Overgrowth In Children Research Articles

Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children.

Small intestinal bacterial overgrowth (SIBO) is defined as the presence of an excessive number of bacteria within the small bowel. Pediatric SIBO is a heterogeneous disorder that manifests as various symptoms ranging from mild gastrointestinal symptoms to malabsorption or malnutrition. The carbohydrate breath test is a commonly used, safe, and noninvasive diagnostic test; however, a standardized methodology is lacking. Multiple factors, such as neuromuscular disorders, systemic diseases, chronic drug use, or altered intestinal anatomy that disturb intestinal motility or induce an abnormality in the body's defense systems against intestinal bacteria, predispose children to SIBO. The high prevalence and similar symptoms of SIBO in functional gastrointestinal disorders, including irritable bowel syndrome, suggest an association between them. The principles of treatment include managing predisposing conditions, nutritional support, symptom control, and antibacterial treatment. Rifaximin is the most commonly used drug. To date, studies of antibiotic treatment in pediatric populations with irritable bowel syndrome or SIBO are lacking and have shown mixed results. Here we review the prevalence, diagnostic tests, and treatment results in pediatric populations.

Risk factors for femoral overgrowth after femoral shortening osteotomy in children with developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) refers to a series of deformity of acetabulum and proximal femur and abnormal relationship between them, it represents the most common hip disease in children. Overgrowth and limb length discrepancy (LLD) was common complication in children undergoing femoral shortening osteotomy. Therefore, the purpose of this study was to explore the risk factors of overgrowth after femoral shortening osteotomy in children with DDH. We included 52 children with unilateral DDH who underwent pelvic osteotomy combined with femoral shortening osteotomy between January 2016 and April 2018, including seven males (six left and one right hip) and 45 females (33 left and 12 right hips) with an average age of 5.00 ± 2.48 years, and an average follow-up time of 45.85 ± 6.22 months. The amount of overgrowth and limb length discrepancies (LLDs) were calculated. The risk factors of femoral overgrowth ≥1 cm and LLD ≥ 1 cm were analyzed. There were statistical differences in age (p < 0.001) and operation duration (p = 0.010) between the two groups with femoral overgrowth <1 cm and ≥1 cm. There was a statistical difference in operation duration (p < 0.001) between the two groups. Age (p < 0.001) was an independent influencing factor of femoral overgrowth in children with unilateral DDH after pelvic osteotomy and femoral shortening osteotomy, and a risk factor (p = 0.008) of LLD in these children. The overgrowth and LLD of children with developmental dislocation of hip after pelvic osteotomy and femoral shortening osteotomy are significantly related to age. There was no significant difference between different pelvic osteotomies for femoral overgrowth in children. Therefore, surgeons should consider the possibility of LLD after femoral shortening osteotomy in children of a young age.

Risk factors of adverse long-term consequences of tibial shaft fractures in children

To analyze leg length discrepancy and overgrowth after tibial shaft fractures in children. We analyzed medical records of 103 patients younger 14 years old with tibial shaft fractures between January 2003 and November 2018. Treatment included plastering and insertion of titanium elastic nail. To identify the risk factors of leg length discrepancy ≥1 cm and overgrowth ≥1 cm, we performed logistic regression analysis. Statistical analysis was carried out using the SPSS software for Windows. Gender (p=0.014) and treatment methods (p=0.011) are the most significant predictors of leg length discrepancy and overgrowth. In boys, the risk of leg length discrepancy ≥1 cm was 7.4 times higher than in girls. The risk of leg length discrepancy ≥1 cm was 4.3 times higher after insertion of titanium elastic nail compared to plastering. The risk of overgrowth ≥1 cm was 5.4 times higher in boys than in girls. The risk of overgrowth ≥1 cm was 4.7 times higher after insertion of titanium elastic nail compared to plastering. One should consider the risk of leg length discrepancy and overgrowth in children with tibial shaft fractures. This is especially true for boys undergoing insertion of titanium elastic nail.

Proton pump inhibitors – their possible influence on the development of small intestine bacterial overgrowth in children

Proton pump inhibitors – their possible influence on the development of small intestine bacterial overgrowth in children

Antibiotic Therapy for Culture-Proven Bacterial Overgrowth in Children With Intestinal Failure Results in Improved Symptoms and Growth.

To evaluate symptoms, enteral tolerance, growth, and antibiotic regimens in pediatric intestinal failure (IF) patients after treated with antibiotic therapy for small bowel bacterial overgrowth (SBBO). Single-center retrospective review of children 0-18 years with IF with endoscopic cultures demonstrating >10 5 CFU/mL from 2010 to 2017. Symptoms, enteral tolerance, growth, and antibiotic regimens were evaluated at the time of endoscopy and 6 months later. Of 505 patients followed in our intestinal rehabilitation program, 104 underwent upper gastrointestinal endoscopy and 78 had positive duodenal cultures. Clinical data pre- and post-endoscopy were available for 56 patients. Compared to baseline, in the 6 months following targeted antibiotic treatment, children showed significant improvement in emesis or feeding intolerance (58.9% vs 23.2%, P < 0.001), abdominal pain (16.1% vs 7.1%, P = 0.02), high stool output (42.9% vs 19.6%, P = 0.002), and gross GI bleeding (19.6% vs 3.6%, P = 0.003). Mean BMI-for-age z scores increased significantly (-0.03 ± 0.94 vs 0.27 ± 0.82, P = 0.03); however, height-for-age z scores, weight-for-age z scores, and percent of calories from enteral intake were not significantly different after therapy. Antibiotic regimens remained highly variable. Children with IF and culture-positive SBBO showed significant improvement in symptoms and BMI-for-age z scores after duodenal culture with subsequent targeted antibiotic therapy. Longer follow-up may be needed to detect improvements in linear growth and percent of calories from enteral feeds. Antibiotic regimens remain highly variable. Long-term consequences of chronic antimicrobial therapy, including antimicrobial resistance, remain unknown. Prospective studies focused on standardizing duodenal sampling technique, correlating culture and pathology data, and evaluating antibiotic resistance patterns are needed.

Small Intestinal Bacterial Overgrowth in Children: Clinical Features and Treatment Response.

A retrospective cohort study of pediatric patients seen at Stanford Children's Health Gastroenterology Clinics from 2012 to 2018 who had a positive BT, defined by a rise in hydrogen by ≥20 ppm, a baseline hydrogen level ≥20 ppm, or a methane value ≥10 ppm. The main outcome was symptom resolution, defined as complete or partial improvement after a course of treatment. Absolute standardized differences and Chi-square tests were used to assess associations. From 98 children, 54 met inclusion and did not meet exclusion criteria (53.7% female). Lactulose substrate was used for 41 (75.9%) patients, whereas glucose was used for 13 (24.1%). Complete or partial resolution of symptoms was achieved in 13 of 16 (81.2%) patients who received probiotics with or without antibiotics versus 21 of 31 (67.7%) patients treated with antibiotics alone (P = 0.524). Metronidazole versus rifaximin versus other antibiotics showed no significant difference in symptom resolution (12 (63.2%), 13 (76.5%), 7 (77.8%), respectively, P = 0.601). Seventy-two percent of patients experienced at least partial symptom relief after treatment. We did not find a strong correlation between specific symptoms and analyte elevation. There was no difference in effectiveness between metronidazole and rifaximin to treat SIBO symptoms. Further research needs to be done to determine effective treatments for SIBO in pediatrics.

Heterozygous Mutations in ANTXR2 Gene in a Child with Oral Manifestations of Hyaline Fibromatosis Syndrome: A Case Report and Review of Phenotype-Genotype Correlations

<h3>Introduction</h3> Hyaline fibromatosis syndrome (HFS) is an autosomal recessive condition with hyaline deposits in the oral mucosa, skin, and other tissues, causing severe deformity and disability. HFS is caused by homozygous and compound heterozygous mutations in the <i>ANTXR2</i> gene. <i>ANTXR2</i>is ubiquitously expressed in all tissues except for the brain, and mutations in this gene are responsible for the complex clinical manifestations of this condition. Clinical hallmarks of the syndrome include progressive joint contractures, gingival hypertrophy, skin nodules, perianal masses, and hyperpigmentation over bony prominences. <h3>Case Findings</h3> A 19 month old female diagnosed with HFS, heterozygous for two novel pathogenic mutations in two separate alleles in <i>ANTXR2</i>, was evaluated for gingival hypertrophy. Additional clinical findings included subcutaneous nodularity of her facial skin, ears, lip commissures and with joint contractures. Rapid gingival overgrowth obscuring the primary dentition over five months, as well as involvement of her facial skin and perianal region necessitated multidisciplinary treatment to debulk the fibromatoses. <h3>Results</h3> A gingivectomy was performed to expose the patient's erupted primary dentition to facilitate oral mastication and potential for speech and language development. A preauricular nodule and perianal mass were excised. The histopathology of the gingival, preauricular, and perianal lesions revealed characteristic diffuse vascular hyaline collagen, typical for the syndrome. <h3>Conclusion</h3> Hyaline fibromatosis syndrome is rare and has significant oral manifestations. The histopathology of lesional tissues are quite characteristic. The novel mutations discovered in our patient and the clinical presentation support the phenotype-genotype correlations that have been previously suggested. The clinical phenotype coupled with the genotypic findings would classify this case as Grade 3 (severe) using a proposed four tier grading system for HFS. The differential diagnosis for progressive gingival overgrowth in children should include hyaline fibromatosis syndrome, as gingival hyperplasia and subcutaneous nodules may be the initial presentation in milder cases.

Role of Glucose Breath Test for Small Intestinal Bacterial Overgrowth in Children and Adolescents With Functional Abdominal Pain Disorders in Korea.

Background/AimsSmall intestinal bacterial overgrowth (SIBO) is expected in children and adolescents with functional abdominal pain disorders (FAPDs). This study is conducted to estimate the prevalence of SIBO and to investigate the role of SIBO in children and adolescents with FAPDs.MethodsThis prospective study enrolled children with FAPDs fulfilling the Rome IV criteria. A hydrogen-methane glucose breath test was used to diagnose SIBO. A survey of bowel symptoms using questionnaires, birth history, types of feeding, and the presence of allergy was conducted.ResultsSixty-eight children and adolescents (range, 6-17 years; median, 12.5 years) were enrolled. SIBO was detected in 14 patients (20.6%). Age (≥ 12 years) (P < 0.003) and loose stool (P = 0.048) were significantly more common in children with SIBO than in children without SIBO. However, the history of allergies (P = 0.031) was less common in children with SIBO than those without SIBO. No significant differences were observed in other demographic findings. In multivariate analysis, age (≥ 12 years) was the independent factor predicting SIBO in children with FAPDs.ConclusionsSIBO is not uncommon in children and adolescents with FAPDs. Among children aged above 12 years and diagnosed with FAPDs, SIBO is a suspected clinical target for treatment to relieve intestinal symptoms. A further study to investigate the association between intestinal bacteria and history of allergy is needed.

Синдром надлишкового бактеріального росту в дітей, хворих на хронічний гастрит

Актуальність. Однією з основних причин виникнення синдрому надлишкового бактеріального росту (СНБР) може бути ахлоргідрія будь-якого походження. Дані про цю проблему суперечливі, ряд дослідників заперечують зв’язок тривалого прийому інгібіторів протонної помпи (ІПП) з розвитком СНБР. Мета. Вивчення клінічних проявів та оцінювання стану мікробіоценозу верхніх відділів тонкої кишки у дітей, хворих на хронічний гастрит (ХГ) зі зниженою кислотоутворюючою функцією шлунка. Матеріали та методи. Обстежено 65 дітей, хворих на ХГ, віком 7–18 років. Методи дослідження включали: езофагогастродуоденоскопію, щиткову біопсію слизової оболонки шлунка на H. рylori, pH-метрію; ультразвукове дослідження органів черевної порожнини. Морфологічні зміни слизової оболонки оцінювали за візуально-аналоговою шкалою. Для верифікації СНБР усім пацієнтам проводився водневий дихальний тест (ВДТ) із використанням аналізатора Gastrolyzer та навантаженням лактулозою. Результати представлялися: кількістю спостережень, середніми значеннями показників, їх стандартними відхиленнями та помилками (М ± m для р &lt; 0,05), відносними частотами (%). Результати. Серед 65 обстежених дітей, хворих на ХГ, виділено 27 осіб, у яких встановлено зниження кислотоутворюючої функції шлунка; середній показник pH становив 4,7 ± 0,4. У 17 дітей, хворих на ХГ, виявлено гастроезофагеальний рефлюкс (ГЕР). В обох групах хворих домінували симптоми діареї і метеоризму, проте в групі пацієнтів із ГЕР на тлі прийому ІПП частота і вираженість симптомів наростала зі збільшенням тривалості терапії. Встановлено, що інфекція H. рylori реєструвалася у 42 (64,6 %) серед усіх дітей, хворих на ХГ. За результатами ВДТ у більше ніж третини (44,4 %) пацієнтів виявлено СНРБ. У дітей, хворих на ХГ у поєднанні з ГЕР, позитивний ВДТ зареєстровано у 41,1 %. Відзначено, що частота виявлення СНБР у цих пацієнтів збільшується зі збільшенням тривалості прийому ІПП. Висновки. У дітей, хворих на ХГ із пониженою кислотопродукувальною функцією шлунка та у хворих дітей із ГЕР, які тривалий час отримували ІПП, відзначається висока частота скарг, пов’язаних із розвитком СНБР. Наявність СНБР у пацієнтів із ХГ і пацієнтів, які тривалий час отримували ІПП, підтверджується результатами ВДТ (44,4 і 41,1 % відповідно).

Lateralized and Segmental Overgrowth in Children.

Simple SummaryCongenital lateralized or segmental overgrowth (LO) disorders are conditions characterized by excessive tissue growth of a body region often associated with a predisposition to cancer. LOs are caused by mosaic DNA anomalies, that is, they are present only in a part of the cells making up the body. LOs have an extremely heterogeneous clinical presentation: they widely overlap in presentation, are difficult to frame from a clinical point of view and have a diagnostic complexity representing a challenge for the clinician who approaches them. Here we review the key features of the various LOs, expose their molecular causes, and detail the implications for each of them, such as the need for specific cancer screening or the possibility of treatment. The latter represents a recent scientific achievement in medicine, allowed by the development of precision drugs finely tuning cellular pathways involved in growth and tumorigenesis deranged in LO.Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith–Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.

Интолерантность к лактозе при аллергическом энтероколите у детей грудного возраста

Актуальность. Пищевая аллергия в раннем возрасте клинически проявляется поражением кожи и желудочно-кишечного тракта. Аллергическое воспаление слизистой оболочки кишечника сопровождается повреждением структуры энтероцитов, что может приводить к значительному уменьшению фермента лактазы на их апикальной поверхности. Материалы и методы. Обследованы 62 ребенка в возрасте от 2 месяцев до 1 года с аллергическим энтероколитом. Для диагностики лактазной недостаточности проводили водородный дыхательный тест с нагрузкой пищевой лактозой с помощью портативного монитора для определения концентрации водорода (Н2) в выдыхаемом воздухе Gastro+ Gastrolyzer (Gastro+ Gastrolyzer Breath hydrogen (H2) monitor) производства Bedfont Scientific Limited (Великобритания). Результаты. Комплексная оценка результатов водородного дыхательного теста с нагрузкой пищевой лактозой установила наличие лактазной недостаточности и лактозозависимого избыточного бактериального роста в тонком кишечнике детей с аллергическим энтероколитом: при белок-индуцированном энтероколитическом синдроме — у 70,3 и 14,8 %, у обследованных с белок-индуцированной энтеропатией — у 100,0 и 41,6 %, у детей с белок-индуцированным проктоколитом — у 36,0 и 32,0 % соответственно. Выводы. По результатам водородного дыхательного теста с нагрузкой пищевой лактозой у 40 (62,5 %) детей грудного возраста с аллергическим энтероколитом диагностирована лактазная недостаточность и у 17 (26,6 %) лактозозависимый избыточный бактериальный рост в тонком кишечнике, которые имеют вторичный характер и нуждаются в коррекции в острый период лечения основного заболевания.

Overgrowth of the Femur After Internal Fixation in Children With Femoral Shaft Fracture-A Multicenter Study.

To evaluate overgrowth after internal fixation for pediatric femur fracture and to identify any factors related with overgrowth in terms of fracture type and fixation method. Retrospective comparative study. Multicenter, children's hospital and general hospital. Eighty-seven children between 4 and 10 years of age were included. Length-stable fracture was noted in 49 children, and length-unstable fracture was found in 38 children. Thirty-six children were treated by minimal invasive plate osteosynthesis (MIPO), and elastic stable intramedullary nail fixation (ESIN) was used in 51 children. The degree of overgrowth after internal fixation compared to fracture type, fracture site, and surgical method. Multivariable logistic regression analysis was conducted to identify factors related with overgrowth. The average overgrowth of the femur was 10.5 ± 7.3 mm. There was no patient who required correction for final leg length discrepancy (>2 cm). There was no significant difference in overgrowth between ESIN (9.9 ± 7.2 mm) and MIPO (11.2 ± 7.6 mm) (P = 0.417). Overgrowth was similar among length-unstable fractures (12.3 ± 7.4 mm) and length-stable fractures (9.2 ± 7.0 mm), although it was statistically greater in length-unstable fractures (P = 0.048). In the MIPO group, length-unstable fractures were associated with an increased log odds of 6.873 for overgrowth of the femur (P = 0.042). Femur overgrowth after internal fixation seems to not be a clinically significant problem, regardless of whether that be for length-stable or length-unstable fractures and whether they were treated by MIPO or ESIN. Length-unstable fracture may be a risk factor for overgrowth in children. However, the difference is very small, and the postoperative overgrowth would likely not be a significant factor in deciding the surgical plan. Therapeutic Level III. See Instructions for authors for a complete description of levels of evidence.

Fracture of the femoral shaft related with bone overgrowth in children admitted at tertiary care institute of Gujarat

Background and Aim: Femoral shaft fractures represent 1.6% of all fractures in the pediatric population. There is abnormal distribution of incidence with the first peak being from two to four years of age and the second in mid adolescence. Present study was conducted to investigate the degree of overgrowth and have attempted to correlate clinical factors that may influence the outcome with such overgrowth.Material and Methods: Present retrospective study was conducted in Children between the ages of 0 to 14 years presented in, the Department of Orthopedics, at tertiary care institute of Gujarat for the period of 3 years. A Total of 31 patients were admitted for femoral fracture during this period of study treated with conservative non-operative management for femoral shaft fractures. These children were reviewed with regard to the differences that were observed in the limb length after treatment.Results: The mean difference in overgrowth between this age group was statistically significant (p < 0.05). Nine of the fractures were in the upper third of the femur; eighteen were in the middle and four were in the lower third. Mean overgrowth of fractures in the upper third group was 0.90 cm; for the middle third the mean was 0.81 cm and lower third mean was 1.05 cm. The mean overgrowth for transverse fractures (18 cases) was 0.89 cm; oblique fracture (6 cases) 0.85 cm and spiral fracture (7 cases) 0.81 cm. Conclusion: Overgrowth after fracture of the femur in children is a universal phenomenon. Gender, level and pattern of fracture do not affect the quantity of overgrowth.

Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review.

Small intestinal bacterial overgrowth (SIBO) is a heterogenous and poorly understood entity characterised by an excessive growth of select microorganisms within the small intestine. This excessive bacterial biomass, in turn, disrupts host physiology in a myriad of ways, leading to gastrointestinal and non-gastrointestinal symptoms and complications. SIBO is a common cause of non-specific gastrointestinal symptoms in children, such as chronic abdominal pain, abdominal distention, diarrhoea, and flatulence, amongst others. In addition, it has recently been implicated in the pathophysiology of stunting, a disease that affects millions of children worldwide. Risk factors such as acid-suppressive therapies, alterations in gastrointestinal motility and anatomy, as well as impoverished conditions, have been shown to predispose children to SIBO. SIBO can be diagnosed via culture-dependant or culture-independent approaches. SIBO's epidemiology is limited due to the lack of uniformity and consensus of its diagnostic criteria, as well as the paucity of literature available. Antibiotics remain the first-line treatment option for SIBO, although emerging modalities such as probiotics and diet manipulation could also have a role. Herein, we present a state-of-the-art-review which aims to comprehensively outline the most current information on SIBO in children, with particular emphasis on the gut microbiota.

P313 Short gut syndrome and bacterial overgrowth in children with cystic fibrosis - experience from a tertiary paediatric cystic fibrosis centre

P313 Short gut syndrome and bacterial overgrowth in children with cystic fibrosis - experience from a tertiary paediatric cystic fibrosis centre

Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition.

Background and AimChildren with intestinal failure (IF) have abnormal intestinal anatomy, secretion, or motility, which impairs homeostatic mechanisms and can lead to small intestinal bacterial overgrowth (SIBO). We sought to describe clinical features at the time of clinically suspected SIBO by experienced clinicians in children with IF on home parenteral nutrition (PN), review specific challenges of diagnostic testing in this population, and describe potential new diagnostic surrogate markers.MethodsA descriptive single‐center retrospective chart review was performed during all episodes of clinically suspected SIBO over 33 months. Information was recorded on clinical symptoms, and diagnostic tests performed.ResultsOf all patients on home PN, 71% (12/17) had at least one episode of clinically suspected SIBO (mean 1 episode/year, range 1–7); 50% of patients had short bowel syndrome (SBS), and 50% had non‐SBS IF. The average reported symptoms per episode were 1.9 (range 1–5). Children with SBS reported fewer symptoms per episode (1.5) than children with non‐SBS IF (2.3). Diarrhea was the most commonly reported symptom, particularly in children with SBS.ConclusionsChildren with IF on home PN are a high‐risk group for SIBO. Clinical features of SIBO vary depending on the cause of IF and may mimic symptoms of the underlying condition. Diagnostic tests have innate challenges in this group, and a strong index of clinical suspicion is paramount. Further research is recommended into potential new surrogate markers (urinary metabolite screen, gastric aspirate) for this diagnostically challenging population.

Role of Epithelial Mesenchymal Transition in Phenytoin Influenced Gingival Overgrowth in Children and Young Adults. A Preliminary Clinical and Immunohistochemical Study.

Objectives: To prove the role of epithelial mesenchymal transition (EMT) in the pathogenesis of phenytoin influenced gingival overgrowth (PIGO) in children and young adults. Study design: Thirty male individuals who are to start with oral phenytoin therapy were recruited for the study. All the 30 individuals underwent full mouth scaling and root planning and were then followed up for a period of one year at intervals of 3 months each. Based on the clinical gingival status they were divided into group1 (responders) individuals who showed gingival overgrowth (GO) and group 2 (non responders) individuals who do not show any GO. Gingival tissue samples were obtained from both the groups at the end of 1 year and subjected to immuno histochemical analysis for E-cadherin expression and histo-pathological for alteration in the basement membrane and confirmation of the fibrosis. Results: Decrease in expression of E cadherin, loss of basement membrane integrity and fibrosis were noted on responder group when compared to non responder group at p<0.001. Fibrosis was seen in the epithelial connective tissue junction. Conclusion: Decrease in cell adhesion, degradation of basement membrane and presence of fibrosis could suggest the role of EMT in the pathogenesis of PIGO.

Синдром избыточного бактериального роста при синдроме раздраженного кишечника у детей: возможности пробиотической коррекции

Синдром избыточного бактериального роста при синдроме раздраженного кишечника у детей: возможности пробиотической коррекции

A Novel Method to Study the Effects of Cyclosporine on Gingival Overgrowth in Children

소아에서 사이클로스포린에 의해 ìœ ë°œë˜ëŠ” 치은과증식의 병인을 ê·œëª í•˜ê¸° 위한 ì´ì „ì˜ 연구에서는, 개체 간의 차이를 ìœ ë°œí• ìˆ˜ 있는 요인을 ì™„ì „ížˆ ë°°ì œí•˜ì§€ 않았다. 본 연구는 개체 별로 ìƒë¬¼í•™ì  변이의 영향을 í†µì œí•œ 실험 모델에 의해 사이클로스포린이 1형 교원질의 대사에 미치는 영향을 알아보았다. 5ì£¼ë ¹ì˜ 수컷 Sprague-Dawley rats 5마리에 6주 동안 사이클로스포린을 위장으로 투여하였다. 사이클로스포린 투여 ì „ê³¼ 투여 후 2, 4, 6주째에 쥐의 í•˜ì• êµ¬ì¹˜ë¶€ì—ì„œ 치은을 채취하였다. 20개의 치은표본으로부터 ì¹˜ì€ì„¬ìœ ëª¨ì„¸í¬ë¥¼ 추출하였다. 개체 별로 사이클로스포린을 투여하기 ì „ 채취한 ì¹˜ì€ì„¬ìœ ëª¨ì„¸í¬ì˜ 반은 대조군, 나머지 반은 실험실 내 약물 처리한 실험군(Tt)으로 하였다. 사이클로스포린 투여 후 2, 4, 6주째 채취한 ì¹˜ì€ì„¬ìœ ëª¨ì„¸í¬ëŠ” 각각의 실험군으로서 T2, T4, T6으로 ëª ëª í•˜ì˜€ë‹¤. 면역형광법을 시행하여 ëª¨ë“ ì¹˜ì€ëª¨ì„¸í¬ 내의 1형 교원질의 존재를 확인하였다. 각 개체 별로 대조군과 실험군에서 1형 교원질의 ìœ ì „ìžì™€ 단백질 발현의 변화를 분석하기 위해서 각각 Real-time polymerase chain reactionê³¼ Western blotting을 시행하였다. 사이클로스포린을 처리하기 ì „ê³¼ 후를 한 개체내에서 비교하여 1형 교원질의 변화를 평가하였다. 대조군과 실험군에서 1형 교원질의 ìœ ì „ìž 발현에서는 ìœ ì˜í•œ 차이가 없었다. ëª¨ë“ ê°œì²´ì—ì„œ 실험실 내 사이클로스포린 처리한 ì¹˜ì€ì„¬ìœ ëª¨ì„¸í¬ì˜ 1형 교원질의 단백질 발현이 증가한 경우, 사이클로스포린을 투여한 후 채취한 ì¹˜ì€ì„¬ìœ ëª¨ì„¸í¬ì—ì„œë„ 1형 교원질의 단백질 발현이 증가하였다. 본 연구에서 시행한 개체별로 ë°œìƒí• ìˆ˜ 있는 ìƒë¬¼í•™ì  변이를 모두 í†µì œí•œ 실험 방법은 ìœ ìš©í•˜ì˜€ë‹¤. 1형 교원질 이외에 다른 요인들에 대한 후속 연구 및 인간에서의 심도 있는 연구가 필요하다.

Amygdala and oxytocin functioning as keys to understanding and treating autism: Commentary on an RDoC based approach

The recent review by Hennessey, Andari and Rainnie (2018) utilizes the proposed Research Domain Criteria (RDoC) to classify amygdala functions and relate them to autism symptomatology. This approach has the potential to challenge the overarching autism diagnosis by furthering our knowledge of the mechanisms giving rise to autism psychopathology and generate novel treatment options. The purpose of this commentary is to provide additional information on a number of points raised in the review. Thus, (1) we discuss the issue of amygdala and brain overgrowth in children with autism and relate it to developmental oxytocin changes, (2) examine potential mechanisms that underlie amygdala overgrowth and dysfunction of the oxytocin system, (3) zoom in on the sexually dimorphic characteristics of the amygdala and potential parallels with the oxytocin system and (4) discuss how the interplay of oxytocin and vasopressin may explain the partially inconsistent findings of their effects on amygdala functioning.