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Subclinical Hypothyroidism in Children Can Normalize after Changes in Dietary Intake

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Food and Nutrition Sciences 2012年第3期3卷 411-416页

作者： Marj.lein W. j. Kuiper ellen j. van der gaag Department of Pediatrics Ziekenhuisgroep Twente Hengelo The Netherlands.

Background: There is no effective treatment for children with subclinical hypothyroidism. The natural course of subclinical hypothyroidism shows a normalization rate of 41% for Thyroid Stimulating Hormone (TSH). Obj.ctive;The thyroid needs (among others) iron, iodine, and vitamin A for a proper thyroid hormone synthesis. We hypothesize that with a dietary change, more children can normalize their TSH. Design: In this case-control study, 54 children aged 1 - 14 years with subclinical hypothyroidism were divided into a diet group and a control group. The diet consisted of green vegetables, beef, full fat milk, and butter. The diet was followed for at least 3 months. A total of 27 patients comprised the diet group and 27 the control group. TSH, Free T4 (FT4), and Body Mass Index (BMI) were evaluated during the follow up. Results: By following this diet, TSH levels decreased significantly compared to when following the natural course. FT4 levels did not change during the follow up. The diet group realized a change of normalizing their TSH with a RR 2.8 (95% CI 1.45 - 5.61). There were no changes in BMI after following the diet. Conclusions: Even though our study population was small, we observed the association of a dietary change and normalization of TSH in children with subclinical hypothyroidism, without adverse effects.

关键词： Subclinical Hypothyroidism TSH BMI Vitamin A Dairy Products Beef Vegetables

The Teaspoon Method;A Simple Training Program for Feeding Disorders in High Functioning Autistic Children

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Open j.urnal of Pediatrics 2017年第2期7卷 59-71页

作者： ellen j. van der gaag Marlou C. E. Snij.1}s Department of Pediatrics Hospital Group Twente Hengelo The Netherlands

Obj.ctive: About 90% of autistic children are known to have a selective feeding disorder. In particular, methods are lacking for stimulating self feeding and treating selective eating amongst school-aged and adolescent autistic children. We developed a simple training programme for paediatricians in a general hospital to improve the eating pattern of autistic children and decrease selectivity. Methods: The study is an experimental patient series. The instructions for the training were given in 15-minute sessions by a paediatrician with the use of social positive and negative reinforcements. The negative reinforcement was an avoidance situation. The training was performed with parental participation in the home environment of the child. Results and conclusion: In the before and after measurement, the quantitative intake of fruit, potatoes and vegetables increased significantly (p < 0.05). Food selectivity decreased, expressed by an increase in variation of consumed fruit, meat, potatoes and sandwich filling (p < 0.01). The costs of the training are low, and the children stay in their home environment.

关键词： Autism Feeding Disorders Children Parents

Recurrent Upper Respiratory Tract Infections in Children;The Influence of Green Vegetables, Beef, Whole Milk and Butter

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Food and Nutrition Sciences 2013年第10期4卷 71-77页

作者： Loes G. H. Ten Velde j.lien Leegsma ellen j. van der gaag Department of Pediatrics Ziekenhuis Groep Twente Hengelo The Netherlands Department of Pediatrics Ziekenhuis Groep Twente Hengelo The Netherlands.

Background: Immunological mechanism and dietary nutrients are important mediators in the health of children. In this intervention study a dietary advice is given to children between 1 and 6 years of age with recurrent respiratory tract infections. Could a change in nutrient intake result in an altered clinical outcome? Design: In this prospective cohort study 61 children were included and evaluated at a paediatric outpatient clinic. The control group consisted of 32 children included at an infant welfare centre. The patient group followed the dietary advice (green vegetables, beef, whole milk, full-fat butter) for three months, in which parents filled out their dietary intake and health status on a daily basis. A follow up form was filled out by the parents 3 months after completion of the study period. For statistical analysis the programme SPSS version 15.0 was used. Results: In the patient group there was a statistical significant reduction in days with a respiratory infection (15.7 to 11.5 days a month), subfebrile temperature days (1.9 to 0.5 days a month) and febrile temperature days (1.0 to 0.7 days a month) compared to the control group. Also, antibiotic use decreased significantly. No significant changes were measured in body mass index. Conclusions: A change of diet towards green vegetables, beef, whole milk and full-fat butter has positive health effects in children. This diet may work by adding nutrients to optimize immunological mechanisms. There were no adverse effects and it can be utilized by general pediatricians and general practitioners.

关键词： Nutrients Respiratory Infections Common Cold Dairy Products Vegetables

CD4^(+)T cells produce IFN-I to license cDC1s for induction of cytotoxic T-cell activity in human tumors

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Cellular & Molecular Immunology 2024年第4期21卷 374-392页

作者： Xin Lei Daniël C.de Groot Marij.j.P.Welters Tom de Wit ellen Schrama Hans van Eenennaam Saskia j.Santegoets Timo Oosenbrug Annemarthe van der Veen j.ris L.Vos Charlotte L.Zuur Noel F.C.C.de Miranda Heinz j.cobs Sj.erd H.van der Burg j.nnie Borst Yanling Xiao Department of Immunology Leiden University Medical CenterLeidenThe Netherlands Oncode Institute Leiden University Medical CenterLeidenThe Netherlands Department of Tumor Biology and Immunology The Netherlands Cancer InstituteAmsterdamThe Netherlands Department of Medical Oncology Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands IMMIOS B.V. OssThe Netherlands Division of Medical Oncology The Netherlands Cancer InstituteAmsterdamThe Netherlands Department of Otorhinolaryngology Leiden University Medical Center LeidenThe Netherlands Department of Pathology Leiden University Medical CenterLeidenThe Netherlands

CD4^(+)T cells can"help"or"license" conventional type 1 dendritic cells(cDC1s)to induce CD8^(+)cytotoxic T lymphocyte(CTL)anticancer responses,as proven in mouse *** recently identified cDC1s with a transcriptomic imprint of CD4^(+)T-cell help,specifically in T-cell-infiltrated human cancers,and these cells were associated with a good prognosis and response to PD-1-targeting ***,we delineate the mechanism of cDC1 licensing by CD4^(+)T cells in *** CD4^(+)T cells produce IFNβvia the STING pathway,which promotes MHC-I antigen(cross-)presentation by cDC1s and thereby improves their ability to induce CTL anticancer *** cooperation with CD40 ligand(L),IFNβalso optimizes the costimulatory and other functions of cDC1s required for CTL response ***-I-producing CD4^(+)T cells are present in diverse T-cell-infiltrated cancers and likely deliver“help”signals to CTLs locally,according to their transcriptomic profile and colocalization with“helped/licensed”cDCs and tumor-reactive CD8^(+)T *** agreement with this scenario,the presence of IFN-I-producing CD4^(+)T cells in the TME is associated with overall survival and the response to PD-1 checkpoint blockade in cancer patients.

关键词： CD4^(+)T-cell help cDC1 licensing IFN-I signaling CD40 costimulation (cross-)presentation CTL priming Tumor control

Hospitalization Can Correct Behavioral Feeding Disorders in Children by Resetting the Pedagogic Climate

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Open j.urnal of Pediatrics 2014年第2期4卷 135-142页

作者： ellen van der gaag Miriam Münow Department of Pediatrics Hospital Group Twente Hengelo The Netherlands

Background: Behavioral feeding disorders are common among children, which sometimes become progressive, and consequently, children may refuse to eat anything. Parents have lots of difficulties to reset such a disturbed eating pattern. The aim of this study was to perform an analysis of clinical intervention in behavioral feeding disorders in young children. Methods: We conducted a retrospective analysis of data of 28 children aged 1 - 9 years with behavioral feeding disorders. A pediatrician and pediatric social worker conducted the training in two groups: outpatient or inpatient setting. Both groups were treated with parental education and guidance. The inpatient group also had a temporarily (2 weeks) resetting of the pedagogic climate in a pediatric ward of a general hospital under guidance of a pediatric social worker. Results: Almost all parents were inconsistent in applying appropriate behavioral contingencies during meals. Eleven patients followed 8 months of outpatient treatment and 25 patients followed 2 weeks of inpatient treatment. The overall success rate of outpatient treatment after 2 weeks was 18%, and that of inpatient treatment after 8 months was 88%. The corrected relapse rates are 18% and 56% respectively after 6 months. Conclusion: Short clinical intervention in a structured pedagogic environment is a successful treatment in behavioral feeding disorders. Herewith, pediatricians have a powerful tool for treating behavioral feeding disorders by temporarily resetting and changing the pedagogic climate.

关键词： Behavioral Feeding Disorder Hospitalisation Behavioral Contingencies Pediatrics

Diminishing demandingness of parents;children with recurrent infections

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Health 2012年第8期4卷 483-489页

作者： ellen van der gaag Miriam Münow Department of Pediatrics Hospital Group Twente Hengelo The Netherlands Department of Pediatrics Marien-Hospital GmbH Wesel Germany

Background and Method: Parenting and parenting styles are in favor of authoritative parents compared with non-authoritative parents. These parents display higher levels of both responsiveness and demandingness. We studied the aspect of demandingness using a questionnaire aimed at children aged between 1 and 4 years. 82 Children with recurrent respiratory infections (RRI) and 399 control children were included. Results: Parents of RRI children regulated the quantitative dietary intake of their child less;likewise they gave less stimulation to their children to eat. They also taught their children less on what they can or cannot touch and they argued more with their children (all p < 0.05). However, when it comes to simple rules like watching television or not, the parents of RRI children were very clear. There were however no differences in rules about television watching, computer time or bedtimes. Conclusions: Our study shows that parents of children with RRI are less demanding in complex pedagogic situations that ask for creativity from the parents. However, they are demanding with respect to simple rules. We found no child factors that could explain why children give their parents a hard time. We hypothesize that the parents of RRI children could be less capable of handling complex pedagogic situations (even more complicated by the infections) instead of being unwilling.

关键词： Recurrent Infections Demandingness Parenting

Multimodal Imaging to Delineate Tumor Heterogeneity in Cerebral Gliomas

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Open j.urnal of Radiology 2014年第2期4卷 182-189页

作者： Astrid ellen Grams j.ns Gempt Florian Ringel Eric Soehngen Sabrina Astner j.rgen Schlegel Bernhard Meyer Claus Zimmer Annette Forschler Department of Neuroradiology Medical University InnsbruckInnsbruckAustria Department of Neurosurgery Klinikum Rechts der IsarTechnical University MunichMunichGermany Department of Neuroradiology Klinikum Rechts der IsarTechnical University MunichMunichGermany Department of Neuropathology Klinikum Rechts der IsarTechnical University MunichMunichGermany Department of Radiation Oncology Klinikum Rechts der IsarTechnical University MunichMunichGermany

Purpose: Magnetic resonance imaging (MRI) is the gold standard in visualizing brain tumors and their effects on adj.cent structures. However, no reliable information concerning different tumor components and borders between perifocal edema and infiltration areas can be received. The aim of the study was to establish and evaluate a multimodal imaging concept, in order to differentiate different biological tumor components and to determine tumor borders. Materials and Methods: 12 patients with cerebral gliomas (four low and eight high grade) received a “morphological” MRI, a 3D MR spectroscopy and a T2* MR perfusion examination prior to surgery. Data was evaluated by defining different tumor components, which were entitled based upon their multimodal characteristics and histological data. Results: In high grade gliomas different components can be differentiated, which were described as: “true edema”, “cellular proliferation”, “vascular proliferation”, “cellular infiltration”, “tumor” and “necrosis”. In low grade gliomas, four different tumor components were found: “true edema”, “cellular infiltration”, “cellular proliferation” and “tumor”. Conclusion: With the applied multimodal imaging and a novel evaluation concept, it was possible to detect different tumor components, which could be helpful in detecting the optimal sites for tumor biopsy. Especially in morphological “edema appearing” sites, this knowledge could be important for the adaption of tumor resection borders and the planning of radiation therapy. Further studies with more patients and histological correlation are needed.

关键词： Glioma Glioblastoma Multiforme GBM MR-Spectroscopy MRS Multimodal MRI