Reference values for venous and capillary S100B in children

BackgroundThe current management guidelines for pediatric mild head injury (MHI) liberally recommend computed tomography (CT) and frequent admission. Serum protein S100B, currently used in management of adult head injury, has recently shown potential for reducing unnecessary CT scans after pediatric mild head injury. Capillary sampling in children is commonly used when venous sampling fails or is inappropriate. We present reference values for both venous and capillary samples of protein S100B in children.MethodsNeurologically healthy children aged 1–16, scheduled for minor surgery requiring general anesthesia, were prospectively included. Samples for S100B were drawn before (venous) and after (venous and capillary) sedation.ResultsSerum values of 455 children (255 boys, 200 girls) aged 1–14 were computed. S100B was higher in younger children for both venous (r = ? 0.32) and capillary samples (r = ? 0.28). Reference levels for children aged 1 and 2 were significantly higher than for children aged 3–14 years (venous 0.15 μg/L, capillary 0.37 μg/L). For capillary blood, a gender difference was found in the youngest age groups.ConclusionsWe present reference values for venous and capillary S100B in healthy children. These results can be utilized when considering future studies on pediatric head injury and S100B levels.     

Saliva S100B in professional sportsmen: High levels at resting conditions and increased after vigorous physical activity

BackgroundNeurological dysfunction is a key medical concern in professional sportsmen (PSM). We investigated whether saliva S100B concentrations in PSM and healthy controls are modified before and after training.MethodsWe conducted a case–control-study in 75 patients (25 PSM vs 50 controls) in which S100B saliva concentrations were expressed as absolute values and percentage of change (%) from samples drawn before (T0) and after (T1) training.ResultsNo differences (P > 0.05) between groups were found regarding clinical, monitoring and laboratory parameters. S100B both in PSM and controls was higher at T1 when compared to T0 (P < 0.01). In PSM, S100B was higher than controls (P < 0.001) at T0 and T1. S100B% at T0–T1 was higher (P < 0.001) in PSM and in controls and between PSM and controls (P < 0.001).ConclusionsIncreased saliva S100B levels in PSM before and after training suggest a paracrine/autocrine protein's role connected to stressing activity, which becomes especially evident in PSMs.     

S100B protein maternal and fetal bloodstreams gradient in healthy and small for gestational age pregnancies

BackgroundBrain S100B assessment in maternal blood has been proposed as a useful tool for early perinatal brain damage detection. Among potential confounding factors the possibility of a protein gradient between maternal and fetal bloodstreams under pathophysiological conditions is consistent. The present study investigates in healthy and small gestational age fetuses (SGA) whether S100B concentrations differ among fetal and maternal bloodstreams.MethodsWe conducted a case–control study in 160 pregnancies (SGA: n = 80; healthy: n = 80), in which standard monitoring parameters were recorded. S100B was assessed in arterial cord and in maternal blood samples at birth. Eighty non pregnant women (NP), matched for age at sampling, served as controls (1 SGA vs. 1 healthy vs. 1 NP).ResultsFetal S100B in SGA and healthy groups was significantly higher (P < 0.01) than that detected in the maternal district and in NP women groups, respectively. No differences in protein's gradient between fetal and maternal bloodstreams (P > 0.05) were observed between groups. No differences (P > 0.05) in fetal S100B have been found between the studied groups. Maternal S100B of SGA and healthy groups was significantly higher (P < 0.01) than that detected in NP women. No differences in maternal S100B concentrations (P > 0.05) were observed between SGA and control groups.ConclusionThe present study shows that S100B is pregnancy-dependent with the presence of a protein's gradient between fetal and maternal bloodstreams. The present data suggests that non-invasive fetal brain monitoring is becoming possible in opening a new cue on further investigations on S100B fetal/maternal gradient changes under pathological conditions.     

Prediction of the neurological outcome with intrathecal high mobility group box 1 and S100B in cardiac arrest victims: a pilot study

ObjectivesTo investigate whether high mobility group box 1 (HMGB1) and S100B in cerebrospinal fluid (CSF) and the serum predict the neurological outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA).Materials and methodsThis study was designed as a prospective observational study. Twenty-five patients, who received standard cardiopulmonary resuscitation and post-resuscitation intensive care, were enrolled in this study. The patients were divided into two groups according to Glasgow-Pittsburgh Cerebral Performance categories (CPCs) at 6 months after return of spontaneous circulation (ROSC), Group G (n = 7, CPC 1 or 2) and Group P (n = 18, CPC ≥ 3). Their blood samples were taken at 6, 24, and 48 h after ROSC. The patients, whose CSF was sampled at 48 h, were also divided into either sub-Group G (n = 6) or sub-Group P (n = 8) at 6 months after ROSC.ResultsHMGB1 and S100B in CSF in sub-Group P were significantly higher than those in sub-Group G (HMGB1, <1.0 vs. 12.4 ng/ml, P = 0.009; S100B, 2.68 vs. 84.2 ng/ml, P = 0.007, respectively). HMGB1 in CSF was strongly correlated with S100B (σ = 0.81, P = 0.001). HMGB1 was elevated in serum at 6 h and normalized within 48 h after ROSC without any significant differences between the two groups. Serum S100B in Group P was significantly higher than that in Group G at each time point.ConclusionsThe significant elevations of HMGB1 and S100B in CSF, and S100B in serum are associated with the neurologically poor outcome in OHCA patients.     

Plasma YKL-40 levels in healthy subjects from the general population

BackgroundPlasma YKL-40 is a new biomarker in patients with cancer and inflammatory diseases. High plasma YKL-40 is associated with poor prognosis. Our aim was to determine reference levels in healthy subjects.MethodsPlasma YKL-40 was determined in 3130 participants aged 20–80 years from the Danish general population, the Copenhagen City Heart Study. They had no known disease at time of blood sampling in 1991–1994 and remained healthy and alive during a 16-year follow-up period. In 644 participants, YKL-40 was measured again in samples taken 10 years after the first.ResultsThe median plasma YKL-40 was 40 μg/L (2.5–97.5% reference levels: 14–155) with no difference between sexes. YKL-40 increased exponentially with age. For age-adjusted reference levels, the YKL-40 percentile as a function of age in years and plasma YKL-40 in μg/L was derived: percentile = 100 / (1 + (YKL-40 ^ ?3) * (1.062 ^ age) * 5000). In subjects with two YKL-40 measurements 10 years apart, the mean increase in YKL-40 was 1.5 μg/L/year (SE: 0.2), while the mean change in the calculated age percentile was minimal (?0.3; SE: 0.1).ConclusionsPlasma YKL-40 increases with age within and across healthy individuals from the general population. Age-stratified or age-adjusted reference levels are important when YKL-40 test results are evaluated.     

A new age-based formula for estimating weight of Korean children

ObjectivesThe objective of this study was to develop and validate a new age-based formula for estimating body weights of Korean children.MethodsWe obtained body weight and age data from a survey conducted in 2005 by the Korean Pediatric Society that was performed to establish normative values for Korean children. Children aged 0–14 were enrolled, and they were divided into three groups according to age: infants (<12 months), preschool-aged (1–4 years) and school-aged children (5–14 years). Seventy-five percent of all subjects were randomly selected to make a derivation set. Regression analysis was performed in order to produce equations that predict the weight from the age for each group. The linear equations derived from this analysis were simplified to create a weight estimating formula for Korean children. This formula was then validated using the remaining 25% of the study subjects with mean percentage error and absolute error. To determine whether a new formula accurately predicts actual weights of Korean children, we also compared this new formula to other weight estimation methods (APLS, Shann formula, Leffler formula, Nelson formula and Broselow tape).ResultsA total of 124,095 children's data were enrolled, and 19,854 (16.0%), 40,612 (32.7%) and 63,629 (51.3%) were classified as infants, preschool-aged and school-aged groups, respectively. Three equations, (age in months + 9)/2, 2 × (age in years) + 9 and 4 × (age in years) ? 1 were derived for infants, pre-school and school-aged groups, respectively. When these equations were applied to the validation set, the actual average weight of those children was 0.4 kg heavier than our estimated weight (95% CI = 0.37–0.43, p < 0.001). The mean percentage error of our model (+0.9%) was lower than APLS (?11.5%), Shann formula (?8.6%), Leffler formula (?1.7%), Nelson formula (?10.0%), Best Guess formula (+5.0%) and Broselow tape (?4.8%) for all age groups.ConclusionWe developed and validated a simple formula to estimate body weight from the age of Korean children and found that this new formula was more accurate than other weight estimating methods. However, care should be taken when applying this formula to older children because of a large standard deviation of estimated weight.     

Serum levels of protein S100B predict intracranial lesions in mild head injury

ObjectivesThis study was aimed to assess whether serum S100B levels at emergency department admission can be used to omit unnecessary computed tomography (CT) in patients with minor head injury (MHI).Design and methodsSixty consecutive patients with recent MHI were included in this study. Serum S100B measurement and CT scanning were performed in all patients within 3 h from head injury.ResultsA positive CT scan was present in 20 out of 60 subjects. Significantly higher values of protein S100B were found in CT positive than in CT negative patients (1.35 versus 0.48 μg/L; p < 0.001). The area under the ROC curve for protein S100B was highly significant (AUC 0.80; p < 0.001) and a S100B cut-off value of 0.38 μg/L displayed 100% sensitivity and 58% specificity.ConclusionsSerum S100-B levels might allow to omit unnecessary CT in patients with pure MHI, thus reducing radiation exposure and saving healthcare resources.     

Association between indices of body mass and antibody titers to heat-shock protein-27 in healthy subjects

ObjectivesWe have assessed the relationship between indices of adiposity and antibody titers to Hsp-27 in healthy subjects.DesignTwo-hundred and fifty subjects were studied, including 50 normal-weight subjects (body-mass-index (BMI) ?25 kg/m²), 100 overweight subjects (BMI 25 to ?30 kg/m²) (n = 100) and 100 obese subjects (BMI ≥ 30 kg/m²).ResultsAnti-Hsp27-antibody levels in obese subjects were [0.34 (0.20–0.39) absorbency unit], being significantly higher than overweight and normal-weight groups (P < 0.05). Anti-Hsp27-antibody levels in overweight subjects [0.29 (0.15–0.34) absorbency unit] were statistically higher than controls [0.18 (0.10–0.23) absorbency unit] (P < 0.05).ConclusionHigh anti-Hsp-27-antibody levels in obese-subjects without established coronary disease may be related to a heightened state of immunoactivation associated with obesity.     

NTproBNP concentrations in healthy children

IntroductionThere have been limited studies generating BNP and NT-proBNP reference intervals for paediatric populations. We prospectively assessed NT-proBNP levels in a cohort of 854 healthy school children from the Lifestyle of Our Kids (LOOK) prospective longitudinal study.Materials and methodsNT-proBNP analysis was performed on 172 girls and 212 boys with average age 8.1 years, 183 girls and 181 boys, average age 10.1 years and 183 girls and 180 boys with average age 11.9 years. Data were stratified according to age and gender with the median, range of results and 2.5th and 97.5th percentiles calculatedResultsThere were no significant differences between males and females at any of the 3 study ages. Significant differences were seen between the 8 and 12 year-olds, 10 and 12 year-olds and the 8 and 12 year-old boys.DiscussionOur study demonstrated that NT-proBNP concentrations in healthy children progressively decline between ages 8 and 12 years. Our selection of unambiguously healthy children produced similar median but lower 97.5th percentile NT-proBNP concentrations to previously published studies.     

Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents

ObjectiveMeasurements of serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) are utilized in the diagnostic work-up and clinical management of children with growth disorders. We designed this study to establish the reference values of serum IGF-I and IGFBP-3 levels according to age, sex and pubertal stage in Korean children and adolescents.MethodsFor the study, 1378 healthy Korean children and adolescents aged 0 to 17 years (722 boys, 656 girls) were randomly selected. Blood samples were collected, and the stored sera were assayed for IGF-I and IGFBP-3 using immunoradiometric assay (IRMA, Immunotech). The R 2.8.1 program (Bell Laboratories) was used to generate reference percentile curves for IGF-I and IGFBP-3 according to age, sex, and pubertal stageResultsSerum IGFBP-3 level was higher in girls compared to that in boys of the same ages throughout the pubertal period, whereas IGF-I was only higher for girls younger than 13 years of age. Serum levels of IGF-I and IGFBP-3 increased steadily with age in the prepubertal stage, followed by a progressive decline thereafter. Peak levels of serum IGF-I and IGFBP-3 were observed two years earlier in girls compared to those in boys (13 vs. 15 years of age, respectively). Serum IGF-I and IGFBP-3 concentrations were highest at Tanner stage IV in boys and girls, with a subsequent decline.ConclusionsOur reference value model based on age, sex, and pubertal stage can improve the diagnostic utility of IGF-1 and IGFBP-3 levels in the evaluation and management of Korean children and adolescents with growth disorders.     

Natriuretic peptide precursor B gene (TTTC)(n) microsatellite polymorphism in pre-eclampsia

BackgroundThere is a variable tandem repeat polymorphism in the 5′-flanking region of the natriuretic peptide precursor B gene (NPPB). A previous study showed association of the (TTTC) small tandem repeat (STR) variants of this gene and essential hypertension. Our aim was to identify this polymorphism in samples of pre-eclamptic patients and healthy controls. We also compared the natriuretic peptide B (BNP) concentrations.MethodsBlood samples were collected from healthy pregnant normotensive women (n = 235) and women with pre-eclampsia (n = 220). DNA was isolated and fluorescent PCR and DNA fragment analysis was performed for the detection of (TTTC) repeats. The plasma BNP concentration was measured by fluorescence immunoassay method.ResultsWe detected 12 different (TTTC) repeats on the NPPB gene in the studied population. The overall distribution of alleles and genotypes was significantly different between the control and pre-eclamptic groups. The number of 10-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnant controls (p = 0.032). After adjustment for confounding factors pre-pregnancy BMI, maternal age, primiparity and smoking, the calculated odds ratio (OR) was 0.19 (95% CI: 0.04–0.87). Similarly, the 12-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnants (p = 0.037; adjusted OR: 0.53 (95% CI: 0.29–0.96)). In contrast the 11-repeat genotype carrier frequency was significantly higher in the pre-eclamptic than in the healthy pregnant group (p < 0.001; adjusted OR 2.91 (95% CI: 1.75–4.84)).The concentration of the BNP was 9.75 pg/ml in the healthy controls and 32.40 pg/ml in the pre-eclamptic group (p < 0.0001). The 11/11 genotype carriers had significantly higher BNP levels in both groups.ConclusionsThe NPPB gene (TTTC) microsatellite polymorphism in the 5′-flanking region showed significant difference in the distribution of alleles and genotypes between healthy pregnant controls and pre-eclamptic patients in an ethnically homogeneous population. The concentration of the BNP was higher in pre-eclamptic women, and it showed association with the (TTTC) genotypes. We introduced an F-PCR and DNA fragment analysis method for the fast and reliable detection of this STR.     

Do dialogues about concepts of pain reduce immigrant patients’ reported spread of pain? A comparison between two consultation methods in primary care

ObjectivesDo dialogues about concepts of pain reduce the reported spread of pain more than the usual consultations?SettingA 4-week programme in primary care for immigrants on sick-leave, aged 16–45 years, containing daily exercises and randomised to either four interviews and dialogues about pain with a female doctor (group A) or the usual consultations with a male doctor (group B).MethodsTwo doctors made the first and the last evaluations (before and after the programme) containing diagnostics of tender-structure locations and depression (yes–no), and ratings of severity of psychosocial stressors. Anxiety about pain was noted (yes–no). The patients pointed to their painful areas and these were noted on pain drawings (0–18 fields). Median values were calculated, and non-parametric statistics were used to test for significant differences between groups and before-and-after values, and the correlation between the number of pain drawing fields and clinical variables.ResultsForty-five persons participated in the whole programme, Group A (8 men, 15 women), group B (7 men, 15 women). Many of them needed an interpreter. Participants in group A had more tender-structure locations (two vs. one in group B). Nearly half had depression and two-thirds had serious psychosocial stressors. Almost all reported anxiety about pain at the start, but afterwards significantly fewer in group A (22 vs. 16, p < 0.05). In both groups, the number of pain drawing fields decreased significantly from, in median, eight to four (p < 0.001), particularly among the women (A: p < 0.05 vs. B: p < 0.01). Some very distressed participants reported more spread of pain than at the start. Reduced spread of pain was not significantly correlated to any clinical variable.ConclusionsParticularly the women in both consultation groups demonstrated much less spread of pain after treatment, despite similar clinical findings and less anxiety about pain in group A. The initially wide spread of pain may thus have been a way of communicating with the doctors.     

Association of hemoglobin levels and brainstem auditory evoked responses in lead-exposed children

ObjectivesDecreased blood hemoglobin (HbB) levels and anemia have been associated with abnormal brainstem auditory evoked responses (BAER). Lead (Pb) exposure has also been associated with anemia and aberrant BAER. This study investigated the relationship between HbB level and BAER wave latency and amplitude in Pb-exposed Andean children.Design and methodsSixty-six children aged 2 to 15 years (mean age: 9.1; SD: 3.3) living in Pb-contaminated villages were screened for HbB levels, blood Pb (PbB) levels and BAER latencies and amplitudes.ResultsThe mean HbB level observed in the study group was 11.9 g/dL (SD: 1.4; range: 8.6–14.8 g/dL). The mean HbB level corrected for altitude was 10.3 g/dL (SD: 1.4; range: 6.9–13.1 g/dL), and suggestive of anemia. The mean PbB level was 49.3 μg/dL (SD: 30.1; range: 4.4–119.1 μg/dL) and indicative of Pb poisoning. Spearman rho correlation analyses revealed significant associations between the BAER absolute latencies and HbB level, indicating that as the HbB level decreased, the BAER wave latency increased. Children with low HbB levels (≤ 11 g/dL) showed significantly prolonged absolute latencies of waves I, II, III, IV and V compared to the children with normal HbB levels. Although a significant relationship between HbB and BAER waves was observed, no significant associations between PbB level and BAER parameters were found.ConclusionLow hemoglobin levels may diminish auditory sensory-neural function, and is therefore an important variable to consider when assessing BAER in children with anemia and/or Pb exposure.     

Evaluating physical activity: the AQAP questionnaire and its interpretation software

ObjectivesUpdating Baecke physical activity questionnaire in French, validating this version named AQAP and developing software for a personalized interpretation of the results.MethodValidation conducted on 702 consultants in health prevention centers aged 18–79 years: reliability of the questionnaire when self-administered, validity according to the energy expenditure per interview and reproducibility after two weeks (n = 31). After two months, assessment of the questionnaire's impact on knowledge and behaviors in 320 young adults aged 18–29 years.ResultsThe results from self- and interviewer-administered questionnaire were correlated (Kappa > 0.60). Furthermore, the total physical activity index was correlated to the energy expenditure (rho = 0.39, P < 0.0001). The four physical activity indexes calculated from self-administrated questionnaires barely varied at the two-week interval (P ≥ 0.23, power ≥ 77%, accepted difference ±10%). Two months later, 80% of the participants had read the interpretation software report, 55% became conscious of their physical activity level, 43% increased their physical activity level and 42% reported being aware of the relationship between physical activity and health.ConclusionAQAP characteristics are satisfactory and thus this questionnaire can be used on the general population in complement of an individual or collective action to promote physical activity and in epidemiological studies for analyzing the links between individual behaviors and health.     

Reference intervals of serum lipid profile in healthy Indian school children and adolescents

ObjectiveTo develop age and sex specific reference intervals of serum lipid parameters in healthy Indian children in the age group of 6–17 years.ParticipantsStudy subjects were selected from the schools of Delhi. Children with BMI either in overweight or obese category were excluded to generate reference intervals. The final analysis included 3076 children with BMI in normal range for age.ResultsThe mean ± SD, 3rd, 10th, 25th, 50th, 75th, 90th and 97th centile values of lipid parameters are presented. All these parameters were significantly higher in girls than in boys. About 89.2% subjects had total cholesterol in acceptable range while 9.1% had borderline elevated and 1.5% had elevated TC. Optimal serum triglyceride levels were seen in 45.1% subjects while optimal levels of HDL cholesterol were seen in 0.3% subjects only.ConclusionsReference intervals of serum lipid parameters for healthy Indian children (6–17 years) are presented.     

Influence of diabetes on homocysteine-lowering therapy in chronic hemodialysis patients

IntroductionThe effect of homocysteine (Hcy)-lowering therapy may be different in hemodialysis (HD) patients with and without diabetes mellitus (DM).MethodsStable HD patients with uremia were administered folic acid and vitamin B for 3 months. The impact of treatment was compared in patients with and without DM.ResultsA total of 61 patients (31 men and 30 women) aged 56 ± 13 y completed the study. Among these, 44 patients (72%) did not have DM and 17 (28%) had DM. At baseline, total Hcy and high-sensitivity C-reactive protein (hsCRP) levels were similar. After treatment, the levels of total Hcy and hsCRP were significantly decreased in the nondiabetic group (total Hcy level decreased from 33.63 ± 14.13 μmol/l to 18.94 ± 8.46 μmol/l, p < 0.001; hsCRP level decreased from 0.58 mg/dl [range, 0.21–1.05 mg/dl] to 0.22 mg/dl [range, 0.11–0.53 mg/dl], p < 0.001) but not in the diabetic group (total Hcy level decreased from 34.97 ± 17.12 μmol/l to 29.53 ± 11.36 μmol/l, p = 0.057; hsCRP level decreased from 0.80 mg/dl [range, 0.24–1.47 mg/dl] to 0.49 mg/dl [range, 0.45–0.98 mg/dl], p = 0.28). Serial monitoring of total Hcy level showed a more sustained effect of therapy on patients without DM.ConclusionFolic acid and vitamin B administration significantly lower total Hcy and hsCRP levels in HD patients without DM but not in those with DM.     

Noninvasive urinary organic acids test to assess biochemical and nutritional individuality in autistic children

ObjectivesQuantitative organic acid testing can give information about potential problems, especially with energy production, neurotransmitter metabolism, intestinal dysbiosis and nutritional individuality which is very important in autistic children. The aim of this study was to find out potential differences between the levels of organic acids in the urine of autistic and non-autistic children.Design and methodsThe organic acids in the urine were determined by capillary gas chromatography/mass spectrometry (GC/MS). All overnight urine samples were collected from 35 autistic children and 36 neurologically normal children as healthy controls (4–10 years).ResultsSignificant differences were found between the autistic children and the control group in organic acids: 2-oxoglutaric, isocitric, citric, 4-hydroxybenzoic, 4-hydroxyphenylacetic, hippuric, adipic, suberic (all with p < 0.05).ConclusionOrganic acids test can be used to assess an individual need for nutrient and biochemical abnormalities, especially important for autistic children.     

Relationship of age-related concentrations of serum FSH and LH with bone mineral density, prevalence of osteoporosis in native Chinese women

BackgroundFollicle-stimulating hormone (FSH) and luteinizing hormone (LH) may play an important role in bone mass regulation in postmenopausal women.MethodsA cross-sectional study of 699 healthy Chinese women, aged 20 to 82 y, was conducted. Serum FSH and LH and BMD were measured at the posteroanterior (PA) spine, lateral spine, total hip, and distal forearm.ResultsThe geometric mean values (± SD) of serum FSH and LH in premenopausal women were 3.94 ± 2.08 and 7.51 ± 2.58 IU/l, respectively, and in postmenopausal women were 28.8 ± 1.88 and 25.6 ± 1.95 IU/l, respectively. The correlation of FSH to BMD at different skeletal regions (r = ? 0.597 – ? 0.492, P = 0.000) was higher than that of LH to BMD (r = ? 0.452 – ? 0.332, P = 0.000). The prevalences of osteoporosis for the quartiles of FSH at various skeletal sites were 0.57%, 0.43%, 27.1%, and 30.9%, respectively; and of LH were 2.14%, 4.43%, 19.5%, and 26.0%, respectively. The prevalence of osteoporosis in 3rd and 4th quartile was more significantly increased than the 1st and 2nd quartile.ConclusionsThese data suggest that FSH and LH levels in circulation are associated with BMD changes and osteoporosis occurrence in Chinese women.