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Rantanen R, Honkila M, Kämä HR, Pokka T, Pihkala J, Rahkonen O, Mattila I, Renko M, Helminen M, Heinonen S, Kekäläinen E, Kallio M, Ruuska TS. Pneumonia, wheezing and asthma were more common in children after thymectomy due to open-heart surgery. Acta Paediatr 2024. [PMID: 38501561 DOI: 10.1111/apa.17205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
AIM This nationwide study evaluated the clinical impact that an early thymectomy, during congenital heart defect (CHD) surgery, had on the health of children and adolescents. METHODS The subjects were patients aged 1-15 years who had undergone CHD surgery at the University Children's Hospital, Helsinki, where all CHD surgery in Finland is carried out, from 2006 to 2018. The parents or the cases and population-based controls, matched for sex, age and hospital district, completed electronic questionnaires. We excluded those with low birth weights or a known immunodeficiency. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for prespecified outcomes. RESULTS We received responses relating to 260/450 (58%) cases and 1403/4500 (31%) controls and excluded 73 cases with persistent cardiac or respiratory complaints after surgery. The CHD group reported more recurrent hospitalisations due to infections (aOR 6.3, 95% CI 3.0-13) than the controls and more pneumonia episodes (aOR 3.5, 95% CI 2.1-5.6), asthma (aOR 2.5, 95% CI 1.5-4.1) and wheezing (aOR 2.1, 95% CI 1.5-2.9). CONCLUSION Hospitalisation due to infections, pneumonia, wheezing and asthma was more common in children after a thymectomy due to open-heart surgery than population-based controls, underlining the importance of immunological follow-ups.
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Affiliation(s)
- Rea Rantanen
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
| | - Minna Honkila
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
| | - Hanna-Riikka Kämä
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Jaana Pihkala
- Department of Paediatric Cardiology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Otto Rahkonen
- Department of Paediatric Cardiology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Mattila
- Department of Paediatric Cardiac and Transplantation Surgery, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjo Renko
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Merja Helminen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Santtu Heinonen
- New Children's Hospital, Paediatric Research Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Kekäläinen
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, Helsinki, Finland
| | - Merja Kallio
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
- Department of Paediatric Cardiology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Terhi S Ruuska
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC) Oulu, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
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Lantto U, Tapiainen T, Pokka T, Koivunen P, Helminen M, Piitulainen J, Rekola J, Uhari M, Renko M. Tonsillotomy for Periodic Fever Syndrome: A Randomized and Controlled Trial. Laryngoscope 2024; 134:968-972. [PMID: 37477273 DOI: 10.1002/lary.30863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Tonsillectomy is an effective treatment for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome. Tonsillotomy has a milder operative risk profile and postoperative morbidity in children than tonsillectomy. We aimed to compare the efficacy of tonsillotomy to observation-only in children with PFAPA syndrome at a 3-month follow-up. METHODS This was a randomized multicenter trial with sequential design. Participants were randomized into a tonsillotomy group and a control group that was only observed. The trial started in 1/2017 and was accomplished in 12/2021 with 16 patients (10 boys, six girls, the mean age 4.2 years). The symptoms were monitored with daily symptom diaries. RESULTS After the 3-month follow-up, 7/8 patients (87.5%) in the tonsillotomy group and 2/8 (25%) patients in the control group were free from PFAPA symptoms (95% CI 13% to 87%; p = 0.0021). The mean number of days with fever was 2.6 (SD 3.7) in the tonsillotomy group and 8.0 (SD 6.5) days in the control group (n = 8) (p = 0.06). Mean number of fever days compatible with PFAPA syndrome was 0.8 (SD 1.4) in the tonsillotomy group and 6.5 (SD 6.0) in the control group (95%CI -10% to -1%; p = 0.007). Rescue tonsillectomy was needed for all patients in the control group and none of the patients in the tonsillotomy group. CONCLUSIONS Tonsillotomy might be an effective treatment option for children with PFAPA syndrome. Further studies are needed to clarify the long-term efficacy of tonsillotomy for treating PFAPA. LEVEL OF EVIDENCE 2 Laryngoscope, 134:968-972, 2024.
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Affiliation(s)
- Ulla Lantto
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Otorhinolaryngology-Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - Terhi Tapiainen
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
| | - Petri Koivunen
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Otorhinolaryngology-Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - Merja Helminen
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere, Finland
| | - Jaakko Piitulainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Department of Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jami Rekola
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Department of Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Matti Uhari
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
| | - Marjo Renko
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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Vuorlaakso M, Kiiski J, Majava M, Helminen M, Kaartinen I. Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes. J Diabetes Complications 2023; 37:108377. [PMID: 36525903 DOI: 10.1016/j.jdiacomp.2022.108377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
AIMS Lower extremity amputation (LEA) is a pivotal event for patients with diabetes. This study aimed to provide updated data on the outcomes and prognostic factors after LEA for patients with diabetes. METHODS This retrospective cohort study included all LEAs (n = 1081) performed at Tampere University Hospital between February 2007 and September 2020. Overall survival (OS) and major amputation-free survival were evaluated. RESULTS Index amputation level was below ankle in 65 % (n = 704) of patients, below knee in 14 % (n = 154) of patients, and above knee in 21 % (n = 223) of patients. In the whole population, OS was 75.8 % (CI 95 %: 73.3-78.3) at one year and 38.3 % (CI 95 %: 34.7-41.7) at five years. Higher age, peripheral artery disease (PAD), more proximal amputation level, and lower glomerular filtration rate (GFR) reduced OS. Multiple amputations and diagnosed dyslipidemia or hypertension associated with improved OS. Further, age, PAD, and GFR were identified as significant factors for major amputation free survival. CONCLUSIONS OS after LEA is poor. After major amputation, the risk for death is higher compared to minor amputation. Recurrent amputation is associated with improved OS. Further, ischemia and renal disease are significant factors for inferior OS.
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Affiliation(s)
- M Vuorlaakso
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland; Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530 Hämeenlinna, Finland.
| | - J Kiiski
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland; Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland
| | - M Majava
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland; Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland
| | - M Helminen
- Tays Research Services, Tampere University Hospital, Arvo Ylpön katu 6, 33521 Tampere, Finland; Faculty of Social Sciences, Health Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - I Kaartinen
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland; Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland
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Aaramaa HK, Isomäki P, Mars N, Helminen M, Kerola A, Palomäki A, Eklund K, Gracia Tabuenca J, Sinisalo J. POS0324 RISK OF CARDIOVASCULAR COMORBIDITIES IN RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCardiovascular diseases (CVD’s) are the most significant comorbidities in rheumatic diseases, causing also increased mortality. [1,2] However, there is only limited data on how the risk of CV comorbidities varies between different rheumatic diseases.ObjectivesThe aim of our study was to estimate the risk of certain CV comorbidities across rheumatic diseases.MethodsThe ongoing FinnGen project links nationwide healthcare register data with genome data. The study (data freeze 7) included 321 302 individuals, and from this group we identified patients with seropositive (N=4293) and seronegative (N=1733) rheumatoid arthritis (RA), ankylosing spondylitis (AS, N=1247), psoriatic arthritis (PsA, N=1235), systemic lupus erythematosus (SLE, N=386), primary Sjogren’s syndrome (pSS, N=557) and gout (N=2178). Each patient was matched based on age, sex and municipality of residence with twenty individuals without any rheumatic conditions. The CV comorbidities studied were any CV disease (CVD), major coronary heart disease event (myocardial infarction and/or revascularization; CHD), ischemic stroke, atrial fibrillation and flutter (AF), deep vein thrombosis of lower extremities (DVT) and pulmonary embolism (PE), chronic heart failure (CHF) and valvular heart disease excluding rheumatic fever (VHD). From the prevalence of each CV disease among rheumatic disease cohorts, we calculated the risk ratio (RR) for each CV disease by comparing the prevalence of these diseases between rheumatic diseases and controls.ResultsThe average age at the time of diagnosis ranged from 39.6 to 64.4 years, and the average duration of follow-up varied from 9 to 19.5 years in different rheumatic diseases. The risk for any CVD was elevated in all rheumatic disease cohorts with RR varying from 1.14 in seropositive RA to 1.65 in SLE. SLE patients carried the highest relative risk for CV comorbidities, demonstrating over 2.5-fold risk for DVT/PE (RR 3.57), stroke (RR 2.57), CHF (RR 2.64) and VHD (RR 2.98). At least two-fold risk compared to controls was identified for AF (RR 2.03), DVT/PE (RR 2.44) and CHF (RR 3.03) in patients with gout, for DVT/PE (RR 2.15) and CHF (RR 2.0) in patients with pSS, and for DVT/PE (RR 2.03) in patients with PsA. Seropositive and seronegative RA demonstrated similar CV risk profiles. In patients with seropositive or seronegative RA, PsA, pSS or SLE, DVT/PE demonstrated the highest RR’s among various CV comorbidities.ConclusionThe risk of CV comorbidities is increased in all studied rheumatic diseases, with the largest effects observed in patients with SLE and gout. Among CV comorbidities, DVT/PE displayed the largest effect sizes in several rheumatic diseases. The current results further strengthen the importance of evaluating and treating risk factors for CV comorbidities across rheumatic diseases, focusing also to the excess risk for thromboses.References[1]Han C., Robinson DW Jr et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167-2172.[2]Avina-Zubieta JA, Choi HK et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008; 15;59(12):1690-1697.AcknowledgementsSpecial thanks to Finnish Foundation of Rheumatology Research and the Foundation of Maire Lisko for issuing research grants to help with the research process and writing of this abstract.Disclosure of InterestsHanna-Kaisa Aaramaa: None declared, Pia Isomäki Speakers bureau: Speaker or chair for AbbVie, Eli Lilly and Pfizer., Consultant of: Consultant for AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma., Grant/research support from: A research grant from Pfizer., Nina Mars: None declared, Mika Helminen: None declared, Anne Kerola: None declared, Antti Palomäki Speakers bureau: Lecture free from Pfizer and Sanofi, Consultant of: Consulting fee from Abbvie, Amgen and Pfizer, Kari Eklund: None declared, Javier Gracia Tabuenca: None declared, Juha Sinisalo: None declared
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Koskela U, Helve O, Sarvikivi E, Helminen M, Nieminen T, Peltola V, Renko M, Saxén H, Pasma H, Pokka T, Honkila M, Tapiainen T. Multi-inflammatory syndrome and Kawasaki disease in children during the COVID-19 pandemic: A nationwide register-based study and time series analysis. Acta Paediatr 2021; 110:3063-3068. [PMID: 34331326 PMCID: PMC8444808 DOI: 10.1111/apa.16051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022]
Abstract
Aim We investigated whether the ongoing COVID‐19 pandemic was associated with the occurrence of Kawasaki disease or with multi‐inflammatory syndrome in children (MIS‐C). Methods This national Finnish register‐based study was based on laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections, MIS‐C and Kawasaki disease cases. We performed a time series analysis on the occurrence of Kawasaki disease in 2016–2020. Results In 2020, there were 5170 laboratory‐confirmed COVID‐19 cases in children under 18 years of age and five fulfilled the MIS‐C case definition. The occurrence of MIS‐C was 0.97 per 1000 (95% confidence interval: 0.31‐2.26) laboratory‐confirmed SARS‐CoV‐2 infections in children. Our time series analysis showed that Kawasaki disease cases decreased during the COVID‐19 pandemic. The seasonally adjusted incidence rate ratio was 0.49 (95% confidence interval: 0.32‐0.74) when it was compared to pre‐pandemic levels. This coincided with a reduced occurrence of respiratory infections, due to social distancing in the population. Conclusion This nationwide register‐based study found that MIS‐C was a rare complication of the SARS‐CoV‐2 infection. The occurrence of Kawasaki disease and respiratory infections decreased during the pandemic. This suggests that transmissible microbes may play an important role in Kawasaki disease and social distancing may have a protective effect.
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Affiliation(s)
- Ulla Koskela
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology) University of Oulu Oulu Finland
- Central Ostrobothnia Central Hospital Kokkola Finland
| | - Otto Helve
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Emmi Sarvikivi
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Merja Helminen
- Department of Pediatrics and Adolescent Medicine Tampere University Hospital Tampere Finland
| | - Tea Nieminen
- New Children’s Hospital Helsinki University Hospital Helsinki Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Marjo Renko
- Department of Pediatrics and Adolescent Medicine Kuopio University Hospital and University of Eastern Finland Kuopio Finland
| | - Harri Saxén
- New Children’s Hospital Helsinki University Hospital Helsinki Finland
| | - Hanna Pasma
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
| | - Minna Honkila
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology) University of Oulu Oulu Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology) University of Oulu Oulu Finland
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Riikonen R, Korppi M, Törmänen S, Koponen P, Nuolivirta K, Helminen M, He Q, Lauhkonen E. Risk factors for irreversible airway obstruction after infant bronchiolitis. Respir Med 2021; 187:106545. [PMID: 34332337 DOI: 10.1016/j.rmed.2021.106545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/03/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increasing evidence shows that environmental factors in childhood play a role in development of irreversible airway obstruction. We evaluated early-life and preschool-age risk factors for irreversible airway obstruction in adolescence after bronchiolitis in infancy. METHODS This study is a secondary analysis of data collected during prospective long-term follow-up of our post-bronchiolitis cohort. Risk factor data were collected during hospitalisation and on follow-up visits at 5-7 and 10-13 years of ages. Lung function was measured from 103 participants with impulse oscillometry at 5-7 years of age and from 89 participants with flow-volume spirometry at 10-13 years of age. RESULTS Asthma diagnosis at <12 months of age showed a significant association with irreversible airway obstruction at 10-13 years of age independently from current asthma. Irreversible airway obstruction was less frequent in children with variant than wild genotype of the Toll-like receptor 4(TLR4) rs4986790, but the significance was lost in logistic regression adjusted for current asthma and weight status. Higher post-bronchodilator respiratory system resistance at 5 Hz and lower baseline and post-bronchodilator reactance at 5 Hz by impulse oscillometry at 5-7 years of age were associated with irreversible airway obstruction at 10-13 years of age. CONCLUSION Asthma diagnosis during the first living year and worse lung function at preschool age increased the risk for irreversible airway obstruction at 10-13 years of age after bronchiolitis. TLR4 rs4986790 polymorphism may be protective for development of irreversible airway obstruction after bronchiolitis.
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Affiliation(s)
- Riikka Riikonen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland.
| | - Matti Korppi
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Sari Törmänen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Petri Koponen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Kirsi Nuolivirta
- Department of Paediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Merja Helminen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Qiushui He
- Institute of Biomedicine, University of Turku, Turku, Finland; Department of Medical Microbiology, Capital Medical University, Beijing, China
| | - Eero Lauhkonen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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Riikonen R, Korppi M, Törmänen S, Nuolivirta K, Helminen M, He Q, Lauhkonen E. Genetic variations in Toll-like receptors 4 or 7 were not linked to post-bronchiolitis lung function in adolescence. Acta Paediatr 2021; 110:959-960. [PMID: 33053215 DOI: 10.1111/apa.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Riikka Riikonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Sari Törmänen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Kirsi Nuolivirta
- Department of Pediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Merja Helminen
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Qiushui He
- Institute of Biomedicine University of Turku Turku Finland
- Department of Medical Microbiology Capital Medical University Beijing China
| | - Eero Lauhkonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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Holster A, Teräsjärvi J, Barkoff A, Lauhkonen E, Törmänen S, Helminen M, Korppi M, He Q, Nuolivirta K. IL17F rs763780 single nucleotide polymorphism is associated with asthma after bronchiolitis in infancy. Acta Paediatr 2021; 110:222-227. [PMID: 32495451 DOI: 10.1111/apa.15390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023]
Abstract
AIM Interleukin-17F (IL-17F) is involved with asthma. The aim of this study was to evaluate the association of IL17F polymorphisms with childhood asthma after bronchiolitis in infancy. METHODS We invited 166 children who were hospitalised for bronchiolitis at younger than 6 months of age to follow-up visits at 5-7 years and 11-13 years of ages. Asthma and allergy diagnoses, asthma-presumptive symptoms and use of inhaled corticosteroids (ICSs) were registered. Blood samples were available for IL17F rs763780 (T/C), rs11465553 (C/T) and rs7741835 (C/T) determinations in 165 cases. RESULTS The presence of IL17F rs11465553 and rs7741835 variations showed no significant associations with any asthma or allergy outcome at either 5-7 years or 11-13 years of ages. Instead, children with the variant IL17F rs763780 genotype had used more often ICSs between the follow-up visits from 5-7 to 11-13 years (adjusted OR 3.58) than those with the wild genotype. Children with the variant IL17F rs763780 genotype reported more often doctor-diagnosed atopic dermatitis (adjusted OR 2.71) at 11-13 years of age than those with the wild genotype. CONCLUSION This prospective long-term follow-up study provided preliminary evidence on the association of the IL17F rs763780 polymorphism with asthma at school age after bronchiolitis in infancy.
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Affiliation(s)
- Annukka Holster
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
| | | | | | - Eero Lauhkonen
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
| | - Sari Törmänen
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
| | - Merja Helminen
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
| | - Matti Korppi
- Center for Child Health Research Faculty of Medicine and Life Sciences University of Tampere and University Hospital Tampere Finland
| | - Qiushui He
- Institute of Biomedicine University of Turku Turku Finland
- Department of Medical Microbiology Capital Medical University Beijing China
| | - Kirsi Nuolivirta
- Department of Pediatrics Seinäjoki Central Hospital Seinäjoki Finland
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Lorenzini T, Fliegauf M, Klammer N, Frede N, Proietti M, Bulashevska A, Camacho-Ordonez N, Varjosalo M, Kinnunen M, de Vries E, van der Meer JWM, Ameratunga R, Roifman CM, Schejter YD, Kobbe R, Hautala T, Atschekzei F, Schmidt RE, Schröder C, Stepensky P, Shadur B, Pedroza LA, van der Flier M, Martínez-Gallo M, Gonzalez-Granado LI, Allende LM, Shcherbina A, Kuzmenko N, Zakharova V, Neves JF, Svec P, Fischer U, Ip W, Bartsch O, Barış S, Klein C, Geha R, Chou J, Alosaimi M, Weintraub L, Boztug K, Hirschmugl T, Dos Santos Vilela MM, Holzinger D, Seidl M, Lougaris V, Plebani A, Alsina L, Piquer-Gibert M, Deyà-Martínez A, Slade CA, Aghamohammadi A, Abolhassani H, Hammarström L, Kuismin O, Helminen M, Allen HL, Thaventhiran JE, Freeman AF, Cook M, Bakhtiar S, Christiansen M, Cunningham-Rundles C, Patel NC, Rae W, Niehues T, Brauer N, Syrjänen J, Seppänen MRJ, Burns SO, Tuijnenburg P, Kuijpers TW, Warnatz K, Grimbacher B. Characterization of the clinical and immunologic phenotype and management of 157 individuals with 56 distinct heterozygous NFKB1 mutations. J Allergy Clin Immunol 2020; 146:901-911. [PMID: 32278790 PMCID: PMC8246418 DOI: 10.1016/j.jaci.2019.11.051] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND An increasing number of NFKB1 variants are being identified in patients with heterogeneous immunologic phenotypes. OBJECTIVE To characterize the clinical and cellular phenotype as well as the management of patients with heterozygous NFKB1 mutations. METHODS In a worldwide collaborative effort, we evaluated 231 individuals harboring 105 distinct heterozygous NFKB1 variants. To provide evidence for pathogenicity, each variant was assessed in silico; in addition, 32 variants were assessed by functional in vitro testing of nuclear factor of kappa light polypeptide gene enhancer in B cells (NF-κB) signaling. RESULTS We classified 56 of the 105 distinct NFKB1 variants in 157 individuals from 68 unrelated families as pathogenic. Incomplete clinical penetrance (70%) and age-dependent severity of NFKB1-related phenotypes were observed. The phenotype included hypogammaglobulinemia (88.9%), reduced switched memory B cells (60.3%), and respiratory (83%) and gastrointestinal (28.6%) infections, thus characterizing the disorder as primary immunodeficiency. However, the high frequency of autoimmunity (57.4%), lymphoproliferation (52.4%), noninfectious enteropathy (23.1%), opportunistic infections (15.7%), autoinflammation (29.6%), and malignancy (16.8%) identified NF-κB1-related disease as an inborn error of immunity with immune dysregulation, rather than a mere primary immunodeficiency. Current treatment includes immunoglobulin replacement and immunosuppressive agents. CONCLUSIONS We present a comprehensive clinical overview of the NF-κB1-related phenotype, which includes immunodeficiency, autoimmunity, autoinflammation, and cancer. Because of its multisystem involvement, clinicians from each and every medical discipline need to be made aware of this autosomal-dominant disease. Hematopoietic stem cell transplantation and NF-κB1 pathway-targeted therapeutic strategies should be considered in the future.
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Affiliation(s)
- Tiziana Lorenzini
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST- Spedali Civili of Brescia, Brescia, Italy
| | - Manfred Fliegauf
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; CIBSS (Centre for Integrative Biological Signalling Studies), University of Freiburg, Freiburg, Germany
| | - Nils Klammer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Frede
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michele Proietti
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alla Bulashevska
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadezhda Camacho-Ordonez
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markku Varjosalo
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Matias Kinnunen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Esther de Vries
- Laboratory for Medical Microbiology and Immunology, Elisabeth Tweesteden Hospital, and Department of Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rohan Ameratunga
- Department of Virology and Immunology and the Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Chaim M Roifman
- Canadian Centre for Primary Immunodeficiency, Immunogenomic Laboratory, Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Yael D Schejter
- Canadian Centre for Primary Immunodeficiency, Immunogenomic Laboratory, Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Robin Kobbe
- Department of Pediatrics, University Medical Centre Hamburg, Hamburg, Germany
| | - Timo Hautala
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Faranaz Atschekzei
- Division of Immunology and Rheumatology, Hannover Medical University, Hannover, Germany; RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany
| | - Reinhold E Schmidt
- Division of Immunology and Rheumatology, Hannover Medical University, Hannover, Germany; RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany
| | - Claudia Schröder
- Division of Immunology and Rheumatology, Hannover Medical University, Hannover, Germany
| | - Polina Stepensky
- Bone Marrow Transplantation Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bella Shadur
- Bone Marrow Transplantation Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Immunology, Garvan Institute of Medical Research, and University of New South Wales, Graduate Research School, Sydney, Australia
| | - Luis A Pedroza
- Colegio de ciencias de la salud-Hospital de los Valles and Instituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador; Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Tex
| | - Michiel van der Flier
- Department of Pediatric Infectious Diseases & Immunology and Nijmegen Institute for Infection, Immunity and Inflammation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mónica Martínez-Gallo
- Immunology Division, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona (UAB), Barcelona, Spain; Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Luis Ignacio Gonzalez-Granado
- Primary Immunodeficiencies Unit, Pediatrics, School of Medicine, Complutense University, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Luis M Allende
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Anna Shcherbina
- Department of Clinical Immunology, Dmitry Rogachev Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Natalia Kuzmenko
- Department of Clinical Immunology, Dmitry Rogachev Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Victoria Zakharova
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical and Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefania, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Peter Svec
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Ute Fischer
- Department of Paediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Winnie Ip
- Department of Immunology and Molecular and Cellular Immunology Unit, Great Ormond Street Hospital & University College London (UCL), Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Oliver Bartsch
- Institute of Human Genetics, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Safa Barış
- Department of Pediatrics, Division of Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Christoph Klein
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Raif Geha
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Mohammed Alosaimi
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lauren Weintraub
- Divisions of Pediatric Hematology/Oncology, Albany Medical Center, Albany, NY
| | - Kaan Boztug
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Department of Pediatrics and Adolescent Medicine and St Anna Kinderspital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Tatjana Hirschmugl
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Department of Pediatrics and Adolescent Medicine and St Anna Kinderspital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Maria Marluce Dos Santos Vilela
- Laboratory of Pediatric Immunology, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas - UNICAMP, Campinas, Brazil
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Seidl
- Center for Chronic Immunodeficiency and Molecular Pathology, Department of Pathology, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Vassilios Lougaris
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST- Spedali Civili of Brescia, Brescia, Italy
| | - Alessandro Plebani
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST- Spedali Civili of Brescia, Brescia, Italy
| | - Laia Alsina
- Pediatric Allergy and Clinical Immunology Department and Institut de Recerca, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Monica Piquer-Gibert
- Pediatric Allergy and Clinical Immunology Department and Institut de Recerca, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Angela Deyà-Martínez
- Pediatric Allergy and Clinical Immunology Department and Institut de Recerca, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Charlotte A Slade
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Melbourne, Australia
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran; Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lennart Hammarström
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Outi Kuismin
- PEDEGO Research Unit, Medical Research Center Oulu, and University of Oulu and Department of Clinical Genetics, Oulu University Hospital, Oulu, Finland
| | - Merja Helminen
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Hana Lango Allen
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom; NHS Blood and Transplant Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, Md
| | - Matthew Cook
- Australian National University Medical School and John Curtin School of Medical Research, Australian National University, Acton, Australia; Department of Immunology, Canberra Hospital, Canberra, Australia
| | - Shahrzad Bakhtiar
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Mette Christiansen
- International Center for Immunodeficiency Diseases and Department of Clinical Immunology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | | | - Niraj C Patel
- Department of Pediatrics, Section of Infectious Disease and Immunology, Levine Children's Hospital, Atrium Health, Charlotte, NC
| | - William Rae
- Southampton NIHR Wellcome Trust Clinical Research Facility and NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Department of Allergy, Asthma and Clinical Immunology, University Hospital Southampton, Southampton, United Kingdom
| | - Tim Niehues
- Department of Pediatric Hematology and Oncology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Nina Brauer
- Department of Pediatric Hematology and Oncology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Mikko R J Seppänen
- Rare Disease Center, New Children's Hospital and Adult immunodeficiency Unit, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Siobhan O Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, University College London Institute of Immunity and Transplantation, London, United Kingdom
| | - Paul Tuijnenburg
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Immunology, Rheumatology and Infectious diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Immunology, Rheumatology and Infectious diseases, Meibergdreef 9, Amsterdam, The Netherlands
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- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; CIBSS (Centre for Integrative Biological Signalling Studies), University of Freiburg, Freiburg, Germany; RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany; Institute of Immunology and Transplantation, Royal Free Hospital and University College London, London, United Kingdom; DZIF (German Center for Infection Research) Satellite Center Freiburg, Freiburg, Germany; Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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10
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Riikonen R, Korppi M, Törmänen S, Nuolivirta K, Helminen M, He Q, Lauhkonen E. Toll-like receptor 10 rs4129009 gene polymorphism is associated with post-bronchiolitis lung function in adolescence. Acta Paediatr 2020; 109:1634-1641. [PMID: 31856358 DOI: 10.1111/apa.15139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
AIM The aim was to evaluate the association of polymorphisms in the Toll-like receptor (TLR) 2 subfamily encoding genes with lung function by spirometry at 10-13 years of age in children who had been hospitalised for bronchiolitis at <6 months of age. METHODS In a prospective cohort of 166 former bronchiolitis patients, 138 returned a structured questionnaire and 89 attended a clinical follow-up visit including spirometry before and after bronchodilation at 10-13 years of age. Data on polymorphisms of the TLR1, TLR2, TLR6 and TLR10 genes were available from 81-82 children. RESULTS In the TLR10 rs4129009, the wild (AA) genotype was associated with lower FEV1/FVC before (92.4 vs 97.4, P = .002) and after (95.5 vs 98.6, P = .011) bronchodilator administration, compared to those with the variant genotype. When the TLR10 rs4129009 and TLR2 rs5743708 genotypes, and the TLR10 rs4129009 and TLR1 rs5743618 genotypes, respectively, were analysed as combined, both baseline and post-bronchodilator FEV1/FVC were lowest in the subjects with the wild (AA) genotype of the TLR10 rs4129009. CONCLUSION In this post-bronchiolitis follow-up, lung function in children with the variant TLR10 rs4129009 genotype with potentially altered TLR10 function was superior to lung function in those with the wild genotype.
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Affiliation(s)
- Riikka Riikonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Sari Törmänen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Kirsi Nuolivirta
- Department of Pediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Merja Helminen
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Qiushui He
- Department of Medical Microbiology and Immunology Turku University Turku Finland
- Department of Medical Microbiology Capital Medical University Beijing China
| | - Eero Lauhkonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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11
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Holster A, Riikonen R, Korppi M, Nuolivirta K, Törmänen S, Helminen M, He Q, Lauhkonen E. Interleukin-10 polymorphisms were not associated with lung function at age 11-13 years after infant bronchiolitis. Acta Paediatr 2020; 109:198-199. [PMID: 31325191 DOI: 10.1111/apa.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Annukka Holster
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Riikka Riikonen
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Matti Korppi
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Kirsi Nuolivirta
- Department of Paediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Sari Törmänen
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Merja Helminen
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Qiushui He
- Institute of Biomedicine Turku University Turku Finland
- Department of Medical Microbiology Capital Medical University Beijing China
| | - Eero Lauhkonen
- Centre for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
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12
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Holster A, Nuolivirta K, Törmänen S, Lauhkonen E, Teräsjärvi J, Vuononvirta J, Koponen P, Helminen M, He Q, Korppi M. Interleukin-10 gene polymorphism rs1800896 is associated with post-bronchiolitis asthma at 11-13 years of age. Acta Paediatr 2019; 108:2064-2069. [PMID: 31074014 DOI: 10.1111/apa.14838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/21/2019] [Accepted: 05/06/2019] [Indexed: 02/04/2023]
Abstract
AIM Interleukin-10 (IL-10) is an anti-inflammatory cytokine that is involved with bronchiolitis and asthma. We evaluated associations between four IL-10 polymorphisms, namely rs1800871, rs1800872, rs1800890 and rs1800896, and post-bronchiolitis asthma in young adolescents. METHODS The cohort consisted of 125 children hospitalised for bronchiolitis at Tampere University Hospital, Finland, in 2000-2004, at less than six months of age. At 11-13 years, asthma diagnoses and asthma-presumptive symptoms, allergic rhinitis and use of inhaled corticosteroids (ICS) were registered. Data on the four polymorphisms and their genotypes, haplotypes and allele frequencies were analysed in relation to asthma, allergic rhinitis and asthma medication. RESULTS The variant IL-10 rs1800896 genotype was associated with less persistent asthma at five to seven and 11-13 years of age (4.3 versus 15.2%, p = 0.04) than the wild genotype and less ICS use during the previous 12 months (5.4 versus 18.2%, p = 0.03), as was the variant allele G. Allele A was associated with more persistent asthma and ICS use. The significant differences between the variant and wild genotypes were lost in adjusted logistic regression, but the direction of the association remained. CONCLUSION IL-10 rs1800896 gene polymorphism was associated with post-bronchiolitis asthma at 11-13 years of age in children hospitalised for bronchiolitis at less than six months of age.
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Affiliation(s)
- Annukka Holster
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
- Department of Paediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Kirsi Nuolivirta
- Department of Paediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Sari Törmänen
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Eero Lauhkonen
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | | | | | - Petri Koponen
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Merja Helminen
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
| | - Qiushui He
- Institute of Biomedicine Turku University Turku Finland
- Department of Medical Microbiology Capital Medical University Beijing China
| | - Matti Korppi
- Center for Child Health Research Tampere University and Tampere University Hospital Tampere Finland
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13
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Riikonen R, Törmänen S, Saari A, Koponen P, Helminen M, Nuolivirta K, Korppi M, Lauhkonen E. Preliminary communication suggests overweight was associated with reduced lung function in adolescence after infant bronchiolitis. Acta Paediatr 2019; 108:1729-1730. [PMID: 31162726 DOI: 10.1111/apa.14886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Riikka Riikonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Sari Törmänen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Antti Saari
- Department of Pediatrics Kuopio University Hospital Kuopio Finland
| | - Petri Koponen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Merja Helminen
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Kirsi Nuolivirta
- Department of Pediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Eero Lauhkonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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14
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Riikonen R, Lauhkonen E, Törmänen S, Backman K, Koponen P, Helminen M, Nuolivirta K, Korppi M. Prospective study confirms that bronchiolitis in early infancy increases the risk of reduced lung function at 10-13 years of age. Acta Paediatr 2019; 108:124-130. [PMID: 29782663 DOI: 10.1111/apa.14412] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/09/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
AIM This study evaluated children hospitalised for bronchiolitis at less than six months of age to see if they had reduced lung function in early adolescence. METHODS We have prospectively followed 166 children hospitalised for infant bronchiolitis in 2001-2004 at Tampere University Hospital, Finland. At 10-13 years of age, flow-volume spirometry was measured in 89 cases and 108 controls without infant bronchiolitis from the local population register. Parameters of flow-volume spirometry before and after bronchodilation were analysed. RESULTS Forced expiratory volume in one second/forced vital capacity (FEV1/FVC) after bronchodilation was lower in cases than controls. FEV1 was pathological - under the 5th percentile of the national references - in 25% of cases and 12% of controls (p = 0.020) before bronchodilation and in 18% of cases and 5% of controls (p = 0.003) after bronchodilation. FEV1/FVC was pathological in 25% of cases and 13% of controls (p = 0.034) before bronchodilation. Logistic regression, adjusted for current asthma and maternal smoking, showed that infant bronchiolitis was associated with pathological FEV1 before (odds ratio 2.4) and after (odds ratio 4.4) bronchodilation. The result was similar for positive respiratory syncytial virus cases. CONCLUSION Reduced FEV1 after bronchodilation was found in early adolescence after infant bronchiolitis, suggesting irreversible bronchial obstruction.
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Affiliation(s)
- Riikka Riikonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Eero Lauhkonen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Sari Törmänen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Katri Backman
- Department of Paediatrics Kuopio University Hospital Kuopio Finland
| | - Petri Koponen
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
| | - Merja Helminen
- Department of Paediatrics Tampere University Hospital Tampere Finland
| | - Kirsi Nuolivirta
- Department of Paediatrics Seinäjoki Central Hospital Seinäjoki Finland
| | - Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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15
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Holster A, Teräsjärvi J, Vuononvirta J, Koponen P, Peltola V, Helminen M, He Q, Korppi M, Nuolivirta K. Polymorphisms in the promoter region of IL10 gene are associated with virus etiology of infant bronchiolitis. World J Pediatr 2018; 14:594-600. [PMID: 29802545 DOI: 10.1007/s12519-018-0161-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bronchiolitis is the most common infection leading to hospitalization in infancy. Interleukin-10 (IL-10) is an anti-inflammatory cytokine, and in our previous study, IL10 gene rs1800896 (- 1082A/G) polymorphism was associated with viral etiology of infant bronchiolitis. The objective of this study was to evaluate the associations between IL10 single nucleotide polymorphisms (SNPs) at rs1800890 (- 3575A/T), rs1800871 (- 819C/T) or rs1800872 (- 592C/A) either alone or combined with the SNP at rs1800896 (- 1082G/A), and the etiology and severity of infant bronchiolitis. METHODS Data on four IL10 SNPs were available from 135 full-term infants, hospitalized for bronchiolitis at age less than 6 months, and from 378 to 400 controls. Viral etiology was studied, and oxygen support, feeding support and the length of stay in hospital were recorded during bronchiolitis hospitalization. RESULTS Infants with rhinovirus bronchiolitis had the IL10 rs1800890 variant AT or TT genotype less often (18.2%) than controls (63.3%, P = 0.03), and likewise, had the IL10 rs1800896 variant AG or GG genotype less often (27.3%) than controls (65.5%, P = 0.009). Twenty-eight infants with bronchiolitis had the variant-variant Grs1800896Trs1800890 haplotype, and none of them had rhinovirus infection. The IL10 rs1800871 or rs1800872 genotypes showed no associations with viruses. No association was found between any genotypes and bronchiolitis severity measures. CONCLUSION IL10 rs1800890 and rs1800896 polymorphisms differed between infants with rhinovirus bronchiolitis and controls, but not between infants with respiratory syncytial virus bronchiolitis and controls.
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Affiliation(s)
- Annukka Holster
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
| | - Juho Vuononvirta
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
| | - Petri Koponen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Child and Youth Research Institute, University of Turku, Turku, Finland
| | - Merja Helminen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Qiushui He
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland.,Department of Medical Microbiology, Capital Medical University, Beijing, China
| | - Matti Korppi
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Kirsi Nuolivirta
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
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Nuolivirta K, Holster A, Teräsjärvi J, Lauhkonen E, Törmänen S, Helminen M, Koponen P, Korppi M, He Q. IL17A gene polymorphisms rs4711998 and rs8193036 are not associated with postbronchiolitis asthma in Finnish children. Acta Paediatr 2018; 107:1290-1291. [PMID: 29601094 DOI: 10.1111/apa.14340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/08/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsi Nuolivirta
- Department of Pediatrics; Seinäjoki Central Hospital; Seinäjoki Finland
| | - Annukka Holster
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | | | - Eero Lauhkonen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Sari Törmänen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Merja Helminen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Petri Koponen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Matti Korppi
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Qiushui He
- Institute of Biomedicine; Turku University; Turku Finland
- Department of Medical Microbiology; Capital Medical University; Beijing China
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Törmänen S, Teräsjärvi J, Lauhkonen E, Helminen M, Koponen P, Korppi M, Nuolivirta K, He Q. TLR5 rs5744174 gene polymorphism is associated with the virus etiology of infant bronchiolitis but not with post-bronchiolitis asthma. Health Sci Rep 2018; 1:e38. [PMID: 30623075 PMCID: PMC6266536 DOI: 10.1002/hsr2.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/09/2018] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIM Bronchiolitis is a leading cause of hospitalization in infants and is associated with a risk of subsequent asthma. The innate immunity genes, such as those encoding toll-like receptors (TLRs), are likely to play a role in bronchiolitis and post-bronchiolitis outcome. Thus far, only one study has considered TLR5 genes in respiratory syncytial virus (RSV) bronchiolitis. The aim of this study was to investigate the association of TLR5 gene polymorphism with virus etiology and severity of bronchiolitis, and with post-bronchiolitis asthma. METHODS We recruited 164 infants (age < 6 months) hospitalized for bronchiolitis in this study and determined TLR5 rs5744174 (C > T) single nucleotide polymorphism, virus etiology and severity markers of bronchiolitis, and presence of post-bronchiolitis asthma until age 11 to 13 years. RESULTS RSV was detected in 113 (68.9%), rhinovirus in 19 (11.6%), and some other virus in 20 (12.2%) cases. Non-RSV etiology was more common among infants with the variant CT or TT genotype in the TLR5 rs5744174 gene than in those with the CC genotype (89.7% vs 71.7%, P = 0.03). TLR5 rs5744174 polymorphism was not associated with the need of supplementary oxygen or feeding support, with the length of hospital stay, or with post-bronchiolitis asthma at any age. CONCLUSION The TLR5 rs5744174 variant genotype may increase the susceptibility to bronchiolitis not caused by RSV.
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Affiliation(s)
- Sari Törmänen
- Center for Child Health ResearchTampere University and University HospitalTampereFinland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and ImmunologyTurku UniversityTurkuFinland
| | - Eero Lauhkonen
- Center for Child Health ResearchTampere University and University HospitalTampereFinland
| | - Merja Helminen
- Center for Child Health ResearchTampere University and University HospitalTampereFinland
| | - Petri Koponen
- Center for Child Health ResearchTampere University and University HospitalTampereFinland
| | - Matti Korppi
- Center for Child Health ResearchTampere University and University HospitalTampereFinland
| | - Kirsi Nuolivirta
- Department of PediatricsSeinäjoki Central HospitalSeinäjokiFinland
| | - Qiushui He
- Department of Medical Microbiology and ImmunologyTurku UniversityTurkuFinland
- Department of Medical MicrobiologyCapital Medical UniversityBeijingChina
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Lauhkonen E, Riikonen R, Törmänen S, Koponen P, Nuolivirta K, Helminen M, Toikka J, Korppi M. Impulse oscillometry at preschool age is a strong predictor of lung function by flow-volume spirometry in adolescence. Pediatr Pulmonol 2018; 53:552-558. [PMID: 29484853 DOI: 10.1002/ppul.23977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The transition from early childhood wheezing to persistent asthma is linked to lung function impairment over time. Little is known how the methods used to study lung function at different ages correlate longitudinally. METHODS Sixty-four children with a history of hospitalization for bronchiolitis before 6 months of age were prospectively studied with impulse oscillometry (IOS) at the mean age of 6.3 years and these preschool IOS results were compared with flow-volume spirometry (FVS) measurements at mean age of 11.4 years. RESULTS The baseline respiratory system resistance at 5 Hz (Rrs5) showed a modest statistically significant correlation with all baseline FVS parameters except FVC. The post-bronchodilator (post-BD) Rrs5 showed a modest statistically significant correlation with post-BD FEV1 and FEV1 /FVC. The bronchodilator-induced decrease in Rrs5 showed a modest statistically significant correlation with the percent increase in FEV1 . Baseline and post-BD respiratory reactance at 5 Hz (Xrs5) showed a modest statistically significant correlation with baseline and post-BD FVS parameters except post-BD FEV1 /FVC, respectively, and post-BD Xrs5 showed a strong correlation with post-BD FVC (ρ = 0.61) and post-BD FEV1 (ρ = 0.59). In adjusted linear regression, preschool Xrs5 remained as a statistically significant independent predictor of FVS parameters in adolescence; the one-unit decrease in the Z-score of preschool post-BD Xrs5 predicted 9.6% lower post-BD FEV1 , 9.3% lower post-BD FVC, and 9.7% lower post-BD MEF50 when expressed as %-predicted parameters. CONCLUSION Persistent post-BD small airway impairment in children with a history of bronchiolitis detected with IOS at preschool age predicted FVS results measured in early adolescence.
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Affiliation(s)
- Eero Lauhkonen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Riikka Riikonen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Sari Törmänen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Petri Koponen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | | | - Merja Helminen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Jyri Toikka
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
- Department of Clinical Physiology, Turku University Hospital, Turku, Finland
| | - Matti Korppi
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Törmänen S, Lauhkonen E, Riikonen R, Koponen P, Huhtala H, Helminen M, Korppi M, Nuolivirta K. Risk factors for asthma after infant bronchiolitis. Allergy 2018; 73:916-922. [PMID: 29105099 DOI: 10.1111/all.13347] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Five studies carried out after bronchiolitis at less than 24 months of age, with a follow-up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalized for bronchiolitis in early infancy. METHODS We previously prospectively followed 166 children hospitalized for bronchiolitis at less than 6 months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age. RESULTS Respiratory syncytial virus caused 66% of the bronchiolitis cases, and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25). CONCLUSIONS After bronchiolitis at less than 6 months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.
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Affiliation(s)
- S. Törmänen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - E. Lauhkonen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - R. Riikonen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - P. Koponen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - H. Huhtala
- School of Health Sciences; Tampere University; Tampere Finland
| | - M. Helminen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - M. Korppi
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - K. Nuolivirta
- Department of Pediatrics; Seinäjoki Central Hospital; Seinäjoki Finland
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20
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Holster A, Teräsjärvi J, Lauhkonen E, Törmänen S, Helminen M, Koponen P, Korppi M, Peltola V, He Q, Nuolivirta K. IL-17A gene polymorphism rs2275913 is associated with the development of asthma after bronchiolitis in infancy. Allergol Int 2018. [PMID: 28647382 DOI: 10.1016/j.alit.2017.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Interleukin-17 (IL-17A) is a mainly pro-inflammatory cytokine, and IL-17 signaling implicates in the development of allergic asthma. The polymorphism rs2275913 in the promoter region of the IL-17A gene has in previous studies been associated with asthma susceptibility. The objective was to evaluate the association between IL-17A rs2275913 (-197G>A) polymorphism and post-bronchiolitis asthma and/or allergic rhinitis in a prospective 11-13 years post-bronchiolitis follow-up. METHODS 166 previously healthy full-term infants, hospitalized for bronchiolitis at age less than 6 months, were invited to follow-up visits at the ages of 5-7 years and 11-13 years. Asthma diagnoses and presumptive symptoms, allergic rhinitis and use of inhaled corticosteroids (ICS) were registered. Blood samples for IL-17A rs2275913 (-197G>A) polymorphism were obtained during hospitalization or at the 5-7 years control visit. RESULTS There were no significant differences between children with the wild GG and variant GA or AA genotype in the severity of bronchiolitis during hospitalization or in the outcomes until the age 5-7 years. At 11-13 years of age, children with the variant GA or AA genotype had significantly less often current asthma, use of ICSs during last 12 months or allergic rhinitis than those with the wild GG genotype. The ICS use during last 12 months retained the statistical significance in adjusted analyses (adjusted OR 0.25), whereas current asthma and allergic rhinitis marginally lost it. CONCLUSIONS The IL-17A rs2275913 (-197G>A) polymorphism decreased the risk of post-bronchiolitis asthma at 11-13 years of age, but not earlier in life, in the present prospective, long-term follow-up study.
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21
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Törmänen S, Korppi M, Lauhkonen E, Koponen P, Teräsjärvi J, Vuononvirta J, Helminen M, He Q, Nuolivirta K. Toll-like receptor 1 and 10 gene polymorphisms are linked to postbronchiolitis asthma in adolescence. Acta Paediatr 2018; 107:134-139. [PMID: 28692144 DOI: 10.1111/apa.13984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022]
Abstract
AIM Toll-like receptors (TLR) are innate immunity molecules and our previous studies found that TLR1 gene polymorphism was associated with postbronchiolitis asthma at one to six years of age, as was TLR10 at five to seven years of age. This study examined any associations at 11-13 years of age. METHODS This prospective follow-up study was part of an ongoing evaluation of children admitted to Tampere University Hospital, Finland, for bronchiolitis in 2001-2004 at less than six months of age. We evaluated the association of TLR1 rs5743618 and TLR10 rs4129009 polymorphisms with asthma and asthma medication in 125 children aged 11-13 years. RESULTS Associations were measured as adjusted odd ratios (aOR) with 95% confidence intervals (95% CI). The variant TLR1 rs5743618 (aOR 4.04, 95% CI 0.99-13.01) and TLR10 rs4129009 (aOR 7.02, 95% CI 1.56-31.53) genotypes increased the risk of needing inhaled corticosteroids (ICSs) at 11-13 years of age. The variant TLR10 genotype (aOR 7.69, 95% CI 1.35-43.95) increased the risk of persistent asthma continuing from five to seven years of age until 11-13 years of age. The results were similar when the combined genotypes were analysed. [Correction added on 3 October 2017, after online publication: The data in the variant TRL1 rs5743618 genotype were incorrect and have been corrected in this version.] CONCLUSION: Polymorphisms in both the TLR1 and TLR10 genes may increase the risk of asthma at 11-13 years after infant bronchiolitis.
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Affiliation(s)
- Sari Törmänen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Matti Korppi
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Eero Lauhkonen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Petri Koponen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and Immunology; Turku University; Turku Finland
| | - Juho Vuononvirta
- Department of Medical Microbiology and Immunology; Turku University; Turku Finland
| | - Merja Helminen
- Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Qiushui He
- Department of Medical Microbiology and Immunology; Turku University; Turku Finland
- Department of Medical Microbiology; Capital Medical University; Beijing China
| | - Kirsi Nuolivirta
- Department of Pediatrics; Seinäjoki Central Hospital; Seinäjoki Finland
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22
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Paunonen J, Helminen M, Peltomäki T. Duration of orthognathic treatment. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Nieminen O, Korppi M, Helminen M. Healthcare costs doubled when children had urinary tract infections caused by extended-spectrum β-lactamase-producing bacteria. Acta Paediatr 2017; 106:327-333. [PMID: 27891664 DOI: 10.1111/apa.13656] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/13/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
AIM The impact of the emergence of antimicrobial resistant organisms has rarely been studied in children, including the healthcare costs of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. We evaluated the effect of ESBL on UTI healthcare costs and risk factors for paediatric UTIs. METHODS This retrospective case-control study covered 2005-2014 and focused on children below 16 years of age treated in a University hospital: 22 children with UTIs caused by ESBL-producing bacteria and 56 ESBL-negative UTI controls. RESULTS The median healthcare costs were 3929 Euros for the 22 ESBL patients and 1705 Euros for the 56 controls (p = 0.015). The mean and standard deviation length of hospital stay was 7.4 (5.9) days for the ESBL group and 3.6 (2.3) days for the controls (p = 0.007), and the figures for antibiotic treatment were 12.3 (5.5) days versus 5.8 (3.0) days (p < 0.001), respectively. The odd ratios for ESBL were underlying disease (6.63, p = 0.013), previous hospitalisation (6.07, p = 0.009) and antibiotic prophylaxis (5.20, p = 0.035). CONCLUSION Healthcare costs more than doubled when children had ESBL-related UTIs, mainly due to their increased length of stay. Effective oral antibiotics are urgently needed to treat paediatric infections caused by ESBL-producing bacteria.
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Affiliation(s)
- Oona Nieminen
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
| | - Matti Korppi
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
| | - Merja Helminen
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
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24
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Puhakka L, Renko M, Helminen M, Peltola V, Heiskanen-Kosma T, Lappalainen M, Surcel HM, Lönnqvist T, Saxen H. Primary versus non-primary maternal cytomegalovirus infection as a cause of symptomatic congenital infection - register-based study from Finland. Infect Dis (Lond) 2017; 49:445-453. [PMID: 28116961 DOI: 10.1080/23744235.2017.1279344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Both primary and non-primary maternal cytomegalovirus (CMV) infection during pregnancy can lead to vertical transmission. We evaluated the proportion of maternal primary/non-primary infections among 26 babies with symptomatic congenital CMV infection born in Finland from 2000 to 2012. METHODS We executed a database search on hospital records from all five university hospitals in Finland to identify infants with congenital CMV infection. The preserved maternal serum samples drawn at the end of the first trimester were analysed for CMV antibodies. Maternal infection was classified to be non-primary, if there was high avidity CMV immunoglobulin G (IgG) in the early pregnancy samples. Infection was considered primary in the case of either low avidity IgG (primary infection in the first trimester or near conception) or absent CMV IgG at the end of the first trimester (primary infection in the second or third trimester). RESULTS The majority of the symptomatic congenital CMV infections (54%) were due to maternal non-primary infection, 27% due to maternal primary infection in the first trimester or near conception, and 19% during the second or third trimester. Long-term sequelae occurred in 59% of patients: in 6/7 after primary infection in the first trimester, in 0/5 after primary infection in the second or third trimester, and in 9/14 after non-primary infection. CONCLUSIONS In this register-based cohort, non-primary infections caused the majority of symptomatic congenital CMV infections, and resulted in significant morbidity.
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Affiliation(s)
- Laura Puhakka
- a Pediatrics , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Marjo Renko
- b Pediatrics, PEDEGO Research Unit , University of Oulu and Oulu University Hospital , Oulu , Finland
| | - Merja Helminen
- c Pediatrics , Tampere University and University Hospital , Tampere , Finland
| | - Ville Peltola
- d Department of Pediatrics and Adolescent Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Maija Lappalainen
- f Laboratory Services (HUSLAB), Division of Clinical Microbiology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | - Tuula Lönnqvist
- h Pediatric Neurology , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Harri Saxen
- i Infectious Diseases , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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25
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Kaustio M, Haapaniemi E, Göös H, Hautala T, Park G, Syrjänen J, Einarsdottir E, Sahu B, Kilpinen S, Rounioja S, Fogarty CL, Glumoff V, Kulmala P, Katayama S, Tamene F, Trotta L, Morgunova E, Krjutškov K, Nurmi K, Eklund K, Lagerstedt A, Helminen M, Martelius T, Mustjoki S, Taipale J, Saarela J, Kere J, Varjosalo M, Seppänen M. Damaging heterozygous mutations in NFKB1 lead to diverse immunologic phenotypes. J Allergy Clin Immunol 2017; 140:782-796. [PMID: 28115215 DOI: 10.1016/j.jaci.2016.10.054] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/02/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The nuclear factor κ light-chain enhancer of activated B cells (NF-κB) signaling pathway is a key regulator of immune responses. Accordingly, mutations in several NF-κB pathway genes cause immunodeficiency. OBJECTIVE We sought to identify the cause of disease in 3 unrelated Finnish kindreds with variable symptoms of immunodeficiency and autoinflammation. METHODS We applied genetic linkage analysis and next-generation sequencing and functional analyses of NFKB1 and its mutated alleles. RESULTS In all affected subjects we detected novel heterozygous variants in NFKB1, encoding for p50/p105. Symptoms in variant carriers differed depending on the mutation. Patients harboring a p.I553M variant presented with antibody deficiency, infection susceptibility, and multiorgan autoimmunity. Patients with a p.H67R substitution had antibody deficiency and experienced autoinflammatory episodes, including aphthae, gastrointestinal disease, febrile attacks, and small-vessel vasculitis characteristic of Behçet disease. Patients with a p.R157X stop-gain experienced hyperinflammatory responses to surgery and showed enhanced inflammasome activation. In functional analyses the p.R157X variant caused proteasome-dependent degradation of both the truncated and wild-type proteins, leading to a dramatic loss of p50/p105. The p.H67R variant reduced nuclear entry of p50 and showed decreased transcriptional activity in luciferase reporter assays. The p.I553M mutation in turn showed no change in p50 function but exhibited reduced p105 phosphorylation and stability. Affinity purification mass spectrometry also demonstrated that both missense variants led to altered protein-protein interactions. CONCLUSION Our findings broaden the scope of phenotypes caused by mutations in NFKB1 and suggest that a subset of autoinflammatory diseases, such as Behçet disease, can be caused by rare monogenic variants in genes of the NF-κB pathway.
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Affiliation(s)
- Meri Kaustio
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Emma Haapaniemi
- Folkhälsan Institute of Genetics, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Helka Göös
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Timo Hautala
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Giljun Park
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Elisabet Einarsdottir
- Folkhälsan Institute of Genetics, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
| | - Biswajyoti Sahu
- Research Programs Unit, Genome-scale Biology Program, University of Helsinki, Helsinki, Finland
| | - Sanna Kilpinen
- Department of Internal Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Samuli Rounioja
- Fimlab Laboratories, Tampere University Hospital, Tampere, Finland; Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Christopher L Fogarty
- Folkhälsan Institute of Genetics, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Virpi Glumoff
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Petri Kulmala
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO) and MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Shintaro Katayama
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Fitsum Tamene
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Luca Trotta
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Ekaterina Morgunova
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Kaarel Krjutškov
- Folkhälsan Institute of Genetics, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Competence Centre on Health Technologies, Tartu, Estonia
| | - Katariina Nurmi
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Eklund
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anssi Lagerstedt
- Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Merja Helminen
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Timi Martelius
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland; Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jussi Taipale
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Janna Saarela
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Juha Kere
- Folkhälsan Institute of Genetics, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.
| | - Markku Varjosalo
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Mikko Seppänen
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Rare Diseases Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Korppi M, Nuolivirta K, Lauhkonen E, Holster A, Teräsjärvi J, Vuononvirta J, Helminen M, He Q, Koponen P. IL-10 gene polymorphism is associated with preschool atopy and early-life recurrent wheezing after bronchiolitis in infancy. Pediatr Pulmonol 2017; 52:14-20. [PMID: 27228545 DOI: 10.1002/ppul.23489] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/30/2016] [Accepted: 05/06/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Variations in the genes that regulate innate immunity responses may be associated with susceptibility to asthma or atopy after early-life bronchiolitis. The aim of this study was to evaluate the association between four different polymorphisms of the IL-10 gene at rs1800871, rs1800872, rs1800890, and rs1800896, either alone or in combination, and post-bronchiolitis asthma or allergies at 5-7 years of age. METHODS Data on single nucleotide polymorphisms (SNP) of IL-10 rs1800896 (-1082G/A), rs1800871 (-819C/T), rs1800872 (-592C/A), and IL-10 rs1800890 (-3575T/A) were available for 135 children. Polymorphisms and their associations with asthma and allergies were studied in 135 preschool-aged children who had been hospitalized for bronchiolitis at age 0-6 months. Their parents were interviewed to record the children's history with asthma and allergies from infancy to the present. RESULTS At 6.4 years (mean), asthma was present in 17 children (12.6%), while recurrent wheezing during the first 7 years of life was present in 39 (28.9%) children. Fifty-three (39.3%) study participants had current atopy (atopic eczema or allergic rhinitis). Eight (72%) of 11 children with the IL-10 rs1800896, IL-10 rs1800871, and IL-10 rs1800872 combination AA + CT + CA had current atopy (P = 0.02 vs. 38% in other genotype combinations). Twenty-three (56%) children with the IL-10 rs1800871C/T or IL-10 rs1800872C/A genotype had present atopy versus 34 (38%) with other IL-10 genotypes (P = 0.03). Between 2 years and 3 years of age, 27% of ATA haplotype carriers had asthma versus 13.7% of other haplotype carriers (P = 0.02). CONCLUSIONS IL-10 polymorphisms at rs1800871, rs1800872, rs1800890, and rs1800896 seem to be associated with elevated allergies and/or recurrent wheezing risk in later childhood, after early-life bronchiolitis. Pediatr Pulmonol. 2017;52:14-20. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matti Korppi
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Kirsi Nuolivirta
- Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Annukka Holster
- Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
| | - Juho Vuononvirta
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
| | | | - Qiushui He
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland.,Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Turku, Finland
| | - Petri Koponen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Lauhkonen E, Koponen P, Nuolivirta K, Helminen M, Paassilta M, Toikka J, Korppi M. Following up infant bronchiolitis patients provided new evidence for and against the united airway disease hypothesis. Acta Paediatr 2016; 105:1355-1360. [PMID: 27472490 DOI: 10.1111/apa.13537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 01/18/2023]
Abstract
AIM The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months. METHODS This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test. RESULTS Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT. CONCLUSION This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis.
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Affiliation(s)
- Eero Lauhkonen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Petri Koponen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | | | - Merja Helminen
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | | | - Jyri Toikka
- Department of Clinical Physiology; Tampere University Hospital; Tampere Finland
- Department of Clinical Physiology; Turku University Hospital; Turku Finland
| | - Matti Korppi
- Tampere Center for Child Health Research; Tampere University and University Hospital; Tampere Finland
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Kääriäinen M, Kuuskeri M, Helminen M, Kuokkanen H. Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results. Scand J Surg 2016; 106:145-151. [PMID: 27528695 DOI: 10.1177/1457496916665542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. MATERIAL AND METHODS Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. RESULTS AND CONCLUSION Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.
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Affiliation(s)
- M Kääriäinen
- 1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
| | - M Kuuskeri
- 1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
| | - M Helminen
- 2 School of Health Sciences, University of Tampere and Science Centre, Pirkanmaa Hospital District, Finland
| | - H Kuokkanen
- 3 Division of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
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Nuolivirta K, Törmänen S, Teräsjärvi J, Vuononvirta J, Koponen P, Korppi M, Helminen M, Peltola V, He Q. Post-bronchiolitis wheezing is associated with toll-like receptor 9 rs187084 gene polymorphism. Sci Rep 2016; 6:31165. [PMID: 27498757 PMCID: PMC4976338 DOI: 10.1038/srep31165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/15/2016] [Indexed: 11/29/2022] Open
Abstract
Innate immunity receptors play a critical role in host defence, as well as in allergy and asthma. The aim of this exploratory study was to evaluate whether there are associations between TLR7 rs179008, TLR8 rs2407992, TLR9 rs187084 or TLR10 rs4129009 polymorphisms and viral findings, clinical characteristics or subsequent wheezing in infants with bronchiolitis. In all, 135 full-term infants were hospitalized for bronchiolitis at age less than 6 months: 129 of them were followed-up until the age of 1.5 years. The outcome measures were repeated wheezing, use of inhaled corticosteroids, atopic dermatitis during the first 1.5 years of life and total serum immunoglobulin E (IgE). There were no significant associations between the genotypes or allele frequencies of TLR7 rs179008, TLR8 rs2407992, TLR9 rs187084 or TLR10 rs4129009 polymorphisms and clinical characteristics or the severity of bronchiolitis during hospitalization. During follow-up, repeated wheezing was more common in children with TLR9 rs187084 variant genotype CC (30.5%) than in children with TLR9 wild-type genotype TT (12.2%) (p = 0.02, aOR 2.73, 95% CI 1.02–7.29). The TLR10 rs4129009 minor allele G was associated with elevated total serum IgE. TLR9 rs187084 gene polymorphism may be associated with post-bronchiolitis wheezing, and TLR10 rs4129009 gene polymorphism may be associated with atopy.
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Affiliation(s)
- Kirsi Nuolivirta
- Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sari Törmänen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - Juho Vuononvirta
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - Petri Koponen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Matti Korppi
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Merja Helminen
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Child and Youth Research Institute, University of Turku, Turku, Finland
| | - Qiushui He
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.,Department of Medical Microbiology, Capital Medical University, Beijing, China
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Kääriäinen M, Salonen K, Helminen M, Karhunen-Enckell U. Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results. Scand J Surg 2016; 106:74-79. [PMID: 27107053 DOI: 10.1177/1457496916645964] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Chest-wall contouring surgery is an important part of the gender reassignment process that contributes to strengthening the self-image and facilitating living in the new gender role. Here, we analyze the surgical techniques used in our clinic and report the results. MATERIAL AND METHODS Female-to-male transgender patients (n = 57) undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. Patient characteristics and data regarding the technique and postoperative results were collected and analyzed retrospectively. RESULTS In addition to the transgender diagnosis, 40.4% of the patients had another psychiatric diagnosis. For mastectomy, a concentric circular approach was used in 50.9% and a transverse incision approach in 49.1% of the patients. In the transverse incision group, 21.4% of the patients underwent pedicled mammaplasty and 78.6% mastectomy with a free nipple-areola complex graft. Compared with the transverse incision group, breasts were smaller (p < 0.001) and body mass index value was lower in the concentric circular group (p = 0.001). One-third of the patients had complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple-areola complex) and the reoperation rate was 8.8%. Hematoma was the most frequent reason for reoperation. Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. Secondary corrections were needed more often in the concentric circular (55.2%) than in the transverse incision group (25.0%; p = 0.031). CONCLUSIONS The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.
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Affiliation(s)
- M Kääriäinen
- 1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
| | - K Salonen
- 1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
| | - M Helminen
- 2 School of Health Sciences, University of Tampere and Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - U Karhunen-Enckell
- 1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
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Lohi O, Helminen M, Korppi M. Audits show that specialist paediatric training programmes are sensitive to medical, staffing and economic changes. Acta Paediatr 2016; 105:701-4. [PMID: 26776769 DOI: 10.1111/apa.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/14/2015] [Accepted: 01/11/2016] [Indexed: 11/26/2022]
Abstract
AIM In Finland, specialist paediatrics training is led by university hospitals, but half of it is carried out in regional central hospitals. We audited the training provided by four regional central hospitals in the tertiary care area covered by Tampere University Hospital, in 2003, 2008 and 2015. METHODS The audits comprised hospital visits and discussions with the chief doctor of the paediatric clinic, the trainees and the specialists who trained them. A modified version of the European Union of Medical Specialists 1997 protocol was used, and the key areas that performed poorly in the audits were followed up. RESULTS In 2008 and 2015, most of the key follow-up issues had improved, but two main areas in need of further development were identified in 2015. These were that educational objectives should be clarified, and their implementation systemically followed up, and that trainees should spend more time working in outpatient settings. CONCLUSION Since 2003, a marked improvement had taken place in the paediatric training provided by regional central hospitals, partly because of the increase in paediatric specialist resources. This study underlines the importance of repeat audits and the need for co-opera-tion between the university hospital and regional hospitals, including regular visits.
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Affiliation(s)
- Olli Lohi
- Tampere Center for Child Health Research; Tampere University Hospital; University of Tampere; Tampere Finland
| | - Merja Helminen
- Tampere Center for Child Health Research; Tampere University Hospital; University of Tampere; Tampere Finland
| | - Matti Korppi
- Tampere Center for Child Health Research; Tampere University Hospital; University of Tampere; Tampere Finland
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Abstract
BACKGROUND The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus (GAS) positive cases with penicillin. The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit. METHODS We analyzed retrospectively the data on microbiological studies and blood tests done, and data on prescribing of antibiotics, of 200 children admitted for febrile exudative tonsillitis. RESULTS After the clinical diagnosis of exudative tonsillitis, antigen test and/or culture for GAS identification was done in >95% of cases. All the 32 (16%) children with GAS infection, but also 52 (38%) of the 137 children without any evidence of bacterial infection received antibiotics. Additional laboratory studies were done in 96% of children. Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis. No serious bacterial infection was diagnosed. CONCLUSIONS The Finnish Current Care Guidelines lead to over-treatment with antibiotics. None of the 200 children returned after discharge, suggesting that undertreatment did not happen.
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Affiliation(s)
- Antti Kunnamo
- Pediatric Research Center, Tampere University and Univesity Hospital, Tampere, Finland
| | - Matti Korppi
- Pediatric Research Center, Tampere University and Univesity Hospital, Tampere, Finland.
| | - Merja Helminen
- Pediatric Research Center, Tampere University and Univesity Hospital, Tampere, Finland
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Lauhkonen E, Koponen P, Vuononvirta J, Teräsjärvi J, Nuolivirta K, Toikka JO, Helminen M, He Q, Korppi M. Gene Polymorphism of Toll-Like Receptors and Lung Function at Five to Seven Years of Age after Infant Bronchiolitis. PLoS One 2016; 11:e0146526. [PMID: 26741133 PMCID: PMC4704821 DOI: 10.1371/journal.pone.0146526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/19/2015] [Indexed: 11/19/2022] Open
Abstract
Aim Toll-like receptors (TLR) play a crucial role in innate immunity, protecting the host from pathogens such as viruses. Genetic variations in TLRs have been associated with the severity of viral bronchiolitis in infancy and with the later occurrence of post-bronchiolitis asthma. The aim of the present study was to evaluate if there are any exploratory associations between TLR gene polymorphisms and lung function at 5 to 7 years of age in former bronchiolitis patients. Methods We performed impulse oscillometry (IOS) at the median age of 6.3 years for 103 children who had been hospitalized for bronchiolitis at less than six months of age. The main parameters evaluated were airway resistance and reactance at 5Hz in baseline and post-exercise measurements. Data on single nucleotide polymorphisms (SNP) of TLR1 rs5743618, TLR2 rs5743708, TLR6 rs5743810 and TLR10 rs4129009 (TLR2 subfamily) and TLR3 rs3775291, TLR4 rs4986790, TLR7 rs179008, TLR8 rs2407992 and TLR 9 rs187084 were available for analyses. Results The TLR4 rs4986790 wild genotype A/A was associated with a greater Rrs5 response (0.72 vs. -0.42, p = 0.03) to exercise. In TLR6 rs5743810, the minor allele T was associated with greater Rrs5 response (0.80 vs. -0.03, p = 0.04) to exercise. In TLR7 rs179008, the major allele A was associated with baseline decline in dRrs/df (-1.03 vs 0.61, p = 0.01) and increased Fres (2.28 vs. 0.89, p = 0.01) in girls. Conclusion Among the nine studied TLRs, only TLR7 rs179008 showed some exploratory associations with post-bronchiolitis lung function deficiency, and polymorphisms of TLR4 rs4986790, and TLR6 rs5743810 in particular, with airway reactivity. These findings call for further confirmatory studies.
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Affiliation(s)
- Eero Lauhkonen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
- * E-mail:
| | - Petri Koponen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Juho Vuononvirta
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Turku, Finland
| | - Johanna Teräsjärvi
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Turku, Finland
| | | | - Jyri O. Toikka
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
- Department of Clinical Physiology, Turku University Hospital, Turku, Finland
| | - Merja Helminen
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Qiushui He
- Department of Medical Microbiology and Immunology, Turku University, Turku, Finland
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Turku, Finland
| | - Matti Korppi
- Tampere Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Niemi P, Numminen J, Rautiainen M, Helminen M, Vinkka-Puhakka H, Peltomäki T. The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection. Int J Pediatr Otorhinolaryngol 2015; 79:2115-9. [PMID: 26454528 DOI: 10.1016/j.ijporl.2015.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection. METHODS This prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3-5 events of middle ear infection during the last 6 months or 4-6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day. RESULTS No statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements. CONCLUSION Combining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.
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Affiliation(s)
- P Niemi
- Department of Maxillofacial Surgery and Oral Diseases, Satakunta Central Hospital, Pori, Finland
| | - J Numminen
- Department of Otorhinolaryngology, Tampere University Hospital, and University of Tampere, Finland
| | - M Rautiainen
- Department of Otorhinolaryngology, Tampere University Hospital, and University of Tampere, Finland
| | - M Helminen
- Science Centre, Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Finland
| | | | - T Peltomäki
- Field of Dentistry, University of Tampere, and Oral and Maxillofacial Unit, Tampere University Hospital, Finland.
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Hahtela N, Paavilainen E, McCormack B, Helminen M, Slater P, Suominen T. Nurses' perceptions of workplace culture in primary health care in Finland. Int Nurs Rev 2015. [DOI: 10.1111/inr.12207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Hahtela
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
| | - E. Paavilainen
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
| | - B. McCormack
- School of Health Sciences; Queen Margaret University; Edinburgh UK
| | - M. Helminen
- Science Centre; Pirkanmaa Hospital District and School of Health Sciences; University of Tampere; Tampere Finland
| | - P. Slater
- Institute of Nursing and Health Research; University of Ulster; Belfast UK
| | - T. Suominen
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
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Dobbs K, Domínguez Conde C, Zhang SY, Parolini S, Audry M, Chou J, Haapaniemi E, Keles S, Bilic I, Okada S, Massaad MJ, Rounioja S, Alwahadneh AM, Serwas NK, Capuder K, Ciftci E, Felgentreff K, Ohsumi TK, Pedergnana V, Boisson B, Haskoloğlu S, Ensari A, Schuster M, Moretta A, Itan Y, Patrizi O, Rozenberg F, Lebon P, Saarela J, Knip M, Petrovski S, Goldstein DB, Parrott RE, Savas B, Schambach A, Tabellini G, Bock C, Chatila T, Comeau AM, Geha RS, Abel L, Buckley RH, Ikincioğullari A, Al-Herz W, Helminen M, Doğu F, Casanova JL, Boztuğ K, Notarangelo LD. Inherited DOCK2 Deficiency in Patients with Early-Onset Invasive Infections. N Engl J Med 2015; 372:2409-22. [PMID: 26083206 PMCID: PMC4480434 DOI: 10.1056/nejmoa1413462] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which the T cells that are present are quantitatively or functionally deficient. Impaired humoral immunity is also common. Patients have severe infections, autoimmunity, or both. The specific molecular, cellular, and clinical features of many types of combined immunodeficiencies remain unknown. Methods We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)-cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement. Results We identified biallelic mutations in the dedicator of cytokinesis 2 gene (DOCK2) in these five patients. RAC1 activation was impaired in the T cells. Chemokine-induced migration and actin polymerization were defective in the T cells, B cells, and NK cells. NK-cell degranulation was also affected. Interferon-α and interferon-λ production by peripheral-blood mononuclear cells was diminished after viral infection. Moreover, in DOCK2-deficient fibroblasts, viral replication was increased and virus-induced cell death was enhanced; these conditions were normalized by treatment with interferon alfa-2b or after expression of wild-type DOCK2. Conclusions Autosomal recessive DOCK2 deficiency is a new mendelian disorder with pleiotropic defects of hematopoietic and nonhematopoietic immunity. Children with clinical features of combined immunodeficiencies, especially with early-onset, invasive infections, may have this condition. (Supported by the National Institutes of Health and others.).
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Pekkarinen PT, Heikkilä N, Kisand K, Peterson P, Botto M, Daha MR, Drouet C, Isaac L, Helminen M, Haahtela T, Meri S, Jarva H, Arstila TP. Dysregulation of adaptive immune responses in complement C3-deficient patients. Eur J Immunol 2015; 45:915-21. [PMID: 25446578 DOI: 10.1002/eji.201444948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/21/2014] [Accepted: 11/26/2014] [Indexed: 11/07/2022]
Abstract
In addition to its effector functions, complement is an important regulator of adaptive immune responses. Murine studies suggest that complement modulates helper T-cell differentiation, and Th1 responses in particular are impaired in the absence of functional complement. Here, we have studied humoral responses to toxoid vaccines in eight patients with C3 deficiency, representing more than 25% of all the known patients worldwide. Serum cytokine levels were also studied. The patients developed normal Ig responses to tetanus and diphtheria toxoids, but IgE levels were low. The pattern of antigen-specific IgG subclasses was abnormal, with increased Th1-related IgG3 responses, low IgG2, and almost completely undetectable IgG4. The patients also had increased amounts of Th1-related cytokines IL-12p70 and IL-21, and these showed a positive correlation with IgG3 levels. Our results confirm that complement modulates Th differentiation, but reveal a more nuanced outcome than previously reported. Since IgG4 has been linked to tolerogenic responses, the data also suggest that in the absence of functional complement at least some aspects of systemic tolerance are impaired.
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Affiliation(s)
- Pirkka T Pekkarinen
- Haartman Institute and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
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Kelkka T, Kienhöfer D, Hoffmann M, Linja M, Wing K, Sareila O, Hultqvist M, Laajala E, Chen Z, Vasconcelos J, Neves E, Guedes M, Marques L, Krönke G, Helminen M, Kainulainen L, Olofsson P, Jalkanen S, Lahesmaa R, Souto-Carneiro MM, Holmdahl R. Reactive oxygen species deficiency induces autoimmunity with type 1 interferon signature. Antioxid Redox Signal 2014; 21:2231-45. [PMID: 24787605 PMCID: PMC4224049 DOI: 10.1089/ars.2013.5828] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in the phagocyte reactive oxygen species (ROS)-producing NOX2 enzyme complex and characterized by recurrent infections associated with hyperinflammatory and autoimmune manifestations. A translational, comparative analysis of CGD patients and the corresponding ROS-deficient Ncf1(m1J) mutated mouse model was performed to reveal the molecular pathways operating in NOX2 complex deficient inflammation. RESULTS A prominent type I interferon (IFN) response signature that was accompanied by elevated autoantibody levels was identified in both mice and humans lacking functional NOX2 complex. To further underline the systemic lupus erythematosus (SLE)-related autoimmune process, we show that naïve Ncf1(m1J) mutated mice, similar to SLE patients, suffer from inflammatory kidney disease with IgG and C3 deposits in the glomeruli. Expression analysis of germ-free Ncf1(m1J) mutated mice reproduced the type I IFN signature, enabling us to conclude that the upregulated signaling pathway is of endogenous origin. INNOVATION Our findings link the previously unexplained connection between ROS deficiency and increased susceptibility to autoimmunity by the discovery that activation of IFN signaling is a major pathway downstream of a deficient NOX2 complex in both mice and humans. CONCLUSION We conclude that the lack of phagocyte-derived oxidative burst is associated with spontaneous autoimmunity and linked with type I IFN signature in both mice and humans.
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Affiliation(s)
- Tiina Kelkka
- 1 Medicity Research Laboratory, University of Turku , Turku, Finland
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Kokko E, Korppi M, Helminen M, Hutri-Kähönen N. Rapid C-reactive protein and white cell tests decrease cost and shorten emergency visits. Pediatr Int 2014; 56:698-701. [PMID: 24689910 DOI: 10.1111/ped.12353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevated white blood cells (WBC) in blood and C-reactive protein (CRP) in serum are often used as non-specific markers for bacterial etiology of infection in children. The aim of the present study was to evaluate how rapid WBC and CRP testing influences patient flow and cost in the pediatric emergency room (ER). METHODS This study was a retrospective chart review. In all, 166 children who were treated during 3 months in the ER of a children's hospital, and in whom rapid tests for WBC and CRP were done, were included. The association between rapid testing and length of ER stay was evaluated, and the cost of rapid tests was compared with the corresponding cost if done in the hospital laboratory. RESULTS Median ER stay was 147.5 min, if no examinations other than rapid CRP and WBC tests were done and if no emergency treatment was given, compared with 201.5 min for laboratory tests or emergency treatment given (P < 0.001). The respective figures were 142.5 min and 179.5 min in those 96 children discharged home (P = 0.003). The cost of rapid testing was only 41.5% of the corresponding laboratory cost. CONCLUSION The simultaneous rapid testing of CRP and WBC in children with presumable infection decreased cost and shortened the length of ER stay, if no other examinations or emergency treatment were needed. The cost of rapid testing was less than half of the corresponding cost in laboratory.
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Affiliation(s)
- Eeva Kokko
- Tampere Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Toode K, Routasalo P, Helminen M, Suominen T. Hospital nurses' individual priorities, internal psychological states and work motivation. Int Nurs Rev 2014; 61:361-70. [DOI: 10.1111/inr.12122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Toode
- School of Health Sciences; University of Tampere; Tampere Finland
- Oncology and Haematology Clinic; North Estonia Medical Centre; Tallinn Estonia
| | | | - M. Helminen
- School of Health Sciences; University of Tampere; Tampere Finland
- Science Centre; Pirkanmaa Hospital District; Tampere Finland
| | - T. Suominen
- School of Health Sciences; University of Tampere; Tampere Finland
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Koponen P, Nuolivirta K, Virta M, Helminen M, Hurme M, Korppi M. Polymorphism of the rs1800896 IL10 promoter gene protects children from post-bronchiolitis asthma. Pediatr Pulmonol 2014; 49:800-6. [PMID: 24167151 DOI: 10.1002/ppul.22909] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/13/2013] [Indexed: 11/10/2022]
Abstract
Viral bronchiolitis is a major cause of hospitalization in infancy, with increased asthma risk in later childhood. However, the principal mechanisms behind post-bronchiolitic asthma have remained unclear. Previously, different cytokine polymorphisms have been associated with asthma occurrence, but no previous follow-up study has investigated cytokine polymorphisms in relation to post-bronchiolitic asthma. We hypothesized that former bronchiolitis patients with cytokine gene variants associating with Th2 cell up-regulation are at asthma risk at preschool age. Our emphasis was in IL10 rs1800896, since IL-10 has an important role in immune tolerance, and lower production of IL-10 has been associated with Th2-type immunology, and accordingly, with increased asthma risk. IL10 rs1800896, IFNG rs2430561, and IL18 rs1872387 polymorphims and their associations with asthma and allergy were studied in 135 preschool-aged children hospitalized for bronchiolitis at age 0-6 months. Parents were interviewed to record asthma and allergy from infancy to present. At age 6.4 years (mean), asthma was present in 17(12.6%), atopic eczema in 47(34.8%) and allergic rhinitis in 36(26.7%) children. IL10 rs1800896 SNP associated significantly with asthma; only 1/32 (3.1%) of those with G/G genotype had asthma (P = 0.04). In logistic regression adjusted for gender, age and atopy, the carriage of allele A (rs1800896) was a significant risk factor for preschool asthma. IFNG rs2430561 or IL18 rs1872387 SNP's had no associations with asthma or allergy. In conclusion, IL10 rs1800896 SNP was significantly associated with preschool asthma after severe lower respiratory tract infection in early infancy.
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Affiliation(s)
- Petri Koponen
- Pediatric Research Centre, Tampere University and University Hospital, Tampere, Finland
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Nuolivirta K, Vuononvirta J, Peltola V, Koponen P, Helminen M, He Q, Korppi M. Toll-like receptor 2 subfamily genotypes are not associated with severity of bronchiolitis or postbronchiolitis wheezing in infants. Acta Paediatr 2013; 102:1160-4. [PMID: 24112285 DOI: 10.1111/apa.12425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/23/2013] [Accepted: 09/19/2013] [Indexed: 02/04/2023]
Abstract
AIM Expression of toll-like receptor (TLR) 2 subfamily genes, including genes encoding TLR1, TLR2, TLR6 and TLR10, have been connected to allergy and asthma. This controlled study investigated the association of TLR1, TLR2 and TLR6 gene polymorphisms with clinical characteristics and subsequent wheezing in young infants with bronchiolitis. METHODS In all, 129 full-term infants hospitalised for bronchiolitis at the age of <6 months were clinically followed up until a mean age of 18 months. Genotyping of the TLR1 T1805G, TLR2 G2258A and TLR6 C745T polymorphisms was carried out by pyrosequencing and in 318 healthy, Finnish controls. RESULTS There were no significant associations between TLR1, TLR2 or TLR6 genotypes and severity of bronchiolitis or risk of postbronchiolitis wheezing. TLR6 polymorphism was associated with allergy in univariate analyses. Minor allele frequency (MAF) in the TLR1 gene (17%) in the hospitalised children was similar to our Finnish controls, but different to European controls from other studies. MAF in the TLR6 gene was 50% versus 41% in both the Finnish and European controls. MAF in the TLR2 gene was low (3%) in study subjects and in both controls. CONCLUSION TLR2 subfamily gene polymorphisms were not associated with severity of bronchiolitis or risk of postbronchiolitis wheezing.
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Affiliation(s)
| | - Juho Vuononvirta
- Department of Infectious Disease Surveillance and Control; National Institute for Health and Welfare; Turku Finland
| | - Ville Peltola
- Department of Paediatrics; Turku University Hospital; Turku Finland
- Turku Institute for Child and Youth Research; University of Turku; Turku Finland
| | - Petri Koponen
- Paediatric Research Centre; Tampere University and University Hospital; Tampere Finland
| | - Merja Helminen
- Paediatric Research Centre; Tampere University and University Hospital; Tampere Finland
| | - Qiushui He
- Department of Infectious Disease Surveillance and Control; National Institute for Health and Welfare; Turku Finland
| | - Matti Korppi
- Paediatric Research Centre; Tampere University and University Hospital; Tampere Finland
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Ruuskanen O, Nurkka A, Helminen M, Viljanen MK, Käyhty H, Kainulainen L. Specific antibody deficiency in children with recurrent respiratory infections: a controlled study with follow-up. Clin Exp Immunol 2013; 172:238-44. [PMID: 23574320 DOI: 10.1111/cei.12053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/30/2022] Open
Abstract
Specific antibody deficiency (SAD) to unconjugated pneumococcal vaccine (PPV) is an established primary B cell immunodeficiency. The occurrence and natural history of SAD in children is unclear. We conducted an observational study to identify SAD in children with recurrent respiratory infections. Ninety-nine children, mean age 5·9 (range 2-16) years, with recurrent or severe infections were vaccinated with PPV; serum antibody concentrations for serotypes 4, 6B, 9V, 14, 18C, 19F and 23F were measured before and 2 weeks after vaccination with enzyme immunoassay. The retrospective control group consisted of 89 healthy children matched for age and gender. No children had received previous conjugated pneumococcal vaccine (PCV) or PPV. The structured history of infectious diseases of all participants was collected. Ten of 91 (11%) children (eight excluded due to immunoglobulin G subclass deficiency) with recurrent respiratory infections had SAD. In the control group, three children (3%) responded inadequately to PPV (P = 0·05). Most children with SAD also had many other minor immune defects. After 0·5-5 years (medium 3·8), eight children with SAD were revaccinated with PPV; five responded adequately and three inadequately. Two SAD children were revaccinated with PCV, one developed an adequate and one an inadequate response. Two children with SAD received treatment with intravenous immunoglobulin; the remaining eight children recovered without replacement therapy during the follow-up. SAD is common in young children with recurrent respiratory infections, but it is often transient and resolves itself within a few years without specific treatment.
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Affiliation(s)
- O Ruuskanen
- Department of Paediatrics, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland.
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Pekkarinen PT, Vaali K, Jarva H, Kekäläinen E, Hetemäki I, Junnikkala S, Helminen M, Vaarala O, Meri S, Arstila TP. Impaired intestinal tolerance in the absence of a functional complement system. J Allergy Clin Immunol 2013; 131:1167-75. [DOI: 10.1016/j.jaci.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Mannose-binding lectin (MBL) is a component of innate immunity and has been linked with the pathogenesis of asthma. The aim of the present study was to evaluate the association of MBL genotypes with preschool asthma and allergy in children with bronchiolitis in early infancy. METHODS In all, 205 infants were hospitalized for bronchiolitis at <6 months of age. Asthma and allergy were studied from a total of 166 children at 6.4 years (mean). A total of 141 (85%) frozen whole blood samples were available for MBL genotyping and MBL2 gene mutations were determined on pyrosequencing for detection of three single-nucleotide polymorphisms. RESULTS Ninety-five children (67.4%) had the wild-type MBL genotype A/A and 46 had A/O or O/O genotypes. Asthma was present in 16 children (11.3%) at 5-7 years of age. Nine children (19.6%) with non-AA genotype had asthma (vs 7.4% of those with genotype AA, P= 0.03). The result remained significant after adjustment for age, gender and atopy. There were no significant associations between MBL genotypes and asthma at any age before the study. Atopic dermatitis, allergic rhinitis or paternal and/or maternal asthma had no significant associations with MBL genotypes. CONCLUSIONS The variant non-A/A MBL genotype is associated with asthma after bronchiolitis in infancy, but not earlier than at 5-7 years of age.
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Affiliation(s)
- Petri Koponen
- Paediatric Research Centre, Tampere University and University Hospital, Tampere, Finland.
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Nuolivirta K, He Q, Gröndahl-Yli-Hannuksela K, Koponen P, Korppi M, Helminen M. Mannose-binding lectin gene polymorphisms in infants with bronchiolitis and post-bronchiolitis wheezing. Allergol Int 2012; 61:305-9. [PMID: 22441636 DOI: 10.2332/allergolint.11-oa-0385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/05/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mannose-binding lectin (MBL) encoded by the MBL2 gene, is an important component of the innate immunity. Low levels have been linked with respiratory infections and both high and low levels with allergy and asthma. The aims of the study were to evaluate the connection between polymorphisms of the MBL2 gene and viral findings, clinical characteristics and subsequent wheezing in young infants with bronchiolitis. METHODS In all, 129 full-term infants hospitalized for bronchiolitis at age less than 6 months have been followed-up until the mean age of 1.5 years. The genotyping of the MBL2 gene mutations was made by pyrosequencing for a simultaneous detection of three single nucleotide polymorphisms (SNP). RESULTS The MBL genotypes or allele frequencies had no significant associations with clinical characteristics of bronchiolitis. The 41 children with variant genotypes were more often infected by multiple viruses (21.9%, p = 0.047) than children with wild-type A/A genotypes (9.1%). In addition, more children with variant genotypes (31.7%, p = 0.016) had used corticosteroids because of post-bronchiolitis wheezing, compared to those with wild-type A/A genotypes (13.6%). No other significant associations with viral findings or post-bronchiolitis outcomes were found. CONCLUSIONS Preliminary evidence was found that the variant non-A/A genotypes may be associated with susceptibility to multiple viral infections and more severe post-bronchiolitis wheezing requiring treatment with corticosteroids.
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Abstract
Properdin deficiency is a rare immunological disorder inherited as an X-chromosomal recessive trait. Properdin deficiency poses a significant risk for severe meningococcal infections. About 20 mutations have been reported to underlie properdin deficiency. Here we report a large Finnish family with a novel mutation in the properdin gene (CFP). Based on the total absence of properdin activity in a 14-year-old male patient with an infection resembling meningococcal bacteraemia, the coding region and splice sites of the gene were sequenced. The mutation is located in exon 9 and changes guanine to adenine at nucleotide 1164 (c.1164G>A) that causes tryptophan to change to a premature stop codon (W388X). The mother of the patient was shown to be a carrier of the mutation. In total, the mutation was identified in six females and three young males in the family. The mutation must be inherited from the grandfather who had died of an unknown infectious disease. This is the first mutation of the properdin gene identified in Finland.
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Affiliation(s)
- M Helminen
- Department of Pediatrics, Tampere University Hospital, University of Tampere, Tampere, Finland.
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Abstract
AIM Low birth weight, high birth weight and excessive weight gain after birth may be risk factors for asthma in childhood, but their associations with wheezing in early childhood are poorly studied. The aim of the study was to evaluate birth weight, weight gain in early infancy and overweight in infancy assessed by weight for length (WFL) as risk factors for wheezing after hospitalization for bronchiolitis in early infancy. METHODS In all, 127 full-term infants hospitalized for bronchiolitis at age <6 months have been followed up until the mean age of 1.5 years. The weights and lengths of the infants were measured on admission to hospital and at the control visit. Birth weights were obtained from the hospital records. RESULTS Both occurrence and recurrence of post-bronchiolitis wheezing were associated with birth weight >4000 g and the recurrence of post-bronchiolitis wheezing with WFL >110% at age 1.5 years. The associations were robust to adjustments with gender and allergy. Higher weight gain from birth to hospitalization at age <6 months was associated with wheezing in the subgroup of children with birth weight >4000 g. CONCLUSION High birth weight and the development of overweight may be associated with post-bronchiolitis wheezing in infancy.
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Salo J, Uhari M, Helminen M, Korppi M, Nieminen T, Pokka T, Kontiokari T. Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial. Clin Infect Dis 2011; 54:340-6. [PMID: 22100577 DOI: 10.1093/cid/cir801] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cranberry juice prevents recurrences of urinary tract infections (UTIs) in adult women. The objective of this study was to evaluate whether cranberry juice is effective in preventing UTI recurrences in children. METHODS A double-blind randomized placebo-controlled trial was performed in 7 hospitals in Finland. A total of 263 children treated for UTI were randomized to receive either cranberry juice (n = 129) or placebo (n = 134) for 6 months. Eight children were omitted because of protocol violations, leaving 255 children for the final analyses. The children were monitored for 1 year, and their recurrent UTIs were recorded. RESULTS Twenty children (16%) in the cranberry group and 28 (22%) in the placebo group had at least 1 recurrent UTI (difference, -6%; 95% confidence interval [CI], -16 to 4%; P = .21). There were no differences in timing between these first recurrences (P = .32). Episodes of UTI totaled 27 and 47 in the cranberry and placebo groups, respectively, and the UTI incidence density per person-year at risk was 0.16 episodes lower in the cranberry group (95% CI, -.31 to -.01; P = .035). The children in the cranberry group had significantly fewer days on antimicrobials (-6 days per patient-year; 95% CI, -7 to -5; P < .001). CONCLUSIONS The intervention did not significantly reduce the number of children who experienced a recurrence of UTI, but it was effective in reducing the actual number of recurrences and related antimicrobial use.
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Affiliation(s)
- Jarmo Salo
- Department of Paediatrics, Oulu University Hospital, University of Oulu, Finland.
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Abstract
Asthma risk is lower after wheezing associated with respiratory syncytial virus (RSV) than with non-RSV infection in infancy. RSV is the main wheezing-associated virus in infants aged <6 months. We evaluated the outcome of children hospitalised for bronchiolitis at <6 months of age, with special focus on viral aetiology and early risk factors. Out of 205 infants hospitalised for bronchiolitis at <6 months of age, 127 (62%) attended a control visit at a mean age of 6.5 yrs and the parents of an additional 39 children were interviewed by telephone. Thus, follow-up data collected by identical structured questionnaires were available from 166 (81%) children. Viral aetiology of bronchiolitis, studied on admission by antigen detection or PCR, was demonstrable in 97% of cases. Current asthma was present in 21 (12.7%) children: 8.2% in the 110 former RSV patients versus 24% in non-RSV patients (p=0.01). 45 (27%) children had ever had asthma. In adjusted analyses, atopic dermatitis, non-RSV bronchiolitis and maternal asthma were independently significant early-life risk factors for asthma. The risk of asthma was lower after RSV bronchiolitis than after bronchiolitis caused by other viruses in children hospitalised at <6 months of age.
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Affiliation(s)
- P Koponen
- Paediatric Research Centre, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland.
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