Collagenous gastritis in children: A national cohort

BACKGROUND

Collagen gastritis is a rare disease that manifests in children mainly as isolated gastric involvement associated with martial deficiency anemia. There are no recommendations for the management and follow-up of these patients. We aimed to describe the clinical data, endoscopic findings, and treatments deployed in France's children with collagenous gastritis.

METHODS

All French pediatric gastroenterology centers and pediatric centers for rare digestive diseases (Centres de Maladies Rares Digestives) were contacted to collect cases of collagenous gastritis, defined on gastric biopsies and diagnosed before 18 years of age.

RESULTS

A total of 12 cases diagnosed (4 males and 8 females) between 1995 and 2022 could be analyzed. The median age at diagnosis was 12.5 years (7-15.2). The most frequent clinical presentation was abdominal pain (6/11) and/or nonspecific symptomatology attributed to anemia (8/10). Anemia was present in all children (11/11; Hb 2.8-9.1 g/dL). Nodular gastritis was present in 10 patients (antrum: 2; fundus: 4; in antrum and fundus: 4). All patients had a basement membrane thickening (from 19 to 100 μm). The treatments received were PPI (11), oral or intravenous martial supplementation (12), budesonide (1), and prednisone (1). Martial supplementation improved anemia in all cases. At discontinuation, nine of 10 patients had a recurrence of anemia.

CONCLUSION

Collagenous gastritis is an exceptional condition, clinically manifested in children as abdominal pain and iron deficiency anemia probably of hemorrhagic origin. Patients require long-term follow-up and monitoring of their disease to describe the risk of progression better.

Ethylene plays a dual role in sex determination and fruit shape in cucurbits

Shapes of vegetables and fruits are the result of adaptive evolution and human selection. Modules controlling organ shape have been identified. However, little is known about signals coordinating organ development and shape. Here, we describe the characterization of a melon mutation rf1, leading to round fruit. Histological analysis of rf1 flower and fruits revealed fruit shape is determined at flower stage 8, after sex determination and before flower fertilization. Using positional cloning, we identified the causal gene as the monoecy sex determination gene CmACS7, and survey of melon germplasms showed strong association between fruit shape and sexual types. We show that CmACS7-mediated ethylene production in carpel primordia enhances cell expansion and represses cell division, leading to elongated fruit. Cell size is known to rise as a result of endoreduplication. At stage 8 and anthesis, we found no variation in ploidy levels between female and hermaphrodite flowers, ruling out endoreduplication as a factor in fruit shape determination. To pinpoint the gene networks controlling elongated versus round fruit phenotype, we analyzed the transcriptomes of laser capture microdissected carpels of wild-type and rf1 mutant. These high-resolution spatiotemporal gene expression dynamics revealed the implication of two regulatory modules. The first module implicates E2F-DP transcription factors, controlling cell elongation versus cell division. The second module implicates OVATE- and TRM5-related proteins, controlling cell division patterns. Our finding highlights the dual role of ethylene in the inhibition of the stamina development and the elongation of ovary and fruit in cucurbits.

Quantification of Chaotic Intrinsic Variability of Sea-Air CO2 Fluxes at Interannual Timescales

Chaotic intrinsic variability (CIV) emerges spontaneously from nonlinear ocean dynamics even without any atmospheric variability. Eddy-permitting numerical simulations suggest that CIV is a significant contributor to the interannual to decadal variability of physical properties. Here we show from an ensemble of global ocean eddy-permitting simulations that large-scale interannual CIV propagates from physical properties to sea-air CO2 fluxes in areas of high mesoscale eddy activity (e.g., Southern Ocean and western boundary currents). In these regions and at scales larger than 500 km (~5°), CIV contributes significantly to the interannual variability of sea-air CO2 fluxes. Between 35°S and 45°S (midlatitude Southern Ocean), CIV amounts to 23.76 TgC yr-1 or one half of the atmospherically forced variability. Locally, its contribution to the total interannual variance of sea-air CO2 fluxes exceeds 76%. Outside eddy-active regions its contribution to total interannual variability is below 16%.

Arabidopsis thaliana plants challenged with uranium reveal new insights into iron and phosphate homeostasis

Uranium (U) is a naturally occurring radionuclide that is toxic to plants. It is known to interfere with phosphate nutrition and to modify the expression of iron (Fe)-responsive genes. The transporters involved in the uptake of U from the environment are unknown. Here, we addressed whether IRT1, a high-affinity Fe²⁺ transporter, could contribute to U uptake in Arabidopsis thaliana. An irt1 null mutant was grown hydroponically in different conditions of Fe bioavailability and phosphate supply, and challenged with uranyl. Several physiological parameters (fitness, photosynthesis) were measured to evaluate the response to U treatment. We found that IRT1 is not a major route for U uptake in our experimental conditions. However, the analysis of irt1 indicated that uranyl interferes with Fe and phosphate homeostasis at different levels. In phosphate-sufficient conditions, the absence of the cation chelator EDTA in the medium has drastic consequences on the physiology of irt1, with important symptoms of Fe deficiency in chloroplasts. These effects are counterbalanced by U, probably because the radionuclide competes with Fe for complexation with phosphate and thus releases active Fe for metabolic and biogenic processes. Our study reveals that challenging plants with U is useful to decipher the complex interplay between Fe and phosphate.

Uranium perturbs signaling and iron uptake response in Arabidopsis thaliana roots

The early plant root response to uranyl was characterized using complete Arabidopsis transcriptome microarrays.

Expression of SofLAC, a new laccase in sugarcane, restores lignin content but not S:G ratio of Arabidopsis lac17 mutant

Lignin is a complex phenolic heteropolymer deposited in the secondarily thickened walls of specialized plant cells to provide strength for plants to stand upright and hydrophobicity to conducting cells for long-distance water transport. Although essential for plant growth and development, lignin is the major plant cell-wall component responsible for biomass recalcitrance to industrial processing. Peroxidases and laccases are generally thought to be responsible for lignin polymerization, but, given their broad substrate specificities and large gene families, specific isoforms involved in lignification are difficult to identify. This study used a combination of co-expression analysis, tissue/cell-type-specific expression analysis, and genetic complementation to correlate a sugarcane laccase gene, SofLAC, to the lignification process. A co-expression network constructed from 37 cDNA libraries showed that SofLAC was coordinately expressed with several phenylpropanoid biosynthesis genes. Tissue-specific expression analysis by quantitative RT-PCR showed that SofLAC was expressed preferentially in young internodes and that expression levels decrease with stem maturity. Cell-type-specific expression analysis by in situ hybridization demonstrated the localization of SofLAC mRNA in lignifying cell types, mainly in inner and outer portions of sclerenchymatic bundle sheaths. To investigate whether SofLAC is able to oxidize monolignols during lignification, the Arabidopsis lac17 mutant, which has reduced lignin levels, was complemented by expressing SofLAC under the control of the Arabidopsis AtLAC17 promoter. The expression of SofLAC restored the lignin content but not the lignin composition in complemented lac17 mutant lines. Taken together, these results suggest that SofLAC participates in lignification in sugarcane.

Disruption of LACCASE4 and 17 results in tissue-specific alterations to lignification of Arabidopsis thaliana stems

Peroxidases have been shown to be involved in the polymerization of lignin precursors, but it remains unclear whether laccases (EC 1.10.3.2) participate in constitutive lignification. We addressed this issue by studying laccase T-DNA insertion mutants in Arabidopsis thaliana. We identified two genes, LAC4 and LAC17, which are strongly expressed in stems. LAC17 was mainly expressed in the interfascicular fibers, whereas LAC4 was expressed in vascular bundles and interfascicular fibers. We produced two double mutants by crossing the LAC17 (lac17) mutant with two LAC4 mutants (lac4-1 and lac4-2). The single and double mutants grew normally in greenhouse conditions. The single mutants had moderately low lignin levels, whereas the stems of lac4-1 lac17 and lac4-2 lac17 mutants had lignin contents that were 20 and 40% lower than those of the control, respectively. These lower lignin levels resulted in higher saccharification yields. Thioacidolysis revealed that disrupting LAC17 principally affected the deposition of G lignin units in the interfascicular fibers and that complementation of lac17 with LAC17 restored a normal lignin profile. This study provides evidence that both LAC4 and LAC17 contribute to the constitutive lignification of Arabidopsis stems and that LAC17 is involved in the deposition of G lignin units in fibers.

[Eosinophilic esophagitis. Clinical presentation, allergology and treatment: a series of 22 children]

BACKGROUND AND AIMS

Eosinophilic esophagitis (EE) is a disorder characterized by severe eosinophilic infiltration of the esophagus, with dysphagia and gastroesophageal reflux disease (GERD) symptoms unresponsive to acid blockade therapy but responsive to the removal of dietary antigens. We report information relating to children diagnosed with EE in Nice, France, over a 6-year period.

PATIENTS AND METHODS

We conducted a retrospective study between January 1, 2004, and July 31, 2009, evaluating all children diagnosed with EE. Clinical and demographic data, endoscopic and histological findings, allergology data, and results of treatment were collected and evaluated.

RESULTS

A total of 22 patients, 19 males, median age 9.5 years (range: 0.8-19 years) were reviewed: 7 presented isolated dysphagia, 6 presented GERD symptoms, and 9 both dysphagia and GERD symptoms. Endoscopically, 14 had multiple esophageal white plaques, 7 had linear furrowing, 5 had circular "tracheal" rings, and 5 esophageal narrowing. The median number of esophageal eosinophils/high power field (×400) was 30 (range: 15-80). Eosinophils were localized in the distal, middle, and upper esophagus. Immunoallergy analysis findings were: high peripheral eosinophil count (74%), high total IgE level (65%), high eosinophil cationic protein (ECP) level (90%) with a median value of 69.5 μg/l and high urinary leukotriene E4 (88%). Food antigen sensitization was positive in skin-prick testing in 11 of 18 and in atopy-patch testing in 9 of 17. Dietary restriction improved clinical symptoms in 5 of 10 and local corticotherapy with viscous budesonide improved clinical symptoms in 9 out of 10.

CONCLUSION

EE diagnosis must be considered in children with dysphagia or GERD who do not respond to acid blockade therapy. ECP may be used to guide diagnosis. Local corticotherapy is effective.

[Neonatal screening for sickle cell disease at the Nice University Hospital: the last 8 years]

INTRODUCTION

Screening for sickle cell disease, the most common of recessive autosomic hemoglobin disorders, allows detection of sickle cell disease SCD (homozygous sickle cell disease, compound heterozygote SC, and S β-thalassemia) in a target population. Our objective was to evaluate its effectiveness at the Nice University Hospital.

POPULATION AND METHODS

This prospective study was conducted between 1 January 2000 and 31 December 2008. The national targeted newborn screening, run together with the Guthrie test on the 3rd day of life, offered at-risk newborns (based on ethnicity and family history), allow the detection of qualitative hemoglobin abnormalities. A confirmatory test is performed when positive. Gender, ethnicity, type of hemoglobin found, zygosity, age at diagnosis, the presence at a 2nd consultation of the families identified, and acceptance of the confirmatory test were collected and analyzed.

RESULTS

A total of 19,775 children were born in Nice University Hospital during this period, among whom screening detected 151 hemoglobinopathies: 139 heterozygotes and 12 major sickle cell syndrome (9 SS and 3 S β-thalassemia). The prevalence of SCD on the targeted and the total population was, respectively, 1 out of 659 and 1 out of 1648 and the prevalence of heterozygotes was 1 out of 57 and 1 out of 142. The sex ratio was close to 1. Hemoglobin S predominated (74% of pathogens Hb). The Maghreb and sub-Saharan Africa were the 2 main areas of origin. One hundred and four of 151 families, including 12 cases of SCD, returned to consultation after they received a letter requesting attendance at a 2nd consultation. For 80 children, the confirmatory test was accepted. Feedback was possible for 72 of the 80 families.

DISCUSSION

The number of children screened is increasing, thanks to better awareness among medical staff. The prevalence of SCD and heterozygotes found in Nice University Hospital is similar to what is described in the literature. With screening, early diagnosis allows early treatment at the age of 2 months before the occurrence of complications, reducing morbidity and mortality.

CONCLUSION

Screening for sickle cell disease appears effective in Nice. It seems necessary to continue focusing on the importance of screening among maternity healthcare actors.

[Abdominal aortic injury in a child: seat-belt syndrome]

Traumatic injuries of the abdominal aorta are rare, especially in the pediatric population, but they must be sought when the clinical signs are associated with a severe traumatic context. We report the case of a 7-year-old child who presented with a partial transection of the abdominal aorta following a traffic accident. The optimal management is based on the detection of the less striking but suggestive clinical signs, such as a belt hematoma in the abdominal wall or a decreased pulse in the lower limbs, as well as a systematic precise X-ray examination, and an urgent surgical intervention. The risk is complete rupture, whose time of occurrence after the accident is unpredictable. The abdominal aorta is anatomically protected, so injury in children is traditionally associated with seat belt wear. Lesions are related to the shearing of the abdominal aorta between the spine and the seat belt.

Changes in culturability and virulence of Salmonella typhimurium during long-term starvation under desiccating conditions

The survival of Salmonella typhimurium under desiccation and starvation conditions commonly associated with farm buildings was investigated in a desiccation model system: filtration onto polycarbonate membranes placed in a sealed desiccator with 0.0067 g/m3 absolute humidity. Heterogeneities within bacterial populations in relation to time of desiccation were investigated on a single-cell basis by epifluorescence microscopy coupled with an image analysis system in conjunction with fluorescent dyes Chemchrome V6 and DAPI. Changes in cellular states were compared to the results of plate counts (colony forming units, CFU) on selective (modified semi-solid Rappaport Vassiliadis (MSRV)) and non-selective (nutrient agar (NA) and R2A agar) media, and to the measurements of infectivity and virulence using two animal models (chicks and mice). During 9 weeks of experimental desiccation, total cell counts (DAPI) of starved S. typhimurium remained stable, as did esterase activity (Chemchrome V6), but DAPI fluorescence intensity decreased slowly. Bacterial cells entered gradually into non-culturable states (decrease of CFU counts on MSRV, NA and R2A agar media) and the total loss of culturability on NA (defined as probability of presence of 1 CFU on the membrane inferior to 10 (-6)) was obtained after 9 weeks. Loss of chick infectivity and mice virulence in animal models occurred more rapidly, within three weeks of experimental desiccation.

Crystallization and preliminary structural analysis of catalase A from Saccharomyces cerevisiae

Yeast peroxisomal catalase A, obtained at high yields by over expression of the C-terminally modified gene from a 2 mu-plasmid, has been crystallized in a form suitable for high resolution X-ray diffraction studies. Brownish crystals with bipyrimidal morphology and reaching ca. 0.8 mm in size were produced by the hanging drop method using ammonium sulphate as precipitant. These crystals diffract better than 2.0 A resolution and belong to the hexagonal space group P6(1)22 with unit cell parameters a = b = 184.3 A and c = 305.5 A. An X-ray data set with 76% completeness at 3.2 A resolution was collected in a rotating anode generator using mirrors to improve the collimation of the beam. An initial solution was obtained by molecular replacement only when using a beef liver catalase tetramer model in which fragments with no sequence homology had been omitted, about 150 residues per subunit. In the structure found a single molecule of catalase A (a tetramer with accurate 222 molecular symmetry) is located in the asymmetric unit of the crystal with an estimated solvent content of about 61%. The preliminary analysis of the structure confirms the absence of a carboxy terminal domain as the one found in the catalase from Penicillium vitalae, the only other fungal catalase structure available. The NADPH binding site appears to be involved in crystal contacts, suggesting that heterogeneity in the occupancy of the nucleotide can be a major difficulty during crystallization.

[Proximal fractures of the femur. Economic analysis of hospital treatment]

The cost of hospital treatment of cervical and intertrochanteric fractures of femur is studied in 218 patients aged 70 and over, treated during 1985 in a specialized university department. Real costs show little difference from contractual prices as established by the hospital administration. They depend mainly on the length of hospital stay (a function of the type of treatment) and only indirectly on the type of fracture. The only hope of reducing costs is to shorten the number of days spent by these patients in costly university departments. The physician should therefore try to use methods of treatment that render patients rapidly independent, but the administration should provide enough rehabilitation wards and homes to admit semi-dependent patients rapidly after acute care of the fracture and of any associated pathology.

Adjusted subcutaneous heparin versus heparin plus dihydroergotamine in prevention of deep vein thrombosis after total hip arthroplasty

In a prospective randomized study, two different antithrombotic regimens were compared with regard to their effects on the incidence of deep vein thrombosis (DVT) in 102 patients undergoing elective total hip arthroplasty. Fifty patients (group 1) received heparin subcutaneously three times daily in doses adjusted as a function of activated partial thromboplastin time (APTT), and 52 patients (group 2) received a fixed dose of 5,000 IU heparin plus 0.5 mg dihydroergotamine twice daily. Both treatments were started 2 days before operation and continued for 7-9 days after operation, when venography of the operated leg was performed in all patients. The overall incidence of DVT was 22% in group 1 and 19.6% in group 2. Eight patients (16%) in group 1 and four (7.6%) in group 2 developed proximal DVT. These differences were not statistically significant. Hemorrhagic complications occurred more frequently in group 1. Heparin plus dihydroergotamine is a simple and effective method of preventing DVT in patients undergoing total hip arthroplasty. Daily APTT-adjusted subcutaneous heparin remains the best method of prevention of DVT in patients with contraindications to the use of dihydroergotamine and those with two or more DVT risk factors.