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1.  Automatic interactive optimization for volumetric modulated arc therapy planning 
Background
Intensity modulated radiotherapy treatment planning for sites with many different organs-at-risk (OAR) is complex and labor-intensive, making it hard to obtain consistent plan quality. With the aim of addressing this, we developed a program (automatic interactive optimizer, AIO) designed to automate the manual interactive process for the Eclipse treatment planning system. We describe AIO and present initial evaluation data.
Methods
Our current institutional volumetric modulated arc therapy (RapidArc) planning approach for head and neck tumors places 3-4 adjustable OAR optimization objectives along the dose-volume histogram (DVH) curve that is displayed in the optimization window. AIO scans this window and uses color-coding to differentiate between the DVH-lines, allowing it to automatically adjust the location of the optimization objectives frequently and in a more consistent fashion. We compared RapidArc AIO plans (using 9 optimization objectives per OAR) with the clinical plans of 10 patients, and evaluated optimal AIO settings. AIO consistency was tested by replanning a single patient 5 times.
Results
Average V95&V107 of the boost planning target volume (PTV) and V95 of the elective PTV differed by ≤0.5%, while average elective PTV V107 improved by 1.5%. Averaged over all patients, AIO reduced mean doses to individual salivary structures by 0.9-1.6Gy and provided mean dose reductions of 5.6Gy and 3.9Gy to the composite swallowing structures and oral cavity, respectively. Re-running AIO five times, resulted in the aforementioned parameters differing by less than 3%.
Conclusions
Using the same planning strategy as manually optimized head and neck plans, AIO can automate the interactive Eclipse treatment planning process and deliver dosimetric improvements over existing clinical plans.
doi:10.1186/s13014-015-0388-6
PMCID: PMC4394415  PMID: 25885689
Automatic treatment planning; Volumetric modulated arc therapy; OAR sparing
2.  Can knowledge-based DVH predictions be used for automated, individualized quality assurance of radiotherapy treatment plans? 
Background
Treatment plan quality assurance (QA) is important for clinical studies and for institutions aiming to generate near-optimal individualized treatment plans. However, determining how good a given plan is for that particular patient (individualized patient/plan QA, in contrast to running through a checklist of generic QA parameters applied to all patients) is difficult, time consuming and operator-dependent. We therefore evaluated the potential of RapidPlan, a commercial knowledge-based planning solution, to automate this process, by predicting achievable OAR doses for individual patients based on a model library consisting of historical plans with a range of organ-at-risk (OAR) to planning target volume (PTV) geometries and dosimetries.
Methods
A 90-plan RapidPlan model, generated using previously created automatic interactively optimized (AIO) plans, was used to predict achievable OAR dose-volume histograms (DVHs) for the parotid glands, submandibular glands, individual swallowing muscles and oral cavities of 20 head and neck cancer (HNC) patients using a volumetric modulated (RapidArc) simultaneous integrated boost technique. Predicted mean OAR doses were compared with mean doses achieved when RapidPlan was used to make a new plan. Differences between the achieved and predicted DVH-lines were analyzed. Finally, RapidPlan predictions were used to evaluate achieved OAR sparing of AIO and manual interactively optimized plans.
Results
For all OARs, strong linear correlations (R2 = 0.94–0.99) were found between predicted and achieved mean doses. RapidPlan generally overestimated the amount of achievable sparing for OARs with a large degree of OAR-PTV overlap. RapidPlan QA using predicted doses alone identified that for 50 % (10/20) of the manually optimized plans, sparing of the composite salivary glands, oral cavity or composite swallowing muscles could be improved by at least 3 Gy, 5 Gy or 7 Gy, respectively, while this was the case for 20 % (4/20) AIO plans. These predicted gains were validated by replanning the identified patients using RapidPlan.
Conclusions
Strong correlations between predicted and achieved mean doses indicate that RapidPlan could accurately predict achievable mean doses. This shows the feasibility of using RapidPlan DVH prediction alone for automated individualized head and neck plan QA. This has applications in individual centers and clinical trials.
doi:10.1186/s13014-015-0542-1
PMCID: PMC4653923  PMID: 26584574
Treatment planning quality assurance; OAR sparing; Knowledge-based planning
3.  Effects of dietary Lactobacillus plantarum and AHL lactonase on the control of Aeromonas hydrophila infection in tilapia 
MicrobiologyOpen  2016;5(4):687-699.
Abstract
This study addressed the effects of dietary Lactobacillus plantarum or/and N‐acylated homoserine lactonase (AHL lactonase) on controlling Aeromonas  hydrophila infection in juvenile hybrid tilapia (Oreochromis niloticus♀ × O. aureus ♂). Fish were fed Lb. plantarum subsp. plantarum strain JCM1149 (108 CFU/g feed) or/and AHL lactonase AIO6 (4 U/g) and were exposed to a chronic challenge of A. hydrophila NJ‐1 (105 cells/mL) for 14 days. Intestinal (foregut) alkaline phosphatase (IAP) activities were evaluated 1 day post challenge to reflect the resistance of fish against A. hydrophila infection. Parallel groups of fish with the same dietary assignments while unchallenged were also included to investigate the effect of dietary Lb. plantarum or/and AIO6 supplementation on gut health of tilapia. The results showed that IAP activity was significantly lower in fish fed with diets supplemented with Lb. plantarum JCM1149 or the combination of Lb. plantarum JCM1149 and AIO6, indicating enhanced resistance against A. hydrophila. Light microscopy and transmission electron microscopy images of foregut revealed damage caused by A. hydrophila NJ‐1, but dietary Lb. plantarum JCM1149 or/and AIO6 significantly alleviated the damages. Compared to the fish immersed in A. hydrophila NJ‐1, dietary Lb. plantarum JCM1149 or AIO6 could maintain the microvilli length in the foregut of tilapia. However, among the unchallenged groups of fish, the microvilli length in the foregut of tilapia fed AIO6 (singly or combination) and the microvilli density of tilapia fed AIO6 (singly) were significantly lower than those of the control, though the microvilli density in the combination treatment was significantly improved. Additionally, the dietary Lb. plantarum JCM1149 could down‐regulate the expression of stress‐related gene in the gut after the acute phase. In conclusion, the dietary Lb. plantarum JCM1149 is recommended to control the A. hydrophila infection in tilapia.
doi:10.1002/mbo3.362
PMCID: PMC4985601  PMID: 27098117
AHL lactonase; disease; immunity; lactobacillus; tilapia
4.  The Respiratory Arsenite Oxidase: Structure and the Role of Residues Surrounding the Rieske Cluster 
PLoS ONE  2013;8(8):e72535.
The arsenite oxidase (Aio) from the facultative autotrophic Alphaproteobacterium Rhizobium sp. NT-26 is a bioenergetic enzyme involved in the oxidation of arsenite to arsenate. The enzyme from the distantly related heterotroph, Alcaligenes faecalis, which is thought to oxidise arsenite for detoxification, consists of a large α subunit (AioA) with bis-molybdopterin guanine dinucleotide at its active site and a 3Fe-4S cluster, and a small β subunit (AioB) which contains a Rieske 2Fe-2S cluster. The successful heterologous expression of the NT-26 Aio in Escherichia coli has resulted in the solution of its crystal structure. The NT-26 Aio, a heterotetramer, shares high overall similarity to the heterodimeric arsenite oxidase from A. faecalis but there are striking differences in the structure surrounding the Rieske 2Fe-2S cluster which we demonstrate explains the difference in the observed redox potentials (+225 mV vs. +130/160 mV, respectively). A combination of site-directed mutagenesis and electron paramagnetic resonance was used to explore the differences observed in the structure and redox properties of the Rieske cluster. In the NT-26 AioB the substitution of a serine (S126 in NT-26) for a threonine as in the A. faecalis AioB explains a −20 mV decrease in redox potential. The disulphide bridge in the A. faecalis AioB which is conserved in other betaproteobacterial AioB subunits and the Rieske subunit of the cytochrome bc1 complex is absent in the NT-26 AioB subunit. The introduction of a disulphide bridge had no effect on Aio activity or protein stability but resulted in a decrease in the redox potential of the cluster. These results are in conflict with previous data on the betaproteobacterial AioB subunit and the Rieske of the bc1 complex where removal of the disulphide bridge had no effect on the redox potential of the former but a decrease in cluster stability was observed in the latter.
doi:10.1371/journal.pone.0072535
PMCID: PMC3758308  PMID: 24023621
5.  SMALL INTESTINAL OBSTRUCTION FROM PERITONEAL ADHESIONS IN CHILDREN SMALL INTESTINAL OBSTRUCTION FROM PERITONEAL ADHESIONS IN CHILDREN  
Abstract
Purpose: The purpose of this study was to assess the incidence of peritoneal adhesions leading to small intestinal obstruction after laparotomy in children in a tertiary paediatric surgical centre.
Methods: A retrospective review of 430 children aged <15 years who had trans-abdominal procedures over a 7 year period.
Results: Four hundred and fifty nine abdominal procedures were performed in 430 children during the study period. The follow up period ranged from 4 months – 7 years (Median 33 months). 22 (4.8%) had intra-operative confirmation of small intestinal obstruction. Their ages ranged from 21 days – 14 years (median 7 years). Postoperative adhesions due to laparotomy for typhoid perforation were the commonest, occurring in 10 (45%). Children undergoing emergency laparotomy were more likely to develop post operative small intestinal obstruction compared to elective laparotomy (p<0.025). Six (27.3%) children had bowel gangrene at laparotomy requiring bowel resection and anastomosis. Post-operative small intestinal obstruction developed in 6 (27.3%). One child died due to sepsis from intestinal gangrene. Conclusion: Small bowel obstruction due to adhesions requiring operative intervention in children in our setting is not un-common. Bowel gangrene is a common complication of postoperative small intestinal obstruction in children in our setting and should be suspected to avoid serious postoperative mortality and morbidity.
PMCID: PMC4170251  PMID: 25452942
Adhesions; Intestinal obstruction; children
6.  Congenital adhesion band causing small bowel obstruction: What’s the difference in various age groups, pediatric and adult patients? 
BMC Surgery  2016;16:79.
Background
A congenital adhesion band is a rare condition, but may induce a small bowel obstruction (SBO) at any age. However, only a few sporadic case reports exit. We aimed to identify the clinical characteristics of congenital adhesion band manifesting a SBO stratified by age group between pediatric and adult patients.
Methods
The medical records of all patients with a SBO between Jan 1, 2009 and Dec 31, 2015 were retrospectively reviewed. Cases associated with previous surgical procedure and cases of secondary obstruction due to inflammatory processes or tumor and other systemic diseases were excluded. The patients were divided into two groups according to age below or above 18 years: pediatric and adult. The basic clinical characteristics were analyzed and compared between groups.
Results
Of 251 patients with a SBO, 15 (5.9%) met the inclusion criteria; 10 cases in pediatric group (mean age 17.9 ± 38.7 months) and 5 cases in adult group (mean age 60.0 ± 19.7 years). The pediatric group (66.6%) included 3 neonates, 5 infants, and 2 school children. They usually presented with bilious vomiting (50.0%) and abdominal distention (60.0%), and demonstrated a high rate of early operation (80.0%) and bowel resection (70.0%). In contrast, the adult group (33.3%) presented with abdominal pain (100%) in all cases and underwent a relatively simple procedure of band release using a laparoscopic approach (60%). However, group differences did not reach statistical significance. In addition, two groups did not differ in the time interval to the operation or in the range of the operation (p = 0.089 vs. p = 0.329). No significant correlation was found between the time interval to the operation and the necessity of bowel resection (p = 0.136). There was no mortality in either group.
Conclusions
Congenital adhesion band is a very rare condition with diverse clinical presentations across ages. Unlike adult patients, pediatric patients showed a high proportion of early operation and bowel resection. A good result can be expected with an early diagnosis and prompt management regardless of age.
doi:10.1186/s12893-016-0196-4
PMCID: PMC5142405  PMID: 27927245
Congenital adhesion band; Obstruction; Pediatric; Adult
7.  Gender Differences in Homicide of Neonates, Infants, and Children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study 
PLoS Medicine  2016;13(4):e1002003.
Background
Homicide of children is a global problem. The under-5-y age group is the second largest homicide age group after 15–19 y olds, but has received little research attention. Understanding age and gender patterns is important for assisting with developing prevention interventions. Here we present an age and gender analysis of homicides among children under 5 y in South Africa from a national study that included a focus on neonaticide and infanticide.
Methods and Findings
A retrospective national cross-sectional study was conducted using a random sample of 38 medico-legal laboratories operating in 2009 to identify homicides of children under 5 y. Child data were abstracted from the mortuary files and autopsy reports, and both child and perpetrator data data were collected from police interviews. We erred towards applying a conservative definition of homicide and excluded sudden infant death syndrome cases. We estimated that 454 (95% CI 366, 541) children under the age of 5 y were killed in South Africa in 2009. More than half (53.2%; 95% CI 46.7%, 59.5%) were neonates (0–28 d), and 74.4% (95% CI 69.3%, 78.9%) were infants (under 1 y), giving a neonaticide rate of 19.6 per 100,000 live births and an infanticide rate of 28.4 per 100,000 live births. The majority of the neonates died in the early neonatal period (0–6 d), and abandonment accounted for 84.9% (95% CI 81.5%, 87.8%) of all the neonates killed. Distinct age and gender patterns were found, with significantly fewer boy children killed in rural settings compared to urban settings (odds ratio 0.6; 95% CI 0.4, 0.9; p = 0.015). Abuse-related killings and evidence of sexual assault were more common among older girls than in all other age and gender groups. Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall (71.0%; 95% CI 63.9%, 77.2%). Abandoned neonates were mainly term babies, with a mean gestational age of 38 wk. We did not have information on abandonment motives for all newborns and did not know if babies were abandoned with the intention that they would die or with the hope that they would be found alive. We therefore considered all abandoned babies as homicides.
Conclusions
Homicide of children is an extreme form or consequence of violence against children. This national study provides one of the first analyses of neonaticide and infanticide by age and gender and shows the failure of reproductive and mental health and social services to identify and help vulnerable mothers. Multi-sectoral prevention strategies are needed.
Jewkes and colleagues present a cross-sectional study that reveals levels of child homicide in South Africa. Identifying causes and vulnerable mothers will lead to prevention methods and strategies.
Editors' Summary
Background
Child mortality (death) is a global public health concern. In 2015, 5.9 million children (43 out of every 1,000 children born alive) died before their fifth birthday. Nearly half of these deaths occurred among neonates (babies 28 days old or younger); three-quarters of them occurred among infants (children less than one year old). Most of these deaths happened in resource-limited countries following delivery complications, infections, and other natural causes. Some, however, were homicides. Infanticide (the killing of a child under one year old) and neonaticide (the killing of a newborn within 24 hours or 28 days of birth, depending on the definition used) can be active (deliberate killing by, for example, suffocation) or passive (killing through nutritional, physical, or emotional neglect). Many infanticides and neonaticides are the result of abandonment—the mother leaves her infant or newborn in a place without care or protection, either with the intention of killing the child or with the hope that someone will find and care for him/her. Unwanted pregnancies are the most common cause of infanticide and neonaticide, but some infants are also killed because they are disabled or of the wrong gender—in some cultures male children are considered more socially valuable than female children.
Why Was This Study Done?
To develop interventions to prevent child homicide, we need to understand when, where, and why these deaths occur. However, little research has been done on neonaticide and infanticide, particularly in resource-limited settings, because these deaths are often poorly identified and reported. In Africa, for example, although quantitative (numerical) research on child homicide is rare, Dar es Salaam, Tanzania, has one of the highest reported rates of neonaticide (27.7 homicides within 24 hours of birth per 100,000 live births); by comparison, a review of studies undertaken in the US, UK, and New Zealand reported incidences of infanticide and neonaticide ranging between 2.1 and 6.9 per 100,000 live births. Here, the researchers use data collected in a national cross-sectional mortuary-based study of child homicides committed in 2009 to investigate patterns among homicides of neonates, infants, and children under five years old in South Africa.
What Did the Researchers Do and Find?
The researchers chose a random sample of 38 medico-legal laboratories (mortuaries where postmortem examinations were performed on all unnatural deaths) across South Africa. They used data extracted from mortuary files, autopsy reports, and police interviews to identify homicides of children under five years old. The researchers estimated that 454 children under five years old were killed in South Africa in 2009. More than half of the children who died were neonates, and nearly three-quarters were infants, giving a neonaticide rate (defined in this study as homicide within the first 28 days of life) of 19 per 100,000 live births and an infanticide rate of 28 per 100,000 live births. Most of the neonates died in the early neonatal period—only eight out of 241 neonates were more than six days old when they died. Abandonment accounted for 84.9% of neonaticides, and abandoned neonates were mainly term babies. Overall, there was no gender bias among child homicides, but 56% of homicides of boys took place in an urban setting, compared to 44% of homicides of girls. Finally, young mothers were the most common perpetrators of child homicide.
What Do These Findings Mean?
These findings show that, in 2009, the rates of infanticide and neonaticide in South Africa were much higher than the rates previously reported for the US, UK, and New Zealand. The rates reported here are likely to be underestimates because it is often difficult to distinguish infanticide from other causes of death during infancy. Another important limitation of this study is the lack of data on the motive for abandonment of newborns. Importantly, however, these findings suggest that a child born in South Africa is at the highest risk of being killed during its first six days of life. This may mean that mothers who abandon their babies simply do not want a child, and suggests that reproductive, mental health, and social services are failing to identify and help vulnerable mothers in South Africa. The researchers suggest, therefore, that multi-sectoral prevention strategies are needed to reduce child homicides in South Africa. A pilot child death review system that has been initiated in South Africa to identify and describe patterns and causes of child death could assist in the development of such prevention strategies.
Additional Information
This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1002003.
This study is further discussed in a PLOS Medicine Perspective by Delan Devakumar and David Osrin
The World Health Organization (WHO) provides information on child health and child mortality and global efforts to reduce child mortality and a factsheet on child maltreatment (available in several languages); a previous paper by the researchers on child homicide is available on the WHO website
The United Nations Children’s Fund (UNICEF) works for children’s rights, survival, development, and protection around the world; its UNICEF Data website provides detailed statistics about child health and mortality; its 2014 report Children in Danger: Act to End Violence against Children provides detailed information about violence against children; Hidden in Plain Sight is a 2014 UNICEF statistical analysis of violence against children
The international non-governmental organization Humanium, which works to stop violations of children’s rights worldwide, has an article on infanticide (in several languages)
Child Trends is a US not-for-profit organization that aims to improve the lives and prospects of children and youth in the US by conducting research; it provides up-to-date information about infanticide in the US
Information on the South African pilot child death review system is available; a guide on the child death review system in the UK for parents and carers is available
doi:10.1371/journal.pmed.1002003
PMCID: PMC4846035  PMID: 27115771
8.  Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues 
Rectal carcinoma represents the 30% of all colorectal cancers, with about 40000 new cases/years. In the past two decades, the management of rectal cancer has made important progress, highlighting the main role of a multimodality strategy approach, combining surgery, radiation therapy and chemotherapy. Nowadays, surgery remains the primary treatment and neo-adjuvant chemoradiotherapy, based on fluoropyrimidine (5-FU) continuous infusion, is considered the standard in locally advanced rectal carcinoma. The aim is to reduce the incidence of local recurrence and to perform a conservative surgery. To improve these purposes different drugs combination have been tested in the neo-adjuvant setting. At American Society of Clinical Oncology 2014 an important abstract was presented focusing on the role of adding oxaliplatin to concomitant treatment, in patients with locally advanced rectal carcinoma. Rodel et al reported on the CAO/ARO/AIO-04 randomized phase III trial that compared standard treatment with 5-FU and radiation therapy, to oxaliplatin plus 5-FU in association with radiation therapy. The addition of oxaliplatin to the neo-adjuvant treatment has been shown to improve disease-free survival from 71.2% to 75.9% (P = 0.03). This editorial was planned to clarify the optimal treatment in patients with locally advanced rectal cancer, considering the results from CAO/ARO/AIO-04 study.
doi:10.4251/wjgo.v6.i12.438
PMCID: PMC4266815  PMID: 25516776
Chemoradiotherapy; Rectal cancer; Locally advanced disease; Neoadjuvant; Debate
9.  Profound systemic inflammatory response syndrome following non-emergent intestinal surgery in children☆ 
Journal of pediatric surgery  2013;48(9):1936-1940.
Purpose
Systemic inflammatory response syndrome (SIRS) is an uncommon but severe complication in surgical patients. While SIRS is well known, it is poorly described in the pediatric population. The goal of this study was to describe the incidence of profound SIRS following non-emergent intestinal surgery in children and to identify potential risk factors.
Methods
A retrospective review was conducted for patients 0–19 years of age following intestinal surgery and/or lysis of adhesions from 01/01/1999-02/28/2012. Children were excluded for preoperative instability or frank bowel perforation. Patients were then placed in a post-operative SIRS or non-SIRS group as defined by the 2005 International Pediatric Sepsis Consensus Conference Guidelines (6. B. Goldstein, B. Giroir, A. Randolph, and Sepsis International Consensus Conference on Pediatric, ‘International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics’, Pediatr Crit Care Med, 6 (2005), 2–8.).
Results
SIRS was identified in 17 of the 381 patients. Logistic regression analysis was performed and showed heart disease, kidney disease, PN dependence, and intestinal obstruction to be predictive of post-operative SIRS.
Conclusion
This study represents one of the first reports to identify a previously poorly described process of significant SIRS after intestinal surgery in children. Both systemic organ failure and intestinal dysfunction are strong risk factors for post-operative SIRS in children. Potentially, these pre-existing conditions may lead to disruption of normal intestinal flora or barrier function, which in turn may predispose these children for dramatic SIRS after intestinal surgery. Understanding how these factors lead to SIRS will be critical to developing prevention strategies.
doi:10.1016/j.jpedsurg.2013.05.065
PMCID: PMC3787315  PMID: 24074671
Systemic inflammatory response syndrome; SIRS; Intestinal surgery; Parenteral nutrition
10.  Developing and Implementing All-in-One Standard Paediatric Parenteral Nutrition 
Nutrients  2013;5(6):2006-2018.
Parenteral nutrition (PN) is a feeding mode suitable for children that do not achieve requirements via the enteral route. For this intervention to be successful, healthcare professionals require: knowledge on nutrient requirements; access to an aseptic compounding facility; and a system that ensures adequate and safe delivery of PN. Previously, it was thought that individualised PN was the “gold standard” for delivering nutrients to children; however, studies have highlighted concerns regarding inadequate delivery of nutrients, prescribing and compounding errors. We, therefore, set out to develop and implement all-in-one (AIO) paediatric PN solutions. Through a systematic approach, four AIO PN solutions were developed: birth–two months of age (Ped 1); two months–10 kg (Ped 2); 11–15 kg (Ped 3); and 16–30 kg (Ped 4). We implemented them with the help of a teaching pack, over a one month time period, and reviewed usage at six months. At that time, five children initially received standard PN without electrolyte changes; but after a few days, electrolytes needed amendments, and three required individualised PN. A change to AIO PN is feasible and safe; however, some may require electrolyte changes, and there will always be those that will require individualised PN.
doi:10.3390/nu5062006
PMCID: PMC3725489  PMID: 23739142
parenteral nutrition; all-in-one parenteral nutrition; paediatrics; development; implementation
11.  Traumatic Jejunal hematoma in childhood—A case report and review of literature 
Highlights
•Intramural jejunal hematoma is very rare with only few cases reported in the literature.•The trauma in majority of cases is trivial and usually the patients present late.•It can present with intestinal obstruction.•It should be suspected when a child presents with intestinal obstruction and history of blunt abdominal trauma.
Introduction
Intramural jejunal hematoma is a very rare condition with only few cases reported in the literature. It rarely occurs spontaneously, and is mostly seen in hemophiliac patients and is also associated with abdominal trauma. It occurs more commonly in children than in adults and can present with features of intestinal obstruction.
Case presentation
A 10 year old boy presented with features of intestinal obstruction. He sustained a blunt abdominal trauma two days prior to presentation. Abdominal computed tomography (CT) revealed jejunal hematoma with signs of complete obstruction. A trial of non-operative management failed and eventually he was managed surgically.
Discussion
Blunt trauma to the abdomen is the principle cause of jejunal hematoma. The trauma in majority of cases is trivial and usually the patients present late. The symptoms range from mild abdominal pain to intestinal obstruction with acute abdomen. A trial of conservative management is justifiable in stable patient. If no clinical improvement surgical intervention is indicated.
Conclusion
Intramural jejunal hematoma after blunt abdominal trauma is seen predominately in pediatric age group and can present as intestinal obstruction. It should be suspected when a child presents with intestinal obstruction and a concurrent history of blunt abdominal trauma. The mainstay of treatment is surgical intervention. Because of the rarity of this disease, the role of conservative therapy is undefined.
doi:10.1016/j.ijscr.2016.10.055
PMCID: PMC5097963  PMID: 27815994
Jejunal hematoma; Blunt abdominal trauma; Case report
12.  4th Pediatric Allergy and Asthma Meeting (PAAM) 
Yavuz, S. Tolga | Koc, Ozan | Gungor, Ali | Gok, Faysal | Hawley, Jessica | O’Brien, Christopher | Thomas, Matthew | Brodlie, Malcolm | Michaelis, Louise | Mota, Inês | Gaspar, Ângela | Piedade, Susana | Sampaio, Graça | Dias, José Geraldo | Paiva, Miguel | Morais-Almeida, Mário | Madureira, Cristina | Lopes, Tânia | Lopes, Susana | Almeida, Filipa | Sequeira, Alexandra | Carvalho, Fernanda | Oliveira, José | Gay-Crosier, Fabienne | Nenciu, Ioana-Valentina | Nita, Andreia Florina | Ulmeanu, Alexandru | Oraseanu, Dumitru | Zapucioiu, Carmen | Machinena, Adrianna | Sánchez, Olga Domínguez | Lozano, Montserrat Alvaro | Feijoo, Rosa Jiménez | Blasco, Jaime Lozano | Gibert, Mònica Piquer | Muñoz, Mª Teresa Giner | da Costa, Marcia Dias | Martín, Ana Maria Plaza | Yilmaz, Ebru Arik | Cavkaytar, Özlem | Buyuktiryaki, Betul | Soyer, Ozge | Sackesen, Cansin | Netting, Merryn | El-Merhibi, Adaweyah | Gold, Michael | Quinn, Patrick | Penttila, Irmeli | Makrides, Maria | Giavi, Stavroula | Muraro, Antonella | Lauener, Roger | Mercenier, Annick | Bersuch, Eugen | Montagner, Isabella M. | Passioti, Maria | Celegato, Nicolò | Summermatter, Selina | Nutten, Sophie | Bourdeau, Tristan | Vissers, Yvonne M. | Papadopoulos, Nikolaos G. | van der Kleij, Hanneke | Warmenhoven, Hans | van Ree, Ronald | Pieters, Raymond | Opstelten, Dirk Jan | van Schijndel, Hans | Smit, Joost | Fitzsimons, Roisin | Timms, Victoria | Du Toit, George | Kaya, Guven | Gulec, Mustafa | Saldir, Mehmet | Sener, Osman | Hassan, Nagwa | Shaaban, Hala | El-Hariri, Hazem | Mahfouz, Ahmed Kamel Inas E. | Gabor, Papp | Gabor, Biro | Csaba, Kovacs | Chawes, Bo | Bønnelykke, Klaus | Stokholm, Jakob | Heickendorff, Lene | Brix, Susanne | Rasmussen, Morten | Bisgaard, Hans | Hallas, Henrik Wegener | Arianto, Lambang | Pincus, Maike | Keil, Thomas | Reich, Andreas | Wahn, Ulrich | Lau, Susanne | Grabenhenrich, Linus | Fagerstedt, Sara | Hesla, Helena Marell | Johansson, Emelie | Rosenlund, Helen | Mie, Axel | Scheynius, Annika | Alm, Johan | Esparza-Gordillo, Jorge | Matanovic, Anja | Marenholz, Ingo | Bauerfeind, Anja | Rohde, Klaus | Nemat, Katja | Lee-Kirsch, Min-Ae | Nordenskjöld, Magnus | Winge, Marten C.G. | Krüger, Renate | Beyer, Kirsten | Kalb, Birgit | Niggemann, Bodo | Hübner, Norbert | Cordell, Heather J. | Bradley, Maria | Lee, Young-Ae | Gough, Hannah | Schramm, Dirk | Beschorner, John | Schuster, Antje | Bauer, Carl-Peter | Forster, Johannes | Zepp, Fred | Bergmann, Renate | Bergmann, Karl | Garcia, Filipe Benito | Santos, Natacha | Pité, Helena | Papadopoulou, Athina | Mermiri, Despina | Xatziagorou, Elpida | Tsanakas, Ioannis | Lampidi, Stavroula | Priftis, Kostas | Fuertes, Elaine | Markevych, Iana | Bowatte, Gayan | Gruzieva, Olena | Gehring, Ulrike | Becker, Allan | Berdel, Dietrich | Brauer, Michael | Carlsten, Chris | Hoffmann, Barbara | Kozyrskyj, Anita | Lodge, Caroline | Pershagen, Göran | Wijga, Alet | Joachim, Heinrich | Zivkovic, Zorica | Djuric-Filipovic, Ivana | Jocić-Stevanovic, Jasmina | Zivanovic, Snežana | Taka, Styliani | Kokkinou, Dimitra | Papakonstantinou, Aliki | Stefanopoulou, Panagiota | Georgountzou, Anastasia | Maggina, Paraskevi | Stamataki, Sofia | Papaevanggelou, Vassiliki | Andreakos, Evangelos | Gibert, Monica Piquer | Spera, Adriana Machinena | Deliu, Matea | Belgrave, Danielle | Simpson, Angela | Custovic, Adnan | Marques, João Gaspar | Carreiro-Martins, Pedro | Belo, Joana | Serranho, Sara | Peralta, Isabel | Neuparth, Nuno | Leiria-Pinto, Paula | Vazquez-Ortiz, Marta | Pascal, Mariona | Plaza, Ana Maria | Juan, Manel | Paparo, Lorella | Nocerino, Rita | Aitoro, Rosita | Langella, Ilaria | Amoroso, Antonio | Amoroso, Alessia | Di Scala, Carmen | Berni Canani, Roberto | Maity, Santanu | Rotiroti, Giuseppina | Gandhi, Minal | Jonsson, Karin | Ljung, Annika | Hesselmar, Bill | Adlerbert, Ingegerd | Brekke, Hilde | Johansen, Susanne | Wold, Agnes | Sandberg, Ann-Sofie | Nordlund, Björn | Lundholm, Cecilia | Ullemar, Villhelmina | van Hage, Marianne | Örtqvist, Anne | Almqvist, Catarina | Selby, Anna | Grimshaw, Kate | Clausen, Michael | Dubakiene, Ruta | Fiocchi, Alessandro | Kowalski, Marek | Papadopoulos, Nikos | Reche, Marta | Sigurdardottir, Sigurveig | Sprikkleman, Aline | Xepapadaki, Paraskevi | Mills, Clare | Roberts, Graham | Neto, Herberto Jose Chong | Wandalsen, Gustavo Falbo | Bianca, Ana Carolina Dela | Aranda, Carolina | Rosário, Nelson Augusto | Solé, Dirceu | Mallol, Javier | Marcos, Luis García | Banic, Ivana | Rijavec, Matija | Plavec, Davor | Korosec, Peter | Turkalj, Mirjana | Bozicevic, Alen | De Mieri, Maria | Hamburger, Matthias | Holley, Simone | Morris, Ruth | Mitchell, Frances | Knibb, Rebecca | Latter, Susan | Liossi, Christina | Hassan, Mostafa M. M. | Barman, Malin | Sandin, Anna | Posa, Daniela | Perna, Serena | Hoffmann, Ute | Chen, Kuan-Wei | Resch, Yvonne | Vrtala, Susanne | Valenta, Rudolf | Matricardi, Paolo Maria | Tsilochristou, Olympia | Rohrbach, Alexander | Cappella, Antonio | Hofmaier, Stephanie | Hatzler, Laura | D’Amelio, Raffaele | Björkander, Sophia | Johansson, Maria A. | Lasaviciute, Gintare | Sverremark-Ekström, Eva | Rüschendorf, Franz | Strachan, David P. | Spycher, Ben D. | Baurecht, Hansjörg | Margaritte-Jeannin, Patricia | Sääf, Annika | Kerkhof, Marjan | Ege, Markus | Baltic, Svetlana | Matheson, Melanie C. | Li, Jin | Michel, Sven | Ang, Wei Q. | McArdle, Wendy | Arnold, Andreas | Homuth, Georg | Demenais, Florence | Bouzigon, Emmanuelle | Söderhäll, Cilla | de Jongste, Johan C. | Postma, Dirkje S. | Braun-Fahrländer, Charlotte | Horak, Elisabeth | Ogorodova, Ludmila M. | Puzyrev, Valery P. | Bragina, Elena Yu | Hudson, Thomas J. | Morin, Charles | Duffy, David L. | Marks, Guy B. | Robertson, Colin F. | Montgomery, Grant W. | Musk, Bill | Thompson, Philip J. | Martin, Nicholas G. | James, Alan | Sleiman, Patrick | Toskala, Elina | Rodriguez, Elke | Fölster-Holst, Regina | Franke, Andre | Lieb, Wolfgang | Gieger, Christian | Heinzmann, Andrea | Rietschel, Ernst | Cichon, Sven | Nöthen, Markus M. | Pennell, Craig E. | Sly, Peter D. | Schmidt, Carsten O. | Schneider, Valentin | Heinig, Matthias | Holt, Patrick G. | Kabesch, Michael | Weidinger, Stefan | Hakonarson, Hakon | Ferreira, Manuel AR | Laprise, Catherine | Freidin, Maxim B | Genuneit, Jon | Koppelman, Gerard H | Melén, Erik | Dizier, Marie-Hélène | John Henderson, A. | Lee, Young Ae | González-Delgado, Purificacion | Caparrós, Esther | Clemente, Fernando | Cueva, Begoña | Moreno, Victoria M. | Carretero, Jose Luis | Fernández, Javier | Swan, Kate | Gopi, Mudiyur | Smith, Tim | Ramesh, Edara | Sadasivam, Arun | Arêde, Cristina | Borrego, Luís Miguel | Pires, Graça | Santa-Marta, Cristina | Brand, Stephanie | Stein, Karina | Heine, Holger | Kauth, Marion | Rolfsjord, Leif Bjarte | Bakkeheim, Egil | Skjerven, Håvard Ove | Carlsen, Kai-Håkon | Hunderi, Jon Olav | Berents, Teresa Løvold | Mowinckel, Petter | Lødrup Carlsen, Karin C. | Munzel, Ullrich | Berger, William | Valiente, Román | Vozmediano, Valvanera | Lukas, John C. | Rodríguez, Mónica | Guarnaccia, Sebastiano | Vitale, Luigi | Pluda, Ada | D’Agata, Emanuele | Colombo, Denise | Felici, Stefano | Gretter, Valeria | Facchetti, Susanna | Pecorelli, Gaia | Quecchia, Cristina | Guibas, George | Spandou, Evangelia | Megremis, Spyridon | West, Peter | Papadopoulos, Nikolaos | Rufo, João Cavaleiro | Madureira, Joana | Paciência, Inês | Aguiar, Lívia | Padrão, Patrícia | Pinto, Mariana | Delgado, Luís | Moreira, Pedro | Teixeira, João Paulo | Fernandes, Eduardo Oliveira | Moreira, André | Dominguez, Adriana Izquierdo | Valero, Antonio | Mullol, Joaquim | Del Cuvillo, Alfonso | Montoro, Javier | Jauregui, Ignacio | Bartra, Joan | Davila, Ignacio | Ferrer, Marta | Sastre, Joaquin | Martins, Catarina | Lima, Jorge | Leandro, Maria José | Nunes, Glória | Branco, Jorge Cunha | Trindade, Hélder | Borrego, Luis Miguel | Conkar, Secil | Kilic, Mehtap | Aygun, Canan | Sancak, Recep | Tagalaki, Eleni | Banos, Lambros | Vlachou, Anna | Giannoula, Fotini | Pavlakou, Marina | Kryoni, Maria | Makris, Kostas | Lazova, Snezhina | Petrova, Guergana | Miteva, Dimitrinka | Perenovska, Penka | Klyucharova, Aliya | Skorohodkina, Olesya | Koumaki, Dimitra | Manousaki, Alkisti | Agrapidi, Maria | Iatridou, Lida | Eruk, Omima | Myridakis, Konstantinos | Manousakis, Emmanouil | Koumaki, Vasiliki | Dimou, Maria | Ingemansson, Maria | Hedlin, Gunilla | Pastor, Nitida | de Boissieu, Delphine | Vanderhoof, Jon | Moore, Nancy | Maditz, Kaitlin | Mehdi, Adeli | Elhassan, Shaza | Beck, Carolin | Al-Hammadi, Ahmed | Maris, Ioana | O’Sullivan, Ronan | Hourihane, Jonathan | Raptis, George | DunnGalvin, Audrey | Greenhawt, Matthew | Venter, Carina | O’Regan, Evelyn | Cronin, Duncan | O’Reilly, Anna | Abdelaziz, Foued | Khelifi-Touhami, Dounia | Selim, Nihad | Khelifi-Touhami, Tahar | Merida, Pablo | Plaza, Ana Mª | Castellanos, Juan Heber | Lozano, Jaime | Dominguez, Olga | Piquer, Monica | Jimenez, Rosa | Giner, Mª Teresa | Kakleas, Konstantinos | Joishy, Manohar | Maskele, Wendmu | Jenkins, Huw R. | Escarrer, Mercedes | Madroñero, Agustín | Guerra, Maria Teresa | Julia, Juan Carlos | Cerda, Juan Carlos | Contreras, Javier | Tauler, Eulalia | Vidorreta, Maria Jesus | Rojo, Ana | Del Valle, Silvia | Flynn, Niamh | Foley, Gary | Harmon, Carol | Fitzsimons, John | Baynova, Krasimira | Del Robledo, Ávila Maria | Marina, Labella | Cortes, Aaron | Sciaraffia, Alicia | Castillo, Angela | Juel-Berg, Nanna | Hansen, Kirsten Skamstrup | Poulsen, Lars Kærgaard | Lazar, Adina | Aguiar, Rita | Lopes, Anabela | Paes, Maria J. | Santos, Amélia S. | Pereira-Barbosa, M. A. | Eke Gungor, Hatice | Uytun, Salih | Sahiner, Umit Murat | Altuner Torun, Yasemin | Zivanovic, Mirjana | Atanasković-Marković, Marina | Vesel, Tina | Nahtigal, Mihaela | Obermayer-Temlin, Andreja | Križnik, Eva Šoster | Maslar, Mirjana | Bizjak, Ruben | Tomšič-Matic, Marjeta | Posega-Devetak, Sonja | Skerbinjek-Kavalar, Maja | Predalič, Mateja | Avčin, Tadej | Pouessel, Guillaume | Beaudouin, Etienne | Moneret-Vautrin, Anne M. | Deschildre, Antoine | Viñas, Marta | Borja, Bartolomé | Hernández, Nora | Castillo, Mª José | Izquierdo, Adriana | Ibero, Marcel | Kocabas, Can Naci | Heming, Camille | Garrett, Emily | Blackstock, Adam | Chodhari, Rahul | Belohlavkova, Simona | Kopelentova, Eliska | Visek, Petr | Setinova, Ivana | Svarcova, Ivana | Sjölander, Sigrid | Nilsson, Nora | Berthold, Malin | Ekoff, Helena | Borres, Magnus | Nilsson, Caroline | González Domínguez, Loreto | Muñoz Archidona, Cristina | Moreira Jorge, Ana | Quevedo Teruel, Sergio | Bracamonte Bermejo, Teresa | Castillo Fernández, Miriam | Pineda de la Losa, Fernando | Echeverría Zudaire, Luis Ángel | Vrani, Olga | Mavroudi, Antigone | Fotoulaki, Maria | Emporiadou, Maria | Spiroglou, Kleomenis | Xinias, Ioannis | Sadreddini, Helyeh A. | Warnes, Mia | Traves, Donna | Kostić, Gordana | Filipovic, Đorđe | Sittisomwong, Sawapon | Sittisomwong, Siripong | Podolec, Zygmunt | Hartel, Marcin | Panek, Daria | Podolec-Rubiś, Magdalena | Banasik, Tomasz | Abbasi, Elham | Moghtaderi, Mozhgan | Sanneerappa, Phani | Deliu, Alina | Kutty, Moosa | Ramesh, Nagabathula | Sherkat, Roya | Sabri, Mohammad Reza | Dehghan, Bahar | Bigdelian, Hamid | Raeesi, Nahid | Afshar, Mino | Rahimi, Hamid | Klein, Christoph | Al-Jebouri, Mohemid | Svitich, Oxana A. | Zubacheva, Daria O. | Potemkin, Dmitrii A. | Gankovskaya, Ludmila V. | Zverev, Vitalii V. | OB Doyle, Elaine | Gallagher, Paul | Dewlett, Sherine | Man, Kin | Pocock, James | Gerrardhughes, Anna | Wasilewska, Jolanta | Kaczmarski, Maciej | Lebensztejn, Dariusz | Thuraisingham, Chandramani | Sinniah, Davendralingam | Chen, Yue | Mei, Xiaomei | Ozdogan, Sebnem | Karadeniz, Pinar | Ayyildiz-Emecen, Durdugul | Oncul, Ummuhan | Sari, Gizem | Cavdar, Sabanur | Farzan, Niloufar | Vijverberg, Susanne J. | Palmer, Colin J. | Tantisira, Kelan G. | Maitland-van der Zee, Anke-Hilse | Yavuzyilmaz, Fatma | Urganci, Nafiye | Usta, Merve | Hoxha, Mehmet | Basho, Maksim | Wandalsen, Gustavo F. | Monteiro, Fernanda | Lame, Blerta | Mesonjesi, Eris | Sherri, Arjeta | Ibranji, Alkerta | Gjati, Laert | Loloci, Gjustina | Bardhi, Ardii | Moghtaderi, Behnam | Farjadian, Shirin | Eghtedari, Dorna | Olaya, Manuela | Del Mar Vasquez, Laura | Ramirez, Luis Fernando | Serrano, Carlos Daniel | Usta Guc, Belgin | Asilsoy, Suna | Ozer, Fulya | Shopova, Sylvia | Papochieva, Vera | Loekmanwidjaja, Jessica | Mallozi, Márcia | Ratner, Paul | Soteres, Daniel | Novák, Zoltán | Yáñez, Anahí | Ildikó, Kiss | Kuna, Piotr | Tortajada, Miguel | Valiente, Román | Feuerhahn, Julia | Blome, Christine | Hadler, Meike | Karagiannis, Efstrathios | Langenbruch, Anna | Augustin, Matthias | Roux, Michel | Kakudo, Shinji | Zeldin, Robert K. | Sokolova, Anna | Silva, Tiago Milheiro | Zivanovic, Snezana S. | Cvetkovic, Vesna | Nikolic, Ivana | Zivanovic, Sonja J. | Saranac, Ljiljana | Nesterenko, Zoia | Radic, Snezana | Milenkovic, Branislava | Smiljanic, Spomenka | Micic-Stanijevic, Milka | Calovic, Olivera | Hofbauer, Anne Marie Bro | Agertoft, Lone | Everson, Lucy | Kearney, Jessica | Coppel, Jonny | Braithwaite, Simon | Christiansen, Elisabeth S. | Kjaer, Henrik Fomsgaard | Eller, Esben | Mørtz, Charlotte G. | Halken, Susanne | Román India, Cristina | Jiménez Jiménez, Juana | Echeverría Zudaire, Luis | O’Connor, Cathal | Kanti, Varvara | Lünnemann, Lena | Malise, Günther | Ludriksone, Laine | Stroux, Andrea | Henrich, Wolfgang | Abu-Dakn, Michael | Blume-Peytavi, Ulrike | Garcia Bartels, Natalie | Schario, Marianne | Stanley, Thorsten | Brandenbarg, Nicolien | Boardman, Alia | McGreevy, Gary | Rodger, Emily | Knight, Katherine | Taylor, Trisha | Scanlan, Gemma | Christoph, Grüber | van Stuivenberg, Margriet | Mosca, Fabio | Moro, Guido | Chirico, Gaetano | Braegger, Christian P. | Riedler, Joseph | Yavuz, Yalcin | Boehm, Günther | Arasi, Stefania | Crisafulli, Giuseppe | Caminiti, Lucia | Porcaro, Federica | Pajno, Giovanni Battista | Tanaka, Akane | Togawa, Yaei | Oida, Kumiko | Kambe, Naotomo | Arkwright, Peter | Amagai, Yosuke | Shimojo, Naoki | Sato, Yasunori | Mochizuki, Hiroyuki | Jang, Hyosun | Ishizaka, Saori | Matsuda, Hiroshi | Barlianto, Wisnu | Olivianto, Ery | Chandra Kusuma, H. M. S. | Mollica, Mariapia | Trinchese, Giovanna | Alfano, Elena | Amato, Francesco | Pirozzi, Claudio | Calignano, Antonio | Meli, Rosaria | Rossberg, Siri | Gerhold, Kerstin | Zimmermann, Kurt | Zaino, Mohammad | Geske, Thomas | Hamelmann, Eckard | Bogovic, Sarah | van den Berg, Jochem | Janssen, Chantal | Claver, Angela | Martin-Muñoz, Mª Flor | Martorell, C. | Belver, M. T. | Alonso Lebrero, E. | Zapatero, L. | Fuentes, V. | Piqué, M. | Plaza, A. | Muñoz, C. | Blasco, Cristina | Villa, B. | Gómez, C. | Nevot, S. | García, J. M. | Echeverria, L. | DeWitt, Brenda | Holloway, Judith | Hodge, Donald | Ludman, Sian | Jafari-Mamaghani, Merhdad | Ebling, Rosemary | Fox, Adam T. | Lack, Gideon | Lovén Björkman, Sofia | Ballardini, Natalia | Basu, Supriyo | Hallet, Jenny | Srinivas, Jyothi | Stringer, Hazel | Jay, Nicola | Fonseca, Paula | Vieira, Clara | Mastrorilli, Carla | Caffarelli, Carlo | Asero, Riccardo | Tripodi, Salvatore | Dondi, Arianna | Ricci, Gianpaolo | Povesi Dascola, Carlotta | Calamelli, Elisabetta | Cipriani, Francesca | Di Rienzo Businco, Andrea | Bianchi, Annamaria | Candelotti, Paolo | Frediani, Tullio | Verga, Carmen | Korovessi, Paraskevi | Tiliakou, Skevi | Tavoulari, Evaggelia | Moraiti, Kalliopi-Maria | Tee, Wan Jean | Deiratany, Samir | Seedhoo, Raymond | McNamara, Roisin | Okafor, Ike | Khaleva, Ekaterina | Novic, Gennady | Bychkova, Natalia | Abd Al-Aziz, Amany | Fatouh, Amany | Motawie, Ayat | Bostany, Eman El | Ibrahim, Amr | Andonova, Sylvia | Savov, Alexey | Zoto, Maria | Kyriakakou, Marialena | Vassilopoulou, Mariza | Balaska, Athina | Kostaridou, Stavroula | Wartna, Jorien | Bohnen, Arthur M. | Elshout, Gijs | Pols, David H. J. | Bindels, Patrick J. E. | Seys, Sven F. | Dilissen, Ellen | Van der Eycken, Sarah | Schelpe, An-Sofie | Marijsse, Gudrun | Troosters, Thierry | Vanbelle, Vincent | Aertgeerts, Sven | Ceuppens, Jan L. | Dupont, Lieven J. | Peers, Koen | Bullens, Dominique M. | Lokas, Sandra Bulat | Zivkovic, Jelena | Nogalo, Boro | Kobal, Iva Mrkic | Oliveira, Georgeta | Pike, Katharine | Melo, Alda | Amélia, Tomás | Cidrais Rodrigues, José Carlos | Serrano, Cristina | Lopes dos Santos, José Manuel | Lopes, Carla | Schauer, Uwe | Bergmann, Karl-Christian | Moral, Luis | Toral, Teresa | Marco, Nuria | Avilés, Beléns García | Fuentes, Mª Jesús | Garde, Jesús | Montahud, Cristina | Perona, Javier | Forniés, Mª José | Arroabarren, Esozia | Anda, Marta | Sanz, Maria Luisa | Lizaso, Maria Teresa | Arregui, Candida | May, Sara | Hartz, Martha | Joshi, Avni | Park, Miguel A. | Posega Devetak, Sonja | Koren Jeverica, Anja | Castro, Leonor | Gouveia, Carolina | Marques, Ana Carvalho | Cabral, Antonio Jorge | Amaral, Luis | Carolino, Fabrícia | Castro, Eunice | Passos, Madalena | Cernadas, Josefina R. | Amaral, Luís | Dias de Castro, Eunice | Pineda, Fernando | Gomes, Armanda | Brough, Helen | Röhmel, Jobst | Schwarz, Carsten | Mehl, Anne | Stock, Philippe | Staab, Doris | Seib, Christine | Critchlow, Anita | Barber, Alyson | Delavalle, Belen | Garriga, Teresa | Vilá, Blanca | Astolfi, Annalisa | Di Chiara, Costanza | Neri, Iria | Patrizi, Annalisa | Neskorodova, Katerina | Kudryavtseva, Asya | Alvarez, Jorge | Palacios, Miriam | Martinez-Merino, Marta | Vaquero, Ibone
Clinical and Translational Allergy  2016;6(Suppl 1):1-60.
Table of contents
WORKSHOP 4: Challenging clinical scenarios (CS01–CS06)
CS01 Bullous lesions in two children: solitary mastocytoma
S. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal Gok
CS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experience
Jessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise Michaelis
CS03 Cold urticaria in pediatric age: an invisible cause for severe reactions
Inês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-Almeida
CS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosis
Cristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José Oliveira
CS05 A child with unusual multiple organ allergy disease: what is the primer?
Fabienne Gay-Crosier
CS06 A case of uncontrolled asthma in a 6-year-old patient
Ioana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu
ORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06)
OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric Hospital
Adrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza Martín
OP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitis
Ebru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin Sackesen
OP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trial
MerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria Makrides
OP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed egg
Stavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. Papadopoulos
OP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacy
Hanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost Smit
OP06 Administration of the yellow fever vaccine in egg allergic children
Roisin Fitzsimons, Victoria Timms, George Du Toit
ORAL ABSTRACT SESSION 2: Asthma (OP07–OP12)
OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthma
S. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal Gok
OP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalities
Nagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. Mahfouz
OP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadium
Papp Gabor, Biro Gabor, Kovacs Csaba
OP10 Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial
Bo Chawes, Klaus Bønnelykke, Jakob Stokholm, Lene Heickendorff, Susanne Brix, Morten Rasmussen, Hans Bisgaard
OP11 Lung function development in childhood
Henrik Wegener Hallas, Bo Chawes, Lambang Arianto, Hans Bisgaard
OP12 Is the effect of maternal and paternal asthma different in female and male children before puberty?
Maike Pincus, Thomas Keil, Andreas Reich, Ulrich Wahn, Susanne Lau, Linus Grabenhenrich
ORAL ABSTRACT SESSION 3: Epidemiology—genetics (OP13–OP18)
OP13 Lifestyle is associated with incidence and category of allergen sensitisation: the ALADDIN birth cohort
Sara Fagerstedt, Helena Marell Hesla, Emelie Johansson, Helen Rosenlund, Axel Mie, Annika Scheynius, Johan Alm
OP15 Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance
Jorge Esparza-Gordillo, Anja Matanovic, Ingo Marenholz, Anja Bauerfeind, Klaus Rohde, Katja Nemat, Min-Ae Lee-Kirsch, Magnus Nordenskjöld, Marten C. G. Winge, Thomas Keil, Renate Krüger, Susanne Lau, Kirsten Beyer, Birgit Kalb, Bodo Niggemann, Norbert Hübner, Heather J. Cordell, Maria Bradley, Young-Ae Lee
OP16 Allergic multimorbidity of asthma, rhinitis and eczema in the first 2 decades of the German MAS birth cohort
Thomas Keil, Hannah Gough, Linus Grabenhenrich, Dirk Schramm, Andreas Reich, John Beschorner, Antje Schuster, Carl-Peter Bauer, Johannes Forster, Fred Zepp, Young-Ae Lee, Renate Bergmann, Karl Bergmann, Ulrich Wahn, Susanne Lau
OP17 Childhood anaphylaxis: a growing concern
Filipe Benito Garcia, Inês Mota, Susana Piedade, Ângela Gaspar, Natacha Santos, Helena Pité, Mário Morais-Almeida
OP18 Indoor exposure to molds and dampness in infancy and its association to persistent atopic dermatitis in school age. Results from the Greek ISAAC II study
Athina Papadopoulou, Despina Mermiri, Elpida Xatziagorou, Ioannis Tsanakas, Stavroula Lampidi, Kostas Priftis
ORAL ABSTRACT SESSION 4: Pediatric rhinitis—immunotherapy (OP19–OP24)
OP19 Associations between residential greenness and childhood allergic rhinitis and aeroallergen sensitisation in seven birth cohorts
Elaine Fuertes, Iana Markevych, Gayan Bowatte, Olena Gruzieva, Ulrike Gehring, Allan Becker, Dietrich Berdel, Michael Brauer, Chris Carlsten, Barbara Hoffmann, Anita Kozyrskyj, Caroline Lodge, Göran Pershagen, Alet Wijga, Heinrich Joachim
OP20 Full symptom control in pediatric patients with allergic rhinitis and asthma: results of a 2-year sublingual allergen immunotherapy study
Zorica Zivkovic, Ivana Djuric-Filipovic, Jasmina Jocić-Stevanovic, Snežana Zivanovic
OP21 Nasal epithelium of different ages of atopic subjects present increased levels of oxidative stress and increased cell cytotoxicity upon rhinovirus infection
Styliani Taka, Dimitra Kokkinou, Aliki Papakonstantinou, Panagiota Stefanopoulou, Anastasia Georgountzou, Paraskevi Maggina, Sofia Stamataki, Vassiliki Papaevanggelou, Evangelos Andreakos, Nikolaos G. Papadopoulos
OP22 Cluster subcutaneous immunotherapy schedule: tolerability profile in children
Monica Piquer Gibert, Montserrat Alvaro Lozano, Jaime Lozano Blasco, Olga Domínguez Sánchez, Rosa Jiménez Feijoo, Marcia Dias da Costa, Mª Teresa Giner Muñoz, Adriana Machinena Spera, Ana Maria Plaza Martín
OP23 Rhinitis as a risk factor for asthma severity in 11-year old children: population-based cohort study
Matea Deliu, Danielle Belgrave, Angela Simpson, Adnan Custovic
OP24 The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children
João Gaspar Marques, Pedro Carreiro-Martins, Joana Belo, Sara Serranho, Isabel Peralta, Nuno Neuparth, Paula Leiria-Pinto
POSTER DISCUSSION SESSION 1: Food allergy (PD01–PD05)
PD01 Allergen-specific humoral and cellular responses in children who fail egg oral immunotherapy due to allergic reactions
Marta Vazquez-Ortiz, Mariona Pascal, Ana Maria Plaza, Manel Juan
PD02 FoxP3 epigenetic features in children with cow milk allergy
Lorella Paparo, Rita Nocerino, Rosita Aitoro, Ilaria Langella, Antonio Amoroso, Alessia Amoroso, Carmen Di Scala, Roberto Berni Canani
PD04 Combined milk and egg allergy in early childhood: let them eat cake?
Santanu Maity, Giuseppina Rotiroti, Minal Gandhi
PD05 Introduction of complementary foods in relation to allergy and gut microbiota in farm and non-farm children
Karin Jonsson, Annika Ljung, Bill Hesselmar, Ingegerd Adlerbert, Hilde Brekke, Susanne Johansen, Agnes Wold, Ann-Sofie Sandberg
POSTER DISCUSSION SESSION 2: Asthma and wheeze (PD06–PD16)
PD06 The association between asthma and exhaled nitric oxide is influenced by genetics and sensitisation
Björn Nordlund, Cecilia Lundholm, Villhelmina Ullemar, Marianne van Hage, Anne Örtqvist, Catarina Almqvist
PD09 Prevalence patterns of infant wheeze across Europe
Anna Selby, Kate Grimshaw, Thomas Keil, Linus Grabenhenrich, Michael Clausen, Ruta Dubakiene, Alessandro Fiocchi, Marek Kowalski, Nikos Papadopoulos, Marta Reche, Sigurveig Sigurdardottir, Aline Sprikkleman, Paraskevi Xepapadaki, Clare Mills, Kirsten Beyer, Graham Roberts
PD10 Epidemiologic changes in recurrent wheezing infants
Herberto Jose Chong Neto, Gustavo Falbo Wandalsen, Ana Carolina Dela Bianca, Carolina Aranda, Nelson Augusto Rosário, Dirceu Solé, Javier Mallol, Luis García Marcos
PD13 A single nucleotide polymorphism in the GLCCI1 gene is associated with response to asthma treatment in children
IvanaBanic, Matija Rijavec, Davor Plavec, Peter Korosec, Mirjana Turkalj
PD14 Pollen induced asthma: Could small molecules in pollen exacerbate the protein-mediated allergic response?
Alen Bozicevic, Maria De Mieri, Matthias Hamburger
PD15 A qualitative study to understand how we can empower teenagers to better self-manage their asthma
Simone Holley, Ruth Morris, Frances Mitchell, Rebecca Knibb, Susan Latter, Christina Liossi, Graham Roberts
PD16 Polymorphism of endothelial nitric oxide synthase (eNOS) gene among Egyptian children with bronchial asthma
Mostafa M. M. Hassan
POSTER DISCUSSION SESSION 3: Mechanisms—Epidemiology (PD17–PD21)
PD17 Pregnancy outcomes in relation to development of allergy in a Swedish birth cohort
Malin Barman, Anna Sandin, Agnes Wold, Ann-Sofie Sandberg
PD18 Evolution of the IgE response to house dust mite molecules in childhood
Daniela Posa, Serena Perna, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Ulrich Wahn, Thomas Keil, Susanne Lau, Kuan-Wei Chen, Yvonne Resch, Susanne Vrtala, Rudolf Valenta, Paolo Maria Matricardi
PD19 Antibody recognition of nsLTP-molecules as antigens but not as allergens in the German-MAS birth cohort
Olympia Tsilochristou, Alexander Rohrbach, Antonio Cappella, Stephanie Hofmaier, Laura Hatzler, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, RaffaeleD’Amelio, Ulrich Wahn, Thomas Keil, Susanne Lau, Paolo Maria Matricardi
PD20 Early life colonization with Lactobacilli and Staphylococcus aureus oppositely associates with the maturation and activation of FOXP3+ CD4 T-cells
Sophia Björkander, Maria A. Johansson, Gintare Lasaviciute, Eva Sverremark-Ekström
PD21 Genome-wide meta-analysis identifies 7 susceptibility loci involved in the atopic march
Ingo Marenholz, Jorge Esparza-Gordillo, Franz Rüschendorf, Anja Bauerfeind, David P. Strachan, Ben D. Spycher, Hansjörg Baurecht, Patricia Margaritte-Jeannin, Annika Sääf, Marjan Kerkhof, Markus Ege, Svetlana Baltic, Melanie C Matheson, Jin Li, Sven Michel, Wei Q. Ang, Wendy McArdle, Andreas Arnold, Georg Homuth, Florence Demenais, Emmanuelle Bouzigon, Cilla Söderhäll, Göran Pershagen, Johan C. de Jongste, Dirkje S Postma, Charlotte Braun-Fahrländer, Elisabeth Horak, Ludmila M. Ogorodova, Valery P. Puzyrev, Elena Yu Bragina, Thomas J Hudson, Charles Morin, David L Duffy, Guy B Marks, Colin F Robertson, Grant W Montgomery, Bill Musk, Philip J Thompson, Nicholas G. Martin, Alan James, Patrick Sleiman, Elina Toskala, Elke Rodriguez, Regina Fölster-Holst, Andre Franke, Wolfgang Lieb, Christian Gieger, Andrea Heinzmann, Ernst Rietschel, Thomas Keil, Sven Cichon, Markus M Nöthen, Craig E Pennell, Peter D Sly, Carsten O Schmidt, Anja Matanovic, Valentin Schneider, Matthias Heinig, Norbert Hübner, Patrick G. Holt, Susanne Lau, Michael Kabesch, Stefan Weidinger, Hakon Hakonarson, Manuel AR Ferreira, Catherine Laprise, Maxim B. Freidin, Jon Genuneit, Gerard H Koppelman, Erik Melén, Marie-Hélène Dizier, A. John Henderson, Young Ae Lee
POSTER DISCUSSION SESSION 4: Food allergy—Anaphylaxis (PD22–PD26)
PD22 Atopy patch test in food protein induced enterocolitis caused by solid food
Purificacion González-Delgado, Esther Caparrós, Fernando Clemente, Begoña Cueva, Victoria M. Moreno, Jose Luis Carretero, Javier Fernández
PD23 Watermelon allergy: a novel presentation
Kate Swan, George Du Toit
PD24 A pilot study evaluating the usefulness of a guideline template for managing milk allergy in primary care
Mudiyur Gopi, Tim Smith, Edara Ramesh, Arun Sadasivam
PD26 Efficacy and safety of cow’s milk oral immunotherapy protocol
Inês Mota, Filipe Benito Garcia, Susana Piedade, Angela Gaspar, Graça Sampaio, Cristina Arêde, Luís Miguel Borrego, Graça Pires, Cristina Santa-Marta, Mário Morais-Almeida
POSTER DISCUSSION SESSION 5: Prevention and treatment—Allergy (PD27–PD36)
PD27 Allergy-protection by the lactic acid bacterium Lactococcus lactis G121: mode-of-action as revealed in a murine model of experimental allergy
Stephanie Brand, Karina Stein, Holger Heine, Marion Kauth
PD29 The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy
Leif Bjarte Rolfsjord, Egil Bakkeheim, Johan Alm, Håvard Ove Skjerven, Kai-Håkon Carlsen, Jon Olav Hunderi, Teresa Løvold Berents, Petter Mowinckel, Karin C. Lødrup Carlsen
PD30 Randomised trial of the efficacy of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥6 years to <12 years with allergic rhinitis
Ulrich Wahn, Ullrich Munzel, William Berger
PD31 10 mg of oral bilastine in 2 to 11 years old children has similar exposure to the adult therapeutic dose (20 mg)
Ulrich Wahn, Román Valiente, Valvanera Vozmediano, John C. Lukas, Mónica Rodríguez
PD33 Daily symptoms, nocturnal symptoms, activity limitations and reliever therapies during the three steps of IOEASMA programme: a comparison
Sebastiano Guarnaccia, Luigi Vitale, Ada Pluda, Emanuele D’Agata, Denise Colombo, Stefano Felici, Valeria Gretter, Susanna Facchetti, Gaia Pecorelli, Cristina Quecchia
PD34 Sensitisation to an inert aeroallergen in weaning rats and longstanding disease, in a sensitisation-tolerant and easily tolerisable rodent strain
George Guibas, Evangelia Spandou, Spyridon Megremis, Peter West, Nikolaos Papadopoulos
PD35 Bacterial and fungi exposure in school and allergic sensitisation in children
João Cavaleiro Rufo, Joana Madureira, Inês Paciência, Lívia Aguiar, Patrícia Padrão, Mariana Pinto, Luís Delgado, Pedro Moreira, João Paulo Teixeira, Eduardo Oliveira Fernandes, André Moreira
PD36 Comparative study of allergy rhinitis between two populations: children vs. adults
Adriana Izquierdo Dominguez, Antonio Valero, Joaquim Mullol, Alfonso Del Cuvillo, Javier Montoro, Ignacio Jauregui, Joan Bartra, Ignacio Davila, Marta Ferrer, Joaquin Sastre
POSTER VIEWING SESSION 1: Inflammation—Genetics—Immunology—Dermatology (PP01–PP09)
PP01 Immune profile in late pregnancy: immunological markers in atopic asthmaticwomen as risk factors for atopy in the progeny
Catarina Martins, Jorge Lima, Maria José Leandro, Glória Nunes, Jorge Cunha Branco, Hélder Trindade, Luis Miguel Borrego
PP02 The impact of neonatal sepsis on development of allergic diseases
Secil Conkar, Mehtap Kilic, Canan Aygun, Recep Sancak
PP03 Clinical overview of selective IgE deficiency in childhood
Athina Papadopoulou, Eleni Tagalaki, Lambros Banos, Anna Vlachou, Fotini Giannoula, Despina Mermiri
PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence
Athina Papadopoulou, Stavroula Lampidi, Marina Pavlakou, Maria Kryoni, Kostas Makris
PP05
PP06
PP07 Asthma control questionnaire and specific IgE in children
Snezhina Lazova, Guergana Petrova, Dimitrinka Miteva, Penka Perenovska
PP08 Features of chronic urticaria of adolescents
Aliya Klyucharova, Olesya Skorohodkina
PP09 Cutaneous mastocytosis in children: a clinical analysis of 8 cases in Greece
Dimitra Koumaki, Alkisti Manousaki, Maria Agrapidi, Lida Iatridou, Omima Eruk, Konstantinos Myridakis, Emmanouil Manousakis, Vasiliki Koumaki
POSTER VIEWING SESSION 2: Food allergy—Anaphylaxis (PP10–PP47)
PP10 Prognostic factors in egg allergy
Maria Dimou, Maria Ingemansson, Gunilla Hedlin
PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula
Nitida Pastor, Delphine de Boissieu, Jon Vanderhoof, Nancy Moore, Kaitlin Maditz
PP12 Anaphylaxis and epinephrine auto-injector use: a survey of pediatric trainees
Adeli Mehdi, Shaza Elhassan, Carolin Beck, Ahmed Al-Hammadi
PP13 Anaphylaxis in children: acute management in the Emergency Department
Ioana Maris, Ronan O’Sullivan, Jonathan Hourihane,
PP14 Understanding Cumbrian schools preparedness in managing children at risk of anaphylaxis in order to provide training and support which will create healthy and safe environments for children with allergies
George Raptis, Louise Michaelis
PP15 A new valid and reliable parent and child questionnaire to measure the impact of food protein enterocolitis syndrome on children: the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form
Audrey DunnGalvin, Matthew Greenhawt, Carina Venter, Jonathan Hourihane
PP16 An in-depth case study investigation of the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity
Evelyn O’Regan, Duncan Cronin, Jonathan Hourihane, Anna O’Reilly, Audrey DunnGalvin
PP17 Cow’s milk protein allergy in Constantine. A retrospective study of 62 cases between 1996 and 2013
Foued Abdelaziz, Dounia Khelifi-Touhami, Nihad Selim, Tahar Khelifi-Touhami
PP18
PP19 Cow’s milk and egg oral immunotherapy in children older than 5 years
Pablo Merida, Ana Mª Plaza, Juan Heber Castellanos, Adrianna Machinena, Montserrat Alvaro Lozano, Jaime Lozano, Olga Dominguez, Monica Piquer, Rosa Jimenez, Mª Teresa Giner
PP20 Professionals’ awareness of management of Cow’s Milk Protein Allergy (CMPA) in North Wales Hospitals
Konstantinos Kakleas, Manohar Joishy, Wendmu Maskele, Huw R. Jenkins
PP21
PP22 Anaphylaxis: the great unknown for teachers. Presentation of a protocol for schools
Mercedes Escarrer, Agustín Madroñero, Maria Teresa Guerra, Juan Carlos Julia, Juan Carlos Cerda, Javier Contreras, Eulalia Tauler, Maria Jesus Vidorreta, Ana Rojo, Silvia Del Valle
PP23 Challenges facing children with food allergies and their parents in out of school activity sectors
Niamh Flynn
PP24 A review of food challenges at a Regional Irish Centre
Gary Foley, Carol Harmon, John Fitzsimons
PP25 The use of epinephrine in infants with anaphylaxis
Krasimira Baynova, Ávila Maria Del Robledo, Labella Marina
PP26
PP27
PP28 Mother’s psychological state predicts the expression of symptoms in food allergic children
Aaron Cortes, Alicia Sciaraffia, Angela Castillo
PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic
Nanna Juel-Berg, Kirsten Skamstrup Hansen, Lars Kærgaard Poulsen
PP30 Food allergy in children: evaluation of parents’ use of online social media
Andreia Florina Nita, Ioana Valentina Nenciu, Adina Lazar, Dumitru Oraseanu
PP31 The impact of food allergy on quality of life: FAQLQ questionnaire
Rita Aguiar, Anabela Lopes, Maria J. Paes, Amélia S. Santos, M. A. Pereira-Barbosa
PP32 An unexpected cause of anaphylaxis: potato
Hatice Eke Gungor, Salih Uytun, Umit Murat Sahiner, Yasemin Altuner Torun
PP33 Is it clinical phenotype of allergic diseases determined by sensitisation to food?
Mirjana Zivanovic, Marina Atanasković-Marković
PP34
PP35 Prescribing adrenaline auto-injectors in children in 2014: the data from regional pediatricians
Tina Vesel, Mihaela Nahtigal, Andreja Obermayer-Temlin, Eva Šoster Križnik, Mirjana Maslar, Ruben Bizjak, Marjeta Tomšič-Matic, Sonja Posega-Devetak, Maja Skerbinjek-Kavalar, Mateja Predalič, Tadej Avčin
PP36 Who should have an adrenaline autoinjector? Adherence to the European and French guidelines among 121 allergists from the Allergy Vigilance Network
Guillaume Pouessel, Etienne Beaudouin, Anne M. Moneret-Vautrin, Antoine Deschildre, Allergy Vigilance Network
PP37 Anaphylaxis by Anacardium Occidentale
Marta Viñas, Bartolomé Borja, Nora Hernández, Mª José Castillo, Adriana Izquierdo, Marcel Ibero
PP38 Anaphylaxis with honey in a child
S. Tolga Yavuz, Ali Gungor, Betul Buyuktiryaki, Ozan Koc, Can Naci Kocabas, Faysal Gok
PP39 Evaluation of courses adopted to children on prevention, recognition and management of anaphylaxis
Tina Vesel, Mihaela Nahtigal
PP40 Symptomatic dust mites and shrimp allergy: three pediatric case reports
Filipa Almeida, Susana Lopes, Cristina Madureira, Tânia Lopes, Fernanda Carvalho
PP41 Poor identification rates of nuts by high risk individuals: a call for improved education and support for families
Camille Heming, Emily Garrett, Adam Blackstock, Santanu Maity, Rahul Chodhari
PP42 DAFALL: database of food allergies in the Czech Republic
Simona Belohlavkova, Eliska Kopelentova, Petr Visek, Ivana Setinova, Ivana Svarcova
PP43 Serological cross-reactivity between grass and wheat is not only caused by profilins and CCDs
Sigrid Sjölander, Nora Nilsson, Malin Berthold, Helena Ekoff, Gunilla Hedlin, Magnus Borres, Caroline Nilsson
PP44 Oil body associated proteins in children with nuts allergy. Allergens to consider in IgE-mediated nuts allergy
Loreto González Domínguez, Cristina Muñoz Archidona, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire
PP45
PP46 Protective effect of helicobacter pylori infection against food allergy in children
Olga Vrani, Antigone Mavroudi, Maria Fotoulaki, Maria Emporiadou, Kleomenis Spiroglou, Ioannis Xinias
PP47 Anaphylaxis pathway: A road tryp-tase to success?
Helyeh A. Sadreddini, Mia Warnes, Donna Traves
POSTER VIEWING SESSION 3: Miscellaneous (PP48–PP58)
PP48 Surveillance study on safety of SLIT in pediatric population
Ivana Djuric-Filipovic, Zorica Zivkovic, Snežana Zivanovic, Gordana Kostić, Đorđe Filipovic
PP49 Efficacy and safety of mixed mite subcutaneous immunotherapy among allergic rhinitis patients in the Northeastern Thailand
Sawapon Sittisomwong, Siripong Sittisomwong
PP50 Effect of inhaled beclomethasone or placebo on brain stem activity in a patient chronically treated with steroids: preliminary report
Zygmunt Podolec, Marcin Hartel, Daria Panek, Magdalena Podolec-Rubiś, Tomasz Banasik
PP51 Sensitisation to aeroallergens in patients with allergic rhinitis, asthma and atopic dermatitis in Shiraz, Southwestern Iran
Elham Abbasi, Mozhgan Moghtaderi
PP52 Referring a child for allergy test: how appropriate are we?
Phani Sanneerappa, Alina Deliu, Moosa Kutty, Nagabathula Ramesh
PP53 EBV lymphoproliferative disease and cardiac lymphoma in a STK4 deficient patient
Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Raeesi, Mino Afshar, Hamid Rahimi, Christoph Klein
PP54 A case study: the effect of massive honeybees attack on various body parameters atopic girl including allergy
Mohemid Al-Jebouri
PP55 The role of TLR9, NLRP3 and proIL-1β in activation of antiviral innate immunity
Oxana A. Svitich, Daria O. Zubacheva, Dmitrii A. Potemkin, Ludmila V. Gankovskaya, Vitalii V. Zverev
PP56 Overnight pulse oximetry, as a screening tool to diagnose obstructive sleep apnoea. How effective is it?
Phani Sanneerappa, Elaine OB Doyle, Paul Gallagher, Nagabathula Ramesh
PP57 The presentation and management of acute urticaria and allergic reactions in children in a multi-ethnic, inner city Emergency Department (ED)
Sherine Dewlett, Kin Man, Minal Gandhi, James Pocock, Anna Gerrardhughes
PP58 Food allergens responsible for delayed-type sensitisation in atopy patch test in children diagnosed with autism spectrum disorder
Jolanta Wasilewska, Maciej Kaczmarski, Dariusz Lebensztejn
POSTER VIEWING SESSION 4: Asthma—Rhinitis (PP59–PP87)
PP59 Systematic review of incense as a trigger factor for asthma
Chandramani Thuraisingham, Davendralingam Sinniah
PP60 Increased risks of mood and anxiety disorders in children with asthma
Yue Chen, Xiaomei Mei
PP61
PP62 Asthma Control Test (ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) association in children
Sebnem Ozdogan, Pinar Karadeniz, Durdugul Ayyildiz-Emecen, Ummuhan Oncul
PP63 Seasonal and gender variations in vitamin D levels in children with asthma and its association with pulmonary function tests
Sebnem Ozdogan, Gizem Sari, Sabanur Cavdar
PP64 Defining treatment response in childhood asthma: rationale and design of the Pharmacogenomics in the Childhood Asthma (PiCA) consortium
Niloufar Farzan, Susanne J. Vijverberg, Colin J. Palmer, Kelan G. Tantisira, Anke-Hilseon Maitland-van der Zee behalf of the PiCA consortium
PP65 Prevalence of asthma and allergic disease in patients with inflammatory disease compared to celiac disease
Fatma Yavuzyilmaz, Sebnem Ozdogan, Nafiye Urganci, Merve Usta
PP66 A severe case with cystic fibrosis (CF) asthma
Mehmet Hoxha, Maksim Basho
PP67 Severe asthma exacerbation complicated with pneumothorax in a child with uncontrolled asthma due to poor treatment compliance
Ioana Valentina Nenciu, Andreia Florina Nita, Adina Lazar, Alexandru Ulmeanu, Carmen Zapucioiu, Dumitru Oraseanu
PP68 Evaluation of the Pediatric Quality of Life inventory (PedsQL) asthma module among low income asthmatic children and adolescents in Sao Paolo, Brazil
Gustavo F. Wandalsen, Fernanda Monteiro, Dirceu Solé
PP69 Early initiation of specific immunotherapy in asthma patients leads to higher benefits
Blerta Lame, Eris Mesonjesi, Arjeta Sherri
PP70 Treatment resistant asthma and rhinosinusitis with recurrent pulmonary infections. Is it primary ciliary dyskinesia?
Alkerta Ibranji, Laert Gjati, Gjustina Loloci, Ardii Bardhi
PP71 The comparison of sensitisation to animal allergens in children- and adult- onset patients with asthma
Behnam Moghtaderi, Shirin Farjadian, Dorna Eghtedari
PP72 Characterisation of children less than five years with wheezing episodes in Cali, Colombia
Manuela Olaya, Laura Del Mar Vasquez, Luis Fernando Ramirez, Carlos Daniel Serrano
PP73 Evaluation of the patients with recurrent croup
Belgin Usta Guc, Suna Asilsoy, Fulya Ozer
PP74 Obesity in adolescence compromising the asthma control
Guergana Petrova, Sylvia Shopova, Vera Papochieva, Snezhina Lazova, Dimitrinka Miteva, Penka Perenovska
PP75 Sleep behavior in children with persistent allergic rhinitis
Gustavo F. Wandalsen, Jessica Loekmanwidjaja, Márcia Mallozi, Dirceu Solé
PP76 Randomised trial of the safety of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥4 years to <12 years with allergic rhinitis
William Berger, Ulrich Wahn, Paul Ratner, Daniel Soteres
PP77 Safety and tolerability evaluation of bilastine 10 mg in children from 2 to 11 years of age with allergic rhinoconjunctivitis or urticaria
Zoltán Novák, Anahí Yáñez, Kiss Ildikó, Piotr Kuna, Miguel Tortajada, Román Valiente, the Bilastine Pediatric Safety Study Group
PP78 Sensitisation to Alternaria alternata: Is it a risk factor for severe rhinitis?
Susana Lopes, Filipa Almeida, Tânia Lopes, Cristina Madureira, José Oliveira, Fernanda Carvalho
PP79 Validation of the Patient Benefit Index (PBI) for the assessment of patient-related outcomes in allergic rhinitis in children
Julia Feuerhahn, Christine Blome, Meike Hadler, Efstrathios Karagiannis, Anna Langenbruch, Matthias Augustin
PP80 Efficacy of sublingual tablet of house dust mite allergen extracts in adolescents with house dust mite-associated allergic rhinitis
Michel Roux, Shinji Kakudo, Efstrathios Karagiannis, Robert K. Zeldin
PP81 Lung function improvement in a child treated with omalizumab for bronchial asthma
Anna Sokolova, Tiago Milheiro Silva
PP82 How to treat a child suffering from asthma, allergic rhinitis, allergy to peanuts and diabetes at the same time?
Snezana S. Zivanovic, Vesna Cvetkovic, Ivana Nikolic, Sonja J. Zivanovic
PP83 Nitric oxide in exhaled air in the relationship of the degree of sensitisation to aeroallergens
Snezana S. Zivanovic, Ljiljana Saranac, Ivana Nikolic, Sonja J. Zivanovic, Zorica Zivkovic
PP84 Clinical basis of diagnostic errors in pediatric asthma
Zoia Nesterenko
PP85
PP86 Childhood asthma control in Serbia and organised Asthma Educational Intervention (AEI)
Snezana Radic, Branislava Milenkovic, Spomenka Smiljanic, Milka Micic-Stanijevic, Olivera Calovic
PP87 Experience from a group of adolescents with severe allergic asthma treated with Omalizumab
Anne Marie Bro Hofbauer, Lone Agertoft
THEMATIC POSTER SESSION 1: Prevention and Treatment—Epidemiology (TP01–TP18)
TP01 A cost effective primary school asthma education program: pilot study from inner London schools
Lucy Everson, Jessica Kearney, Jonny Coppel, Simon Braithwaite, Rahul Chodhari
TP02 The prevalence of allergic diseases among 14–15 years old adolescents in two Danish birth cohorts 14 years apart
Elisabeth S. Christiansen, Henrik Fomsgaard Kjaer, Esben Eller, Charlotte G. Mørtz, Susanne Halken
TP03 Does pattern of sensitisation to phleum pratense change with age? Is it different in children with allergic rhinitis or asthma?
Cristina Román India, Ana Moreira Jorge, Loreto González Domínguez, Cristina Muñoz Archidona, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Juana Jiménez Jiménez, Luis Echeverría Zudaire
TP04 Practicalities of prevention of peanut allergy: modelling a national response to LEAP
Cathal O’Connor, Jonathan Hourihane
TP05 Comparison of the influence of sunflower seed oil and skin care lotion on the skin barrier function of newborns: a randomised controlled trial
Varvara Kanti, Lena Lünnemann, Günther Malise, Laine Ludriksone, Andrea Stroux, Wolfgang Henrich, Michael Abu-Dakn, Ulrike Blume-Peytavi, Natalie Garcia Bartels
TP06 The effect of daily skin care on skin barrier properties in infants with dry skin and risk for atopic dermatitis
Varvara Kanti, Lena Lünnemann, Laine Ludriksone, Marianne Schario, Andrea Stroux, Ulrike Blume-Peytavi, Natalie Garcia Bartels
TP07 Change in sum total aeroallergen skin prick test wheal diameters at 6 months predicts which children will respond to subcutaneous immunotherapy by three years
Thorsten Stanley, Nicolien Brandenbarg
TP08 Are mobile apps regarding adrenaline auto-injectors accessed by adolescents for support and education in the community?
Alia Boardman, Gary McGreevy, Emily Rodger, Katherine Knight, Victoria Timms, Trisha Taylor, Gemma Scanlan, Roisin Fitzsimons
TP09
TP10 Prevention of early atopic dermatitis among low-atopy-risk infants by immunoactive prebiotics is not sustained after the first year of life
Grüber Christoph, Ulrich Wahn, Margriet van Stuivenberg, Fabio Mosca, Guido Moro, Gaetano Chirico, Christian P. Braegger, Joseph Riedler, Yalcin Yavuz, Günther Boehm
TP11
TP12
TP13 Treatment with Omalizumab in a 16-year-old Caucasian girl with refractory solar urticaria
Stefania Arasi, Giuseppe Crisafulli, Lucia Caminiti, Federica Porcaro, Giovanni Battista Pajno
TP14 Ultra-pure soft water ameliorates skin conditions of adult and child patients with atopic dermatitis
Akane Tanaka, Yaei Togawa, Kumiko Oida, Naotomo Kambe, Peter Arkwright, Yosuke Amagai, Naoki Shimojo, Yasunori Sato, Hiroyuki Mochizuki, Hyosun Jang, Saori Ishizaka, Hiroshi Matsuda
TP15 Potential adjuvant effect of immunomodulator to improve specific immunotherapy in asthmatic child
Wisnu Barlianto, Ery Olivianto, H. M. S. Chandra Kusuma
TP16 How can Component Resolved Diagnosis (CRD) influence in Specific Immunotherapy (SIT) prescription, in a Spanish children population
Ana Moreira Jorge, Cristina Román India, Loreto González Domínguez, Cristina Muñoz Archidona, Juana Jiménez Jiménez, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Luis Echeverría Zudaire
TP17 Mitochondrial dysfunction in food allergy: effects of L. rhamnosus GG in a mice model of peanut allergy
Rosita Aitoro, Mariapia Mollica, Roberto Berni Canani, Giovanna Trinchese, Elena Alfano, Antonio Amoroso, Lorella Paparo, Francesco Amato, Claudio Pirozzi, Antonio Calignano, Rosaria Meli
TP18 Prediction of atopic diseases in childhood: elevated blood eosinophils in infancy in a high risk birth cohort
Siri Rossberg, Kerstin Gerhold, Kurt Zimmermann, Mohammad Zaino, Thomas Geske, Eckard Hamelmann, Susanne Lau
THEMATIC POSTER SESSION 2: Food allergy—Anaphylaxis (TP19–TP38)
TP19
TP20
TP21 Double-blind provocation tests in non-IgE mediated cow’s milk allergy and the occurrence of placebo reactions
Sarah Bogovic, Jochem van den Berg, Chantal Janssen
TP22 Gradual introduction of baked egg (BE) in egg allergic patients under 2 years old
Angela Claver
TP23 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy I: safety and efficacy of daily vs. weekly protocols of induction
Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria
TP24 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy II: a randomised controlled trial to study a safer, more effective and easy to perform maintenance (daily vs. every two days) pattern of egg SOTI
Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria
TP25 Determining the safety of baked egg home reintroduction for children with mild egg allergy
Brenda DeWitt, Judith Holloway, Donald Hodge
TP26 Demographics, investigations and patterns of sensitisation in children with oral allergy syndrome in a London Teaching Hospital
Sian Ludman, Merhdad Jafari-Mamaghani, Rosemary Ebling, Adam T. Fox, Gideon Lack, George Du Toit
TP27 Airborne peanut challenge in children: allergic reactions are rare
Sofia Lovén Björkman, Caroline Nilsson, Natalia Ballardini
TP28 The nutty question on Pediatric Wards: to be or “nut” to be?
Supriyo Basu, Jenny Hallet, Jyothi Srinivas
TP29
TP30
TP31 Allergy education in nursery schools
Hazel Stringer, Nicola Jay
TP32 Food allergy in the first year of life
Tânia Lopes, Cristina Madureira, Filipa Almeida, Susana Lopes, Paula Fonseca, Clara Vieira, Fernanda Carvalho
TP33 Prevalence and geographic distribution of oral allergy syndrome in Italian children: a multicenter study
Carla Mastrorilli, Carlo Caffarelli, Riccardo Asero, Salvatore Tripodi, Arianna Dondi, Gianpaolo Ricci, Carlotta Povesi Dascola, Elisabetta Calamelli, Francesca Cipriani, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Tullio Frediani, Carmen Verga, Paolo Maria Matricardi
TP34 Are common standardised allergen extracts used in skin test enough in the diagnosis of nuts allergy?
Cristina Muñoz Archidona, Loreto González Domínguez, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire
TP35 Evaluation of IgE sensitisation in children with allergic proctocolitis and its relationship to atopic dermatitis
Despina Mermiri, Paraskevi Korovessi, Skevi Tiliakou, Evaggelia Tavoulari, Kalliopi-Maria Moraiti, Fotini Giannoula, Athina Papadopoulou
TP36 Food allergy in children: are we managing them appropriately in the Emergency Department?
Wan Jean Tee, Samir Deiratany, Raymond Seedhoo, Roisin McNamara, Ike Okafor
TP37 Importance of oil body associated allergenic proteins in nuts suspected allergy children
Loreto González Domínguez, Ana Moreira Jorge, Cristina Muñoz Archidona, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Fernando Pineda de la Losa, Miriam Castillo Fernández, Luis Ángel Echeverría Zudaire
TP38 Practical application of basophil activation test in children with food allergy
Ekaterina Khaleva, Gennady Novic, Natalia Bychkova
THEMATIC POSTER SESSION 3: Asthma (TP39–TP57)
TP39 Effect of corticosteroid therapy upon serum magnesium level in chronic asthmatic children
Amany Abd Al-Aziz, Amany Fatouh, Ayat Motawie, Eman El Bostany, Amr Ibrahim
TP40 ADAM33 in Bulgarian children with asthma
Guergana Petrova, Dimitrinka Miteva, Snezhina Lazova, Penka Perenovska, Sylvia Andonova, Alexey Savov
TP41
TP42 The impact of vitamin D serum levels in asthma and allergic rhinitis
Maria Zoto, Marialena Kyriakakou, Paraskevi Xepapadaki, Nikolaos G. Papadopoulos
TP43 Life-threatening, first reported, paradoxical bronchospasm after nebulised Salbutamol in a 10 year old child
Paraskevi Korovessi, Mariza Vassilopoulou, Athina Balaska, Lambros Banos, Stavroula Kostaridou, Despina Mermiri
TP44
TP45 Asthma symptoms in children with treatment for allergic rhinoconjunctivitis
Jorien Wartna, Arthur M. Bohnen, Gijs Elshout, David H. J. Pols, Patrick J. E. Bindels
Erasmus MC, Rotterdam, The Netherlands
TP46 Atopy increased the risk of developing exercise-induced bronchoconstriction in young athletes
Sven F. Seys; Ellen Dilissen, Sarah Van der Eycken, An-Sofie Schelpe, Gudrun Marijsse, Thierry Troosters, Vincent Vanbelle, Sven Aertgeerts, Jan L. Ceuppens, Lieven J. Dupont, Koen Peers, Dominique M. Bullens
TP47 The effect of higher BMI on risk for asthma and treatment outcome in overweight and obese children
Ivana Banic, Sandra Bulat Lokas, Jelena Zivkovic, Boro Nogalo, Iva Mrkic Kobal, Davor Plavec, Mirjana Turkalj
TP48
TP49
TP50
TP51
TP52 The impact of a multidisciplinary project intended to change the culture of nebulisers towards pressurised metered dose inhalers
Georgeta Oliveira, Katharine Pike, Alda Melo, Tomás Amélia, José Carlos Cidrais Rodrigues, Cristina Serrano, José Manuel Lopes dos Santos, Carla Lopes
TP53
TP54
TP55
TP56 Increased asthma control in patients with severe persistent allergic asthma after 12 month of nightly temperature controlled laminar airflow (TLA)
Eckard Hamelmann, Uwe Schauer, Karl-Christian Bergmann
TP57
THEMATIC POSTER SESSION 4: Drug allergy—Dermatology (TP58–TP77)
TP58 Should we proceed directly to provocation challenges to diagnose drug allergy? Our experience says yes
Luis Moral, Teresa Toral, Nuria Marco, Beléns García Avilés, Mª Jesús Fuentes, Jesús Garde, Cristina Montahud, Javier Perona, Mª José Forniés
TP59 Anaphylaxis to 13-valent pneumococcal vaccine
Esozia Arroabarren, Marta Anda, Maria Luisa Sanz, Maria Teresa Lizaso, Candida Arregui
TP60 Intrapartum antibiotic exposure for treatment of group B streptococcus was not associated with the development of penicillin allergy in children
Sara May, Martha Hartz, Avni Joshi, Miguel A. Park
TP61 Evaluation of suspected drug hypersensitivity reactions in 169 children referred to the General Hospital
Sonja Posega Devetak, Tina Vesel, Anja Koren Jeverica, Tadej Avčin
TP62 Drug provocation testing: experience of a tertiary hospital
Leonor Castro, Carolina Gouveia, Ana Carvalho Marques, Antonio Jorge Cabral
TP63 Perioperative anaphylaxis: a growing concern in pediatric population
Luis Amaral, Fabrícia Carolino, Eunice Castro, Madalena Passos, Josefina R. Cernadas
TP64 Raising awareness of hypersensitivity to non-steroidal anti-inflammatory drugs in the pediatric age
Fabrícia Carolino, Luís Amaral, Eunice Dias de Castro, Josefina R. Cernadas
TP65 Perioperative anaphylaxis in young children: how to confirm the suspicion
Josefina R. Cernadas, Fabrícia Carolino, Luís Amaral, Fernando Pineda, Armanda Gomes
TP66 A case study of a child suspected to be penicillin allergic-digging deeper
Katherine Knight, Roisin Fitzsimons, Helen Brough
TP67 Prevalence, characteristics and risk factors of hypersensitivity reactions to antibiotics in patients with cystic fibrosis
Jobst Röhmel, Carsten Schwarz, Anne Mehl, Philippe Stock, Doris Staab
TP68 Antibiotic drug hypersensitivity in cystic fibrosis: A pilot study using cellular allergy tests for diagnostics
Jobst Röhmel, Carsten Schwarz, Christine Seib, Doris Staab, Philippe Stock
TP69 Oral antibiotics challenges in children
Anita Critchlow, Alyson Barber, Nicola Jay
TP70 Hypersensitivity reaction to vancomycin: a new successful desensitization protocol
Belen Delavalle, Teresa Garriga, Blanca Vilá, Cristina Blasco
TP71
TP72 Clinical phenotypes according to FLG gene loss of function mutations in children with atopic dermatitis
Francesca Cipriani, Annalisa Astolfi, Costanza Di Chiara, Elisabetta Calamelli, Iria Neri, Annalisa Patrizi, Gianpaolo Ricci
TP73
TP74 Urticaria in children: clinical and epidemiological features
Katerina Neskorodova, Asya Kudryavtseva
TP75
TP76 Acute urticaria at the Pediatrics Emergency Department: is it allergy?
Esozia Arroabarren, Jorge Alvarez, Marta Anda, Miriam Palacios, Marta Martinez-Merino, Ibone Vaquero
TP77
doi:10.1186/s13601-016-0117-8
PMCID: PMC5123301
13.  Regulation of arsenite oxidation by the phosphate two-component system PhoBR in Halomonas sp. HAL1 
Previously, the expression of arsenite [As(III)] oxidase genes aioBA was reported to be regulated by a three-component regulatory system, AioXSR, in a number of As(III)-oxidizing bacterial strains. However, the regulation mechanism is still unknown when aioXSR genes are absent in some As(III)-oxidizing bacterial genomes, such as in Halomonas sp. HAL1. In this study, transposon mutagenesis and gene knock-out mutation were performed, and two mutants, HAL1-phoR931 and HAL1-▵phoB, were obtained in strain HAL1. The phoR and phoB constitute a two-component system which is responsible for phosphate (Pi) acquisition and assimilation. Both of the mutants showed negative As(III)-oxidation phenotypes in low Pi condition (0.1 mM) but not under normal Pi condition (1 mM). The phoBR complementation strain HAL1-▵phoB-C reversed the mutants' null phenotypes back to wild type status. Meanwhile, lacZ reporter fusions using pCM-lacZ showed that the expression of phoBR and aioBA were both induced by As(III) but were not induced in HAL1-phoR931 and HAL1-▵phoB. Using 15 consensus Pho box sequences, a putative Pho box was found in the aioBA regulation region. PhoB was able to bind to the putative Pho box in vivo (bacterial one-hybrid detection) and in vitro (electrophoretic mobility gel shift assay), and an 18-bp binding sequence containing nine conserved bases were determined. This study provided the evidence that PhoBR regulates the expression of aioBA in Halomonas sp. HAL1 under low Pi condition. The new regulation model further implies the close metabolic connection between As and Pi.
doi:10.3389/fmicb.2015.00923
PMCID: PMC4563254  PMID: 26441863
arsenite oxidation; arsenite oxidase AioBA; phosphate two-component system; regulation of gene expression; Halomonas sp. HAL1
14.  Evaluation of Innotrac Aio! Second-Generation Cardiac Troponin I Assay: The Main Characteristics for Routine Clinical Use 
The availability of a simple, sensitive, and rapid test using whole blood to facilitate processing and to reduce the turnaround time could improve the management of patients presenting with chest pain. The aim of this study was an evaluation of the Innotrac Aio! second-generation cardiac troponin I (cTnI) assay. The Innotrac Aio! second-generation cTnI assay was compared with the Abbott AxSYM first-generation cTnI, Beckman Access AccuTnI, and Innotrac Aio! first-generation cTnI assays. We studied serum samples from 15 patients with positive rheumatoid factor but with no indication of myocardial infarction (MI). Additionally, the stability of the sample with different matrices and the influence of hemodialysis on the cTnI concentration were evaluated. Within-assay CVs were 3.2%–10.9%, and between-assay precision ranged from 4.0% to 17.2% for cTnI. The functional sensitivity (CV = 20 %) and the concentration giving CV of 10% were approximated to be 0.02 and 0.04, respectively. The assay was found to be linear within the tested range of 0.063–111.6 μ g/L. The correlations between the second-generation Innotrac Aio!, Access, and AxSYM cTnI assays were good (r coefficients 0.947–0.966), but involved differences in the measured concentrations, and the biases were highest with cTnI at low concentrations. The second-generation Innotrac Aio! cTnI assay was found to be superior to the first-generation assay with regard to precision in the low concentration range. The stability of the cTnI level was best in the serum, lithium-heparin plasma, and lithium-heparin whole blood samples (n = 10 , decrease < 10 % in 24 hours at +20°C and at +4°C. There was no remarkable influence of hemodialysis on the cTnI release. False-positive cTnI values occurred in the presence of very high rheumatoid factor values, that is, over 3000 U/L. The 99th percentile of the apparently healthy reference group was ≤ 0.03   μ g/L. The results demonstrate the very good analytical performance of the second-generation Innotrac Aio! cTnI assay.
doi:10.1155/JAMMC/2006/39325
PMCID: PMC1903460  PMID: 17671616
15.  Ulcerated choledochocele: A case report 
Highlights
•Upper gastro-intestinal endoscopy is part of diagnostic work-up for massive bleeding per rectum.•A positive ‘pillow sign’ in a mass in the region of the ampulla of Vater may be a choledochocele.•Cyst excision and marsupialization is the definitive treatment for a choledochocele.•Laparoscopic adhesiolysis is useful in adhesive small bowel obstruction.
Background
The cystic dilatation of the biliary tract is an uncommon anomaly. Choledochocele, a cystic dilatation of the distal common bile duct, rarely presents clinically as massive gastrointestinal bleeding.
Aim
This is to report a very rare disease condition and highlight minimal access options in surgical care.
Case summary
A 13 year-old boy was referred with a day history of sudden onset of passage of bright red blood per rectum with a fainting episode. There was no anal protrusion, jaundice, recurrent epigastric pain nor bleeding from any other orifice. An initial endoscopic assessment of the upper digestive tract showed profuse bleeding from a sub-mucosal mass in the region of ampulla of Vater. Emergency laparotomy revealed small intestine filled with blood from duodenum to ileum. A duodenotomy showed a cystic mass with an ulcerated mucosa at the dome containing bilious fluid in the second part of the duodenum. The cyst was de-roofed and marsupialized. Post-operative recovery was complicated by features of adhesive small bowel obstruction on the 9th post op day and treated by laparoscopic adhesiolysis. He was discharged home in good clinical state.
Conclusion
Choledochocele is a differential diagnosis in the endoscopic finding of a submucosal mass in the second part of the duodenum. An initial oesophagogastroduodenoscopy endoscopy is necessary in the evaluation of massive lower gastrointestinal bleeding.
doi:10.1016/j.ijscr.2016.08.028
PMCID: PMC5037116  PMID: 27677116
Gastrointestinal bleeding; Choledochocele; Case report
16.  Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities 
European Spine Journal  2011;20(Suppl 1):95-104.
The traditional surgical treatment of severe spinal deformities, both in adult and pediatric patients, consisted of a 360° approach. Posterior-based spinal osteotomy has recently been reported as a useful and safe technique in maximizing kyphosis and/or kyphoscoliosis correction. It obviates the deleterious effects of an anterior approach and can increase the magnitude of correction both in the coronal and sagittal plane. There are few reports in the literature focusing on the surgical treatment of severe spinal deformities in large pediatric-only series (age <16 years old) by means of a posterior-based spinal osteotomy, with no consistent results on the use of a single posterior-based thoracic pedicle subtraction osteotomy in the treatment of such challenging group of patients. The purpose of the present study was to review our operative experience with pediatric patients undergoing a single level PSO for the correction of thoracic kyphosis/kyphoscoliosis in the region of the spinal cord (T12 and cephalad), and determine the safety and efficacy of posterior thoracic pedicle subtraction osteotomy (PSO) in the treatment of severe pediatric deformities. A retrospective review was performed on 12 consecutive pediatric patients (6 F, 6 M) treated by means of a posterior thoracic PSO between 2002 and 2006 in a single Institution. Average age at surgery was 12.6 years (range, 9–16), whereas the deformity was due to a severe juvenile idiopathic scoliosis in seven cases (average preoperative main thoracic 113°; 90–135); an infantile idiopathic scoliosis in two cases (preoperative main thoracic of 95° and 105°, respectively); a post-laminectomy kypho-scoliosis of 95° (for a intra-medullar ependimoma); an angular kypho-scoliosis due to a spondylo-epiphisary dysplasia (already operated on four times); and a sharp congenital kypho-scoliosis (already operated on by means of a anterior–posterior in situ fusion). In all patients a pedicle screws instrumentation was used, under continuous intra-operative neuromonitoring (SSEP, NMEP, EMG). At an average follow-up of 2.4 years (range, 2–6) the main thoracic curve showed a mean correction of 61°, or a 62.3% (range, 55–70%), with an average thoracic kyphosis of 38.5° (range, 30°–45°), for an overall correction of 65% (range, 60–72%). Mean estimated intra-operative blood loss accounted 19.3 cc/kg (range, 7.7–27.27). In a single case (a post-laminectomy kypho-scoliosis) a complete loss of NMEP occurred, promptly assessed by loosening of the initial correction, with a final negative wake-up test. No permanent neurologic damage, or instrumentation related complications, were observed. According to our experience, posterior-based thoracic pedicle subtraction osteotomies represent a valuable tool in the surgical treatment of severe pediatric spinal deformities, even in revision cases. A dramatic correction of both the coronal and sagittal profile may be achieved. Mandatory the use of a pedicle screws-only instrumentation and a continuous intra-operative neuromonitoring to obviate catastrophic neurologic complications.
doi:10.1007/s00586-011-1749-y
PMCID: PMC3087044  PMID: 21468647
Thoracic pedicle subtraction osteotomy; Severe pediatric spinal deformities; Surgical treatment; Posterior-instrumented fusion only; Thoracic pedicle screws
17.  MicroRNA-21 Knockout Improve the Survival Rate in DSS Induced Fatal Colitis through Protecting against Inflammation and Tissue Injury 
PLoS ONE  2013;8(6):e66814.
Background
MicroRNA-21 (miR-21) is overexpressed in most inflammatory diseases, but its physiological role in gut inflammation and tissue injury is poorly understood. The goal of this work is to understand the role of miR-21 in colitis and damage progression of intestine in a genetically modified murine model.
Methods
Experimental colitis was induced in miR-21 KO and wild-type (WT) mice by 3.5% dextran sulphate sodium (DSS) administration for 7 days. Disease activity index(DAI), blood parameters, intestinal permeability, histopathologic injury, cytokine and chemokine production, and epithelial cells apoptosis were examined in colons of miR-21 KO and WT mice.
Results
miR-21 was overexpressed in intestine of inflammatory bowel diseases (IBD) and acute intestinal obstruction (AIO) patients when compared with normal intestinal tissues. Likewise, miR-21 was up-regulated in colon of IL-10 KO mice when compared with control mice. WT mice rapidly lost weight and were moribund 5 days after treatment with 3.5% DSS, while miR-21 KO mice survived for at least 6 days. Elevated leukocytes and more severe histopathology were observed in WT mice when compared with miR-21 KO mice. Elevated levels of TNF-α and macrophage inflammatory protein-2(MIP-2) in colon culture supernatants from WT mice exhibited significant higher than miR-21 KO mice. Furthermore, CD3 and CD68 positive cells, intestinal permeability and apoptosis of epithelial cells were significantly increased in WT mice when compared with miR-21 KO mice. Finally, we found that miR-21 regulated the intestinal barrier function through modulating the expression of RhoB and CDC42.
Conclusion
Our results suggest that miR-21 is overexpressed in intestinal inflammation and tissue injury, while knockout of miR-21 in mice improve the survival rate in DSS-induced fatal colitis through protecting against inflammation and tissue injury. Therefore, attenuated expression of miR-21 in gut may prevent the onset or progression of inflammatory bowel disease in patients.
doi:10.1371/journal.pone.0066814
PMCID: PMC3691313  PMID: 23826144
18.  Conservative treatment of adhesive small bowel obstruction in children: a systematic review 
BMJ Open  2014;4(9):e005789.
Objective
To assess the effectiveness of conservative treatment for adhesive small bowel obstruction (ASBO) in children.
Design
Systematic review of studies involved children with ASBO who received initial conservative/non-operative treatment.
Setting
The search was performed in April 2013 using PubMed (see online supplementary file 1), current contents, and the Cochrane database.
Participants
Children with ASBO.
Interventions
Conservative treatment included nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance.
Primary outcome
Treatment success.
Secondary outcomes
Length of hospital stay and the time to first feeding after hospital admission.
Results
7 studies (six retrospective, one prospective), involving 8–109 patients (age: 1 month to 16 years) treated conservatively, were included in the review. The nature of conservative treatment was generally consistent between studies (nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance), although patients in one study also received Gastrografin. The rate of conservative treatment success ranged from 16% to 75% among the five studies, but one trial showed 0% successful rate. The hospital length of stay ranged from 3 to 6.5 days for conservative treatment (vs 10.2–13 days for operative treatment). The time to first feeding ranged from 31 to 84 h for conservative treatment.
Conclusions
In conclusion, in the majority of cases, conservative treatment is an effective means of managing ASBO in children.
doi:10.1136/bmjopen-2014-005789
PMCID: PMC4166136  PMID: 25223569
QUALITATIVE RESEARCH
19.  Single Stage Transanal Pull-Through for Hirschsprung’s Disease in Neonates: Our Early Experience 
Objective:
Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in neonates.
Design: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung’s disease in our institute from January 2011 to January 2013.
Material and Method:
Five newborn boys who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years.
Results:
Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range – 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series.
Conclusion:
Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.
PMCID: PMC4420292  PMID: 26023459
Hirschsprung’s disease; Transanal pull through; Single stage surgery
20.  Clinical Utility of Vitamin D Testing 
Executive Summary
This report from the Medical Advisory Secretariat (MAS) was intended to evaluate the clinical utility of vitamin D testing in average risk Canadians and in those with kidney disease. As a separate analysis, this report also includes a systematic literature review of the prevalence of vitamin D deficiency in these two subgroups.
This evaluation did not set out to determine the serum vitamin D thresholds that might apply to non-bone health outcomes. For bone health outcomes, no high or moderate quality evidence could be found to support a target serum level above 50 nmol/L. Similarly, no high or moderate quality evidence could be found to support vitamin D’s effects in non-bone health outcomes, other than falls.
Vitamin D
Vitamin D is a lipid soluble vitamin that acts as a hormone. It stimulates intestinal calcium absorption and is important in maintaining adequate phosphate levels for bone mineralization, bone growth, and remodelling. It’s also believed to be involved in the regulation of cell growth proliferation and apoptosis (programmed cell death), as well as modulation of the immune system and other functions. Alone or in combination with calcium, Vitamin D has also been shown to reduce the risk of fractures in elderly men (≥ 65 years), postmenopausal women, and the risk of falls in community-dwelling seniors. However, in a comprehensive systematic review, inconsistent results were found concerning the effects of vitamin D in conditions such as cancer, all-cause mortality, and cardiovascular disease. In fact, no high or moderate quality evidence could be found concerning the effects of vitamin D in such non-bone health outcomes. Given the uncertainties surrounding the effects of vitamin D in non-bone health related outcomes, it was decided that this evaluation should focus on falls and the effects of vitamin D in bone health and exclusively within average-risk individuals and patients with kidney disease.
Synthesis of vitamin D occurs naturally in the skin through exposure to ultraviolet B (UVB) radiation from sunlight, but it can also be obtained from dietary sources including fortified foods, and supplements. Foods rich in vitamin D include fatty fish, egg yolks, fish liver oil, and some types of mushrooms. Since it is usually difficult to obtain sufficient vitamin D from non-fortified foods, either due to low content or infrequent use, most vitamin D is obtained from fortified foods, exposure to sunlight, and supplements.
Clinical Need: Condition and Target Population
Vitamin D deficiency may lead to rickets in infants and osteomalacia in adults. Factors believed to be associated with vitamin D deficiency include:
darker skin pigmentation,
winter season,
living at higher latitudes,
skin coverage,
kidney disease,
malabsorption syndromes such as Crohn’s disease, cystic fibrosis, and
genetic factors.
Patients with chronic kidney disease (CKD) are at a higher risk of vitamin D deficiency due to either renal losses or decreased synthesis of 1,25-dihydroxyvitamin D.
Health Canada currently recommends that, until the daily recommended intakes (DRI) for vitamin D are updated, Canada’s Food Guide (Eating Well with Canada’s Food Guide) should be followed with respect to vitamin D intake. Issued in 2007, the Guide recommends that Canadians consume two cups (500 ml) of fortified milk or fortified soy beverages daily in order to obtain a daily intake of 200 IU. In addition, men and women over the age of 50 should take 400 IU of vitamin D supplements daily. Additional recommendations were made for breastfed infants.
A Canadian survey evaluated the median vitamin D intake derived from diet alone (excluding supplements) among 35,000 Canadians, 10,900 of which were from Ontario. Among Ontarian males ages 9 and up, the median daily dietary vitamin D intake ranged between 196 IU and 272 IU per day. Among females, it varied from 152 IU to 196 IU per day. In boys and girls ages 1 to 3, the median daily dietary vitamin D intake was 248 IU, while among those 4 to 8 years it was 224 IU.
Vitamin D Testing
Two laboratory tests for vitamin D are available, 25-hydroxy vitamin D, referred to as 25(OH)D, and 1,25-dihydroxyvitamin D. Vitamin D status is assessed by measuring the serum 25(OH)D levels, which can be assayed using radioimmunoassays, competitive protein-binding assays (CPBA), high pressure liquid chromatography (HPLC), and liquid chromatography-tandem mass spectrometry (LC-MS/MS). These may yield different results with inter-assay variation reaching up to 25% (at lower serum levels) and intra-assay variation reaching 10%.
The optimal serum concentration of vitamin D has not been established and it may change across different stages of life. Similarly, there is currently no consensus on target serum vitamin D levels. There does, however, appear to be a consensus on the definition of vitamin D deficiency at 25(OH)D < 25 nmol/l, which is based on the risk of diseases such as rickets and osteomalacia. Higher target serum levels have also been proposed based on subclinical endpoints such as parathyroid hormone (PTH). Therefore, in this report, two conservative target serum levels have been adopted, 25 nmol/L (based on the risk of rickets and osteomalacia), and 40 to 50 nmol/L (based on vitamin D’s interaction with PTH).
Ontario Context
Volume & Cost
The volume of vitamin D tests done in Ontario has been increasing over the past 5 years with a steep increase of 169,000 tests in 2007 to more than 393,400 tests in 2008. The number of tests continues to rise with the projected number of tests for 2009 exceeding 731,000. According to the Ontario Schedule of Benefits, the billing cost of each test is $51.7 for 25(OH)D (L606, 100 LMS units, $0.517/unit) and $77.6 for 1,25-dihydroxyvitamin D (L605, 150 LMS units, $0.517/unit). Province wide, the total annual cost of vitamin D testing has increased from approximately $1.7M in 2004 to over $21.0M in 2008. The projected annual cost for 2009 is approximately $38.8M.
Evidence-Based Analysis
The objective of this report is to evaluate the clinical utility of vitamin D testing in the average risk population and in those with kidney disease. As a separate analysis, the report also sought to evaluate the prevalence of vitamin D deficiency in Canada. The specific research questions addressed were thus:
What is the clinical utility of vitamin D testing in the average risk population and in subjects with kidney disease?
What is the prevalence of vitamin D deficiency in the average risk population in Canada?
What is the prevalence of vitamin D deficiency in patients with kidney disease in Canada?
Clinical utility was defined as the ability to improve bone health outcomes with the focus on the average risk population (excluding those with osteoporosis) and patients with kidney disease.
Literature Search
A literature search was performed on July 17th, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 1998 until July 17th, 2009. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology.
Observational studies that evaluated the prevalence of vitamin D deficiency in Canada in the population of interest were included based on the inclusion and exclusion criteria listed below. The baseline values were used in this report in the case of interventional studies that evaluated the effect of vitamin D intake on serum levels. Studies published in grey literature were included if no studies published in the peer-reviewed literature were identified for specific outcomes or subgroups.
Considering that vitamin D status may be affected by factors such as latitude, sun exposure, food fortification, among others, the search focused on prevalence studies published in Canada. In cases where no Canadian prevalence studies were identified, the decision was made to include studies from the United States, given the similar policies in vitamin D food fortification and recommended daily intake.
Inclusion Criteria
Studies published in English
Publications that reported the prevalence of vitamin D deficiency in Canada
Studies that included subjects from the general population or with kidney disease
Studies in children or adults
Studies published between January 1998 and July 17th 2009
Exclusion Criteria
Studies that included subjects defined according to a specific disease other than kidney disease
Letters, comments, and editorials
Studies that measured the serum vitamin D levels but did not report the percentage of subjects with serum levels below a given threshold
Outcomes of Interest
Prevalence of serum vitamin D less than 25 nmol/L
Prevalence of serum vitamin D less than 40 to 50 nmol/L
Serum 25-hydroxyvitamin D was the metabolite used to assess vitamin D status. Results from adult and children studies were reported separately. Subgroup analyses according to factors that affect serum vitamin D levels (e.g., seasonal effects, skin pigmentation, and vitamin D intake) were reported if enough information was provided in the studies
Quality of Evidence
The quality of the prevalence studies was based on the method of subject recruitment and sampling, possibility of selection bias, and generalizability to the source population. The overall quality of the trials was examined according to the GRADE Working Group criteria.
Summary of Findings
Fourteen prevalence studies examining Canadian adults and children met the eligibility criteria. With the exception of one longitudinal study, the studies had a cross-sectional design. Two studies were conducted among Canadian adults with renal disease but none studied Canadian children with renal disease (though three such US studies were included). No systematic reviews or health technology assessments that evaluated the prevalence of vitamin D deficiency in Canada were identified. Two studies were published in grey literature, consisting of a Canadian survey designed to measure serum vitamin D levels and a study in infants presented as an abstract at a conference. Also included were the results of vitamin D tests performed in community laboratories in Ontario between October 2008 and September 2009 (provided by the Ontario Association of Medical Laboratories).
Different threshold levels were used in the studies, thus we reported the percentage of subjects with serum levels of between 25 and 30 nmol/L and between 37.5 and 50 nmol/L. Some studies stratified the results according to factors affecting vitamin D status and two used multivariate models to investigate the effects of these characteristics (including age, season, BMI, vitamin D intake, skin pigmentation, and season) on serum 25(OH)D levels. It’s unclear, however, if these studies were adequately powered for these subgroup analyses.
Study participants generally consisted of healthy, community-dwelling subjects and most excluded individuals with conditions or medications that alter vitamin D or bone metabolism, such as kidney or liver disease. Although the studies were conducted in different parts of Canada, fewer were performed in Northern latitudes, i.e. above 53°N, which is equivalent to the city of Edmonton.
Adults
Serum vitamin D levels of < 25 to 30 nmol/L were observed in 0% to 25.5% of the subjects included in five studies; the weighted average was 3.8% (95% CI: 3.0, 4.6). The preliminary results of the Canadian survey showed that approximately 5% of the subjects had serum levels below 29.5 nmol/L. The results of over 600,000 vitamin D tests performed in Ontarian community laboratories between October 2008 and September 2009 showed that 2.6% of adults (> 18 years) had serum levels < 25 nmol/L.
The prevalence of serum vitamin D levels below 37.5-50 nmol/L reported among studies varied widely, ranging from 8% to 73.6% with a weighted average of 22.5%. The preliminary results of the CHMS survey showed that between 10% and 25% of subjects had serum levels below 37 to 48 nmol/L. The results of the vitamin D tests performed in community laboratories showed that 10% to 25% of the individuals had serum levels between 39 and 50 nmol/L.
In an attempt to explain this inter-study variation, the study results were stratified according to factors affecting serum vitamin D levels, as summarized below. These results should be interpreted with caution as none were adjusted for other potential confounders. Adequately powered multivariate analyses would be necessary to determine the contribution of risk factors to lower serum 25(OH)D levels.
Seasonal variation
Three adult studies evaluating serum vitamin D levels in different seasons observed a trend towards a higher prevalence of serum levels < 37.5 to 50 nmol/L during the winter and spring months, specifically 21% to 39%, compared to 8% to 14% in the summer. The weighted average was 23.6% over the winter/spring months and 9.6% over summer. The difference between the seasons was not statistically significant in one study and not reported in the other two studies.
Skin Pigmentation
Four studies observed a trend toward a higher prevalence of serum vitamin D levels < 37.5 to 50 nmol/L in subjects with darker skin pigmentation compared to those with lighter skin pigmentation, with weighted averages of 46.8% among adults with darker skin colour and 15.9% among those with fairer skin.
Vitamin D intake and serum levels
Four adult studies evaluated serum vitamin D levels according to vitamin D intake and showed an overall trend toward a lower prevalence of serum levels < 37.5 to 50 nmol/L with higher levels of vitamin D intake. One study observed a dose-response relationship between higher vitamin D intake from supplements, diet (milk), and sun exposure (results not adjusted for other variables). It was observed that subjects taking 50 to 400 IU or > 400 IU of vitamin D per day had a 6% and 3% prevalence of serum vitamin D level < 40 nmol/L, respectively, versus 29% in subjects not on vitamin D supplementation. Similarly, among subjects drinking one or two glasses of milk per day, the prevalence of serum vitamin D levels < 40 nmol/L was found to be 15%, versus 6% in those who drink more than two glasses of milk per day and 21% among those who do not drink milk. On the other hand, one study observed little variation in serum vitamin D levels during winter according to milk intake, with the proportion of subjects exhibiting vitamin D levels of < 40 nmol/L being 21% among those drinking 0-2 glasses per day, 26% among those drinking > 2 glasses, and 20% among non-milk drinkers.
The overall quality of evidence for the studies conducted among adults was deemed to be low, although it was considered moderate for the subgroups of skin pigmentation and seasonal variation.
Newborn, Children and Adolescents
Five Canadian studies evaluated serum vitamin D levels in newborns, children, and adolescents. In four of these, it was found that between 0 and 36% of children exhibited deficiency across age groups with a weighted average of 6.4%. The results of over 28,000 vitamin D tests performed in children 0 to 18 years old in Ontario laboratories (Oct. 2008 to Sept. 2009) showed that 4.4% had serum levels of < 25 nmol/L.
According to two studies, 32% of infants 24 to 30 months old and 35.3% of newborns had serum vitamin D levels of < 50 nmol/L. Two studies of children 2 to 16 years old reported that 24.5% and 34% had serum vitamin D levels below 37.5 to 40 nmol/L. In both studies, older children exhibited a higher prevalence than younger children, with weighted averages 34.4% and 10.3%, respectively. The overall weighted average of the prevalence of serum vitamin D levels < 37.5 to 50 nmol/L among pediatric studies was 25.8%. The preliminary results of the Canadian survey showed that between 10% and 25% of subjects between 6 and 11 years (N= 435) had serum levels below 50 nmol/L, while for those 12 to 19 years, 25% to 50% exhibited serum vitamin D levels below 50 nmol/L.
The effects of season, skin pigmentation, and vitamin D intake were not explored in Canadian pediatric studies. A Canadian surveillance study did, however, report 104 confirmed cases1 (2.9 cases per 100,000 children) of vitamin D-deficient rickets among Canadian children age 1 to 18 between 2002 and 2004, 57 (55%) of which from Ontario. The highest incidence occurred among children living in the North, i.e., the Yukon, Northwest Territories, and Nunavut. In 92 (89%) cases, skin pigmentation was categorized as intermediate to dark, 98 (94%) had been breastfed, and 25 (24%) were offspring of immigrants to Canada. There were no cases of rickets in children receiving ≥ 400 IU VD supplementation/day.
Overall, the quality of evidence of the studies of children was considered very low.
Kidney Disease
Adults
Two studies evaluated serum vitamin D levels in Canadian adults with kidney disease. The first included 128 patients with chronic kidney disease stages 3 to 5, 38% of which had serum vitamin D levels of < 37.5 nmol/L (measured between April and July). This is higher than what was reported in Canadian studies of the general population during the summer months (i.e. between 8% and 14%). In the second, which examined 419 subjects who had received a renal transplantation (mean time since transplantation: 7.2 ± 6.4 years), the prevalence of serum vitamin D levels < 40 nmol/L was 27.3%. The authors concluded that the prevalence observed in the study population was similar to what is expected in the general population.
Children
No studies evaluating serum vitamin D levels in Canadian pediatric patients with kidney disease could be identified, although three such US studies among children with chronic kidney disease stages 1 to 5 were. The mean age varied between 10.7 and 12.5 years in two studies but was not reported in the third. Across all three studies, the prevalence of serum vitamin D levels below the range of 37.5 to 50 nmol/L varied between 21% and 39%, which is not considerably different from what was observed in studies of healthy Canadian children (24% to 35%).
Overall, the quality of evidence in adults and children with kidney disease was considered very low.
Clinical Utility of Vitamin D Testing
A high quality comprehensive systematic review published in August 2007 evaluated the association between serum vitamin D levels and different bone health outcomes in different age groups. A total of 72 studies were included. The authors observed that there was a trend towards improvement in some bone health outcomes with higher serum vitamin D levels. Nevertheless, precise thresholds for improved bone health outcomes could not be defined across age groups. Further, no new studies on the association were identified during an updated systematic review on vitamin D published in July 2009.
With regards to non-bone health outcomes, there is no high or even moderate quality evidence that supports the effectiveness of vitamin D in outcomes such as cancer, cardiovascular outcomes, and all-cause mortality. Even if there is any residual uncertainty, there is no evidence that testing vitamin D levels encourages adherence to Health Canada’s guidelines for vitamin D intake. A normal serum vitamin D threshold required to prevent non-bone health related conditions cannot be resolved until a causal effect or correlation has been demonstrated between vitamin D levels and these conditions. This is as an ongoing research issue around which there is currently too much uncertainty to base any conclusions that would support routine vitamin D testing.
For patients with chronic kidney disease (CKD), there is again no high or moderate quality evidence supporting improved outcomes through the use of calcitriol or vitamin D analogs. In the absence of such data, the authors of the guidelines for CKD patients consider it best practice to maintain serum calcium and phosphate at normal levels, while supplementation with active vitamin D should be considered if serum PTH levels are elevated. As previously stated, the authors of guidelines for CKD patients believe that there is not enough evidence to support routine vitamin D [25(OH)D] testing. According to what is stated in the guidelines, decisions regarding the commencement or discontinuation of treatment with calcitriol or vitamin D analogs should be based on serum PTH, calcium, and phosphate levels.
Limitations associated with the evidence of vitamin D testing include ambiguities in the definition of an ‘adequate threshold level’ and both inter- and intra- assay variability. The MAS considers both the lack of a consensus on the target serum vitamin D levels and assay limitations directly affect and undermine the clinical utility of testing. The evidence supporting the clinical utility of vitamin D testing is thus considered to be of very low quality.
Daily vitamin D intake, either through diet or supplementation, should follow Health Canada’s recommendations for healthy individuals of different age groups. For those with medical conditions such as renal disease, liver disease, and malabsorption syndromes, and for those taking medications that may affect vitamin D absorption/metabolism, physician guidance should be followed with respect to both vitamin D testing and supplementation.
Conclusions
Studies indicate that vitamin D, alone or in combination with calcium, may decrease the risk of fractures and falls among older adults.
There is no high or moderate quality evidence to support the effectiveness of vitamin D in other outcomes such as cancer, cardiovascular outcomes, and all-cause mortality.
Studies suggest that the prevalence of vitamin D deficiency in Canadian adults and children is relatively low (approximately 5%), and between 10% and 25% have serum levels below 40 to 50 nmol/L (based on very low to low grade evidence).
Given the limitations associated with serum vitamin D measurement, ambiguities in the definition of a ‘target serum level’, and the availability of clear guidelines on vitamin D supplementation from Health Canada, vitamin D testing is not warranted for the average risk population.
Health Canada has issued recommendations regarding the adequate daily intake of vitamin D, but current studies suggest that the mean dietary intake is below these recommendations. Accordingly, Health Canada’s guidelines and recommendations should be promoted.
Based on a moderate level of evidence, individuals with darker skin pigmentation appear to have a higher risk of low serum vitamin D levels than those with lighter skin pigmentation and therefore may need to be specially targeted with respect to optimum vitamin D intake. The cause-effect of this association is currently unclear.
Individuals with medical conditions such as renal and liver disease, osteoporosis, and malabsorption syndromes, as well as those taking medications that may affect vitamin D absorption/metabolism, should follow their physician’s guidance concerning both vitamin D testing and supplementation.
PMCID: PMC3377517  PMID: 23074397
21.  Development and validation of a new global well-being outcomes rating scale for integrative medicine research 
Background
Researchers are finding limitations of currently available disease-focused questionnaire tools for outcome studies in complementary and alternative medicine/integrative medicine (CAM/IM).
Methods
Three substudies investigated the new one-item visual analogue Arizona Integrative Outcomes Scale (AIOS), which assesses self-rated global sense of spiritual, social, mental, emotional, and physical well-being over the past 24 hours and the past month. The first study tested the scale's ability to discriminate unhealthy individuals (n = 50) from healthy individuals (n = 50) in a rehabilitation outpatient clinic sample. The second study examined the concurrent validity of the AIOS by comparing ratings of global well-being to degree of psychological distress as measured by the Brief Symptom Inventory (BSI) in undergraduate college students (N = 458). The third study evaluated the relationships between the AIOS and positively- and negatively-valenced tools (Positive and Negative Affect Scale and the Positive States of Mind Scale) in a different sample of undergraduate students (N = 62).
Results
Substudy (i) Rehabilitation patients scored significantly lower than the healthy controls on both forms of the AIOS and a current global health rating. The AIOS 24-hours correlated moderately and significantly with global health (patients r = 0.50; controls r = 0.45). AIOS 1-month correlations with global health were stronger within the controls (patients r = 0.36; controls r = 0.50). Controls (r = 0.64) had a higher correlation between the AIOS 24-hour and 1-month forms than did the patients (r = 0.33), which is consistent with the presumptive improvement in the patients' condition over the previous 30 days in rehabilitation. Substudy (ii) In undergraduate students, AIOS scores were inversely related to distress ratings, as measured by the global severity index on the BSI (rAIOS24h = -0.42, rAIOS1month = -0.40). Substudy (iii) AIOS scores were significantly correlated with positive affect (rAIOS24h = 0.56, rAIOS1month = 0.57) and positive states of mind (rAIOS24h = 0.42, rAIOS1month = 0.45), and inversely correlated with negative affect (rAIOS24h = -0.41, rAIOS1month = -0.59).
Conclusions
The AIOS is able to distinguish relatively sicker from relatively healthier individuals; and correlates in expected directions with a measure of distress and indicators of positive and negative affect and positive states of mind. The AIOS offers a tool for CAM/IM research that extends beyond a disease emphasis.
doi:10.1186/1472-6882-4-1
PMCID: PMC343287  PMID: 14725717
complementary and alternative medicine; well-being; global outcomes; questionnaire; validation; rehabilitation
22.  A randomized, phase III trial of capecitabine plus bevacizumab (Cape-Bev) versus capecitabine plus irinotecan plus bevacizumab (CAPIRI-Bev) in first-line treatment of metastatic colorectal cancer: The AIO KRK 0110 Trial/ML22011 Trial 
BMC Cancer  2011;11:367.
Background
Several randomized trials have indicated that combination chemotherapy applied in metastatic colorectal cancer (mCRC) does not significantly improve overall survival when compared to the sequential use of cytotoxic agents (CAIRO, MRC Focus, FFCD 2000-05). The present study investigates the question whether this statement holds true also for bevacizumab-based first-line treatment including escalation- and de-escalation strategies.
Methods/Design
The AIO KRK 0110/ML22011 trial is a two-arm, multicenter, open-label randomized phase III trial comparing the efficacy and safety of capecitabine plus bevacizumab (Cape-Bev) versus capecitabine plus irinotecan plus bevacizumab (CAPIRI-Bev) in the first-line treatment of metastatic colorectal cancer. Patients with unresectable metastatic colorectal cancer, Eastern Cooperative Oncology Group (ECOG) performance status 0-1, will be assigned in a 1:1 ratio to receive either capecitabine 1250 mg/m2 bid for 14d (d1-14) plus bevacizumab 7.5 mg/kg (d1) q3w (Arm A) or capecitabine 800 mg/m2 BID for 14d (d1-14), irinotecan 200 mg/m2 (d1) and bevacizumab 7.5 mg/kg (d1) q3w (Arm B). Patients included into this trial are required to consent to the analysis of tumour tissue and blood for translational investigations. In Arm A, treatment escalation from Cape-Bev to CAPIRI-Bev is recommended in case of progressive disease (PD). In Arm B, de-escalation from CAPIRI-Bev to Cape-Bev is possible after 6 months of treatment or in case of irinotecan-associated toxicity. Re-escalation to CAPIRI-Bev after PD is possible. The primary endpoint is time to failure of strategy (TFS). Secondary endpoints are overall response rate (ORR), overall survival, progression-free survival, safety and quality of life.
Conclusion
The AIO KRK 0110 trial is designed for patients with disseminated, but asymptomatic mCRC who are not potential candidates for surgical resection of metastasis. Two bevacizumab-based strategies are compared: one starting as single-agent chemotherapy (Cape-Bev) allowing escalation to CAPIRI-Bev and another starting with combination chemotherapy (CAPIRI-Bev) and allowing de-escalation to Cape-Bev and subsequent re-escalation if necessary.
Trial Registration
ClinicalTrials.gov Identifier NCT01249638
EudraCT-No.: 2009-013099-38
doi:10.1186/1471-2407-11-367
PMCID: PMC3173448  PMID: 21861888
23.  Measuring changes in self-concept: a qualitative evaluation of outcome questionnaires in people having acupuncture for their chronic health problems 
Background
Changes in self-concept are an important potential outcome for many interventions for people with long-term conditions. This study sought to identify and evaluate outcome questionnaires suitable for quantifying changes in self-concept in people with long-term conditions, in the context of treatment with acupuncture and Chinese medicine.
Methods
A literature search was followed by an evaluation of three questionnaires: The Wellbeing Questionnaire W-BQ12, the Patient Enablement Instrument (PEI), and the Arizona Integrative Outcome Scale (AIOS). A convenience sample of 23 people completed the questionnaires on two occasions and were interviewed about their experience and their questionnaire responses. All acupuncturists were interviewed.
Results
Changes in self-concept were common and emerged over time. The three questionnaires had different strengths and weaknesses in relation to measuring changes in self-concept. The generic AIOS had face validity and was sensitive to changes in self-concept over time, but it lacked specificity. The PEI was sensitive and specific in measuring these changes but had lower acceptability. The sensitivity of the W-BQ12 was affected by initial high scores (ceiling effect) and a shorter timescale but was acceptable and is suitable for repeated administration. The PEI and W-BQ12 questionnaires worked well in combination.
Conclusion
Changes in self-concept are important outcomes of complex interventions for people with long-term illness and their measurement requires carefully evaluated tools and long-term follow-up. The literature review and the analysis of the strengths and weaknesses of the questionnaires is a resource for other researchers. The W-BQ12 and the PEI both proved useful for this population and a larger quantitative study is planned.
doi:10.1186/1472-6882-6-7
PMCID: PMC1434784  PMID: 16539737
24.  Study protocol of the Asian XELIRI ProjecT (AXEPT): a multinational, randomized, non-inferiority, phase III trial of second-line chemotherapy for metastatic colorectal cancer, comparing the efficacy and safety of XELIRI with or without bevacizumab versus FOLFIRI with or without bevacizumab 
Background
Capecitabine and irinotecan combination therapy (XELIRI) has been examined at various dose levels to treat metastatic colorectal cancer (mCRC). Recently, in the Association of Medical Oncology of the German Cancer Society (AIO) 0604 trial, tri-weekly XELIRI plus bevacizumab, with reduced doses of irinotecan (200 mg/m2 on day 1) and capecitabine (1600 mg/m2 on days 1–14), repeated every 3 weeks, has shown favorable tolerability and efficacy which were comparable to those of capecitabine and oxaliplatin (XELOX) plus bevacizumab. The doses of capecitabine and irinotecan in the AIO trial are considered optimal. In a phase I/II study, XELIRI plus bevacizumab (BIX) as second-line chemotherapy was well tolerated and had promising efficacy in Japanese patients.
Methods
The Asian XELIRI ProjecT (AXEPT) is an East Asian collaborative, open-labelled, randomized, phase III clinical trial which was designed to demonstrate the non-inferiority of XELIRI with or without bevacizumab versus standard FOLFIRI (5-fluorouracil, leucovorin, and irinotecan combination) with or without bevacizumab as second-line chemotherapy for patients with mCRC. Patients with 20 years of age or older, histologically confirmed mCRC, Eastern Cooperative Oncology Group performance status 0–2, adequate organ function, and disease progression or intolerance of the first-line regimen will be eligible. Patients will be randomized (1:1) to receive standard FOLFIRI with or without bevacizumab (5 mg/kg on day 1), repeated every 2 weeks (FOLIRI arm) or XELIRI with or without bevacizumab (7.5 mg/kg on day 1), repeated every 3 weeks (XELIRI arm). A total of 464 events were estimated as necessary to show non-inferiority with a power of 80% at a one-sided α of 0.025, requiring a target sample size of 600 patients. The 95% confidence interval (CI) upper limit of the hazard ratio was pre-specified as less than 1.3.
Conclusion
The Asian XELIRI ProjecT is a multinational phase III trial being conducted to provide evidence for XELIRI with or without bevacizumab as a second-line treatment option of mCRC.
Trial registration ClinicalTrials.gov NCT01996306. UMIN000012263
doi:10.1186/s40880-016-0166-3
PMCID: PMC5178089  PMID: 28007025
Metastatic colorectal cancer; Randomized phase III clinical trial; XELIRI; Bevacizumab; Second-line therapy
25.  Palliative first-line therapy with weekly high-dose 5-fluorouracil and sodium folinic acid as a 24-hour infusion (AIO regimen) combined with weekly irinotecan in patients with metastatic adenocarcinoma of the stomach or esophagogastric junction followed by secondary metastatic resection after downsizing 
Summary
Background
The aim of this retrospective study was to evaluate the efficacy and safety of weekly high-dose 5-fluorouracil (5-FU)/folinic acid (FA) as 24-h infusion (AIO regimen) plus irinotecan in patients with histologically proven metastatic gastroesophageal adenocarcinoma (UICC stage IV).
Material/Methods
From 08/1999 to 12/2008, 76 registered, previously untreated patients were evaluable. Treatment regimen: irinotecan (80 mg/m2) as 1-h infusion followed by 5-FU (2000 mg/m2) combined with FA (500 mg/m2) as 24-h infusion (d1, 8, 15, 22, 29, 36, qd 57).
Results
Median age: 59 years; male/female: 74%/26%; ECOG ≤1: 83%; response: CR: 1%, PR: 16%, SD: 61%, PD: 17%, not evaluable in terms of response: 5%; tumor control: 78%; median OS: 11.2 months; median time-to-progression: 5.3 months; 1-year survival rate: 49%; 2-year survival rate: 17%; no evidence of disease: 6.6%; higher grade toxicities (grade 3/4): anemia: 7%, leucopenia: 1%, ascites: 3%, nausea: 3%, infections: 12%, vomiting: 9%, GI bleeding of the primary tumor: 4%, diarrhea: 17%, thromboembolic events: 4%; secondary metastatic resection after downsizing: 16 patients (21%), R-classification of secondary resections: R0/R1/R2: 81%/6%/13%, median survival of the 16 patients with secondary resection: 23.7 months.
Conclusions
Combined 5-FU/FA as 24-h infusion plus irinotecan may be considered as an active palliative first-line treatment accompanied by tolerable toxicity; thus offering an alternative to cisplatin-based treatment regimens. Thanks to efficient interdisciplinary teamwork, secondary metastatic resections could be performed in 16 patients. In total, the patients who had undergone secondary resection had a median survival of 23.7 months, whereas the median survival of patients without secondary resection was 10.1 months (p≤0.001).
doi:10.12659/MSM.881764
PMCID: PMC3539586  PMID: 21525806
gastroesophageal cancer; palliative chemotherapy; irinotecan; 5-fluorouracil

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