Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology.

"Managing Undernutrition in Pediatric Oncology" is a collaborative consensus statement of the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. The early identification and accurate management of malnutrition in children receiving anticancer treatment are crucial components to integrate into comprehensive medical care. Given the scarcity of high-quality literature on this topic, a consensus statement process was chosen over other approaches, such as guidelines, to provide comprehensive recommendations. Nevertheless, an extensive literature review using the PubMed database was conducted. The following terms, namely pediatric, childhood, cancer, pediatric oncology, malnutrition, undernutrition, refeeding syndrome, nutritional support, and nutrition, were used. The consensus was reached through the Delphi method. Comprehensive recommendations aim to identify malnutrition early in children with cancer and optimize nutritional interventions in this group. The statement underscores the importance of baseline and ongoing assessments of nutritional status and the identification of the risk factors for malnutrition development, and it presents tools that can be used to achieve these goals. This consensus statement establishes a standardized approach to nutritional support, aiming to optimize outcomes in pediatric cancer patients.

Pediatric endoscopy in times of pandemic: A nationwide retrospective analysis.

BACKGROUND: Gastrointestinal endoscopy is a procedure that carries an increased risk of transmission of SARS-CoV-2 infection to medical staff. In patients, COVID-19 is a risk factor for adverse events of medical procedures. This study analyzed the real-life risk of, and factors contributing to, infection transmission to endoscopic personnel, and possible adverse events of the endoscopy procedure and anesthesia in children with COVID-19. METHODS: Nationwide retrospective analysis of medical records of children with confirmed SARS-CoV-2 infection who underwent gastrointestinal endoscopy in Poland between February 2020 and February 2022. RESULTS: Fifty-eight patients were included in the analysis, 35% of whom had COVID-19 symptoms at the time of endoscopy. The dominant indications for endoscopy were foreign body or corrosive substance ingestion and gastrointestinal bleeding. Nine cases of virus transmission were registered among endoscopic personnel. In all of these cases, the endoscopy team was unaware of the patient's infection (p < 0.01), although symptoms were present in 78% of the children. Lack of use of personal protective equipment was the strongest predictor of SARS-CoV-2 transmission (p < 0.01). The risk of infection was not statistically significantly dependent on the method of anesthesia, intubation or the type of endoscopy. No statistically significant correlation was found between symptomatic infection and adverse events of endoscopy or anesthesia occurrence. There was one reported anesthesia-related adverse event involving extubation difficulties due to worsening respiratory infection symptoms. CONCLUSIONS: The risk of transmitting SARS-CoV-2 to endoscopic personnel during procedures in children is low and depends on compliance with infection prevention and control measures. Performing gastrointestinal endoscopy in children with COVID-19 does not appear to be associated with an increased risk of adverse events.

Effect of metabolic activity of lactic acid bacteria and propionibacteria on cheese protein digestibility and fatty acid profile.

This study aimed at investigating the influence of different variants of bacterial starter cultures on the metabolism of the bacteria used, cheese protein digestibility, and fatty acid profile. The results revealed that lactic acid bacteria had a significant effect on the proportions of fatty acids in cheeses, with saturated fatty acids being predominant in in all cheese variants. Fatty acid proportions are complex and depend on the type of cheese culture and monoculture used. Additionally, the analysis of fatty acid composition showed variations in the proportion of saturated and unsaturated fatty acids, impacting the values of atherogenic and thrombogenic indices. Notably, the atherogenic index was highest in samples of mature cheeses obtained from a typical mesophilic cheese culture, whereas it was lowest in samples of fresh milk and mature cheeses obtained from a mesophilic cheese culture and monocultures of Lacticaseibacillus casei and Propionibacterium. The study also highlighted the influence of lactobacilli on the content of available free lysine, glycine, and methionine in cheese proteins. Mature cheeses obtained with Propionibacterium and L. casei starter cultures exhibited higher free lysine and glycine content compared with fresh cheeses and those obtained solely with the cheese culture. Additionally, mature cheeses obtained with starter cultures of mesophilic cheese culture, Propionibacterium, and L. casei had the highest free methionine content. Based on these findings, it is evident that the choice of cheese making cultures and monocultures can significantly affect the fatty acid composition and amino acid content of cheese and fresh milk, potentially bearing important health implications.

Bismuth Tungstate Nanoplates-Vis Responsive Photocatalyst for Water Oxidation.

The development of visible-light-responsive (VLR) semiconductor materials for effective water oxidation is significant for a sustainable and better future. Among various candidates, bismuth tungstate (Bi2WO6; BWO) has attracted extensive attention because of many advantages, including efficient light-absorption ability, appropriate redox properties (for O2 generation), adjustable morphology, low cost, and profitable chemical and optical characteristics. Accordingly, a facile solvothermal method has been proposed in this study to synthesize two-dimensional (2D) BWO nanoplates after considering the optimal preparation conditions (solvothermal reaction time: 10-40 h). To find the key factors of photocatalytic performance, various methods and techniques were used for samples' characterization, including XRD, FE-SEM, STEM, TEM, HRTEM, BET-specific surface area measurements, UV/vis DRS, and PL spectroscopy, and photocatalytic activity was examined for water oxidation under UV and/or visible-light (vis) irradiation. Famous commercial photocatalyst-P25 was used as a reference sample. It was found that BWO crystals grew anisotropically along the {001} basal plane to form nanoplates, and all properties were controlled simultaneously by tuning the synthesis time. Interestingly, the most active sample (under both UV and vis), prepared during the 30 h solvothermal reaction at 433 K (BWO-30), was characterized by the smallest specific surface area and the largest crystals. Accordingly, it is proposed that improved crystallinity (which hindered charge carriers' recombination, as confirmed by PL), efficient photoabsorption (using the smallest bandgap), and 2D mesoporous structure are responsible for the best photocatalytic performance of the BWO-30 sample. This report shows for the first time that 2D mesoporous BWO nanoplates might be successfully prepared through a facile template-free solvothermal approach. All the above-mentioned advantages suggest that nanostructured BWO is a prospective candidate for photocatalytic applications under natural solar irradiation.

The Survival of Psychobiotics in Fermented Food and the Gastrointestinal Tract: A Review.

In recent years, scientists have been particularly interested in the gut-brain axis, as well as the impact of probiotics on the nervous system. This has led to the creation of the concept of psychobiotics. The present review describes the mechanisms of action of psychobiotics, their use in food products, and their viability and survival during gastrointestinal passage. Fermented foods have a high potential of delivering probiotic strains, including psychobiotic ones. However, it is important that the micro-organisms remain viable in concentrations ranging from about 106 to 109 CFU/mL during processing, storage, and digestion. Reports indicate that a wide variety of dairy and plant-based products can be effective carriers for psychobiotics. Nonetheless, bacterial viability is closely related to the type of food matrix and the micro-organism strain. Studies conducted in laboratory conditions have shown promising results in terms of the therapeutic properties and viability of probiotics. Because human research in this field is still limited, it is necessary to broaden our understanding of the survival of probiotic strains in the human digestive tract, their resistance to gastric and pancreatic enzymes, and their ability to colonize the microbiota.

Can photocatalysis help in the fight against COVID-19 pandemic?

Mould fungi are serious threats to humans and animals (allergen) and might be the main cause of COVID-19-associated pulmonary aspergillosis. The common methods of disinfection are not highly effective against fungi due to the high resistance of fungal spores. Recently, photocatalysis has attracted significant attention towards antimicrobial action. Outstanding properties of titania photocatalysts have already been used in many areas, e.g., for building materials, air conditioner filters, and air purifiers. Here, the efficiency of photocatalytic methods to remove fungi and bacteria (risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 co-infection) is presented. Based on the relevant literature and own experience, there is no doubt that photocatalysis might help in the fight against microorganisms, and thus prevent the severity of COVID-19 pandemic.

Continuous Glucose Monitoring in Enterally Fed Children with Severe Central Nervous System Impairment.

Children with severe central nervous system (CNS) impairment are at risk of developing various degrees of nutritional deficit that require long-term nutritional intervention. Interventions are most often implemented through enteral nutrition (EN) using commercially manufactured feeds administered via gastro/jejunostomy or nasogastric or nasojejunal tubes. The modality of feeding-continuous feeding or bolus feeding-is dependent on the function of the gastrointestinal tract, particularly the efficiency of gastric emptying. In the literature, the relationship between this type of nutrition and the occurrence of hyperglycaemia is often discussed. In addition, children with chronic neurological diseases are vulnerable to disorders of many mechanisms of neurohormonal counter-regulation related to carbohydrate management, and due to limited verbal and logical contact, it is difficult to recognise the symptoms of hypoglycaemia in such patients. We aimed to assess the carbohydrate metabolism in children with severe CNS impairment, with enteral nutrition delivered via nasogastric, nasoenteral, or percutaneous tubes, based on continuous glycaemic monitoring (CGM) and the measurement of glycated haemoglobin (HbA1c) levels. MATERIALS AND METHODS: This prospective, observational study included nineteen patients (median (25-75 pc) age: 12.75 (6.17-15.55) years) with permanent CNS damage (Gross Motor Function Classification System V) receiving long-term tube enteral feeding, recruited from two paediatric university nutritional treatment centres. Patients with acute conditions and diagnosed diabetes were excluded. The nutritional status and nutritional support were analysed in all the inpatients in accordance with a uniform protocol. Using the CGM system (Medtronic iPro2), glycaemic curves were analysed, and in addition, HbA1C levels were determined in fourteen patients. CGM results were analysed using GlyCulator2.0. Statistical analysis was performed using the Statistica version 11 software (StatSoft Inc. Tulsa, OK, USA). RESULTS: More than half (11/19; 58%) of the patients were undernourished (BMI < 3 pc for age and gender), with the stature age being significantly lower than calendar age (5 (4.5-9) vs. 12.75 (6.17-15.55) years; p = 0.0010). The actual caloric intake was 50 (37.7-68.8) kcal/kg (median; 25-75 pc). In patients fed using the bolus method, the number of calories consumed per day was statistically significantly higher than in children subjected to a continuous feeding supply (56.00 (41.00-75.00) vs. 33.40 (26.70-50.00) kcal/kg BW (body weight; p = 0.0159). Decreases in blood glucose levels below the alarm level (<70 mg/dL) were recorded in fifteen patients (78.9%), including two patients with episodes of clinically significant hypoglycaemia (<54 mg/dL). The minimum and maximum glycaemic values recorded in any individual CGM records were 67 mg/dL (median) (minimum: 41 mg/dL; maximum: 77 mg/dL) and 146 (minimum: 114 mg/dL; maximum: 180 g/dL), respectively, for the entire recording. The maximum percentage of glycaemic concentrations > 140 mg/dL (TAR 140) recorded overnight in children with BMI ≥ 3 amounted to 1.6% vs. 0% in undernourished patients (TAR 140: 0.0 (0.00-1.6%) vs. 0% (0.00-0.0%; p = 0.0375); the percentage of glycaemic concentrations <70 mg/dL in the entire recording was comparable (0.77% (0.13-2.2%) vs. 1.8% (0.5-14.4%) vs. p = 0.2629). There was a positive correlation between the mean daily glucose recorded using the CGM method and patients' BMI z-scores (R = 0.48, p = 0.0397). No statistically significant relationship was demonstrated between the occurrence of alarm hypoglycaemia events in the CGM records and undernutrition expressed by BMI z-scores (OR = 1.50 (95%CI: 0.16-13.75), the type of diet (for commercially manufactured OR = 0.36 (95%CI: 0.04-3.52), and the modality of diet delivery (for bolus feeding OR = 2.75 (95%CI: 0.28-26.61). CONCLUSIONS: In children with chronic OU damage, enteral feeding is associated with a risk of hypoglycaemia, but further studies involving a larger number of patients are needed, and CGM might be a useful tool to estimate the metabolic adequacy of enteral nutritional support in terms of glucose control.

DNA aptamer-based affinity chromatography system for purification of recombinant proteins tagged with lysine tag.

Affinity chromatography (AC) is one of the techniques widely used for the purification of recombinant proteins. In our previous study, we presented a successful application of the Argi system [1] for the purification of recombinant proteins, based on the specific interaction between an arginine tag and a DNA aptamer. Exploring the possible application of positively charged peptide tags in the purification of recombinant proteins, in this study we developed and characterized an AC system based on the specific and reversible interaction between a DNA aptamer and a lysine tag (Lys-tag) comprising five lysine residues (5 K). We optimized the length of both the selected DNA aptamer and Lys-tag which were named B5K aptamer and 5K-tag, respectively. The results showed that the stability of the B5K aptamer and 5K-tag was dependent on the presence of potassium ions. The conditions for mild elution of 5K-tagged protein from B5K aptamer were determined. Our study proved that the developed system can be used for the purification of recombinant proteins from Escherichia coli total protein extracts.

Evaluation of Antifungal Properties of Titania P25.

Commercial titania photocatalyst­P25 was chosen for an antifungal property examination due to it exhibiting one of the highest photocatalytic activities among titania photocatalysts. Titania P25 was homogenized first (HomoP25) and then annealed at different temperatures. Additionally, HomoP25 was modified with 0.5 wt% or 2.0 wt% of platinum by a photodeposition method. The obtained samples were characterized by diffuse-reflectance spectroscopy (DRS), X-ray photoabsorption spectroscopy (XPS), X-ray diffraction (XRD) and Raman spectroscopy. Moreover, photocatalytic activity was tested for methanol dehydrogenation under UV/vis irradiation. The spore-destroying effect of photocatalysts was investigated against two mold fungal species, i.e., Aspergillus fumigatus and Aspergillus niger. Both the mycelium growth and API ZYM (estimation of enzymatic activity) tests were applied for the assessment of antifungal effect. It was found that annealing caused a change of surface properties of the titania samples, i.e., an increase in the noncrystalline part, a growth of particles and enhanced oxygen adsorption on its surface, which resulted in an increase in both the hydrogen evolution rate and the antifungal effect. Titania samples annealed at 300−500 °C were highly active during 60-min UV/vis irradiation, inhibiting the germination of both fungal spores, whereas titania modification with platinum (0.5 and 2.0 wt%) had negligible effect, despite being highly active for hydrogen evolution. The control experiments revealed the lack of titania activity in the dark, as well as high resistance of fungi for applied UV/vis irradiation in the absence of photocatalysts. Moreover, the complete inhibition of 19 hydrolases, secreted by both tested fungi, was noted under UV/vis irradiation on the annealed P25 sample. It is proposed that titania photocatalysts of large particle sizes (>150 nm) and enriched surface with oxygen might efficiently destroy fungal structures under mild irradiation conditions and, thus, be highly promising as covering materials for daily products.

Property-governed performance of platinum-modified titania photocatalysts.

Titania is probably the most widely investigated semiconductor photocatalyst because of various advantages, such as high activity, thermal and chemical stability, low price, abundance, and negligible toxicity. However, pristine titania is also characterized by charge carriers' recombination, and thus lower quantum yields of photocatalytic reactions than theoretical 100%. Moreover, its wide bandgap, despite being recommended for excellent redox properties, means also inactivity under visible part of solar radiation. Accordingly, titania has been surface modified, doped and coupled with various elements/compounds. For example, platinum deposited on the surface of titania has shown to improve both UV activity and the performance under vis. Although the studies on titania modification with platinum started almost half a century ago, and huge number of papers have been published up to now, it is unclear which properties are the most crucial and recommended to obtain highly efficient photocatalyst. In the literature, the opposite findings could be found on the property-governed activities that could result from huge differences in the reaction systems, and also examined photocatalysts. Considering the platinum properties, its content, the size of nanoparticles and the oxidation state, must be examined. Obviously, the characteristics of titania also influence the resultant properties of deposited platinum, and thus the overall photocatalytic performance. Although so many reports on Pt/TiO2 have been published, it is hardly possible to give indispensable advice on the recommended properties. However, it might be concluded that usually fine platinum NPs uniformly deposited on the titania surface result in high photocatalytic activity, and thus in the low optimal content of necessary platinum. Moreover, the aggregation of titania particles might also help in the lowering the necessary platinum amount (even to 0.2 wt%) due to the interparticle electron transfer mechanism between titania particles in one aggregate. In respect of platinum state, it is thought that it is highly substrate-specific case, and thus either positively charged or zero valent platinum is the most recommended. It might be concluded that despite huge number of papers published on platinum-modified titania, there is still a lack of comprehensive study showing the direct correlation between only one property and the resultant photocatalytic activity.

The property-governed activity of silver-modified titania photocatalysts: The influence of titania matrix.

Commercial titania photocatalysts were modified with silver nanoparticles (NPs) by the photodeposition method in the presence/absence of methanol. The obtained photocatalysts were characterized by XRD, XPS, diffuse reflectance spectroscopy, STEM, and time-resolved microwave conductivity (TRMC) methods. The photocatalytic activity was tested under UV/vis irradiation for (i) methanol dehydrogenation (during silver deposition), (ii) oxygen evolution with in situ silver deposition, and (iii) oxidative decomposition of acetic acid, as well as under vis irradiation for 2-propanol oxidation. The action spectra of 2-propanol oxidation were also performed. It has been confirmed that modification of titania with silver causes significant improvement of photocatalytic activity under both UV and vis irradiation as silver works as an electron scavenger (TRMC data) and vis activator (possibly by an energy transfer mechanism). The obtained activities differ between titania samples significantly, suggesting that the type of crystalline phase, particle/crystallite sizes, and electron traps' density are crucial for both the properties of formed silver deposits and resultant photocatalytic activity. It might be concluded that, under UV irradiation, (i) high crystallinity and large specific surface area are recommended for rutile- and anatase-rich samples, respectively, during hydrogen evolution, (ii) mixed crystalline phases cause a high rate of oxygen evolution from water, and (iii) anatase phase with fine silver NPs results in efficient decomposition of acetic acid, whereas under vis irradiation the aggregated silver NPs (broad localized surface plasmon resonance peak) on the rutile phase are promising for oxidation reactions.

Materials Used for the Microencapsulation of Probiotic Bacteria in the Food Industry.

Probiotics and probiotic therapy have been rapidly developing in recent years due to an increasing number of people suffering from digestive system disorders and diseases related to intestinal dysbiosis. Owing to their activity in the intestines, including the production of short-chain fatty acids, probiotic strains of lactic acid bacteria can have a significant therapeutic effect. The activity of probiotic strains is likely reduced by their loss of viability during gastrointestinal transit. To overcome this drawback, researchers have proposed the process of microencapsulation, which increases the resistance of bacterial cells to external conditions. Various types of coatings have been used for microencapsulation, but the most popular ones are carbohydrate and protein microcapsules. Microencapsulating probiotics with vegetable proteins is an innovative approach that can increase the health value of the final product. This review describes the different types of envelope materials that have been used so far for encapsulating bacterial biomass and improving the survival of bacterial cells. The use of a microenvelope has initiated the controlled release of bacterial cells and an increase in their activity in the large intestine, which is the target site of probiotic strains.

Development of Sulfur-Doped Graphitic Carbon Nitride for Hydrogen Evolution under Visible-Light Irradiation.

Developing eco-friendly strategies to produce green fuel has attracted continuous and extensive attention. In this study, a novel gas-templating method was developed to prepare 2D porous S-doped g-C3N4 photocatalyst through simultaneous pyrolysis of urea (main g-C3N4 precursor) and ammonium sulfate (sulfur source and structure promoter). Different content of ammonium sulfate was examined to find the optimal synthesis conditions and to investigate the property-governed activity. The physicochemical properties of the obtained photocatalysts were analyzed by X-ray diffraction (XRD), field emission-scanning electron microscopy (FE-SEM), scanning transmission electron microscopy (STEM), specific surface area (BET) measurement, ultraviolet-visible light diffuse reflectance spectroscopy (UV/vis DRS), X-ray photoelectron spectroscopy (XPS), photoluminescence (PL) spectroscopy and reversed double-beam photo-acoustic spectroscopy (RDB-PAS). The as-prepared S-doped g-C3N4 photocatalysts were applied for photocatalytic H2 evolution under vis irradiation. The condition-dependent activity was probed to achieve the best photocatalytic performance. It was demonstrated that ammonium sulfate played a crucial role to achieve concurrently 2D morphology, controlled nanostructure, and S-doping of g-C3N4 in a one-pot process. The 2D nanoporous S-doped g-C3N4 of crumpled lamellar-like structure with large specific surface area (73.8 m2 g-1) and improved electron-hole separation showed a remarkable H2 generation rate, which was almost one order in magnitude higher than that of pristine g-C3N4. It has been found that though all properties are crucial for the overall photocatalytic performance, efficient doping is probably a key factor for high photocatalytic activity. Moreover, the photocatalysts exhibit significant stability during recycling. Accordingly, a significant potential of S-doped g-C3N4 has been revealed for practical use under natural solar radiation.

Oesophageal pH-Impedance for the Diagnosis of Gastro-Oesophageal Reflux Disease: Validation of General Population Reference Values in Children with Chronic Neurological Impairments.

Diagnosis of gastro-oesophageal reflux disease (GORD) in children with chronic neurological impairment (NI) remains a clinical challenge. The study aimed to validate the relevance of the reference values used to assess gastro-oesophageal reflux (GOR) in children with NI and to determine the optimal cut-off level of the pH-impedance parameter with the best predictive value for outcomes associated with endoscopic assessments of the oesophagus. Sixty-seven children (32 male, 35 female; age: interquartile range, 5 years 6 months-14 years 10 months; median, 11 years 3 months) with NI were prospectively recruited for the study. The exclusion criteria were previous fundoplication and lack of consent for the study. All patients underwent evaluations for GOR disease, including pH-impedance and gastroscopy. Based on endoscopy, oesophagitis was diagnosed in 22/67 children (32.8%); 9/67 (13.4%) were classified as having Hetzel-Dent grade III or IV. GOR was present in 18/67 children (26.9%), as determined by pH-impedance. Patients with endoscopic lesions had a significantly higher number of total reflux (p = 0.0404) and acidic episodes (p = 0.0219). The total number of reflux episodes, with a cut-off level of 44 episodes, was the pH-impedance parameter most strongly predictive of the presence of lesions in gastroscopy (specificity: 50%, sensitivity: 73%). These findings suggest that endoscopic lesions may be present in children with chronic NI with a low number of GOR episodes, as recorded by pH-impedance. The use of standardised reference norms determined for the general population may underestimate GOR episodes in this group of patients.

Some Dietary Phenolic Compounds Can Activate Thyroid Peroxidase and Inhibit Lipoxygenase-Preliminary Study in the Model Systems.

The presented research concerns the triple activity of trans-cinnamic (tCA), ferulic (FA) and syringic acids (SA). They act as thyroid peroxidase (TPO) activators, lipoxygenase (LOX) inhibitors and show antiradical activity. All compounds showed a dose-dependent TPO activatory effect, thus the AC50 value (the concentration resulting in 50% activation) was determined. The tested compounds can be ranked as follows: tCA > FA > SA with AC50 = 0.10, 0.39, 0.69 mM, respectively. Strong synergism was found between FA and SA. The activatory effects of all tested compounds may result from interaction with the TPO allosteric site. It was proposed that conformational change resulting from activator binding to TPO allosteric pocket results from the flexibility of a nearby loop formed by residues Val352-Tyr363. All compounds act as uncompetitive LOX inhibitors. The most effective were tCA and SA, whereas the weakest was FA (IC50 = 0.009 mM and IC50 0.027 mM, respectively). In all cases, an interaction between the inhibitors carboxylic groups and side-chain atoms of Arg102 and Arg139 in an allosteric pocket of LOX was suggested. FA/tCA and FA/SA acted synergistically, whereas tCA/SA demonstrated antagonism. The highest antiradical activity was found in the case of SA (IC50 = 0.22 mM). FA/tCA and tCA/SA acted synergistically, whereas antagonism was found for the SA/FA mixture.

Analysis of frequency and risk factors for complications of enteral nutrition in children in Poland after percutaneous endoscopic gastrostomy placement.

OBJECTIVES: The aim of the study was to assess the complication rate and identify whether age, nutritional status, and history of respiratory aspiration prior to percutaneous endoscopic gastrostomy (PEG) are risk factors for post-PEG placement complications in Polish children. In addition, the safety of two enteral feeding methods (3 h vs. 8 h) after PEG insertion in children was compared. METHODS: Children with clinical indications for PEG placement were recruited from six medical centers in Poland to participate in the study. The patients were centrally randomized to receive the first bolus feed via a feeding tube at 3 h (group 1) or 8 h (group 2) after PEG placement. The preprocedural preparation, postoperative care, and resumption of feeding were performed on all of patients in accordance with the study protocol. Patients were followed for 12 mo. RESULTS: Of the 97 randomized patients, 49 were assigned to group 1 and 48 to group 2. Full feed after PEG placement was achieved within 24 to 48 h in most cases (74% vs. 82%). There were no differences between the groups regarding the number of early mild (31.3% vs. 31.3%) and serious (2.1% vs 8.3%) complications or the duration of hospitalization after PEG placement (P > 0.05). The most common serious complication after PEG placement was accidental displacement of PEG. Most reported late complications were mild. The results of the regression analysis indicate no statistically significant effect of age, body mass index standard deviation score, white blood cell count, serum albumin level, and respiratory aspiration in the medical history on the occurrence of mild and severe complications. CONCLUSIONS: The early initiation of post-PEG feeding was not associated with an increase in the number of complications. Most complications after the PEG procedure were mild. Age, serum albumin level, white blood cells, body mass index standard deviation score, and a history of aspiration to the respiratory tract were not confirmed as a risk factor for post-PEG complications in children.

Home Artificial Nutrition in Polish Children: An Analysis of 9-Year National Healthcare Provider Data.

BACKGROUND: Home artificial nutrition (HAN) is a developing method of treatment that reduces the need for hospitalizations. The epidemiology of pediatric HAN in Poland has not yet been covered in detail. This study is a longitudinal nationwide analysis of incidence, prevalence, and patients' profile for HAN in Polish children. METHODS: Assessment of National Health Fund (NFZ) data covering all pediatric patients treated with HAN in Poland between 2010 and 2018. RESULTS: HAN was received by 4426 children, 65 patients were on home enteral nutrition (HEN) or home parenteral nutrition (HPN) at different times (HEN n = 3865, HPN n = 626). HAN was most frequently started before the child was 3 years old and long-term HAN programs (5-9 years) were reported. The most common principal diagnosis in HEN was food-related symptoms and signs. In HPN, it was postoperative gastrointestinal disorders. A regionally differentiated prevalence of HAN patients and centers was demonstrated. Mortality among patients was 24.9% for HEN, and 9.6% for HPN, and the main in-hospital cause of death was cardiac arrest. CONCLUSIONS: HAN's use is increasing and evolving in Poland. Uneven distribution of patients and centers results in difficult access to the nutritional procedure which, together with the increasing number of patients, highlights the need for data analysis and development of nutrition centers.

Analysis of vitamin D3 metabolites in survivors of infantile idiopathic hypercalcemia caused by CYP24A1 mutation or SLC34A1 mutation.

Infantile hypercalcemia (IH), is a rare disorder caused by CYP24A1 or SLC34A1 variants which lead to disturbed catabolism of 25(OH)D3 and 125(OH)2D3 or increased generation of 125(OH)2D3. AIM OF STUDY: To assess the status of 2425(OH)2D3 and other markers of vitamin D in IH survivors, in whom variants of CYP24A1 or SLC34A1 gene were found and to compare these unique biochemical features with those obtained from subjects who were diagnosed in the first year of life with hypercalcemia, elevated 25(OH)D3 and low PTH but in whom neither CYP24A1 nor SLC34A1 variant was found. PATIENTS AND METHODS: 16 IH survivors in whom CYP24A1 (n = 13) or SLC34A1 (n = 3) variants were found and 41 subjects in whom hypercalcemia was diagnosed in the first year of life but in whom CYP24A1 or SLC34A1 variants were not found were included in the study. 25(OH)D3, 3-epi-25(OH)D3, 25(OH)D2, 2425(OH)2D3 were assessed by liquid chromatography coupled with tandem mass spectrometry. 125(OH)2D3 concentrations were assessed by chemiluminescence. RESULTS: Subjects with CYP24A1 variants, despite normal 25(OH)D3 levels, had higher 25(OH)D3/2425(OH)2D3 ratio values (487; 265-1073 ng/mL) when compared to subjects with SLC34A1 variants (16; 16-23 ng/mL) and with subjects in whom CYP24A1 or SLC34A1 were not found (56; 9-56 ng/mL) (p = 0.00003). Separation of interfering metabolite further increased differences between subjects with and without CYP24A1 mutation. CONCLUSIONS: Survivors of IH with CYP24A1 variant, despite being normocalcemic, still presented extremely high 25(OH)D3/2425(OH)2D3 ratio values. Separation of interfering compound further increased differences between subjects with CYP24A1 mutation and without this mutation.

Long-term outcome of the survivors of infantile hypercalcaemia with CYP24A1 and SLC34A1 mutations.

BACKGROUND: Infantile hypercalcaemia (IH) is a vitamin D3 metabolism disorder. The molecular basis for IH is biallelic mutations in the CYP24A1 or SLC34A1 gene. These changes lead to catabolism disorders (CYP24A1 mutations) or excessive generation of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] (SLC34A1 mutations). The incidence rate of IH in children and the risk level for developing end-stage renal disease (ESRD) are still unknown. The aim of this study was to analyse the long-term outcome of adolescents and young adults who suffered from IH in infancy. DESIGN: Forty-two children (23 girls; average age 10.7 ± 6.3 years) and 26 adults (14 women; average age 24.2 ± 4.4 years) with a personal history of hypercalcaemia with elevated 1,25(OH)2D3 levels were included in the analysis. In all patients, a genetic analysis of possible IH mutations was conducted, as well as laboratory tests and renal ultrasonography. RESULTS: IH was confirmed in 20 studied patients (10 females). CYP24A1 mutations were found in 16 patients (8 females) and SLC34A1 in 4 patients (2 females). The long-term outcome was assessed in 18 patients with an average age of 23.8 years (age range 2-34). The average glomerular filtration rate (GFR) was 72 mL/min/1.73 m2 (range 15-105). Two patients with a CYP24A1 mutation developed ESRD and underwent renal transplantation. A GFR <90 mL/min/1.73 m2 was found in 14 patients (77%), whereas a GFR <60 mL/min/1.73 m2 was seen in 5 patients (28%), including 2 adults after renal transplantation. Three of 18 patients still had serum calcium levels >2.6 mmol/L. A renal ultrasound revealed nephrocalcinosis in 16 of 18 (88%) patients, however, mild hypercalciuria was detected in only one subject. CONCLUSIONS: Subjects who suffered from IH have a greater risk of progressive chronic kidney disease and nephrocalcinosis. This indicates that all survivors of IH should be closely monitored, with early implementation of preventive measures, e.g. inhibition of active metabolites of vitamin D3 synthesis.

The Dark Side of UV-Induced DNA Lesion Repair.

In their life cycle, plants are exposed to various unfavorable environmental factors including ultraviolet (UV) radiation emitted by the Sun. UV-A and UV-B, which are partially absorbed by the ozone layer, reach the surface of the Earth causing harmful effects among the others on plant genetic material. The energy of UV light is sufficient to induce mutations in DNA. Some examples of DNA damage induced by UV are pyrimidine dimers, oxidized nucleotides as well as single and double-strand breaks. When exposed to light, plants can repair major UV-induced DNA lesions, i.e., pyrimidine dimers using photoreactivation. However, this highly efficient light-dependent DNA repair system is ineffective in dim light or at night. Moreover, it is helpless when it comes to the repair of DNA lesions other than pyrimidine dimers. In this review, we have focused on how plants cope with deleterious DNA damage that cannot be repaired by photoreactivation. The current understanding of light-independent mechanisms, classified as dark DNA repair, indispensable for the maintenance of plant genetic material integrity has been presented.