Healthy Children Research Articles

Lipid levels in a cohort of healthy Danish schoolchildren ages 5 to 17 years

It is internationally recognized to use clinical decision limits (CDL) when interpreting the lipid levels in both adults and children, even though the evidence for children is scarce. The purpose of this study is to describe how lipid levels progress in healthy Danish children ages 5 to 17 years. This study is based on the Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS-study DK) consisting of 1456 observations of schoolchildren aged 5 to 17 years. Participants have been tested for blood levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and remnant cholesterol levels are calculated. Finally, sex-specific percentile reference curves are presented. Percentile reference curves stratified by sex were generated for all cholesterols and showed that the total cholesterol level peaks at 4.32 mmol/l in 10-year-old boys and 4.46 mmol/l in nine-year-old girls. HDL levels in boys peak at 1.72 mmol/l in nine-year-old boys. HDL levels in girls and LDL levels in both sexes are nearly constant. Triglycerides kept rising to the age of 17 years in both sexes and remnant cholesterol decreased from age 5 to 17 years in both sexes. BMI z-score adjustment revealed no significant association with total cholesterol in both sexes but a significant association between HDL, LDL, triglycerides, and remnant cholesterol. This study is the first to generate percentile reference curves for blood levels of total cholesterol, LDL, HDL, triglycerides, and remnant cholesterol in a cohort of healthy Danish children aged 5 to 17 years.

Creating a community advisory board for pediatric bladder health

IntroductionPediatric lower urinary tract symptoms (LUTS) are highly prevalent in neurologically healthy school-aged children. However, no evidence-based programs exist to prevent or treat LUTS in the community setting. To address this, we established the first community advisory board (CAB) that aims to identify individual and societal structures impacting pediatric bladder health in Northern California's Bay Area and co-design culturally relevant bladder health interventions.MethodsProbability and non-probability sampling methods were used to recruit community stakeholders to the CAB. Our final CAB comprised of two parents, two community health workers, one educator, one pediatric urology registered nurse, and one pediatrician. The CAB met quarterly during the 1-year study period.ResultsBi-directional feedback identified community-level barriers to bladder health, particularly in the school environment, and the need for tailored resources to teach children and families about healthy bladder behaviors.DiscussionThe CAB co-designed school-based bladder health interventions, including bladder health posters, and provided feedback on three school-based research study proposals. The CAB will continue to guide and inform future community-engaged research efforts.

Risk factors and management countermeasures for obstructive sleep apnea hypoventilation syndrome in children.

Obstructive sleep apnea hypoventilation syndrome (OSAHS) in children is a sleep respiratory disorder characterized by a series of pathophysiologic changes. Statistics in recent years have demonstrated an increasing yearly incidence. To investigate the risk factors for OSAHS in children and propose appropriate management measures. This study had a case-control study design. Altogether, 85 children with OSAHS comprised the case group, and healthy children of the same age and sex were matched at 1:1 as the control group. Basic information, including age, sex, height, weight and family history, and medical history data of all study participants were collected. Polysomnography was used to detect at least 8 h of nocturnal sleep. All participants were clinically examined for the presence of adenoids, enlarged tonsils, sinusitis, and rhinitis. The analysis of variance revealed that the case group had a higher proportion of factors such as adenoid grading, tonsil indexing, sinusitis, and rhinitis than the control group. A regression model was established, and glandular pattern grading, tonsil indexing, sinusitis, and pharyngitis were identified as independent risk factors affecting OSAHS development.

Exploring the mechanism of IgA vasculitis pathogenesis through the interaction of thrombin and inflammatory factors using urinary proteomics

To explore the evidence, urinary biomarkers, and partial mechanisms of hypercoagulability in the pathogenesis of IgA vasculitis (IgAV). Differential expression of proteins in the urine of 10 healthy children and 10 children with IgAV was screened using high-performance liquid chromatography-tandem mass spectrometry, followed by Reactome pathway analysis. Protein-protein interaction (PPI) network analysis was conducted using STRING and Cytoscape software. In the validation cohort, 15 healthy children and 25 children with IgAV were included, and the expression levels of differential urinary proteins were verified using enzyme-linked immunosorbent assay. A total of 772 differential proteins were identified between the IgAV group and the control group, with 768 upregulated and 4 downregulated. Reactome pathway enrichment results showed that neutrophil degranulation, platelet activation, and hemostasis pathways were involved in the pathogenesis of IgAV. Among the differential proteins, macrophage migration inhibitory factor (MIF) played a significant role in neutrophil degranulation and hemostasis, while thrombin was a key protein in platelet activation and hemostasis pathways. PPI analysis indicated that thrombin directly interacted with several proteins involved in inflammatory responses, and these interactions involved MIF. Validation results showed that compared to healthy children, children with IgAV had significantly higher urine thrombin/creatinine and urine MIF/creatinine levels (P<0.05). Thrombin contributes to the pathogenesis of IgAV through interactions with inflammatory factors. Urinary thrombin and MIF can serve as biomarkers reflecting the hypercoagulable and inflammatory states in children with IgAV.

The Outcome of a Single Stage Repair for Proximal Hypospadias in Otherwise Healthy Child at Mymensingh Medical College Hospital

Hypospadias is a birth defect that involves the development of a penile urethra that opens on the ventral side of the penis. Proximal hypospadias is one of the most severe forms of hypospadias that is generally associated with chordee. Hypospadias surgery, especially in the proximal location, is challenging, and many operations have been proposed, including one-stage and two-stage operations. Objectives: The aim of the study was to evaluate the success rate and safety of a single-stage surgery in children with proximal hypospadias and to determine the complications. Materials and Methods: This interventional study was conducted on forty patients, aged between one and twelve years, who had proximal hypospadias and were admitted to Mymensingh Medical College Hospital between January 2014 and April 2015. A one-step operation with tabularized incised plate urethroplasty (TIPU) was done. Patients’ demographic data, intraoperative details, and postoperative outcomes were recorded within 3 months after the operation. Results: The common age at surgery was 2-4 years, and they were 40% of the total patients. There was Haematoma in 5% of cases, a devitalized skin flap in 7.5% of cases, and stent blockage in 10% of cases during the immediate postoperative period. In our 3-month follow-up, all the patients had conical glans and cylindrical penises. Meatal stenosis and narrow stream were noted in 5 percent of patients but were relieved with meatal dilatation. Urethrocutaneous fistulas remained patients in 7.5% of cases. Conclusion: TIPU repair of proximal hypospadias is safe, effective, yields good results, and has low risks of complications in otherwise healthy children. It is a less risky and more viable method that helps to exclude extra steps in the process.

Detection and characterization of autoreactive memory stem T-cells in children with acute immune thrombocytopenia

Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by an isolated decrease in platelets below 100 × 109/l after the exclusion of other conditions associated with thrombocytopenia. We investigated the role of different memory T-cell subsets, including T stem cell memory (TSCM), in children diagnosed with primary ITP and its association with therapeutic duration. This case–control study included 39 pediatric patients with acute ITP admitted to the Children's Hospital at Assiut University. Using a FACSCanto flow cytometer, CD8 + and CD4 + T-lymphocytes were gated. Five different subsets were characterized in each of these cells according to CD45RO and CD45RA expression. Afterward, gating was performed based on CCR7, CD95, and CD27. Examination of the CD8 + T cells subpopulation showed that Central memory T (TCM) and CD8+ Naïve T (TN) cells were significantly lower in ITP patients than in healthy children (p < 0.0001) and (p = 0.01), respectively. In addition, CD8 + TEMRA was significantly higher in ITP children than in controls (p = 0.001). CD4 + TCM cells were significantly lower in the ITP patient group (p = 0.04). However, CD4 + TEM was significantly higher in patients than controls (p = 0.04). Our research found that ITP patients had an imbalance in the ratio of CD4+ to CD8+ T cells in the peripheral blood and that TCM cells may be involved in the pathogenetic mechanism of ITP. TCMs could help in prediction of patients with higher risk of developing ITP.

Diagnostic efficacy of serum 14-3-3β protein combined with fractional exhaled nitric oxide and conventional ventilatory lung function parameters for bronchial asthma in children

To explore the diagnostic efficacy of serum 14-3-3β protein combined with fractional exhaled nitric oxide (FeNO) and conventional ventilatory lung function parameters in diagnosing bronchial asthma (referred to as "asthma") in children. A prospective study included 136 children initially diagnosed with asthma during an acute episode as the asthma group, and 85 healthy children undergoing routine health checks as the control group. The study compared the differences in serum 14-3-3β protein concentrations between the two groups, analyzed the correlation of serum 14-3-3β protein with clinical indices, and evaluated the diagnostic efficacy of combining 14-3-3β protein, FeNO, and conventional ventilatory lung function parameters for asthma in children. The concentration of serum 14-3-3β protein was higher in the asthma group than in the control group (P<0.001). Serum 14-3-3β protein showed a positive correlation with the percentage of neutrophils and total serum immunoglobulin E, and a negative correlation with conventional ventilatory lung function parameters (P<0.05). Cross-validation of combined indices showed that the combination of 14-3-3β protein, FeNO, and the percentage of predicted value of forced expiratory flow at 75% of lung volume had an area under the curve of 0.948 for predicting asthma, with a sensitivity and specificity of 88.9% and 93.7%, respectively, demonstrating good diagnostic efficacy (P<0.001). The model had the best extrapolation. The combination of serum 14-3-3β protein, FeNO, and the percentage of predicted value of forced expiratory flow at 75% of lung volume can significantly improve the diagnostic efficacy for asthma in children. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 723-729.

The Influence of Growth Hormone and Insulin-like Growth Factor 1 on Anthropometric Parameters in Children with Type 1 Diabetes Mellitus

The goal is to study the indicators of somatotropic hormone and insulin-like growth factor-1 to assess the effect on anthropometric indicators of children with type 1 diabetes mellitus. 74 children with type 1 diabetes mellitus and 14 children in the control group were examined. Average age 12±3.5 years. The assessment of physical development was carried out on the basis of an assessment of anthropometric indicators — height and body weight with the calculation of BMI and compared with centile tables. Determination of the concentration of hormones such as GH and IGF-1 was determined by special ELISA kits using the enzyme immunoassay method using an analyzer (Mindray MR-96A). The obtained data were subjected to statistical processing. It was revealed that 8 (36.4%) boys and the majority of girls 14 (63.6%) achieved the target level of glycated hemoglobin. Children with T1DM are statistically significant and stunted in height and weight compared to healthy children in the control group.

Normal values of peripheral (brachial) blood pressure measured in 14062 Hungarian healthy children and adolescents with normal body mass index

Bevezetés: Korábban a gyermekek és serdülők vérnyomás-referenciaértékeire vonatkozó ajánlások adatbázisai a túlsúlyos/elhízott egyének adatait is tartalmazták. A vérnyomás és a túlsúly/elhízás közötti szoros összefüggés, valamint a túlsúly/elhízás előfordulási gyakoriságának az elmúlt évtizedekben világszerte tapasztalt emelkedése miatt a gyermekekre és serdülőkre vonatkozó vérnyomás-referenciaértékek meghatározásának módja felülvizsgálatra szorul. Célkitűzés: Célunk volt keresztmetszeti vizsgálatban meghatározni a 3–19 éves korú, normál testtömegű gyermekek és serdülők vérnyomásértékeit Magyarországon, valamint összehasonlítani a normál testtömegű gyermekek és serdülők vérnyomásértékeit a túlsúlyos/elhízott társaikéval. Módszer: 17 828 (9350 fiú) egyén esetében végeztünk antropológiai méréseket és oszcillometriás vérnyomásmérést. A normál testtömegű (n = 14 062, 7195 fiú), a túlsúlyos (n = 2527, 1427 fiú) és az elhízott (n = 1239, 728 fiú) csoportot a testtömegindex percentilisértékei alapján különítettük el. A vérnyomás-percentilisgörbéket és -értékeket LMS-módszerrel képeztük. Eredmények: Mind a systolés, mind a diastolés vérnyomás emelkedett az életkor előrehaladtával mindkét nemben, minden súlykategóriában. A normál testtömegű csoportban a medián testmagasságon mért systolés és diastolés vérnyomás 50. percentilisértéke 94/59 Hgmm-ről 124/68 Hgmm-re emelkedett a fiúkban, míg 94/59 Hgmm-ről 116/68 Hgmm-re a lányokban. A pubertás előtt a systolés vérnyomás nem különbözött szignifikánsan a nemek között, ezt követően fiúkban jelentősebben emelkedett. A diastolés vérnyomás tekintetében nem találtunk klinikailag releváns szignifikáns különbséget a nemek között. A vérnyomás-percentilisértékek a túlsúlyos és az elhízott páciensek csoportjában szignifikánsan magasabbak voltak a normál testtömegűekhez képest (p&lt;0,001). Következtetés: A közölt vérnyomás-normálértékek a jelenkori magyar gyermek- és serdülőpopulációra vonatkozó ismereteinket gyarapítják. Miután a túlsúlyos/elhízott gyermekek és serdülők vérnyomásértékei magasabbak, mint normál testtömegű társaiké, adataikat elkülönítve javasolt tanulmányozni. Orv Hetil. 2024; 165(28): 1086–1100.

Data-driven exploratory method investigation on the effect of dyslexia education at brain connectivity in Turkish children: a preliminary study.

Dyslexia is a specific learning disability that is neurobiological in origin and is characterized by reading and/or spelling problems affecting the development of language-related skills. The aim of this study is to reveal functional markers based on dyslexia by examining the functions of brain regions in resting state and reading tasks and to analyze the effects of special education given during the treatment process of dyslexia. A total of 43 children, aged between 7 and 12, whose native language was Turkish, participated in the study in three groups including those diagnosed with dyslexia for the first time, those receiving special education for dyslexia, and healthy children. Independent component analysis method was employed to analyze functional connectivity variations among three groups both at rest and during the continuous reading task. A whole-brain scanning during task fulfillment and resting states revealed that there were significant differences in the regions including lateral visual, default mode, left frontoparietal, ventral attention, orbitofrontal and lateral motor network. Our results revealed the necessity of adding motor coordination exercises to the training of dyslexic participants and showed that training led to functional connectivity in some brain regions similar to the healthy group. Additionally, our findings confirmed that impulsivity is associated with motor coordination and visuality, and that the dyslexic group has weaknesses in brain connectivity related to these conditions. According to our preliminary results, the differences obtained between children with dyslexia, group of dyslexia with special education and healthy children has revealed the effect of education on brain functions as well as enabling a comprehensive examination of dyslexia.

Anti-α-1,4-D-polygalacturonic acid antibodies as a new biomarker for juvenile idiopathic arthritis.

Diagnosing juvenile idiopathic arthritis (JIA) is challenging. Our study aimed to investigate the clinical significance of anti-α-1,4-D-polygalacturonic acid (PGA) antibodies in JIA, focusing on their role in diagnosis and assessing disease activity. In this prospective case-control study, we examined variations in serum levels of PGA-IgA and PGA-IgG among children with different types of JIA and healthy controls. Serum PGA-IgA and PGA-IgG levels were assessed concurrently in children with active and inactive JIA. This study included 126 patients diagnosed with JIA, 13 neonates, and 76 healthy children. Serum PGA-IgA and PGA-IgG levels were assessed, which revealed significant differences in PGA-IgA levels between various JIA subtypes and controls. An analysis of PGA-IgA levels in various JIA states revealed a statistically significant difference. Receiver operating characteristic (ROC) analysis demonstrated the robust predictive capability of PGA-IgA, with an AUC of 0.879 (p < 0.001), along with a specificity of 0.842 and sensitivity of 0.848. Increased levels of anti-PGA antibodies, particularly PGA-IgA, were significantly associated with JIA. PGA-IgA may serve as a sensitive biomarker for disease activity in JIA and could potentially aid in the diagnosis of JIA. Key Points • This study found a significant correlation between blood levels of PGA-IgA and juvenile idiopathic arthritis (JIA), which may provide valuable diagnostic insights. • PGA-IgA shows potential as a sensitive biomarker for the assessment of disease activity in JIA patients, helping to determine disease activity.

Early appearance of thyroid autoimmunity in children followed from birth for type 1 diabetes risk.

Autoantibodies to thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) define pre-clinical autoimmune thyroid disease (AITD) which can progress to either clinical hypo- or hyperthyroidism. We determined the age at seroconversion in children genetically at risk for type 1 diabetes. TPOAb and TgAb seropositivity were determined in 5066 healthy children with HLA DR3 or DR4 containing haplogenotypes from The Environmental Determinants of Diabetes in the Young (TEDDY) Study. Children seropositive on the cross-sectional initial screen at 8-13 years of age had longitudinally collected samples (from 3.5 months of age) screened retrospectively and prospectively for thyroid autoantibodies to identify the age at seroconversion. First-appearing autoantibody was related to sex, HLA genotype, family history of AITD, and subsequent thyroid dysfunction and disease. The youngest appearance of TPOAb and TgAb was 10 and 15 months of age, respectively. Girls had higher incidence rates of both autoantibodies. Family history of AITD was associated with a higher risk of TPOAb hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.17, 3.08; and TgAb HR 2.55, 95% CI 1.91, 3.41. The risk of progressing to hypo- or hyperthyroidism was not different between TgAb and TPOAb, but children with both autoantibodies appearing at the same visit had a higher risk compared to TPOAb appearing first (HR 6.34, 95% CI 2.72, 14.76). Thyroid autoantibodies may appear during the first years of life, especially in girls, and in children with a family history of AITD. Simultaneous appearance of both autoantibodies increases the risk for hypo- or hyperthyroidism.

Evolution of natural myocardial shear wave behavior in young hearts: determinant factors and reproducibility analysis

BackgroundMyocardial diastolic function assessment in children by conventional echocardiography is challenging. Recent high frame rate (HFR) echocardiography facilitates the assessment of myocardial stiffness (MS) -a key factor of diastolic function- by measuring the propagation velocities of myocardial shear waves (SWs). However, normal values of natural SWs in children are currently lacking. ObjectivesTo explore the behavior of natural SW among children and adolescents, their reproducibility, and the factors affecting SW velocities from childhood into adulthood. Methods106 healthy children (2-18 years) and 62 adults (19-80 years) were recruited. HFR images were acquired using a modified commercial scanner. An anatomical M-mode was drawn along the ventricular septum, and propagation velocities of natural SWs after mitral valve closure (MVC) were measured in the tissue acceleration coded M-mode display. ResultsThroughout life, SW velocities after MVC exhibited pronounced age dependency (r= 0.73; P<0.001). Among the pediatric population, SW velocities correlated significantly with measures of cardiac geometry (septal thickness and left ventricular end-diastolic dimension), local hemodynamics (systolic blood pressure), as well as with echocardiographic parameters of systolic and diastolic function (global longitudinal strain (GLS), mitral E/e’, isovolumetric relaxation time and mitral deceleration time) (P <0.001). In a multivariate analysis including all these factors, the predictors of SW velocities were age, mitral E/e’, and GLS (r= 0.81). ConclusionsNatural myocardial SW velocities in children can be detected and measured. SW velocities showed significant dependence on age and diastolic function. Natural SWs could be a promising additive tool for assessment of diastolic function among children.

Successful treatment of diffuse alveolar hemorrhage secondary to Mycoplasma pneumoniae complicated with hemophagocytic lymphohistiocytosis in children: a case report and non-systematic literature review

BackgroundAfter quarantine-related measures were completely lifted in China, the respiratory infection rate of children caused by Mycoplasma pneumoniae (MP) increased significantly, and MP infection may lead to rare severe intra- and extrapulmonary manifestation. Hemophagocytic lymphohistiocytosis (HLH) and diffuse alveolar hemorrhage (DAH) are life-threatening clinical syndromes. Timely recognition may contribute to timely treatment and an improved prognosis. Currently there are no reports of children with DAH secondary to MP infection complicated with HLH.Case presentationWe successfully treated a previously healthy school-aged child who was admitted to the pediatric intensive care unit with fever, cough, drowsiness, and progressive dyspnea. HLH was confirmed by clinical and testing criteria, DAH was indicated by computed tomography scan of the chest, and Mycoplasma antibody detection and endotracheal aspirates pathogen metagenomic next-generation sequencing (mNGS) confirmed MP infection. After invasive mechanical ventilation, antibiotics, and glucocorticoid treatment, the patient recovered well and was discharged. At follow-up, she did not experience any more initial symptoms. For the fourth consecutive month, all indexes remained normal.ConclusionmNGS can be considered for identifying the causative agent of infection in patients with DAH and/or HLH. The clinical manifestations of DAH in children may only present as acute hypoxic respiratory failure, significantly decreased hemoglobin without bleeding elsewhere, and chest imaging findings may assist in the diagnosis of DAH. When MP infection is associated with hemocytopenia, HLH should be considered.

Acute myocardial infarction in a previously healthy child: case report

Acute myocardial infarction in a previously healthy child: case report

Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial

BackgroundPostpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms.MethodsWe will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called “Smart-e-Moms,” which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group’s assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization.DiscussionIf Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development.Trial registrationGerman clinical trials registry DRKS00032324. Registered on January 26, 2024.

Subtle myocardial effects of rheumatic heart disease in children are revealed earlier with two-dimensional speckle tracking echocardiography

Objective. Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in developing countries and remains a serious public health problem. In the subclinical course of carditis, the absence of typical symptoms and the normal range of classical echocardiographic measurements used to evaluate cardiac functions have required new echocardiographic methods and parameters. Previous studies regarding rheumatic heart disease in children and adults have shown that strain patterns obtained by speckle tracking echocardiography, are in fact affected although left ventricular systolic functions are preserved, yet some studies have suggested otherwise. The aim of our study is to compare the use of speckle tracking echocardiography with conventional methods in the evaluation of cardiac functions and myocardial involvement in children with subclinical RHD. Materials and Methods. The study group consisted of 24 patients with asymptomatic cardiovascular who had no history of acute rheumatic fever, but had definite or probable rheumatic valve disease. This study group was determined according to the World Heart Federation guidelines by an echocardiographic examination performed for different reasons, as well as the control group of 22 healthy children. In order to evaluate the left ventricular regional myocardial functions of the patients, tissue Doppler echocardiography (TDE) and speckle tracking echocardiographic parameters were compared with the control group. Results. The mean ages of the patient and control groups were 14.1±2.7 years and 13.9±2.3 years, respectively. There was no statistically significant difference between the two groups in terms of conventional methods (p&gt;0.05) but global longitudinal strain and strain rate values were found to be significantly lower in the patient group (p&lt;0.01). These changes appeared to be relevant throughout the duration of the illness. Conclusion. In patients with subclinical rheumatic heart disease, conventional echocardiographic evaluations are likely negative, whereas two-dimensional speckle tracking echocardiography reveal systolic and diastolic dysfunctions of the disease.

Application of peripheral blood cytokine and immunoglobulin detection in ACTH therapy for the treatment of infantile spasms

ObjectiveThis research aims to investigate the levels of lymphocytes, immunoglobulins, and cytokines in children with infantile spasms (IS) before and after adrenocorticotropic hormone (ACTH) therapy and to explore the application of these markers in evaluating the therapeutic effects of ACTH on infantile spasms.MethodsFrom May to November 2022, 35 children initially diagnosed with IS and treated at our hospital were regarded as the observation group, and 35 healthy children who underwent physical examination at our hospital during the same period were regarded as the control group. Children in the observation group received intramuscular injections of ACTH for 2 weeks. Fasting venous blood was collected from the control group and the observation group before and after ACTH therapy. Serum levels of immunoglobulins IgG, IgA, and IgM in serum were detected by immunoturbidimetry. T-cell subsets (CD3+, CD3+CD4+, and CD3+CD8+) and B-cell subsets [CD3−CD19+ and CD3−CD16+CD56+ natural killer (NK) cells] were detected by flow cytometry, and the ratio of CD3+CD4+/CD3+CD8+ was calculated. Serum levels of interleukin-1β (IL-1β), interleukin-2R (IL-2R), and interleukin-6 (IL-6) cytokines were detected by the enzyme-linked immunosorbent assay, and changes in serum cytokine and immunoglobulin levels in the two groups were compared before therapy, whereas in observation group one, these comparisons were made both before and after ACTH therapy.ResultsCompared to the control group, the observation group showed significantly increased serum levels of immunoglobulins IgG and IgM before therapy, while the level of IgA was significantly decreased (p &amp;lt; 0.05). Also, the percentage of CD3−CD19+ B cells was significantly increased, while the percentages of CD3+ T cells and CD3+CD4+ T cells were significantly decreased (p &amp;lt; 0.05). The percentages of CD3+CD8+ T cells, CD3−CD16+CD56+ NK cells, and CD3+CD4+/CD3+CD8+ cells did not change significantly (p &amp;gt; 0.05); the levels of cytokines IL-1 β, IL-2R, and IL-6 were significantly increased (p &amp;lt; 0.05). Compared to levels before treatment, the serum level of immunoglobulin IgG in the observation group after ACTH therapy was significantly reduced (p &amp;lt; 0.05), while the IgA and IgM levels did not change significantly (p &amp;gt; 0.05). The percentages of CD3+ T cells and CD3+CD4+ T cells were significantly increased, while the percentages of CD3−CD16+CD56+ NK cells and CD3−CD19+ B cells were significantly decreased (p &amp;lt; 0.05); however, the percentages of CD3+CD8+ T cells and the CD3+CD4+/CD3+CD8+ ratio did not change significantly (p &amp;gt; 0.05). Furthermore, the levels of cytokines IL-1 β, IL-2R, and IL-6 were significantly reduced (p &amp;lt; 0.05).ConclusionChildren with IS exhibit immune dysfunction, and the changes in serological immune indices after ACTH treatment indicate that ACTH may control seizures in IS children by regulating and improving immune dysfunction. Therefore, the therapeutic effects of ACTH on IS can be evaluated by detecting the levels of cytokines and immunoglobulins.

Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial

BackgroundPostpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms.MethodsWe will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called “Smart-e-Moms,” which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group’s assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization.DiscussionIf Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development.Trial registrationGerman clinical trials registry DRKS00032324. Registered on January 26, 2024.

ATP-P2X7R pathway activation limits the Tfh cell compartment during pediatric RSV infection

BackgroundFollicular helper T cells (Tfh) are pivotal in B cell responses. Activation of the purinergic receptor P2X7 on Tfh cells regulates their activity. We investigated the ATP-P2X7R axis in circulating Tfh (cTfh) cells during Respiratory Syncytial Virus (RSV) infection.MethodsWe analyzed two cohorts: children with RSV infection (moderate, n=30; severe, n=21) and healthy children (n=23). We utilized ELISA to quantify the levels of PreF RSV protein-specific IgG antibodies, IL-21 cytokine, and soluble P2X7R (sP2X7R) in both plasma and nasopharyngeal aspirates (NPA). Additionally, luminometry was employed to determine ATP levels in plasma, NPA and supernatant culture. The frequency of cTfh cells, P2X7R expression, and plasmablasts were assessed by flow cytometry. To evaluate apoptosis, proliferation, and IL-21 production by cTfh cells, we cultured PBMCs in the presence of Bz-ATP and/or P2X7R antagonist (KN-62) and a flow cytometry analysis was performed.ResultsIn children with severe RSV disease, we observed diminished titers of neutralizing anti-PreF IgG antibodies. Additionally, severe infections, compared to moderate cases, were associated with fewer cTfh cells and reduced plasma levels of IL-21. Our investigation revealed dysregulation in the ATP-P2X7R pathway during RSV infection. This was characterized by elevated ATP levels in both plasma and NPA samples, increased expression of P2X7R on cTfh cells, lower levels of sP2X7R, and heightened ATP release from PBMCs upon stimulation, particularly evident in severe cases. Importantly, ATP exposure decreased cTfh proliferative response and IL-21 production, while promoting their apoptosis. The P2X7R antagonist KN-62 mitigated these effects. Furthermore, disease severity positively correlated with ATP levels in plasma and NPA samples and inversely correlated with cTfh frequency.ConclusionOur findings indicate that activation of the ATP-P2X7R pathway during RSV infection may contribute to limiting the cTfh cell compartment by promoting cell death and dysfunction, ultimately leading to increased disease severity.