Endothelial Colony Forming Cells and Mesenchymal Stem Cells are Enriched at Different Gestational Ages in Human Umbilical Cord Blood.

Endothelial progenitor cells (EPCs) are used for angiogenic therapies and as biomarkers of cardiovascular disease. Human umbilical cord blood (UCB) is a rich source of endothelial colony forming cells (ECFCs), which are EPCs with robust proliferative potential that may be useful for clinical vascular regeneration. Previous studies show that hematopoietic progenitor cells are increased in premature UCB compared to term controls. Based on this paradigm, we hypothesized that premature UCB would be an enriched source of ECFCs. Thirty-nine UCB samples were obtained from premature infants (24-37 weeks gestational age (GA)) and term controls. ECFC colonies were enumerated, clonally isolated, and identified by expression of endothelial cell surface antigens and functional analysis. 33-36 week GA UCB yielded predominantly ECFC colonies at equivalent numbers to term infants. UCB from 24-28 weeks GA infants had significantly fewer ECFCs. Surprisingly, 24-28 week GA UCB yielded predominantly mesenchymal stem cell (MSC) colonies, capable of differentiating into adipocytes, chondrocytes, and osteocytes. MSCs were rarely identified in 37-40 weeks GA UCB. These studies demonstrate that circulating MSCs and ECFCs appear at different GA in the human UCB, and that 24-28 week GA UCB may be a novel source of MSCs for therapeutic use in human diseases.

Javed MJ, Mead LE, Prater D, Bessler WK, Foster D, Case J, Goebel WS, Yoder MC, Haneline LS, Ingram DA.

Department of Pediatrics [M.J.J., L.E.M., D.P., W.K.B., D.F., J.C., W.S.G., M.C.Y., L.S.H., D.A.I.], Herman B Wells Center for Pediatric Research [M.J.J., L.E.M., W.K.B., D.F., J.C., W.S.G., M.C.Y., L.S.H., D.A.I., Department of Biochemistry and Molecular Biology [M.C.Y., D.A.I.], Department of Immunology and Microbiology [L.S.H.], Indiana University School of Medicine, Indianapolis, IN, 46202.

Torquetenovirus Infection and Ciliary Dysmotility in Children With Recurrent Pneumonia.

BACKGROUND:: The aim of the study was to assess Torquetenovirus (TTV) loads within respiratory ciliated cells and to verify the existence of a correlation between TTV loads and functional or structural ciliary abnormalities, in a group of children with recurrent or persistent pneumonia. METHODS:: Nasal brushing samples of 55 children (28 male) were evaluated for ciliary motion and ultrastructural assessment, as well as for detection and quantification of TTV. Moreover, presence and load of TTV within ciliated cells, obtained from 5 patients by laser capture microdissection, were determined. RESULTS:: The nasal samples of 47 (85%) children with persistent or recurrent pneumonia resulted positive for TTV (loads = 2.1-7.3 log10 copies/mug total DNA). TTV were demonstrated also within microdissected ciliated cells. No significant difference between primary (11 subjects) and secondary ciliary dyskinesia (44 subjects) for TTV prevalence and mean loads were found. A significant correlation was observed between nasal TTV loads and ciliary beat frequency score (r = 0.305; P < 0.05), but not between TTV loads and presence of abnormal motion patterns, in patients with secondary ciliary abnormalities. As expected no correlations were found between nasal TTV loads and ciliary motion analysis in primary ciliary dyskinesia. CONCLUSIONS:: The presence of TTV in nasal samples demonstrates TTV ability to infect respiratory ciliated cells and suggests that these cells are potentially able to support virus replication. Moreover, TTV may behave in respiratory cells in a similar way to other viruses, that is, they disrupt the mucociliary escalator.

Pifferi M, Maggi F, Cristofano CD, Cangiotti AM, Nelli LC, Bevilacqua G, Macchia P, Bendinelli M, Boner AL.

From the *Department of Pediatrics, †Virology Section and Retrovirus Center, and Department of Experimental Pathology, and ‡Department of Oncology, Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa, Pisa, Italy; §Electron Microscopy Unit, Umberto I Hospital, Institute of Normal Human Morphology, Polytechnic University, Ancona, Italy; and ∥Department of Pediatrics, University of Verona, Verona, Italy.

Age-Specific Prevalence of Dengue Antibodies in Bangkok Infants and Children.

Seroprevalence of dengue antibodies were determined in healthy children in Bangkok. At 9, 12, and 18 months of age 23%, 9%, and 17% of children respectively had neutralizing antibodies against one or more serotypes. DEN1 was the most prevalent, followed by DEN3, DEN2, and DEN4. Twelve children had serologic evidence of dengue infection. The nadir of dengue antibodies in children was at 12 months of age. In highly endemic areas, dengue vaccination could be needed at an early age.

Pengsaa K, Limkittikul K, Luxemburger C, Yoksan S, Chambonneau L, Ariyasriwatana C, Lapphra K, Chanthavanich P, Lang J, Sabchareon A.

From the *Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; †Sanofi Pasteur, Lyon, France; ‡Center for Vaccine Development, Institution of Sciences and Technology for Research and Development, Mahidol University, Salaya Campus, Nakhon Pathom, Thailand; and §Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand.

Clinical and Laboratory Aspects of Moraxella catarrhalis Bacteremia in Children.

Moraxella catarrhalis is an uncommon cause of bacteremia in children. We present 17 children with M. catarrhalis bacteremia. Most patients were <2 years old (76.4%), immunocompetent (82.3%), and had concomitant lower respiratory symptoms (76.5%). Moraxella catarrhalis bacteremia occurs in young immunocompetent children and is frequently associated with lower respiratory tract symptomatology.

Ahmed A, Broides A, Givon-Lavi N, Peled N, Dagan R, Greenberg D.

From the *The Pediatric Infectious Disease Unit, †The Pediatric Emergency Department, and ‡The Clinical Microbiology Laboratories, Soroka University Medical Center, the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Clinical and Laboratory Features of Neonatal Herpes Simplex Virus Infection: A Case-Control Study.

BACKGROUND:: Neonatal herpes simplex virus (HSV) infection can cause significant morbidity and mortality but can be difficult to identify, particularly in neonates without vesicular rash. OBJECTIVE:: To determine the unique clinical and laboratory features of neonates with and without HSV infection admitted to Texas Children\’s Hospital during a 14-year period. METHODS:: An historic case-control study of all hospitalized neonates with laboratory-confirmed HSV infection and a restricted sample (ratio 1:4) of HSV test-negative hospitalized neonates. Univariate and multivariate analyses were performed to identify clinical and laboratory factors associated with neonatal HSV infection. RESULTS:: Forty cases and 160 comparison subjects were identified. The following factors were associated with neonatal HSV infection by univariate analysis: maternal primary HSV infection, maternal fever, vaginal delivery, prematurity, postnatal HSV contact, vesicular rash, hypothermia, lethargy, seizures, severe respiratory distress, hepatosplenomegaly, thrombocytopenia, elevated hepatic enzymes, and cerebrospinal fluid (CSF) pleocyosis and proteinosis. Factors not associated with neonatal HSV infection were fever, total peripheral white blood cell count, and red blood cells in the CSF. For neonates presenting without vesicular rash, maternal fever, respiratory distress requiring mechanical ventilation, and CSF pleocytosis were independently associated with HSV infection. CONCLUSIONS:: Inclusion of the newly appreciated features of maternal fever, respiratory distress, and thrombocytopenia might improve the detection of neonatal HSV infection. Clinical and laboratory factors typically associated with neonatal HSV infection were confirmed to be maternal primary HSV infection, vaginal delivery, prematurity, neonatal seizures, vesicular rash, elevated hepatic enzymes, and CSF pleocytosis.

Caviness AC, Demmler GJ, Selwyn BJ.

From the Sections of *Pediatric Emergency Medicine and †Infectious Diseases, Department of Pediatrics, Baylor College of Medicine; ‡Diagnostic Virology Laboratory, Texas Children\’s Hospital; and §University of Texas School of Public Health, Houston, TX.

Association Between Herpes Simplex Virus-1 Infection and Idiopathic Unilateral Facial Paralysis in Children and Adolescents.

We studied the association between herpes simplex virus-1 (HSV-1) infection and Bell palsy in children. Thirty-three of 42 affected patients had a positive HSV-1 enzyme-linked immunosorbent assay compared with 16 of 41 controls (P = 0.0003). Ten of 47 affected patients had a positive HSV-1 polymerase chain reaction compared with 4 of 45 of controls (P = 0.08). Our findings support an association between HSV-1 infection and Bell palsy in children.

Khine H, Mayers M, Avner JR, Fox A, Herold B, Goldman DL.

From the *Division of Emergency Medicine, and †Division of Infectious Diseases, Department of Pediatrics, Children\’s Hospital at Montefiore, Albert Einstein of College Medicine, Bronx, NY; and ‡Division of infectious Diseases, Mount Sinai Medical Center, New York, NY.

Congenital Mycoplasma pneumoniae Pneumonia in a Neonate.

A fatal case of vertical transmission of Mycoplasma pneumoniae manifesting as congenital pneumonia in a neonate is presented. The diagnosis was based on the detection of DNA by polymerase chain reaction on the neonatal nasopharyngeal aspirates and placenta and rising titers of maternal anti Mycoplasma antibodies by complement fixation test.

Srinivasjois RM, Kohan R, Keil AD, Smith NM.

From the *Departments of *Neonatal Paediatrics, †Microbiology, and ‡Pathology, PathWest Laboratory Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia.

First Report of CTX-M-15 in Salmonella enterica Serotype Kedougou Recovered From an Algerian Hospital.

Touati A, Benallaoua S, Gharout A, Amar AA, Le Magrex Debar E, Brasme L, Madoux J, De Champs C, Weill FX.

Laboratoire de microbiologie appliquée; FSNV, Université A/MIRA de Béjaia; Béjaia, Algérie (Touati, Benallaoua, Gharout) Laboratoire de Microbiologie-Parasitologie; CHU De Tizi Ouzou, Algérie (Amar) Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière; CHU Reims, UFR; Médecine Université Reims Champagne Ardenne, France (Le Magrex Debar, Brasme, Madoux, De Champs) Centre National de Référence des Salmonella Unité de Biodiversité; des Bactéries Pathogènes Emergentes; Institut Pasteur; 28 rue du Docteur Roux; Paris cedex 15, France (Weill).

Cost-effectiveness of Quantitative Fecal Lactoferrin Assay for Diagnosis of Symptomatic Patients With Ileal Pouch-anal Anastomosis.

BACKGROUND AND AIMS: To assess cost-effectiveness of fecal lactoferrin (FL) as the initial diagnostic approach to symptomatic patients with ileal pouch-anal anastomosis (IPAA). METHODS: Four competing strategies [empiric metronidazole therapy (txMTZ), initial pouch endoscopy with biopsy (testBiop), initial FL assay followed by metronidazole therapy (testFL+MTZ), and initial FL assay followed by pouch endoscopy and biopsy (testFL+Biop)] were modeled in a decision tree. RESULTS: In the base-case, the average cost per patient was $241 for testFL+MTZ, $251 for txMTZ, $405 for testFL+Biop, and $431 for testBiop. The testBiop strategy had greater effectiveness compared with txMTZ but at an incremental cost of $158 per day. The txMTZ strategy was slightly more costly and minimally more effective than testFL+MTZ with an incremental cost effectiveness of just over $12 per day. However, the testFL+MTZ strategy was associated with a 31% absolute reduction in antibiotic exposure compared with the txMTZ strategy. CONCLUSIONS: Compared with empiric metronidazole therapy, FL before treatment with metronidazole is less costly with less exposure to antibiotics and less need for endoscopy, with only marginal decrease in effectiveness.

Parsi MA, Ellis JJ, Lashner BA.

*Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Cleveland Clinic ‡Center for Inflammatory Bowel Disease, Departments of Gastroenterology and Pharmacy, Cleveland Clinic Foundation, Cleveland, Ohio †Center for Medication Use, Policy & Economics, University of Michigan, College of Pharmacy, Ann Arbor, MI.

Prevalence and Clinical Characteristics of Barrett\’s Esophagus in a Chinese General Population.

BACKGROUND: The prevalence of Barrett esophagus (BE) remains elusive in the general populations. GOALS: The purpose of this study was to identify the prevalence and clinical characteristics of BE in a Chinese general population. STUDY: Between June 2003 and December 2006, consecutive subjects were evaluated via upper gastrointestinal endoscopy during a routine health examination. Patients were evaluated for any abnormalities, including endoscopically suspected esophageal metaplasia (ESEM) and erosive esophagitis (EE). Biopsies were attained from patients with ESEM to confirm a diagnosis of BE. The demographic data and endoscopic findings were retrospectively analyzed. RESULTS: Of the 19,812 endoscopies performed, 56 patients (0.28%) were diagnosed with ESEM and 3129 patients (15.7%) with EE. Twelve of the 56 patients diagnosed with ESEM (0.06% of the total number of patients who underwent endoscopy) were confirmed to have BE after histologic analysis of the biopsies. Patients with BE were older than patients without BE (61.6 vs. 51.7 y), and only one of the 12 patients diagnosed with BE (8.3%) reported typical gastroesophageal reflux symptoms. A majority of the BE patients were categorized as short-segment BE (91.7%) and concomitant EE was found in 4 (33.3%). Smoking, alcohol, and metabolic disorders seemed to be associated with the presence of BE and EE. CONCLUSIONS: The prevalence of BE in a Chinese general population was lower than that in other reported studies, particularly in comparison with the studies originating from Western countries. Patients with advanced age and metabolic disorders are risk factors for developing BE.

Tseng PH, Lee YC, Chiu HM, Huang SP, Liao WC, Chen CC, Wang HP, Wu MS, Lin JT.

*Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County †Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health Departments of ‡Internal Medicine §Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.