Prolonged Feeding Time Research Articles

Functional analysis of novel cystatins from Haemaphysalis doenitzi and evaluation of their roles in cypermethrin and λ-cyhalothrin resistance

Currently, the primary strategy for tick control relies on chemical agents. Pyrethrins, which are botanically derived compounds, have demonstrated efficacy in controlling ticks without posing a risk to human or animal health. However, research into pyrethrins' metabolic mechanisms remains sparse. Cystatin, as a reversible binding inhibitor of cysteine protease, may be involved in the initiation of pyrethrin detoxification of Haemaphysalis doenitzi. In this study, two novel cystatins were cloned, HDcyst-3 and HDcyst-4, the relative expression of which was highest in the Malpighian tubules compared with the tick midguts, salivary glands, and ovaries. Prokaryotic expression and in vitro studies revealed that cystatins effectively inhibit the enzymatic activities of cathepsins B and S. RNAi results showed that the reduction of cystatins significantly decreased the engorgement weight, egg mass weight, and egg hatching rate of adult female ticks, and prolonged feeding time by two days. The control rate of rHDcyst-3 and rHDcyst-4 protein vaccination against female adults were 55.9% and 63.2%, respectively. In addition, the tick immersion test showed that cypermethrin and λ-cyhalothrin had significant acaricidal effects against adult unfed H. doenitzi. The qPCR result indicated that compared with the control group, the expression of HDcyst-3 and HDcyst-4 was markedly decreased in the sublethal cypermethrin and λ-cyhalothrin group at LC50. Enzyme activity showed that cypermethrin and λ-cyhalothrin could significantly induce the activities of glutathione S-transferase (GST), carboxylesterase (CarE), and acetylcholinesterase (AchE). The aforementioned results provided indirect evidence that cystatin plays an important role in pyrethrin detoxification and provides a theoretical basis for future acaricide experiments and pest management.

BEDNAR’S APHTHAE IN INFANTS IN DUHOK; A PROSPECTIVE CROSS-SECTIONAL STUDY

Background 
 Bednar’s aphthae are small shallow ulcers at the margin of the palate of newborns. They primarily result from the traumatic action of a bottle teat or the nipple of the mother’s breast during feeding. More recently, an immune process has been hypothesized to explain its pathogenesis.
 Objectives 
 To study the clinical features, the associated factors, and the time of healing of Bednar’s aphthae in Duhok. 
 Patients and Methods
 This study was conducted from January 1st, 2020, to February 1st, 2021. It enrolled 17 newborns and infants diagnosed with Bednar’s aphthae through clinical examination while undergoing routine health checkups. Information about sex, delivery mode, age, birth weight, gestational age, perinatal problems, feeding method, feeding habits, type of milk (formula, breast milk, or both), and using a pacifier or not were obtained from mothers through direct interviews. Through the use of a tongue depressor, the palate was visualized. In addition, parents were educated on how to posture the patient while feeding properly. Four weeks later, a follow-up visit was for the ulcers’ course follow-up.
 Results
 Male is the predominant gender. Vaginal delivery was the most common. All the participants were full-term with normal birth weights. The age at which diagnosis was made ranged from 14 to 60 days. Most of them were formula-fed. In 15 patients (88.23%), feeding was in a horizontal posture; 11 (64.7%%) had weak sucking, 10(58.82%) had prolonged feeding time, and 13(76.47%) used pacifiers. The location is marginal in 12 cases (70.58%). The shape was oval in 13 patients (76.47%), and the healing time ranged from 1 week to 4 weeks. The largest ulcer was 2x2 cm, and the smallest was 0.2x0.3 cm. 
 Conclusion
 Bednar’s aphthae are self-limiting disorders in newborns and infants. Mechanical and immunologic factors can be responsible for their pathogenesis. Health education for mothers can help the healing of the ulcers and prevent their recurrence.

Vomiting and Gastric Motility in Early Brain Damaged Children With Congenital Zika Syndrome.

This study investigated the occurrence of vomiting and gastric dysmotility in dysphagic children with congenital Zika syndrome (CZS) and assessed possible associations of these findings with the severity of dysphagia and the presence of tube feeding. Forty-six children with CZS were assessed for dysphagia, and the occurrence of vomiting, dietary volume tolerance <15 mL/kg, and feeding time per meal >30 minutes were evaluated. Gastric antrum ultrasonography was used to detect the frequency of contractions and measure antral areas (at fasting and 15 minutes postprandial), from which the gastric emptying rate (GER) was calculated. Antral ultrasonography findings were compared with those of ten healthy controls. Vomiting and gastric motility were compared between CZS patients according to the severity of dysphagia and the requirement for tube feeding. Overall, 76% (35/46) of children with CZS had moderate-to-severe dysphagia (MSD), among whom 60% (21/35) were tube fed [MSD tube fed (MSDTF)]. Vomiting occurred in 54% (25/46) of children, whereas dietary volume intolerance and prolonged feeding time were observed in 59% (27/46) and 37% (17/46), respectively, most frequently in MSDTF patients. On ultrasound, 61% (28/46) of children with CZS had no antral contractions, whereas 90% (9/10) of controls did. Compared to healthy controls, GER was eight-fold lower in children with CZS and 60-fold lower in MSDTF children. In dysphagic children with CZS, vomiting, volume intolerance, and prolonged feeding time were frequent and possibly associated with impaired antral contraction and delayed gastric emptying, especially in cases of severe dysphagia and tube feeding.

Eating and swallowing disorders in children with cerebral palsy

Introduction. Cerebral palsy is characterized by abnormalities of muscle tone, movement and motor abilities caused by disorders in brain development. Many children with cerebral palsy have severe swallowing problems. Cerebral Palsy. Cerebral palsy is a neurodevelopmental disorder characterized by abnormalities in brain development. Swallowing is a process by which a bolus that is formed within the oral cavity is transported through the pharynx into the esophagus and stomach. It has four phases: preparatory oral, oral, pharyngeal and esophageal. Swallowing disorders in children with cerebral palsy. Swallowing disorders vary depending on the type of cerebral palsy. Children with spastic paralysis have a more pronounced disorder of the voluntary phases of swallowing, while children with athetoid paralysis are expected to have a disorder at the oral-motor level. Neurological lesions may affect the muscle function of the jaw, cheeks, lips, tongue, palate and pharynx, which is manifested by difficulties in controlling saliva and swallowing. Diagnosis and treatment of dysphagia in cerebral palsy. Diagnosis and treatment of dysphagia is best accomplished by a team of experts including a pediatrician, neurologist, otorhinolaryngologist, gastroenterologist, radiologist, dental specialist, speech therapist, nutritionist, and a specialist in physical medicine and rehabilitation. Conclusion. Dysphagia is a common comorbidity in children with cerebral palsy. Although swallowing disorders often correlate with the type of cerebral palsy, the most prevalent signs of dysphagia include: coughing, prolonged feeding time, laryngotracheal penetration and aspiration, suffocation, which leads to dehydration, malnutrition, but also to the need for alternative feeding methods. It is important to emphasize the importance of early treatment by a team of experts, with a speech therapist as a team leader.

Enhanced growth, gonad maturation, and low-level parasite infection in juvenile Manila clam Ruditapes philippinarum cultured in subtidal cages on the south coast of Korea

The growth performance of intertidal marine bivalves is often enhanced when they are transplanted to the subtidal environment due to extended feeding time. In this study, juvenile Manila clams Ruditapes philippinarum were transplanted to subtidal suspended cages (SSC) to examine enhanced growth and reproductive activity. Juvenile clams (11.6 mm in shell length, SL) were placed in cages and suspended at 2 m depth, and shell and somatic growth, gonad maturation, and pathology were monitored. Over 103 days of the experiment, shell and somatic growth of SSC clams were significantly greater than those of the control clams cultured at the intertidal bottom (p < 0 .05). At the end of the experiment, SSC clams reached 29.0 mm in SL, whereas the intertidal bottom cage (IBC) clams only reached 18.0 mm. In late July, after 44 days in the subtidal zone, the first spawning clam was observed, and 80% of SSC clams were actively engaged in spawning by late August. In contrast, spawning in IBC was not observed until late September, and most (25%) remained sexually immature. The protozoan parasite P. olseni was detected after 30 days in the intertidal zone, increasing from 1.6 × 104 cells g−1 tissue wet weight in July to 1.30 × 106 cells g−1 tissue wet weight in September, while P. olseni infection in the SSC clams was not observed until September at much lower intensity (6.6 × 104 cells g−1 tissue wet weight). High mortality of IBC clams occurred in late July, preceded by a dramatic increase in P. olseni infection in August, suggesting that the parasitic infection was, in part, responsible for the mortalities. We speculated that prolonged feeding time in the SSC enhanced growth and gonad maturation and that the high level of parasite infection in the IBC reduced growth and reproduction further.

Effects of different carbohydrate levels in puffed feed on digestive tract morphological function and liver tissue structure of snakeheads (Channa argus)

The major objective of this study conducted for 8 weeks was to investigate the influence of different carbohydrate levels in the feed on the digestion and tissue structure of snakeheads (Channa argus) with prolonged feeding time. The control (CT) group was fed chilled fish, and the experimental groups were fed flour as a carbohydrate source to prepare puffed feed containing 13%, 16% and 19% flour (WS13, WS16 and WS19 respectively). The results demonstrated that carbohydrate levels in the feed had significant effects on amylase activity in the intestinal segment and Na+, K+-ATPase activity in the stomach (p < .05). In all the experimental groups, the pepsin activity in the gastrointestinal tract showed a decreasing trend over time in different feeding cycles. The alkaline phosphatase (AKP) activities in all groups showed a downward trend, and with increased feeding time, AKP in all experimental groups had an increasing trend. The liver index, liver crude fat content and serum triglyceride of snakeheads increased significantly with the increase in carbohydrate content in feed at 4 weeks (p < .05). There were no differences in the stomach structure among the groups as determined using light microscopy. The intestinal villi were injured, and the liver cells became larger and showed damage in a time and carbohydrate level-dependent manner. In conclusion, when the carbohydrate content is too high, it not only affects the morphological function of the snakeheads' digestive tract, but also affects the normal structure of liver cells and the metabolic function of the liver.

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses.

To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

Diagnosis and treatment of abnormal left coronary artery originating from the pulmonary artery: A single-center experience.

Objective:We aimed to review symptoms, findings, surgical treatment options, short- and mid-term outcomes, and reoperation rate of patients diagnosed with of left coronary artery from the pulmonary artery (ALCAPA) of an anomalous origin in our institution.Methods:From May 2000 to March 2018, 33 patients who had left coronary artery originating from the pulmonary artery were retrospectively examined. The clinical features of patients, diagnostic tools and their efficacy, outcomes of surgical repair, and problems during follow-up were evaluated.Results:Thirty-three patients (22 females, 11 males) were included in the study. At the time of surgery, the median age and weight of patients were 6 months (minimum/maximum, 1–166 months) and 6.5 kg (minimum/maximum, 3–38.5 kg), respectively. The mean follow-up was 5±3.5 years (range, 1–16 years). Dyspnea, tachypnea, diaphoresis, prolonged feeding time, and developmental delay were common presenting signs and symptoms. It was determined that all the patients who were diagnosed at another center reached our center for surgical treatment within 1 month. Twenty-three (69.7%) patients had pathologic Q wave with anterior and/or anterolateral myocardial infarction signs on an electrocardiogram (ECG), whereas 22 (66.6%) patients had ST-T segment changes. Twenty-one (63.6%) patients had cardiomegaly on the telecardiogram. A reimplantation surgery was performed to 22 patients and 10 patients underwent the Takeuchi procedure. In addition to ALCAPA repair, 5 patients needed mitral valve plasty. Atrial septal defect (ASD) and ventricular septal defect (VSD) were closed in one patient, and Tetralogy of Fallot was totally corrected in another. At discharge, there was a significant improvement in left ventricular (LV) systolic functions. At the last visit, all patients had normal LV systolic functions except four who had mild dysfunction. The mean follow-up of the four patients was 2.8 years. In the early postoperative period, complications were seen in 10 patients. Five patients died in the early postoperative period, while one patient died 9 months after the ALCAPA surgery because of low cardiac output syndrome that developed after mitral repair.Conclusion:Patients with ALCAPA commonly present with congestive heart failure symptoms. When the diagnosis is confirmed in these patients, surgical treatment should not be delayed. The availability of surgical center and surgery outcomes for ALCAPA diagnosed patients are comparable with other countries, but the delay in the diagnosis of disease is still a problem in our country.

Preoperative liquid gastric emptying rate does not predict outcome after fundoplication

Aim of the studyPreoperative gastric emptying (GE) rate in patients with gastrointestinal reflux disease (GERD) was evaluated as a predictor of outcome after antireflux surgery. Methods and patientsGE was assessed using radionuclide scintigraphy and a standardized meal with cow's milk. GE half time (T1/2), patient demographics and GERD symptoms including vomiting (>4days/week), retching (>4days/week), prolonged feeding time (>3h/day), and discomfort after meals were recorded pre- and postoperatively. A standardized follow-up included a 24-h pH-monitoring and an upper gastrointestinal contrast study. Of 74 patients undergoing Nissen fundoplication between 2003 and 2009, 35 underwent a preoperative GE study. The remaining 39 patients were not examined owing to volume intolerance, cow's milk intolerance or allergy, inability to lie still, or parents refusing participation. Main resultsMedian age at fundoplication was 4.9 [range 1.1–15.4] years, and follow-up time was median 4.3 [1.9–8.9] years. GERD recurred in 7 (20%) patients. Preoperative T1/2 in the seven patients with recurrent GERD was median 45 [21–87] min compared to 44 [16–121] min in the 28 patients without recurrent GERD (p=0.92). There was no significant difference between the one third of patients with the slowest GE [T1/2 54–121min] and the remaining patients [T1/2 16–49min] regarding GERD recurrence or postoperative vomiting, retching, prolonged feeding time, or discomfort after meals. ConclusionPreoperative GE rate did not predict outcome after antireflux surgery, as slow GE was not associated with recurrent GERD or postoperative troublesome symptoms such as vomiting, retching, or meal discomfort.

Trialling exudate-based enrichment efforts to improve the welfare of rescued slow lorises Nycticebus spp.

Slow lorises Nycticebus spp. are heavily targeted in the illegal animal trade through- out Southeast Asia. Because lorises are venomous, many have their teeth inhumanely removed by animal traders in order to 'tame' them to live as pets or to be used for tourist photography. Confis- cated animals are brought to rescue centres where captive care and rehabilitation has proven challenging. Many rescue centres report high mortality, high rates of abnormal behaviour, and low rates of successful reintroductions. Most centres, however, provide little or no gums or saps to these highly specialised exudativorous primates. Our study evaluated the effects of exudate- based enrichment efforts on confiscated wild-born slow lorises at a rescue centre in Java, Indone- sia, including methods to provide exudates to animals lacking teeth. We found that these enrich- ment efforts prolonged foraging and feeding times, but did not reduce abnormal behaviour or promote social behaviour. We found a strong relationship between the amount of time spent on the ground and the time spent performing abnormal behaviour. We discuss the positive implica- tions of prolonging feeding periods, the practicality of each of the enrichment efforts for different types of captive settings, and methods for improving the welfare of captive slow lorises via dietary changes.

Management of rasopathies

Noonan syndrome (NS) and NS-related disorders (Cardio-Facio-Cutaneous (CFC) syndrome, Costello syndrome, LEOPARD (Lentigines, ECG conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth and sensory neural Deafness) syndrome) share common clinical features characterized by unique facial features, postnatal growth failure, psychomotor retardation, ectodermal abnormalities, congenital heart diseases, chest & skeletal deformity and delayed puberty. During last decade, strident progress has been made in molecular understanding of NS. The functional alterations of the Ras-mitogen-activated protein kinase (MAPK) pathway are caused by the mutation in more than 10 genes (PTPN11, SOS1, RAF1, SHOC2, BRAF, KRAS, NRAS, HRAS, MEK1, MEK2). Thus, NS and NS-related disorders are called RASopathies as a disease group. PTPN11 (40-50%), SOS1 (10%–20%), and RAF1 (3%-17%) mutations are common in NS patients. Noonan syndrome and its related disorders are not rare as a whole. Since their disease natural course and management are different, it is important to recognize RASopathies and differentiate them primarily based on typical clinical feature. By utilizing DNA testing, the confirmatory diagnosis can be made. Multi-systemic involvement in RASopathies requires multidisciplinary evaluation and regular monitoring for each special clinical issue. It involves whole spectra of clinical issues of cardiovascular, growth & endocrine, neuro-cognitive, developmental, skeletal & orthopedic, opthalmo-otolaryngological, GI-nutritional, dental, hemato-oncological and ectodermal systems. For instances, surgical intervention is required for congenital heart defects and cryptoorchidism. Before the surgery, bleeding diathesis should be excluded. Also the risk for malignant hyperthermia has to be considered in choosing anesthetics. Special education might be required in 10-40% of NS patients. However, NS patients carrying the mutation in the SOS1 gene and N380D or N380S mutation in the PTPN11 gene tend to show normal cognitive function. Many NS infants have feeding difficulties with poor suck and prolonged feeding time and may require tube feeding in 24% of NS infants. Most NS patients show normal levels of IGF-1 and IGF-BP3, indicating growth hormone (GH) deficiency is not culpable for postnatal growth failure. However, some studies have demonstrated subnormal overnight mean growth hormone concentration, suggestive of impaired GH secretion. The rhGH therapy in NS has been reported to be effective to improve both the height velocity and the final adult height. In this review, the constellation of overlapping clinical features of RASopathies will be described based on genotype as well as their differential diagnostic points and management.

A Proposed Multidisciplinary Approach for Identifying Feeding Abnormalities in Children With Cerebral Palsy

Children with neurodevelopmental disabilities, such as cerebral palsy, frequently have associated oral motor dysfunction, which leads to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise. The authors propose a comprehensive multidisciplinary assessment, including neurological and dysphagia examination and ear, nose, and throat examination, to evaluate clinical indicators and severity of feeding impairment in children affected by neurodevelopmental disorders. A representative sample of 40 children with cerebral palsy (spastic, dyskinetic, or mixed), intellectual disability, and feeding problems was included in the study. A specific multidisciplinary evaluation and standardized mealtime observation in patients with cerebral palsy appear feasible and appropriate to recognize proactive indicators of dysphagia and to establish personalized programs of gastric and rehabilitative interventions.

Trypanosoma brucei Modifies the Tsetse Salivary Composition, Altering the Fly Feeding Behavior That Favors Parasite Transmission

Tsetse flies are the notorious transmitters of African trypanosomiasis, a disease caused by the Trypanosoma parasite that affects humans and livestock on the African continent. Metacyclic infection rates in natural tsetse populations with Trypanosoma brucei, including the two human-pathogenic subspecies, are very low, even in epidemic situations. Therefore, the infected fly/host contact frequency is a key determinant of the transmission dynamics. As an obligate blood feeder, tsetse flies rely on their complex salivary potion to inhibit host haemostatic reactions ensuring an efficient feeding. The results of this experimental study suggest that the parasite might promote its transmission through manipulation of the tsetse feeding behavior by modifying the saliva composition. Indeed, salivary gland Trypanosoma brucei-infected flies display a significantly prolonged feeding time, thereby enhancing the likelihood of infecting multiple hosts during the process of a single blood meal cycle. Comparison of the two major anti-haemostatic activities i.e. anti-platelet aggregation and anti-coagulation activity in these flies versus non-infected tsetse flies demonstrates a significant suppression of these activities as a result of the trypanosome-infection status. This effect was mainly related to the parasite-induced reduction in salivary gland gene transcription, resulting in a strong decrease in protein content and related biological activities. Additionally, the anti-thrombin activity and inhibition of thrombin-induced coagulation was even more severely hampered as a result of the trypanosome infection. Indeed, while naive tsetse saliva strongly inhibited human thrombin activity and thrombin-induced blood coagulation, saliva from T. brucei-infected flies showed a significantly enhanced thrombinase activity resulting in a far less potent anti-coagulation activity. These data clearly provide evidence for a trypanosome-mediated modification of the tsetse salivary composition that results in a drastically reduced anti-haemostatic potential and a hampered feeding performance which could lead to an increase of the vector/host contact and parasite transmission in field conditions.

Care of the Child Assisted by Technology

Care of the Child Assisted by Technology

Cutting Edge: Immunity against a “Silent” Salivary Antigen of the Lyme Vector Ixodes scapularis Impairs Its Ability to Feed

Ixodes scapularis ticks transmit the Lyme disease agent in the United States. Although strong antitick immunity mediates tick rejection by certain vertebrates, only a few Ags have been molecularly characterized. We show that guinea pig vaccination against a secreted tick salivary immunomodulator, sialostatin L2, can lead to decreased feeding ability of I. scapularis nymphs. Increased rejection rate, prolonged feeding time, and apparent signs of inflammation were observed for nymphs attached to vaccinated animals, indicating a protective host immune response. Interestingly, sialostatin L2 humoral recognition does not take place upon repeated tick exposure in control animals, but only in the vaccinated animals that neutralize sialostatin L2 action. Therefore, we demonstrate an essential sialostatin L2 role upon nymphal infestation that can be blocked by vertebrate immunity and propose the discovery of similarly "silent" Ags toward the development of a multicomponent vaccine that will protect against tick bites and the pathogens they transmit.

Gastrointestinal disorders in children with neurodevelopmental disabilities

Children with neurodevelopmental disabilities such as cerebral palsy (CP), spina bifida, or inborn errors of metabolism frequently have associated gastrointestinal problems. These include oral motor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise. Gastrostomy tube feeding is increasingly being used in these children to circumvent oral motor dysfunction and prevent malnutrition. Foregut dysmotility causes several problems such as dysphagia from oesophageal dysmotility, gastro-oesophageal reflux disease, and delayed gastric emptying. Gastro-oesophageal reflux disease is common in these children but often fails to respond to medical management and may require surgical treatment. Finally, constipation is often a problem that may be overlooked in this population. This article focuses on these associated gastrointestinal manifestations and discusses the current diagnostic and therapeutic options available.

Pediatric Enteral Nutrition

Common to all pediatric patients receiving enteral nutrition is the inability to consume calories orally. This is often secondary to issues of inadequate weight gain, inadequate growth, prolonged feeding times, weight loss, a decrease in weight/age or weight/height ratios, or a persistent triceps skinfold thickness <5% for age. Enteral nutrition requires enteral access. In the neonatal period the nasoenteric route is usually used. In pediatric patients requiring long-term enteral access, surgically, endoscopically, or radiologically placed percutaneous feeding tubes are common. Jejunal feeding tubes are used in pediatric patients with gastric feeding intolerance or persistent gastroesophageal reflux. Low-profile enteral access devices are preferred by most pediatric patients because of their cosmetic appearance. For most children, a standard pediatric polypeptide enteral formula is well tolerated. There are specialized pediatric enteral formulas available for patients with decreased intestinal length, altered intestinal absorptive capacity, or altered pancreatic function. Weaning patients from tube feeding to oral nutrition is the ultimate nutrition goal. A multidisciplinary approach to patients with short bowel syndrome will maximize the use of enteral nutrition while preserving parenteral nutrition for patients with true enteral nutrition therapy failure.

Gastrointestinal problems in disabled children

Summary Children with disabilities such as cerebral palsy, spina bifida or other neurological impairments frequently have associated gastrointestinal problems. These include oromotor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times and malnutrition with its attendant physical compromise. Gastro-oesophageal reflux disease is common in these children and may require surgical treatment. Finally, constipation is often a problem that may be overlooked in this population. This article focuses on these associated gastrointestinal manifestations and discusses the current diagnostic and therapeutic options available.

International Society for Heart and Lung Transplantation: Practice guidelines for management of heart failure in children

Heart failure (HF) in the United States is well recognized as a major public health problem, with over 900,000 hospital admissions annually in the United States, and greater than 250,000 deaths per year. The great majority of heart failure occurs in adults. In children, the scope of the problem is less well defined, but recent data from the Pediatric Cardiomyopathy Registry suggest an annual incidence of 1.13 cases of cardiomyopathy per 100,000 children. 1 While some of this represents asymptomatic disease, the burden of disease overall is nonetheless quite high. In the Pediatric Cardiomyopathy Registry, the majority of children with cardiomyopathy also had HF, with mortality rates of 13.6% at 2 years in dilated forms of cardiomyopathy. The etiology of heart failure differs greatly between children and adults. Children in the Pediatric Cardiomyopathy Registry had a recognizable syndrome or genetic diagnosis in 27% of cases, with an additional 5% of cases due to myocarditis. Furthermore, a large percentage of children with end-stage HF (between 25% and 75%, depending upon the age group) have an underlying diagnosis of congenital heart disease. 2 In contrast to adult patients, ischemic heart disease is rare in children. There is a large, and rapidly growing literature addressing HF treatment for adult patients, with a much smaller literature concerning HF therapy in children. Excellent guidelines for adult patients have recently been published, but given the significant differences between adult and pediatric patients with HF, there is little reason to believe that these guidelines are directly applicable to children. 3 Accordingly, in this document we have attempted to summarize the relevant literature and synthesize management guidelines for children with HF. The document that follows has been prepared in a consensus fashion, with input from pediatric cardiologists at multiple sites throughout the United States and Canada.

The effect of dietary vitamin E and C level on market-size turbot (Scophthalmus maximus ) fillet quality

Fish fillet quality has been shown to be influenced by the level of antioxidants in preslaughter diet. Thus, an experiment was conducted to study the effect of different levels of vitamin E and C on the fillet quality of market-size reared turbot (Scophthalmus maximus). Turbot of a mean initial weight of 347 ± 20 g were divided into four groups and fed commercial turbot diets (60% protein, 12% fat), supplemented with α-tocopheryl acetate (mg kg−1) and ascorbyl-2 monophosphate (mg kg−1) at the following dietary levels: 500/100, 1000/100, 100/1000, 100/100 respectively. Over a dietary supplementation period of 15 weeks, fish were fed to satiation and reached a final mean weight of 916 ± 29 g. α-Tocopherol levels increased significantly (P < 0.001) in tissue (i.e. muscle, liver, heart and kidney) of fish fed diets containing elevated levels of α-tocopheryl acetate. In ice storage, fillets of these fish exhibited significantly lower (P < 0.001) levels of lipid oxidation, and showed significantly less (P < 0.001) colour deterioration (higher hue angle and lower chroma). Elevated dietary α-tocopheryl acetate levels had a negative effect (P ≤ 0.001) on the concentration of ascorbic acid in muscle tissue. An increase in dietary vitamin C did not have any detectable effect on fillet quality. Prolonged feeding times had a negative effect on lipid oxidation (P < 0.001) and colour deterioration (P < 0.01). These results suggest that increased dietary α-tocopheryl acetate could prevent colour deterioration and lipid oxidation of turbot fillets in retail storage on ice.