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Abstract Background Anorexia nervosa (AN) is associated with abnormalities that may increase the risk of future cardiovascular disease. This study assessed the cardiovascular health of individuals who recovered from AN during adolescence by conducting wave power analysis. Methods Former AN patients discharged from the Royal Children’s and Monash Children’s Hospitals (N = 17) in Melbourne, Australia underwent ultrasound imaging of the right carotid artery. Wave power analysis was conducted to assess biomechanical interactions of the cardiovascular system. Patient measures were compared to healthy controls (N = 51). Results Eighty-eight percent of the former AN patients and controls were female, aged approximately 25 years, with a healthy body mass index. Mean carotid flow and pulsatility index were not different between groups. Carotid arterial strain and distensibility were lower, and the wave speed and beta stiffness index higher in the former AN patients. Characteristic impedance was not different nor were the forward and backward wave amplitudes. However, wave reflection indices (ratios of backward-to-forward compression wave area, and wave-related effect on pressure and hydraulic power) were 12–18% lower in the former AN patients (p

Objective: This study investigated the accuracy of two oscillometric devices for measuring brachial and central blood pressures (BP) in children and adolescents, using high fidelity intra-arterial measurements as a gold-standard reference. Methods: 57 children and adolescents aged 9.5 ± 4.6 years (mean ± SD, range 3 to 17, 74% 0.18). Results in sub-groups ≥13 and

Objective: To assess whether reservoir pressure (Pres) in young individuals with a compliant aorta is uniform throughout the aorta, as has recently been reported in older adults with cardiovascular disease (1). Methods: High fidelity pressure was measured with a Verrata wire (Philips Volcano) in 5 aortic locations (ascending-to-abdominal) via pull-back in 11 children with a normal aorta (age 10.4 ± 4.9 years, mean ± SD). Pres was calculated using the ‘pressure-only’ approach (2), with exponential fitting over the whole of diastole (1) (WholeDia) or the period when pressure declined in an approximately exponential fashion (ExpDia). Results: ExpDia produced a better fit than WholeDia (R2=0.99 ± 0.01 vs 0.91 ± 0.11, P < 0.001). Pres amplitude (ΔPres) in the ascending aorta from WholeDia fitting (12.0 ± 4.1 mmHg) was less than with ExpDia fitting (19.0 ± 5.2, P = 0.001). The zero-flow asymptotic pressure (Pinf) obtained from the fitting procedure was negative (non-physiological) in 76% (WholeDia) and 44% (ExpDia) of recordings, but fixing Pinf to 37 mmHg (average of physiological values) had little effect on the resulting ΔPres. ΔPres varied by 5.7 ± 3.0 mmHg (WholeDia) and 7.3 ± 3.7 mmHg (ExpDia) between aortic locations (both P

Objective: The aims of this study in children were to 1) evaluate two brachial oscillometric devices for estimating central augmentation index (AIx) and reflection magnitude (RM), and 2) test whether AIx or RM are associated with left ventricular mass index (LVMI). Methods: Intra-aortic (IA) AIx was calculated from high-fidelity pressure measured with a Verrata wire (Philips Volcano) in 60 children (9.2 ± 4.7 years) with unobstructed aorta undergoing clinically-indicated catheterisation. AIx was also obtained from SphygmoCor XCEL (SC, AtCor) and/or Mobil-o-Graph (MB, IEM) brachial oscillometric devices. RM(IA) was calculated via wave separation using a representative normalised flow waveform obtained from MRI in a separate group of normal adolescents, RM(SC) via the triangulation method, and RM(MB) provided by the proprietary software. LVMI was estimated via echocardiography. Results: Invasive vs non-invasive AIx and RM are compared in the Table. AIx(IA) correlated weakly with AIx(SC) (R = 0.27, P = 0.04) but not AIx(MB) (P = 0.4). Neither RM(SC) nor RM(MB) correlated with RM(IA) (P = 0.13 and P = 0.96 respectively). RM(IA) was moderately correlated with AIx(IA) (R = 0.69, P < 0.001) and weakly correlated with AIx(SC) (R = 0.36, P = 0.007) but not AIx(MB) (P = 0.7). In a multivariable regression, height (P < 0.001) and RM (IA) (P = 0.04) were independently and positively associated with LVMI (adjusted R2 = 0.24), whereas there were no associations of any AIx or non-invasively estimated RM with LVMI. Conclusion: Central AIx and RM were poorly estimated by SC and MB in children. Unlike RM(IA), none of the non-invasive indices of wave reflection correlated with LVMI, likely due to inadequate estimation of the central pressure waveform shape in this age group.

The pathogenesis of Kawasaki disease (KD) remains unknown and there is accumulating evidence for the importance of the innate immune system in initiating and mediating the host inflammatory response. We compared innate immune responses in KD and toxic shock syndrome (TSS) participants more than two years after their acute illness with control participants to investigate differences in their immune phenotype. Toxic shock syndrome shares many clinical features with KD; by including both disease groups we endeavoured to explore changes in innate immune responses following acute inflammatory illnesses more broadly. We measured the in vitro production of interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-1 receptor antagonist (IL-1ra), and IL-10 following whole blood stimulation with toll-like receptor and inflammasome ligands in 52 KD, 20 TSS, and 53 control participants in a case-control study. Analyses were adjusted for age, sex, and unstimulated cytokine concentrations. Compared to controls, KD participants have reduced IL-1ra production in response to stimulation with double stranded RNA (geometric mean ratio (GMR) 0.37, 95% CI 0.15, 0.89, p = 0.03) and increased IL-6 production in response to incubation with Lyovec™ (GMR 5.48, 95% CI 1.77, 16.98, p = 0.004). Compared to controls, TSS participants have increased IFN-γ production in response to peptidoglycan (GMR 4.07, 95% CI 1.82, 9.11, p = 0.001), increased IL-1β production to lipopolysaccharide (GMR 1.64, 95% CI 1.13, 2.38, p = 0.01) and peptidoglycan (GMR 1.61, 95% CI 1.11, 2.33, p = 0.01), and increased IL-6 production to peptidoglycan (GMR 1.45, 95% CI 1.10, 1.92, p = 0.01). Years following the acute illness, individuals with previous KD or TSS exhibit a pro-inflammatory innate immune phenotype suggesting a possible underlying immunological susceptibility or innate immune memory.