Fecal Calprotectin and Eosinophil-Derived Neurotoxin in Children with Non-IgE-Mediated Cow's Milk Protein Allergy.

Our aim is to assess the efficacy of fecal calprotectin (fCP) and fecal eosinophil-derived neurotoxin (fEDN) as diagnostic markers of cow's milk protein allergy (CMPA) and for monitoring the infants' response to a non-IgE mediated cow's milk protein (CMP)-free diet. We prospectively recruited infants aged 0 to 9 months. Stool samples were taken from 30 infants with CMPA, 19 with mild functional gastrointestinal disorders, 28 healthy infants, and 28 children who presented mild infections. Despite the fact that levels of fCP and fEDN in CMPA infants were higher than in healthy infants at month 0, differences for both parameters did not reach statistical significance (p-value 0.119 and 0.506). After 1 month of an elimination diet, no statistically significant differences in fCP with basal levels were found (p-values 0.184) in the CMPA group. We found a high variability in the fCP and fEDN levels of young infants, and discrepancies in individual behavior of these markers after a CMP-free diet was started. It seems that neither fCP nor fEDN levels are helpful to discriminate between healthy infants and those with signs or symptoms related to non-IgE-mediated CMPA. Additionally, it is debatable if on an individual basis, fCP or fEDN levels could be used for clinical follow-up and dietary compliance monitoring. However, prospective studies with larger populations are needed to draw robust conclusions.

Fecal calprotectin in healthy children aged 4-16 years.

Reference values of fecal calprotectin (fCP) have not been convincingly established in children. We aimed to investigate fCP concentrations in a larger population of healthy children aged 4-16 years to analyze more in depth the behavior of fCP in this age range and to determine if cut-off levels could be conclusively recommended. A prospective study was conducted to investigate fCP concentrations of healthy children aged 4-16 years. In 212 healthy children, the median and 95th percentile for fCP were 18.8 mg/kg and 104.5 mg/kg, respectively. We found a statistically significant association between the 95th percentile of fCP concentrations and age (p < 0.001). We propose a nomogram to facilitate the interpretation of fCP results in children aged 4-16 years. Further studies are required to validate the proposed values in clinical practice.

The Cow's Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability.

The Cow's Milk-related Symptom Score (CoMiSSTM) was created as an awareness tool for cow's milk allergy. The aim of the present study was to analyze the inter-rater variability between a pediatrician, parents, and day to day variability. A Health Care Professional (HCP) and parent filled in the CoMiSS independently and blinded for each other to evaluate inter-rater variability. In order to validate day-to-day variability, a parent filled in the CoMiSS during 3 consecutive days and was compared to the CoMiSS scored by the HCP. The absolute agreement between parent and HCP was 75%, and 92.6% and 100% with a tolerance of 0, 1, and 2 points, respectively, resulting in excellent agreement with an intraclass correlation coefficient (ICC) 0.981 (95% Confidence Interval 0.974-0.986, p < 0.001). Day-to-day variability during 3 consecutive days resulted in an absolute agreement of 30%, increasing to 80% and 88.6% when 2 and 3 points, respectively, were accepted. The ICC was excellent for the parental prospective scores (0.93, 95% CI 0.90-0.96; p < 0.001). Day-to-day variability indicates that CoMiSS has a moderate inter-rater reliability. A very low variability was observed when scored prospectively over three days. Data suggest that the CoMiSS can reliably be scored by parents without additional training.

Chronic, but not acute, fatigue predicts self-reported attentional driving errors in mothers attending infant children.

Mothers attending infant children usually experience high levels of fatigue, and fatigue has been shown to be related to car crashes through attentional errors, among other causes. The current study investigates the effects of fatigue on the attentional errors while driving of women attending infant children. A sample of 112 women-67 attending infant children and 45 not attending-filled out self-report questionnaires assessing acute fatigue, chronic fatigue, and attention-related driving errors. A mediational analysis showed that women attending infant children had higher levels of fatigue, and that chronic fatigue, but not acute fatigue, was related to attentional errors while driving.

The Cow Milk Symptom Score (CoMiSSTM) in presumed healthy infants.

OBJECTIVE: The Cow's Milk-related Symptom Score (CoMiSSTM) was developed as an awareness tool to recognize possible manifestations of cow's milk protein allergy (CMPA). Arbitrarily, a cut-off value of ≥12 was defined as a "positive score." The aim of this study was to determine an age-related CoMiSS in healthy infants to minimize the risk of false reassurance or over-diagnosis of CMPA in case of a negative or positive score, respectively. METHODS: General pediatricians determined the CoMiSS in presumed healthy infants aged ≤6 months during a routine visit. Exclusion criteria included any known acute or chronic disease, preterm delivery (< 37 weeks), therapeutic formula, any food supplement (except vitamins) or medication. RESULTS: Data from 891 consecutive infants were collected. Complete information was obtained from only 413 (46.4%) infants: Belgium: 31.2%, Italy 18.2%, Poland 19.1% and Spain 31.5%. Since gender (girls vs boys) (p = 0.579) had no influence on the CoMiSS, the data were re-calculated to include those infants with missing gender. The overall median and mean (SD) CoMiSS scores were, respectively, 3.0 and 3.7 (2.9). The 95th percentile was 9. Median crying (p<0.001), regurgitation (p = 0.009) and eczema (p = 0.039) scores differed significantly across the age categories. The other components of the CoMiSS were not age dependent. CONCLUSION: In healthy infants ≤ 6 months, the median CoMiSS is 3.0. More prospective studies in different sites and comparing healthy and allergic infants are warranted to obtain further evidence on the utility of the CoMiSS.

Description, culture and phylogenetic position of a new xerotolerant species of Physarum.

A new widespread myxomycete species, Physarum pseudonotabile, inhabiting the arid regions of the Eurasia, South and North America is described and illustrated. Tentatively assigned to Ph. notabile T. Macbr., a phylogeny based on the small ribosomal subunit (SSU) and elongation factor 1 alpha (EF1a) genes placed the new species in a clade far from Ph. notabile. Ph. pseudonotabile was found to be frequent in surveys based on the moist chamber culture technique with samples of litter, bark and herbivore dung collected in dry steppe and deserts of the Caspian lowland (Russia), Kazakhstan, Mongolia, China, Spain, Argentina and USA. The main morphological difference between Ph. pseudonotabile and Ph. notabile lies in spore ornamentation. Spores of the former species display irregularly distributed verrucae, whereas the latter species possesses spores with dense and regularly arranged spinulae. In addition, the ecological preferences of the two species differ. Ph. pseudonotabile inhabits the bark of living plants and ground litter in arid regions, whereas Ph. notabile is found on coarse woody debris in boreal and temperate forests. Although the new species appears to be closest to Ph. notabile morphologically, the phylogenetic analysis reveals Ph. pusillum and Ph. nivale as the closest relatives. In addition, the molecular investigations revealed a considerable amount of hidden diversity within species of Physarum with gray lime flakes. Currently we have only sufficient material to assess the morphological variation of Ph. pseudonotabile but expect that more taxa within this clade may emerge within studies combining morphological and molecular analyses.

Influence of concurrent obesity and low birth weight on blood pressure phenotype in youth.

The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (P=0.165) or ambulatory (P=0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (P<0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight subjects.

Birth weight impacts on wave reflections in children and adolescents.

The objective of the present study was to assess central aortic pressure and wave reflection in children and adolescents at different birth weights. Two hundred nineteen healthy children (126 girls), from 7 to 18 years of age (mean, 11.3 years) and born at term after a normotensive pregnancy, were included. The subjects were divided according to birth weight: <2.5 kg, from 2.5 to 2.999 kg, from 3.0 to 3.5 kg, and >3.5 kg. Pressure waveforms were recorded from the radial artery of the wrist, and the waveform data were then processed by the SphygmoCor radial/aortic transform software module to produce the estimated aortic pressure waveform. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in children with the lowest birth weights compared with the other birth weight groups. In a multiple regression analysis, short stature, low heart rate, female gender, and lower birth weight had independent significant inverse correlations to the augmentation index when adjusted for diastolic blood pressure (R2=0.21). In summary, the results showed a relatively aged phenotype of large-vessel function in the children with the lowest birth weights. These early alterations may be amplified throughout life and may contribute to the increased cardiovascular risk associated with low birth weight.

Presentación difusa o focal de los tumores troncoencefálicos en los niños: imagen y valor pronóstico / Diffuse and focal presentations of brainstem tumors in children: the images and the prognostic value

Objetivo: Comprobar si la forma de presentación difusa o focal tiene valor pronóstico en los tumores del tronco de encéfalo en los niños. Material y métodos: Revisión retrospectiva de los hallazgos neurorradiológicos en 43 niños con tumores de tronco, todos explorados con TC y 31 con RM. Resultados: Los tumores difusos (20 casos) se localizaron todos en la protuberancia, extendiéndose a mesencéfalo en seis casos y al bulbo en uno, con crecimiento exofítico preferente a la cisterna prepontina. Mostraron hipoatenuación homogénea en TC (90 por ciento), y disminución/aumento de la intensidad de señal en imágenes T1/T2 en RM (91,6 por ciento). Se objetivó captación de contraste en el 20 por ciento de casos, concordando la TC y la RM. Tuvieron una buena respuesta inicial al tratamiento (70 por ciento), una alta frecuencia de recaídas (80 por ciento), y una supervivencia del 12 por ciento a los cinco años. Los tumores focales (23 casos) se localizaron en la protuberancia (11 casos, dos con extensión bulbar), mesencéfalo (11 casos, nueve tectales y dos pedunculares) y bulbo (un caso), con un crecimiento exofítico preferente al ángulo pontocerebeloso y a los pedúnculos cerebelosos. Mostraron cierta tendencia a la heterogeneidad (21,7 por ciento) y a la isoatenuación en TC (47,8 por ciento) e isointensidad en T1 en RM (26,3 por ciento). Se observó captación tumoral en el 26 por ciento con TC y en el 58 por ciento con RM. El 50 por ciento tuvo buena respuesta al tratamiento, con un 28 por ciento de recaídas y una supervivencia del 63 por ciento a los cuatro años. Conclusión: Con neuroimagen se definen dos patrones fundamentales de tumores troncoencefálicos que van a influir en el pronóstico de los pacientes. El tumor difuso, que característicamente muestra una buena respuesta terapéutica inicial, es el que peor pronóstico tiene, reflejando probablemente su agresividad histológica (AU)