Search

Abstract: Background: Aberrant generation of eicosanoids is associated with asthma, but the evidence remains incomplete and its potential utility as biomarkers is unclear. Major eicosanoids in exhaled breath condensates (EBCs) were assessed as candidate markers for childhood asthma. Methods: Ten exhaled eicosanoid species was evaluated using ELISA in the discovery phase, followed by prediction model‐building and validation phases. Results: Exhaled LTB4, LTE4, PGE2, and LXA4 showed significant difference between asthmatics (N = 60) and controls (N = 20). For validation, an expanded study population consisting of 626 subjects with asthma and 161 healthy controls was partitioned into a training subset to establish a prediction model and a test sample subset for validation. Receiver operating characteristic (ROC) analyses of the training subset revealed the level of exhaled LTB4 to be the most discriminative among all parameters, including FeNO, and a composite of exhaled LTB4, LXA4, together with FeNO and FEV1, distinguishing asthma with high sensitivity and specificity. Further, the Youden index (J) indicated the cut point value of 0.598 for this composite of markers as having the strongest discriminatory ability (sensitivity = 85.2% and specificity = 83.6%). The predictive algorithm as “asthma classification ratio” was further validated in an independent test sample with sensitivity and specificity being 84.4% and 84.8%, respectively. Conclusions: In a pediatric study population in Taiwan, the levels of exhaled LTB4, LTE4, LXA4, and PGE2 in asthmatic children were significantly different from those of healthy controls, and the combination of exhaled LTB4 and LXA4, together with FeNO and FEV1, best characterized childhood asthma. [ABSTRACT FROM AUTHOR]

This study aimed to compare differences of acute pancreatitis between adult- and pediatric-onset systemic lupus erythematosus (SLE) patients and to clarify the risk factors for mortality. Medical records that carried the dual diagnosis of SLE and acute pancreatitis between 1991 and 2005 were reviewed. Forty-eight episodes of acute pancreatitis were identified in 13 pediatric-onset SLE (pSLE) and 27 adult-onset SLE (aSLE) patients. The prevalence was 1.34% overall, with higher prevalence in pSLE (5.22%) compared with aSLE (0.99%) (p < 0.001). The SLEDAI score on presentation of acute pancreatitis was higher in pSLE (mean ± SD: 21.77 ± 13.09) than in aSLE patients (13.37 ± 8.32) (p = 0.05). Eleven patients died during episodes of acute pancreatitis and mortality rate was significantly higher in pSLE than in the aSLE group (53.8% and 14.8%, respectively, p = 0.015). Mortality was associated with concurrent SLE symptoms (p = 0.049), higher SLEDAI score at presentation of acute pancreatitis (p = 0.011), severe acute pancreatitis (p < 0.001), and the presence of complications (p < 0.001). The multivariate logistic regression analysis showed that severity of acute pancreatitis was the most powerful risk factor for mortality in SLE patients with this disease. In summary, our results indicate that acute pancreatitis occurs more frequently, tends to be more severe, and is associated with higher mortality in pSLE patients when compared with aSLE patient. [ABSTRACT FROM AUTHOR]

Mannose-binding lectin (MBL) gene polymorphisms may be associated with adult-onset systemic lupus erythematosus (SLE), but studies in children with SLE are rare. This study tested the genetic association between MBL polymorphisms and paediatric-onset SLE in a cohort of Chinese children in Taiwan. In all 150 children with SLE and 100 healthy controls of comparable age were genotyped for codon 52, 54 and 57 mutations of theMBL gene using a polymerase chain reaction—based assay. Clinical manifestations, organ involvement, disease activity, laboratory characteristics and outcome were recorded and compared between patients with differentMBL genotypes. Codon 54 mutation was fairly common in both SLE patients and controls, whereas codon 52 and codon 57 mutations were not detected in our study subjects.No statistically significant differences were found in allele frequencies of the codon 54 mutation between SLE and control groups. Moreover, no association was found between thisMBL polymorphismand clinical manifestations, organ involvement, disease activity, laboratory characteristics or outcome of SLE. These results suggest that MBL polymorphisms do not influence susceptibility to paediatric-onset SLE and do not influence clinical manifestations of SLE in Chinese children. [ABSTRACT FROM AUTHOR]

A polymorphism in the monocyte chemoattractant protein 1 (MCP-1) gene regulatory region has been associated with asthma in Caucasians. This polymorphism is possibly endemic to the Asian region, but its impact on Asian populations is unclear. In addition, the relationship of this marker with life-threatening asthma has not been clarified. The aim of this study was to test the genetic association between the MCP-1 –2518A/G polymorphism and asthma/atopy in a cohort of Chinese children, with particular emphasis on those patients who had experienced life-threatening asthma attacks. Forty-eight children with near-fatal asthma, 134 mild-to-moderate asthmatics, 69 allergic-disorder cases without asthma, and 107 nonasthmatic, nonatopic control children were genotyped by a polymerase chain reaction-based assay. Comparison of the four groups of children ( n = 358) revealed no detectable differences in genotype or allele frequencies of the MCP-1 –2518A/G polymorphism. There was no evidence of association between the polymorphism and any of the outcomes of interest including clinical severity, blood eosinophil count, atopy, total serum IgE levels, and degree of bronchial hyper-responsiveness. These results suggest that the MCP-1 –2518A/G polymorphism is not a risk factor for near-fatal asthma. Furthermore, this polymorphism seems to play no role in the development of asthma or atopy in Chinese subjects, possibly as a result of the genetic heterogeneity between Asian and Caucasian populations with respect to regulation of MCP-1 expression. Our results underscore the necessity of accounting for ethnic background in the investigation of asthma-predisposition genes. [ABSTRACT FROM AUTHOR]

A case beta-thalassaemia major complicated with Klebsiella pneumoniae endogenous endophthalmitis is presented to increase physician awareness of the association of the two clinical conditions. Severe morbidity including subretinal abscess and retinal detachment may develop despite aggressive intravenous and intravitreal ceftriaxone therapy, along with vitrectomy and external drainage. [ABSTRACT FROM AUTHOR]

Background: Aberrant generation of eicosanoids is associated with asthma, but the evidence remains incomplete and its potential utility as biomarkers is unclear. Major eicosanoids in exhaled breath condensates (EBCs) were assessed as candidate markers for childhood asthma., Methods: Ten exhaled eicosanoid species was evaluated using ELISA in the discovery phase, followed by prediction model-building and validation phases., Results: Exhaled LTB 4 , LTE 4 , PGE 2, and LXA 4 showed significant difference between asthmatics (N = 60) and controls (N = 20). For validation, an expanded study population consisting of 626 subjects with asthma and 161 healthy controls was partitioned into a training subset to establish a prediction model and a test sample subset for validation. Receiver operating characteristic (ROC) analyses of the training subset revealed the level of exhaled LTB 4 to be the most discriminative among all parameters, including FeNO, and a composite of exhaled LTB 4 , LXA 4 , together with FeNO and FEV 1 , distinguishing asthma with high sensitivity and specificity. Further, the Youden index (J) indicated the cut point value of 0.598 for this composite of markers as having the strongest discriminatory ability (sensitivity = 85.2% and specificity = 83.6%). The predictive algorithm as "asthma classification ratio" was further validated in an independent test sample with sensitivity and specificity being 84.4% and 84.8%, respectively., Conclusions: In a pediatric study population in Taiwan, the levels of exhaled LTB 4 , LTE 4 , LXA 4, and PGE 2 in asthmatic children were significantly different from those of healthy controls, and the combination of exhaled LTB 4 and LXA 4 , together with FeNO and FEV 1 , best characterized childhood asthma., (© 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

This study was undertaken to establish reference values of exhaled nitric oxide fraction (F(eNO)) and its determinants in healthy Asian children. 693 healthy Asian children aged 5-18 yrs were assessed using a single-breath online F(eNO) measurement (exhaled flow 50 mL·s(-1)), questionnaires, anthropometric measurements, spirometry and total and specific immunoglobulin (Ig) E. Geometric mean F(eNO) and the upper 95% CI were 13.7 ppb and 49.7 ppb, respectively, for healthy children, and 11.2 ppb and 30.2 ppb, respectively, for those without allergic sensitisation. F(eNO) was positively associated with age, allergic sensitisation, total IgE, ambient nitric oxide, measurement in the afternoon, and drinking water within 1 h before testing, and was negatively associated with weight. In healthy children without allergic sensitisation, age was the single best explanatory variable. The F(eNO) predicted values were 1-2 ppb higher in Asian than in Caucasian children in earlier studies, while the upper 95% CI were 9-10 ppb higher. In conclusion, the upper limits of normal F(eNO) in Asian children depend on age, from 21 ppb in young children to 39 ppb in adolescents. Ethnicity, age, allergic sensitisation, total IgE, ambient nitric oxide, time of testing, drinking water and weight are important determinants.

Of all patients with systemic lupus erythematosus (SLE), 15-20% are diagnosed during childhood, with disease onset prior to the age of 16 years. Because disease expression in SLE is influenced by environment factors and differs between racial and ethnic groups. The aims of this review were to describe prevalence, clinical manifestations, common infectious complications, and outcome of pediatric-onset SLE in Asia. The prevalence of pediatric-onset SLE was 6.3-19.3 per 100,000 in Asia. The ratio of female to male was 4.7-6.2. The mean age at diagnosis of pediatric-onset SLE was 8.6-13.5 years. The most common clinical features of pediatric-onset SLE in Asia were cutaneous rashes, arthritis, hematological involvement and nephritis. The occurrence of nephritis varies from 29% to 81%. The most common histopathology of lupus nephritis was diffuse proliferative glomerulonephritis (WHO Class-IV) which occurred in 39.4-54% of case of lupus nephritis. Pediatric-onset SLE patients with infections have poor outcomes than uninfected patients. Gram-negative bacilli are the most common microorganisms responsible for bacteremia in Asian patients with SLE. Recurrent major infections predict poorer disease outcome and associated organ damage in pediatric-onset SLE. Improving the survival of SLE patients was reported in Asia in recent decades. The survival was 92% at the age of 5 years, 86% at 10 years and 79% at 15 years in children with SLE in Taiwan in 2008.

Objective: To estimate the national prevalence of systemic lupus erythematosus (SLE) and juvenile chronic arthritis (JCA) in Chinese children in Taiwan., Methods: A nationwide prospective population based epidemiologic study for the prevalence of pediatric SLE and JCA was undertaken in Taiwan (23 million inhabitants). The population at risk was identified as children under the age of 16 living in Taiwan (5.78 million). All citizens have been obligated to participate in Taiwan's National Health Insurance program since 1995. This gave us access to nationwide case data from the Major Illness/Injury registry and enabled us to calculate population prevalence. The population data were derived from the 1999 Taiwan census., Results: Three hundred sixty-five and 218 prevalent cases of pediatric SLE and JCA were identified, respectively. The prevalence of pediatric SLE was 6.3 per 100,000 (95% CI: 5.7-7.0). The prevalence in girls (11.2 per 100,000, 95% CI: 10.0-12.5) was 6.2 times higher than that in boys (1.8 per 100,000, 95% CI: 1.4-2.4). The prevalence of SLE substantially increased in children over the age of seven, especially in girls. The prevalence of JCA was 3.8 per 100,000 (95% CI: 3.3-4.3). The figures were similar for boys (3.5 per 100,000, 95% CI: 2.9-4.2) and girls (4.1 per 100,000, 95% CI: 3.3-4.9)., Conclusion: In this first population based epidemiologic survey of pediatric SLE and JCA in Taiwan, we provided a good starting point in our understanding of the epidemiology of these serious conditions in the Chinese population. The discrepancies between our prevalence figures and those reported from Western countries are possibly the results from true differences pertaining to ethnicity, geography or both. Future studies are necessary to elucidate the implications suggested by these data.

Many controversies remain regarding the role of bilirubin in the developing human. Although kernicterus and cognitive impairment have been linked to hyperbilirubinemia, more recent studies have suggested that there might actually be beneficial effects of bilirubin at a cellular level; thus, the need to better understand the molecular and cellular physiology of this molecule is important. The attempted management of serum or tissue levels of bilirubin may either have implications for long-term neurologic development or interfere with normal body stress responses. Production of CO via heme catabolism also warrants further investigation regarding its role in cell to cell communication or in other important cellular reactions. New methods are being developed to better detect CO under a variety of experimental conditions, as well as to estimate total bilirubin production by measuring the COHb level of pulmonary excretion of CO. The development of new drugs to modulate bilirubin production is the subject of ongoing research. Although some metalloporphyrins already have been used clinically, the advantages and disadvantages of each drug still require further study. These new drugs are not only raising fascinating research questions about heme and bilirubin metabolism, but they may soon revolutionize the way we approach the diagnosis and management of neonatal jaundice, and provide new pharmacologic tools for exploring other aspects of metabolism.