Endothelial progenitor cell levels in juvenile idiopathic arthritis patients: effects of anti-inflammatory therapies

BACKGROUND

Juvenile idiopathic arthritis (JIA), similarly to other arthritides, can be associated with damage of endothelial layer of which structure and function is dependent on reparative properties of endothelial progenitor cells (EPC). To date, it remained unknown whether EPC numbers are altered in young JIA patients and whether on-going anti-inflammatory therapies could exert positive effects on these progenitor cells.

METHODS

We performed a quantitative analysis of EPC numbers in 25 patients diagnosed with JIA according to International League of Associations for Rheumatism (ILAR) criteria [age 11.50 (7.50-15.00) years] in a broad context of inflammatory and cardiovascular parameters as well as different types of anti-inflammatory treatments. 11 healthy children [age 13.00 (11.00-14.00) years] were recruited as a control group.

RESULTS

We demonstrated that EPC numbers were similar in JIA patients and control subjects (0.02% vs. 0.05%, respectively, p = 0.37). EPC levels in JIA patients were negatively correlated with index of insulin resistance (rho = -0.458, p = 0.021), endogenous insulin (rho = -0.472, p = 0.017), triglyceride (rho = -0.438, p = 0.029) and TNF-alpha levels (rho = -0.446, p = 0.026). Notably, glucocorticoid (GC) therapy, was associated with detection of decreased EPC levels in JIA patients (p = 0.023). In contrast, methothrexate (MTX) and etanercept therapy in JIA patients did not affect EPC levels (p = 0.92 and p = 0.08, respectively).

CONCLUSIONS

We found that EPC numbers are maintained at normal levels in JIA patients and are not enhanced by disease-specific anti-inflammatory treatments.

A potential pathogenic role of oxalate in autism

BACKGROUND

Although autistic spectrum disorders (ASD) are a strongly genetic condition certain metabolic disturbances may contribute to clinical features. Metabolism of oxalate in children with ASD has not yet been studied.

AIM

The objective was to determine oxalate levels in plasma and urine in autistic children in relation to other urinary parameters.

METHOD

In this cross-sectional study, plasma oxalate (using enzymatic method with oxalate oxidase) and spontaneous urinary calcium oxalate (CaOx) crystallization (based on the Bonn-Risk-Index, BRI) were determined in 36 children and adolescents with ASD (26 boys, 10 girls) aged 2-18 years and compared with 60 healthy non-autistic children matched by age, gender and anthropometric traits.

RESULTS

Children with ASD demonstrated 3-fold greater plasma oxalate levels [5.60 (5th-95th percentile: 3.47-7.51)] compared with reference [(1.84 (5th-95th percentile: 0.50-4.70) μmol/L (p < 0.05)] and 2.5-fold greater urinary oxalate concentrations (p < 0.05). No differences between the two groups were found in urinary pH, citraturia, calciuria or adjusted CaOx crystallization rates based on BRI. Despite significant hyperoxaluria no evidence of kidney stone disease or lithogenic risk was observed in these individuals.

CONCLUSIONS

Hyperoxalemia and hyperoxaluria may be involved in the pathogenesis of ASD in children. Whether this is a result of impaired renal excretion or an extensive intestinal absorption, or both, or whether Ox may cross the blood brain barrier and disturb CNS function in the autistic children remains unclear. This appears to be the first report of plasma and urinary oxalate in childhood autism.

Peripheral blood T lymphocyte subsets in children with congenital asplenia

The aim of the current study was to examine whether a congenital lack of the spleen changes distribution, state of activation and function of peripheral lymphocyte T subsets. Seven children with congenital asplenia (CA) aged 1.5-17 years and seven age-matched controls were tested. By triple-color flow cytometry we examined: (1) the expression of CD3(+), CD4(+), CD8(+), CD19(+), and CD56(+) on lymphocytes; (2) the distribution of CD45RA(+) and CD45RO(+) in CD4(+) and CD8(+); (3) the expression of CD27(+) in the CD4(+) and CD8(+) T-cell-bearing CD45RA(+), CD45RO(+), or CD45RB(+). Lymphocyte proliferative responses and cytokines production (IFN-gamma, IL-6, TNF-alfa, and IL-10) in anti-CD3-induced peripheral blood mononuclear cells were tested. The results indicate (1) a normal distribution of the basic lymphocyte subsets, (2) low CD3(+)/CD8(+) percentage but expressing CD8(+high) and non-significantly elevated CD4(+)/CD8(+) ratio, (3) CD45RA(+high) and CD27(+high) in the CD4(+) and CD8(+) T cell, and (4) CD45RB(+high) in the CD4(+) and CD45RO(+high) in the CD8(+). The distribution of CD27(+) in the CD45RA(+) and CD45RO(+) CD4(+) T cells remained unchanged. However, the percentage of CD8(+)/CD45RO(+)/CD27(+) T cells tended to be elevated. Altogether, these data indicate that CA is connected with (1) the presence CD4(+) T cells expressing the "naive" phenotype (CD45RA(+high) RB(+high) and CD27(+high)), (2) high numbers of activated CD8(+) T cells shifted toward the memory phenotype (CD45RO(+high)) but still showing high CD27(+) expression, which may indicate failure in T CD8(+) cytotoxic effectors differentiation, and (3) a tendency to the rather pro-inflammatory status of cells, low IL-10 expression, and suboptimal lymphocytes responses to mitogenic stimulation.

Impact of lipophilic antioxidants and level of antibodies against oxidized low-density lipoprotein in Polish children with phenylketonuria

The treatment of phenylketonuria (PKU) patients constitutes a phenylalanine (Phe) intake restriction in their diet, which is achieved by adding a special Phe-free amino acid mixture to the diet. It has been reported that this diet could have some micronutrient deficiency. Several authors have also reported an increased oxidative stress or impaired antioxidant status in human and experimental PKU. Our project assessed the concentrations of retinol, alpha-tocopherol, coenzyme Q10, and anti-oxidized low-density lipoprotein (ox-LDL) antibodies in PKU children's plasma. It was found that retinol concentration in PKU children remains within the norm despite a low intake. The lower plasma alpha-tocopherol concentration in PKU children compared with normal children was associated with the lower level of antibodies against ox-LDL. This raises the question whether higher than observed circulatory alpha-tocopherol is indeed beneficial to lower plasma ox-LDL levels. Further studies are needed to explain the genetic factor in PKU patients (e.g., CD36/FAT polymorphism gene). The open clinical question is whether daily supplementation of alpha-tocopherol changes the PKU patients' level of antibodies against ox-LDL.

Neutrophil phenotypic characteristics in children with congenital asplenia and splenectomized for hereditary spherocytosis

The spleen plays an important role in the granulocyte homeostasis due to such mechanisms as pooling, elimination of senescent cells and regulatory effects on granulocyte renewal in the bone marrow. The expression profile of granulocyte receptors was tested in children with congenital asplenia, and splenectomized for spherocytosis. Receptors tested included those appearing with maturation (CD16, CD11b, CD11c, TREM-1), disappearing (CD54, CD49d, CD64) and maintained during maturation (CD11a, CD45). In general, we found that the circulating granulocyte pool in the asplenic patients had phenotypical features of highly matured but not apoptotic neutrophils with a significantly elevated expression of CD16 (CD16(high)), tendency to a lower expression of CD45 (CD45(low)) and an unchanged expression of CD64 (and other markers indicating systemic inflammatory reactions). The high fluorescence intensity of CD11b,c, and TREM-1 in the congenital asplenia may indicate a potentially elevated pro-inflammatory status of granulocytes, possibly due to the low activity of vagus nerve and spleen-dependent cholinergic anti-inflammatory pathway.

Thigh circumference as a useful predictor of body fat in adolescent girls with anorexia nervosa

BACKGROUND/AIM

Girls with anorexia nervosa (AN) demonstrate severe depletion of body fat. The aim of this study was to determine an accurate anthropometric measurement for clinical assessment of fat depletion in girls with AN in connection with body composition measured by dual-energy X-ray absorptiometry (DXA).

METHODS

In 64 female AN patients aged 12.8-23.1 years (mean 16.0 ± 1.8), body mass index (BMI), skinfold thickness (subscapular, abdominal and triceps), mid-upper arm and thigh circumference, fat mass (FM) and lean mass were determined and compared with the data of 71 controls.

RESULTS

Girls with AN had lower anthropometric traits and were fat depleted compared to controls (14.9 ± 7.3 vs. 27.4 ± 6.4% of FM using DXA; all p < 0.001). BMI, thigh circumference and subscapular skinfold thickness demonstrated a very similar predictive value for DXA assessment of body fat. Based on the receiver-operating characteristic curve analysis and the determination of the positive predictive value, thigh circumference appeared the most specific and sensitive anthropometric predictor of fatness discriminating between AN and healthy girls, with the AUC value reaching 0.95 (95% CI = 0.92-0.97). Using a cutoff value of 49.6 cm, accuracy was 90.6%, sensitivity 93% and specificity 88.7%.

CONCLUSIONS

Thigh circumference strongly correlates with DXA-FM and demonstrates a slight clinical advantage over BMI. This simple measurement might also serve as a useful predictor of body fatness in adolescent girls with AN and should therefore be further evaluated in independent cohort studies.

Chronic non-cholestatic liver disease is not associated with an increased fracture rate in children

Chronic liver disease in adults is a risk factor of osteoporosis, but little is known about risk of fractures in children with non-cholestatic liver disease. The aim of this study was to investigate associations among the severity of liver fibrosis, bone mass and low-energy fractures in children. History of fractures, anthropometry, and bone mass and size were examined in 39 Caucasian children (25 boys, 14 girls) aged 7.1-18 years (mean 11.9 ± 3.1) with chronic hepatitis B and liver fibrosis evidenced by liver biopsy. Severity of liver fibrosis was based on histological classification according to the method of Batts and Ludwig (mild, 1-2 scores; advanced, 3 scores) and Ishak (1-3 and 4-5 scores, respectively). Bone mineral content (BMC), density (BMD) and body composition were determined in the total body and lumbar spine using dual energy X-ray absorptiometry. Seven subjects (4 girls, 3 boys; 18% of the sample) had low BMD in the total body and lumbar spine region (Z-scores below -2.0). No associations were found among BMC, BMD, bone size and the severity of liver fibrosis. Nine boys (36% of all boys) and one girl reported repeated fractures (forearm, wrist, tibia, ankle, humerus), showing trends similar to the prevalence in general population. Fractures were neither associated with lower BMD/BMC nor with scores of liver fibrosis. Deficits in BMD in children with chronic hepatitis B are not associated with the severity of liver fibrosis. This study suggests that non-cholestatic liver disease does not increase the risk of low-energy fractures during growth. From the practical perspective, however, children with chronic liver disease should be screened for history and clinical risk factors for fractures rather than referred to bone density testing.

Plasma Levels of Vitamins A and E, Coenzyme Q10, and Anti-ox-LDL Antibody Titer in Children Treated with an Elimination Diet Due to Food Hypersensitivity

Aim: Has elimination diet applied in children with food hypersensitivity in infancy any effect on plasma levels of anti-oxidative vitamins and antibodies to oxidized low-density lipoprotein (anti-ox-LDL antibody) titer in these children at their pre-school age?” Material: The study involved 92 children (3 to 7 years of age) with food hypersensitivity treated in their infancy and early childhood with soy formula or casein hydrolysate, as a milk substitute for at least 12 months. Control group comprised 62 children, who had never been treated with an elimination diet. Methods: The status of the anti-oxidative system was evaluated by determination of retinol, α-tocopherol, and coenzyme Q10 plasma levels by high-performance liquid chromatography (HPLC). The titer of antibodies to oxidized LDL lipoproteins was specified by immunoenzymatic assay. On the basis of the Results, the following Conclusions have been reached: 1. It was shown that α-tocopherol and retinol levels in pre-school children who had received dietary treatment in their infancy, were higher than in the control group. No deficiencies in anti-oxidative vitamins within the control group were found. 2. A type of milk-substitute formula applied in the elimination diet had no effect on the status of the anti-oxidative system in the children examined.

Fractures during growth: potential role of a milk-free diet

Dietary calcium deficiency may increase fracture risk. In girls, 29.4% of fracture cases and 11.8% of controls without fracture had a history of milk-free diet. The odds ratio (OR) for fracture with a milk-free diet in girls was 4.6, p < 0.01. In boys, 23% of cases and 19% of controls had a history of a milk-free diet; OR = 1.3, NS). A milk-free diet due to cow's milk allergy is associated with increased fracture risk in girls.

INTRODUCTION

An intake of calcium below the reference daily intake (RDI) of 800-1200 mg/day during growth is thought to increase fracture risk even though convincing evidence for this view is scarce. The paucity of evidence may be partly due to many trial participants being calcium replete. Children and adolescents with cow's milk allergy (CMA) avoid milk and have a calcium intake below the RDI. The aim of this study was to examine the association between consumption of a milk-free diet and fracture risk.

METHODS

In this case-control study conducted in Poland, 57 boys and 34 girls aged 2.5-20 years with fractures (cases) were randomly matched by age and sex with 171 boys and 102 girls without fractures (controls). Weight and height were examined using standard methods. Bone mineral density (BMD) and body composition were measured using dual-energy X-ray absorptiometry. Conditional logistic regression and Bayesian analyses were used to determine the proportion of the fracture risk attributable to a milk-free diet.

RESULTS

In girls, 29.4% of cases and 11.8% of controls had a history of milk-free diet producing an odds ratio (OR) for fracture associated with a milk-free diet of 4.6 (95% confidence interval [CI]: 1.4-15.5, p < 0.01). In boys, 23% of cases and 19% of controls had a history of a milk-free diet; OR = 1.3 (95% CI: 0.6-2.7, NS). If the prevalence of CMA in the population is 5%, only 6.7% of the fractures occurring are attributable to CMA and the associated nutritional deficit.

CONCLUSIONS

Cow's milk allergy is associated with increased fracture risk in girls. Whether this association is due to the illness, calcium deficit or a deficit in other milk nutrients is uncertain. These data suggest that the contribution of milk-free diet to fracture liability among children and adolescents is modest.

Dental malocclusion is associated with reduced systemic bone mineral density in adolescents

There is no published data about associations between the state of dentition and bone mass in adolescents. The objective of this study was to investigate whether the prevalence of caries and dental malocclusion is associated with bone mass during growth. In 123 healthy Caucasian subjects (72 males, 51 females) aged 14-18 yr, DMFT figures (decayed teeth, missing teeth, filled teeth) and presence of malocclusion, according to Angle classification, were determined. Participants completed a questionnaire regarding dental hygiene, physical activity level, and consumption of sweets. Anthropometry and pubertal stages were examined. Bone mineral density (BMD) was examined using dual energy X-ray absorptiometry (DXA) in the total body, head, and lumbar spine. No association was found between DMFT (mean+/-SD: 8.33+/-3.9) and BMD or Z-scores for BMD. Malocclusion was found in 49 subjects (39.8%) and was more prevalent in females than males. Malocclusion was associated with lower total BMD independently of body size (p=0.001; Z-scores: -0.21+/-0.27 vs +0.33+/-0.17; p=0.1) in males (but not females), producing odds ratio 1.6 (95% confidence interval: 1.09-2.34%; p=0.02). Head BMD was also lower in the males with malocclusion than in those without (p=0.004). Neither caries nor the tooth loss appear to be associated with BMD during growth. Boys with malocclusion are at higher risk of reduced BMD. This suggests that inadequate bone mass accrual in males coexists with impaired growth of the masticatory system in childhood and adolescence, however, the causal pathway is unknown. Factors that produce malocclusion may also affect bone mass or size but further prospective studies are needed to evaluate the relationship.

HPLC method for simultaneous determination of retinol, alpha-tocopherol and coenzyme Q10 in human plasma

A simple HPLC method with UV detection is proposed for the simultaneous determination of three lipophilic vitamins: all-trans-retinol, alpha-tocopherol and coenzyme Q(10) (ubiquinone) in human plasma. The following chromatographic conditions were used: RP-18 column, a mobile phase consisted of methanol -n-hexane 72:28 (v/v) and UV detector set at 324, 292 and 276 nm for all-trans-retinol, alpha-tocopherol and coenzyme Q(10), respectively. The linearity range was 0.35-70 microM for all-trans-retinol, 0.23-44 microM for alpha-tocopherol and 0.12-23 microM for coenzyme Q(10). Deproteinised plasma samples were extracted with n-hexane prior to the analysis. The within-day and between day reproducibilities were 1.5 and 3.7% for all-trans-retinol, 4.0 and 5.8% for alpha-tocopherol and 2.3 and 3.1% for coenzyme Q(10), respectively. Using the proposed method the following recoveries were achieved: 91% for all-trans-retinol, 86% for alpha-tocopherol and 88% for coenzyme Q(10). The method was applied to the determination of the levels of retinol, tocopherol and coenzyme Q(10) in plasma of healthy children and children treated by elimination diet.

Plasma fibrinogen concentration in pediatric patients treated with an elimination diet based on soy proteins and casein hydrolyzate

PURPOSE

Fibrinogen is one of the most discussed new risk factors of atherosclerosis. The aim of the study was to assess the relationship between fibrinogen concentration and classic risk markers of atherosclerosis in a group of children aged from 2 to 6 with or without a family history of circulatory system diseases (FHCAD) (American Academy of Pediatrics--AAP criteria). The study also considered the impact of allergies/food intolerance treatment with elimination diets on the concentration of atherosclerosis markers specially fibrinogen.

MATERIAL AND METHODS

INCLUSION CRITERIA

a) family history of early occurrence of circulatory system diseases (FHCAD+) according to AAP standards; b) the type and duration of elimination diet continued in infancy and early childhood. 134 of 388 children were included in the investigation.

RESULTS

The analysis of data relating to the so-called classic biochemical risk factors of atherosclerosis (total cholesterol--TC, HDL, LDL, triglycerides, glucose) did not reveal any differences between the tested groups. It was found that in the FHCAD+ group the concentration of fibrinogen was statistically higher than in the group with a negative family history. It was discovered that the type of elimination diet had no effect on fibrinogen level in the FHCAD+ group. In the group of children with negative family history the concentration of fibrinogen was statistically lower in the group on casein hydrolysate than in children treated with soy formula.

CONCLUSIONS

The initial interview in pediatrics should include information on the patient's family history of atherosclerosis. In case of a positive family history, fibrinogen, as one of atherosclerosis risk factors, should be monitored.

Comparison of phalangeal ultrasound and dual energy X-ray absorptiometry in healthy male and female adolescents

The aims of this study were to determine if there is a correlation between dual energy X-ray absorptiometry (DXA) and phalangeal quantitative ultrasound (QUS) in identifying children and adolescents with low bone density, and to assess if body size influences the results of the two techniques to the same degree. Measurements were performed in 67 girls and 83 boys aged 14 to 19 y using DBM Sonic 1200 (IGEA, Carpi, Italy) and the DXA equipment (LUNAR Radiation Corp., Madison, WI, USA). Twelve adolescents (eight males and four females) reported a past history of nonosteoporotic fractures. Lumbar spine bone mineral density (LS BMD), total body bone mineral density (TB BMD) and total body bone mineral content (TB BMC) correlated positively with age, height, BMI and weight, in both genders. Amplitude-dependent speed of sound (Ad-SOS) was positively correlated with age, height and Tanner stages in both genders and negatively correlated with BMI in females. TB BMD, TB BMC and LS BMD positively correlated with Ad-SOS only in males. In females, there were no significant correlations between Ad-SOS, TB BMD, TB BMC and LS BMD measurements. Twelve teenagers with previous fractures (high impact fractures) were found to have lower DXA and QUS values than age-matched teenagers without fractures but the statistical significance was found only in relation to TB BMD values (p = 0.02). In conclusion, we obtained results similar to those that have been reported by other authors using different QUS techniques. Furthermore, the Ad-SOS measurements taken at the distal metaphysis of the proximal phalanges correlate poorly with LS BMD and TB BMD measured by DXA in growing subjects.

ATM Gene Founder Haplotypes and Associated Mutations in Polish Families with Ataxia-Telangiectasia

Ataxia-telangiectasia (A-T) is an early onset autosomal recessive ataxia associated with characteristic chromosomal aberrations, cell cycle checkpoint defects, cancer susceptibility, and sensitivity to ionizing radiation. We utilized the protein truncation test (PTT), and single strand conformation polymorphism (SSCP) on cDNA, as well as denaturing high performance liquid chromatography (dHPLC) on genomic DNA (gDNA) to screen for mutations in 24 Polish A-T families. Twenty-six distinct Short Tandem Repeat (STR) haplotypes were identified. Three founder mutations accounted for 58% of the alleles. Three-quarters of the families had at least one recurring (shared) mutation, which was somewhat surprising given the low frequency of consanguinity in Poland. STR haplotyping greatly improved the efficiency of mutation detection. We identified 44 of the expected 48 mutations (92%): sixty-nine percent were nonsense mutations, 23% caused aberrant splicing, and 5% were missense mutations. Four mutations have not been previously described. Two of the Polish mutations have been observed previously in Amish and Mennonite A-T patients; this is compatible with historical records. Shared mutations shared the same Single Nucleotide Polymorphism (SNP) and STR haplotypes, indicating common ancestries. The Mennonite mutation, 5932 G>T, is common in Russian A-T families, and the STR haplovariants are the same in both Poland and Russia. Attempts to correlate phenotypes with genotypes were inconclusive due to the limited numbers of patients with identical mutations.

The characteristics of fractures in Polish adolescents aged 16-20 years

The aim of the study was to identify associations between fractures in childhood and family, anthropometric and lifestyle factors. Among 1,246 subjects aged 16.3-20.6 years (539 boys, 707 girls), based on a questionnaire, 869 were fracture-free while 377 (30.26%) had fractures. Of those reporting fractures, 146 reported multiple fractures (12% of studied population, 39% of all fractures). More boys had fractures than girls (35.6% vs 24.9%, p < 0.001). Fracture sites included: forearm (37%), fingers (23%) wrist (16%), ankle (14%), humerus (10%), tibia (8%) clavicle (7%) and femoral shaft / neck (3%). Among adolescents with multiple fractures, 52% also reported fractures in at least one family member, compared with 29% of those without a fracture history. Fractures in siblings and mothers (but not fathers) accounted for 44% of the liability in adolescents' fractures. Subjects with multiple fractures reported more time at the computer than those without fractures and reported more time participating in team sports, and 18.6% avoided milk, whereas 12.4% of those without fractures reported milk-free diets. Using a logistic regression model, none of the lifestyle factors, except for computer use, were independently associated with fractures. Fractures, particularly multiple fractures, are common in childhood and adolescence. Familial clustering of fractures suggests shared genetic and environmental factors are responsible.

Depression in anorexia nervosa: a risk factor for osteoporosis

CONTEXT

Both anorexia nervosa (AN) and depression are associated with osteoporosis. We hypothesized that adolescent girls with AN and depression will have lower bone mineral density (BMD) than anorexic girls without depression.

OBJECTIVE

The objective of this study was to investigate whether depression is an independent risk factor for osteoporosis in anorexic adolescent girls.

DESIGN

This study was cross-sectional.

SETTING

This study was conducted at the University Children's Hospital (Bialystok, Poland) from October 2002 through September 2003.

PARTICIPANTS

Forty-five Caucasian anorexic girls aged 13-23 yr, matched by age, Tanner stage, weight, height, calcium intake, and duration of AN, were studied, including 14 with comorbid depression (based on Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale) and 31 anorexic girls without depression.

MAIN OUTCOME MEASURES

Total body and lumbar spine (LS) BMD, fat mass, and lean mass assessed using dual-energy x-ray absorptiometry were compared between AN girls with and without depression.

RESULTS

BMD was reduced in both groups, relative to reference data, but girls with AN and depression had lower BMD than those with AN alone (LS Z-scores, -2.6 +/- 0.3 vs. -1.7 +/- 0.3; P = 0.02) (mean +/- sem). Quantitative assessment of depression correlated independently with total body BMD (r = -0.4; P < 0.05) and LS BMD (r = -0.6; P < 0.001).

CONCLUSION

Anorexic girls with depression are at higher risk of osteoporosis than those without depression. The mechanisms responsible for decreased BMD in depression are not known. Independent treatment of the depressive disorder in AN may partly alleviate the bone fragility.

The duration of breastfeeding and attention deficit hyperactivity disorder

PURPOSE

To examine whether duration of the breastfeeding is associated with the symptoms of attention deficit hyperactivity disorder in children.

MATERIAL AND METHODS

A total of 100 children aged 4-11 years were divided into two groups: 60 children with ADHD symptoms (based on ICD-10) and 40 subjects of normal control grup. The structured interview and the retrospective questionnaire (including the items: number of pregnancy, pregnancy course, gestational age, status of newborn, birth weight, duration of breastfeeding: <3 months; 3-6 months; 6-12 months; >12 months) were used during the study of the both examined groups to indicate the risk factors of development.

RESULTS

No significant differences in the percentages of duration of pregnancy, pregnancy complications, delivery complications, condition of the newborn, and birth weight were found between the two groups. The mean of the duration of breastfeeding for group with ADHD was 0.45 year: 5 months and 9 days (median 0.25 year: 3 months). The mean of the duration of breastfeeding of control group was 0.55 year: 6 months and 18 days (median 0.46 year: 5 months) and was significantly greater than that of group with ADHD (p<0.04). The 36 (60%) children with ADHD were breast fed less than 3 months. For comparison 13 (32.5%) controls were breast fed less than 3 months. Significant differences were found among the two children groups (p < 0.05).

CONCLUSIONS

The short duration of breastfeeding as environmental factor may be considered a risk factor of ADHD symptoms. However, the further studies are nedeed.

[Bone mineral density and markers of bone turnover in patients treated for malignant disease in childhood]

Development in diagnostic and therapeutic methods has led to increased survival rates in children with malignancies. The treatment with corticosteroids, methotrexate and irradiation may all cause reduction in bone mass. We assessed bone mineral density (BMD) and several parameters involved in bone formation in long-term survivors with a malignancy at completion of therapy. Total body and lumbar spine bone mineral densities (gram per cm2) were measured by dual energy x-ray absorptiometry in 40 patients (age 12-27 yr; median 17.5 yr; 21 with acute lymphoblastic leukemias, 19 with other malignancies) from 3 to 13.9 years (median 7 yr) after discontinuation of therapy. These results were compared with those from 473 healthy controls and expressed as a percentage of the age and sex-matched control values (mean and standard deviation). Serum levels of osteocalcin, bone specific alkaline phosphatase, parathormone, 1.25 dihydroxyvitamin D, urinary concentrations of deoxypyridinoline were determined as well as several specific markers of bone turnover.

RESULTS

The total BMD and in the lumbar spine were not significantly reduced in survivors of childhood malignancies compared to the control population. No correlation was found between the BMD values and the cumulative doses and time of corticosteroids, administered Mtx, irradiation, duration of treatment, age at diagnosis. Duration of follow-up showed correlation with lumbar spine BMD. Serum markers of bone formation and resorption were in the normal range (expressed as standard deviation score relative to the age and sex-matched healthy population), bone turnover was not disturbed at the time of the study.

CONCLUSION

We found no difference in bone mineralisation between our patients and the healthy population.

[Bone mineral density in children before and after completion of cancer treatment]

This study was performed to determine the degree of osteopenia in children with malignancy before and after completion of treatment. Twenty six subjects (17 male, 9 female) treated for acute lymphoblastic leukemia (n=15), lymphogranulomatosis maligna (n=7) or solid tumor (n=4) at a mean age 9.34 (range 3-17.41 years) before and 15.85 (range 9.66-23) after treatment participated in this longitudinal study. Mean follow up period after discontinuation of therapy was 5.5 years (range 2.6-8.3 years). Interview (estimation of physical activity, other chronic disease, and fractures), anthropometric measurements of body mass and height, body mass index (BMI), bone mineral density total (BMD Total) and spine (BMD Spine) were obtained from every child. Gained findings were compared to the same parameters in the group of 473 healthy children, comparable in age and gender with examined group and showed as SD score. There were no differences in BMI and BMD Total and Spine between patients and controls. No correlation was found between the BMD values and the diagnosis, age at diagnosis, gender and cranial irradiation and duration of follow-up. BMD Spine SD score was significantly increased in a subgroup of patients in pubertal stage at diagnosis as compared to patients in prepubertal stage. Further studies are needed to evaluate the long-term effect on BMD in patients with cancer and how to prevent a decrease of BMD.

[Subjective perception of hypersensitivity to selected additives-containing foods in children and adolescents from schools in Bialystok]

The incidence of adverse reactions to food additives is difficult to establish and therefore not completely known. The aim of the present study is an attempt to determine the actual incidence of this problem in the population of school-age children and adolescents. The current work is the preliminary stage of this study and contains recapitulation of information obtained from parents and foster-parents of 5044 children aged 6-16 years from Białystok. Analysis of data has revealed that 9.8% of children complain of undesired symptoms after consumption of additive-containing foods. The problem referred to younger children statistically significantly more frequently (p < 0.05), while no correlation was found with sex (47.9% boys, 52.1% girls). The foods most frequently associated with adverse symptoms appeared to be: sparkling drinks e.g. Coca-Cola, orangeade--9% and sweets products (e.g. chewing-gums, crisps, sweets, cakes)--6.4%. The most common symptoms related to the consumption of additive-rich foods were: abdominal pain--9.9%, cutaneous rash--8.8%, cough and rhinitis--5.5% and 5.6%, headache--4.9%. The preliminary findings should be verified using double-blind placebo-controlled food challenge tests in order to establish the actual incidence of food additive intolerance.

[Comparison of subjectively perceived hypersensitivity to selected additives-containing foods among children with and without food allergy/intolerance]

The incidence of adverse reactions to food additives is difficult to establish and therefore not completely known. The equally important problem is to what extent food additives induce ailments and to what degree they exacerbate symptoms of the already existing disease, e.g. urticaria, atopic dermatitis, asthma or rhinitis. The aim of the present study is to establish the actual incidence of this problem in the population of school-age children and adolescents. This work presents the preliminary evaluation. Analysis of the questionnaire data obtained from parents or foster-parents of 5044 children aged 6-16 years from Białystok has revealed that 9.8% of children complain of subjective adverse symptoms after consumption of particular foods containing additives. The aim of this stage of the study is to determine and compare the incidence of adverse symptoms ascribed to food additives in the group of children with food allergy and/or intolerance and in unburdened children. The incidence of each of the evaluated features (i.e. type of food, clinical symptoms) was statistically significantly higher in children with symptoms of allergy or intolerance (p < 0.001).

Coenzyme Q10 level in plasma of children with inflammatory process

Using a newly developed method by HPLC with ultraviolet detection we measured plasma coenzyme Q10 (CoQ10) level in group of 43 children (19 females and 24 males: ages 1 month-9 years) with an acute inflammatory process. The results for coenzyme Q10 were expressed as molar concentration (mumol/l plasma). Our study confirmed that CoQ10 concentration (median--0.8 mumol/l) was independent of sex, and we established which biochemical parameters influence on ubiquinone levels. The results indicate that CoQ10 concentration is connected with leukocytosis, calcium and magnesium levels. These findings suggested that transferin, amylase and serum glutamic transmainase may also determine the CoQ10 plasma levels.

The incidence of some civilization diseases in families of children with food allergy/intolerance

PURPOSE

The aim of the study was to evaluate the incidence of chosen civilization diseases in families of children with food allergy/intolerance. We also wanted to indicate the need for developing and implementing activities preventing these diseases among children.

MATERIAL AND METHODS

On the basis of information from questionnaires, two groups of children were distinguished: a group of 80 children suffering from food allergy/intolerance on elimination diet (GR1) and a group of 67 healthy children (GR2) on regular diet. In GR1, the elimination diet with soya bean preparations or casein hydrolysates was introduced before the age of 6 months and continued for at least 12 months. A high risk of hypercholesterolemia according to extended American Academy of Pediatrics criteria including hypertension, diabetes and obesity was determined for children in both groups.

RESULTS

The research showed that 31.25% of children examined according to AAP criteria and 46.25% according to extended criteria had a positive family history of premature diseases of the circulatory system. The study proved that hypertension was the most frequent cause of morbidity in families of children from a high risk group and it was found in 67.7% of families with children on elimination diet and with a positive family history and in 78.7% of families with children from GR2 with a positive family history. Obesity, coronary heart disease, hypercholesterolemia, atherosclerosis and diabetes were listed consecutively.

CONCLUSIONS

Once a positive family history of cardiovascular diseases is discovered, systematic education promoting health in a family and complex evaluation of physical and psychomotor development of the children should follow. Arterial blood pressure and lipid profile in serum ought to be monitored to eliminate risk factors of these diseases for children.

[Contemporary vaccinology--scientific and practical aspects]

Vaccinology became interdisciplinary field of knowledge. It takes advantage of epidemiological and immunological researches and achievements of molecular biology, biotechnology and genetic engineering. Nowadays vaccinology remains mainly immunoprevention, but immunization of organism, as a result of vaccine injection, opens new possibilities in medicine. Directions of development present vaccinology are subordinated to one task--to invent an ideal vaccine. According to Edelman's criterions this vaccine has to be safe, effective in immunization, efficient in disease prevention and accessible for people all over the world. Realization of this aim causes modification of antigens, changes of adjuvant and preservatives and applying new technologies in production of vaccines.

[The assessment of nutritional status in children with chronic hepatitis B treated with interferon alpha]

The aim of the study was an evaluation of nutrition status in children with chronic hepatitis B during IFN-alpha therapy. Observation was carried out in a group of 40 children in the age range of 1-14 years with clinically, diagnosed chronic hepatitis B. Respectful of age 2 subgroups were distinguished. I: 27 children up to 4 years old, II: 13 children in the age range of 4-14 years. The nutritional status was evaluated by anthropometric measurement (body mass, body length/height). Moreover Cole index was estimated at the beginning and completion of the treatment and in the time of the highest weight loss. None of the examined children has body mass deficiency before IFN-alpha treatment: Cole index was in normal range as well. Lack of appetite, connected with IFN-alpha administration, was observed in 42.5 children during therapy. Weight loss was observed in 65% of the examined children especially in the first 2 months of therapy. Return to the initial body mass value was observed within 3 months after IFN-alpha completion in 77% children; but in 2 children only 12 months after IFN-alpha therapy termination. 12 months after IFN-alpha completion Cole index lower than initial was observed in 42.5% of the examined children in spite of return of body mass to initial values. There was no observed unfavourable influence of IFN treatment on body height. 20-weeks IFN-alpha therapy in children with chronic hepatitis B often causes lack of appetite, which may lead to reversible disturbances in nutritional status. Correct dietetic proceeding is necessary to decrease the frequency and intensity of disturbances in nutritional status in this group of children.

[Densitometric evaluation of mineral deposits in children and young people with food sensitivity who were treated by diet therapy]

Bone mineral content (BMC) and bone mineral density (BMD) of the whole skeleton were measured with dual energy x-ray absorptiometry (DEXA) using DPX-L bone densitometer (Lunar) in 240 caucasian subjects with food hypersensitivity, aged 2-18 years, fed milk-free diet (mean duration: 3.6 yrs). DEXA results were compared to the age and sex-matched reference population (n = 473) presenting normal consumption of milk and dairy products, Breast-feeding duration, social conditions and general physical activity did not differ in these groups. All subjects ranged between 3rd and 97th percentile for body weight and height and their nutritional status was similar in both groups, as assessed by means of anthropometric methods (BMI, skinfolds, midarm circumference). Mean values of total BMC and total BMD did not show significant differences between two groups of children, regarding to diet application. Although dietary calcium intake has a significant positive influence on the bone mineral content, our cross-sectional study suggests that the properly applied and controlled elimination diet should not disturb bone mass accumulation in children and adolescents with food allergy.

Application of derivative spectrophotometry for determination of coenzyme Q10 in pharmaceuticals and plasma

The use of derivative spectrophotometry is proposed in this work for determination of coenzyme Q10 in formulations and in human plasma. The spectrophotometric procedure is simpler and less expensive than chromatographic techniques commonly used for the analysis of coenzyme. The active compound can be determined in the range 0.25-10 ppm for standard solutions and pharmaceuticals and 0.05-1.5 ppm in plasma. The proposed method was applied for coenzyme determination in real samples. The results agree well with declared value and with these obtained by HPLC.

Assessment of bone density in children with Scheuermann's disease

Twenty four children with Scheuermann's disease (11 girls and 13 boys) aged 9-18 years measured for bone mineral density. The total skeleton (TB BMD) and lumbar spine (L2-L4 BMD) mineral density were investigated by dual energy X-ray absorptiometry (DEXA). In nine patients with Scheuermann's disease and backache we found lower levels of TB BMD and L2-L4 BMD in comparison with reference population of Lunar database. Osteopenia in these children may be caused by decreased physical activity due to vertebral pain.

Auxological evaluation of children with cow's milk protein intolerance treated an elimination diet

A somatic development assesment, including the nutritive condition at the moment of diagnosis and after at least a year's dietary treatment was carried out in a group of 55 children with primary cow's milk protein intolerance. The influence of the applied elimination diet and/or anti-allergic supporting treatment on the clinical picture was evaluated as well as calcium--phosphorus--magnesium balance parameters.