Rate of trabecular bone area in 3–6‐year‐old children and relation to intrauterine growth

Background: The aim of the present study was to investigate bone mass using rate of trabecular bone area (RTBA) in Japanese children to determine its relationship with indices of growth such as height and weight from before birth through childhood. Methods: A cross‐sectional study was conducted. The sample consisted of Japanese boys (n= 716) and girls (n= 586) aged 3–6 years. RTBA was measured using quantitative ultrasound (ultrasonic bone densitometer, Benus III; Ishikawa Seisakusho, Kanazawa, Japan). The relation between RTBA and height and weight during childhood and also at birth was assessed. Results: The average RTBA in boys was 27.7 ± 1.59% (mean ± SD) and that in girls was 27.9 ± 1.59%. RTBA significantly correlated with weight both in boys (P= 0.013) and girls (P= 0.016). Significant correlation was demonstrated between RTBA and height, especially in girls (P= 0.045). Statistical significance was shown between RTBA and birth length in boys (P= 0.015) and girls (P= 0.007), and weight at birth in boys (P= 0.014). On multiple regression analysis RTBA correlated significantly with birthweight for boys (standardized coefficient β= 0.093, P= 0.028) and birth length for girls (β= 0.122, P= 0.007). Conclusion: Augmentation of bone mass is related not only to weight and height during childhood but also to prenatal factors such as growth, and possibly with nutrition in utero.     

Laparoscopyvs inguinal exploration for nonpalpable undescended testis

Objective : The optimal initial surgical approach for nonpalpable undescended testis (UDT) is debated. The aim of the present study is to compare the results of initial laparoscopy and inguinal exploration in the management of unilateral nonpalpable undescended testes.Methods : The results of 20 children with unilateral nonpalpable UDT managed by initial laparoscopy (group I) were compared with 20 age-matched children managed by inguinal exploration (group II). The location of testes and results of orchiopexy were compared in both groups. A single surgeon performed all the operative procedures.Results : The majority of testes (16/20 group 1,17/20 group II) in both groups were canalicular or low abdominal. Vanishing testes accounted for one-third (13/40) of the testes, the majority (85%) of which were located in the inguinal canal. All children were discharged within 24 hours of the operation. The success of orchiopexy at 4–6 weeks post-operatively was 85% and 86% in the two groups respectively. Retrospectively, only 7/40 (18%) of the testes would benefit from laparoscopy.Conclusions : Initial laparoscopic and inguinal approaches to nonpalpable UDT give comparable results. This report failed to demonstrate any specific advantage of initial laparoscopy in the majority of children with unilateral nonpalpable UDT.     

Increased plasma type B natriuretic peptide in the acute phase of Kawasaki disease

Background: The aim of this study was to identify possible factors associated with type‐B natriuretic peptide (BNP) production in the acute phase of Kawasaki disease (KD). Methods: Subjects were 54 patients with KD (KD group [KDG]) and 18 age‐matched controls (control group [CG]). We evaluated left ventricular function using multi‐modal echocardiography and determined blood chemistry including BNP, white blood cell count, C‐reactive protein (CRP), and interleukin (IL)‐6 in the KDG. We compared echocardiographic parameters between the KDG and the CG and determined the correlation between log (BNP) and echocardiographic parameters, white blood cell count, CRP, and IL‐6 in the KDG. Results: The KDG showed high BNP (169.6 ± 529.6 pg/ml) despite preserved left ventricular function indicated by no significant difference in left ventricular ejection fraction (72.2 ± 9.2 vs 71.2 ± 7.8 %), z‐score of left ventricular diastolic dimension (0.8 ± 1.3 vs 0.9 ± 0.8 SD), and Tei index (0.29 ± 0.09 vs 0.30 ± 0.06) between the KDG and the CG. However, left ventricular ejection fraction (r =?0.44, P= .001) and left ventricular end‐diastolic dimension (r = 0.30, P < .05) significantly correlated with log (BNP). On the other hand, the KDG showed high CRP (89.7 ± 55.6 mg/l) and high IL‐6 (242.2 ± 243.5 pg/ml), and CRP (r = 0.60, P < 0.0001) and IL‐6 (r = 0.78, P < 0.0001) significantly correlated with log (BNP). Multiple stepwise regression analysis identified IL‐6 (r = 0.77, P < 0.0001) most significantly correlated with log (BNP). Conclusions: In acute KD, BNP significantly increases, despite well‐preserved global left ventricular function, and inflammation might be associated with this increased BNP.     

Quantitative ultrasonometry of the calcaneus in children with osteogenesis imperfecta

Aims: Osteogenesis imperfecta (OI) is characterised by low bone density and increased bone fragility. The aim was to evaluate calcaneal quantitative ultrasonometry (QUS) parameters in children with OI and to look for relationship with the number of prevalent fractures. Methods: Eighteen children (12 boys and six girls; mean age 9.8 ± 3.5 years) with OI (type I, n= 15; type IV, n= 3; mean fracture prevalence 3.7 per patient) had the velocity of sound (VOS) and broadband ultrasound attenuation (BUA) measured on both heels with a Cuba Clinical (McCue Ultrasonics, Winchester, UK) dry ultrasound portable device. Both BUA and VOS were expressed as either age‐dependent or height‐related values. The obtained values of VOS and BUA were correlated to number of prevalent fractures. Results: The patients were of short stature (Z‐score –1.73 ± 1.20 SD; P < 0.001). Both age‐related BUA and VOS were low in comparison to reference values (P < 0.0001), same as height‐adjusted BUA and VOS (P < 0.0001). We found no correlations between number of prevalent fractures and BUA or VOS (age‐related or height‐adjusted) (r= 0.02, r= 0.017, r=–0.13, r= 0.015, respectively). Conclusions: Children with OI have low QUS parameters with no relationship to number of prevalent fractures.     

Possible pathologenic role of interleukin-5 and eosino cationic protein in Henoch-Schönlein purpura nephritis

Abstract Background : The mechanism for the onset of Henoch‐Schönlein purpura nephritis is unknown. In order to identify the pathogenesis of nephritis, laboratory findings and serum cytokines between Henoch‐Schönlein purpura (HSP) patients without nephritis and with nephritis were investigated. Methods : We enrolled 32 patients who had been diagnosed with HSP from January 1993 to December 1998. These patients were divided into two groups. Group 1 consisted 12 patients without nephritis and group 2 consisted 20 patients with nephritis. We evaluated laboratory findings such as eosinophil counts, serum IgE, eosino cationic protein (ECP), and serum cytokine (interleukin (IL)‐2, IL‐4, IL‐5, IL‐6, IL‐10, IL‐13 interferon‐γ and tumor necrotic factor‐α) concentrations between both groups. Results : At the acute phase, serum IL‐5 and ECP concentrations in group 2 were higher than those in group 1 (59.4 ± 32.7 pg/mL vs. 10.8 ± 12.8 pg/mL, P < 0.05, 24.3 ± 5.1 µg/L vs. 8.9 ± 4.2 µg/L, P < 0.05, respectively). Serum IL‐4 concentrations at the acute phase in group 1 were higher than those in group 2 (40.2 ± 21.5 pg/mL vs. 10.7 ± 5.4 pg/mL, P < 0.01). In group 2, serum IL‐5 concentrations at the acute phase were higher than those at recovery phase. Conclusions : These findings suggest that IL‐5 and eosinophil activation may be one of the factors involved in the mechanism for onset of nephritis.     

Fertility and unilateral undescended testis in the rat model III: ultrastructural changes in the contralateral descended testis

Fertility is decreased in rats with experimentally-created unilateral undescended testis (UUDT). Although light microscopy has shown changes in the UDT, it has consistently failed to demonstrate any significant damage in the contralateral descended testis (CDT) of these animals in previous experimental studies utilizing the same model. To study the ultrastructural details of the CDT and the ipsilateral UDT using transmission electron microscopy (TEM) in rats with experimentally-created UUDT, in Wistar albino rat pups UUDT was experimentally created in accordance with the model described previously. Ten rats with UUDT were compared with 10 control rats. The UDT and CDT were harvested at 135 days of age and sections from specimens studied by TEM for changes in the seminiferous tubules, Leydig cells, and extracellular matrix. All observations were graded and analyzed for statistical significance. TEM of the testes of control rats was normal, while both the ipsilateral UDT and the CDT showed significant changes. Significant changes in the CDT included thickening of the basement membrane (P=0.001), a decrease in spermatogenic cell lines (P=0.02), vacuolation (P=0.0001) and other features of degeneration (P=0.02), single cell apoptotic figures (P=0.02), and an increase in Sertoli-cell numbers (P=0.01), size (P=0.01), and endoplasmic reticulum (P=0.01). Another significant feature was the occurrence of morphologic sperm abnormalities in the form of tail denudation (P=0.02). The surgically-created UDT showed changes of gross degeneration and atrophy. TEM studies thus revealed gross ultrastructural damage to the UDT and similar subtle but significant changes in the CDT. These may explain the decrease in fertility in rats with UUDT. Accepted: 18 April 2001     

The effects of orchiopexy on serum anti-Müllerian hormone levels in unilateral cryptorchid infants

Background/Purpose: In males, serum anti-Müllerian hormone (AMH) reflects Sertoli cell function and provides an estimate of seminiferous tubular integrity. It has been suggested that comparison of AMH levels before and after surgery could be useful to determine effectiveness of the treatment. In this study, we determined the serum AMH levels in infants with unilateral cryptorchidism before and after orchiopexy procedure and compared these data with the AMH values in age-matched controls. Methods: The study population was 20 cryptorchid children with unilateral palpable testes who underwent orchiopexy as a cryptorchid group, and 20 healthy children who underwent circumcision as a control group. All children are 12 months of age. Serum AMH levels were measured at just before surgery (at 12 month old) and 6 months after surgery (at 18 month old). Results and Conclusions: All undescended testes were found to be normal in size and in the superficial inguinal pouch or subcutaneous region of the groin at surgery. With regard to the preoperative serum AMH levels, there was a significant difference between the cryptorchid and the control groups (40.04±4.97 ng/ml versus 53.46±7.51 ng/ml) (P<0.05). Similarly, the postoperative serum AMH levels were lower in cryptorchid children than in controls (39.27±4.58 ng/ml versus 52.79±6.27 ng/ml) (P<0.05). In cryptorchid children, serum AMH levels measured at 6 months after orchiopexy were similar with preoperative basal levels (40.04±4.97 ng/ml versus 39.27±4.58 ng/ml) (P>0.05). AMH levels in children with unilateral palpable undescended testes remain unchanged 6 months after orchiopexy performed at 1 year of age. This is the first report in literature regarding the effect of orchiopexy on the serum AMH levels.     

Efficacy of two different doses of oral vitamin D supplementation on inflammatory biomarkers and maternal and neonatal outcomes

Hypovitaminosis D during pregnancy is suggested to have a link with complications in both mother and infant. We aimed to evaluate the efficacy of two doses of vitamin D3 supplementation during pregnancy on maternal and cord blood vitamin D status, inflammatory biomarkers, and maternal and neonatal outcomes. A total of 84 pregnant women (gestational age of <12 weeks) were randomly allocated to one of two groups: (a) 1,000‐IU/d vitamin D and (b) 2,000 IU/d. Biochemical assessments (25‐hydroxycalciferol (25(OH)D), hs‐CRP, and cell‐culture supernatant concentrations of IL‐1β, IL‐6, and TNF‐α) of mothers were performed at the beginning and 34 weeks of gestation. Assessments of infants at delivery comprised cord blood serum concentrations of 25(OH)D, hs‐CRP, IL‐1β, IL‐6, TNF‐α, birth sizes, and Apgar score. Circulating concentrations of 25(OH)D increased in both intervention groups with more increment in 2,000 IU/d than in 1,000 IU/d (46.7 ± 30.7 vs. 24.0 ± 21.07 nmol L^?1, P = .001). Concentrations of TNF‐α decreased significantly in group 2,000 (?913.1 ± 1261.3 ng L^?1, P = .01). The cord blood concentration of IL‐6 in group 2,000 IU/d, compared with 1,000 IU/d, was significantly lower (25.9 ± 32.0 vs. 4.6 ± 1.4 ng L^?1, P = .03). The birth sizes including weight, length, and head circumference of the infants of group 2,000 IU/d were significantly higher than the infants' of group 1,000 IU/d. Supplementation with 2,000‐IU/d vitamin D3 is more effective than 1,000 IU/d in pregnant women in terms of increasing circulating 25(OH)D, ameliorating pro‐inflammatory markers notably TNF‐α in mother and IL‐6 in cord blood, and improving neonatal outcomes including the birth sizes.     

Interleukin‐6 polymorphism and bronchopulmonary dysplasia risk in very low‐birthweight infants

Background: The aim of the present study was to evaluate the role of interleukin (IL)‐6‐634 polymorphism in neonatal disorders such as bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) in very low‐birthweight (VLBW) infants. Methods: This prospective cohort study included 202 infants (gestational age at birth, 23–34 weeks; birthweight, 500–1499 g). Genotypic analysis (polymerase chain reaction–restriction fragment length polymorphism) was performed with DNA extracted from whole‐blood samples. Results: Genotype distribution (66.8% CC, 28.2% CG, 5.0% GG) was similar to that in the adult Japanese population. BPD occurred in 85 infants (42.1%) among 202 VLBW infants. The duration of O₂ therapy in infants with CG/GG genotypes was significantly longer than that in infants with the CC genotype (CG/GG vs CC: 40.3 ± 52.2 days vs 28.4 ± 32.6 days, P < 0.05), but the prevalence of BPD was not associated with the CG/GG genotype (CG/GG, 40.0%; CC, 46.3%, P= 0.24). Infants with CG/GG genotypes were more likely to have received postnatal corticosteroid therapy for BPD than those with the CC genotype (CG/GG vs CC: 20.9% vs 11.1%, P= 0.05). PVL occurred in six infants (3.0%). There was no significant difference in the prevalence of PVL among IL‐6‐634 polymorphisms (CG/GG, 3.0%; CC, 3.0%, P= 0.65). Conclusions: IL‐6‐634 polymorphism is associated with duration of oxygen therapy in VLBW infants. This suggests that the IL‐6‐634 polymorphism G allele is an aggravating factor of BPD. IL‐6‐634 polymorphism is not associated with PVL.     

Treatment of encapsulated pleural effusions in children: A prospective trial

Background: The aim of this study was to improve the efficacy of treatment of complicated pleural effusions. Methods: In this prospective study, 76 consecutive children (average age 5.0 ± 4.14 years) fulfilling the required classification criteria were duly treated with chest tube placement and divided into two groups depending on the presence of encapsulated or non‐encapsulated effusions. Treatment of the former group was supplemented by intrapleural fibrinolysis. The effectiveness of treatment was assessed in terms of chest tube dwell‐time and total length of hospitalization. Regression analysis was performed using independent factors that were associated with these dependent factors. Value differences for P < 0.05 were considered significant. Results: The ultrasound pleural distance and lactic‐dehydrogenase content in the pleural fluid was significantly associated with the length of treatment (P < 0.01). Improved response to treatment, reduced duration of hospitalization (9.2 ± 1.9 vs 11.5 ± 0.9; P < 0.01) and tube dwell‐time (7.6 ± 1.3 vs 9.5 ± 0.9; P < 0.01) was achieved in the intrapleural‐fibrinolysis‐treated group (n= 38) compared with controls (n= 38), with virtually the same total tube output (606.1 ± 257.5 vs 673.1 ± 347.4; P= 0.175). All patients were completely cured. Following 104 applications of the fibrinolytic agent there was one change in coagulation parameters: hypofibrinogenemia (in 1%). Conclusions: The authors recommend intrapleural fibrinolysis as an effective and safe alternative treatment strategy in treating encapsulated pleural effusions in children.     

Evaluation of working memory impairment in children with primary nocturnal enuresis: evidence from event-related functional magnetic resonance imaging

Aim: To assess the working memory and explore the differential activations of brain areas in children with primary nocturnal enuresis (PNE) by performing functional magnetic resonance imaging (fMRI) scans using the categorical N‐Back task. Methods: Thirteen right‐handed PNE children (M/F = 7:6, average age 11.4 ± 0.8 years) and 15 age‐matched, right‐handed, healthy controls (M/F = 9:6, 11.3 ± 1.0 years) were recruited for the study. First, intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence in PNE children and controls. The full intelligence quotient (FIQ), verbal IQ (VIQ), performance IQ (PIQ) and memory/caution (M/C) factor were measured. After intelligence tests, event‐related fMRI scans were performed using the categorical N‐Back working memory task on a 3.0T MR scanner. The percent of correct responses (PCR) and the mean reaction time to correct response (mRT) were recorded and compared; fMRI data were analysed using SPM2, the differences in activation were compared with the single subject and between‐group levels. Results: The FIQ, VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group (P > 0.05). The M/C factor was statistically significantly lower in the PNE group (P < 0.05). In the N‐Back test, PNE children had lower PCR and longer mRT than controls (P < 0.05). A between‐group analysis of fMRI data revealed significant attenuation in the left posterior cerebellar lobes of PNE children. Conclusion: PNE children had deficits in working memory, and dysfunction in the left cerebella might be associated with their working memory deficits.     

The relation of arterial stiffness with intrauterine growth retardation

Background: Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages. Methods: Thirty‐two (24 girls and eight boys) IUGR children aged 8.77 ± 2.05 years were enrolled in the study. The birthweight was traced from the medical records. Their gestational ages were 38.9 ± 0.85 weeks and birthweights 2130 ± 198 g, respectively. Thirty‐one healthy subjects who had normal gestational age and birthweight, matched for age and sex were recruited as a control group. Aortic strain, pressure strain elastic modulus (Ep), and normalized Ep and aortic distensibility were measured by a sphygmomanometer and transthoracic echocardiography in all subjects from the abdominal aorta. Results: There was no statistically significant difference between the study and the control groups in sex, mean age, body mass index, lipid profile, leptin, insulin‐like growth factor‐1 or insulin‐like growth factor binding protein 3. In IUGR children, aortic strain (0.201 ± 0.027 vs 0.254 ± 0.031, P < 0.001) and aortic distensibility (1.08 ± 0.19 vs 1.42 ± 0.24, P < 0.001) were significantly lower compared with the control group. However Ep (188 ± 36.2 vs 146 ± 27.1, P < 0.001) and normalized Ep (2.97 ± 0.40 vs 2.1 ± 0.39, P < 0.001) were significantly higher in IUGR patients. Conclusions: This study demonstrates that abdominal aortic stiffness is increased in IUGR patients. These data suggest that prenatal events could be related to cardiovascular risk in later life.     

Vitamin B12 treatment reduces mononuclear DNA damage

Background: DNA damage effects of vitamin B₁₂ deficiency were performed in vitro and in adults. Methods: The study group included 32 children (13 girls, 19 boys) with vitamin B₁₂ deficiency (mean age 44 ± 58 months) and their 27 mothers (mean age 30.4 ± 5.3 years). The control group contained 30 healthy children and 25 mothers. DNA strand breaks in peripheral blood mononuclear leukocytes were assayed by single‐cell alkaline gel electrophoresis (comet assay) before and 8 days after the first injection of vitamin B₁₂. Results: Mean DNA damage scores in children with vitamin B₁₂ deficiency and their mothers were significantly higher before treatment than those after treatment. The DNA damage scores of children after treatment were still significantly higher than controls. There were significant negative correlations between the children and their mothers in terms of vitamin B₁₂ levels and DNA damage scores (r = 0.3, P= 0.02; r = 0.58, P= 0.002, respectively). There were correlations between the children's and their mothers' DNA damage and the severity of vitamin B₁₂ deficiency, suggesting that the children and their mothers may play a role in the scarcity of nutritional vitamin B₁₂. Conclusion: DNA damage is increased in children with vitamin B₁₂ deficiency and in their mothers. DNA damage scores were significantly improved through vitamin B₁₂ therapy 8 days after the first injection, however, they were still significantly higher than those of controls.     

Chromium levels in healthy and newly diagnosed type 1 diabetic children

Background: The aim of this study was to compare the chromium levels of plasma (PCL), erythrocyte (ECL) and urine (UCL) in type 1 diabetics and healthy subjects and to review the relation between metabolic parameters. Methods: We evaluated 165 subjects who were: newly diagnosed type 1 diabetics (group 1 [n= 29]); previously diagnosed type 1 diabetics (group 2 [n= 18]); non‐diabetic control subjects who were admitted and treated for any reason in hospital (group 3 [n= 21]); and two other groups of control subjects from two schools that have different socioeconomic levels (group 4 [n= 48] and group 5 [n= 49]). Results: PCL in group 1 and group 2 subjects (7.21 ± 4.78 and 10.94 ± 3.04 mcg/L, respectively) was significantly lower than in all control groups (21.84 ± 7.87, 16.11 ± 7.44, 17.25 ± 8.58 mcg/L, respectively) (P < 0.05). A significant difference in PCL between the group 1 and group 2 subjects was present (7.21 ± 4.78 and 10.94 ± 3.04, respectively) (P= 0.021). ECL (as tissue chromium) in group 1 and group 2 subjects (13.99 ± 11.37 and 19.64 ± 12.58, respectively) was significantly lower than in all control groups (28.20 ± 7.34.25, 49 ± 12.47, 26.37 ± 9.77 mcg/L, respectively) (P= 0.05). UCL in group 1 and group 2 subjects (11.44 ± 6.88 and 15.68 ± 6.75 mcg/L, respectively) was significantly lower than in group 3 subjects (28.83 ± 9.37mcg/L) (P < 0.05). There were significant correlations between length, bodyweight and PCL in the group 1 subjects (r = 0.42, P= 0.22 and r = 0.53, P= 0.03, respectively). There was a negative correlation between plasma glucose and UCL, which was not statistically significant in group 2 subjects (r =?0.4, P= 0.061). Conclusion: There was a negative chromium balance in type 1 diabetics. This negative balance may affect the insulin function badly. If this negative balance should be confirmed by recent studies we suggest that chromium supplementation with insulin is necessary for type 1 diabetes.     

G6PD缺陷与肠道病毒71型手足口病的关系

目的 探讨葡萄糖-6-磷酸脱氢酶(glucose-6-phosphate dehydrogenase, G6PD)缺陷对肠道病毒71型(Enterovirus 71, EV71)感染所致手足口病的影响及可能机制。方法 选取确诊为EV71感染手足口病的男性患儿220例,根据病情分为普通组(145例)和重症组(75例);将同期体检的132例健康男性儿童设为对照组。用全自动生化仪进行血液中G6PD、还原型谷胱甘肽(GSH)及丙二醛(MDA)水平的测定。结果 重症组G6PD缺陷比例明显高于对照组(P<0.0125)。重症组中G6PD缺陷患儿的总热程、精神异常时间、肢体抖动持续时间及住院时间均较G6PD正常者长(P<0.05)。急性期及恢复期普通组与重症组患儿血中GSH、G6PD水平均低于对照组(P<0.05),MDA水平均高于对照组(P<0.05)。普通组及重症组G6PD缺陷患儿急性期血GSH水平均低于G6PD活性正常患儿,MDA水平均高于G6PD活性正常患儿(P<0.01)。急性期及恢复期患儿GSH水平与G6PD活性均呈正相关(分别r=0.61、0.58,均P<0.01);急性期患儿MDA水平与G6PD活性呈负相关(r=-0.29,P<0.01)。结论 G6PD缺陷可能是EV71型手足口病的易感因素,伴G6PD缺乏的患儿病情可能更重,其机制可能与氧化应激有关。     

Exhaled carbon monoxide levels in preschool‐age children with episodic asthma

Background: The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known. Methods: A sampling bag was developed to collect the exhaled air of preschool children. A total of 257 preschool‐age children (≥3 years and ≤6 years old) were studied; 111 had a diagnosis of asthma (43 suffering a mild asthma attack and 68 without active asthmatic symptom), 99 had upper respiratory infection (URI) and 47 were healthy. Results: In preschool‐age children, eCO levels of those with asthma attacks (mean ± SE, 2.7 ± 0.3 p.p.m., n= 43) were significantly higher than those of subjects with asymptomatic asthma (0.5 ± 0.1 p.p.m., P < 0.05), URI (0.8 ± 0.1 p.p.m., P < 0.05) and healthy children (0.4 ± 0.1 p.p.m., P < 0.05). A multivariate linear regression model showed that eCO was higher in children with asthma attacks independent of age and gender. In 33 asthmatic children followed before and after treatment, eCO levels during asthma attacks significantly decreased after inhalation therapy with a combination of salbutamol and sodium cromoglycate (before therapy, 2.9 ± 0.4 p.p.m.; after therapy, 0.6 ± 0.1 p.p.m., P < 0.0001). Conclusions: The measurement of eCO using a novel collecting system is useful in the recognition of asthma in preschool children.     

Cardiac function in survivors of acute lymphoblastic leukaemia and Hodgkin's lymphoma

Aim: The study objective was to assess plasma N‐terminal–pro‐brain natriuretic peptide (BNP) levels and to evaluate left ventricular mass as well as left ventricular systolic and diastolic functions in 44 children who had undergone treatment for acute lymphoblastic leukaemia and Hodgkin's lymphoma, with regard to gender, age at disease onset, time that had passed since therapy completion, cumulative dose of antracyclines and mediastinal radiotherapy applied. Methods: The median levels of pro‐BNP were found to be higher in the whole study group as compared with the control (55.9 ± 53.1 ng/mL vs. 38.5 ± 47.7 ng/mL, P= 0.059). The pro‐BNP values >80.0 ng/mL (standard deviation score (SDS)) were noted in 11/44 patients, including those exceeding 115.0 ng/mL (2 SDS) – in 6/44 patients. Results: No correlation was observed of pro‐BNP levels with the accumulated dose of antracyclines (r=?0.42, P= 0.79) or mediastinal radiotherapy (r= 0.197, P= 0.2). However, negative correlation was found between pro‐BNP and the time that had passed since therapy completion (r=?0.378, P= 0.009). In echocardiography, shortening and ejection fractions remained normal, whereas the indexed stroke volume was below 40 mL/m² in 16/44 patients. The E/A index below 1.5 was found in 6/44 cases. The left ventricular systolic mass remained within the normal range. Negative correlation was noted between isovolumetric diastolic time and pro‐BNP level. Conclusions: Increased levels of pro‐BNP after anti‐cancer treatment with the involvement of cardiotoxic substances may indicate the first symptoms of myocardial dysfunction, despite the lack of major echocardiographic disorders.     

Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age

In a study of 1,002 consecutive Malaysian male newborns, 48 (4.8%) were found to have undescended testes (UDT). The rate and laterality of the UDT were associated with lower birth weight (P < 0.001) and prematurity (P < 0.001). Boys with UDT were also more likely to have other congenital abnormalities of the external genitalia, the commonest being hydrocele. No correlation between UDT and maternal age, birth order, social class, or mode of delivery was demonstrated in this study. Although 26/34 (76.5%) of UDT achieved full spontaneous descent by 1 year of age, 1.1% of all infants whose testes remained undescended required regular long-term follow-up with surgical referral and correction at an appropriate time. A premature infant with UDT is more likely to achieve full testicular descent at 1 year of age than a term infant. Accepted: 22 November 1996     

Significance of acanthosis nigricans in childhood obesity

Aim: Acanthosis nigricans (AN) is among the most common dermatologic manifestations of obesity and hyperinsulinism. In this study, we aimed to find the clinical and laboratory differences in obese children with AN and without AN (non‐AN). Methods: In total, 160 obese children were included in the study. The duration of obesity, body mass index (BMI), BMI z‐scores, birth weight, parental BMI, lipid profile, fasting and post‐meal (PM) glucose and insulin levels were compared in 67 obese with AN and 93 obese without AN. Results: Age was similar in both groups. AN group had higher male to female ratio (42/25 in AN, 43/50 in non‐AN; P = 0.03), higher BMI (30.3 ± 6.1 in AN, 26.4 ± 3.6 in non‐AN; P < 0.001) and weight for height (162.6 ± 28.8 in AN, 144.6 ± 15.8 in non‐AN; P < 0.001) than non‐AN group. There were no significant differences between the groups in birth weight, parental BMI and blood pressure. AN group had higher fasting (19.9 ± 16.2 mU/L in AN, 10.4 ± 7.6 mU/L in non‐AN; P < 0.001) and PM insulin (88.6 ± 87.3 mU/L in AN, 51.1 ± 42.0 mU/L in non‐AN; P = 0.01) and homeostasis model assessment for insulin resistance (HOMA‐IR) (4.0 ± 2.5 in AN, 2.2 ± 1.8 in non‐AN; P < 0.001) than non‐AN group. However, fasting and PM glucose, triglyceride, low‐density lipoprotein‐, high‐density lipoprotein‐ and total cholesterol levels were similar in both groups. BMI was correlated with HOMA‐IR in both groups (r = 0.40 for AN, r = 0.28 for non‐AN). PM glucose and PM insulin were correlated in both groups (r = 0.56 for AN, r = 0.39 for non‐AN). However, fasting glucose and fasting insulin were correlated in only non‐AN (r = 0.25), but not in AN group. Conclusions: Obese children with AN show higher insulin levels and HOMA‐IR. AN is an important predictor of the insulin resistance in childhood obesity. Insulin secretory dynamics seem to be disrupted in fasting state initially, which is reflected as the loss of fasting insulin–glucose correlation in AN group.     

Risk factors for persistent hyperparathyroidism in children with stable renal function after kidney transplantation

This study aimed to investigate the risk factors for PHPT in children with stable renal function who received KT. We retrospectively analyzed the clinical findings and laboratory results of patients who underwent KT below 19 years of age, between 1996 and 2016 at our hospital. Patients were followed up for more than 1 year after KT. We calculated the mean ± standard deviation or median [minimum – maximum] for each parameter. We included a total of 46 patients (male:female = 26:20). Twelve patients (26.1%) were included in the PHPT group, and 34 (73.9%) were in the nPTH group. The dialysis duration was 57.1 ± 49.9, 44 [0‐145] months in the PHPT group and 23.5 ± 25.8, 15 [1‐121] months in the nPTH group (P = .040). The post‐KT total CO₂ level was significantly higher in the PHPT group (P = .022). The pre‐ (P = .021) and post‐KT (P = .005) and 3‐month average (P = .018) iPTH levels were also significantly higher in PHPT group. The height z‐score showed a negative correlation, and the pre‐KT, 3‐month average phosphorus and alkaline phosphate levels showed positive correlations with iPTH levels, at 1 year after KT. Patients who undergo prolonged durations of dialysis, have increased iPTH levels before and after KT, and have low bicarbonate levels after KT are at risk of PHPT and should be monitored carefully.