Exceeded Reference Values Research Articles

Immune status in bronchopulmonary dysplasia

Aim. To study cell-mediated and humoral immunity in bronchopulmonary dysplasia in children.Methods. The inpatient and outpatient medical records of 103 children from the 1st day of life up to 3 years of age: 58 boys and 45 girls, were analyzed. T-lymphocytes helper and suppressor activity markers, the immunoregulatory index, B-lymphocytes markers, concentration of the three main immunoglobulins classes, pro- and anti-inflammatory interleukins, circulating immune complexes were determined.Results.. The helper activity in exacerbation phase was at the lower limit of normal (42.1±0.9) and significantly increased in remission phase (52.6±0.8), without exceeding the reference values. CD8 lymphocytes percentage in the blood remained within the reference ranges both in exacerbation of inflammation and in remission phase. Immunoregulatory index was above normal both in the exacerbation and in the remission phases, reducing in remission phase. Pro-inflammatory interleukin-4 concentration in the exacerbation period exceeded reference values by 1.5 times and amounted to 21.0±0.6 pg/ml. In the remission phase its normalization (11.1±0.4 pg/ml) appeared. Interleukin-8 and interferon-γ levels in the exacerbation stage were significantly higher than normal and amounted to 70.3±1.2 and 15.1±0.4 pg/ml, respectively. The tumor necrosis factor concentration was at the upper limit of normal (19.54±0.29 pg/ml). The humoral immune response was characterized by a slight decrease in the immunoglobulin A level, some increase in immunoglobulin G and a significant increase in the circulating immune complexes concentration (109.5±6.6 units) in the exacerbation phase.Conclusion. Pronounced immunosuppression is uncharacteristic for bronchopulmonary dysplasia; identified changes are an adequate immune response to viral and bacterial infection in the acute phase of disease.

The Monocyte-to-Lymphocyte Ratio Correlates with Psycho-Neuro-Inflammatory Factors in Patients with Stable Coronary Artery Disease

Background: Psychosocial stress and depression have been recognized as major risk factors of coronary artery disease (CAD). Although monocytes are known to be key players in atherosclerosis, monocyte-based associations with psychoneuroendocrino-immuno-inflammatory (PNI) markers have not been widely investigated in stable CAD. Objective: We examined associations between the monocyte-to-lymphocyte ratio (MLR) and key PNI markers in stable CAD. Methods: We studied 23 patients with stable CAD who completed the Beck Depression Inventory (BDI) and Rahe's Brief Stress and Coping Inventory. A white blood cell differential was performed, and levels of cortisol, chromogranin A (CgA), LL-37, interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed in plasma. Results: Monocyte fraction, MLR and plasma CgA levels exceeded reference values, the social support score was low, and 7 patients had elevated BDI scores. In the multivariate-adjusted analysis, a higher MLR was associated with greater depressive symptom severity (r = 0.624, p < 0.01) as well as with higher concentrations of CgA (r = 0.660, p < 0.01), LL-37 (r = 0.643, p < 0.01), IL-6 (r = 0.532, p < 0.05) and CRP (r = 0.470, p < 0.05). BDI scores associated with CgA concentration (r = 0.618, p < 0.01) and CgA level correlated negatively with the social support score (r = -0.511, p < 0.05). Conclusions: Our findings suggest that, in patients with stable CAD, elevated MLR may be associated with depressive symptoms, with increased neuroendocrine-sympathetic activity (marked by CgA) and inflammatory markers that are pertinent to atherosclerosis initiation and progression. The increased neuroendocrine-sympathetic activity correlated with low social support and depressive symptom severity. The MLR might serve as an easy-to-obtain and inexpensive proxy measure of an activated PNI network in stable CAD.

Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study.

Timeliness may influence emotional distress during the diagnostic phase of suspected lung cancer patients. We performed a prospective observational study to compare distress and quality of life (QoL) in two medical centres with a Rapid Outpatient Diagnostic Program (RODP) and two using conventional Stepwise Diagnostic Approach (SDA) on the basis of trained nurse-led care. Outpatients with radiological suspicion of lung cancer completed the Hospital Anxiety and Depression Scale (HADS), European Organization for Research and Treatment of Cancer 30-item Quality of Life Questionnaire (QLQ-C30) and its 13-item Lung Cancer specific module (QLQ-LC13) upon first visit, 2 days later, thereafter weekly for 5 weeks and after 3 months. The 72 SDA patients and 121 RODP patients had a mean pre-diagnostic HADS-total score of 13.5 (SD 7.6); 63.4% had a score ≥10. Baseline QLQ-C30 global QoL was 61.6 (SD 22.7) exceeding reference values for lung cancer patients. Generalized least square models showed a significant centre by time interaction effect: during the first 6 weeks, HADS-total scores decreased in RODP patients (13.8-11.9) but sustained in SDA patients (13.1-13.6), whereas QoL showed no relevant changes. Times to diagnosis and discussion of therapy plan for RODP patients were 7 and 11 days shorter, respectively. Suspected lung cancer patients had high baseline distress levels. A decrease over time was found in RODP compared with SDA patients. QoL did not change relevantly. Albeit observational, these data indicate that patients experience less distress in rapid diagnostic programs than in stepwise diagnostic evaluation.

Evaluation of a novel secondary check tool for intensity‐modulated radiotherapy treatment planning

The purpose of this study was to assess the accuracy and efficacy of an automated treatment plan verification, or “secondary check”, tool (Mobius3D), which uses a reference dataset to perform an independent three‐dimensional dose verification of the treatment planning system (TPS) dose calculation and assesses plan quality by comparing dose‐volume histograms to reference benchmarks. The accuracy of the Mobius3D (M3D) system was evaluated by comparing dose calculations from IMRT and VMAT plans with measurements in phantom geometries and with TPS calculated dose distributions in prostate, lung, and head and neck patients (ten each). For the patient cases, instances of DVH limits exceeding reference values were also recorded. M3D showed agreement with measured point and planar doses that was comparable to the TPS in phantom geometries. No statistically significant differences (p<0.05) were noted. M3D dose distributions from VMAT plans in patient cases were in good agreement with the TPS, with an average of 99.5% of dose points showing γ5%,3mm<1. The M3D system also identified several plans that had exceeded dose‐volume limits specified by RTOG protocols for those sites. The M3D system showed dosimetric accuracy comparable with the TPS, and identified several plans that exceeded dosimetric benchmarks. The M3D system possesses the potential to enhance the current treatment plan verification paradigm and improve safety in the clinical treatment planning and review process.PACS number: 87.55.D‐, 87.55.km, 87.55.Qr,

Biological Air Contamination in Elderly Care Centers: Geria Project

Indoor air quality (IAQ) affects health particularly in susceptible individuals such as the elderly. It has been estimated that the older population spends approximately 19–20 h/d indoors, and the majority of the elderly spend all of their time indoors in elderly care centers (ECC). Older individuals may be particularly at risk of exposure to detrimental effects from pollutants, even at low concentrations, due to common and multiple underlying chronic diseases that increase susceptibility. This study, aimed to assess the impact of indoor biological agents in 22 ECC located in Porto, was conducted during summer and winter from November 2011 to August 2013 at a total of 141 areas within dining rooms, drawing rooms, medical offices, and bedrooms (including the bedridden). Air sampling was carried out with a microbiological air sampler (Merck MAS-100) and using tryptic soy agar for bacteria and malt extract agar for fungi. The results obtained were compared with the recently revised Portuguese standards. In winter, mean fungi concentration exceeded reference values, while bacteria concentrations were within the new standards in both seasons. The main fungi species found indoors were Cladosporium (73%) in summer and Penicillium (67%) in winter. Aspergillus fumigatus, Aspergillus niger, and Aspergillus flavus, known potential pathogenic/toxigenic species, were also identified. Although the overall rate and mean values of bacteria and fungi found in ECC indoor air met Portuguese legislation, some concern is raised by the presence of pathogenic microorganisms. Simple measures, like opening windows and doors to promote air exchange and renewal, may improve effectiveness in enhancing IAQ.

Health and Aquatic Environment Assessment of Captive Central American River Turtles,Dermatemys mawii,at Two Farms in Tabasco, Mexico

Abstract Health evaluations were conducted in 2 captive colonies of Central American river turtles, Dermatemys mawii, from sites in Tabasco, Mexico: Government of the State of Tabasco's turtle farm (GOV) and Arroyo Tabasquillo turtle farm (TAB). Health assessments were conducted in February, May, and August. Each assessment included a group clinical history, physical examinations, serum biochemistry panels, and bacteriological analyses. Additionally, water quality of turtle ponds was analyzed monthly at each site. High frequency of shell lesions and other clinical signs related to a harmful aquatic environment were found at both farms. Serum biochemistry results include levels of urea in both farms that repeatedly exceeded reference values for this species and values greater than normal for total protein, uric acid, and triglycerides at TAB. Bacteriological results showed potentially pathogenic microorganisms in lesions, including Staphylococcus aureus, Escherichia coli, Proteus vulgaris, Serratia spp., K...

Mercury loads into the sea associated with extreme flood

Floods are an important factor determining riverine pollution loads, including toxic mercury (Hg). The impact of the Vistula River flood in 2010, which was the biggest one recorded in 160 years and its influence on marine environment was studied. Mercury concentration was analyzed in river and sea water, suspended matter, phytoplankton and sea surface sediment. Flood and gulf water contained several times higher concentration of Hg (exceeded reference values safe for aquatic organisms) than before or after the flood. In 2010 the Vistula introduced into the Baltic ca. 1576 kg of Hg, of which 75% can be attributed to the flood water. Increase of water temperature, decrease of oxygen content contended increasing of dissolved mercury concentration, which was transported far into the Baltic. This phenomenon led to an increase of Hg concentration in phytoplankton and during many months in surface sediments. It is a potential threat to marine organisms.

Comparison of Insulin and Glucose Metabolism in Horses with Pituitary Pars Intermedia Dysfunction Treated Versus Not Treated with Pergolide

Equine pituitary pars intermedia dysfunction (PPID) is known to alter glucose/insulin metabolism. This study evaluated changes in parameters relating to glucose/insulin metabolism and determined whether there is a difference between pergolide-treated and untreated animals. We hypothesized that glucose/insulin dynamics in PPID horses receiving pergolide would be different than those in untreated horses. A total of 38 horses with diagnoses of PPID were included in the study (average age: 24 years). A total of 25 horses were untreated; 13 horses were treated with pergolide (>3 months). Parameters relating to glucose/insulin metabolism were determined in all horses, as follows: adrenocorticotropin-releasing hormone (ACTH), insulin, fructosamine, triglyceride, glucose, modified insulin-to-glucose ratio (MIRG), and reciprocal of the square root of insulin (RISQI). A combined glucose-insulin test (CGIT) was performed in 23 horses as not all owners agreed to the testing. Treated animals showed a tendency to have lower ACTH, but results were not significant. All animals had fructosamine levels exceeding reference values (mean value 314 ± 32 μmol/L; reference range: <280 μmol/L). There were no statistically significant differences between insulin, glucose, ACTH, triglycerides concentrations, RISQI/MIRG calculations, and CGIT results of pergolide-treated PPID and those of untreated horses. Five horses (13.2%) had combined hyperglycemia/hyperinsulinemia, whereas 7 horses (18.4%) displayed hyperglycemia, and 3 horses (7.9%) showed hyperinsulinemia alone. Forty percent of the horses with altered glucose/insulin metabolism were treated with pergolide. Based on RISQI and MIRG calculations, 19 animals displayed changes in glucose/insulin metabolism. Fourteen of twenty-three horses (61%) showed signs of insulin resistance in CGIT results. In conclusion, PPID horses frequently show alterations in glucose/insulin metabolism, but no significant differences were found between treated and untreated animals. Changes in insulin/glucose dynamics may not be a useful indicator of response to pergolide treatment.

Brain Hypothermic Therapy Dramatically Decreases Elevated Blood Concentrations of High Mobility Group Box 1 in Neonates with Hypoxic-Ischemic Encephalopathy

Background. According to the Consensus 2010 of the International Liaison Committee on Resuscitation (ILCOR), children with moderate to severe hypoxic-ischemic encephalopathy (HIE) should receive brain hypothermic therapy (BHT) after successful resuscitation. Elevated high mobility group box 1 (HMGB1) in the blood at the early stage of brain ischemia-reperfusion injury has been suggested to be involved in the release of various inflammatory cytokines. Methods. In total, 21 neonates plasma HMGB1 concentration was measured. These neonates included 8 with HIE in whom BHT was indicated, 5 controls diagnosed as having HIE but who were not suitable candidates for BHT, and 8 normal controls. Results. The umbilical artery HMGB1 (UA-HMGB1) level before undergoing BHT significantly exceeded reference values. The UA-HMGB1 level in the BHT (−) group did not differ significantly from reference values, but was significantly increased 24 hours after birth. Repeated measure ANOVA showed a significant difference in time course changes between the BHT (+) and BHT (−) groups (P = 0.0002). Conclusions. This study demonstrated hypothermic therapy to significantly decrease HMGB1. Furthermore, HMGB1 is a useful index of the inhibition of early stage inflammation.

Myopathy Associated with Congenital Fibre Type Disproportion in a Young Dog

A 4-month-old, female collie-cross dog was presented for evaluation of slowly progressive weakness, exercise intolerance and muscle atrophy. Neurological examination and electrodiagnostic testing were consistent with a generalized myopathy or, less likely, an axonal polyneuropathy. Muscle biopsy samples revealed marked variability in myofibre size with scattered or clustered atrophic or hypotrophic type 1 fibres. Type 1 fibres were 65% smaller than type 2A fibres and the percentage of type 1 fibres exceeded reference values for both limb muscles examined. On the basis of the clinical evaluation, pathological changes and the absence of another defined congenital or acquired myopathy, a diagnosis of a myopathy associated with congenital fibre type disproportion was made. Three months later the animal was humanely euthanized because of worsening clinical signs.

Comparison of four ventilatory protocols for computed tomography of the thorax in healthy cats

To identify ventilatory protocols that yielded good image quality for thoracic CT and hemodynamic stability in cats. Animals-7 healthy cats. Cats were anesthetized and ventilated via 4 randomized protocols (hyperventilation, 20 seconds [protocol 1]; single deep inspiration, positive inspiratory pressure of 15 cm H(2)O [protocol 2]; recruitment maneuver [protocol 3]; and hyperventilation, 20 seconds with a positive end-expiratory pressure of 5 cm H(2)O [protocol 4]). Thoracic CT was performed for each protocol; images were acquired during apnea for protocols 1 and 3 and during positive airway pressure for protocols 2 and 4. Heart rate; systolic, mean, and diastolic arterial blood pressures; blood gas values; end-tidal isoflurane concentration; rectal temperature; and measures of atelectasis, total lung volume (TLV), and lung density were determined before and after each protocol. None of the protocols eliminated atelectasis; the number of lung lobes with atelectasis was significantly greater during protocol 1 than during the other protocols. Lung density and TLV differed significantly among protocols, except between protocols 1 and 3. Protocol 2 TLV exceeded reference values. Arterial blood pressure after each protocol was lower than before the protocols. Mean and diastolic arterial blood pressure were higher after protocol 3 and diastolic arterial blood pressure was higher after protocol 4 than after protocol 2. Standardization of ventilatory protocols may minimize effects on thoracic CT images and hemodynamic variables. Although atelectasis was still present, ventilatory protocols 3 and 4 provided the best compromise between image quality and hemodynamic stability.

Comment on “Cytokines and Oxidative Stress Status following a Handball Game in Elite Male Players”

In a well-conducted study, Marin et al. [1] reported significant alterations of oxidative stress biomarkers, antioxidant capacity, and indices of muscular damage in elite handball players after a friendly match. The authors were surprised by the marked increase of muscular damage indirectly assessed by serum creatine kinase (CK) in experienced players, which increased from about 80 U/L at baseline to 150 U/L 24 hours after game. However, average CK values reported here are quite low in comparison to reference values of athletic populations [2] and do not exceed reference values used in clinical practice [3, 4]. Although containing lots of eccentric exercises like abrupt stopping or landing after jumping and the risk of muscle injury due to direct contact with other players, the average 24-hour postmatch value reported by Marin and colleagues reached only 20% of the upper reference level of swimmers. Swimmers generally exhibit low CK levels because of the non-weight-bearing, noncontact, and concentric nature of their sport [2, 5, 6]. We investigated twenty-one elite handball players to obtain representative values during a regular play-off season and found 12-hour postmatch CK values of 347 U/L (SEM: 43 U/L) and values of 255 U/L (SEM: 38 U/L) during a normal training week (60 hours after match). The relatively low values reported by Marin et al. are due to the study design, which included the abstinence from handball training and games before a friendly match for 2 and 4 days, respectively. Furthermore, serum CK is not always an (indirect) marker of muscular damage, but rather reflects increased rates of muscle turnover, stimulated by muscle use [6–8]. Thus, a 2-fold and even higher increase in response to exercise is not surprising [6, 9, 10].

Time-specific and population-level differences in physiological responses of fathead minnows (Pimephales promelas) and golden shiners (Notemigonus crysoleucas) exposed to copper

The influence of exposure time on gill Na+/K+ ATPase activity and metabolic rate in populations of fathead minnows (Pimephales promelas) and golden shiners (Notemigonus crysoleucas) hatcheries in Ohio (OH) and Pennsylvania (PA) when exposed to sublethal concentrations of copper (Cu) was examined. The pattern of change in gill Na+/K+ ATPase activity was similar in all species/populations and results support expectations based on the concept of acclimation. In all populations, Na+/K+ ATPase activity declined significantly compared to reference values within 24h, recovered by 48h, and then continued to increase before exceeding reference values by 192h. With the exception of PA fathead minnows, Na+/K+ ATPase activities returned to reference levels by 384h. Although metabolic rates of individual fish were not strongly correlated with Na+/K+ ATPase activities, the pattern of change in mean values of these physiological parameters was very similar. However, OH populations of both fathead minnows and golden shiners demonstrated much more dramatic changes in metabolic rate compared to PA fish. At 24h, metabolic rate of PA fathead minnows had decreased by 16% compared to the reference value whereas the OH population had decreased by 31%; metabolic rate of PA golden shiners declined by 23% compared to 59% in OH shiners at 24h. Similar differences were observed in the maximum metabolic rates achieved at 192h. While the increased sensitivity of OH fish to Cu is not readily explainable by genetic or environmental factors, results suggest the need for considering population level differences when evaluating the physiological effects of toxicants.

Creatine kinase MM TaqI and methylenetetrahydrofolate reductase C677T and A1298C gene polymorphisms influence exercise-induced C-reactive protein levels

Physical training induces beneficial adaptations, but exhausting exercise increases reactive oxygen species, which can cause muscular injuries with consequent inflammatory processes, implying jeopardized performance and possibly overtraining. Acute strenuous exercise almost certainly exceeds the benefits of physical activity; it can compromise performance and may contribute to increased future risk of cardiovascular disease (CVD) in athletes. Polymorphisms in the muscle-type creatine kinase (CK-MM) gene may influence performance and adaptation to training, while many potentially significant genetic variants are reported as risk factors for CVD. Therefore, we investigated the influence of polymorphisms in CK-MM TaqI and NcoI, methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) and C-reactive protein (CRP G1059C) genes on exercise-induced damage and inflammation markers. Blood samples were taken immediately after a race (of at least 4 km) that took place outdoors on flat tracks, and were submitted to genotyping and biochemical evaluation of aspartate aminotransferase (AST), CK, CRP and high-sensitivity CRP (hs-CRP). CK-MM TaqI polymorphism significantly influenced results of AST, CK and hs-CRP, and an association between MTHFR C677T and A1298C with CRP level was found, although these levels did not exceed reference values. The results indicate that these polymorphisms can indirectly influence performance, contribute to higher susceptibility to exercise-induced inflammation or protection against it, and perhaps affect future risks of CVD in athletes.

Creatine kinase MM TaqI and methylenetetrahydrofolate reductase C677T and A1298C gene polymorphisms influence exercise-induced C-reactive protein levels

Physical training induces beneficial adaptations, but exhausting exercise increases reactive oxygen species, which can cause muscular injuries with consequent inflammatory processes, implying jeopardized performance and possibly overtraining. Acute strenuous exercise almost certainly exceeds the benefits of physical activity; it can compromise performance and may contribute to increased future risk of cardiovascular disease (CVD) in athletes. Polymorphisms in the muscle-type creatine kinase (CK-MM) gene may influence performance and adaptation to training, while many potentially significant genetic variants are reported as risk factors for CVD. Therefore, we investigated the influence of polymorphisms in CK-MM TaqI and NcoI, methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) and C-reactive protein (CRP G1059C) genes on exercise-induced damage and inflammation markers. Blood samples were taken immediately after a race (of at least 4 km) that took place outdoors on flat tracks, and were submitted to genotyping and biochemical evaluation of aspartate aminotransferase (AST), CK, CRP and high-sensitivity CRP (hs-CRP). CK-MM TaqI polymorphism significantly influenced results of AST, CK and hs-CRP, and an association between MTHFR C677T and A1298C with CRP level was found, although these levels did not exceed reference values. Results indicate that these polymorphisms can indirectly influence performance, contribute to higher susceptibility to exercise-induced inflammation or protection against it, and perhaps affect future risks of CVD in athletes.

Bowel habit, diet and body weight in preadolescent children

The possible influence of diet and body weight on bowel habit in children is unknown. The present study aimed to investigate the inter-relationships between bowel function, excess body weight and dietary intake in a group of preadolescent children. Eighty-four preadolescent children aged 7-10 years were recruited [mean (SD) age 9.7 (1.0) years]. All children completed a bowel habit diary, examining specific parameters of bowel function and a weighed food inventory concurrently for seven consecutive days. Height and weight measurements were also taken. Children were grouped according to whether they met dietary recommendations and by overweight status; differences in bowel function between the groups were then analysed. Children who exceeded reference values for fat were more likely to report an incidence of straining to start (P = 0.005) and pain during defaecation (P = 0.021). Subjects who met protein recommendations were less likely to report incomplete evacuation (P = 0.000) and those who met zinc recommendations were less likely to report pain during defaecation (P = 0.044). Excess body weight (according to International Obesity Task Force cut-offs) was also associated with poor bowel habit, with overweight and obese children reporting lower defaecation frequency and a higher incidence of straining and feelings of incomplete evacuation, although these findings were not statistically significant. Defaecation frequency in healthy children was 1.4 defaecations per day compared to 1.2 defaecations for overweight and obese children. A poor diet that fails to meet dietary recommendations as well as being overweight and obese appears to be associated with increased defaecation problems in preadolescent children.

Activity of some enzymes and electrolyte concentration in students’ serum of region of smelter Ferronikel in Glogovc – Kosovo

The triangle Mitrovica‐Obiliq‐Gllogovc is considered among the most polluted regions in Europe with heavy metals and toxic gases (WHO, 2002, Lunchakom P. et al. 2008). In blood serum of students exposed to pollution by the Ferronikeli smelter in Glogovc, the activity of enzymes has been investigated: alkaline phosphatase (FA), asparat aminotranspherase (AST), alanin aminotranspherase (ALT), and the concentration of electrolytes (K+, Na+, Cl−, total Ca, PO43− and Fe++). As a control group was taken a student group of the same age in Gjakova, located far from Ferronikeli. Preliminary results of research show the higher activity in significant scale of FA and significant lower values activity of AST, ALT and concentration Fe++, Cl−, total Ca++, compared with their respective values registered in the serum of control group. There is no difference between analyzed groups regarding the concentration of K+, Na+ and PO43. With the exception of FA, analyzed parameters do not exceed reference values, but in students from Gllogovc they are near the lower scale of allowed level, while in students of Gjakova near the above allowed level of the reference values.

Indoor Air Quality in Schools and Health Symptoms among Portuguese Teachers

ABSTRACT The purpose of this study was: (i) to characterize the school indoor environment; (ii) to evaluate self-reported prevalence of disease symptoms among Portuguese teachers; and (iii) to evaluate, as far as we know for the first time in Portugal, the impact of the indoor air quality of schools on the prevalence of disease symptoms among teachers. The study was performed in the city of Oporto, starting in 2004; it included the analysis of questionnaires fulfilled by schoolteachers (n = 177), walkthrough surveys of schools grounds, buildings, and individual classrooms (n = 76), as well as indoor air monitoring. Respirable particle increase was related to chalk use and CO2 concentrations widely exceeded reference values. Schools located near traffic lines presented higher benzene and toluene concentrations. The guideline for total viable microorganism concentration was exceeded in 35.6% of classrooms. Significant increases in disease symptoms among teachers could be related to poor indoor air quality, which was mainly due to inefficient ventilation and influence of traffic emissions. Statistically significant correlations were found between central nervous system injuries and the levels of CO2 and total volatile organic compounds, and between upper respiratory problems and mucosal irritation and the levels of TVOC and respirable particles.

Safety of vitamin D3 in adults with multiple sclerosis

Background: Vitamin D3 may have therapeutic potential in several diseases, including multiple sclerosis. High doses of vitamin D3 may be required for therapeutic efficacy, and yet tolerability—in the present context, defined as the serum concentration of 25-hydroxyvitamin D [25(OH)D] that does not cause hypercalcemia—remains poorly characterized.Objective: The objective of the study was to characterize the calcemic response to specific serum 25(OH)D concentrations.Design: In a 28-wk protocol, 12 patients in an active phase of multiple sclerosis were given 1200 mg elemental Ca/d along with progressively increasing doses of vitamin D3: from 700 to 7000 μg/wk (from 28 000 to 280 000 IU/wk).Results: Mean (± SD) serum concentrations of 25(OH)D initially were 78 ± 35 nmol/L and rose to 386 ± 157 nmol/L (P < 0.001). Serum calcium concentrations and the urinary ratio of calcium to creatinine neither increased in mean values nor exceeded reference values for any participant (2.1–2.6 mmol/L and <1.0, respectively). Liver enzymes, serum creatinine, electrolytes, serum protein, and parathyroid hormone did not change according to Bonferroni repeated-measures statistics, although parathyroid hormone did decline significantly according to the paired t test. Disease progression and activity were not affected, but the number of gadolinium-enhancing lesions per patient (assessed with a nuclear magnetic brain scan) decreased from the initial mean of 1.75 to the end-of-study mean of 0.83 (P = 0.03).Conclusions: Patients’ serum 25(OH)D concentrations reached twice the top of the physiologic range without eliciting hypercalcemia or hypercalciuria. The data support the feasibility of pharmacologic doses of vitamin D3 for clinical research, and they provide objective evidence that vitamin D intake beyond the current upper limit is safe by a large margin.

Prospective Volumetric Analysis of Gallbladders in Critically Ill Newborns: The Impact of Nutrition

Background:Neonatal reference values of gallbladder size have been assessed in healthy newborns with enteral feeding regimen. Their applicability to critically ill patients under total parenteral nutrition (TPN) remains to be questioned. Objective: Our aim was to evaluate the impact of short-term TPN versus enteral nutrition (EN), gender and birth weight on neonatal gallbladder volume. Method: A prospective pilot study was initiated with a single sonographic investigator blinded towards feeding regimen. In total, 61 neonates (33 males, 28 females) were consecutively enrolled on the intensive care unit; 31 newborns were examined both under TPN and bolus EN (breast milk/formula). Patients with malformations of the biliary tract were excluded. Prior to ultrasound examinations, a minimum fasting period of 2 h was maintained. Sonographic measurements of gallbladder length, depth and width were performed to calculate gallbladder volume using the ellipsoid formula. Results: Neonatal gallbladder volume differed significantly between TPN and EN (p < 0.001). Using TPN, range of gallbladder length, width and volume exceeded reference values. Birth weight was weakly correlated with gallbladder volume (correlation index 0.3776, p = 0.01). We found no gender-related differences. Conclusions: Neonatal gallbladder volume under TPN was significantly larger compared to EN. Using TPN, gallbladder dimensions exceeded reference values without causing clinical complications. The benign course of gallbladder enlargement required no specific medication or surgical treatment.