Increased serum IL-10/IL-12 ratio in wheezing infants

To investigate the association between various serum markers and atopic symptoms in the first year of life, and to evaluate the prognostic value of these markers for the development of wheezing and skin rash in the second year of life. Data of 86 children on the development of wheezing and skin rash in the first 2 years of life were collected prospectively, making use of parental completed questionnaires, weekly symptom cards, structured interview and physical examination. Serum markers (IL-10, IL-12, IL-13, eotaxin, sE-selectin, sICAM-1, sIL-2R) and total and specific IgE were determined at age 1. Children who developed wheezing in the first year of life had lower serum levels of IL-12 than children without symptoms (median 40.3 pg/ml vs. 49.0 pg/ml, p = 0.01) and a higher serum IL-10/IL-12 ratio (0.41 vs. 0.31, p = 0.001) at age 1. The IL-10/IL-12 ratio increased with an increasing number of wheezing episodes. Levels of sE-selectin in children with wheezing and in children with itchy skin rash in the first year of life were higher than in symptom free children (6.1 ng/ml and 5.9 ng/ml vs. 4.9 ng/ml, p = 0.01 and p = 0.03, respectively). Children who developed wheezing in the second year of life already had increased sICAM-1 levels at age 1. Children who developed wheezing in the first year of life showed a serum cytokine response that is skewed towards a T-helper 2 profile, with lower IL-12 levels and an increased IL-10/IL-12 ratio. Children who developed wheezing in the second year of life had elevated sICAM-1 levels at age 1. Follow-up of the children is needed to evaluate the prognostic value of various serum markers for the development of allergic disease in later childhood.     

Serum concentration of macrophage-derived chemokine may be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young children

Chemokines are responsible for the trafficking of leukocytes to sites of inflammation. Serum chemokine levels were previously shown to be increased in adult patients with atopic dermatitis (AD). We tested whether serum concentrations of chemokines, including macrophage-derived chemokine (MDC), thymus and activation-regulated chemokine (TARC), eotaxin (EOX), interferon gamma inducible protein 10 (IP-10) and monocyte chemotactic protein 1 (MCP-1), are useful inflammatory markers for assessing AD severity in infants and young children. To investigate this, we assessed the severity of AD clinically using the SCORing Atopic Dermatitis (SCORAD) index system. Serum chemokine concentrations were determined by sandwich enzyme immunoassay. Twenty AD patients with a median age of 2.1 years [interquartile range (IQR): 0.6–4.2] were recruited. Their SCORAD score was 23.5 (12.5–33.5). Serum concentrations of MDC, TARC, EOX, IP-10 and MCP-1 were 2551 (1978–3935), 1469 (1125–3070), 68 (57–85), 126 (101−226) and 518 (419–614) pg/ml, respectively. Serum MDC levels correlated with SCORAD (r = 0.608, p = 0.004) and its extent (r = 0.629, p = 0.003) and intensity (r = 0.557, p = 0.011) components. Serum TARC concentration showed weaker correlation with extent (r = 0.474, p = 0.035) and intensity (r = 0.465, p = 0.039) of skin involvement but not SCORAD. The median serum levels of MDC (3131 vs. 2394 pg/ml; p = 0.031) and EOX (80 vs. 61 pg/ml; p = 0.046) were also higher in children with moderate as compared with mild AD. The other chemokines did not correlate with AD severity. In conclusion, our results suggest that serum MDC concentration may be a useful inflammatory marker for assessing AD severity in infants and young children.     

Serum soluble endothelial-cell specific adhesion molecules in children with insulin-dependent diabetes mellitus

Endothelial-cell specific adhesion molecules are reported to be elevated in patients with diabetes mellitus and related to diabetic vascular complications. We studied serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), endothelial-leukocyte adhesion molecule (sE-selectin) in 30 healthy children and 35 children with type 1 diabetes without symptomatic vascular complications. sE-selectin levels were higher in diabetics than in controls (p < 0.001). sVCAM-1 and sICAM-1 levels were not different between the groups (p > 0.05). In seven newly diagnosed diabetics with ketoacidosis, concentrations of these molecules were not different before and after one month of insulin therapy (p > 0.05). In the combined group, only sE-selectin was correlated positively with serum glucose, HbA1c (r = 0.3, p < 0.05 for both) and negatively with C-peptide levels (r = -0.4, p < 0.05). In diabetic children without symptomatic vascular complications, sE-selectin but not sICAM and sVCAM levels was elevated; this finding might reflect ongoing endothelial-cell activation rather than endothelial damage.     

Circulating soluble adhesion molecule levels in children with acute lymphoblastic leukaemia

The aim of this study was to evaluate levels of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) as parameters of disease activity and to monitor the response to treatment in children with acute lymphoblastic leukaemia (ALL). The above soluble adhesion molecules were determined in the serum of 35 children with ALL and 30 healthy children (control group) of the same age range. The samples were obtained before treatment, 6 months after the beginning of the treatment (remission of the disease), 6 months after the end of the treatment and during relapse of the disease. The mean levels of sICAM-1, sVCAM-1 and sE-selectin at the onset of the disease were 646.6 ± 80.9 ng/ml, 1786 ± 151.8 ng/ml and 140.5 ± 17.3 ng/ml, respectively. These values were significantly higher (P < 0.001) than those of the control group, which were, 245.8 ± 25.7 ng/ml, 798.6 ± 78.9 ng/ml and 44.7 ± 18.2 ng/ml respectively. During remission, the mean levels did not differ significantly from those of the control group. After the end of the treatment the mean levels again did not show any significant differences compared to the control group. During relapse the soluble adhesion molecule mean levels (923.9 ± 110.1 ng/ml, 2945.7 ± 349.9 ng/ml and 258.2 ± 5.1 ng/ml) were significantly higher (P < 0.001) than those of the control group and also than those obtained during remission and after the end of the treatment (P < 0.001). Pearson's correlation coefficient r was computed in order to detect possible linear correlations between: (1) sICAM-1 and sVCAM-1 (r = 0.632); (2) sICAM-1 and sE-selectin (r = 0.788) and (3) sVCAM-1 and sE-selectin (r = 0.752). All three cases correspond to P < 0.001, thus indicating strong linear correlations. Conclusion The levels of soluble circulating adhesion molecule levels can be utilized for monitoring disease activity of ALL and its response to treatment, as well as for early detection of relapse. Strong linear correlations between the three soluble adhesion molecules tested suggest that each of them may be sufficient as an indicator. Received: 5 August 1996 / Accepted: 13 February 1997     

Effect of oral cyclosporin A in children with Staphylococcus aureus-colonized vs. S. aureus-infected severe atopic dermatitis

Atopic dermatitis (AD) is frequently associated with skin colonization or infection with Staphylococcus aureus strains producing exotoxins. The aim of this investigation was to evaluate the effect of oral cyclosporin A (CsA) on disease severity and bacterial counts in colonized and infected patients. Eleven children with severe AD (SCORAD index >50, mean objective SCORAD score >40) were treated for 8 weeks with 2.5–5 mg/kg CsA. In five patients, the skin was only colonized with S. aureus whereas the remaining six patients presented clinically relevant suppurative S. aureus skin infections characterized by small pustules, crustings, pus and increased pruritus in the presence of S. aureus as determined by contact sampling and culture which regularly resulted in the indication for antibiotic treatment. Clinical and microbiological investigations were performed before and after CsA therapy. Clinical signs and symptoms of AD improved in all patients with a reduction in mean SCORAD index from 74 to 29 (p < 0.001). However, disease severity and bacterial counts were more reduced by CsA in the colonized patients compared with the patients with clinical overt infections. In conclusion, treatment with CsA resulted in an improvement of clinical symptoms in children suffering from severe AD. However, anti-infective treatment administered before immunomodulatory therapy is likely to be decisive for the long-term therapeutic effect.     

Serum levels of adhesion molecules in children and adolescents with immune and non-immune thyroid diseases

Serum levels of sICAM-1, sVCAM-1 and sP-selectin were determined in patients with Graves' disease before and after 8 weeks and 24 months of methimazole therapy, in levothyroxine suppressed patients with non-toxic nodular goiter, and in a group of healthy controls, to elucidate the relationship to circulating antithyroid antibodies and possible role of soluble adhesion molecules as markers of inflammatory activity. sICAM-1, sVCAM-1, and sP-selectin in patients with untreated hyperthyroidism were markedly elevated compared with controls. After 8 weeks of methimazole treatment, the concentrations of these molecules dropped, but were still significantly higher than in healthy children. In patients with clinical and biochemical remission after 24 months of therapy, sICAM-1 values were on the verge of significance, but still higher than in the control group, whereas serum levels of sVCAM-1 and sP-selectin had normalized. Slightly higher serum sICAM-1 values were observed in patients with non-toxic nodular goiter compared with healthy children.     

Influence of measles vaccination on the progression of atopic dermatitis in infants

Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting 10-20% of children. Measles vaccination has been reported to have contradictory effects on incidence of AD in children. Therefore, we performed the first prospective, double-blind, placebo-controlled study to analyze the evolution of AD in infants after measles vaccination. The study included 12 infants (10-14 months old) with AD, randomly assigned to two groups: while the first group received a single dose of a standard measles vaccine ROUVAX, the second was treated with placebo (vehicle). Infants were followed-up for 6 months after administration of ROUVAX/placebo for the clinical signs associated with AD, by determination of SCORAD index. In addition, serum was taken before vaccination and 1 month later to determine the presence of seroconversion and to analyze the progression of serum levels of CCL18 (PARC) and E-selectin, known to be distinct serum markers that reflect clinical features of AD. In the vaccinated group, five of six children seroconverted 1 month after treatment and one infant showed a 50% improvement of SCORAD. Serum levels of CCL18 were significantly decreased in two treated infants (of four analyzed for this group) and E-selectin slightly decreased in one infant (of three analyzed by this test). In placebo-treated group the SCORAD improved in one patient and serum levels of CCL18 and E-selectin did not change. These data suggest that measles vaccination not only does not aggravate AD, but may also improve some of the immunological parameters of this allergic disease. Inclusion of a higher number of patients in a similar study should give a more comprehensive overview of the benefit of measles vaccination on the clinical evolution of AD patients, and potentially open new avenues to the clinical application of the anti-inflammatory effect of measles virus proteins.     

Does the severity of atopic dermatitis correlate with serum IgE levels?

Recent studies suggest an association between atopic phenotypes and serum IgE levels. In contrast to asthma, this association has not been proven for atopic dermatitis. For 345 children (mean age 2.9 years), we investigated a correlation of the severity of eczema (defined by SCORAD score) and serum IgE levels. Additionally, the data was analyzed for differences between children with high and low SCORAD quartile. Parameters such as genetic background, the prevalence of other atopic phenotypes such as bronchial asthma, allergic rhinoconjunctivitis, and allergic sensitization were recorded. Our results indicate a significant correlation between SCORAD and serum IgE levels (R = 0.31, p < 0.001), but the standard deviation was large. Children with atopic dermatitis showed a high prevalence of sensitization to foods independent of the IgE levels; children with high SCORAD levels showed a sensitization to aeroallergens significantly more often (p < 0.02). No differences were found in prevalences of atopic family background, or a number of additional atopic symptoms such as asthma and allergic rhinoconjunctivitis. These results suggest that serum IgE levels seem to correlate with the degree of eczema. Children with severe atopic dermatitis and high IgE levels are at risk for sensitization to food allergens and aeroallergens.     

Plasma and urinary soluble adhesion molecule expression is increased during first documented acute pyelonephritis

Background: The degree of inflammatory reaction and leucocyte trafficking during acute pyelonephritis has been related to the risk of developing renal parenchymal scarring. Adhesion molecules play a central role in leucocyte recruitment during inflammation. Aims: (1) To determine whether circulating and urinary concentrations of E-selectin and intercellular adhesion molecule 1 (ICAM-1) were abnormal during first documented acute pyelonephritis; (2) to investigate whether circulating or urinary concentrations were predictive for the development of abnormalities on DMSA imaging. Methods: Plasma and urine samples were collected from 40 children with a first episode of acute pyelonephritis within one week of infection (acute sample) and at six weeks (late sample). Control samples were collected from 21 healthy age matched controls and 18 age matched controls with febrile illness not secondary to urinary tract infection. Results: Plasma and urinary sE-selectin were higher in acute samples (median 176.3 ng/ml and 0.12 ng/mmol respectively) compared with late (97.8 ng/ml and 0.029 ng/mmol) and both control (65.6 ng/ml and 0 ng/mmol) and febrile control (urine 0 ng/mmol) samples. Plasma sICAM-1 was higher in acute samples (428 ng/ml) than controls (365.2 ng/ml), and acute sICAM-1 urine concentrations were higher than febrile control concentrations (3.2 v 0.7 ng/mmol). No correlations were detected between sE-selectin or sICAM-1 and acute or late DMSA scan changes. Conclusion: Plasma and urinary sE-selectin and sICAM-1 are significantly increased during acute pyelonephritis, though no correlation exists between the presence of high plasma or urine concentrations and DMSA scan changes, both during acute infection and six weeks post-infection.     

Circulating adhesion molecule levels in childhood asthma

The present study aims at comparing the levels of circulating forms of E-selectin, ICAM-1 and VCAM-1 in 10 patients with acute asthma, 10 stable atopic asthmatics, 10 nonatopic stable asthmatics and 10 age-matched healthy children. sE-selectin levels of patients with acute asthma were found to be significantly higher than that of the other three groups. The insignificant rise in sICAM-1 levels was attributed to the usage of inhaler corticosteroids. Serum sE-selectin and sICAM-1 seem to be promising serological markers for monitoring disease activity in childhood asthma.     

A prospective study of the sensitivity,specificity and diagnostic performance of soluble intercellular adhesion molecule 1, highly sensitive C-reactive protein,soluble E-selectin and serum amyloid A in the diagnosis of neonatal infection

Background  

Diagnosis of neonatal infection is difficult, because of it's non-specific clinical presentation and the lack of reliable diagnostic tests. The purpose of this study was to examine the potential diagnostic value of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin), highly sensitive C-reactive protein (hsCRP) and serum amyloid A (SAA) measurements, both individually and in combination in the setting of a neonatal intensive care unit.     

过敏性紫癜患儿血清可溶性血管细胞黏附分子-1及可溶性细胞间黏附分子-1表达的意义

目的 检测过敏性紫癜(HSP)患儿血清可溶性血管细胞黏附分子-1(sVCAM-1)及可溶性细胞间黏附分子-1(sICAM-1)表达,并探讨其临床意义.方法 酶联免疫吸附法(ELISA)测定53例HSP患儿(其中急性期37例,恢复期16例)及25例健康儿童血清sVCAM-1、sICAM-1水平,分别比较其急性期和恢复期及有或无肾损害HSP患儿上述因子表达水平.结果 HSP急性期患儿血清sVCAM-1和sICAM-1水平明显高于恢复期和健康对照组(Pa＜0.01);肾损害组血清sVCAM-1、sICAM-1明显高于无肾损害组(Pa＜0.01).结论 sVCAM-1、sICAM-1参与HSP病理生理过程,与疾病分期相关;血清sVCAM-1、sICAM-1水平增高可作为儿童HSP肾损害的判断指标之一.     

Low-dose cyclosporin A microemulsion in children with severe atopic dermatitis: Clinical and immunological effects

Cyclosporin A (CsA) is an effective and well-tolerated treatment for severe childhood atopic dermatitis (AD). By starting at a low dose, the therapeutic safety should be further increased. The aim of this study was to evaluate low-dose CsA in childhood AD with respect to clinical outcome and modulation of T-cell dysregulation. In an open prospective study, 10 children (age: 22–106 months) with severe AD (mean objective SCORAD score > 40 on two baseline measurements at a minimum interval of 2 weeks) were treated with CsA solution for 8 weeks. All patients received a starting dose of 2.5 mg/kg/day, which was increased stepwise in non-responders to a maximum of dose of 5 mg/kg/day. Disease activity was monitored using the SCORAD index. The frequency of cytokine-producing peripheral blood T lymphocytes was analyzed by intracellular cytokine staining, and T-cell numbers were measured by fluorescence-activated cell sorter (FACS) analysis. Twenty healthy age-matched children were included as controls for the immunological data. Nine of the 10 patients had a SCORAD reduction of at least 35%. In seven patients this was achieved with low-dose CsA at 2.5 mg/kg/day (n = 4) and 3.5 mg kg/day (n = 3). Seven of the nine responders experienced no relapse within the 4-week follow-up period. At baseline the percentage of interleukin-4 (IL-4), IL-13, and human leucocyte antigen (HLA)-DR-positive CD3⁺ cells was higher in the patient group than in the controls. After CsA treatment there was a significant reduction in interferon-γ (IFN-γ), IL-2, IL-4, IL-13, and HLA-DR-positive CD3⁺ cells. Hence, in severe pediatric AD, CsA microemulsion, when started at a low dose (2.5 mg/kg/day), improves clinical measures of disease, reduces T-lymphocyte cytokine production, and regulates T-cell activation.     

脉冲振荡肺功能与黏附分子在儿童哮喘中的临床意义

目的：脉冲振荡肺功能是近年来开展的一项肺功能测定新技术, 特别适用于学龄前儿童,但目前有关报道不多,且尚无统一正常值。可溶性细胞间黏附分子-1（sICAM-1）、内皮细胞黏附分子-1（sVCAM-1）是已明确的反映哮喘严重程度的指标,该文旨在探讨上述指标在儿童哮喘中的临床意义。方法：应用Master Screen系列肺功能测定系统,对25例健康儿童、40例哮喘发作期儿童用脉冲振荡法（IOS)进行肺功能检测,其中23 例患儿激素治疗达缓解期后再次检测;同时对部分上述儿童（发作期23例,缓解期20例, 对照组16例）进行sICAM-1、sVCAM-1水平检测。 结果：IOS肺功能测试发作期R5,R20,R5-R20,X5,Fres,Zrs均高于对照组和缓解组,差异均有显著性(q= 2.91 ~15.61,P<0.01或P<0.05),缓解期与对照组比较,R5,R5-R20,Fres,Zrs差异有显著性(q=3.08~9.19,P<0.01或 P<0.05)。发作期血清sICAM-1,sVCAM-1明显高于缓解期及对照组(q= 6.23~26.15,P＜0.01）,而缓解期仍高于对照组(q=16.86,12.46, P<0.01)。发作期sICAM-1,sVCAM-1与R5-R20呈正相关（r=0.45,0.57 P<0.05） 结论：IOS肺功能和sICAM-1、sVCAM-1都可以作为儿童哮喘病情严重程度和治疗效果的评价指标,两者之间有一定的相关性,IOS肺功能测定简便、无创,适合于学龄前儿童。［中国当代儿科杂志,2007,9（5）：415-418］     

Plasma and urinary soluble adhesion molecule expression is increased during first documented acute pyelonephritis.

BACKGROUND: The degree of inflammatory reaction and leucocyte trafficking during acute pyelonephritis has been related to the risk of developing renal parenchymal scarring. Adhesion molecules play a central role in leucocyte recruitment during inflammation. AIMS: (1) To determine whether circulating and urinary concentrations of E-selectin and intercellular adhesion molecule 1 (ICAM-1) were abnormal during first documented acute pyelonephritis; (2) to investigate whether circulating or urinary concentrations were predictive for the development of abnormalities on DMSA imaging. METHODS: Plasma and urine samples were collected from 40 children with a first episode of acute pyelonephritis within one week of infection (acute sample) and at six weeks (late sample). Control samples were collected from 21 healthy age matched controls and 18 age matched controls with febrile illness not secondary to urinary tract infection. RESULTS: Plasma and urinary sE-selectin were higher in acute samples (median 176.3 ng/ml and 0.12 ng/mmol respectively) compared with late (97.8 ng/ml and 0.029 ng/mmol) and both control (65.6 ng/ml and 0 ng/mmol) and febrile control (urine 0 ng/mmol) samples. Plasma sICAM-1 was higher in acute samples (428 ng/ml) than controls (365.2 ng/ml), and acute sICAM-1 urine concentrations were higher than febrile control concentrations (3.2 v 0.7 ng/mmol). No correlations were detected between sE-selectin or sICAM-1 and acute or late DMSA scan changes. CONCLUSION: Plasma and urinary sE-selectin and sICAM-1 are significantly increased during acute pyelonephritis, though no correlation exists between the presence of high plasma or urine concentrations and DMSA scan changes, both during acute infection and six weeks post-infection.     

过敏性紫癜患儿血清sE-选择素和sICAM-1水平的变化及其意义

目的研究过敏性紫癜(HSP)患儿血清sE-选择素和可溶性细胞间黏附分子1(sICAM-1)水平变化,探讨其在HSP发病机制中的作用。方法采用酶联免疫法检测60例HSP患儿、25例健康对照组儿童血清sE-选择素、sICAM-1水平。结果 HSP患儿血清sE-选择素和sICAM-1水平均高于对照组,差异有显著性(P<0.05)。sE-选择素水平在腹型组显著高于非腹型组(P<0.05);sICAM-1水平在不同临床表现组间差异无显著(P>0.05)。结论 HSP患儿血清sE-选择素、sICAM-1水平显著升高,sE-选择素水平在腹型组显著高于非腹型组,提示sE-选择素可能参与HSP急性期血管内皮细胞炎性以及脏器损伤的机制。     

Measurement of body surface area in atopic dermatitis using specific PC software (ScoradCard©)

In skin diseases, evaluation of involved surface area is a crucial factor in grading the degree of severity. We examined the reliability of body surface area assessment and relative inter-observer and intra-observer variability using new software (ScoraCard^©), specifically designed to evaluate automatically the extension of the involved area in the SCORAD index. Twenty pediatricians, untrained in the evaluation of skin disease, estimated the percentage of surface area involved in photo-tests of two children with artificial well-delimited lesions, at first by sight and then through software. As 'gold standard' the exact amount of pixels was counted for the whole body surface of the children, for the different body zones and for the painted artificial lesions, expressed as percentage of the respective zone. For photo 1, gold standard was 38.06% and median percentage was 43.44% (95% CI 40.7–46.21) by sight (p = 0.002) and 37.99% (95% CI 36.04–39.94) by ScoradCard (p = 0.79). For photo 2, gold standard was 27.84%, median percentage was 30.44% (95% CI 28.25–32.63) by sight (p = 0.047) and 27.8% (95% CI 26.55–29.04) by ScoradCard (p = 0.79). The level of agreement (kappa statistic), cumulative for the two photo tests, was 0.38 (fair agreement) by sight method and 0.67 (good agreement) by ScoradCard^©. Among the 10 pediatricians who repeated the computer aided evaluation 3 months apart, the intra-observer variability was not significantly different: the median percentage was 31.5% (95% CI 27.0–49.4) at time 0 and 29.0% (95% CI 26.7–47.2) 3 months later (p = 0.76). This new software could be a useful tool in evaluating skin lesions extension, minimizing inter- and intra-observer variability, which is an important goal in multi-centre studies.     

Correlation of nitrites in breath condensates and lung function in asthmatic children

We aimed to evaluate the value of exhaled breath condensates in monitoring airway inflammation in childhood asthma before and after high altitude climate therapy.
Forty-eight asthmatic children on regular anti-asthma treatment with a normal FEV₁ and positive skin prick test for house dust mites were recruited. All children had been referred to an alpine clinic for high altitude climate therapy, because of persistent asthmatic symptoms despite use of daily anti-inflammatory treatment. Subjects were assessed on their arrival and before departure from the alpine clinic. Spirometry, bronchial provocation tests and measurements of nitrites in breath condensates were performed.
Median levels of nitrites were significantly higher before than after high altitude climate therapy (1.27 vs. 0.93 μ m ; p = 0.008). In addition, MEF₅₀ improved significantly (p < 0.0005). There was a significant correlation between nitrites in breath condensates and MEF₅₀ (r = −0.63, p < 0.0001), symptoms (r = 0.47, p = 0.0007) and airway hyper-reactivity (AHR) (r = −0.41, p = 0.004).
In summary, we found a reduction in nitrites in breath condensates after a high altitude climate therapy. Significant correlations were found between nitrites and MEF₅₀, AHR and symptoms. We conclude that the measurement of nitrites may be feasible to objectively assess airway inflammation in asthmatic children in order to detect ongoing inflammation in children with normal FEV₁ but persistent symptoms.     

Elevated serum soluble E-selectin is associated with poor outcome and correlated with Serum ALT in biliary atresia

BACKGROUND AND AIM: Biliary atresia (BA) is a serious liver disease. Our objective was to investigate possible roles of serum soluble E-selectin (sE-selectin) in BA. METHODS: During their annual follow-up, the serum levels of sE-selectin were determined by ELISA in 53 postoperative BA patients and 10 healthy children. The patients were categorized into two groups according to their jaundice status. Comparisons of demographic data and serum sE-selectin levels between jaundice-free patients and jaundice patients were performed. Correlation analysis was carried out of serum E-selectin with serum ALT and serum GGT. Data are expressed as mean and SD (ng/mL). RESULTS: The serum sE-selectin of BA patients was higher than that of controls (114.1 +/- 44.0 vs. 88.7 +/- 22.2; p = 0.01). Further subgroup analysis showed that there was an increase in serum sE-selectin levels of BA patients with jaundice (n = 21) compared to those without jaundice (n = 32) (129.7 +/- 48.6 vs. 103.9 +/- 38.1; p = 0.035). Also, serum E-selectin was positively correlated with serum ALT, a marker for liver injury (Pearson r = 0.355, p = 0.009), but not with serum GGT (Pearson r = 0.223, p = 0.12). CONCLUSION: Elevated serum sE-selectin was associated with a poor outcome of BA. There was a positive correlation between serum sE-selectin and serum ALT. E-selectin probably plays a role in the pathophysiology of liver injury in postoperative BA.     

Obesity and the prevalence of allergic diseases in schoolchildren

Although the association between obesity and bronchial asthma (BA) has been gaining more attention, few studies have been conducted concerning the relationship between obesity and other allergic diseases. The objective of this study was to determine whether and how childhood obesity is associated with allergic diseases other than BA, such as atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis (AC), and either AR or AC (AR/AC). A questionnaire was administered to the parents of 50,086 Japanese schoolchildren. Associations between childhood obesity and the various allergic diseases were evaluated by univariate and multivariate logistic models. Significant associations were found between higher body mass index (BMI) and AD (p = 0.03), and lower BMI and AC (p < 0.0001), and AR/AC (p < 0.0001). There was a significantly higher prevalence of BA in girls with obesity (p = 0.009) than in those without obesity. Significantly lower prevalence of AC (p = 0.01) and AR/AC (p = 0.002) among children with obesity, and AR (p = 0.04) and AR/AC (p = 0.0004) among boys with obesity were observed than those without obesity. Those who were obese and had AD were significantly more likely to have severe symptoms (p = 0.01). Overall, childhood obesity has positive associations with BA prevalence and AD severity, whereas it has negative associations with AR and AC prevalence, especially among boys. Changes in the immunologic balance accompanied by obesity might have different effects on each type of allergic disease. Exploring the mechanisms by which childhood obesity affects allergic status should lead to new management options for childhood allergy.