NGAL is an early predictive biomarker of contrast-induced nephropathy in children

We hypothesized that neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of contrast-induced nephropathy (CIN). We prospectively enrolled 91 children (age 0–18 years) with congenital heart disease undergoing elective cardiac catheterization and angiography with contrast administration (CC; Ioversol). Serial urine and plasma samples were analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay (ELISA). CIN, defined as a 50% increase in serum creatinine from baseline, was found in 11 subjects (12%), but detection using increase in serum creatinine was only possible 6–24 h after CC. In contrast, significant elevation of NGAL concentrations in urine (135 ± 32 vs. 11.6 ± 2 ng/ml without CIN, p < 0.001) and plasma (151 ± 34 vs. 36 ± 4 without CIN, p < 0.001) were noted within 2 h after CC in those subjects. Using a cutoff value of 100 ng/ml, sensitivity, specificity, and area under the receiver-operating characteristic (ROC) curve for prediction of CIN were excellent for the 2-h urine NGAL (73%, 100%, and 0.92, respectively) and 2-h plasma NGAL (73%, 100%, and 0.91, respectively). By multivariate analysis, the 2-h NGAL concentrations in the urine (R ² = 0.52, p < 0.0001) and plasma (R ² = 0.72, p < 0.0001) were found to be powerful independent predictors of CIN. Patient demographics and contrast volume were not predictive of CIN.     

Optical quality and impact resistance comparisons of 2 football helmet faceshields

BACKGROUND: Currently there is no standard that specifically addresses the optical and impact performance of football protective faceshields. This study compared the impact resistance and optical quality between 2 popular football faceshields. Testing was performed only on new faceshields. METHODS: To test impact resistance, baseballs were propelled at the faceshields with velocities up to 66.4 m/sec. Structural integrity was evaluated after each impact. Ten visors from each of 2 companies underwent a single impact at various velocities. Two visors from each company were impacted 3 times to evaluate the effects of repeated blows. Additional visors were conditioned to -10 degrees C and impacted once. Additionally, prismatic power, refractive power, haze, visible light, and ultraviolet (UV) transmittance, and optical distortion were measured to evaluate optical quality. All testing was done with faceshields mounted to facemask and, when appropriate, to a helmet. RESULTS: None of these new faceshields fractured even with impact velocities up to 66.4 m/sec. With regard to optical quality, both protectors met the optical requirements for the standards of faceshields for selected sports (ASTM F803-2003). CONCLUSIONS: Both faceshields tested should protect football players from anticipated impacts while providing adequate optical quality for satisfactory visual performance.     

Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis

Background:  Prevalence rates of headache in multiple sclerosis (MS) patients varied widely in recent studies. This study aimed to investigate the 1 year prevalence of headache in MS compared with the general population.
Methods:  Population-based case–control study in Germany.
Results:  We included 491 patients with definite MS (68% female, mean age 45.3 years, 63.7% relapsing remitting MS, mean Expanded Disability Status Scale (EDSS) 3.2, 106 treated with interferon-β, 53 with glatiramer acetate, 271 untreated) and 447 age and gender matched controls. Headache was diagnosed with a validated questionnaire according to the International Headache Society Criteria. Headache prevalence was 56.2% (tension type headache 37.2%, migraine 24.6%). Headache prevalence rates did not differ from controls. Headache was not associated with disability or treatment. Trigeminal neuralgia was found in 6.3% of MS cases.
Conclusion:  Results suggest that headache in MS patients reflects comorbidity in most conditions.     

Unsuccessful surgical excision of optic nerve drusen

Background  

To report the case of failed surgical excision of optic nerve drusen (OND).     

Exercise Capacity Improves after Transcatheter Closure of the Fontan Fenestration in Children

Objectives. This study evaluated the aerobic capacity, exercise capacity, and arterial oxygen saturation (O₂Sat) in children before and after transcatheter Fontan fenestration closure. Design. Observational study comparing exercise parameters and hemodynamics before and after transcatheter fenestration closure in Fontan patients. Outcome Measures. Working capacity, exercise duration, oxygen consumption (VO₂), and arterial O₂Sat were evaluated during aerobic exercise. Results. Twenty patients (mean age 11.4 years) underwent standardized exercise testing before and after fenestration closure. Twelve patients underwent cycle ergometry testing (mean age 14.8 years) (group1), and eight younger patients (mean age 6.4 years) underwent Bruce treadmill testing (group 2). The same exercise protocol was used in each patient before and after fenestration closure (interval between tests: 118 ± 142 days). Immediately following fenestration closure at cardiac catheterization, cardiac index decreased (3.0 to 2.1 L/minute/m²) and Fontan pressure increased (11 ± 2 to 12 ± 2 mm Hg) with an increased arterial saturation (92 to 96%) (P < .001). The total group demonstrated no significant change in pre‐ and postclosure maximal heart rates (164 ± 21 and 169 ± 19 bpm). Rest and exercise O₂Sat increased (89 and 82 to 95 and 92%) (P < .0001). Exercise duration increased (7.7 ± 1.9 to 9.2 ± 2.4 minutes) (P < .0005). Maximal VO₂, indexed maximal VO₂, and total working capacity in kilopond‐meters (kpm) increased (1.2 ± 0.5, 27 ± 7 and 2466 ± 1012 to 1.3 ± 0.4 L/minute, 31 ± 9 mL/kg/minute and 2869 ± 1051 kpm, respectively) (P < .005). Conclusion. In children with a univentricular heart after Fontan palliation, transcatheter fenestration closure improves exercise arterial O₂Sat and aerobic capacity despite a restricted resting cardiac output documented by catheterization immediately after the closure procedure.