, this is not feasible in many regions, so the treatment generally relies on clinical experience and regional culture sensitivity profiles. We aimed to integrate the treatment of pediatric H. pylori infection through a systematic literature review. Databases including PubMed, Cochrane Library, EMBASE, and Scholar were searched using terms containing (Helicobacter OR Helicobacter pylori OR H. pylori) AND (child OR pediatric) for all relevant manuscripts and guidelines, published from January 2011 to December 2021. The eradication rate for pediatric H. pylori infection was not satisfactory using triple therapy, sequential therapy, concomitant therapy, bismuth-based quadruple therapy, or adjuvant therapy with probiotics as the first-line therapy. Most therapies could not achieve the recommended eradication rate of >90%, which may be attributed to varying regional antibiotic resistance and possible poor children’s compliance. More studies are required to establish a best practice for pediatric H. pylori infection treatment.
Sarcopenia is prevalent in chronic hemodialysis patients. This prospective cohort study evaluated the impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in 126 chronic ...hemodialysis patients.
Skeletal muscle mass, handgrip strength (HGS), gait speed, and blood parameters were assessed. Sarcopenia was evaluated using the criteria of the European Working Group on Sarcopenia in Older People and the Taiwanese criteria for Sarcopenia. Muscle quality was defined as HGS divided by mid-arm muscle circumference.
Prevalences of uremic sarcopenia were 8.7% and 13.5% according to Taiwanese and European criteria, respectively. Low HGS and gait speed were much more prevalent than low muscle mass. Within 3 years, 79 (62.7%) patients were hospitalized and 26 (20.6%) died. Low HGS and slow gait speed were associated with hospitalization and mortality, while sarcopenia was associated with mortality but not with hospitalization. Notably, in our patients without sarcopenia, close associations between increased hospitalization and mortality risk with low HGS and slow gait speed remained unchanged. In Cox proportional hazard analysis, muscle quality hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19–0.93, p = 0.032 and serum creatinine (HR = 0.82, 95% CI = 0.71–0.95, p = 0.009) were independently associated with composite outcome of hospitalization or death.
Muscle functionality and quality can predict hospitalization and overall survival in chronic hemodialysis patients, better than muscle mass.
The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The ...annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan.
We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed.
Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery.
The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets.
Sarcopenia, defined as low muscle mass and strength, is highly prevalent in patients undergoing chronic hemodialysis (HD). However, muscle function and muscle mass do not share the same clinical ...relevance. In fact, muscle strength was more closely associated with the risk of mortality in chronic HD patients than was muscle mass. Therefore, to identify the risk factors of muscle weakness is vital. Angiotensin II overexpression had been recognized to impair skeletal muscle strength. Accordingly, angiotensin II receptor blockers (ARBs) potentially possess a muscle protective effect. This cross-sectional study aimed to identify the factors associated with low muscle strength and to explore the relationship between ARB use and muscle strength in chronic HD patients.
A total of 120 chronic HD patients, aged 63.3 ± 13.2 years, were included in this study. Basic characteristics, handgrip strength (HGS), body composition, and nutritional status were assessed, and blood samples for biochemical tests were obtained. We divided these participants into normal- and low HGS groups according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP).
We observed that 78 (65.0%) patients had low HGS. In our cohort, we found that height (r = 0.653; P < 0.001), weight (r = 0.496; P < 0.001), body mass index (r = 0.215; P = 0.020), skeletal muscle index (r = 0.562; P < 0.001), albumin (r = 0.197; P = 0.032), and serum creatinine (r = 0.544; P < 0.001) were positively and age (r = - 0.506; P < 0.001), subjective global assessment (SGA) score (r = - 0.392; P < 0.001), fractional clearance index for urea (Kt/V) (r = - 0.404; P < 0.001) and urea reduction ratio (URR) (r = - 0.459; P < 0.001) were negatively correlated with HGS. According to our analysis, age (Odds ratio, OR = 1.11, 95% confidence interval, 95% CI = 1.05-1.17, P < 0.001), HD duration (OR = 1.01, 95% CI = 1.00-1.02, P = 0.010), diabetes (OR = 13.33, 95% CI = 3.45-51.53, P < 0.001), Kt/V (OR = 1.61, 95% CI = 1.06-2.46, P = 0.027), and SGA score (OR = 1.19, 95% CI = 1.03-1.38, P = 0.017) were regarded as independent predictors of low HGS. In contrast, ARB use (OR = 0.25, 95% CI = 0.07-0.93, P = 0.039) was independently associated with preserved HGS in chronic HD patients, after adjustment for multiple confounding factors.
Our study is the first report in chronic HD patients to indicate a potentially protective effect of ARB on muscle strength. However, further longitudinal follow-up and intervention studies are needed to confirm this finding.
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